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Full text of "The Edinburgh Medical and Surgical Journal"

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BOSTON 
MEDICAL LIBRARY 




IN THE 

Francis A.Countway 
Library of Medicine 

BOSTON 



■^ 



THE 

EDINBURGH 

MEDICAL AND SURGICAL 

JOURNAL: 

EXHIBITING 

A CONCISE VIEW 

OF THE 

LATEST AND MOST IMPORTANT DISCOVERIES 

IN 

MEDICINE, SURGERY, AND 
PHARMACY. 



VOLUME THIRTEENTH. 
I8I7. 



EDINBURGH: 

Prialed bg Getrge Btrntn/ If Cvmfmji, 

TOR ARCHIBALD CONSTABLE AND COMPAMT, EOINBUROII ; 
I«IiailAM, BORST, RBSS, ORME, & BROlTN, LONDON J • 
AMD JOBN C0ltMINO,'l>VBLIN. 

1817. 



CONTEMTS 

or 

voLxm. 



ORIGINAL COMMUNICATIONS. 

KcXIlX. F^ 

AiT'I* Critical Revfew of tlie State of Medkke doring the last 

ten yetn> • ■ • 1 

H. On the cautei of the tropical Endemiiuor Teilow-Feter. 

Bf D. J. H. DickMn. M4>. FX.8. &c. - 81 

fli. Case of Fnemnoniay with Fever of a {Tilioys Type. By 

Hr William Lucasy ... 58 

iV. Case of Diseased Arm. Communicated by Alexander 

Kennedy, Esq. Bladras. (Witl^ an B^gravm.) 54 

V. Dr Lobenstein-Lobers Fh)po8al of a New Mrthod of 

Operating for the Cataract. Communicated by Dr 
vonEmbdeny • - 58 

VI. Remarks on some Remedies whidi are used in lvits%f 

By Bfr Richard Lanphier Drapes, - .59 

Vn. Gootribatkms to Dia^gnosis. By Marshall Vk^ BID. Ac 68 

n«.L. 

AiiT. i Critical Remr of tihe State of Medjcine during the last 

tenyeask - - - 187 

IL Reports on iKeArdeot Fever of the West ImUe^ as oQonr* 
ring on board his Majesty's Wps Raven and Niobe^ 
in 9ie year 1815, ... 165 

JXL Case of Enlargement of theHeart, with Polype &c which 
occurred on board the Honourable East India Com- 
pany's Ship Camatic^ By Mr James Stewart, - 189 
IV. Case of Pneumonia, vrith Observations on the Practice of 
ttoodJctting in that disease. By William Gibney, 
MJ).5u:. . - . -184 

V* Reflectbns on the Airangenent of Cutaneous Diseases ; 
with the snggestiee of a PraotiGal and D&ignosticj|io4o 
of Classification. 3y MacshaU Hal), M.P. ^x. 188 

VI. Remarics on the PkMcrvation q£ lime- Water. 9y IL 

Dewar, M3. 5bc. - . - 195 

vn. An History, wsith RemaslH» ff an Aefttf A«eiBisai, coo- 
jmned with a PuliMttvy fihtkisk. Bf George f ear- 
•OQ, M.D. F JLS. 5cc. p - 188 



IV GONTENTfiU 

No.U. 

Art. I. On die Statiitical Pathology of Briitol and of Clifton, Page 

Gkmceitenhire. By C. Chisholm^ M. D. F. R. S. 265 
Appendix. Geological Description of the Citv of 

Brittoly and Parish of Clifton. By Mr G. Cumberland, 89€ 
IL Some Observations relative to the new method of extracting 

the Cataract. By Mr Edward Chapman, • SOO 

in. Contributions to Oiagnous. By Marshall Hadl, M. D. SOS 

IV. Case of Morbus Cceruleus. By WOliam Howison, M. D. S09 

V. Case of Wounded Bladder. By Mr J. Douglas, - SI 3 

VI. History of a Case of Dislocation of the Lower Jaw. By Mr 

John Forbes, - • - si^ 

VIL Observations on Yellow-Fever. By Mr George Bimi«, SSI 

VIIT. Observations upon Diseased Spinel By Mr J. B. Estlin, S41 
DC. Account of the fatal Accident which happened .in the 

Leadhills Company's Mines. By Mr James Braid, S5S 

X. Cases of Catarrhos Hepaticus. By Mr John Hay, « S57 

No. LH. 
Art. I. Case of Injurv of the Spinal Cord. By John Gordon, M.D. 409 
IL Cases of Typlius Fever^ with Observations on the Natuoe 

and Treatment of that Disease. By J. C. Prichard, MD. 41S 
)IL On the Mercurial Treatment of Yellow-Fever, By Mr 

J. B. Sheppard, - - - - 427 

IVT Observations on Inflammation and Brain-Fever. By 

James Wood, M.D. - - - - 4?S 

V. Case of Stricture of the Rectum, successfully treated. By 

Mr G. F. Edwards^ - • • 441 

yi. Case of Recovery after the separation and discharge by 
Stool of a portion of the Ileum. By Mr Alexander 
Renton, - - • - 447 

Vn. Case of Tetanus. By Emanuel Lazzaretto, M. D. F. ^. S. 451 
Vni. Case of obstinate Colica Stercorea, cured by the exhibition 

of Quicksilver. By Mr John O'Keill, - - 455 

IX. An Historical Sketch of Medicine in the Russian Empire* 
from the Earliest Period to the Present Time. Com- 
municated by Dr von Embden, • * - 455 
X. On the Benefit from Cold applied to the Head in the Fever 

called Typlius. B^ J. Wood, M. D. - ' - 465 

XI. Case of Femoral Aneunsm cured by tying the external Iliac 

Arterjr. By Archibald Robertson, M. b. . - 467 
Xn.* Observations on the Character and Writings of the late 
William Royston, Esq. F. L. S. &c. &c. By Mr 
James Robinson Scott, - - • , 471 

CRITICAL ANAL>rSIS. 

No. XLIX. 
AfcT. I. F. C. Hesselbach, M. D. de Ortu et Progressu Hemtarum 

inguinalium' et cruralium» 5cc. - - - 69 

IL On the Causes of the Epidemic Fever which prevailed in 
the Provinces of Coimbatore, Madura, Dmd^u|, and 
Tinnivelly, during the years 1 809, 18)0, and is 11, 76 

IL A Treatise on Uterine HsmOTrhage. By Duncan Stew- 
art, M.D. - « • - 89 
1 



CONTENTS. Y 

IT. Outfine of a New Syitem of Noiology. By T. Bvkb- F^;e 
sooyM.D. - - - - 97 

V. A Treatiie on the Nature and Cure of Goat. ByChariei 

Scndamoret M. D. - - • 99 

VI. Practical Illuftrations of Typhus and other Febrile Dvh 

eases. By John Armstrong, M. D. * - lOt 

VIL A MeoMur on the Cutting Gorget of Hawkins. By AiH 
tonio Scarpa. To which is addedy a Biographical ac» 
count of J. B. Carcano Leone. TranslaMd from the 
Italian by Mr J. H. Wishart, - * 118 

No. L. 

Aat. I. Traits des Poisons tires des R^es Mm^a]» Vlg^al, et 

Animalf ou Tozicologie Generale* consider^ sous les 

rapports de la Physiologies de la PatholMie^ et de la 

Medicine legale. Par M. P. Orfila» M. D. ate SOS 

n. A General System of Toxicology ; or^ a Treatise on 

Poisons, &c. Bv M. P. Orfila, M. D- - - tlS 

III. Observations on the projected Bill for restricting the . 
Practice of Surgery and Midwifery. By a Gmeral 
J^ctitiooery - «• - - 91T 

IV. A Vmdication of the Universitv of Edinburgh, (as a 
School of Medicine,) from the Aspersions of ** a 
Member of the University of Oxford.'' By Law< 
son Whalley, M. D. &a. . - - SS5 

V. Philosophical Transactions of the Royal Society of Lon- 
don. For the year 1816- Part I. and II. - SS9 
VI. Transactions of the Royal Society of Edinburgh. Vol. 

VIILPirtL . - - - W7 

Vn. bbservationa and Inquiries into the Nature and Treat- 
ment of the Yellow or Bulam Fever, in Jamaica and 
at Cadiz. By Mr Edward Doughty, - - S3t 

VIIL A Treatise on Tetanus. Illustrated by a Number of 

Cases. By John Morrison, M. D. - - S41 

IX. An Answer to Dr Kinglake ; shewing the Danger of 
his Cooling Treatment of the Gout. By Mr John 
Ring, - ' - - - tU 

• - No. LI. 

Art. L An Essay on the Utility of Blood-lettmg in Fever, Blut- 

trated by numerous Cases. By Thomas Mills, M^ D. 868 

II. On Fever, as it occurred in Germany. By Hufelandt 

Hildenbrand, and Richter, - ' - • 374 

III. Some Practical Observations in Suigery, Illustrated by * 

Cases. By A. Copland Hutchison, - - 389 

IV.^ Joann. Christ. Albersii, Medecinae et Chtrurgise Doctons, 
Commentarius de Diagnosi asthmatis MUlari strictius 
definienda, ..... 392 

V. Crawford's Inquiry into the Cohesion of the Animal i^- 

br^ 39s 

> No.Ln. 
A&T. L Medico-Chirurgical Transactions, - - 482 

II. Practical Observations on the Diseases of the Urinary Or- 

gansy 8tc. By Mr John Howship, - - - 496 

IIL A Practical and Historical Treatise on Consumptive Dis« 

eases. By Thomas Young» M. D. - - • 499 



of the Blood. By Mr George Kei? ,1— Obicmtioiit on 
tiM HttTMlin Jteeriae «f tilt GbwbMM «f tbe 91^ 
in reply to those lately addneed by GeoW Kor* Eiq. 
if Ataatti«rB«iaf.M.D. • - .501 

V. Remarks on Arveaicy coMNlered u a PoboA aad a Medi- 

ciiMwAr. ByMriohnMarriiAll* ^ • ^^ 

VI. If «dic«l and MSsc^smm OUervMiM relati^ to the 

WittfaMiwIslajMli. ByMuiWiUbarawUD. »o 

MEDICAL INTELLIGENCE. 
No.XUX» 

Medical 0«|iai«iiiM«f the Araif, • -^ • 1S« 

Midical Benefit CocfittiM, 126 

BftedicalKOT«t « ...««.. 1S8 

MBe*Qucttionsf «• « « « ^ . ib. 

Poisononf£iMtofi«iiitlitSlMigofaBt«9 ^ • . •• ISO 

Analysis ol the Baacf«mc«t«f«lM Bon ComtiiBtnry * - 131 

Bllniple of Congenital Amanraeii at a Family I>iHne» - 1 38 

BiUfbrEignlatingttePr;«iMofSii«erf,an. « ^ . ISS 

Rq^ulatbnt ior GnidMMi at Bdiflbnrgfi, te» « , . 134 

1I«.L. 

Q^arterfy Report of the New Town DUpennry^ « S45 

xsftracu from a Lrtltetlrmn a Physician mLottdotty • *- ^^^ 

OnOelirinm, - - • - • . • S5S 

On Blood-letting in Hydfophobia* • - « - . 2^^ 
Experiments on Groten Timim> or ParKine Cretno-Niit. By William 

Ingle<low,Stq. - ««« 

Sfiianent of the Sizes of Blen in Afferent Counties of Seollnndt S60 
Compantive tetement of i9ie Height and Thickness of Men voind the 

ClMstj in different Countiest - - - - 2^3 

Notices <>fBo4c^ftc. - - - . - S64 

No. LL 

Quarterly Report of the New Town Dispensaryt - - 398 

Extract of a Letter from Professor Scarpa of Pavia» - - 404 
Extract df a Letter from Mr Grace, on die occoirenoe of Variob after 

Vaccination, .--.-- 405 

Medical Notices, Ac, . • . . • 4oa 

No.Ln. 

Qnartetk Report of the New Town Dispensary, - * ^2t 

Graduations at Edinbui^ in 18 1 7^ * . - - 587 

Medical Lectures in theUniversity of Edinburgh, - - 529 

Mode oftising the Vapour-bath in Mysore, . « • 530 

Remarkable Case. Communicated by James VtrtOiamson, Esq. • 551 

Successful employment of the Piper Cubeba, . • • 588 

Medical Notices, &c, ^'^ 



ERRATA. 

Fi^ f70> ]i]ieS8,>^NoltrM^Nott, aadrine 89 tbt i 
•*— 2789^— \ifir magnificence rtad munificeaca 

289, ^far Breilot read Brwtol 

— » 886, *^ 40» the Engfish tpeUing of the Mro Hdireir words thoiild be 

«Ksr ra^pia^ not rtib mm as erroneoutly given in die aiamitcript. 
— — 894, subjoined to the Table of the General Sute of Wfttber and Sick- 
nessy &c the feUoving has been omitted by the printer, viz* Medium 
Tempcntore 48«. Medium Banmietrical Height 89.19* MedhuDQnin- 
tit7a£Rain/«r«»i. S5.86 
— -* 89^ in Mr Cumberhuid's Geological descriptioa 
^ line >i%fir Potteidown retid Totterdown 
— 9% for Redlam nod Redland 

I0%fir Gotham read Gotham 

898. — - iS^for MycelatSB r?A/MyceUtflB 

SSI, — Sffir James Robinson Scott, F.Ril. rtad James Robinson 

Scott, FJLkS* 



^w.Jnsr* 



JlTKtnnn^'h Ciue. 




EMitA^.'/ J^ 



J%S4iJU/^jltimUmU0 UCT £ !dim*m: f A., J^^l UtT 



lUfi 

EDINBURGH 

MEDICAL AND SURGICAL JOURNAL. 

1. JANUARY, 1817. 

PART L 

ORIGINAL COMMUNICATIONS. 



I 



L 

Crilk«tMnim of the State qf Medicine during ike tmsl Ten 
' Years. 

(Continued from VoL XIL p. 41 i.) 

III. Pathologtf. 
A 8 the progress of pathologj most always depend upon that of 
^^ philology, the improvement of the former science, during 
this period, corresponds with the discoveries made in the natard 
' history of the human body. 

We begin with the elementary works* Among these, there 
appeared new editions of Spren^l's Elements of Pathology | (a) 
ano tf Ladn translation of the whole work, in two volumes. (6) 

Sinkelmann^s publication was founded upon the doctrine of 
flree difFerent systems of the body, (c) Andrew Roschlatd)^ 
had determinedly atyured the theory of excitement, at- 
^^ ij% ^^^ ^ advance new principles, (rf) which, however. 



x^jfjtJf^ ^^Sjprengert Haiidbuch .der PatJiologte die dritt« Audage Jes sweyten 
^b^'tSOe,' des diitten Theils, 1810, die vierte AuSnge des ersten TheUs, 1814. 
r/felitulioftcfl Pafhologtie gcneralis ct specialls, VoL I. II. Amit 1815, 



'der dynnhiaChen Fftthogenie. Bnniiucfav. 1S05. 8. 
-.^Mj^ 4mb Knielnlebeo els geediiedirD Ton Geeemmtlebtn dtr Ketnr, fim 
jer cKtituiitfieii dee geStdgcn Lebeni Torn korperltcben* 
VOU XIII. NO. 49. ▲ 



2 Eeeent Progress of Meiidne. Jan. 

have appeared to be of little valae. (a) A. F. Heeher^s sketch {b) 
was not remarkable either for novelty of ideas or exactness. 
The same may be said tX L.F.Burdttctirs{c) and A.Henke*s pub- 
lications (d) on the subject, in the tatter of which, the theory of 
excitement is predominant. J. D. Brafidis{e) explained pretty 
well some physiological and pathological doctrines $ for example, 
the teleological notion of disease, the deranged associations, and 
the doctrine of infection; but, upon the whde, he rather furnish- 
ed additions to physiology and patholo^, dian an elementary 
work on the latter science. J.Spindler m his publication (f) has 
accumulated learned nonsense. D. 6. Kieser^s work(ff) also is 
distinguished by the misapplication of the oriental duafism, and 
the totally misunderstood laws of curves, to the explanation of 
diseases. J. W. H. Conradfs treatise, {h) on the contrary, de- 
serves great praise, owing to the considerate use be made of the 
newest discoveries, its go^ arrangement, and a judicious selection 
of literature. £. Grm also, in bis treatise, (i) deliv^ed a me- 
thodical, natural-historical explanation of the changes which take 
Siace in particular parts of the body, in consequence of disease. 
\ O. Omelin*s (k) and P. C. Hartmann*s books (/) are to be 
reckoned among the best and most original attempts to deliver 
this science in a better order than has been hidierto done. ' 

A new nosology, arranged very like CuUen'Sf taking into 
view all the exciting causes of diseases, was 'published by jPI 
Sooediaur ; (m) often, however, it is not sufficiently critical, and 
scarcely ever mentions authorities. 

The doctrine of the diagnosis of diseases was delivered in an 
iDgeDious and useful tabular form by K. G. Schmah. (n) The 



a) Le1iri>. der boondern Kotologie, Iati«usiologie nod Jattrie. Abth. I« 2. 
Frkf. a. Main, 1807, 1808. 8. 

h) Kuraer Abrias der Palbologie und Semiotik. Bcrl 1806. 8. 

«} Handbuch der Paaiologic. Leips. 1808. 8. 

d) Hasdbuch der aUgm&einen und apedelieii Arthologia. HiL l*-3. BerL 
1806—1806. 8. . 

tj Patbologic, Oder Lehra von den Affecten dea lebendigeo Oiganiiintti. Hanb. 
1808. 8. 

/; AUgemeine Nowlogie und Therapie als linawnacbaft. Frk£ %. BL 1810. 8. 

g) GnindsUge der Pathologte und Therapie dca Menachen. Jens, 1812. 8. 

h) Qnindriaa der Pathologie und Tbenpie. ThL 1, 9. Maib. 1811, 1818. 8. 

i) Veraich einer allgem. Krankheitalefara B. 1, 8. Miincfaen, 1811. 8. 

h) AUgem. Pathologie dea menachL Korpeti. SttHtg. 1813. 8. 

I) Thcoria morbi a. pathologia generalis. Viennae, 1814. 8. 

^) *i«rfiii«« a. noTun medkiwm rationalia ayateaw, VoL L II. HaL 181S. 8. 

n) Yeraucb eiaer medldn. ohinugiadMB DiagQoattk in TabeUen. Ldps. 180^ 
fol. und Drwk 1606. foL 



1S17. BeceniProgrmqf Medicine. 5 

investlgitkm of diseases, at the bed*side of the sick, was once 
more omlaioed by IL C. Heuser^ (a) who followed the example 
of his illustrious predecessor!. 

Sfmiolics, or the doctrine of morbid sims, also gained some 
add iti onSf or at least corrections. A. F.Hecker {V) threw out 
aasaegaeid ideas how semiotics were to be improyed, and how 
they were injured by system. «7» C. JL Hemndh reedited F. G. 
Damfs work, (c) K» WoffaKt {d^ also pretended to remodel se- 
miotics; but it is doubtful if his mystical language was intelli- 
gible to himself. In France, it was still thmght sufficient to 
apply and explain the dogmas of Hippocrates § {e) but Doubs (/) 
counted some good obs^ations on voice and qseech, and tne 
Tarioas circumstances of the external appearance as signs of dis» 
ease. Hemandez{g) published a prise essav on the signs de* 
rived from the tongue. The remarks made by Dumas (A) on 
the changes of the teatures of the lace, as signs in disease, were * 
mteresting. Joh. Low (i) represented the urine as an important 
rigOy but chiefly from extravagant philosophical ideas. The 
remarks of J. JL Ekasser^ {k) on the swelling of the parotids in 
acnte diseases^ were more important. 

Morbid anatomv, a veiy useful assistant to pathology, was 
coUivfUed. successfiilly, and partly upon new principles. In 
Germany, we must consider JP. F. and «/• F. Meckel as the most 
inteUigeot masters, promoters, and founders of this science. The 
former left behind him the first part of die Journal for anatomi- 
cal varieties, (/) in which single observations upon the diseases of 
the uterus and urinary organs occur ; he also caused and pro- 
moted VoigjtePs manual, (m) But his son's work, with the same 
title which we have already mentioned, has acquired the reputa- 
tion of being classical by the admirable elucidation of the idea that 
oongeniul malformations are, in a great measure^ to be explain- 



«) Uebcr KnnkeB-Extnwn. Riotelo, 1806. 8. 

h) Annakn, B. 3. S. i — 18. 

AUtemane aMdiciDWche Zddwnlehre. X4i|a%« 181S. 8. 

^ Ucfacr die BedaBtnof dcr Zdcbmlebre in der Hdlicaiides BcrBa^ l8fo. t. 

#) GtUhm \m Joam. de SedHlot, Tom. XLL AotU 

/) Joorn. de Sedillot, Tom. XXXfl. Join. Joilt. Tem. XXXIII. Dec. Tom. 
XXXIV. JaoT. At. Tom. XXXV. Join. Tom. XXXVll. Jao? . Tom.XXXVlIl. 
MaL i 

g) Mem. sar U qoestlon piopoice pur la Soc de Med. de Lf m : QueUes (pnt let 
lignes, que peut fouroir la laogue ? Tookin, 1808. 8. 

S) Joarn. de SedsUot, Tom. XXXIX. Dec. 

f) Ueb«r den Urin, alt Zdchcn. X«andflmt, 1809. & 

i) Diss, de natora parotidam malignanim in morbiclcntls. Tqbiii$..l8o9. 8. 

/) FctneK DBd patholog. Anatomie. Halle, 1805. 8. 

m) Handbncb dcr patbologifchen Anstomie. & I— |. HsUc, i8oiH-l8q|. t 

AS 



.4 BecerU Progr^ of Medicine. - Jan. 

ad from the process 6f defclopihttit fh tftectttbryo being propri*^* 
dive; and by thesotind criticism of our previnnar information. Nor 
is A, W Otto {a) without merit. , G. Fletit^mltnni (ft) hasakd ac*' 
riuired considerable praise by liis explanation of raakjOAfetroa- 
tions. Joi. and Charles Wmzd{c) ascertained the morbt^eblR^-^ 
ifs of the pituitary and pineal glands in the brains of epleplie 
stibjects, and published excellent observations on the fun^misrex-^ 
crescences bf the dura mater, {d) J. IL F. AtUehrieth tmA J. A 
PJkiderer {e) described a case of difficult deglutiCion, in conse* 
quence of the origin of the right «ubclavian artery on the left 
t»idey and its passing upwards to the rights bet^e^B the ctto^ 
phagus and the spine. 

■ In France there appearcfl a capital work by P&rial^ (/) fuH df 
solid observations on morbid informations ifi the structure of 
the body. In Englaind, C BtU*s (^) admirable enf^aftngs tn 
elocidate mofbid ansrtomy have htety been pubiisbi^, as well 
as W, Partes (A) observations oft' the diseases of the liver; upon 
which subject, and the diseases of the spleen, lienj, Iimh{i) laid 
oi>cn the treasure of his e5cperience. Among the Italians, A. «/. 
Testa {k\ deserves especiaHy to be named, whose*' wdrk on the 
diseases of the heart contains many important additions to pa- 
thological anatomy^ Ftor, Cdtdani [l) also publishtd soffie hK 
tcrcsting observation?. 

The laws of pathology ifself were, durhig this pipnod, ex- 
amined with less partiality than fi>Tmerly, as 'it was universally 
Acknowledged, at least in Germany, tliat disease, $% an ftff^etion 
of life, can only have its seat in the living parts, diversified ac- 
cording to the various systems of the body, but that the mecha- 
nical and chemical derangements cannot be overkicked, in ex- 
pkintng the whole of the diseased state. 

The limited dynamic tfeit9 of the school of excitement wef^ 
already revived by W.A.Ficfper^ (m) and^ in the division of animal 

«) Handb. der patholop. Anatomic. Brest. 1814. 8. 

^) De ▼itiif congeniCis civca tiionocm el ftbdoocit. £rU 1810. 4# 

€) BdoMffhtMs^ Ubctacd Hirnmlhanf falUik^tigcr Pcnonen. Matnt , i8xa 8. 

J) Uber die lehwanimiKcn AoitfUcKae auf der ioMcrn Uirnhayt. Mains, t8ci« foi. 

i) Diss, de dysphagia lusoria. Tubing, 1.806. 8. MeWs Aichiv, & 7. S. 145. fo). 

/) Goars d*anatomie midieale. Tom. 1.^ — ^V. Paris, 1S05. 8. 

£) Engravings from tpedmens of morbid parts. Lond. 1813. fol. 

^)kMorbid Anatomy of the Liver, P. I. Lond. 18 13. 4. 

Medic, and Phys. Joorn. Vol. XTl. Scptv^8o6, p. 193. f. Sammt. far prakt. 
Aerzte, B. 13. S. 517. f. 

i) Delle malattie del cuore, Vol. I — lU. ^logna, x8ll. &r 

/} Memor. defia see lul. Vol. XII. P. s. 

m) Aiifslcxe und Beobachtnngen mlt }cdesmaliger Hiniidit auf illf Errr|ang»- 
theorie* B. ^* Pkderborn, l3o6. %. 



J«17. Itecfifil Progfrn of hfedicine. 5 

life into three degM^s^* only that developed that reproduction 
repeats itself in aJI istf uctures. J. Brawn's works were again pub- 
lished in 1806r in three vdumesy at Frankfort, by A^ lidscfi^ 
tombs and Jm J* Kausch endeavoured to correct the idea of 
sthenic and asthenic disease, (a) and to determine more precisely 
the relali^a of the powers* (b) J. R, Giesc(c) showed himself 
more prejudiced* as he only rejected the unity and indivisibUicy 
of excitai>ility« but adhered to the Brunonian dichotomy* F/\ 
Uikieirmmdi{d) examined more accurately the different ideas of 
debiitty. 

It appears, from the example already quoted of «7. Tommasini, 
that the Italians had previously begun to have a clear percep- 
tion of the weak points of the system of excitement; and hence 
firuneit AnmigUf(e) in investigating each disease, takes tbre^ 
points of view ; i. th? diathesis or dynamic relation ; 2. the pa- 
thdogic conditioni or local material changes 3 and, 3. the form of 
the iiisease* or aggravate of the symptoms. The idea of direct 
debility^ which Jos* Giannim(j) bad endeavoured to correct by 
supposing relaxation of the nervous^ and excitement of the other 
systcmsy vvas admirably elucidated by £7. C. F. Jiigert{g) and a 
flaotostiont an unequal distribution through the nerves of tb^ 
iropoaderabfe principles ai^sumed as the most frequent cause of 
«lial4« calied debility. .This idea is also followed out by J. F. 
Ackermannfih) although, according to his earlier chemical views, 
he stiU makes oxygen play the principal part. J. G« Schqffir (i) 
had previously brought into view the diversity of debility in the 
-diffisrent systems of the body. Also A. H. F Gutfeldt \k) had 
investigated the idea of debility successfully, but K. Wolfart (/) 
by no means. fVagtter (m) and J. G. F.Henning (n) inquired in- 
to the morbid irritability and idiosyncrasy connected with debility. 

With these views the opinion of original diseases of the 
fluids, maintained in the preceding period, was incompatible. 



a) H^dam^s Journ. B. 17. St. 1. 

i) Utifeltttuts Joorn. Bd. 30. St. I, S. 

«) GrundzQge so einem System der Heilknnde. Miintt. x8xx. 8. 

i) Abhandt. der phfs. meil. SdcietMt to SrlaDgai, B. %, 

t) Sargio sulk differcme eiienziali delle nalktie aiiivcvnli. Pador. 1809. & 

/; De& naUra deUe fcbbQ, Vol. I. II. Milaoo, 1805— x8o9» 8. 

f) Uebcr die Nator ond Behaodlung der krankhalten SchwScbe des mentchi. or- 
ganttmus. Stattg. 1807. 8. 

1} Be'conttraendis, cognoaeeiidii, et caraadJi febri^ Hddelb. x8o^ 8. 

«) Anv*/ ncDes Aidii«« B. 4. 1S07. 

I) BufiUm^i Journ. Bd. S7. St. % — 4. # 

Im noien Asklep. Hft. I. 

m) Hufeian^s Joarn. a 33. St. 5. ' 

lO Veber die krSnklichSe Laone. Zcrb^* x8lo. 8. Ucen Ubcr Idiot)'aknsic, An« 
ttpathk Dod kr^nkliche Reizbarkeit. Stendal, xtlX. 8. 



6 Mecent Progrem tf MeHdne. Jan. 

They found, indeed, a defender in H. M. Mareardf{a) but A. JFl 
Hecker, as he had done on a former cKxsaaion, {b) subjected than 
to an impartial examination, (c) as did abo A. Henke.{d) 

There are, indeed, several remarkable iacts, espedaliy thoae 
collected by A. J. Testa(e) and F. H. NySien^fJ) wbieb seem 
to prove that, at least in asthma, air passes over into the bloodf 
or that gases may evolve themselves in the blood. 

With this the doctrine of contagion is connected. Upon this 
subject the first correct views were given by J. D. Brtmditf{g) 
partly by a comparison of the propagation of disease by ooiw 
tagion with the process of generation, and partly by investigat- 
ing the multiplication of the matter of contagion, as an impon- 
derable substance. A. IV. Beyer {h) had already maintained^ 
that the matter of contagion was of the nature of bydroMi ; 
and F. C. Bach (i) taught it more drcumstantialiy, as wol aa 
the mode of acting of contagious matter, in the manner of im- 
ponderable substances, and the relation of epidemic with goq- 
lagious diseases. Fr. Schnurrer(k) published v€»y interesting con- 
clusions upon the nature of ^idemic and contagious d iae a a e o > 
The stationary epidemics were oy him considered aa diseasce of 
development in particular people and races, and their being in- 
depenaent of the weather and constitution of the afar waapraved. 
Several important observations on the infection of partieolar dis- 
eases were also made. Thus Aliberi (I) thought himself obliged to 
deny the contagious nature of the poison of cancer, because he 
had inoculated nimself with impunity. On the other hand, the 
communication of the carbuncle from cattle to the human sub- 
ject was observed, (m) That syphilis was communicable to ani- 
mals, especially dogs, S. Zetter von Zellenberg (n) thought he had 
observed ; and C Euggieri(o) asserted, that local venereal lymp- 



«) Versuch doer Beantwoitung der Aufgabe : Wdche benndere Rftnkhaten and 
Fehler der FcuchtigkettCB and S&fte fioden im mcnichUchcn K5rper wirklkh Statfc ? 
Utrecht, i8io. 8. 

6) Nencs Joarn. der Erf. St. 17, 1 8. 

€) Annalen. B. 3. S. 430. 

W) Ucber die Vitalitslt det Btats vnd primure Slftekranheiten. Berl. 1806. 8. 

tf) DeUe nulattk del cnore, VoL III. 

/J Rechercbes de phytiologie ct de chimie patbolosiqoes. Pins, l8xx. 8. 

g) Pathologie. Hamb. x8o8. 

I) Momenta quaedam de contagii« diss. Gott. 1805. 8. 

«) Grandztise zu einer PathoU deranateckcDdea Krankheiten* HaUe, x8io. 8. 

4) Materialien cu einef allgemeinen Natorlchie der Epidemieeo nod ConUgieii. 
Tttbtng. 1810. 8. ^ 

Salzb. med. Zeit. 1809, B. I. S. l^ 

m) HufilamTt Journ. B. 32. St. I. 

mj Abhandl. iiber die tntcn EnchcinQUgeo veiicrischer Local-Kraokbeitsformcn 
nnd deren Bebandiung. Wiin, 1810. 8. 

0j Storia di luui bleonoica prodotu da bunbimcnto csniiio. Vcnes. 1809. 8. 



1817. Siceta Pl^cgresi qf Uleiicine. 7 

toms had arisen from a dog merely lickbg the female oarts of ^ 
neralion. A» F. Hecker (a) imagined he could prove that gyphiUs 
becomes strangely de^erated, and even communicates itself 
without sexual connexion. Larrey{b) is also convinced that he 
€>b8enred in the East its degeneration into a leprosy, which can be 
cured by cinGhona, camphor, and opium, without the aid of 
mercury. A singular form of syphitis, in which the general 
aymptoms come on at once, without being preceded by local 
symptoms, was observed at Fiume. (c) J^assal {d) thought he 
could prove that the contagion of syphilis was communicable to 
the foetus in the womb, by the process of nutrition, even when 
the mother exhibited no apparent symptoms of the disease. JS. 
Jamer {t) observed several times, that the poison of small-pox 
was communicated to the child without affecting the mother. 

Some experiments seemed to give a better explanation of the 
manner in which poisons act upon the body. According to 
Mongjlis eiperiments, (f) the poison of the viper only produces 
speedily fiual efiects when it is taken up by the blood-vessels, pr 
applied to muscular organs, for its operation is slow when it acta 
tnnHigh the absorbents, and it does not prove fatal when di- 
rectly applied to the nerves. The volatile oil of bitter almonds 
and laurel water contains Prussic acid, which is found to be a 
rapid poison when applied to the muscular or sanguiferous sys- 
tem, (g) More recenuy, the body of a self-murderer was exa* 
mined, who had killed himself with an ounce of spiritous Prus- 
sic acid. Ail the blood was blue-black, smelt strongly of bitter 
ahnonds, and was accumulated in the veins. (A) G. F. Jager (i) 
made the action of arsenic on organized bodies the subject of 
his mvestigation. He proved that oxygen is not predominant 
in arsoiic,^ — that exposed nerves do not convey the effects of the 
poison to the body, — but that it operates by the reduction of the 
power of action, mA the excitement of the sensibility. 

Climate, and the constitution of the atmosphere, are unques- 
donably to be considered among the most general and import- 
ant causes of disease. This subject was thoroughly examined 

a) HufiL Joum. B. 26. St 4. 

bj DeukivurdigkeiteD, S. 175, 176. 

cj Joum. de SediUot* Tom. XLII. Sept 

dj Mdnoira nir Ift tranmiiwion du vinu v^ierien d« U m^e k Tenftnt Paris, 
1S07.8. 

ej Medic. Chimtg: Abh. d«r Om. in Load. B. 1. Aim dcm EngL B«rLlSll«8. 

fj Sul vencno della Tipen. PaWa, 1809. S. 

gj a F. Emm£ri dita. de veDenatis addi bonueid in tnimalia eflfbctilNi& Tu« 
tang, 1805. 8. 

hj Horn's Archir, 1815. Mai— Dec. 5ia 

ij I)i«,dsrfgctibMiaii«iaitty^iMaoi yniMiio i i , Tuiniig. 1806.8. 



8 ^ Rtxerd Progress tf Medicine. Jan. 

by Fr. Schnnrrer. (a) A grcnt many more or less Qsefal medi- 
cal topographies were also published. Amon^^ those relating to 
Germany, we may enumerate wh^t are mentioned in the note, {b) 
From France we received publications by McnuretU) and Af ti- 
ro/, (rf) In England, suggestions for the writing ot medical to- 
pographies were published by W, fVoolcombe^ {e) and similar sng>- 
gefitions, in regard to Sweden, were published by C Travenfelt, (f) 
That the epidemic constitution was independent of the 
chemical composition of the air, was proved not only by F. 
ScknutTCTf as already mentioned, but also by H. liubertson* {g) 
W, Knoblauch derived the course of general diseases from the 
involutions and evolutions of life; {h) and C. F. HarlesiJ) made 
some interesting observations on the permanent epidemic con- 
stitutions. The last mentioned author also applied the sci- 
ence of electricity to the explanation of diseases, {k) which was 
also successfully done by G. T/iouvenel, (/) Ckavassieu d^Aude- 
bfrt {m) investigated moist air, and the exhalations from stag- 
nant water, as a cause of disease. On the contrary, Th, SuUan (n) 

qJ Geognph. Koiologie. Stutt. 1815. 8. 

bj F, A' Memminger'i Venuch einer Beachreibung der Stadt Reutliogen, 1805. 8, 

Joh. Schneider** Venuch einer Topographic der ReudeiUEstadt FuMa, 1806. 8. 

J. H. Xopp*M Topognphie von der Stadt Hanau. Frkf. a. M. 1807. 8. 

J, F, Noidti medic, und anthropolog. Bemerk. iiber Rostock und sein^ Betroh- 
ner. Abth. 1, 2. Frf. 1807. 8. 

Frank Uber den Gesundhettsiuatand des Depart, von Posen, in Hufeiand's Joum. 
B. S4. St. 4. 

Si BenediUch Topogr. Kunde von dm- Hauptatodt Grifta. 1808. 8. 

Jot. Steinert Versuch einer medicinischen Topographie vom Landgerichtsbczirk 
Parkstein und Weyden in der obem Pfali. Sulxbach, 1808. 8. 

PhU, J. ffortek Beobacbtungen iiber die Witterung und die Krankheiten in Wiirs- 
^rg im Jahre 1807. Rudolst 1806. 8. 

Wunderlich*t Venuch einer mediciniichen Topographic der Stadt Suls am Neckar. 
Tiibing. 1809.8. 

Z. Wertkeim*$ Vemich einer median. Topographie von Wien, 18ia 8. 

G. r. Ehr1\arCt physiach-medicinischf Topc^. der Stadt Memmipgen, 1813. 8. 

J. T. C, Bernstein t Topographie von Neuwied, in deuen kleinen medicinischen 
^isc^llen, Prkf. a. Main, 1814. 8. 

ej Menuret*t Esiais nir Fhistoire Mddico-topographique dc Piaria. Pir. 1805. 8. 

dj Murat^t Topog. physique et medicate du territoire d*Aubin. Paris, 1805. 8. 

eJ Remarka {a\ th^ frequency and fatality of different diseases. Lond. 1809. 8. 

/; irii/Wan<f'« Journal, Vol XXXI U. No. 1. 

gj General View of the Natural History of the Atinoaphcre. Edinbi 1808. 8, 

kj Hufeland't Joum. B. 35. St 4. 

ij Jahibiichcr der deuischen Medicin. B. I. 

kJ Abhandl. der phya. Med. Soc. in Erlangen, 9. 1. 

^J Melanges d'binoirc naturelle, de physique etde ehimie. Vol. I. — lit. Paris. 
1807. 8. ^ 

mj Des inondations d'hiver et d*ft^. Paris, 1806. 8. 

nj LettWB addrcsifd to H. R. H. tl^e Duke of KcBt» on Cooaumptioii. LqqcL 
1814. 8. 



ISIT. Recent Progress of Medicine. 9 

considered the too dry air of our apartments as the cause of 
phthisis. C. C Haherle {a) subjected the whole of meteorology 
to a new examitiation, in whiob also an important influence on 
the constitution of the atmosphere was ascribed to its elec- 
trical relations. But his attempt to establish meteorology on a 
sure basis failed, like all those which preceded it. The influ- 
ence of the moon on the progress of diseases, was newly con* 
finned by A. Transieri (ft) m a case of asthma. What was for- 
merly ascribed to the constitution of the atnaosphcrci was refer* 
red by F* L. P, Cerutti (c) to the soil and its exhalations. The 
antomnal constitutions of several years was described by G. F. 
KlettSi, (d) under the ancient appellation of atrabilious. 

UpoD the influence of the passions on the production of 
disease, we received important contributions, besides others, 
from H, J. Mortcsan^ (e) and especially from M. A* Peiit^ (f) 
in which the influence of the French revolution upon the health 
was admirably developed. Among the German writings upon 
this sobpect, that of J. G. JS. Maavi[£^ deserves to be mention* 
ed. The oration of Scktferli is insignificant. (A) 

The agency of intestinal worms, as a cause of disease, was ex* 
amined more completely and scientifically than heretofore* At 
the head of the works on this subject stands K^ A. Rudolphfs 
classical prodoction.({) Besides other things, there is proved in 
it, that worms do not perforate the intestines, and that th^ 
are ' spontaneously generated in the body, N. L, Brercrs 
work \k) also contains interesting observations, with several un* 
tenabk opinions. J. Reinlein (/) made some insignificant obser-p 
vations on the natural history of the common tape^worm, falsely 
called Taenia lata.# The real Taenia lata was determined by 
Bremser (m) to be the botryocephalus of Rudolphi. H.K.L. Z.0* 
derssen(n) determined the hydatids more accurately, and de* 

9) Mcteofologiscfacs Jahrbuch. Th. 1, 8^ Weimar, 1801, 1811. 8. Meteor 
do^tcbe Hefte. St 1, 2. Weimar, 1810, 1811. 8. 

h) HarU** Neuca Jottrn. der Ainland. LHemtnr. B. 9. 8l S. 

€) Collectanea de telluris in organi^mum animalem acdone. Lipg. 1814. 4. 
. 4) De coutdtutione morborum atnbilaria. Wittebi 1806. 4. 

€) Traits de rinfluencc dct pasaona sur la «uit£. Par. 1805. 8. 
f) Eani sur la m^d^ne du cocur. Lyon. 1806. 8. 

g) Vcnuch Obcr die Lddenscbaften. TbL 1, 2. Halle, 1807—1805. 8. 

k) Rede Ober den Einflun der Gemiithsbewegungen auf Gcsundheit und L^ 
teMdnier. Be^^ 1806. 8. 

i) Eotosoorum s. Tennium intcrtinalium bistoria oaturalii. Vol I. II. Amit 
tsoa, 18ia 8. 

k) Memorie fisico-mcdiche sopra i prindiiali Tenni dal corpo umanow CreiiHU 
|8ll. 4. 

I) Animadrenionca circa ortum etc. Taeniae laSae, Vieonae, 181], 8, 

m) Sahb. med. Zeit 1812. B. S. S. 837. 

p) Piit.de bjdatidibtti. Oott 1808. §, 



fc-S'^**?. 



10 Beeeni Progreu of Meiieine* Jon. 

scribed the aoephalocyatisi almost the simpket of animals. The 
Hydatis finna was excellenUy described by K, Hirnihf^ (a) and 
L. de Carro furnished some recent information ooncerning the 
Filaria medinensis. {h) 

Urinary calcaliy their causes and symptoms were investigated 
by Ritter \c) and jTA. Egan, {d) The former tried muriatic acid, 
and the latter showed that an excess of add certainly contri- 
buted to the generation of urinary caicuiL W. Brmnde{e) en- 
deavoured to show, that uric acid predominated in nephritic 
calculi, and that the phosphoric acid was not produced nntil 
the stone had fallen into the bladder. The inquiries of Ma%tati 
and AUemanni(/) furnished new results, in regard to the com* 
position of urinary calculi. They found magnesia and silpc. 
The latter was also found by Wunxr. {g) 

Marc {A) and Kopp{i) instituted inquiries into the sponta- 
neons combustion of living bodies. The most recent caae 
narrated by FiUeau {k) requires to be more accurately ezamio-i 
ed. 

In regard to special pathology, many attempts were made to 
explain the general theory of fevers, but they only furnished 
new proofs that it is a stumhUngblock to the human under- 
standing. Jos. Gianmnfi text-brokyf/) insignificant as it is, 
certainly deserves to be preferred to tne absolutely useless pro- 
duction of Reich^ (m) in which materialism, without limitation, 
performs the principal part, and the essence of fever is madte to 
consist in altered secretion and excretion. A purely chemical 
theory, on the preponderance of oxygen, was advanced bv 
J. W. A, Froweifif (n) and also by J. F. Ackermann^ (o) although 
useful ideas concerning the accumulation and exhalation of 
the imponderable subsunces (Aura oxygenea, Ackerm.) occur 

tLj Hufeland't Journ. B. 29. St 6. 

hj J{ufelan(Ct Journ. B. 87. St 5, 6. 

€j HufelamCt Journ. B. 85. St S. 

4 J Medic, and Fhyi. Journ, N. 90—94. SMumL fur {Hnskt. A«Rte, B. 24. S. 
553. f. 

tj HarU*i Keues Journ. der AusUmd. Lit B. la 9t 1. 

/; Memorie delU soc. iul VoL XIII. p. 2. 

f ; GehUn*» Journ. B. 8. & 867. 
. hJ Sdib. med. Zeit 1809. B. 8. & 835. f. 

ij Aua(ilhrlich« Darttellung und Untenuchung der Selbstfwbrannungcn. Frkft. 
S. M. 1611. d. 

kj Journ. de Sedillot, Tom. XLVL Mars. 

tj Delia natunt deAe febbrl VoL I. II. Mflano, 1805, 1S09. 

mj Erlauterung der ilcberlehre, B. 1, 8. B«rL 1805, 1806. 8. 

•; Was sind Fiebcr ? Elberfeld, 1806. 8. 

•) De coDstrueadia, coguoBcendis, et curandb ftbribut. Hcidelt. 1609. SL - 



1S17. Btecm Progress rfUsiicine. U 

as Games of agsravation« Similar ideasv eoncerning tbe origia 
of the came of fevers, were already advanced by F. C. iUk^i- 
ger. {a) G. Fk, Parrot {b) considered fever as a calorific procesi^ 
and demonstrated the real increase of temperature of the surface 
in the fdirile heat Hie doctrine of fever was, according to the 
principles of the theorr of excitabili^, givoi by KHom g (c) and 
A. Henke explained tne doctrine of crises, (d) J. A. fVaUher^s 
explanatioii of metastasis {e) is insignificant ; but that of Fr. 
Hufelandj (f) concerning general and local diseases, is very in» 
tercstlng. A good and l^rned work by «/• if. Bahn (g) was 
published after his death. 

Upon intermittent fever we have had a good practical work 
from J. Bidkard. (A) Klerfeld {%) described the remarkable con- 
version of an intermittent epidemic into a partially remittent 
tjfphoos fever ; and Minderer (Jc) described the true hemitritaeus, 
as it occurs in the southern provinces of Russia. Audouard^g 
theory of intermittent Sever (2) is as little to be commended as 
his method of core. 

JtfiiNfer^made some interesting observations on the plague, (m) 
on wfaidb subject Larrtyin) has abo made some observations, and 
C Mayer given a theory, (o) The last showed the coincidence 
of die plague <tf the East with that of the West, or the yeliow- 
fiever, which had indeed ceased to rage in Europe, but of which 
sporadic traces still occurred, (j?) To the later writings of Oer* 
man phyucians, who considered the nature of this disease from 
the observations of others, bdong the treatises of C. F.Fischer^ (;) 



a) Diss, de natuTa et medeU moibomm nenrioonim. Tubbg. 180S. 4. 
6) Ueber den Einfliis der FLynk und Gli«mie auf die Aiioc|kiuide. Dorpe^ 
[1807.] 4. 
e) Aafeag^grunde der med. Klinik. AlKh. 2. Erf. 1807. 8. 

d) Dwttellung und Kritik der Lebre tod den Kiiaen. Numb. ISOS. 8. 

e) HwfSUm^M Joum. B. SS. St S. 

f) HufitMid^$ Joum. a 23. St. 1. 
l) Fi^ierlcbre. Ziiricb, 1814. 8. 

k) De insidiow quefundnm Ibbfittai iatsmiMnitiiiBi si nadMiiitinas nstsis. 
Und. 1807. 8. 

BufOand^M Journ. B. S9. St 5. 

k) HufiUnuVi Journ. B. S. St S. 

Q Kouvelle tbempeutique des fievres intennitlenles. Firft, 1818. S, 

m) BufelatuTi Joum. B. 24. St 2. 

«) DenkwiirdigkeitGO, S. 96—139. 

o) Specimen preeticum de remediis cfficsciaaiaiR in moiMs ssnUgiSBis H psitU 
lentialilxn. Viennae, 1806. 8. 

;») ZmT«y'« BenkwSrdigk. S. 140. /. C Itmoni ia il^ Jsim. B. $1 St 8. 

t) Hrftlan^i Joom. B. 21. St 4. 



! i Recent Prcgress of Medicine. Jani 

C F. L. trildberg, {a) an anonymoQs pttbllcsdon at Vienna^ (ft) 
jl. P MafTtis*s contributions, {c) and ihi works of K. Wot/art^ (d) 
J, H. Kujrpy [e) and J. J, de Bartoldi, {/) Of mdcb knore import- 
ance was the information furnished by those who saw the dia* 
ease themselves; Fr. Torrigianiy(g) L. ValenUnf{h) Dalmas^ (i) 
B. Rush, {k) and especially A. V. HumMdij (l) and A. M. T. 
havaresi. (wi) 

The nervous or typhous fever, a^rgravated by almost continual 
wars in Europe, and constituting a troe PeaUi BMica^ was so 
repeatedly investigated during this period, its nature so varioualy 
determined, and its method of cure so differently laid down, that 
we must necessarily be convinced ' that the epidemica were not 
only porfectiv different at different times, but that the same epi» 
clemic varied in difTerent countries, • 

The i^estis Belitea appeared in 1805, during the campaign 
of the French in Austria, after the battle of Austerlits, upon 
which Lan'ey{n) has given us some not uninterestiog ohserva* 
tlons. Upon the epidemic u^phus which accompanied the war 
of 1806-7, so unfortunate lot Germany, Ckardd{o) and Fr. 
Jahn (//) made some practical observations. The former found 
ipecacuan, the latter calomel, particularly aervtoeable. P* &. 
Jdrdens (q) enriched the symptomatology of the disease with 
some valuable additions. Nor should we overloolt M. v, lVil» 
Itches (r) observations on the appearance of that fever at Ail* 
gen. C. fV. HufHand^s valuable remarks (5) deserve particu* 

c) Ueber das gelbe Flcber. BerL 1805. 8. 

6) Betchreibung des gelben Fieben fiir diterr. Aente und Wundante. Wieo, 
1805. 8. . 

c) M«aa»afur qpMieUt TlMnpia, B. 2. St 1. 

d) Das Wescn des gelben Fiebers. BerL 1805. 8. 

e) Versucb eioer Daistellimg dm gdben Ffebert. 'Mf. am BC 1805. 8. 
/; La febbre gialla. Venei. 1605. 8. 

g) DeUa febbre gialla. Pisa, 1805.8. 

k) Abhandl. iiber das amerikanlscbe gelbe Fieber. Aus dam Frant. tod IC« C, 
G. Amelung. BerL 1806. 8. 

a) RadiadwaUfloiiquM at m^dicalcd siir la fi^nw jauna. Paria, 1805. 8. 

h) Inquiry into die Tarious sources of the usual forms of summer and winter dis- 
eases in the United States. Philadelphia, 1805. 8. HufelandU Joum. a SS. 8t 5. 

Voyage en Am^rique, Vol III. p. 750. Harlca Jiriub. & & & S. 

m) De la %kn% jauna^ N^to, 1809. 8. 

n) Denkwiirdigk. S.379. 

o) Journ. de Sedillot, Tom. XXXIII. Oct 

|r) tfa^M^>i«wr9. B, 83. St 1. 

q) HufelatuVi Joum. B. 55, St. 3. 

r) BufeUnr»Uunu.U.90, St 6. 

•) Ht^feiand*$ Joum. B, 26. St 3, 



1 8 17. Recent Progress of Medicine. 1 S 

ktly to be read. It Wfcs hi the sBine year that H & JirJfe- 
mm {a) dbserred in GibralUr, that inflammation oFthe brain ofr 
ten su)>ervened in typhus. Th« numerous compiications which 
ocetirred id ibis epidemic (in GermsSny, l^OS^l) were deuilea 
by A. F. Hecker, (6) G. A. Hpaugenberg^ (c) and F. J, Witi» 
mantu {d) The insidious form nrhich often occurs was particu^ 
lariy noticed by P. L. MUtkr. (e) 

Tie war between France and Austria in 1809 produced a si« 
nttlar diaeasey and we are indebted to j; V. v. MiUknbrand (f) 
for the most striking observations, the most impartial and coai» 
plete inquiry into its nature, and the best directions for iu coie 
and prerenti^n. Paid Kolbany^s remarks (g) also deserve to be 
noticed with approbation, on account of good pathological ob^ 
lenrationa, end more especially the application of Curriers prac- 
tice. On the contrary^ F. C. SckltdtterU remarks on the ap* 
pearante of the epidemic at Weimar are insignificant (Ji) 

In 1811, A. P. MartH5(i) published his theory of the identity 
of inftammation of the brain with typhus, which, however, he aa- 
•erted, he had conceived and esublished in 1806. But neither 
the iff- managed eases, nor the asserted success of his method of 
cuiv, were capable of deceiving impartial judges. £. Horn (le^ 
iaeertaioed with some precision the difference between typhus 
and inflammation of the brain ; and it was mere prejudice 
which made Atarcus consider - Horn's observation of accumula- 
tion of water in the ventricles of the brain after death, from 
nerroos fever, (l) as a proof of the truth of his theory, (m) 

In the. depopulating epidemic which accompanied the cam« 
pairas or 1813 and 1814; and which in some places had 
un&igone a total ch/iqge in its nature, Marcus's theory ob- 
tained occasionally more support. He considered as a proof 
of its tnith, the appearances discovered by dissection in the 

c) Obtervatiixns on thiB epidemfc diaeaaei which lately' jiretailed «t Gimter, 
1806. 8. 

h; Ucber die Nervenfieber, Welche in Berlin 1807. heiVsehieii. BerUa, iSoe. 8. 

cj Si>m*$ Arch. 1809, B^ 2. ' 

dj Di« tiMicitca tm Rhdn hemehenden Volkskrankbeiteii. MaliiB, 1811. 8. 

€j AbliaadL Ubp dis fchlf ich^nde Nenrenfieber. Duisbui^ 1806. 8. 

/; Ueber den ansteckenden Typhus. Wlcn. 1810. 8. 

gj Bemcrkungen tUber den ansteckenden Typhus, dtt 1809-10 in Firesaborf 
bennMdite. Presah. 1811. 8. 

kj HufeUnuTs Journ. B. 32. St 5. ' 

ij Epb^meridBn der Heilkund*, B. 1. Hft. 1. 

kJ Aidiiv, 1812. Sept* 

/; AidiiT, 1810. B. 2. & 267. 

mj Ephemer, der Heflknnd^ B. 1. Heft 2. 



14 Beceni Progress qf MedicifU^ * Jbh. 

body of J. P. RUier^ who dted bf the typbus, because the 
fcsads of ihe brain were distended with blood, the meduDar^ 
part red, and water ooUected on tbte bans of the skulL (a) His 
opponent, A» Dom^ {b) set out with the ptincipka of the theory 
of excitement, and, therefore, conid not obtain any support from 
impartial judges. Still less to be approTed was the controversial 
production of P. J. fVehttx, (c) because in it the liver was just as 
erroneously assumed as the seat of the disease, and ihe reason- 
ings about its nature were still more unintelligibly More suo^ 
cessful, and less partially written than usual, was Marcuses next 
woTk.(d) Out of lis typhous patients he lost only 12. Jl. 
BSsehlauVs controversial pamphlet {e) is entirely devoid of in- 
terest for science, and merely a monument of personal enmity. 
Equally reprehensible is Marcuis reply. {J') Another production 
of the same kind, by M* IV. Schneemantif {jg) is very. raor. The 
author will not even admit the pestis bellica to be typbo^ ; there* 
fore the reply b^ Siranz is well founded.(A) P.Beuss{i) and Spej^ 
erUk) agree entirely with Marcus: and the phvsicians of Mayenc^ 
fVsttmann and Rmard^ acknowledge the innammatory nature of 
the pestis bellica. (/) P. IL Hartmann (m) and J. «7. Reuss (n) 
likewise agree.that the disease is preceded by an inflammatory 
process in the mucous membranes, which, according t» the latter, 
extends to the tunica arachnoidea of the brain, and, according to 
•die former, generates contafdon, when the muopus membranes 
are affected with gangrene. : out the dissections on which JReuss 
relies were found by KHom {o) and N.Friedreich {p)tobe quite 

a) A, F» Marcui ilber den jetst hTWcfagndan •mteckenden Typhui. BamK. 
1815. 8. 

5) Beroerkungen dber di6 Scbrift des D. JMarciu^ den bcmdieBdeo ctmtafjSSma 
Typbiia betraffend. Bunb. 1813. 8. 

e) Bericfatigang •inigcr SftM In dcr Scbfift dsi jBhk i/orvst itev d^ .7>pbiw» 
Bamb. 1813. 8. 

d) BslciidituQg d^r.EinwUile g^gen.m^uM Aniirhttn jbbar den hmachenden 
nntteckendcn Typbua. Bamb. 1813. 8. 

e) An J, F. AfarttM Qbtr den Typbus. Landdi. 1814* 8. 
/; An J. RStehtawb Ober den Ty^tuia, Bamb. 1814b 8. 

g) BsftcUga aur firkan&tniM und Cur dea anataAendea l^us- Bambw 
1814. 8. ,' 

h) An Jf. W. Schneemann Ober den aosteckenden Typbus.* Bamb. 181^ 8. ' 

t) BainatI:. Qbcr den anateckenden Tophus. WQnb. 1814. 8. 

k) Epbemeriden der Heilk. B. 3. St 4. 

I) SaUb. medic Zeit. 1814. B. 3. & 35a 

m) Die Tbeorie dea antteckandan T^rpbua^ WJan^ 1818. 8. 

n) Das Weien dar Ezantbama. Enter TheiL Hm Flackanfieb^r ode d 
KriegBpeit Aicbaffenbuig, 1814. 8. 

o) Erfahningen Obcr dsa Haihing des amtackenden l^phtis. . BierL 1814. 

/») Ueber den Typbna und dia enuiindungswidrige Metbode dagegem WOrib* 
1814. 



1517. Beceni Progress of Medicine. 1 5 

otherwise Often there wftsno obviotts deviatioD from the naturil 
state* ofien the vessels of the brain were full of blood* but very 
rarely was there any mark of inflammation. The insufficiency of 
dissection, to ascertain the nature of typhns, was explained in a 
!q)ecia) treatise by N. Friedreich, (a) E. Horn (&) also made some 
valuable observations concerning the duration of the period of in- 
fection, and upon the transition of typhus into apoplectic fever* 
C A. WienAotd (c)- refuted admirablv the pretended inflamma- 
tion, by proving that the state of tne nerves in the bodies of 
those who died of typhus, was exactly the reverse of what it is 
where the nerves ai^ inflamed. In a practical point of view^ 
Ht^etand^s essay on this pestilence (</) deserves particular notice. 
Also G, V* Wedekind {e) nas published one of the most impon- 
■nt and impartial inquiries into the nature of the disease. He 
assumes in typhus an erysipelatous inflammation. J. C 6* 
Jorg(f) deserves to be read, on account of the investigation 
of die influence of moral causes upon the disease. S. ffolf{g) 
describes the measly eruption in the beginning, and notices 
the muscular debility which is here truly remarkable.* J. F* 
Ackermatm (A) has written entirely in the spirit of his well kftown 
theory. 6. A. Richter (r) has strikingly delineated the dread- 
fbl form of the disease in Torgau, during its siege. The pro- 
ductions of Eiserdohr {k) and 6. Wedemeyer (/) are insignifi- 
cant Wacker (m) advanced views derived from the new j^ilo- 
sopby, without any use ; and the same thing had been pre- 
viously done by H. A. Goden. fn) Similar nonsense, delivered 
vritb equal pretensions, is to oe found in K. fVo^arfs newest 

a) Werdi dcr Leicfaenofihungen sur BesUmmung : Typhus sey HirnentiUndung. 
Wunb. 1SI4. 8. 
S) Arehhr, 1815. Utl-^Vec 

c) Kridsdie Blicfce auf d»s Wetcn des Neirenftebin. Dresd/ 18 14. 8. 
4) JamtL B. 56. St 6. 

e) Blkke in di« Lehre von den Entsiloduiigen und voa den Fi«btm iibcrfutipt^ 
VMidcn Gebirn-EnUundungcn und dcm an^teckenden fuuleii Nc!r>'cn(id^ ini^be- 
aoiidcre. Dmnnstadt, 1614. 8. 

fj Dm Nervvnficbcr im J. 1815. BerL 1814. 8. 

g) H^fitandTi Joarn. B. 59. St 8. 

k) Von der NatnrdM an«teckenden Typhut Heldelb. 1814. 8. 

{) Mcdidnitdie Geschlcbtc d«r Belagerung und Einnohme der Festung Torgau. 
BerL 1814.8. 

k) Uber die Natur und Behandlung des epidetcisch-contagiosen Kcrvenficbors. 
Gbitauiie,1814.8. 

f) Ubar den aneteckciidcB Typhni. Halbentadt, 1814. 8. 

m) Ubcr den aneteckeiMleii Typhus und die herr«chend«n Kranklieitcn. DHlin- 
fro, 1814h 8. 
%) Ucbcr Natur und Bcfasndlmig dct Typhus. Berl. 161 1. 8. 



1 6 Bec^U Progress of MtdkinM, . . Jm« 

theory oftypliiis ; (a) where, besides other thtv^s, the (iftvkible) 
nervous pelands are said to be the seat of the matter of pesti- 
lence, and the greatest light upon the subject is expected from 
mesmerismt as it is called. 

The theory of inflammation did not acquirci during this pe- 
riod, any remarkable elucidation or addition, except BeHed, 
Hofrichter^s [h) chemical explanation from the increase af cat«- 

. bon. The opinion that, the capillary vessels, excited to arterial 
action, were the seat of inflammation, was almost general, when 
now Marcus{c) advanced the opinion, that inflammation is * the 
seizing of the electrical moment, in the dimensions;' which 6- 

.gurative expression must be thus translated : The arterial 8y8tera» 
on account of its dendritic expansion, resembles positive ele^* 
tricitv, but the electricity disappears in the indifferent capillary 
vessels and in the absorbents ; that is, in the reproductive^ sysr 
tero, and yields to simple attraction = Magnetism. Hence it is, 
that when the capillaries enter into the sphere of action of the 
arteries; or, what is the sf^.me thing, when the activity of tbe 
arteries communicates itself to the capillaries, the electricity is 
concerted into magnetism. Now, in so far as irritability or 
contractility predominates in the arteries, is inflammation al» 

. ways a contraction of the arteries. This is an exposition' of 
Marcuses theory, by which he is made to coincide with P. JF. 
Walther {d) and Nemmann. [e) But Marcus will not admit of 
this coincidence, and more recently (f) abides by his metapho- 
rical expressions. 

When we read BSscUaub^s pretended explanation of inflam- 
mation, (g) we seem to be carried back to the latter half of the 
sixteenth century. < The fiery life plays into the material cpr- 
porality, and endeavours to form a proper body. to itself. ' As 
little common sense will be found in H. A^ Gddcn*s theory ; {h) 
according to which, the inflammatory nature consists in the 
fierceness, in the unbounded egotism of tbe irritable momerU^ 
and in the corruption and acrimony of the matter. 

More interesting are F. v. P. Gmithuisen^s microscopioll in- 

a) Ncttct Aaklep. 1814. Hf. 2. 

h) Vertuch iiber das fintniadungificber und die £utzuiidun|^ BresL 1S06. 8. 

c) Entwurf einer speciellen llierapie. Thl. 1» 2. *Nunih. 1807, 1810. 8. 
Jahrbticher der MediciD ala Wisaenachait, B. 8. Hit 1. 

d) Phyiiologie, B. 8. Abb. aut dem Gtbiete der prikt Ifedida. Landbb. 
ISia 8. 

e) HufdawVi Journ. B. 23. St 4. 

// Epbemer. dar Heilkunde, B. 2. Heft. 5. 

g) Magas. lur Venrolk. der Heillc. B. lO St 2, 3. 

h) Die Theorie der Entettndung. BcrL 1811. 8. 



1817. lB£cera Progress of Medicine. 17 

aairiess^o) by which the seat of inflammation is proved to be in 
^e capillary vesseb ; and P, J. HorscJCs thoatrhu, (&) in which 
Maraas theory is made more iotelli^ble. Jl Meyer published 
a learned and profound history of inflammations, (c) The latest 
work upon this subject, by K. H. Dzondi^ (d) does not bring us 
one step nearer to its knowledge. The capillary vessels are here 
called the plastic jiystem, in which the inflammation has its seat^ 
and is perverted jfor the production of new matter. The causes 
of inflammation are divided into quantitative and qualitative ; 
and» among the latter, contagion and miasmata are enumerated. 

For^gners confined themselves more to the phenomena and 
consequences of inflammation, as J. Thomson^ (e) and A* J. Tes^ 
toi {/) or, like P. J. K BroussaiSf(g) they continued to consider 
the capillaiy vessels to be the seat of inflammation, and endea* 
voured to elucidate the natnre of individual inflammations by 
morbid dissecriona. 

Some good remarks on the inflammation of the viscera of diil- 
it&k were made \y C. F. Harks, (k) He was also induced, by 
the translation ot Brera^s essay on the inflammation of the 
spin^ (i) to collect several observations on that subject (k) But 
Bc^/iunCs latest work, (2) though indeed more of a surgical na«' 
lure, could not be known to him. 

Inflammation of the brain was a frequent subject of investiga- 
lioi^ not only because it often occurred along with the pestis 
bdlica, and was even confounded with it« but Decauso it not nn* 
freouentW terminates in an accumulation of water in the ven- 
tricles of the brain, or between its membranes. The morbid 
conditions of the glands and lymphatics, under which, collections 
of lymph or serum take place in the brain, were^ investigated by 
the brothers JFenzel (m). An anonymous writer puHished^ a 
valuable contribution to the diagnosis of hydrocephalus, by dis* 

s) Sahb. oefie. Zdt. iSxt. B. s. 6. %^ 

i) AanaJ. der clintfch-tcdinischen Sdinle, Heft. %. Radolst. x8lo. 

v) Sfittjclie Octdikhte der EntzQAdsngea. Th. I. BerL i8l4. S. 

d) De inflammatione aphorkmoram Lib. I. HaL 1814. 8. 

#} LcQnics on IfiHarafnatiofk Edinb. 18x3. 8. 

/) DeUe mahtde dd enort. Vol. L— Iff. Bologiu i8xt, tSis. 

9) Hifltoire dct phlcgmaiiet ou loflammatioiis chroniques. Tom. L II. Bull, 
1808. 8. 

B) Einige praktische Bereerknngen ttber innere EntxQndungen bey Kindern. 
M3mb. l8xa 4- 

Delia radiialgtte ; Atli dell' acad. £ LiTorno, Vol. L 

i) JabrfaQcbcr der Dentschcn Med. a. (Jhir. B. %. Heft. %, 

/) Aocottot of a tucoessfol method of treating diKases of the ipine. Load. X813. 8. 

m) Bemerkangeo ttber die Hlraara&sertttchu TObing. x8o6. 4. 
VOL. XIJI. NO. iU. 9 



16 Sfiunt PfOgt€t$ fjf Menctm* Jui* 

tifigttithiog ft fhMn tyinptcMM product by wormft* <«) jf. 
MMey md Zaetmee do not eonoeal the diffleidty of die diiyc^ 
nothi etpecialiy in rc^^erd to die state of the piip9. f6) F. PF. 
Neggefffind^i ohservBtioD of the tnembnne^Klce tmfMlttg of tlie 
brain in a case of chnxue, but not congenital hydroeephtlns, (e) 
was interesting s and coidlrmed by Rasari. \d) J. C. Cke^e (e) 
lend^ed the snojeet mere intricate, as he considered cases of 
aoenmulation of blood as bdon g i ng to Ais disease. I^ Ar- 
^M9(jO gatre an eKoelient history ctf this affsction, Ibonded on 
experience, in which several rfgns hMietto ne|{1ectednrepoinlai 
o«ti Hemdkmfs Bmyig) de^mes to be read ; and ahothatof 
Jds.v.PifrtemcUag'Ledermefers{k) dthough ihe htter eKtenda 
his idea of the dieease too fiv, andindndes evcsy ease in whidi 
fluid is found in the ventricles on diaieeticsi. The diagnosia 
is enriched bf the reuMrks of E. MbenUem-IMd^ (t) W. Jl 
DrQfssig, (k) J. C. Smuih^ {I) and J. MUman CO^. (m) ML 
BaUtUs observation of a chronic hvdrocepliahis, m a man W 
years old, in whmn there was no otner eseentid symptom Aaa 
paby of the Kaibs, fa impottant ^ 

No diseaaa of the human bodj set so toany pttes in nmtiont 
during this period, direughoul the ciriliied world, as the ofi- 
gjma membranaeeaf ahnoatnniversdty^deiionilotted byltsEni^dl 
name Omp; not merely because k has become more comutoo> 
but because the Qvant ct the wottd allotted an extraordinary 
inme fer the best treati^ on this tf^ease, by which he had feat 
one of his fkvourites. This was done on the 4th of Jnn^ 
1607. Before this, A. M. R GuifiMi(o) had given i^'Mrtect 



«} Xdinb. Mfed. and Sm$. Jwun. Vol. JI. 1806. p. 5a, 
I) Joam. de CorYiiatt, ito6« J^do. 
«) litftk»f$ Jonrn. B. S4* St. X. 

4 Giorn. ddU sbc nied. di Pftniui, Xo\. IL N.4. iUkV Joan* d«r«arii|id^ 
Lit. B. 10. St. X. S. xS6. 
9) Versnch Qbcr dea Mntcn Wasierkopf. Ant dan BnsL voo A MtfUsE. Bkbmo, 

i«09, a. 

/; Von der WaoenSdit der 0duiiih5hlciu BerBa, x8xa 8. 

l) BufdamJtt Jooriu B. 3s. St. 3. 

A) Ueber den Wasserkopf. Wlen, x8ia. 8. 

I) Die XrkelitotnlM und Heilnng der Oehim-EntsOiidiiiiv, dci inncRi WailwkspSw 
and der Knmpfkrankbciten im kuidUchen Alter. i.eips» x8x J. 8* 

I) lland«6rter1w«h der medidDUckeii Rlinik, B. 3. Th. x. 

l)Titat.onMrdraecphalsi«rDra|MyoftheBrafak LMML1813.B. 

m) a Practical Treat, on the Remittent Fever of Infinity vhli rcnurkt oa Irfdie* 
cepbalus interntu. Lend. 18x3. 8. 

») Medic Tratinct. publ. by the CoUcse of Phy^ ia Load. VoL IV. ^ V^ 

§) BwiCi Archiff, xSoj. B. a. Bcft. x. 



1fl\7. iUxadPf$gtm0fMB(lkini. 1ft 



iriew dl^^ JHsMae «tHiem(( tn irtflMiaMiCiMi of Aemuoi^iifl tfwni* 
l»nM of Are'tftiebei) fefioirad bj etadatioii 6f lymrb. J. C 
jDM»sar^i^ U() on tile Mntnuy, opposed die niflammfltory nature 
of Ae MNlnoiif irtid considered it to eMtbt only in a «topt>8ge 
ef ffc itomMift Mfioke mi gletsJfl i end in this opinion he mm 
m pp a uM i byJ.GF. tJurm. (b) By die obserrationt p«bliriiea 
brG: f^kmea^ftie) it 'Appeared fkat pen different states of Ae 
glottis and traebea niere con f oe nd ed, as be eras aeqnainted wttb 
n nervooe or misfinfdie, a eh^onic^ and a eatarrlial ^ronp. This 
Mea, wMeh Krriar bad prstioosiy aAopttd, was more deteiop- 
edf l^^ h&ac. {i) Now appeared J. H. V. MOenritOft excdkift 
ti bagi M ari ons on ^thie disease, \e) in wiridi the rdation between 
Wtka^t aatbnm and the spasmodie farm of the disease Was ex-^ 
pMneril s and it ^ms also sh6#n that death was sometimes tlm 
consequence of the mere paiigr of the parts alFedted* On the 
contrary » /. Ckiy^ (ff and tikmr (g) eonsideral the realeroop 
as n.tnie itflkmmation. 

* The commitise appofaited hy the Frenob flovernment for seu 
dtiig the prize-qeestion, pnUished preffossTy the state of oar 
Itnowhkfae regarding the disease at thai time.(^ The first 
works wfei<:ir appeared in Germany after thre priae-qnestion waa 
gi?en out, (^ J.' W, Hogfi (t) and Che translation of an earlier 
£a^sb pahtieation, {k) were not nery important More vahiN 
aMift was'the miaric of JMMne/fri (/) that^ in Mality^ as htA 
been nio^ by Auiemtetk^ and denied bv Wickmann^^t meni» 
brsflotts angina is often eompiicated witn, or degenemSes hito 
WUh^i asthma. A. F. MarcwfB great pretensloiis (sf ) aooorded 
Tery fl wkh the Mtde additmn which Iris work nnMle to onr pn» 
thomgieal or therapeutical knowledge dt the disease. Be ttH- 
ed it 8 catarrh ; and oonsidefnd it to consist essenihUy hi ^ 



tf) Wkn, Mr b eroop. Hirit, r80S. t. 

l)Trmitc do croop-aigo^ IM|» SSoS; S; 

#) jBoro. de Cornnn, iSod. Dec. p. 4SSr 

4 HtcfceT't ilBatfk% & 3. S. 4^. 

#) Vcnodie Ilk die pnkt. HetlkiMde. TQbinr^ iSb;. t, Tli.< %^ 

f) PMholosy of tbe membrane of the larynr and (he (MMcfcia. Sdin. tiof. fL 

f>liumel for le croup. Vkris, rSeS. ta; 

hy SuunL von Bervbachtaogen and Thatsacfaen« dfe ditf hSStige BHHwe betfdfear 
Udwn. T. J#. Jtf: frmdUimitr, TOU09. iSoe. S.- 

Abimdl. Ober dea Cr«iip. Hhimu', fSdS. S; 

I) /r. Hm0» UntciMKbongto Ober die NaCor, ^imAk eSd l Uto i y te 4lottp^ 
Ml »BtiwiL tmX Anmabuogen «ob j^. ^. .4^Sto». BiwaiD» tSo^. & 

i) HmfiUmis Journ. B. ftS. St. 6. 

a) VcbcK die Matw ood Bcfaaadhiniiirt der hSiit%ca JBrisiiSi BftSlb. HtSb H 



90 . Reeem Progreu if MuUdne. iut^ 

flMBmadon of Ae |^k^ end trMhfa. A. R Heiker kid dainr 
to ibe praise of hnring uticipatod Anatenri^^-^nem^ia) andi 
naiDtaiiied that Ibe diaeaao was pooKtmca apatimKlief in oppo* 
ridon to Vormejfi who bad denied it»^) ^ After thia •ppaa]rt«^ 
,the exoallent^ alinost daiaical treaiaBe^ bjr W. &wAm^ (c) in^vliiGb 
icaraiimiy eyperieiieei and acateneist aw eqaal^ ao Mp i y iioo a . 
,Wem% who had -crit ici aed Marciuf$ oaMqs (tf) draw ypovbioMol^ 
^by some opiniona^ ihe.obsenrotioiis of the aoite J. A Aiders, (e) 
In this reply, it was doubted- that Htim was aequainlwl with 
real croup, as Fsm^ bad previously dovbled that AnigrmetM 
had observed the leal disease, fibers also atsored us ijttt ^ 
WttdatioB of lymph was iioialway»coiisiderable» and that, tbeirfr. 
^e, the nanse os angina merabraoaoea was to be lejected* P. JC 
Hortck {/) foondr in the epidemio vhieb be observedy the sym- 
ptoms at first catarrhalr then, so soaamodioi - that the form of 
JdiUof^s asthma appeared, and lastly, perfectly infUmmntory. 
Like Duvalf he excited the disease artiSdally in swipe, .by in* 
jetting dikated salphlifie acid, and also by caustic alkalL AW 
most similar views regaiding. the irr^^ar form of the di se a s e 
were advanced by E. L. IMemUin^lMd. (g) But the distinc- 
tion fippm MiUa$^$ asthma is drawn too sharp to be quite coi^ 
irect. The essay of JE. W. JValUch (/<) is veiy insignificant s oq 
she contrary, ,D. Neummnn^s treatise deserves ^preat praise, espe- 
ciallv on account of die parallel between the disease nod phtUais 
teacbealis. CO 

. In the beginning of 1819, the report of the French com* 
mittee, upon the iMst answer to their priz^uestioo, appeared* 
Among 79 answers which were seat in and examinedy the 
prise was. conferred upon two treatises by Jurine and J. A» 
AIbers.{k) Jurine considers the disease to conaist essentially 
in a catarrhal affection of the mucous membrane^ caused by aa 



a) Ton den EntzOndnngen im Halie. Berl. iSo^ 8. 
i) Hftfi Ardh 1809. R 3. Heft a. 

c) Das WissenswQidigtte Qbcr die hintifc BrSone. LQhedu tSta S. B. s. Huh- 
no?. xSift. 

^ J7«r**# AichiT, iSlo. B. I. Heft« %• 

«) Krittidie BcincrkuDgea 8<S«Q cuw Recemioii d» Hrn* Hda^ etc. Bremen t 
sSia 8. 

/) Annal. dir klintsch'technischcn Schole, Heft. s. 

g) ErkenntnUi nnd Heilnng det hSutigen Brttmt, del AGUir'achcn AithiM and 
4ie KckhhiMUnf. Leips. iSii. 8. 

b) Dringeodei Wort ttber die jctsige gefUinolle KindcrkraaJUMit, die Uutwt 
BrSnne. Wten. 1811. 8. 

f) Hfin** ArckiT, x8l|. Miirx. - 

k) Rapport adms^ i S. £. k Minipttt de llnterien m in oofnget cn?oy^ aa 
gancourft sur le cronp. Parn» i8i». 8. 



tSl lr« Recent Progress of Medicine* St 

mAnmrnsiarr tdmvJmf and combined with spasms. It attacks 
aometimei mH iarynx, frfiere it is more acute, and sometiroet 
fhe nmeoiis fisembraiie of the tradiea, lirbere it is more chronic* 
Tbare is a 6im|4jr s pa sm o d i c croup, which imermits, and is 
eiAer Jft'lbr^s attbma, or constitutes a transitioii to it. Hd 
liirther deriires tiie disease from catching cold, and ascribes its 
jncrearfng fremency to the dissemkiation of tlie phlegmatic 
eoastitotion; In Atkenft treatise, the inflsnHnatonr nature oC 
file diaeaee is assuraed,'but a double form is admitted, the pure- 
ly tnflaasmatorjr, and the tiervous. The spasm in croup is 
iudd to be maintained by the inflanMnatioB, and commonly 
aflone intermpu the breatiitng, «nd ttsuaily intermits. Hence 
JShen will not agree to the maiked diagnosis between MUlof^g 
asAma and tiie croap^ nor does be consider the mechanical 
ohstade of the exuded lymph or fake tnen^raDO as the corn- 
tdon cause of death. Of the treatises, of which honourable 
mention was made in the report of the committee, two have 
been published by 6. Vieusseus{m) and F. J. Doubie. (») The 
mws of die former almost agree with those of Aibers, and ara> 
the Tesnlt of great expedence $ the latter does not write from 
modi personid obsertation, but has produced a learned wor}c, 
in which, howeiwrf the periods of the disease are too nicely 
-distinguished. In the seventh -Volume of the Dictionnaire des 
Sdenoes Medieales, Bcyer-CaUard inserted e good treatise on 
fUs sohjeet, a-Glenttafl trandation of which Jlbers enriched 
with excellent notes. (<) Two other works, one of which was 
not received in competition for the prize^ and the other is npt 
even mentioned in &e report deserve little notice. The firsts 
by C £ Clrnon, {d) refers only to a recommendation of tracheo* 
toay, and of aamionia as the most certain remedy in cropp. Some 
other observations, {e) and a polemical pampnlet by tne same 
author, (/J deserve no notice. The seconds- by J. JSonnqfox de 
Malteif (g) represents the disease as a consequence of the coagu- 
lation of albumen. A better work was published by A, Ma^ 
vmeaMi,{k) Ako the observations of IXtfti^, (t) Lgeune^^k) 

«; Mfaioin wax ]e craup. Paiii, 18 IS. S. 

kj Tnit^ da croup. Paris, 1811. 8. 

xj Abh. Ubcr den croup. Aus dem Fraas. HannoY. 1814. 8. 

dj Frograimne d'un prix relatif k la trach^otomie dans le ttaitenMiit dtt croup.- 
Paris, 1812. 

eJ Jouni. da SediUot, Tom. XLV. Nor. 

fj R^utadon du m^oire de la clinique cfairurgicale de Jf. PeUUm tur lulnoi^ 
csioniie.. Paris. 

gj M^oire sur U eroup. Paris, 1818. 

Sy De U Phlcgmasie trach^e ai^utt. Pteia, ISOa S. 
4 J Journ. de Corvisart, 1811. F^vr. 

ij Joum. de Csmsrt, 18IS. Oct 



98 BmM Brcfftm^qf Ueiidm^ Juu 

L^ine, (a) Mtkrim, (i) Mercier^ U) Sabnade^ (Am^SUsv <^) 
dkienre to be read. The work of GirMtafy ii almak below cri- 
ticism.^ In GenDanj, the distipctioa dntwn bjr fVuhmanm 
between croop end MtUar^s eethnui wee rendered more doub^ 
fill, eepeciaHy by C F. Fischer {g) aod 4. HpmM, (h) ekhpugh 
J. A. Wi Eeeard{i) reeled a greet deel upon libe inflammatory 
nature of the disease. Escimmajfer (k) has also made eoqae 
good observations, in reference to AutewriHh's ideas. 

The true inflammation of the larynx was observed in tba 
body of Djt Pitcairn by Bailiie^iJ) and F4urre{m) published al 
the same time some observations rep^arding it 

Among the other pbiegmasias, J.DavUjn) and A. F. Testa fe) 
mhUshed some important obssorvations on the diseeees of the 
Mart* The latter described particidarly the chronic form and 
its oonsaquenees» and also the inflammation of the vena cava. 
Examples of thift inflammatiop were idescribed by Dao. Dun^ 
das (p) and J* BmselL (g) A. F. Manus (r) supposed be had 
diSQOveied pathogaompBic si^is of the disease in the feeUng^ 
as if the Mood escaped from the heart into the cavity of the 
breast, and in the coldness of the limbs* The same author (e) 
represents ioflammeiion of the spleen as not an n nc o mm on 
diseaset occurring under the form of vomiting of Uood» and 
eometimes reiuminc periodically. . 

Upon puerperal fever, which was almost universallv con^der- 
ad as an inflammation of the peritonsaum, J. 4» SchmtdimUl" 

Qj JoiiTD. a« SedUIot^ torn. XXXVII. F^vr, 

^J AnnaL clkL d« MontpeUier, 1810. Juim 

fj Journ. de SedOlot, Tom. XLIfl. Mari. 

dj Journ. de Sedillot, Tom XXXtl. 

fj Jounu de ^dtlloC, T«id. XXXIX. SepC 

/; Do Vangte ti»cli6ric Aeb, 1811.8. 

gj BmfkUnufM XmmL & 97. St 1. 

kj Dim. de gsdnnoiit MOhtA «t aagliMM ^polfpmm Mmmkm, ITielfaL leiSL 
M^nCs ArcJMy. tSlS. Iftw— 0e& 

ij BrnMitirn^uDd Hdhmg dtr hiwUla— Byjuat. V0nibkl81S.8. 

kJ Die ^idemie dw croupt sii Kifrtihriro. fitui^ iai& 8. 

ij Tnrnr -^ - °— ^— '"11 i-^-^Tftdhr inil OifeMt Innwl Vnl TIL 

1^ S7S. I. BiWicM and FhjK Journ. 1S09. Juee. 

m) Medic Chiriirg. T^nuct publ hf the M«dic and Cbimrr. See. of Loud. 
roLIII.p.84i • 

m) Inqoiiy into the lyii^toini of carditM. lend* 1808« 
oy DslVi iiv4attie del qioEa Vol Ih 

pj Med. Chir. AbbandL dcr Med. Ghinin. Gcscllacfa in London. oaeneCHvoa 
Oinnn. Beri. 1811.8. . 

qj Edtnb. Medic, end Sug. Jem. Ha ST. 1S14 Jsn. 
rj Epheraer. der Heilk. & S. Heft. I. 
0) Sfbtmet. dor BeUk. & 9. St I, 



1S17, |tfl6«fl|h)p-€»crJ|^dK^ SA 



far C^) "$11^ ^'^^"^ ^( ^^ important obiervatioiu. Tbe< 

^flcmM iiy j^om (&) vere purely inflammatory* Also L. Jm 
J^oa^s ofasenratioast {p) ^th upon this disease, and upon the 
mistaken inflamma^on of the uteru5» des^rye to be mention^ 
w&h nraise. Upon an epidemic puerperal fever which occurred 
ID Hodellierg, K C. Nagefe(d) and C. R Bamhqfftr {e) pub«. 
fiihed th^ir observationa, Tne form of the disease whicn J# 
JbrnatrimE observed^ was purely inflammatory. 

Upon the water canker of the lqp» which occurs frequently if| 
Old Qrandenburgh, and its cure bj muriatic acid, we got somei 
good observations by Siebert^ (g) and others, also good, vpm 
the cancer of the lip in general^ by JC C Slart. (A) 

We come next to the eruptive diseases. Their general theory 
was treated oi^ usefully and acut^Ijr, by C ^ Hrfdand^ {%) and 
jdsp hgA. F. Marcus^ (£) but partiallj in rqgard to their inflsmifl 
n^tory fprm. Z). Gr. Kieser (/) considered thep only as ei$^ 
of development an idea previously advanced iXK regard ^ 1^ 
9BaII-pQ3^ by L. J. C.'Mende.\m) Beneath all criticisu) is thci 
work of Fr. v. Ihbscha. (n) For the knowledge and dUagoosia 
of t^ese diseases, advantage may be derived from the elaboi^t^ 
works of Mob. Willan (o) and Aliffcrt^ {p^ and the lystematie 
descrjptions'of Suasso^ {q) J. Wilson^ (r) and Th. j^afeman* {$} 

Among the acute eruptive diseases, scarlatina most engSMii 
the attention of tb^ tjerman physicians, both on account oTi^ 

aj Kom\ Archly. 18dS. B. 5. Heft. 1. BMndbtiOk §tt mfedSc GdtoriAvUk 

hj AfddK. laCBl. B. 9L Hflft. U 

t} AUsaA nod Vcnudhe gflaiitrimfliphro loMte la. a 7k a: Uto, 

1806. & £r«tiir»lH nwdiduw obHetriMA libri VIL Vi«||B« laia. S. f^ 

dj 9ddi^ei^ng d«i Kindbettfeben. ^eidelh. ISIS. 8. . . 

ej Beminiuogen iiber das epidemisch^ Kindbettfitiber. FVkf. a. Ifain, 181 S. S. 

fj Pacts and Obscrvadons felaiiTtf fd ffie TMr oommovlf ofiStd PMemfnl. 
Mid fSMl 8. 

fJ Bt^khnd^i JoanL B,S5. St 6. 

kj De caacro labii inferioris. Jen. 1812. 4. 

tf/ Joura. B. 8f . 8t ^ 

fty Entwurf einer speciellan Therapic, B. 7. ^. t. 

ly Uber das Wesen and die Bedeutung der Ezsnthem*. Stom^ 1812. 4L 

mj Horn's ArchiT, 1807. B. 1. Heft. 1. 

nj De cute et moibis cutaneis eonim^e cunidone; JeiL 1809; 8. 

a) DescriptioD and treatises of Cutaneous Ditaeses, orA 8. et ^ 1808. 4 

^3 0i«9Plpcion dM laaliidles de k ^ees, dbMrtte iyhdpitil 9. Looms. lAf. I*^ 
l^aria, 1806—1811. fol. 

f) Itetmstt cMMbeAitiMtam detttfpL tpedttefti VA L IL Amsi, 1809. 
jsia 

r) Treat, od Cutaoeoua Dbeases. Lend. 1 81 9. 8. 

0) Fi^fim^ Sipif9fm f f GtilfBMilM Obetses. inmd. 1919. S. 



>4 Recent Progress of MeHchie. * Jan. 

more firequent occorrence and greater daqger^ as on aoeomit of 
its (brm di£Pering from earKer epidemics. J*. SieigHlz {a) en« 
deavoured to show that its mater mortality in modem tiknes 
depended npon the abuse of the stimaladnor method of core, 
and recommended the cooling treatment In Suabia, on the 
contrary^ the disease was treated^ on acconnt of its obyioosly 
typhous character, with stimulating remedies, and it is said 
Buccessfallv. (6) Insigtiificant are the oboervations of J. O. 
lh-emser{c) and J. K. Gutberiet. (d) More important is die dis- 
tinction established between scarlatina and put^ura (Purpurfrie- 
ael) fay 5. Hahnemann* {e) This difference is, however, ascribed 
by O. JF; C. Wendelstadt (f) to a d^^eration of true scarlatina, 
and by D. G. Kie$er{jg) to a variation of it The last paper is 
particularly imporunt for dhe diagnosis of searbtina irom pe» 
techial fever; and there is an equallv ioterestiog piqper by 
B. S. Heims{h) upon the distinction of scarlatina from roseola 
and rubeola^ in which our attention is particnlarly directed to 
the peculiar smell of the perspiration. A. D&kne (i) endeavour- 
ad io propagate enthnely false views of the nature of scarlatina, 
as he looked upon it as a process of development for the pro^ 
duction of a new skin, and that it was merely a kind of erysi- 
pelatous inflammation, not even succeeded by true desquama- 
tion, bat that the ok) skin only made mw for the new. Ideas 
ef riie same kind were advanced by 0. 6. Beich^ (k) but with 
ffre^er pret^e^isionsa and the perverted application of physic* 
At the same time he ^ves unqoalified praise to the cooling treat* 
ment, as alone admissible in this disease. The two last men- 
tioMd papers were aevaraily criticised by jL F. Heeker* II) The 
diversity of scariatina, according to the difference of the exist«> 
iog epidemic, was explained by E. Kleiten. (m) Considered 

' » ■ I ■ ■ I I n III I i -I m i I ■ I'll " 

«; Vemich mntr FHifung ond Viihiwupg dkr Jctit gtwHhnlktwn Bchaadii 
loBgsut det Scbarlackfieben. HannoT. ISOT. S. 

bj J, J. FriM d«Kriptio xaoiW cpid^miei MumcfaiiigM gnMa«lL Tubing. 1S07. 4« 

e) Ein Ptor Woite iflwar die Srhariif hkisufchcit und dto Miasm. Visn, IS06« 8., 

4) Bufshfurt Journ. B. 83^ Qu 1. 

€j H^ela^9 Jlmufi. aS4. St 1^ 

/; Bufeland^i Joura. B. 87. St S. 

gj Hufdand^t Journ. B. 54. St i. 

hj fft^elamrs Jounv 9.54. St X 

ij lEitdgB Bejtriig^ tur A^Qlpgi^ uad ^u* dcft ScfaarkclHoder HSatungiieb«n« 
Xeips. 1810.8. 

V Neue AolWIiMiS iflwg jie ystm i»nd Hjilwiy dsi Srhwiafb<sb<M> Hidlet 
^sias. 

IJ AnnaL B. 8. Heft 4. 

^J Pe v^ nMHgnit#ni»i«>e fa fdlyiti n i ristJn aMt. I4SS' l8\Ui*w< 



181 7. Secent Progress of Medicine. 2S 

in this point of view, the contradictions of Stiegliix^ by J. P» 
Vt^ler^ (a) may be easily set aside. The method of the former 
gained a defender in 71 W. G. Benedict, {b) The remarks of 
Bleieier are ibsigniJBcant $ {e) those of Neumann (d) are better^ 
espedally in regard to the diagnosis. The observations of «7. J. 
Mers{e) serve to adjust the cooling treatment. Lastly, we 
have to remarki that the scarlatina which F, Pascalis observed 
at Philadelphia /^ was quite different from that of Germany, 
and is scarcely to be ttMixi by the same name, as, besides other 
drcomstatices, the inflammation of the fauces terminated in 
suppuration. 

Ureat importance is to be attached to the progress piade in 
the knowledge of the Rose of new-bom infants, and the indura- 
tion of their cellttlar membrane. *«/. C Renard related a case 
zaccestMfy treated l^ musk and camphor ; {g) and Nees von 
Bsenbeek another, in which evacnimts were of use. (h) Lodenuum 
distingaished two kinds of induration, (i) one which had its 
seat in the oelhlar membrane, the other in the muscles. - The 
Rose of infants was frequently observed by Honij and described 
under the name of induration of the cellular membrane. (A-) 
This mistake is well exposed by Lodemann^ {I) who showed that 
cold of the whole body, and absetice of fever and gangrene, 
characterize the true induration of the ceOular membrand. C 
B. Fischer (m) pointed out the resemblance of the hitter disease 
to the aphthae and tetanus of new-born infants i and Sybel (n) 
narrated some remarkable cases, while W. v. FoUen(o) descnb« 
ed the true rose of infants. 

In regard to the other ezanthematoos diseases, die false 
pox were more aocnrately detemrined by B. L. Heim^ {p) ud 



a J Skfeian^s Joan. B. 88. St 5. 

6; G«Mliiditete8c4isrlacliMm, NinffSliiadaic^ Mp* 

«^ ISia '• 

ej HvnCt Afdiiv, ISia Sept 
d) Umn*t ArtfaiT, 1811. ac|»t 
t) Bom't Atdur, 1S18. Bfay. 
/; J?arfa*« Joiini.dkrausLLiter.B. laSta 
gj Bi^idamirM Jomni. B. 93. St S. ^ 

kj Htfit. JoMnL B. 35. St 8. 
i) BuJUamd'i Joarn. B. 81. St ^ 
kJ Afdihr, 18 la May. 
IJ Bk/elmutt Joom. B. 88. St 1. 
mj mfdmnd'i Joan. B. 88. St 1. 
nj Hufil, Jouni. B. 88. St 5. 
0j BonCt ArdiiT, 1811. Norembw 
r) Bbm'j Aiddr, B. % Hsft. % 1811. Seftk 



the oec nf reDCe of natural small-pox %fter inocolatioDt atil mwr 

twined by Siieglitz, (a) was ascribed by Sprengel^ except in a few 
VDOiMsiioDable cases, to the fake-pox. (6> 

We have still to notica the history of aa epidemic meaalea 
ty J&wjr. (c) Autenrieth also made some exoeBent remarks up- 
on the difierent forms of scabies in cbildraa an^ adults, and tt|^ 
on the eiFects of its retropulsion. {d) 

Upon the haemorrhagies appeared two essays oe the princi- 
ples of the theory of excitement, by Jl B. WolSkq]^{e) and G. 
A. SfangefJb^rg i (/) also the continoatioii of a worK of little ya* 
Ihe by iL J. Meyer, {g) The treatise of J5L Horn upon haemop* 
^sis (A) deserres to be read. J. Lon^dat (i) treated the subject 
ratirely*iBCcordiDg to antiquated principlea. Hie causes of W 
morrhagies were considers by £ HohnhoH^ (i) to be morbid 
irritability and debility. 

Among the publications on dysentery, that of W* Hari^{l) U 
particularly to be disUnguisbed, in which the disease b compar* 
cd with rheumatism, and some good remarks, on its inflamma* 
iory nature are add^lt In Germany we had an exceUeat work 
ty J. G, Rademacker^ {m) and an useful one by £. Hum. (n) (?• 
t. ffedekind (o) viewed the disease very partially as eiysipejatoiio 
mflammation of the reqtum, and even adduo^ ascarides as ita 
^use. What Marcus (p) has advanced about the ''^fl^nf^mation 
^f the mucous membrane, and even of the stuff in the alimencarj 
oaitalf is ins^nificant } and also what £. Sp€yer[q) hM sidc^ ac- 
cording to his' piincipies, of the venousneiis of the organa a£> 
fected oy dysentery. II. A, Ooden^ in his description of an, 

m/ Jr0Hi*» AiidbH» 1809^ B. a HML a. 

Sy lostit pathok ipec. & 540, f. 

c/ Trute sur U nnigeele. Parian 1807. 8. • 
, djyvam^auihdmw^BmSk.n. 1. Heft, a^ 

ej UntertudiiuigeB iiber die ErachwBung, Bildung and lUiluDg dcm TThaiOi ■ 
iHMw. Th. 1, 2. Xeipt. 1809. 8. 

fj Ueber dk BIuiIIum in medic. Himacht Bnunachweig, 1805. 8. 

gj Systemat. Handboch lur Eikemitiust and Heiluag der Itlntflflma S^ 2. 
Wien, 1805. 8. 

kj Axchif, 1805. B. S. Heft. & 

ij Treitc des hemoiTliegiei. Fteii» 1806. 8. 

kJ Ueber eJne beioadew Art dee flbennanigwi jf nneM^imfli Srisa^UU.S. 

9J Observetmie on the Simple DTsentny and ils Combioetwns. Load* 190B^S. 

m) Libellus do dyaenlerin. Colon. 1808. & 

m) Veimch tiber die Natnr and Heflvag der B«b«; Sr£ 1S08. a. 

•) Ueber die Ruhr, henuagegeben von Hannen^g. 1*1^ e. Main,. 18U. SL 

y) Epbencriden der Heilk. B. 5. Heft. 4. 

rt Vetiacb Ubier dig Natur wnd B«!baydhinyrt <yr j^^ ^i|r?i|^ }8]taa. 



181'7. Se^^ Pt<igrcs$ of iSedieim S7 

epidemic dywnteiy In MeclleQburgh,(a] and Fr. S^hmacJier^ (b) 
k^ve EaxniMicd ^xampl^ of ao high sounding empty style. 

The iirioe in diabetes was anahzi^d by Ihiyuytrm and TThti^ 
nardy {c) and by Bosloci. {d) Their inquiries differed, in aa 
nmab aa the. French chemists examined the urine in the saccha- 
rlaei 9aA the Englishman in the insipid species. The latter found 
tb^ urea inuch reduced in quantity, but also the phosphates of 
soda and ammonia. By this, 8« well as by Rob. IVatfi striking 
ireatment of diabetes, with copious bfood- letting, {e) EoUoi$\Ae% 
of defective. animali^atioB as the cause of the disease was much 
fimited. 

To the most important, and hitherto most mistaken, dis- 
eases, we m^y reckon the oi^^anic disei^ses of the heart, and the 
many forms which they may assume. The last period of our 
history may boast of having produced classical works on thU 
subjecCt and useful contributions to the knowledge of these 
diseafies. Among the former we may reckon those by Fr* 
ZulianiyCf) J. N. Corvisart^{gj A.Burns,{h) Alj.Testa,{i) and 
£. Xr. Kryfig»{A) Useful contributions, especially upon the oon- 
genital mdeonformationa of the heart, and the blue disease con- 
nected with it, were published by <X F, Meckel^ (Z) who coi> 
siders these malconformations as arising from the formation of 
the heart being interrupted in its progressive development, and 
remaining stationary fn fts early stages ; by C. F. Na^, {m) 
B^ALSeiUr, («) Standert^ (o) Caillot, and Duret^ {p) MarcH^ ^) 

«) HmnU AidiH, 1818. MtfS, 

h) Bcftb inr KotoeoKM imd Nowilogie der Rulv. Coblnw* 181S. a. 

c) Journ. de Carvisart, 1806. Adut. Annai ds diimi«» Tom. LIX. a. 173. 
GMaCi Joura. B. 2. & 2ia SamnJ. ftir praktiscbe Aerzft. B. 84. 8. 189. 

<0 Bfemolnof die Med. Soc of Lond. Tom. VI. p. 8^. Gektf't Jbutn. BL & 
& 195. ' 

f ) Cases of Diabetes Consumption, etc. Glasg. 1808. 8. 
fj Ve qulbusdam cordis affiKtionitnit. Brif. 1805. 4. 

g) Easai snr lea maladi?s oi^ganiques du coeur at lea loioM 6m ffm wt amm^* 
Puis, 1806. 8. 

k) Obsenwftions on wme of the mott frequcm and important Dise^aea ^tjhm 
Heart Edinb. 1809.8. libera, von Nasse. Lemgo, 1819. 

0. JMb m^tf^ del cuom. Vi^ I.->-iIl. Bologn. ISII. Bk Ueben. vpa 
fipnngri. Halle, 181 J. 8. 

k) me KnmUiiita& des Hevsans, systemsliscfa besibeit«t Th. U B«il. 18U. $. 

/) l^ndb. 4cr jptbol Amt & 48a C 

m) ReiTi Arch. B. la & 213. f. 

n) De moitio eaeruleo obi. Wkteb. 1805. 4. JftmV Arehi im$. 9$ A MfA^^ 

#) Fhiloi. TKH^PKtb ia05< NaHe*0hm^^^mlULBi%Vbi^U 

p) Bulletin de la Soc Med. de Paris. 180^ p. n.0^ 

f) Edinb. Hsd. and Surg. Jo|in& W* h !• A% 



n Itecent Progress of MeHeine. 3 sou 

Thomas, (a) Obet, {h) POois, <r) 5. J. B. Sehder, (d) and C P. 
ffiULse. (e) Cases of enormous hearts were poblished by JB. 
Hom,{f) Memmif^ery{g) C.tr.Hu/ektnd,(A) HeMeeken^{t) and 
BerUcs^ (k) Good inquiries into the diffin'ent causes and pheno- 
mena of palpkation w«re made by G. A. Spangenhirg. (Q Casea 
of ruptured heart were related by Efdmantit (m) C. K A)My (») 
J. U L. Schqffer^ {p) F. Xj. Brera, (p) Jngidssola^ {q) and Re^ 
nauldifu (r) A petrifaction of the neart was observed by We» 
her. {s) J. GUrtner made some sound inquiries into polypi of 
the heart \ {t) and the observation of Abemethf {u) upon die 
contraction of the passage from the left anride into the left ven- 
tricle is remarlcable. 

The disease called angina pectoris, which is commonly oon* 
nected with organic affection of the heart, was attributed by 
Jahn to palsy of the heart, {x) and by V. L. BrerOf (y) to pre* 
tematural size of the abdominal viscera, by which the diaphragm 
k pressed upwards. J. G. Elfiss (z) published a case remarkable 
for its anomalous symptoms. 

That apoplexy often arises from diseases of the heart, waa 

S roved by Testa^s observations, and the universally lamented 
eath of the Prince of Holstein- Augustenburgh, elected Crown 
Pribce of Sweden, (aa) The doctrine of apoplexy, in general^ 

m) M^m. of the Lond. Med Soc VoL VI. p. 57. 

a) Bullet, dm Scicns. Mid. par la Soc d'EmuUtion, 1608. "Vbj. 

€) Barleys Jahrb. B. S. & 12S. 

4) Diss, de morbo caenileo. Insbr. 18 la 8. 

•) Diss, dc roorbo caenileo. Lips. 1815. 4. ' 

fj Anhhr, 1608. B. 4. Heft. 8. 

g) Mufa, Joun. B..S4. St. 4. 

k) Journ. B. 92. St 4. 

t') Hont'M Asohiv, I8ia Jaa. 

k) Journ. de Sediltot, Tom. XXXV. Nor. 

i) Ji<Hm*s Arcfa. 1811. JjiJ. 

ai) Home't Arcbiv, 1806. Heft 1. 

n) Diss, de ruptura cordis. Lips. 1806. 

•) Hufelani't Journ. B. 30. St. 8. 

|>) Di una straordinaria jnottura di cuore. Verona^ 1808. 

q) Glom. della soc. med. di Farma, VoL XL n. 11. Horde's Journ. der asst 
liL B. 10. St 2. 

f^ Journ. de Corrtsart, 1806. Jan. Sanunl. flirpndLt Aerste, B. S4. S. 299. 

9) Salsb. med. Zeit 1811. B. S^ & 185. 

i) Diss, de pt^ypo cordis, in specie infantum. Wittcb. 1810. 8. 

SI Medic chirurg. Beobocbt der med. cblruig. Gesellsdi. in London, Qberset|S 
▼on Osann, n. 4.. BerL 1811. 8. 
'«) JfufOantCi Joufft. B. fiS. at 3. ' 

jf) DeUa«t0Bocaiidia. Verona, ISia HarhU Jahib. B. 2. Heft, h 

9) Sufeland*$ Journ. B. 97. St 5, 6. 

m) JBotit in JGrom'i Archir, 1S13. B. & & S7. ft 



1817. StMUPtcgmi qf Uedidm. 



mUotd npcrn tbe pondples of tbeoiy of exciieiMiity bf 
J. L. Oiiensee t {a) by JLRMurdach, (b) upon the partial view of 
coQapae end contraction of the brain i and by «/• A. Gqgf («) 
merely to refute tbe geQeraIlj|r 8an|niipeoas natnre of apopleiy* 
Tbe bpothera Mtmiain ^ divided the aaDfuineoiiB apopiezy ii^ 
to arterial and venous, and endeavoured to distiofpuli uepi 
from the other kinds. Gamtkr de Ctaubry {e) puUisbed soma 
intevaating observations on the accumulation of blood in the ve^ 
aek €»f tbe qiinal marrow $ and D&rr f/J apd pthera upon internal 
▼aricose veins. - P. Bonom^s {g) observations on tbe paby of the 
lower extremities, combined with distortions of the spine^ de* 
acrve to be read. 

Upon the nervona diseaaea, in generalf P. fV. v. Hooen{Ki 
published a practical mauuaL Hydrophobia^ as a nervous disease 
waa supposed by Jonas (i)* to proceed often from excited imagi- 
naticm. JB« HariQg(/c) treated of tW. disease scientifically, and 
considered hydrogen produced in 4<3gP by the retention of the 
aesnen, as the exciting cause of the nervous affections. 71 W* 
6. Benedict if) gave some good hints on the nature of the dis- 
cnea. Also iMtt^t remaric^ (in) that hydrophobia is rare 
among the f^grptiaa dogs, because they are of a mild race, anA 
procreate onj^ once a^year, contributed somewhat to expfaua 
the natnre of the disease. In England, on the contrary, the dis- 
ease waa remarkably frequent in summer 1808 ; and some good 
cases were published by PawM. (n) M.P.B. (jorof^s (o) obs«r« 
vationa ana inquiries siso desierve to be read. 

Upon St Vitus's dance, the work of J* BenU (p) deserres^to 

a) Von te firiunvtaki uad HcOuiig dM 8eh)igauiiei lad dor 
BidLlSQS^a. 



k) Dk VAn torn SdUflgiwii wincr Nstiir, 
BAit. Ldp8.180S.8. 

c) Vott SDT le caracOre et U tnitciaciit df t'lfsplcii* P«riS| lS07*a. 

«)lVml6dsrapivletie. Lyim.l811,S» 

c) Joum. geadr. dc Ia aoe. da mfldec. a Paris. Hofii*! Jonm. d. sad. lik Bl % 
8LS. 

/; Af^^MMff Jouro. B. as. St & 

g) 8Ukotd:$ Chiroo. & 8. St 1. 

k) Vmidi Uber die NervankranUisitsn. Kundk iSlS. 8, 

B0nC$ AitliiT, 1805. B. 3. Heft. 1. 

iQ Din.de hyiterieenotagioM&lijfdrai^^ £iL180S.a» , 

IdeniiiirBegritiidiingemef iitioarfkn Heilwiil hw fa d»ai ^ Ui^ 

sig, 1808. 8. 

«) DcDkwiii«giB. 8. asa 

«) Graver hydropbobie. Londiio* 180S»a 

o) JkiDraLdeCorfi«»t,Toa[tXIU.e.aa. tanLfllrfiak^ AsnH^ KM 

a 873. t 

j»i MoasfniiliiadioKSsai^tL Phf^lSia^ 



oD lUciflt PfigttSS ^' MSmCtiKm Jsll* 



t>^ ficAiitH and dlstingulAed. WmltirSjA dbdiftv^ it irt ndtAtft. 
A bialory of a case n kntportant (6) J St^tteidir puWbbed lit 
H^rbom, 1^6^ Svo, a good treatise on iht tetmfu^ of diiMreit. 
*Y)ie cbinctnigh was considered according to the mdderfr ideis 
^ V. ft. i. I^aldamus, {c) and at the satn^ time by J^. JbM:^^) 
JR. Fr^//5 (f) se^ms to have confbttnded it with the crotip. - if. m. 
D. Chsius is the latest antboi* dn the Subject, f/} 

The dolor facid FothergillK t^as observed by Jbnai(g) ind X 
G. Sreitiiig. {h) C. T. M I/tngenberk (i) ingoired into the eeat 
of the disease io the frontal nerve. F. X </.-v. LeuikHetXt) ind 
C jL T.' Haftffttinn \t) pubtished good compiktions on ttie sub- 
ject. Masius (m) looked for the oriffin of tiie fiseose fai this f«w 
vered potsoft; ' B. Herbet (n) piibli£cd a e«se.«aodte^ifly trac- 
ed ; and SteinhucKsrrixitDi oMsrvadon {6) lA intereatihg. 

On bypoehoindrfakfs we h«ve a cfassioBl woirk by Z^ Aarr i {^ 
and good observations on the theory of gout by Ktinm^ (^ wMh 
whicn the explanation of chalk' stones by J. Mare ft) agreee. 
Upon chronic rhematfsm, an imli^nHicaiit work by IMmnH{t^ 
appeared. iTbe French phvrfdftns observed at Madrid a%iM 
4>r cholic, iitile known, wMch was aacvibed ttreheaiiddett changet 
of weather, {t) 

Th^ desire to Investf^e the dBseases-of the mind Mdeittffiorii^ 
was general among physiciana. fVom fHhePs Moiograpliie MA- 

•) J^om*« Avddv, lafs. Sti. 

») UcbcrdMFallsacfat. 2«r^ii Aui. 9tmiL'l9m.'^ 
' ^ Der Sliekfaiiateii. Rdlv, 1809. $. ... 

d) Ueber den KcichhiMH^ MmUkl^ l$QB,S. 

#) Viant m te omn md awMMnf of dtfaeii^. Miatv 9i«.r$. - 
f) Etwas <iber die Quelle, den Sits, die £igentliumlichkeiteD h.. 
mm Wsli nilf H^ealiiaifti dar Sitidw. Hsdsawy iai9b «p 
«) iTom's AicfatT, 1805. B. S. Heft. S. 
A) AfWoMTt jMra. & tSL tii 4. 
Tract. aaatomico-diiruTgicut dc Bertfa cearfM in iaCif* AkW 

A) Dim. de dolore fiwiei FoChergilliL Eri. 1810. 8. 

\) fti I iTJili m ntnrmriniifii niiMdam d< pintDfilj^ti Tafc«MIil.ll 

«} Bujtl, Journ. B. 25. St 1. 

«) Htt/. Journ. B.J6.^i6. 

e) Abh. der physic, medio. Sec in Erlaagsa, & & H. 18. 

p) UnteisucbungaL nar deb Pegiii| 4h 2ha» ai4 die IfiilfcuitiUMaia iTii 

Jly^irhaiytois 4iBi^Wfil.«. ^ :. 

9) i7om*< Arch. 1808. B. 4. SC.1. 

r) Med. chir. Abh. einer med. cbir. OeseDscfa. in Loi^ia, ahtfie Tat QwaS, ft. la 

j) Traite du rbeumatasme chroni^bsb • t«yieiii' aSCft. 8^ 

^) j:^<ei»^D M i*ai i i il i ; 4ib<<^ :giiffawi»Jaasi^»aaaah»lh^ 
Sept 1809. 



1817. Secera Pft^as if MeiktHe. SI 

lo0O|ihiqpe« Paris, 18^7, {n wbkh tl^e mentftl xleraiigeiiieiits ai^ 
ttetw off according to their symptoms, without any particular 
pfailiMophieal arrangement, Utile advantage accrued, althoagk 
mtSs/tA by his CDnntrymen, exactly In regard to diis brancL 
Yet Pbid had the twofold m^rit of naTing pointed out the abdo- 
men as lii6 cause of many derang^mentB, and of having intrd- 
dnoed a better tr^tment of these diseases. P. JL Frod (4) 
fiflo#efl fahn in the padiolog^y ^spedaBy in deriving derange- 
ment from the mcvibio state of tihe nervous gan^tiii 01 the abSa- 
men. In Germany, journals were allotted &s the improve* 
ment af onr teowkdge of diese diseates, with little advanliigfe, 
by X Winidmemn^ (5) and J. C. Itdl^ and Kaysder. {c) Aa- 
other periodical work by J. C. Reit^ and J. C. Hojffbauer^ (^ 
was more socceatfuL J. C DOtdder [e) explained weQ an acute 
theory of mania, in which he considers It to be a ihorbid afiec- 
tion df like sympathetic ahd olftctoty nerves, with prepondesat- 
ii^ Tenosity. X C. Hoffb(mtr published a new edition ef 
Gidktwi I (f) and to this plade belong a WoA <^ his own, (g) 
and another by O. IR. Mteti. (A) Winxker {{) endeavoured to 

Cf€ that mcnCal derangement coifld be cured by medicines 
A. HeMorf^s {k) Is Unquestionably the most successful weric 
of icaldha* 

Among the cadh^xies, the favourite 8nb}ects wi0i medieal an* 
dioia were phthisis pulmonalis and syphilis. G. P. SaUhom (2) 
pointed out l3ie cheesy, or granulated and pultacebus white ex- 
t>eB l o il imi ^Aiiieh oeeart tn gottty (pifthlsicad ii pettjplh. Sat* 
made {m) renewed the old controversy about the oon^gious na<- 
tore of pnlmoftary (Athisis ; aifd afterwards^) fropoaed aaflio 



nn M i n t m m 



a) Caup^oal ftpiciLofpqae nir ]m foUe. Paris, laoS* S. feteiidote «t Itir 
■teoa^'ML Tarn, idSOT.SL 
h) ArcfaiT fur die Gemiiths-und Nervenknnkbeitcn. St 1. Berfin, 1805. S. ' 
«) Ua^i^f^S^ftfMi. fl«aibiind«, 8. 1. Ilert. IBOiT.S. 

Balk, 1808. ISIO. 

e) Dim, it natun maniaa. Tubing. 1806. 4. 

f) UttlenMiRiiig iiber die Nadir iitid Sta Vrspnog dar -€feiitM-2atufiCaog; 
taipa.l8ia8. ^ 

g) ftycMa^t Ib ftmi HavptailwtnduiigeB cuf db Ite^itsplle^, tmdk d^ 
aDfOBeinaB Gesidrtspuncten dar OeflctagdrnDg. HaHe, ISM. 8. 

k) VmmUMamt fSMtrmAang 4m e^nuftttosttnaisa. Ttfb. ISIO. 8. 

i) Bm^t AniL tsro» May. 

ifc) VaKsodh einer Fatliologie u. Theraj^e dar Ceistes und GemOth s lt r a wH i ai tea, 
lladiaiarg, IStl. 8. 

I) Id nnp<M«" pfathiwMM pulnionaUs aigf urn oommantatui^ Hanoov* 1805. 8. 

af) Dml ^ lead & £ca]|lir, ^le 1* jihtluaia pnfajiiMWOTa a'sH fS^ ^ 
BBis» 1805. 8. 

s) Jomn. ds SotfUot, Ton. XLVI. Alan. 



a JUeftii Prcgress qf it^ichu. Jao. 

very inadequate means fi>r preventing the diaease. B. C« 
Vogel (a) related some successfully treated cases. An elabo- 
rate treatise on tbe mucous species of phthisis was published by 
E. fVichelkatisen.{b) J. J. Busch{c) directed tbe attention of 
physicians once more to neglected c^ds as a cause of pbthisia ; 
and recommended sulphuret of lime as a remedy acainst sup-* 
puration of the lungs. The same author treated of the com- 
plication of the disease with hypochondriasia. {d) An excellent 
'work, upon the different forms of the diseaset was published by 
Th* Beid. (e) . Acute reflections concerning the disturbed pro- 
portions ot animal electricity in this disease^ as weD as upon the 
difference between the florid, chlorotic, and nervous consump- 
tion, ate to be found in L. Stands Essays. (/) C. W. Ht^c- 
land (g) and Baumes {h) also gave very good rules for the treat- 
ment of the different forms of the disease. A new and ingeni- 
ous theory of consumption, that it consists in the interruption 
of the disozydation process of the venous blood, and hence that 
it is influenced by the diseases of the liver, was promulgated by 
J, D. HerholdL (i) We are acquainted with the titles only of 
two recent publications in England, (k) 

Among tne general works on tbe venereal disease, one by F* 
H. Martens (l) received little, but another by F. A. Walch (m) 
greater praise. In the bitter, the theory is also thus elucidated, 
uat it is proved that the lymphatics and capillary vessels partly 

a) Stmmluiig tehwieriger SMdie. und cfainirg. KOIe. Ente licftnitic. Atenf. 
1805.8. 

h) Ueber die EHconntniss, Verfailtung und HeQung der achleimiffeii Lunsen- 
Mcht 111. 1. Mannhrim, 1806. 8. 

c) Ueber die Nstur und HcQsrt der LaBseuiidit und der gefahrfoUen Katarr- 
Uieber. SCmli. ISOe. 8. 

d) Ueber die edyiuunieartige odcr legeiiaiiiite nenroie LttBgemueht 8cni4i. 
1807.8. 

e) IVeat. on the origiii, pragras end treetment ofeoiuiiiivlioD. Loud 1806. & 

f) HtfehndTi Joum. B. 8$. 8l 5. Ueber die Natur und HeUung der Lun* 
genadnnndsuchL fituttg. 1809. 8. 

g) Joum. B. sa St 1, a. 

h) YoD der Imngeosucht, iibeiietst von C P. Richer. Th, 1, 2» HUdbuicb. 
1809, 8. ^* 

HarU't Jahib. B. 8. a 161. t Ueber die T^ii^enkninkheiteD, tiben. von 
A. 8cbonbeig. Numbb 1814. 8. 

k) A» Dunean*$ obBervetaont on the '^««*^"g^"«Hng lyaiptoins of three ditf^rent 
ipeciee of pulmonaiy consumption. Edinb. 181S. 8. CA. Pear's obsenr. pn the na- 
ture and treatment of connimption. London, 18 14. 8. 

Handb. lur Kenntniw und Kur der Tenetischen Krankheit Tli. 1, S. Lps. 
1805. 8. 

m) AuifUhrildie Darstellung dea Unmnings, der Erkcnnt^ss. Heilung und 
Vorbattong der feneriNben Kzsakbeili Jena, 181 U 8. 



1817. Mecerti Progress of Medicine. 8$ 

pass rrom their indiiFerent state into the sphere of the nerves* 
E. Horn {a) also gave some valuable contributions to the theob 
ry of thb disease. ' J. A. Sckmidfs ideas (6) are likewise worth 
xeadjn^, although delivered in a very inflated style. A work 
by J. B. Arofisohn {c) is perfectly insignificant t another by J* 
Louvrier (d) is more useful. P. O. Masofi^s (p) treatise also de- 
serves notice. The old controversy about the syphilitic nature 
of gonorrhoea, which has iieen long decided, was renewed, witb-^ 
out any good result, by C Ehrmann^ surnamed Sieltwag. (f) 
A very sttperfluous compilation was published by 6. W. TopeU 
mantu (g) 

On the Plica Polonica, J. F. A. Scklegel (A) published very good 
obaervatiom* The French army physicians, who observed this 
disease in their earlier campaigns In Poland, did not look VLpon 
it as a disease of a pcenliar nation, but as a degenerated form of 
syphilis, (i) A work by T, B. Ckronegs von Ruhmfild {k) de^ 
serves no particular notice. ' 

Upon the scrofulous aflfections, we had a good work from 
Baumes ; {I) and upon the same disease, as well as upon 
rickets, another disease of the same natare, we had good obser^ 
vations by M. A, Stdmade. {m) With this subject the excellent 
treatise of Ahrd on leprosy (w) is connected. Cases of scabby 
leprosy were detailed by Z. CHtner^ (o) Reusch^ [p) A. Metttr^ 

■ > ■! ■ ' • ■ ■' ■ 

a) Hanilb. der medic Chlrurgie. Tb. 2. Berk iS06. 8. 

h) Vorlesungen tiber die ^hiUtiiche Knnkbeit and ibre OesUdten. Wieii| 
1812.6. 
e) VoUstahdige Abh. aller vtnerisdien Knuikbeiten. Berl. 1806. 8. 

d) NoAigrapLisch - therapeutiscfae Dalrstellung sfrpbilitiscbcr KrankbtttfcCbnMa. 
Wi«o, 1809.8. 

e) Uber die syphilitischen Krankheiten der SchwaBgern, der neugcbomen Kinder 
uod AmAPtt. Uebers. Hildesb. 1807. 8» 

f) Uohfisucbung der Frege, ob def Tripper eitie Krankbeit eigener Ait, od«r 
do veneriscfaer Zufali sey ? Frkf. a. Main, 1S06. 8. 

g) Nett'ere ^rfahningen ubcr zweckmassige Bobandlung Venerisdier Scblelmaua* 
film nod der ibnen nachfolgendeti Uebeh Leipx. 1809. 8. 

k) Ceber die Unacben des Wcichsehopfea der Mea&cheh und Thiere. Jetia, 
1S06.8. 

f) Bvyer in ffvfetaiutt Joum. If). 28. St 4. Larrry^t Denkw. S^ 431. J2eii«it2fe* 
Ckanuem im Juum. de ScdiUot, Tom. XXXV. Juill. 

k) Neoeste Amftfat des Weichsehopfs. Freyb. 1815. 8« 

i) Traite sur le vice Jtcropbuleiix. Paris, 1^0^. 8. 

m) Pr^s d*obscrvations pratiijucs sur les maladies de la lymphs. Paris, 1810f 8. 

m) Histoire d*une maladie partictfliere au sjttt^me lymphatique. Paris, 1807. 8. 

e) DffeB. obaervata^uaedam in histtmam lcpime» aulju&cto cam raccntiori leprM 
Gnbecorum. Tubiug. 1805. 

f) MufH. Journ. B. 30. St 6. 

VOJU 3klll. NO. 49* O 



5# Eecent Pragreu qf Msdidm* Jaiu 

pidf and Fr. WiUmann^ (a) and HorsL (ft) The Borthem va« 
liety of leprosy, called Radesyge, was described anew hy Ji 
Vau^ ; (c) and J. H. G, Schlegd{d) edited a collection of papers 
on FeUagra, 

The theory of dropsies was again attempted to be established 
by J. A. WaUher (e) on excess of hydrogeut and defect of the 
formation of blood in the capiUary vessels. The latest work, by 
J. BlaekaUj (f) we only know bw its title. 

Lastly* we proceed to notice the most interesting observations 
on the diseases of individual organs. J. Abemethfs observa- 
tions upon the diseases of the digestive organs in general (g) are 
worthy of perusal ; likewise PemberknCs remarks upon the difier- 
ence of diseases seated in the nutritive and secretory glands \ (h) 
J. A. Stamps observations on the diseases of the stomach ; {f^ 
C/iardel upon scirrhus of the stomach ; (k) and Jaget's excel- 
lent remarks on the softening of the bottom of the stomach. (I) 

Upon the diseases of the liver, «7. Tarr^i publication (m) is 
greatly praised i and CX JFl HarUi (n) has made some good re- 
marks on the diseases of the pancreas especially its suppun^ 
tion. 

On the stricture of the ossophagust Heind[en*s (o) and Nae^ 
quarts (p) observations are to be recommended. Metzlar (9) 
published on strictures of the rectum ; (r) Bubini on those of 
the jejunum ; and S. T. SSmmerring^ {$) and W* Schmidt^ (/) on 
the diseases of the urinary organs. 

{To be concluded in imrne^t Number.) 



HufiU Journ. B. 59. 8t 6. 

DiMi casum nngulaiem moiln Icproii Ubioniin Coloniae observtlL Twh; 

isia. 8. 



:! 

sia.8. 

e) Obi. in eianthcma arcticuiii, vulgo Sadcm* dictam. Gryph. 1811. 4. 

d) Briefe cmiger Acnte in ItiaiMi iiber dM N«gim. J«d«, 1807. 8. 

e) HvfdandU Joum. B. 95. 8c 5. 

/) Obaervationi on the Nature and Cure of Dropsies. Lond. 1815. 8. 

g) Surgical Obfenrationa, P. IT. Lend. 1806. 

A) Practical treat, on Tarioua diiewcs of abdominal ▼iacera. Lond. 1806. 

i) Practical treat, on the diseases of the stomach. Lond. 1806. 

k) Monographie des generations scirrheuacs de rertomac. PariS| 1808. 8. 

/) Htc/ffa«id*« Joum. B. 58. St 5. 

m) Morbid Anatomy of the Liver. Load. 1814. 4. 

n) Uebcr die Krankhelten dea Pufiteai. Niimbfltg, 181S. 4b 

o) HufeUmtVt Joum. B. 32. St. 5. 

J)) Joum. de Sedillot, Tom. XLIL Sept 

q) ffufelandU Joum. B. 85, St 1. 

r) ffarle's Joum. der auaL Liter. B. la St 8. 

«^ Abh. uber die schnell und laagsam todtlicfaen KnaklMitien dcr TtMwi^iim 
imd Hamrohre bey Manncra im hbhen Alter. Frkf. am Mayn, 1809. 4w 

ij Uebcr dicjenigen KranUieiten der Harablase, VoniecherdrOae und Hararulm. 
dsncn Toratiglich MSiiner im bohen Alter nugtaum dad. Win, 1806. 8. 



]<I7. Dt DidtMB M ihe Qaues af iht YMm-Fner. SS 



IL 

On the Causes qf the Tropical Endemic^ or YettaiKhFever. By 
D. J. H. Dickson, M. D. F. L. S. Fellow of the Royal CoU 
1^ of PhjfiiciaDS of Edinburgh, and laCe Pbytician to tht 
Fleet in the West Indite &o« 

IN tke 47tk Nmnbtr of the Edinbnrgh Medical and Sut^cal 
Jeumal, Mr Sbeppard has yen aUy explained some of those 
ftonreea ironi which Mlaeioofl deductions have been formed on 
the nature dP yellow^ik^w. The chief design of that paper seems 
to he, to arrest the attention to the difl&renee between relatiTe 
and absohite immnnity i and, as I have reason to believe that 
the writer codd have instanced a second atUck of yeUow-fever 
in otbcra, as well as in his own person, it appears to me that he 
niffht have extended bis observations with increasing advantage 
In his eondosions, which closdy accord with the results of my 
own expencooe* 

My p re s e n t object is to make some aetiological remarks appli* 
cable to the snigect, with the view of accounting for, rather than 
wi^ the hope isi reconciling, some of the conflicting ofnnions 
which have been entertained; but, as I cannot now go at 
length Into the proofs of those I have to oflTer, I must tmst to be 
alkiwed credit on this occasion for having a superabundance of 
evidence in their favour in my possession. 

Marsh miasma is very generally, and justly, consider^ as the 
grand source of the fevers of warm climates ; but, though very 
mquently so, it is not necessarily always, or the only source of 
that in question. While its operation has been too exclusively 
insisted upon by some authors, it has only been admitted under 
great limitations by others* The term, indeed, is not free from 
oligectioD, since it has caused the latter to recdve it in a sense 
far too strict and literal, and to question the existence of such 
exhaktions, except in the vicinity of a complete swamp, or 
marsh. 

I am at present to coniider the miasmata of decomposttiony 
with reference to thehr eflfect, and not to their intimate nature, 
in whatever situation they may occur i and, in this general 
sense,^it appears to me, that, in a temperature so uniformly high 
as that of the West Indies, and where decomposition is so ra- 
pidly promoted by the agency of heat and moisture, there can 
be very few places where the occasional production of noxious 
effluvia may not be calculated upon on shore i and soxnetimes^ 

c2 



M Dr Dicbon on the Causes'ofihe YelUm^PeiAr. SwmZ 

also, on ship-board. Of fever arising in particular ships, firons 
impure exhalations emanatin|^ from a foul state of the hold« 
continuing notwithstanding every attention to preventive mea- 
sures, and ceaidng only upon the hold being cleared, Lbaye seen 
inany well-mark^ instances. As the most unseasoned part of 
ti ship's company, and especially strangers, will be most Kafole 
to suffer; in .this case, it is easy to perceive that sach attacka 
might sometimes be construed in favour of infediotts fever; but, 
that they proceeded solely from the source above mentioned, 
appears to me elearly demonstrated by the previoas inefficao^ 
of ventilation and cleanlinessr-^by the impunity with wbid^ 
promiscuous intereoorse, elsewhere, is maintained with other 
ships, — by (he extinction of the disease upon the bold being 
cleared, and not till then, — and by its not being propagated or 
communicated by the sick, when removed from its original 
source. I shall adduce one example^ where, from die peculiar 
construction of the vessel, the aouree of the lebrifie exluilations 
could be more clearly ascertftined than when they arise from a 
ibul state of. the ballast in general. In April 1807, a iever pre*- 
vaiied in the Dart, lying guard-ship at Barbadoee, which, at 
fir^t, was attributed to land influence, and irreguiaritieaoommit^ 
ted by the men employed on shore ; bm as it continued, from 
time to time, to attack new-comers* especially after sleeping two 
or three nights on board, an internal cause became suspected. 
The ship was divided into compartme4ts bebw^ so as to allow 
of the water being carried in large tanks or cisterosf instead of 
the usual manner ; and these, having been disused in harbour^ 
their bottoms were found to be covered with an offensive depo- 
aition of slimy mud. On the 17th of May, cases of fever still 
supervening, I find by my notes that this evil had been detect- 
ed, and remedied ; and communications between the divisions 
bad been opened, so as to allow a free circulation of air below ; 
and on the 2^th I find it stated, < For the last week no fre^h 
attacks of fever have occurred on bgard the Dart. * The fatal 
cases terminated at the hospital with the usual symptoms of 
yellow-fever. As such fevers may occur at various periods after 
exposure, conseauently, after the cause has been removed, tl>e 
early cessation ol the disease, in the present insunoe, is more 
material, where the ship was constantly receiving new men ; bo- 
cause their not being affected subsequently, showed that the 
cause which had existed previously, existed no longer. 

Impure cfQuvi^ will be most apt to be generated in a new 
ship, particularly if built of green wood ; or where tlie shingle 
ballast has not been restowed for a length of time, or had not 
been, originally, carefully selected. If such exhalations (be* 



IB17. Dr Dickson 4)n tie Causes of the YellffWrFever^ S7 

tweeh which and animal effluvia, confined or produced by the 
human body under disease, a wide distinction obtains, though 
their cfiTects have been often confounded) be admitted to occur, 
occasionally, in a man of war, where cleanliness is proverbial^ 
it is easy to perceive, that, by the a^irency of beat and moisture, 
they may, under particular circumstances, in a transport or mcr- 
chant^ship, become so abundant and concentrated, that the hold, 
without the expression being very figurative, might be denomi^ 
nated a ship marsh. 

Bat the principal source of obscnrity, and of contradictory 
opinions on the yellow- fever, appears to me to arise from suffi- 
cient attention not having been paid to those states of the sys« 
tern upon which the frequency and fatality of the disease so 
much depend, and which may be designated by the terms, sus- 
ceptibiltty and disposition. By the first I mean simply the na- 
tural liaiMlity of the unseasoned European constitution to be a& 
fected with that fever in the torrid zone, upon exciting causea 
sufficiently powerful being applied ; by the latter, an acquired, 
or higher degree of susceptibility, by means of which, causes lesa 
powerftti, and otherwise inefficient, become adequate to the pro* 
duction of yellow-fever. The propriety of distinguishing those 
stales, though it may be said they differ only in degree, I hope 
to make apparent; but I do not mean to say that the terms are 
the best that could have been selected } it is sufficient, in this 
ease, that they are understood. I have substituted, on reflec- 
tion, the word disposition for predisposition, (though I should 
have preferred the more fiimiliar term), because it might be con- 
tended, that the latter ought to imply a previous, rather than an 
acquired tendency. 

. The degree of such disposition will fluctuate considerably dur* 
ing the earlier period of an European's residence in the West 
ladies, according to his age, the season of the year, and as va- 
rious stimuli have a greater or less influence upon the system ; 
or, in other words, in proportion as it has been freely and sud- 
denly, or cautiously and gradually exposed to their operation. 
In such a climate, where the youthful, sanguine temperament 
is, at any rate, goaded by the stimulus of unnatnral heat, into 
a degree of febricular excitement, it is not extraordinary that^ 
from free living, intemperance, or undue exposure or exertiouy 
there should be much danger of this artificial excitation termi- 
nating in real fever, until the system becomes gradually inured^ 
and km sensible of such influence by the efiiect of habit, or assi- 
milated by the supervention of, what have been called, season- 
in^or milder attacks of sickness. 
The dangerous increase of this siisceptibility may be often 



S8 Dr Dickson an ike Camn of He YelkmhFeoer. My 

cbserved in ships recently arrived from Europe^ oondnuioff heal- 
tby, while refitting in harboar, for ten days, a fortamt, or 
longer, according to the season, and becoming very sickly after- 
wards. Its variationi and decline, are mfficienUy exemplified 
in the disparity of health enjoyed by die crews of ships under 
repair, at the same time, in the same harbour, and exposed to 
precisely similar exciting causes, but diflerinff in the length of 
their residence in a tropical cHmate, or the deme of exposure 
to which they had been previously subjected. The variation in 
these respects will cause such dissimihur results, that a fatal fever 
will become general, in a short ttme^ in one ship ; in another^ 
the sickness will be partial, and less dangerous ; while a third 
will be altogether exempt, or experience only mild and occa* 
sional attacks. This gradation will be sniKcieirtly obvious, al- 
though its uniformity may be somewhat afiected by peculiaritiea 
in season, modes of discipline, and various minuter causes, while 
the chief circumstances are apparently the same. 

The danger of a West India cUmate, or, in other words, ibm 
tendency to yellow-fever, I conceive, then, to be in the com* 
pound ratio of the disposition, and the force of the excit- 
ing cause; a weaker exciting cause being sufiicient when the 
system is stronprly disposed, and viee versa $ for, fortunately, 
these often obtain in an inverse proportio»; and the constita- 
tion hss been more or less habituated, previously to any consi« 
clerable exposure. How greatly the preservation of health mubt 
depend upon the inurement being gradual, is too obvious to re- 
quire any comment. The degree of security, however, that mav 
be acquired, will be relative \ for the insusceptibility will be much 
greater after an attack of this fever, — or from being habituated 
to miasma, or other remote causes, than from mere length of 
residenos. 

Mardiy effluvia, or similar impuoe emanations in other situa* 
tions, I have already stated to be, in my opinion, a great source 
of yellow-fever, either as a predisposing or exciting cause ; but, 
if the above premises be correct, it nirther follows, that the 
causes of yeliow*fever may be the same as the remote causes of 
fever in genersi ; that they may act in various d^frees of inten- 
sity, or combination ; that the weaker require the aid of dispo- 
•ition^ to become eflieient ; but when the system is h%[bly excit- 
ed, or prepared to fall into fever, that any additional agency* 
though of itself inoperative and insignificant, may become the 
eocaatonai cause ; and, consequently, that this disease may be 
ea)led into action, in some cases, by such a» are feeble, dissimi- 
lar, and so obscure as to elude investigation. 

In speaking of causation, then^ I do not mean to express indi- 
vidual agency, but any concurrence of circumstances which con* 



iSl7. Ih1)kka(manae<kmusqfikfYdida)Ef9et. 89 

idtatet ft eame; fiir I imagine we am tddom, in pathdopeal 
pfayBicB at least, 'calciihite upon eidier singleness of canse, or 
snn^id^ of eflbet* If the preceding principles are well-foand- 
ed, it will not be mcwMsry here to enter into any length of iliiia* 
tratlon to show, Aat sporadic cases may ariae^ in this way, at all 
seasons of the year, from andne exposure, intemperance, fatigue 
or other farregahrities, as weU as mm circumstances so minutCy 
as often to escape detefedon i that a number of men, such as a 
regiment, or a snip's company, or any part of them, from simi- 
larity of temperament, employment, or situation, will often su& 
fer simultaneously, particulariy during the hurricane seasout 
and $Sl the latter halt of the year ; and that in particular years, 
from prerioos unseasonable weather, or an efHdmic constitu- 
tion of the atmosphere, and in all years, during the sickly 
monAs, when a considerable number of unassimilated men have 
been recently introduced into the West Indies, the yellow fever 
may be expected to beeome general among them, and to be at-' 
tended widi great mortality, particularly after much exposurer 
and exertion, often inseparable from active warftre. As the con^ 
stitntion will snflfer less excitement from the heat, the coming 
from another part of the torrid zone, or a southern dimate^ 
will confer a certain degree of protection i but this will be only 
sufficient to guard against the wedcer, or ordinary causes of 
ydlow fever. In my own case, I considered the danger dimi- 
nished by having previously served four years in the s£Kliterra- 
nean. The ^rtKiation which I have above attempted to ex- 
plain# is well diustrated by the ibllowing unstudied, but impres- 
sive extract of a letter, now lying before me — ^ While we were 
all iB, and dying in the Alligator, in English Harbour, shortly 
after our arrival in the West Indies, the Emerald, which had 
been two or three years in the climate, remained near us heal- 
thy, though under predsely the same circumstances of duty and 
exposure. The Emersid was succeeded in her situation fy the 
Carysfort, fresh from Europe, which shipi in a few wedu, bor 
ried almost all hands. '— 

From regarding the habits, as well as the srtiology of the tro- 
pical endemic, the laws which govern its appearance seem to 
me to be entirely different from &ose of the piagi^e and typhus 
fever^ with which it has been sometimes compared. To tnose 
cKsoiders, strangers^ and the natives of the countries in whicb 
they prevail, are, cettem paribus, obnoxious in the same de- 
gree; and all such as are equally exposed, may be said to be e- 
qually endangered. But it is totally different in the legitimate 
yeOow fever in the West Indies. It is the disease of manhood, 
of the exdted| unassimilated| full habit. It mpre rarely attacks 



40 lirBiAaonMiheOtMiii^aeYeUcftoFeoifU /Amv 

an earlier or later period of life; and seldom ibe female^ or 
only in proportion, as from intemperance, or other causes, they 
approach to the habit of the male sex ; while o)d residents, 
whether native or assimilated, and people of colour, thouj^h 
subject to remittent and other milder forms, may be said to be 
almost entirely exempted from this severe form of disease,— >for 
they are so, with as rare exceptions as we witness in the appli- 
cation of any other general rule. 

But whatever may be the peoaliar coincidence of circumstan'* 
ees, or modification of cause, most fertile in the generation of 
yellow fever, an uniformly high temperature is the sine qua nan* 
This is literally aj^d eminently entitled to be so denominated, be« 
cause it indispensably precedes the effect. In the Caribbean Ar^ 
dupelago, the temperature is not only high, but eqi^ibly and 
durably so ; and from its little variation in diis respecti I eonsi« 
der the yellow fever us the legitimate product of the climate $ 
ibr in the more southern colonies on the cootineDt, where, from 
the vicinity of woods, mountains, &c. the temperature, thougU 
often as high, is not uniformly so, and where the winds are more 
variable, and the nights cooler, the disease is much less preva^ 
lent, and oftener assumes a remittent type. 

To the importance which I attach to an equably high atrno^ 
spheric temperature, it will be objected by some persons, that^ 
in countries which should be still more favourable to thisdisease, 
because the heat is more intense, and also in places lying in the 
same latitude, the yellow fever is not known. But, in the first 
place, it becomes incumbent on such persons to show, why a 
temperature above a certain height ought to be more favour*^ 
able; for, on the contrary, I should expect that great beat 
would dissipate and destroy, if not prevent the formation of the 
miasmata of decomposition f and, sepond^, it by no m/eans fol^ 
lows that the climate of two places is alike, because they lie at the 
same distance from the equator. 

• M. Humboldt remi^rlu, that the salubrity of tropical climatea 
depends more on the drvness of the air, than on any of its o^ 
tber sensible qualities. The burning province of Cumaoa, the 
coast of Cora, and the plains of Caracas, prove, that excessive 
heat, alone, is not unfavourable to huipan life. 

All historians concur in admitting the difierent laws, tc^ which 
the corresponding degrees of the two hemispheres are subject,^ 
with respect to the aistributioo of heat apd cold ; for the ex-» 
ceptions, from local causes, stated by Clavigero, cannot affect 
the general principles. The difference in the same latitude has^ 
bpen estimated at ltJ% or more degrees ; but, according torela^ 
tive i^ituatioib it Qiust be often ^ittcb greater. 



1817. Dr DicksoD m lie Causes of the Yellaw Weoer, 41 

The dimmilarity of climate, between the eastern and western 
sides of the New Continent, from this oaute, and from the great- 
er variableness of the wind, is also noticed by various writers^ 
and particularly in the voyages of UUoa, Anson, and oUiers* 

At Lima, in a southern btitude, nearly corresponding with 
the northern of Carthagena, the heat is far more moderate; and 
tlic observations made dj the academicians at Quito show, that, 
from its elevated situation, althou/vh close to the line, the tlier- 
roometer does not rise, thera^ so high in summer as it does in 
Paria ; nor does it fall so low as in the temperate climates of 
Europe in winter,*— so uniform are tlie seasons, llees. Pinker- 
ton, Walton, &c. 

This disparity of the Old and New Continent, and of places 
l^ing in the same parallel, is sufficiently accounted for upon 
philosophical principles, and depends on the elevation, depres- 
sion, or extent of country, direction of the winds, nature and 
cultivation of the soil, proximity and height of mountains, and 
many circumstances which modify the temperature of a climate, 
besides its distance from the equator, and the consequent more 
vertical or more oblique incidence of the solar rays. 

Dr Robertson observes, * while the negro on the coast of 
Africa is scorched with unremitting heat, the inhabitant of 
Peru breathes an air equally mild and temperate, and is per- 
petually shaded under a canopy of grey clouds, which intercepts 
the fierce beams of the sun, without obstructing his friendly in- 
Ouence. Along the eastern coast of America, the climate, 
ihough more similar to that of the torrid zone in other parts 
of the earth, is nevertheless considerably milder than in those 
countries of Asia and Africa, which lie in the same latitude. ' 

He afterwards shows, that the trade wind is still further cool- 
ed in its passage from the Atlantic to the Pacific shore of the 
New Continent. * As this wind advances across America, it 
meets with immense plains covered with impenetrable forests, 
or occupied by large rivers, marshes, and stagnating water?, 
where it can recover no considerable degree of heat : At length 
it arrives at the Andes, which run from north to south through 
the whole Continent. In passing over their elevated and fro- 
zen summits, it is so thoroughly cooled, that the greater par( 
of the countries beyond them hardly feel the ardour to which 
they seem exposed by their situation. In the other provinces 
of America, nrom Tierra Firme, westward to the Mexican em- 
pire, the heat of the climate is tempered in some places by the 
elevation of the land above the sea, in others by the extraordi- 
nary humidity, and also by the enormous mountains scattered 
pyer this tract. * — Htst. of Amer, vol. II. p. 9. et seqq. 9th edit. 



4S J}tJKikamvntheCMse$^ilUYeB(mtlg^ J«iU 

Hence the great sahibrit? of the table-land, in the centre of New 
Spain, compared with tne low marshy lands upon the coast 

00 the opposite sides of Meicico, where the distance is so 
nuch less than across the other ports of the Continent, the 
influence upon disease is yet considerable. Thus we learn from 
M. Humboldt, that although bilious fevers and cholera morbus 
prevail, the black vomit has never yet been observed on the west 
coast of New Spain, while Vera Crus is considered as the chief 
teat of thai terrible distemper. 

The disastrous resulu of the expeditions to Carthagena, Porto 
Bello, Vera Cruz, &c. which have been the theme of the histo- 
rian^ and of the poet, have^ indeed, &tally proved the pecoltalr 
noxiousness of the extremely hot and marshy climate of t^e 
eastern shore. • 

Even in the short distance of 60 miles, between Panama and 
Porto Bello, the difference is sufficiently perceptible, ahhough, 
from improvements, it may be less so of hte years. Ulfoa re- 
marks, that the garrison detachments sent from the former to 
the latter, * though coming from a place so near, are affected 
to such a degree, that, in less than a month, they are so at- 
tenuated as to be unable to do any duty, till custom again re- 
atores them to their strength ; ' and that * the inhabitants of 
Panama are not so meagre and pale as those who live at Car* 
tbagena and Porto Bello. ^-^TrandaHcm by Adams, voL I. p. 98 
& 12S, 4th edit 

1 am the more anxious to advert to these points, because they 
assist in explaining the influence of locality and susceptibility in 
the production of yellow fever. 

For, baides the lower and more variable temperature and 
winds on tlfte extensive coast washed by the Pacific Ocean, the 
introduction of Europeans b more gradual and limited, and 
their constitutions may be supposed to have lost that freshness 

* To one who has been an actor in such scenes, I do not know*,* 
in the whole circle of poetry, a passage which more irresistibly a* 
Wakens the memory of former painful feelings, thaa the following af- 
fecting picture, in Thomson's Summer, of the pestilence thkt de- 
gtrqye4 the English fleet at Carthagena. 

.. < ¥ou, gaUsnt Vernon, saw 

The miserable scene ; you pitying saw 

To infiiJit weakness simk the warrior's arms ; 

Saw the deep racking pang, the ghastly form ; 

The lip psle quivering, and the beamiess ejre 

No more with ardour bright ;— you heard the groaqe 

Of agonising slrips from shore to shore ; 

Heard uightly plunged, amid the sullen wayes 

The frequent corse. *— L 1050. 



18 17. Dr Dickson an the Camn of the Yelhm Tever. 43 

(if I may nae tbe expreftion) so fivfoonible to this diseflse, by 
the length of the voya^ and ciioiates through which they mnsC 
past ; or by the seasoning attacks, to which they are liable before 
thcT^ reach their destinatioDi if they land at an eastern port. 

There are two powerftil reasons, then, why Earopeans, on 
the odier stde^ are so much less sabfect to yellow fever : They 
have not only lost a condderabie share of their original suseep-* 
tibility by pre-asdmilation, but their equatorial parallelism is so 
far counteracted by the dUFerence of oimate, that they may be 
eonskleped, thoogh adually living in the same, as whtaUy liv-* 
log in a more northern latitude. 

Tbe converse of this proposition apjpears to me well adapted 
' to explain the occasional appearance or the fever which has ex* 
dted so mndi controversy in America and in the south of Eu^ 
rope. During the unnsnal and long-continued height of the 
thermometer, by which these epidemics have been preceded; 
the inhalntants are virtuaDv placed in a new or tropical climate ; 
and the same general efllect ibliows which would result from 
the sudden tranidtion of a body o6 men to the West Indies, 
with a consideraUe share of northern susceptibility. In both 
eases, the constitution, being unassimilated to the change, will 
be liable to be affected by the unasually heated and peculiar 
state of the atmosnhere, whether its influence, may be admitted ' 
to consist in proaodng the dispositional tendency of which I 
have spoken, or the development of those miasmal products 
most farvourable to this form of fever, or in both. 

Upon these modifications of fever I do not propose to oStt 
any observations at present ; but I am inclined to believe, that 
the discrepancy of opinion thereon is much to be attributed to 
partid and incomplete views of disease in limited and detached 
situattona % and that tbe more we see of fevers in the various 
quarters of the world, the more we shall be induced to refer 
to general but determinate principles their phenomena, as well 
as their mode of action or effects upon the body, though the 
latter, of course, will be susceptible of great diversity, according 
to the nature or concentration of cause, individuality of consti* 
tntion and structure, and relative importance of the organs pan* 
ticuiarly affected. 

In his celebrated work on tbe polidcal state of New SpaiUf 
to which I have already alluded, M. de Humboldt seems to 
have justly appreciated the influence of uniformity of tempera^ 
ture, sitnation, and individual susceptibility, in the production 
of yellow fever. I shall quote from my notes, as I have not the 
book before me. He is of opinion that the yellow fever has 
aecurred 8poradici% whenever persons bom in a cold dimattf 



44 Dr Dickfion on the Comes qf the YeUm Fever. Jan* 

liave been exposed in fhe torrid zone to air loaded with roias- 
mata; and lie very properly cautions ur against confounding; 
the period when a disease was first describedt with the date of 
its firfet appearance. 

. The yellow fever* he infomis us, is still unknown at Aca- 
pulco ; though, from the uniformity of the beat, he is apprehen- 
sive that, if ever developed, it will continue the whole year, as 
in other situations where the temperature varies only two or 
three degrees during the year; and he most judiciously re- 
marks, that if this port, instead of being frequented bv ships 
from Manilla, Guayoouil, and other places of the torrid zoney 
received ships from Chili, or the north-west coast of America, 
if it were visited at the same time bv a great number of Euro- 
peans, or of Highland Mexicans, we bilious would probably 
socn^ degenerate into yellow fever, and the germ of this last dis- 
ease would develop itself in a still more fatal manner than a( 
Vera Cruz. M. Ilumboldt afterwards gives a still more satis- 
factory reason why it is not brought from Chili, viz« that it 
does not exist there ; — which I imagine to be not a little appli- 
cable to the Bulama, and some other instances of imputed im- 
portation, like that from Slam, characterized by Dr Lind as 
* truly chimerical. ' For, after stating that tiie yellow fever baa 
not appeared upon the coast of the Pacific Ocean during the 
last fifty years, except at Panama, and that there, as at Callao, 
the commencement of a great epidemic is often marked by the 
arrival of seme ships from Chili, he adds, not that they import* 
ed the disease from a country where it never existed, but be^ 
cause the inbabitanu, coming from the healthiest country in 
the world, experience the same fatal effects of a sultry air, load- 
ed with putrid emanations, as the inhabitants of the north. 
See his Second Volume, and the 29th JSumber of the lulinburgh 
Medical and Surgical Journal. 

The same reasoniug, I may observe, particularly applies to 
the error which has betn so often committed, of mistaking epi- 
demic for contagious diseases, and supposing them to be im- 
ported by new-comers ; because, from unassimilation to the new 
atmosphere, they are generally the lirst and greatest sufferers 
from local causes. Thus, Ulloa states, though he does not seem 
to believe it, that, when the black vomit first appeared at Gua- 
yaquil in 174rO, the galJeops of the South Sea having touched 
there, it was tlie general opinion that they bad brought that 
distemper, and that great numbers died on board the ships, to- 
gether with many foreigners, but very few of the natives.— 
(Adams, Vol. I. p. 161.) 1 need hardly remark how infinitely 
inore probable it is, thai the poor sailors, coming froni a pure 



2817. Br BkksOD on the Causes 0/ iht YeUam-Ptiver. H 

air« soffisred from the dnhealthy marsh in the vicinttyt which 
EstaDa describes a? infecting the city, at p^rticuhr seasons, with 
pestilential vapoars ; but which to the natives, from habitua- 
tion, were compamtively innoxioas. Even in ordinary seasonsf 
in the West Indies, it is not unfr^queiilly observed, that men, 
tboogh partially seasoned in one place, are, neverthi^less, liable 
to be again attacked by fever upon their removal to another, or 
even to a different part of the same island ; and this sometimes 
happens, although the latter may be esteemed as healthy, or even 
a healthier sitCiation \ proving the influence of a new, or in some 
respect diiFerently modified atmoi^phere, or of other circumstances 
whidi the apparent locality, thoUgh it may in some degree, is 
insufiBcient wholly to explain. 

Indeed, we not only observe striking peculiarities in the fea« 
tores of disease, in different climates, but often a considerable 
change in the state of health from a seemingly inconsiderable 
change of sitnation; and if such effects happen from modifications 
of climate, soil, or other circumstances, for which we are so often 
unable to account, it is necessarily much more to be expected that 
strangers arriving at the commencement of a sickly or epidemic 
season, should be the earliest victims ; and thus, erroneously^ 
tbey^ have been sometimes thought to have brought a disease, 
merely because they were the first affected by new miasmata, or 
other local causes, increasing the susceptibility of a habit pro* 
babiy already prone to febrile or inflammatory action. 

As, for the reasons already given, and from personal observa« 
tion of the tropical endemic in almost every variety of situation 
— proving it to arise in hot, low, moist, close places, whenever 
new men are exposed to miasmata, intemperance, or fatigue,—- 
I must consider the yellow-fever, not as an imported or conta* 
gious disease, but as a strictly local and indigenous evil, ' quod 
sol atque imbres dederant, quod terra crearat sponte sua,' to use 
the words of Lucretius in a different application. I shall only 
remark here, that, if it possessed any contagious property, it is 
to me altogether unaccountable, that conviction thereof should 
not have l^en coerced, almost with the force of mathematical 
demonstration, long before the present day, considering the 
continual and unrestricted intercourse generally carried on be- 
tween ships, as well as between the- opposite sides of the Isthmus 
of Darieo. But, on the contrary, examples of individual dis* 
ease, or of a limited number only, are constantly occurring in 
the same ship, again and again, without extending further; and 
it becomes epidemic, as I have endeavoured to explain, only 
when a generally operating cause produces a general effect. 
Hence it is legitimately endemic in the West Indies, and be- 



46 Dr Didaon on ike Ck$ise$ of ike Y0Utf»-Fev^^ Jto. 

qomes often epidemic there at pertioolar leifom, aid oeeasionk 
allVf in other countries, after exposHre to the influence of tropi* 
cal beat. If the fever of Gibraltar and other parts of Spain be 
the same disease, and if it posseas any such property, which I 
consider as still remaining to be proved, I must therefore con- 
tend that it is not a native, but an adventitious character, and that, 
like other diseases attended with febrile action in temperate cli* 
inates especially, it is susceptible of being modified by the occs« 
sional coincidence of peculiar drcumstanoes, such modification 
placing it in a class which, in mv official report on the subject 
|o the Naval Medical Board, (perbap inaccurately, but for the 
fake of distinction merely), I callea THffusMe Disorders ; the 
power of dissemination in such, not being, as in other commo* 
picable diseases, native and inherent, but oontungent and acquir- 
ed. Although I do not mean here to enter mrther upon the 
question of Uie Peninsular fever, yet, as its progress has been 
^nsidered by some to be satisfactoriljf traced, and its prevalence 
to be unaccounted for by any supposition of an epidemic change 
of the air, or endemic origin, without a reference to contagioD, 
I may be permitted to remark, in passing, without dwelling up* 
on the inference, that, in the latest work upon the sutgect, and 
in which this opinion is temperately supported, the co pcn r rwtt 
of a certain height of temperature, and of a combination of cir^ 
pnmstances difficult to define, but connected with checlimaia 
and individual predisposition,— >is nevcFthdess admitted to be 
necessary to the existence of the disorder. 

Indeed, stronger evidence of a highly deleterious state of the 
atmosphere, as exemplified by its pernicious influence upon ani- 
jnal life, in these instances at least, cannot well be adduced, than 
that furnished by the author of the reports himself; fer, in the 
fever at Cadiz in 1800, Sir James Fellowes, I believe in page 
45, speaking of the air, says, * its noxious qualities aficted even 
animals ; Canary birds died with blood issuing from their biHs:* 
And he quotes the authority of Arejula in further proof efsimi* 
lar fatal effects upon domestic animals, parttcnIarJy dogs, eats, 
horses, poukry, and birds. 

'. In accounting for the tropical endemic becoming epidemic at 
particniar seasons, the eminent traveler before referred to, fnr- 
,ther shows the intimate connexion, on the coast of Mexico, be- 
tween the progress of the disease, and the temperature and state 
of the seasons; and, accordingly, that, at Vera Cruz, the x»mi^ 
to prieto does not commence, generally, dll the medium heat 
is 75^ Fahr* It is, therefore, seUorn seen in December, Ja- 
nuary, and February, unless it has been very violent in the 
summer^ when it oontinuea more or lest through the winter $ 



1817. JDr Dicbm on Oe Omm of tie YelUm^Feotr. Vh 

butt as ke oUeffycs^ although it is hotter in May* its ra?agei 
are more dreadful in Septemoer and October, because a certain 
duration seems necessary to devebp its fiiH force; which musty 
inoreover, be augmented after the rains have ceased, which last 
from June till S^tembefy as well as be influenced by the direc- 
tion of the winds.^ The^ same increase of disease, I may re- 
markt is observed in the islands, during the hurricane months; 
aad fthia is also in proportion as the previous weather has been 
naseasonaUe ; But the medial heat at which the disease begins 
to be prevalent* majr be calcukted at, at lea9t» from Sl^ to iO^ 
hi^eri from which it may be deduced, that, in proportion aa 
the air is more loaded with miasmata, as on Uie Atlantic shorea 
of New Spaittt the disease may become active at a lower tern* 
perature, than when these effluvia are less abundant and concen* 
tntcd I and it may further account for its appearance beyond 
the tro|>ic8, during the summer heat 

In proof of the effect of seasons, I have now before me m 
letter from Dr Macarthur, who ably conducted the Naval 
Hospital at Barbadoes for several years, corresponding with 
his report to the Medical Board in September 1809, in which 
he say^^* I remarked, while at Barbadoes, that the fever was 
more frequent, and more violent^ when the raiQs were partial, 
than when continued and general* The heat of the sun pro- 
duced the decomposition of animal and vegetable substancea 
more rapidly when the earth was slightly moistened bv rain, 
than when perfectly drenched. In these years, when the raiift 
Uk abundantly during the months of June, July, and August, 
the fever did not appear until September, Octobert and No- 
vember. On the contrary, when June, July, and August, were 
comparatively dry months, the fever invaded us earlier. We 
know, in Europe, that the effluvia from marshes are more delo- 
tcriona • week or two after the beginning of hot dry weather, 
than immediately after the rains are over i the first evapcratioQ 
from the sorface of the marsh being inpoxiouss compared with 
that which afterwards foHows. ' Upon the same principle, aa 
has been well explained by Dr Bancroft and others, it is not 
daring excessively wet or dry seasons, but some time after the 
rains, or after partial showers, that marshv effluvia are most 
abnndant and concentrated, as I saw dreadfully exemplified in 
the garrison epidemic at Mariegalante» in the autumn of 1808. 
At certain seasons, therefore, in hot countries, wherever there 
are vejgetable and animal life and decay, even though no water 
be stagnating on the earth, the whole flat surface may be con- 
sidered aa a marsh $ and, consequently, there can be very few 
situations, as I mentioned at the commencementi exempt from 
the occasional influence of such miasmata* 



48 t>r t>Ick8on on the Causes (if the Yellmh^eoir. jatf • 

It is only by tracing its connexion with the season?, then^ 
that we can rationally expect to unfold the laws of the tropicarl 
endemic ; and such topographical hints as I have here offered^ 
if followed up, I should hope would materially contribute to 
this end, although the peculiar and intimate combination of 
circumstances, as well as its sporadical occurrence, must oftea 
depend upon causes so minute as to elude all investigation. 

The degree of exemption from the disease will be, generally, 
conditional, and contingent upon various circumstances; for 
though indemnity to a considerable extent may be purchased 
by a previous attack, or by mere length of residence, yet such 
protection is but relative ; and, though a sufficient security a* 
gainst ordinary causes, is not proof against such as are of great 
intensity. 

The Circe frigate, after having been several times at Anti- 
mia, and escaping with a limited number, or only individual 
instances of yellow- fever, by putting to sea before it became 
general, entered English Harbour, which was then heahhr, co 
the 4th of January 1808, no man requiring medicine. In five 
days afterwards, tne fever appeared ; and, from bein^ engaged 
in the unwholesome duty of clearing the hold, and heaving 
down, between that period and the 2d of February, 146 meii 
were sent to the hospital, of wfrich number 22 died with black 
vomit, although it was then the iiealthiest season of the year, 
and the ship had been nearly twb years and ten months in the 
West Indies. 

Still, though the immunity was far from amounting to fn« 
susceptibility, the danger here was much lessened by partial 
assimilation \ for it may be fairly inferred, that the mortality 
would have been much greater if the ship had been recently 
from England. 

A great proportion of these men had suffered previous at- 
tacks of fever ; and I think there can be as little doubt, that 
some of them, at least, would have terminated in the same way^ 
if they had not been controlled. 

If this fatal fever, incident to Europeans in the West Indies, be 
admitted to be only a higher grade of the fevers of the torrid zone, 
it may, perhaps, be inaccurate, in a strictly philosophical sense, 
to press the necessity of giving it a distinctive or more ap* 
propriate appellation than that of jellow-fevcr. The incorrect- 
ness of naming it from an incidental and unessential symptonr, 
has been sufficiently commented upon ; but the great objection 
consists in this s3mptom, ofting causing it to be confounded 
with the conr.mon bilious, and other milder fevers ; and hence 
do we read of many instances cf the succcssAil treatment of 



]«i7« Dr OiekiPii on the Cauasofih YdlcuhFever. M 

nBom^tgmtt by wmiui vhick were never entilkd to tbot credit. 
What Dvne may be deemed the moit approprUtCy I do not 
take npon me io determiae. Tbe tenn Catum would, at first 
si^tf appear to be si^ciently €0, as the dueaie it $q generally 
aoeonip%oied with great beat and vascalar aetion ; but as it 
doea not aiHinie this aideiit forot io ^om^ ins ta n ces , tbe name 
m^t mislead* and ttnd to throw the young practitioner off bia 
nardy when these symptoms were not present. Tbe epithet 
Endemial, may be considered too vaguci — that of Caribbean^ or 
even Tropical fever, may be conttderod too locals'—hut, perhaps* 
die latter ia the hmt okgectionable (provided the mtJder fevera 
of Um torrid aone were understood to be excluded), since thia 
diaesse only occnra in tropical regions, or in place! subjected to 

Be this aa it asay, I mnst contend that the yeOow^ver (diarao* 
teriaed by gastric irritability and inflammation» and ending in dm 
Uack vomit) oo^^bt io be regarded, for all practical intents and 
pBrpoaea, aa a distinct and peculiar disease^ and a diagnosia, at 
fiur aa it ia poaaiUet establisbed, with a view both to a hist prog** 
noaia andtreatmtat. For, though soccam will be greatly inflne^- 
cad by iooaiife|r and constitution, and thoogh the aymptoma of 
thia naalady do not alwaya p«rmit, nor can they, where tb^ do 
aothoriaet be alwaya arrested by the co|NOua abstraction of 
blood i jH I fediaatified in saying, that it ia only from this re» 
medy, employed while the fever is fiNrming, or within a abort 
time after it ia formed, aided, of conrse, by purgatives, and l^ the 
eold affusion, if indhmted, that we cairentertain any pbuaible 
mqieetation of arreattng a diaease where the morbid motiona 
are of such inordinate power and rapidity* In making this n^ 
mark, I more particularly allude to that which I have most 
frequently witnessed, the ardent continued form of this diae aae^ 
where the deceitful pause, daring the transition from one stage 
to the other, has been ao often mistaken for a remission* To 
admit the e&eta of the morbid action upon the stomach, con^ 
tiguous intestine, and brain, often in the course of a fear boura^ • 
wouU appear to me equtvaleDt to admitting that we could only 
ratiooallv hope to counteract them by sitth powerful meanat 
provided we put aaide preconceived opiniona and theory. 

The ability with wbicb men bear the lose of blood, I hava 
already allowed very much to depend upon habit and locality $ 
and ita efficacy entirely on the early stage of thf disease. 

In situations peculiarly pcatilentialf or where, from ooncen* 
tratioit of cause, the animal energy b ao far depressed, as early 
to incapacitate the functions fi;>r the performance of those duties 
by which Ufe is aupportfid, ur after suffident time haa elapsed 

VOL. XIII* NO. 49. n 



50 Dr Dickson on the Causes vf the YdUmhtevet, Jatf^ 

to have allowed the establishmeiit of fatal congestioiiar^I do not 
pretend that there is any hope of these being removed, buC| on 
the contraryi death will be accelerate by the »e of the lancet* 
All I mean td say is, that, during the first stage, at least in the 
shape in which I have most frequently seen the disease, and 
while the progress of infiamroation in the most vital parts is 
rapidly proceeding, yet still remediable, I am acquainted with 
no other remedy which has either time of power to save tbem 
from disorganization. 

- Having had bat tod niany opportonitiea of being convinced 
of the want of commensurate efficacy in those inerter means hf 
which the fevers of temperate climates are often conducted to a 
safe termination^ I feel perfectly satisfied, when I hear of fpreat 
success in the treatment of this disease, either that results so 
fortunate have been the reward of a prompt and decisive plan 
of treatment at the very commeneedtent, or that the disorder 
was of a far milder, and more remediable natore, than that 
which I have been accustomed to, under the name of yelloww 
fever. Would to God I could aay, . that the most prompt and 
decisive measures will be generally attended with snocesa ; batt 
I may say, that this will almost entirely depend i^n the earli* 
neas of their application ; or upon the judgment to determine 
when the disease has so far advanced, that they are no longer 
applicable, and must be succeeded by an immediate, and entire* 
ly opposite mode of 'treatment. 

The mediocrity of remedies often causes them to retain that 
xeputation which they have previousivi and sometimes unjustly 
acquired ; but the power of^ a remedy so active as venesection, 
yet whose utility is so entirely dependent, not only oil time and 
Quantity, but on the varying state of the system, is in continual 
clanger of being rated too high or too low. I am sorry, there- 
fore, to observe, that it is spoken of with too much confidence 
by some writers ; because this tends, on failure, to bring ita ciia- 
racter into disrepute with others, though it oftener suffers fxom 
the opposite extreme of unfounded apprehension. 

Upon the now undisputed and general utility of purgatives, 
it is quite unnecessary to say any thing here : They have not 
only the great advantage of being eminently serviceable where 
bloodletting is proper, but where it cannot be resorted to, and, 
in a vast variety of milder cases of fever, where it is not requir- 
ed. 

The preservation of individual health in the West Indies 
will very much depend upon following the advice contained in 
the comprehensive maxim of Cekus, — ^the avoiding of various 
predisposing and exciting causes, until the physical sensibility of 
the system is reduced by habit. 



im7. Dr Dickwti on ihe Causes &f the YttU^F^oef. Bl 

The general heaMiiiiestf of tbftt country will vanr at diflerent 
periods, according to atmospheric influence $ for^ of the influence 
of certain seasons, which has been admitted from the time of 
Hippocrates -downwards, and even from that of Homer, I do 
not think any person who has followed the history of epidemics 
in the various parts of thegiobe, can entertain any reasonable 
doubt. It will be also aflected by unusually wet, or dry, or 
what has been called unseasonable weather. But generallv, the 
decree of faeahh enjoyed in the West India Islands will ?ery 
much depend upon the number of Europeans introduced, the 
time of the year, and situation chosen, and upon the exposure 
being limited at first, and gradually increased. 

During war, when the influx of unseasoned constitutions is 
considerable, particularly after active service or much exertion^ 
great sickness and mortality are, I fear, unavoidable* 

The healthiness of the Navy will very much depend upon 
avoiding undue exposure to the sun, tain, night air, fatigue, in^ 
terapersEnce, and unwholesome shore duties, especially during 
the sickly season; and upon the attention paid to various regu« 
lations^ and preventive measuresi of which I have had ample op- 
portunities of appretiating and of stating the value, from the in-' 
specticNi, and reports of, generally, between 60 and 70 vessels 
of War. The bad ^eflfects of staying too long in port at one timet 
and, independent of irregularities, of harmur duties, partiG»> 
larly early in the morning, and after the setting of the sun, as 
well as dnrrog his meridian power, cannot be too strongly ad- 
verted to here; and, therefore, a measure of paramount import- 
ance is the employment. of negroes, natives of the country, or 
at least of men accustomed to the torrid zone, in wooding, wa« 
taring, transporting stores, rigging, clearing, careening ships, 
ftc; and in fine, in all such occupations as must subject them to 
excessive heat, or noxious exhalations, which cannot fail of be- 
ing highly dangerous to the health of the unassimilated Euro- 
pean. But, when this cannot be done, it will also be greatly 
preserved by relieving the ships, &c. 

Bat it wU diieBy be preserved by relieving the ships on that 
station (the prospect of which, alone, has a wonderful effect on 
the health and spiriu of the men) so often, that a foul state of 
the bold, and the necessity of clearing it in that country, shall, 
as seldom as fMwsible, arise. During a period of nearly eight 
yeara of the kte war, considerable sickness and mortality must 
neeessarily have occurred; but, in that time, I have likewise had 
the gieat satisfaction of witnessing, in various ships, and on 
various occasions, that a great degree of health might be maiq- 
tained in that climate, particularly latterly, when, the season of 

d2 



W Dr0(dttO&MA#GMiit«^lA^T€tfM»-J^^ hm. 



gfddn Wftrfiune being pMtt tbe awiemty was priduded, and con- 
ieqneatly the uQwholiiCNna dntict of aotriQg the bold, heavipg 
down, or undergoing lengthened repaii* in the cloee harbours 
of the Wert Iodies» were interdieted; rad I am therefore led 
to conclude, that, to avoid the stiwger eseitang causes is» to a 
great extent, to esoafie the disease. 
Oiftan, Britiok Sepiember 181$. 



IIL 

Cafe ^Pneumonia wiih Fever of a Bilious Tjfpe. By William 
LvcA^ Surgeon, Stirling. 

IN the month of September 1816, I was caiied in by m oonop 
try surgeon, lo tne north of Dunblane, to consult on a case 
of hepatitis (as he supposed) oeeurrtng in the pernon of a re^- 
apectable fiirmer residing at Kinbuek* On niT arrival, Mr 
Stewart, the very intelligent praditioner in attendanoe, expressp 
ed his doubts as to die disease being l^petitis, but stated that 
Ae symptoms exhibited in the course of the disease, resembled 
kepatitis more than any other comphunt On examinatioBt 
I feond our natient endentl;f in a state of convalcscenosy but 
labouring nnoer great depression of spirits^ arising firom an idea 
lie had concdTsd, sosd which he fondly dierished, and in which, 
ahw, he was most religiously confirmed by the oiU medical tbc^ 
ioreues of the neighbourhood, that he was labouring under a 
eeoBumption, of which he roust infaUibiy die. I found him finee 
from ferer, pulse 65 and soft, respiration 18, fifue and easy, bel- 
ly natural, and complaining of nothing Imt a pain (of which 
more hereafter) which was totally distinct from tne disease from 
irhich I thought him now convaksoent. On inouiry. what 
symptoms the disease had raanilested at the period ot iu attack 
and subsequent progreu, I was informed that the disease, which 
he attributed to cold, was ushered in with rigors, alternated with 
flttshingB of heat, attended with severe cough, violent pain in 
the left side of the chest, laborious breathing, and all the othsr 
well known signs of pneumonic inflammation. To subdue 
tiiese symptoms, it was found necessary (and the disease re- 
tjuired it) to Meed three times at the interval of a day each timet 
to the extent of twenty ounces at each bleeding. This vigor* 
DOS treatment was (as might be expected) attended with the rf- 
fect of subduing the diseMe, and oonpletely luwking its foEce. 



I€l7. Mr Ijaaafi Que rfPfieummiig. U 



The drcilinstattee %lricll ocotrioned the iknmt being ttuitdMtt ^ 
for hepatitis^ was, that, at the accession of the disease, the skio# . 
s» also the adnata of the eyes, assumed a dingy yellowish ap- 
pearance. During the pn^;re8s of the complaint, likewise, the 
bowels were very litegQlaf In fheir action t and a smart dose of* 
jalap and calomd was invariably attended with the effect of bring- 
ing away an immense quantity of highly fetid and bilious feces^ 
vSi of prodndnff the most signal relief. Indeed, it resulted from 
my inquiries, that our patient was habitually of a disordered 
state oi bowels, so mttch so^ that at times a very small dose of a 
purgative medkine affected them violently i while, at other 
timefl^ it required an immense dose even to move them. The 
Mood dso^eshtbited that partieillar ookmr which resulta froA 
an intermixtmre of blood and bile« On the supposition, likewiier 
of its being an hepatic affisction, the surgeon in attendance bad 
put the patient under a course of mercui^, which had produced 
a sa]ivation,«->whtch was the state of affairs when I saw him. 

FVom the present eondhiaD of our patient, but more partksu* 
larly fironl the result of my inquiries, being thoroughhr convin- 
ced that our pittient, at no perfod of the presant affection at 
least, had ever hboured under hepatitiSf I ordeied the saUva^ 
don to be checked immediately, and, for that purposei while in 
the honse, saw Administered a dose of magnesias sulphai dissohr* 
ed in a targe qnantily of water. By this timc^ through die 
agency of the general bleeding, and the topical application of 
leeches, dte aymptomaticdiffieul^ of brealiiiag waa compietely 
anbdned; bat he srill conqriained of a pain in bisie/i side, of so. 
cnrlona a natnre^ as lo r^nifte a particular description. Thia 
pain, wWch was aggravated by oongbin^i though, for very ob» 
viouei'easoDat not by the rcsph^toiy motions^ occlipiod about um 
inch in tangch of tb^ cartilagnioiis ea:tMmi^ of the first leA fake 
rib, laid was so eom|4eteIy circumscribed^ chat, although it felt 
mofbidly painfU on pressure, l^et presstire sft the diataace of m 
haitkfaMKlth above or bek)w the |»n a&cted, or betwoeei tbli 
cartilage and interior parts, (for from the emaciatioUf this oonU 
be tftsSy done), ' produced no panL Ouf patient had received 
a \itom on this part, (Ibr how long pveviousiy I cannot say)v 
Sottt tiaae befbrtv to reaaove this affection, a large blister waa 
applied wililooteflsct I and conceiving the cartilage to be in » 
stat^ of inflammation, I ordered the immediate application of 
hdfrtioJen of ieetdie^ which waaattatided with die e£R^t of re^ 
Seving the paia completely. Our patient i» now weU» and ha$ 
aasvmed his ordinary avocation of a farmer and caltk-desler^ 

Tbia ease certainiy afforded me a very faistructive lesson i and 
were f caUad upop lo give a name to tbia aiiqpUar a^tioui I 



8t Mr Kenned;'' Cose afJDueatei Arm. Jan. 

wonld caH it pnemnous, conjoined with •' fever of « bffiovs 
type. 



IV. 

Case qf Diseased Arm. Commanicated by Auxazoee Ksn- 
NEDY| Esq. Madras. (With an Engraving. J 

AT Tanjore, on the 9th of February 1796, PteniiaQli a Cd- 
lery, from Tondiman's country, aged S5 yeam» cafne to 
ask my assistance for a tumefaction of his left armi of whidb the 
following is the description and history. 

It measured round the thumb and outside of 

the wristy ..... 1 foQtr4| inchea. 
Round the arm above the wrist, * 1 5 

Half way up the fore-arm^ • - - 1 li 
Below the elbow joint, --17 

Round the elbow joint, - - - 1 H 
Just above the eIl>ow joist, - - 1 4 

This swelKng terminated half way up the humerus i but he 
aaid that it was both rising further up the arm, and that the 
arm was also growing every day larger and heavier. Tfaeosp- 
peorance of it, both m size and shape, was monstfbus. The 
skin was rough and scaly. The enlar^ment seemed to be 

frincipally in the muscles, with some thickening of the skin. 
t had to the eye every appearance of being a sweHing of the 
same kind as that described by Dr Handy, under the name of 
the disease of Barbadoes, or wbat are caUed, in the East Injdies, 
Cochin legs. 

Upon examining the axiBa, he comphined of pain upon 
presfiure^ and, though no swelling of any of the lymphatic 
glands could be discovered, there was evidently « considerable 
wickening of the parts there, when compared with the amila of 
the right side. 

The circumferenee of tlie right arm, at the thickest part be« 
low the elbow, was 8} inches, and just above the elbow- joint 
when the arm was extended, 8 inches. The man was otherwise 
}n perfect health. He carried this overgrown limb slung 
round his neck in a cbtfii whidi at some little distenee kxA^ea 



m^. Mr KemiBdj'iL Gase of leased Jbv" 5^ 

•6 if be were cmrryfaig a youag i^biid ip it* ^e complaiaed 
very mucfa of its eumberaome weight,, apd. wna very earnest in 
entreating that he might be relieved from the load of it, by it9 
being cat off. He imputed the origin of it to the following ac- 
cident. About six months before^ while in the act of discharge 
ing a matchlock) it burst in bis .hand, by which his left arm was 
much woanded. The principal wound was upon the inner side 
Qf the jcHnt of ihe elbow, with five smaller ones on different parts 
of the fore arm ; these last healed up in about three months^ 
mfter having discharged pus rooderatdy ; but the wound on the 
joint was open for upwards • of four months, during which time 
ii disdiarged great quantities of matter. About 2 inches of 
ijtke ]iea4 of the ukia then came away, after which thf wound 
healed up. 

On the day of ihe accidpnt» a swelling came on, which He de- 
scribed AS not very considerable in point of size, though it ex- 
tended from the points of the fingers to an hand Vbreadth above 
the elbow. It was at first exceedingly painful ; but a rag dipped 
in cold water having been kept constantly applied to it for some 
days, the heat, pain, and throbbing, went almost entirely ofil 
This swelling, he said, never went down ; and, at the tipe the 
wounds on his fore arm were healed up, he described it to have 
been of such a ai^, as to make the left arm appear about twice 
the balk of the right one. At this time an itdbi^g and sense of 
pain began on tm back of this hand^ and at the roots of the 
fiiigcfh ttid th^ sweUing of xhe hand began to increase rapidly. 
The itching and sense of pain then attacked the outside of the 
wrist, and the swelling after this spread itself more than half 
way up the fore arm. The itching and pain then began anew 
ip the upper part of the fore arm, and the swelling spread itself 
up to the joint. And lastly, the itching and pain began above 
the elbow joint, and the swelling follow^, as it had done in the 
(brmer places. The itching s^ll continued in all these four 
placea, but is most troublesome hi the last station ; and, though 
the whole of the arm was still increasing in size, he said that it 
inareaaed mpsi rsipUllv above, the elbow, v^here he ^Iso complain- 
ed c^ A ^opaUerabl^ degree of constant pain. 

Finding that the swelling was actually increasing, and also 
IJsing np towards the axilla, I resolyed to (ake it off. The am« 
putation was performed on the 20tb of February, and the man 
retomed to his home on ihe SUt of March, to all appearance 
perfectlv welL A very accurate drawing of the man, and hia 
diseased limb, had preyiopsly been made by my friend the late 
Baron BeichelL 

1^ living tb^^nq^s of weighing the limb after tbe opera- 



56 Mr Keome^'i Case ^ Hiieased Arm. Jan. 

tion, we cotdd on! j |pitt« at the wei^^t of k ; but all who wem 
present judged that it could not be leu than 95 or 97 pomida 
weight, perhaps even more. 

Upon cutting into the muBcks of the arm after it wae fwior* 
edy the flesh of it appeared of a colour nooiething between Ae 
eolour of fat and the colour of the flesh of an unboiled flsh. A 
vast quantity of serum flowed from lt| whichi together with its 
colour, led us to compare it to an immense hrge water-melon. 
This fluid was pure and colourless, and without the smallest ad» 
mixture of red globules ; nor did the Hmb look as if it- bad ever 
contained a particle of red blood. The larger vesseis bad com-* 
pletely emptied themselves during the operation | bat in enttinsr 
down to the bone afterwards, we did not find even a drop ef ff«3 
blood* 

The man returned in about three months, and showed me <be 
stump, which had no appearance of a return of the disease. The 
axilla remained, as I have described it before, a little thickened. 
1 saw him also about a year afterwards, when there was not the 
smallest appearance of any retutn of the disease 

At Tanjore, in the month of August 1797, I took e#flie mnK 
die finger of the right hand of a woman about 90 years of age, 
which was monstrously enlarged by a disease, to an appearance 
die same as Piermanrs ; only that, during its increasing, she did 
not complain of the itching. It came on wttboot any evident 
eause. The finger was taken ottt of the metacatptd jointi and 
the cure completed in a few days. 



y. 

Dr Ldbensteiff^LSbers Fnfpdsal tf a Nifb Metkoi af Opmithfg 
Jvr the Caiaraci. Communicated by Dr vo^v £mM£k. 

IN operations for the cataracti keratonyxis, as weH as extrac* 
tioii and depression^ whieh the amhor has had frequent op^ 
portunities of performing, the idea st)-uck him, whether extrao* 
tion might inot be performed in that place where ocular surgerjr 
directs the depression to be ma&, viz. one or two lines distance 
from the cornea through the sclerotica. In the belief of this 
general notion, he was Gonflrmed by the foAowing most re- 



ni9. Dr LSteiteui^Liibtl onaN^ ItitlM, ^c. 5? 

ttstluMe ftfscidtiit, ytAUtk Imppaitd to a boy about five yeafa 

of «g6^' at Ho^fenMBt a small cMtanea from I«Iaombargh. Thia 

Iwy, plajF^ with anodiar, with a penkDife, wfaicfa tha other en- 

daatoMiad td giiatcfa from hniy drew it quickly back^ and hap« 

paattd 10 rmi it mt6 hit aya* He set a^sercamihg most Tident- 

fy ; and. the paranta miiiaDa to faim^ Immediately seat for the 

oatlfar ttcm Na»i»biii|>k On fan erHval ,- he exadiiBad the boy^ 

aad foand a fMDilrlniiig iilcitioiH of about ooo*sixth of an inch 

is feagdiv h» the fldatotica, one or two lines finomtheco#nea» to« 

wards the bettom of the balb# Tbe boy having all the time 

held a CdVM hamHtevehtef befive tbe ^e^ the cmtaUine lena 

waa foand to have eome ant upon it* Between the lips of the 

wmmd Dr LSbel ibo^ht he saw sroaU fragments of the lacerated 

esqpsale: the aqoeoas homoar had eicspMl, and the'cortiea wp* 

peered collapsed. Having thns minntety examined the e]ne» the 

aafibor eottsidersd it as lost, as tbe sclerotic and choroM coats, the 

aenafai Zinaii, and the vitreous humour^ must unavoidably bare 

been injured bythis penetrating incision* The boy moanmg areata 

lyi and ooflSfriMDing of much pain, and being of a plethoric habit ^ 

tbe eye wee difeoted not to be opened i four ounces of OonHird-» 

water were prescribed, in which elotbs were to be dipped, and 

appKed Jdfcewarm to the closed eye. An emukion of pojppies, with 

allit^ was also prescribed, an antiphlogiscfe reaimrn incafeated^ 

and all solid food prohibited for eight days, m was also onhtr* 

e* to Us rather low, on his back or left side, and the only win* 

dew in the mom in which be lay was hung with cloths, besidea 

iNr sbuttera being shut, so that even the smallest ray of light 

was eadttded. Sugar wntert with some cream of tartar, was the 

obW beverage he was permitted to take. 

• Oa virilmg the boy ^pin, on the third day after the accident^ 

Dr L. was greatly surprised to find, that be feh not the least pant 

ia the eye, and that his pulse was not at all fiiveridi, but quite 

regular* The eyewater was ordered to be cominned but 

twfee a day, the emuhion with the nitre was omitted, but the 

cftam t/l tartar drink pafseveved in. After four days more^ 

the bdt waa allowed to get out of the bed, and sii sometimce 

IB a chairf bat be was desired to be kept from stooping, or 

lesriog the dark chamber. The diet pteseribed was to be eon<* 

tma^ until the tenth day i not did Dr Li ventave to open the 

eye before tbHK Oh revisiting tbe patient on the tenth day 

mm the aeradent, a little daylight ,benig let in thvoo^b tlie 

whdow into tiie patient's room, be plu^ the boy with his 

badi to the window,' and then cautiously and fosrfuUy opened 

the injured eye, covering the healthy one with his r%bt hand^ 

Ii9d edOng ti^ ehiM, Whether be coi^ lee? How agrees 



M Br Lolieiisteia-Lobd m a New MMod inu 

Mj wM h^ sorpmed to find tfast hk mM notonlj dialingfwih 
the white wall» but ako a wliip hangiiig od the same I He iiair> 
permitted bim to see, for aboat foar or fiTe.iiiiiNitea9 ia the same 
poaitioa, in order that the affected oegaa might tiot be too vjo- 
knthr affected by the operation of the ligh^ bttt becoone m^ 
dttaHy accustomed io it ; then turninp^ the bqjr. more with hisie(b 
mde towards the window, he examined the-CMdition oi the oaor- 
bid eye, and found that the cornea had abnoat recovered its coor 
vexity, but that the pupil was aomewhat larger than that of thct 
kerithy eye : The albuginea was rather red, and only a bluish red 
streak showed itself in that place where the penetrating incisioo 
bad happened. The eye was now tied up again with a dry coos^ 
press, die fluid regimen continued> and the boy ordered to re^* 
move the bandage every morning for half an hour, and to see 
with the eye under a green eye«4Cieen» On visiting bim agaia 
aiker six days, the cornea hod fully recovered its natural shapes 
the pupil was of the same size with < the others the bluish red 
streak had gone off, and the patient^ seeing clearly and distinct^ 
}y ail objects, was discharged as perfectly cufed» the author be^ 
iog much astonished at bis not having lost his io/m and vision* 

This fact, however, corroborated urn author to tbe idea* tbaft 
depression and extraction might be made musb'easier throiigh 
tbe conjunctiva than through the cornea. He thinks this opiAr 
aiion promises the following advantages. 
• 1. It would be chiefly indicated in caaes where sieithpar de» 
pvession or keratonyxis can be mftde with snoeessi #> s^ wbiw 
the cApsulei half or a whole line thiok, .is morbidly iopofftedf 
or when the lens is very large* and cw^ot be Woke dowo» 

2. Neither prolapsus of the iris nor iritis would be to be 
dreadedy whicn^ in extracting the cataract through the cornea^ 
is frequently the case. 

9. The reunion of the wound would be more expeditious thaa 
on making the incision through the cornea, as the upper and 
lower eyelids would close the labia of the wound more intimately. 
2rhe incision in tlie bulb would have to be made many lines lowr 
er down in the conjunctiva than the depressing needle is conip 
monly thrust in ; and this method might thus be called extrac- 
tion through the posterior chamber. 

4. Tbe point of the knife used in extraction should be press* 
ed and moved towards tbe lenS| and, in ovder pot to injure tbe 
iris with it, it should bs carried vertically through tbe eye» right 
opposite the place where it entered, when, instead of applying 
the pressure usual in the common method of extraction, in or* 
der to caYry the lens through the pupil and opened >oornea« the 
iippcx eyelid would <mly want a little rabbingi aiidagenllt 



pvessofie* By this m&nipuIatidD,: the lens will, for a certointyy 
descend tbrougb the incision and the conjunctiva, .and the cap* 
sale follow it| or st least the latter will be absorbed if it be tbin» 
and lacerated by the point of the knife. Sbonldi however, brso 
fWigmeots of the capsule be perceiriid to swim about,: tbey might 
be carefully removed by a small pair of pincers* 

JDr I«. tb^is piropoBes this method in svch' casos where 
keratonyxis and depression .^r^ contraindicatedy and where 
extraction is the ' only rssoi^rce, or where adhesions of tha 
crysti4Ka6 exist. As ta the objections which migjit be taken 
firom the unayoidable k^psioii ^f . the oonjupctiva, sclerotica^ zo- 
nsda Zinniit and corpus vitreum, be is persuaded from experi- 
ence^ thatyhy proper management, and due medical care, these 
cannot be sp dangeronsas to iiifluence us : For, in the first place^ 
if diey were so, the greater nnmber of depressions must prove 
nmeh mcikie onsnecessful, which is really the ease ; and, second- 
ly, in the above ease of injury with the penknife^ in which 
he most likely pressed, the crystalline through the wound by the 
pressure he caused by holding the folded handkerchief before 
the ey^ and where be^ by bis crying, and screaming, caused 
determination to the bead, and the injured organ» the ooy must 
Kave lost bis eye and visioni through the Gombination of such 
inimical eJietunstances. 

The author concludes with.oonjecturing^ that Kerkringiusy 
Bdrbins, TayJoTy and WooUumse, made use of this method, 
when they boasted of having restored a young and acute vision 
to aged people^ by vemoving the corrupted and turbid humoura 
of the eye^ and repbicing new ones in their stead. 



vi. 

Bemarla on mne Bemedies tnAicA are used in Feoen. IBf 
Richard Lanpuieb Deapes, Member of the Royal College 
of Surgeons in IiQndon» &c« 

IF the editors shouM think this paper worth a place in their 
excellent Journal, tb^will oblige a bver of the profession 
by giving it publicity. The observations are the experience of 
some years, bot more principally made during the time of an e» 
pidemic, which has raged in this town and nei^bourhood during 
the latter pwrt of the sununeri and the autonm of the present year« 



60 Mr Dr^NV mBmeiUi USeJtin Rvets. Jmu 

Bat, withorft fonber ptthtt^ I flhtR stele the Yemttrk» I htHr 
iflftde on the effects of Tftrtons refiiedieB, which arre M this tiM# 
most commonly pfeseribcd fn fevers i and lAittll be happy if 
they contribute, in the sm^diest degree, to the dlsserainiitlon iff 
that method of trestmenti which hiis lately been found tmist 
saccessful. 

Bmetici. Mtny physicians are ffi the habit of prescribing 
an emetic on the first accession of a fever; enpeeting by fMa 
means to interropt its further plbgress. Whatever benefit 
iftight be obtained from this practice iA a few pafticnkr oaeesi 
I am convinced, fhrni experience, that when used, wichout die- 
thfietion, thev have most freqnently prchred injnriotts^ and have 
seldom failed to aggravate the symptoms they Mpt deigned 
to remove, in a very obvious manner. The greet cG»c«asioflf 
they give the whole system, parehnlltfly the In^aln, *hnoiii )ii-* 
variably increases the violent paift a6 often felt )ti file bettdg 
and especially over the eyeballs t tnd this, it is to be presume 
€Af by increasing the moroid action df the vessels of the enc«» 
phalon. The debOity, too, which socceeds thdr dftcts oft 
weakly habits, Is a freouent retardation of the patient's reooviery. 
IF emetics have been knind serviceable fbr headsK^hs which are 
sympathetic with the state of the etomach and priitiatf vfee, it 
is drawing a false conclusion to suppose they will n^ove ' d^- 
lare^ capms' in iWv^hr, whefe iire heiid Itself Appfiars Co be the 
primary seat of the disesise. The only casei iti Whith emetioil 
tfre admi«(sibFe, are, I ima^bM, those in which an iobstlMt^ 
vomiting takes place, owing tb some crndMee ill the stomadi 
which require to be evacuated. Fof this purpose, the. mUdeSt 
are generally preferable, such as an infusion of Anthemis nobi- 
Eli but they sbould.be used veiy cautiouslyj when there appears 
to be a morbid accumulation of blood in the head. On the 
whole, as a general remedy, I cannot approve of emetics. 

Diaphoretics. The great reliaiice which practitioners in ge» 
nerai place on sudorific medidnes, througn the whole course 
•f contiottcd feverly renders it necessary to say a few words on 
^Is subject I believe it Is go the principle of tlie heat of the 
body being morbidly increased,' owing to obstructed perspira- 
tion, that sudorifics are prescribcfd, fc^ the porpo^ of removihg 
this obstruction, and of course lowering the temperature. How- 
ever, I conceive this practice is Hot well founaed. If the prd» 
ternaturaf heat is owing to the presence of inflaimnaflon, dia- 
phoretics, which, before they can have the desired effect, a^ost 
iilways increase the morbid action, must obviously have an in- 
jttrlous tendency.. Besides," as we have other means of lessen* 
hig vascular tf^on, iai(l redudng tnorlrid beat, withont being 



fttnded with the same tnconvemeiicei ab 8iidorjfic99 (particu- 
larly mmoog the poor)^ I do not look upon the latter to be at 
all necessary in the greater number of cases ; especially as we 
every day see patiepts attacked with fever completdv recover, 
without there being the smallest tendeqcy to a oiaphoresia 
during ita whole course. Where these medipines have beea 
chiefly relied op» I have always observed the disease to be much 
protracted* end the cure extremely tedious, 

PhUbotQwof. The result of a few cases, in which I have 
employed tlie lancet^ induces me to think highly of its efficacy 
aa a remedy, in most cases of continued fiever i and I have no 
hesitation in giving it aa my opinion, that* when we can dives( 
ourselves of the prejudices of eaucation* jt will be much oftener 
resorted to than it is at present. We are cautioned against 
blood-letting, except when the patient is of a full pleUioric 
babity and robust constitution; but experience convinces m# 
that It is attended with the most decioed benefit» even when 
employed on subjects of a contrary description. I have never 
seen any bad effitct follow such practice when employed in time^ 
and r^ttlated according to its effects; but, on ibe contrary^ ^ 
apeed/ reiqisslon of all the symptoms, and a rapid recovery^ 
were almost invariably the consequence. The sxeat debility so 
often observed in fevers, is only sympathetic afa derangemenit 
of some of the internal organs ; and dissections^ prove that a 
degree of inflammation, narticularly of the brain« is always pre- 
sent. This, along with the success attending the practice^ 
sufficiently warrants us in violating those precepts wnich re- 
strict us in the use of the lancet* What n^an in his senses, 
(unless, indeed, he is shamefully ignorant), will refuse to bleed a 
person attacked with inflammation of the bowels, pleurn, &c. 
merely because he is of a delicate, s^are habit ? and why not 
bleed in fevers, where inflammation is obviously present also f 
A copious bleeding, at the onset of a fever, very frequently ren« 
ders the employment of other remedies unnecesaary* 

Purgmives. The utility of purgative medicines in fever cah 
be denied by no one. However, the generality of pliysiciana 
place too little dependence on these, ^nd trust too much tp 
other recnedies, I know of no general means attended with so 
much success^ as the liberal em^oymcnt of cathartics. During 
the £sver which has prevailed here for some time, purgatives, 
when relied on as the principal me^ns of cure* have seldoqi 
failed to be ibilowed by the most beneficial effbcta. They 
dionld be given, in large dotes, and often repeated, till the 
patient becomes convalescent, wliich is generally in a very few 
days from tbeuf first eipployment. When giveUi as is com- 



69 Mr Drapes on Jtefnedies used in Fevers. * Jan. 

monly t))e case, merely with a view of acting a^ aperients* their 
rfftcts are only triflin/^; but when administered with 'sufRcietit 
freedom, and, if I may be allowed the expression, with a deter- 
mination of reducing inflammation, their curative powers are 
often astonishing. U the state of the stomach allows the exhi- 
bition of saline purges, I generally give them the preference. 

With respect to many other remedies commonly employed ia 
continued fevers, I can say but little in addition to what is con- 
tained in every work on these subjects. I am in the habit of 
using partial cold ablution, e. g. of the face, neck, and superior 
extremities ; by which the patients have alwajrs expressed tbeob^ 
aelves to be considerably refreshed. It diminishes very much 
the pain in the head, and contributes to reduce the almost in* 
sufferable heat 

From what I have said, it will be perceived, that I eonsider 
blood-letting and purgatives to be most entitled to oonfideoee, of 
any general remedies that I am acquainted with. According to 
circumstances, I employ them either separately or combined. It 
was the judicious work of Dr Mills on Fever, that first directed 
me to this mode of practice ; and, after an extensive trial of it, I 
never had reason to repent my having adopted it : But, on the 
contrary, when swayea by the opinion of my ciders in the pro- 
fession, and fearful of departing from the established methoos of 
treatment, I have had reason, more than once, to regret mj 
want of su£Scient firmness. The man of most experience is not 
he that has practised for a lon^ series of years, or that has at- 
tended the greatest number ot patients. If this was the case, 
our nurse-tenders, who see a much greater number of sick than 
any medical man, would be the most experienced physicians we 
have. But the fkct is otherwise. The man of experience, old 
or young, is he who, at the bedside of his patient, studies the 
various symptoms of the complaint ; marks its progress ; as- 
aureshimself of its remote, predisposing, and proximate cause ; 
compares it with the cases he has seen before, or heard or read 
of; makes himself acquainted with the constitution, peculiar ha- 
bits, and idiosyncrasies of the invalid ; and who, treasuring all 
tiiese in^is mind, reflects, according to the true principles of me^ 
dical science, on the properest * metfaodus medendi. ' He attends 
to the operation of the medicines he prescribes, and directs his 
further practice accordingly. This alone is the man that can 
have experience } and not be, who, in his daily routine of prac- 
tice, depends on his collection of medical receipts, and whose 
prejudice b such against what he terms * innovations, ' * mad 
experiments, ' && that he obstinatelv shuts his eyes against the 
most important improyementsi and still perseveres in bis oM 



mr. Dr fUP$ Qmbiiutmns to DUfffunii. S8 

wty, ftdmiiiistemg;, indiflcrimimtdy, bis * care for thecoi^;iit' 
€fr ^ Gofdud for the' ocdd, ' in defiance of ill Buooess. 
Boss, Gmnty Wesford, October SI, 1816. 



VIL 

Coniribtdions to Diagnosis. By Marshall Hall, M. D. &e. 
Contribution Second f containing^ U An Instance of P^rmaneni 
Spasmodic Contraction of the Muscles of one side of the FacCm 
9. Benuttrts om the Character and Cure 4^ Sycosis. 8. TheDe-^ 
sertptkn of a Particular Ulcer wkidi appears en the Nose. %. 
The Suggestion of a Mode of Preparing and Presercing Veg^ 
table Remedies. 

h A CASK of permanent qMsmodic contraction of tbe mnsdes 

,-^ of one aide of the face. 

Miaa J—; — v^ aged 19. — Two yeArs ago, in the winter sear 
son, the face became affscted, daring the course of one nighty 
in the foUowina manner. All the muscles of the right side of 
the face were drawn into a state of spasmodic contraction i the 
sensibility oC.the skin became mvdh impaired, tbe contact of an 
external object inducing a feeling of numbness : there was a de- 
gree of swelling, and considerabk: pain ; and a sense of rigidity 
was fielt in the muscles of the right side of the neck. 

The muscular contraction was permanent, and very consider- 
able! the ri^ht angle of the mouth was drawn downwards ; the 
retraction of the integuments, the effect of muscular action, and 
usually observed extending from each nostril obliquely down- 
wards^ ia, on the right side, very deeply marked ; on the lefl, it 
is seen in its natural state. The tongue, when protruded, is 
drawn a little towards the right side ^ the point of the nose ia 
considerably so. Tbe right eyebrow is drawn a little low^r 
down than the left one; and two small dimples, the effect and 
evidence of muscular contraction, are seen immediately above 
it. A dimple in the chin is also distinctly marked, and it ia 
drawn considerably to the right of the mesial plane of the fiu^e. 
Articulation was at first very indistinct, and is still so in some 
^^ff^i the letter jS, enpecially, is pronounced with difficulty, and 
partifopales in the eoft sound of th. There wan no difficulty in 



M ShBOfjOmlHMifmtQJ Oimf f m fm- 



8|if^«dtiQiit but eomid^TiUe kmumimm ^emmd dfomm 
mastication,. from . a t^ency of the bolus of food to ptm ana 
collect into the rigb( «ide of Uie joputb* Oa dosing the right 
eje, a decree of tightness is induced and felt at the right angle 
of the mouth ; this tightness is seetif even when the patient 
n)esks with the right eye perfiBetly dosed. On dimwing down 
tne right angle of the month, by an effort of the musdes of this 
part of the face, the upper eyelid of the right eye is also drawn 
sensibly downwards, ana the aye is partiaUy dosed. In the first 
instance^ this eye was dosed with difficulty. 

The state x>f contraction pf the musdes is seen much mor^ 
idistinctly; and the deformity induced is much greater, on 
sp^in^ or laughing, dian when the pati»t is in a state of 
tranquimty. 

At present tha coatnictim of tl^ JBASobs is mudi kss than 
at first Tba sif^bility is ^ar&cdy rastorcd* The dimioutioa 
4»f symptoms took place during the administration of ckctridty, 
the operation of blisters, and the exhibition of an emetic, fol- 
lowed by purgative medidnes. 

.This affection was considered bv the patient as an effect of 
taking odd. Tha swaiUng and pam ware daa^i^d an attack of 
toothach. but without reason, as theia is no decay of any of the 
teeth. Before and about the period of the attaw, pains were 
«xp^ienoed in both aims and wrists, and ware cnnsinered rben» 
matic. Durmg two years prcviouslv to the accession of the aC> 
fectk>n described, this young ledy had tKperienced some gene*> 
ral indisposttioa, having been feeUe, nervons» and subject to 
difficukv of breathing and palpitation of the heart The catn- 
menia nad been somewhat irregular* Tie andes were affected 
with Gsdemaioas swelling in the evening of each day. 

The above case is deemed particnlaBy interesting, as it esta- 
blishes a distinct diagnosis between a spasmodie t^g^ctim^ and a 
case, verv similar in appearance, consisting ofAparafym of one 
aide of tne face ; a distinction which, it is thought, has been 
lometimes ne^scted. A further diMoosis, to which the praett« 
tioner must attend, consistB in the msttnction between a primfr> 
TV paralysis of the muides of one side of the face, occasioned by 
tne agency of external causes $ and a secondarv paralytic aibc- 
tion, the conseque n ce of internal pressure on the brain. 

fi. Remarks on the character and cure of Sycosis. 
' iSyeosis oecuia as a transient and as a permanent af&etion. 
The author is acquainted with two persons, in whom an appear- 
ance of sycosis is apt to reeur on the most osual el&ct of expo- 
sure to cold* The afiection continues ibr ten days or. kn»ger» 



iSir. X>r Hairs Confributions to Dtagnosts. 0g 

and' is reinoyed ^aduafiy. ft nsoally occupies tome part of the 
bentd on the oppef lip; It has not b<»en examined in its inci- 
pient eta^e. In- the tixro cases about to be descHhedi the afiec- 
tinn has been mofre ^rmanertt, havinor cbntihued in one during 
seven, and in (he other darinp; eleven years. In these eades, 
too, the afFectioii was seated prihei[Saliy on'the upper lip, point* 
inf( out the propri^y of emf>loy)n$f' the expression of Celsusj 
• in barba^ ' in preference to that of Sjfcosts mentis 

J. J. aged 54*} a framework-kiiitter, has been subject to the 
affection of the upper lip, (the appearances of which are about 
to be detailed), eleven years. Its commenceHient cannot be dis- 
tinctly described. At present the bottom part of the internal 
Bostrife is sh'ghtly sore and excoriated. Under the nostrils 
there is an irregular and interrupted scab on the borders and 
base in general, of which, there is a little induration, thidc* 
ening, aad redness of the skin. Surrounding this party there' 
are a nHober of distinct small suppurations, of which tiie fol- 
lowing circumstances may be observed. 

The centre of each of these points of suppuration is observed- 
to i>e occupied by a hair« This hair is surrounded by a little 
white or yellowish pnriform matter, about half a line in dia«^ 
ni^r; and, in its turn, surrounded by.redness^ tumour, and 
pain'of the integaments. This suppuration does not penetrate 
to the root of the hair, which still remains when the fluid is 
pressed from the little cavity. The scitb under the nostrils is 
sometimei removed, and the subjacent part is then occupied by 
a number of distinct points o( suppuration. 

The formation of pus is preceded by inflammation, and aa 
acute sense of itcbing and springing. The affection is usually 
aggravated in the summer season. No medicine, or applic»- 
tion, has erer provcxl of material or lasting benefit. 

Mr I. aged S4, first experienced a little excoriation about 
the noariis, and some part of the following affection of the beard^ 
seven years ago. The first point affectecT was the bottom of the 
right nostril i afterwards the eraption extended to the right 
part of the upper lip, subsequently to the left« and ultimately td 
the chin, and, in a slight d^ree, to the eyebrows. 

In the first in8tiMu:e, minute suppurations appeared at points 
on tbe iurface of the Upj of which each was occupied distinctly 
by a hair. A small portion of whitish pus was formed, increas* 
ing in ma^itude during about four hours, and attended by an 
jci^iog pain, which was relieved by washing with cold water. 

VOL. ziu. tfo. 49. X 



«6 Dr Hiir< Canirikdions io Diag!wu$. Jan* 

Sometimes there was e dq;ree of redness, but sometimes this 
was entirely absent In every instance, the removal of the |m- 
nilent matter leaves a small pit, the centre of which is occupied 
by a hair. The bursting of the suppurating point is followed 
by the flow of a thin fluid, which concretes, and forms a thin 
scab, removeable by washing with water. 

At present, there are permanent induration, redness, and tu- 
mour, along the bearded part of the upper, and immediately un* 
der the lobe of the under lip. On these inflamed parts, a little 
pus sometimes forms superacially, the centre of whidi is not 
occupied by a hair ; but, in eaoi distinct suppuration, the ap- 
pearance is invariably as already described. A point, occupied 
by a hair, is at present seen near each eyebrow. 

Having observed the fact, that the centre of each of the mi* 
nute suppurations described was occupied by a hair, and that 
the affection attacked those parts of the body onlv which are 
furnished with hairs,-— as the scalp, the upper lip, the chin, the 
eyebrow, — ^it occurred to the author's mina, that this cutaneous 
disease might be essentially an affection of their roots or bulbs* 
and that, if th^ were slowly but effectually plucked from their 
sockets, the tendency to future suppurations of the part might 
cease. The experiment was accordingly made in this patient, 
on the part immediately under the small lobe of the under I^». 
It succeeded perfectly, and the part became quite weU, as frcmi 
four to six hairs were plucked up from day to day. In this state 
the patient passed from under the author's care, fully determine 
ed, nowever, to persevere with this mode of cure. Indolence 
and carelessness prevented the patient, whose case is first de- 
scribed, from trying a plan of cure, which, like the many others 
be had employed* might prove unavailing, 

S. Description of a particular ulcer which appears on the 
nose. 

A small ulcer, aflfecting some part of the surface of the nose* 
and possessing the following characters, has occurred in foui^ 
patients who have fallen under the author's observation. It haa 
not, he thinks, been described. It must be distinguished from 
cancer, syphilis, sibbens, lupus, 3^. 

This ulcer is slightly irremilar in its circumference, but ap* 
preaches the circular or ovsl form ; the edges are little elevated, 
rather rounded, scarcely discoloured s the surface is uneven, the 
granulations moderately elevated, and rather pale in colour ; 
tiiere is no sul||acent or surrounding tumour, or induration ; no 
pain ; no increased sensibility. . This ulcer has appeared in twQ 
cases on the ridge or side of (he nose $ in two other cases it haa 



] 817. Dr Haffi Gmiributions io Diagnosis: 67 

divided tlie alao nasL In none, faowerer^ has it appeared to pe- 
netrate deep into the flesh. 

Of the two cases which appeared on the upper stur&ce of 
the nos^ one was cured by the ung. arsenici, the other by ap- 
plying the nitras arffenti, after the former remedy had appeared 
ineffectual. One of the casesy which divided the alse nasi, was 
treated with the ung. arseniciy which seemed to prove the canse 
of a violent attack of erysipelas of the head ; the other case 
healed under the employment of a stimulating ointment, not 
specified in the author's notes. Both the two last eases occur- 
red in very old penons. 

This nicer is distinguished from other ulcers of the nose^ 1* 
By the character given ; 2. By being unattended by morlnd red- 
ness, induratioui tumour, sensibQity, pain, subjacent disease, or 
affection of die bone ; S. Bj its slow progress ; and, 4. By its 
yielding to the local application of escharotics or stimulants. 

Dr i^ickson, formerly the author's coHeague as clerk in the 
Royal Infirmarv of Edinburgh, will rememMr oixe or more 'of 
die instances of ulcer of the nos% to which aOusion has been 
made in this paper. 

It has 'not hitherto occurred on any other part of the fiice. 
My friend Mr Toogood has also' seen this affection in two in- 
stances. He has favoured me with the following particulars of 
them/ Mrs R., aged 82, was afiected, some years ago, with an 
ulcer on the nose, which was removed by the application of the 
lunar caustic This uker recurred about two months ago. It 
was situate on the point of the nose, was of a circular figure^ 
about the size of a small sixpenny piece, unattended with pain» 
swdiing, induration, or redness ; it had an irregularly granu- 
lated suriace, of a ptle red colour, which became covered with 
a whitish incrustation on exposure to the external air. It heal- 
ed nnd^ the application of a solution of sulphate of zinc. Mr 
Toogood witnessed a similar case about fifteen years ago. It 
was situate on the upper part of the ridge of the nose, was long 
treated with emollient applications without advantage, and at 
length cured b^ being toudied with the sulphate of copper* 

4. Suggestion of a mode of preparing vegetable remedies. 

It has long been an object of regret, that all the modes of 
preparing and preserving the vegetaole remedies are objection- 
able, either because the process itself injures the remedy, or be- 
cause its subsequent preservation is imperfect. Dried vegetable 
remedies, extracts, tinctures, infusions, and decoctions, are all 
liable to one or both of these objections* And it is a great de« 



fig Dr- HbIYs ContrihutioHS io Diagnoiis^ J^n. 

sideraiom in pharmacy, to discover aopie mode. oF pr^aration 
that may be free from them. 

The plan which the author would surest for triali; is that of 
preparing and preserving these substaBCQS» without subjecting 
them to the previous operation c^ any external agent whatever, 
by which tneir virtues maybe impaired. In'tnQcase of digi* 
talis, cicuta, hyoscyamus, &c. he. has taken the fresh herb, col- 
lected free from dew, and, having rubbed the leaves into the 
finest pulp or paste,, he has simply* formed a suSicfeptly consist- 
ent mass, by' the addition aad careful intermixture of dried 
aoap. 

In this manner the vegetable may be long preserved ; and the 
advantage is obtained of administering it throughout the year 
10 its pristine state, and without having previously subjected it 
to any process, or to the agency, of any substance by which its 
virtues might be destroyed or enfeebled. It mav be administer- 
ed in the form of pills, or mechanically suspended in a draught 
or mixture. 

Time must be aHowed for subsequent experiments on this 
subject. At present the author contents himself with suggest- 
ing this, mode of .preparing an^ preserving vegc^ab]^»to those 
members of the profession who- may feel mteresled in the in* 
quiry. Perhaps some other ' article may prove preferable to 
spap, with the view of preserving vegetable substances without 
subjecting them to the operaUoQ of beat, alcohol,^ or other che« 
mical agents* 

November 20^ \S16^ 



1817. 69 



PART II. 

CRITICAL ANALYSIS. 



I. 

jR C H^uelbachf M. Z>. in Theatro Anatomico Wirceburgensi 
ProsectariSf sac. phys, med. Eriang. Membri^ DisquisUiones ana^ 
torritco ptUholc^icae de Ortu et Progressu Hemiarum inguinal 
Hum et cruralmmy accedit Descriptio instrumentif haemorrha'- 
giis stJ> hemiotomia ortis et secure detegendis^ et sistendU 
apti^ icmibus iUmtrata. Latiniutc dooavit Th. Aug. Rir- 
LAND* Med. D. et. Pjrof. P. 0. 4U>. Wircebnrgi» 1816. pp. 80^ 

npHERE are few sargical diseases which occur so freqaentl}% 
-^ and are more complicated, than ingoinal and crural hernia^ 
Thar origin, diagnosis, and method of cure, have equaiiy oo- 
eopied the attention of the ancient and modem surgeon. When 
obsenrationa were made without accorate anatomical knowledge^ 
coDsklerabie obscurity necessarily prevailed. Thus, for exam* 
pie, the epigastric Mtery was observed to be situated, sometimes 
on the inner, sometimes on the outer side of the hernia ; but 
the cause of this variation was unknown, and from hence arose 
the difference of opinion among surgical writers, as to the di* 
rection of the incision of the inguinal ring. The accurate in« 
vestigatioxi of the tumour, formed by the neck and body of 
hernia in the external inguinal region, attention to its direct 
Cion, and to the variety of the situation of the spermatic cord 
and epigastric artery in the healthy and morbid state, have 
removed all the uncertainty and fears which frequently filled 
die mind €)t the surgeon when operating for this disease. 

The author of the work now before us, about ten years agOf 
published a short account of inguinal hernia ; * aqd, after seven 

* Anatoraisch-chirurgische Abhandlung liber den Ursprung der 
Leistenbruche, mit 4« Kupfern. Wurzburg, 1806. 



70 Dr Hendbadi m Hernia. Jan. 

yean fbriher inTestigstion and experience, this work appeared, 
now translated into Latin by Dr Ruland, with many rafaiable 
additions by the author. 

Most of onr readers are aware that Heaselbadi, * in his 
description of inguinal hernia, divides it into two spedes, the 
internal and external^ or, in the more accurate hmguaffe of Dr 
Barclay, the mesial and lateral. The internal inguinal hernia, 
b what is usually termed in this country oen/ro-ffigtttJia/, the 
viscera passing directly through the anterior ring ; in the exter-' 
nal inguinal, they protrude alon^ die whole inguinal canaL 

In the commencement -of diis work, we have an accurate 
description of the anatomy of the abdominal parietes, and of 
the usual places where hernia protrude ; but we conceive it un« 
* necessary to recapitulate- thi^ part, as it coincides with that of 
Scarpa and Cooper, of which, in former numbers of this Jour- 
nal, we have given veiy minute details : We shall therefore pro- 
ceed to lay tefore our readers a full account of the author's 
observations on the origin of inguinal hernia, and of his divi- 
sion of it into external and internal^ which is of great import- 
ance in the treatment of this disease. 

On the inside (central aspect) of the inguinal region, the 
author observes that there are three places favourable to the 
fonnation of hernia. The first is the nearest to the inner 
(mesial) angle of the triangular surface of the groin, lying 
opposite to the anterior inguinal ring, covered only by thin 
fiucicnli of the internal oblique musclei and, bdiind these, is the 
weakest part of the internal inguinal limment. The perito- 
naeum passing over it is loosely oonnect^ to it fay cellular sub- 
stance; but although this is the wedcest part of the abdo* 
minal parietes, hemiae rarely occur at this place. The second 
is at the external (lateral) angle of the triangular plane, under 
which is the fossa for the inguinal vessds. This fossa is not 
guarded by any muscular fibres, but merefy by the peritonaeum 
and loose cellular substance i it is wider in females than in the 
males and hence the more frequent occurrence in them of 
hernia at this part, or crural hernia. The third phce whete 
hernia originat^ is at the posterior (lateral) inguinal ring. In 
most men this ring is closed by Uie peritonaeum passing over it i 
but there are a considerable number in whom an oblong round 
opening is found, corresponding exactly to the posterior ingui- 
lud ring, into which the peritonaeum penetrates like a mem- 



* See Scaq^*s Treatises on Heinia, p. 82. 



1817. XkHeagOMdi OH Hernia. T\ 

branoitt tabe» and this opening arises (torn the upper part of the 
Paginal process net having closed after the descent of the testt- 
tie. At this part hernia in the male most frequently appears. 

From various observations, the author was convinced of the 
existence of these two species of inguinal hernia, each of which 
follows its own course^ although they have a common exit from 
the cavity of the abdomen, by the anterior (mesial) inguinal 
ring. From the circumstance of the situation of their origint 
he was led to denominate them irdemal (mesial) and extermd 
(lateral) inguinal hernia. Each of them is marked by particu<- 
lar appearances of the inguinal region, and therefore the snr«- 
geon wiO easUy determine to which species they belong,— a point 
of importance with regard to the taxis, the application of a truss^ 
and the performance of the operation* 

External (lateral) inguinal hernia is much more frequent than 
iniemal (mesial) inguinal hernia. Of an hundred cases, more 
than nine^ are stated to belong to the former. Extehud (la- 
teral) inguinal hernia is more frequently observed on the right 
aide than on the left ; the vaginal process of the peritoneum re*> 
maining longer open on the right side. 

The author enumerates the following as the LHagnostie it/m* 
pUms of external inguinal and scrotal hernia^ 

* Tumoris Diredio^^Sacd hemialis collum, ab intestinis prdlap^ 
as extensuin, parietem canalis inguinalis anticom, simulque integu* 
menta conmiunia incumbentia in tumorem oblongum attollity oUique 
introTSimiy deorsumque aanulum inguinalem anticum versus deOurren- 
tem, atque ante hunc in tumorem corporis sacci hemialis desinentem. 
Cojus tumoris prindpium ante planum annuli inguinalis postid recta 
positum, annulum inguinalem anticum versus sensim, sensimque altiua 
evadit, latiusque ; quo plura intestina fuerint prolapsa, quoque majua 
sacd hemialis corpus evaserit, eo distinctius tumor obliquus CenVitur, 
prsdpue coUo natnralem nacto longitudinem. 

* Prout saccus hemialis et, ex conse^uentf, collum quaqiie sacci 
hemialis breviom evadunt, pariter tumoris longitudo minuitur, at- 
que, canali ingutnali licet penitus aboleto, planum tamen annuli in- 
guinalis postici crurale, cui|ique hoc ilia colli sacd hemialis extensi 
pan restat, que directionem tumoris oMiquain, extrorsum sursum- 
que tendentem, in regione inguinis extema manifestat ; absque haic 
colli particula tumoris ad annulum inguinalem anticum ambitus lequo, 
ac in hernia inguinali interna, orbicularis compareret. ' p. Sa, d9. 

The author points out a cause of error in judging from the 
direction of the tumour alone, where an imperfect external (la- 
teral) inguinal hernia is complicated with an internal {meuBiyt 
An accurate investigation wiU show the eatistence of the double 
hernia, the boundary of each species being marked by an inier« 



72 Dr M^ssdibBcli on Hernia. hn^ 

mediate depression or furrow ; and if it' sjiould happen tbat 
either species is reducible, the existeuce of the other is th^more 
evident. 

The 2d diagnostic symptom is the posUion qf the Jleshy 
bundles of the cfema^ter mmcle. — These are observed running 
over the anterior part pf the hernial sac in an arched form ; and 
the author says that he has not hitherto noticed, them in the 
internal hernia. 

3. The situation of the ^ermatic cord and testicle. — The va- 
ginal process of the peritoiiaeum is situated before the spermatic 
cord in its whole course, from the posterior (lateral) inguinal 
ring, downwards to the testicle $ and the peritonieuro, forming 
jthe tjernia) sac, advances in the same way, and retains its situa- 
tion anterior to the spermatic cord and testicle. 

• • ^ Quum jam hernise scrotalis extems saccus hemitdis intra toni-' 
cam vaginalem commuDem solummodo ad testem usque descendere 
possit, consequens est, ut tcsticulus membrana vaginaU propria hiro- 
lotus fundo sacci hernialis immediate subjaceat, et vasa spermaticat 
f xtra saccum hernialem expllcita parieti ejus postico appliceutur^ 
adeoque venae Spermatlcse extrorsum, introrsum vero vas deferens 
et in medio arteria spermatica disponantur. Quare sacco hemiali 
profundius descendente testiculus seque, ac saccus herniaUs, tunica 
vaffinali communi inclusus riusquam evadere poterit, sed a sacci her- 
niuts fundo magis etiam deprimetur ; sed semper fere fundo, paulum- 
modo retrorsom, subjectus reperletur. Hernia inguinali externa pra*- 
aente fiuiiculum spermaticum, cum modice ilium intenderisr, pone sac- 
cam hernialem positum exquisite invenies. Funiculi spermatici et 
testis situm, neque minutf obliquam tumoris difectionem, duo prteci-' 
pua signa habeto, qtiibus ductus quodvis hemiarum inguinalium genu9 
secure contintto dignoscas. ' p/ 31. 

4. The situation of the epigastric fl;7^.r-Considerin;» the 
natural course of this artery, we are led to conclude that it 
should always be on the* inner (mesial) side of the neck of thi? 
hernial sac in this species of hernia. This conclusion is war« 
ranted by the presence of the other dia^vnostic symptoms, for 
the fact can only be ascertained afteii death. 

5. The origin of the hernia. — We learn from observation that 
hernittf aomeiimes arise withoot any evident occasional cause, 
or from one so slight, that we would scarcely conceive it capable 
of producing them : in this case the predi^ponent causes must 
necessarily have the chief influence in producing them. 

* Tali modo hernia congenita, ad hemit^ extemce genus referenda. 
iepe oritur ; quae ab hac eo solummodo discrepat, quod iutestina 
prolapsa et testiculus tmiica sua vaginali orbus uuo eodemque sjicca 
•ontinaanter ; nempe tunica tesliculi va^nalis fundum sacci hi:rniali«» 



18I7« Br HeBseBwdb m ffemia. i% 

eficit, ipseqne testis fiindo Infra impoflitin est. Ereniente forsitaA iih 
carceratioQe saccm hemialis utrinque fl?quabilHer tenstts est,- neque ul- 
iuBi testis in sacci hernislis fundo vestigium ; quo signd dupiici her- 
nia congenita ab hernia scrotali externa communt facile distingui po- 
test ' p. 32. 

6. T/ie preternainral stntctnre of Ihe hody of the hernial wrc,— 
This only occurs in the process of the vaginal peritonseum, and 
never in internal scrotal herniay because it is only in ex^mal 
hernia that the sac is formed of the process of the vaginal per^ 
tjnseum. 

* Quodsi processus vaginalis post partuni apcrtus restiterit» atque 
cxigua tantuni sui parte extra unnulum inguinalem anticuxn fuerit 
coarctatus, quin pen it us claudatur ; pars inferior adhucdura amplior 
tunicam testis vaginalcm, superior vcro accidente intestinorum ppo- 
lapsu saccum heniialem constituet i turn vero tunica vaginalis et sac- 
ci hemialis cavitates parte coarctata quidcm, sed nondum penitus 
clausa inter se correspondent, atque in tunica vaginali humor aqueus 
cdligi consuevtt. Qualicunque demum causa occasionali intestino- 
rum sacco hernial! cont^ntorum portio per partem angustatam in tuni- 
cam testis vi^'nalem detrudi, ibique incarcerari potent* ' p. 3d. 

After describing the dificrent parts formit^ the hernial sac, 
the author observes, that certain viscera are more frequently 
met with in inguinal and scrotal hernia of the right side, an4 
others in that of the left side ; and he then proceeds to the de- 
scription of the treatment of external ingujnal hernia. 

* Cognito signuB memoratis hernise genere, chinirgus hemis extemft 
tnedelsum facile poterit administrare i quippe pressionem, reponendii 
intestinis prolapsis impendendam, pro directione, quam collum sacd 
hemialis ipsura sequitur^ nempu oblique extrorsum, sunumqoe ante- 
riorera crisis ossis ileispinam versus, dirigat, necesse est; coUo autem 
hemis valde brevi, et pariete canalis inguinalis postico abolito, pre8-> 
sionem fere ex antica parte retrorsum instituere oportet. Hernia ritD 
reposita bracherio conveniente retineri, ejusque sequels averti pos* 
sunt, ubi potissimum pila hemis inguinali cxtems longo sacci her- 
nialis collo prodeunti ita adaptatnr, ut non solum in annulum ingui* 
nalem anteriorem, sed in collum quoque et annulum inguinalem pos- 
teriorem pressfonem exerat ; quod si vero sacci hemialis collum per- 
breve fuerit, forma pils talis, fere sit, necesse est, qu^is hemis in- ' 
guinali interns convenit. ' p. 35. 

If strangulation of the hernia supervenes, and cannot be re- 
moved by any of the usiial means, we must have recourse to the 
operation, on which poiiit the author gives the following direc* 
tions. 

^ Quuin, prsesente hernia externa, arteriam epigastricam inferiorem 



74 Br HeitdlMidi cm HeruUu Jan. 

pone sacci hemalk coUam sitaniy in latere iprius interno semper fl- 
scendere, conatety annulus inguinalia anterior, gacci hemialia coUum, 
et urgente necessitate, annulus quoque inguinalis posterior oblique 
extrorsum sursumque absque uUa hsesttatione incidi poterunt. 

* Quodsi vero annulus inguinalis posterior anteriori ex directo forte 
adponatur, quo scilicet fit, ut hernia inguinalis externa intemie red- 
datur similior, sique tali in casu chinirgus circa sectionis diree- 
tionem dubius hsereat, via potius media est eligenda : nempe annul! 
inguinalis antici cms vel internum, vel superius ita in medio, rec- 
taque sursum incidendum, ut sectio linee albae abdominis sit paral- 
lela. ' p. S6. 

Of the internal (mesial) inguinal <fnd scrotal hernia. 

This hernia arises at the inner (mesial) angle of the triangu- 
lar surface of the groioi where the peritonaeum u extended into 
a slight oblong fossa, supported by the weakest part of the in- 
guinal ligament and some fibres of the internal oblique muscle. 

* Peritonaeum igitur hoc loco causa quacunque occasionali irehe- 
mente magis tensum cum intestmis retro positis a parte postica an- 
trorsum recta protrusum ligamenti inguinalis intemi fascicules inter 
et lacertos musculi abdominis obliqui intemi cameos, ad latns funt- 
culi spermatici internum tandem per annulum inguinalem andcum 
prolabitur, moxqiie ampliorem in saccum efformatur, qtu integup 
menta communia in tumorem elevat, super annulo inguinali antico 
ambitus orbicularis forma comparentem. 

* CoUum sacci hemialis perbreve, immo brevius, quara in hernia 
externa esse possit; ligamoiti inguinalis intemi non minus, quam 
musculi abdominis obliqui intemi foramen, per quod collum direc- 
tione recta retro antrorsum ad annulum inguinalem anticum transit, 
orbiculare atque in aliis angustius, in aliis vero ampllus est. ' p« 37* 

After some pertinent observations on the causes of the dif- 
ferent appearances of this and the preceding species of herniat 
the author proceeds to treat of the diagnostic symptoms, which 
he limits to three, viz. the situation of Uie tumour formed by the 
body of the hernial sac, immediately before the anterior (mesial) 
inguinal ring, the situation of the sprmatic cord, and the 
course of the epigastric artery; and describes them in the fol- 
lowing terms. 

< Turner^— ^uum collum sacci hemialis sit perbreve, neque hsec 
hernia ita, uti externa consueyit, obliqua, sed recU directione a parte 
postica antrorsum per annnlum inguinalem anticum prodeat, sacdque 
hemialis corpus directe ante ejus collum ponatur, accidit, ut ne mi- 
nimum quidem tumoris extensi sacci hernialis colli vestigium obser- 
▼etur : qnare nuUus tumor conspicuus est, pneter ilium, qui, corpore 
sacci hernialis productus, brevi ante annulum inguinalem anticum 
ambitu satis rotundo apparet« Jamque ipsemet colli situs, herniam in- 



1817. Dr HessdMh m Hernia. 75 

tcamam praprias, quam externaii), ajwafhysi ommn pubis adjacere, 
indicat. Hoc tumore excepto, in. sexu sequiore nullum herniae in* 
terme signum externum habetur. 

* Funiculi spermatid 8itu8.-*Principio quidem saccus hicce hernia- 
lis ad annulum inguinalem anticum usque vaginali funiculi spermatid 
timica conununi excluditur; ad annulum vero inguinalem anticufn 
inter funiculum spermaticum, tenuemque tunics vaginalis communis 
aponeuroain descendit, qua, licet imperfecte et inaequali firmitudine» 
circumdatur. Nempe stratum hujus vaginalis tunicee communis te- 
BuiiiB latm sacd hemialis intemo, crassius vero lateri antico et ex- 
temo incumbit. Fasdculi cremasteris camei descendentes stratum 
tunics vaginalis communis crassius solimimodo comitantur. Denique 
Ibniculus spennaticus aut in latere extemo, aut in medio lateris an« 
tid extemo situs est, ac vasa quidem spermatica sanguifera antror** 
sum, et vas deferens retrorsiun collocantur. 

* Arteriae epigastricae inferioris situs. — De hujus arteriae situ> nisi 
aignia pnecedentibus diagnostidsi certus non evades ; plerumque in 
latere colli sacd bemialis extemo oblique introrsum, ngroque lusu in 
ejufldem latere intenio ascendit ; atque lianc a cursu solito aberratio- 
nem in cadavere foeraineOy herniam labialem intemam exhibente, ob- 
aervatam supra, regionem scilicet inguinalem intemam describensi 
jam memoravL ' pp. S9, 40, 41. 

In the taxis of die internal (mesial) inguinal hernia, the pres- 
sure ia to be made in a straight direction from before, back- 
wards and upwards. The pad of the truss for retaining this 
hernia, can exercise no force on the neck of the hernial sack ; 
but its action oueht to be directed solely on the anterior (mesial) 
inguinal ring. In the operation, the surgeon req^uires to use 
particular attention, in order to avoid wounding tne spermatic- 
cord and epigastric artery ; on which the author very judiciouS"- 
ly observes, 

' Ut funiculi spermatid laesio evitetur, sub cutis in latere hemiae 
antico incisione directio obliqua, superne introrsum, deorsumque 
abiens, servanda est. 

* Plerumque arteria epigastrica inferior in latere colli sacd hemf* 
ailis extemo, perraris tantum in casibus in latere ejusdem intemo a- 
soendit. Ergo plurirais in casibus hujus arteriae laesio> sectione per 
eras amnili inguinalis antici superius oblique introrsum sursumque 
facta, tutissime evitaretur ; sed eadem incisione arteria quoque laedi 
posset, siquando intemo colli sacci hemialis lateri a^aceret. — Quae 
aberr^o quum nullo penitus signo cognoscatur, in quavis hemia in^ 
tema cms annuli inguinalis antid superius medium rectaque surtum 
inddatur, oportet. pp. 42, 43. 

We have endeavoured to give a fuH account of the author's 
very accurate description of these two species of hernia, which 
we have been induced to extend Co a greater length than we at 



76 Dr Hesseibacli on Hernia^ Jan. 

first intended, firom the importance of an accurate didgnosi?, 
and from observing that he mentions some cincumstances not 
so clearlj explained by other writers. He next proceeds to the 
subject of femoral hernia ; and, in an appendix, has inserted a 
description of an instrument for the discovery and stoppage of 
hecmorrhnge from a wound of an artery in the operation for 
hernia ; but for these we must refer our readers to the work 
itself. 

This work is accompanied by seventeen engravings, from 
drawings by the author, which give a very accurate view of the 
anatomica] structure and of the usual appearances of this dis* 
ease ; and they, in particular, illustrate the origin and progress 
of the two species of hernia, in a simple and intelligible manner* 
In some respects they possess a superiority over the plates hitli^* 
to puhfished on hernia. Scarcely inferior to the original plates 
of Scarpa, in point of engraving, by representing only the parts 
essential for«the explanation of the subject, thev are reduced to 
a convenient and useful size, while they infinitely surpass in difr- 
tinctness all attempts to reduce view^ of so complicated a subject 
to our octavo form. 

Upon the whole, we consider this work as a valuable addition 
to our treatises on hernia ; and trust that Dr Ruland will not 
be disappointed in the views which induced him to render it ac- 
cessible to those who are not acquainted with the German lan- 
guage. 



11. 

Medicaid Geographical, and Agrictdtural Report of a Committee 
appoitiied by the Madras Government^ to inquire into the 
Causes of the Epidemic Fever xohich prevailed in the Provinces 
of Coimbatore, Macbira^ Dindigul, and TinniveUy^ during the 
Years 1809, 1810, and 1811 : of which Dr W. Ainslie was 
Presidents Mr A. Smith, Second Member; Dr M. Christy, 
Third Member. Svo. London, 1816. pp. 170. 

'T'his is a most valuable little volume. It is almost a perfect 
-*• model of medical topography. It is an inquiry into the 
nature of an epidemic fever, which was of several years dura- 
tion, occasioning the death of no less than 106,7 69 person>. 



1817. On Oe £pidmic Fever in India. n 

wad roiakig tbe cooatitatioii of many tbotmaBds. Such epide* 
mics are not UBGommon ia our Indian dominions, apd, at timesp 
have been attended with the most unhappy consequences; and, 
therefore, we cannot conceive a more noble application of me« 
dical science, than the investigation of the causes of so much 
evil, and of the means of lessening or obviating them. The re- 
commendation of this dangerous and laborious task to their me* 
dical officers, — the furnishing of them with every assistance to 
complete it, — and the leaving nothing undone which can render 
it successiul — are obligations imposed upon the Honourable East 
India Company, by the circumstances in which they are placed* 
The benefits resulting to the natives from their being success* 
fiilly discharged, is one of the circumstances which has a ten* 
denqr to reeoiicile the occupation of these distant lands with tbe 
prindplea of natural justice* Tbe very able manner in which, 
in tbe present instance, the medical officers have fulfilled that 
part of tbe great public duty entrusted to them, has given then 
a strong claim upon tbe gratitude of the Company, the inhabi- 
tants of the East in general, and of science. 

In tbe first section of their Report, the committee give a geo« 
graphical description of the provinces in which the epidemic fe- 
ver prevailed, with some account of their climate in healthy 
seasons, of their agricultural products, and of the relative con- 
dition of their native inhabitants. The second section contains 
an account of the climate since November 1808, contrasted 
with that above mentioned, and of its effects on the cultivation 
of the soil. The district which engaged the attention of the 
committee, and which suffered most from the ravages of the 
feyer, was tbe western side of the extremity of the peninsula of 
India, ftomL Cape Comorin on the south, to tbe great southern 
ghaata of Mysore, on the north; and from, the chain of moun« 
tains which divides the peninsula longitudinally on the west, to 
the Coromandel coast on the east. This country lies between 
the T?"" and SO^ east longitude, and 8* and ll'' SO' north lati* 
tude. The provmee of Coimbatore is' an open elevated country, 
about 900 feet above the level of the sea. Its soil isi in general, 
dry, and well cultivated; but, in the* vicinity of the bills, (here 
is. much unhealthy, low, marshy ground. Its towns are well 
built and populous, and the situation of the inhabitants is com* 
fortable. In the town of Coimbatore, cutaneous affections, 
ascribed to its well-water being brackish, are common araonrrst 
the poorer inhabitants, who cannot afford to bring it from the 
Noel, distant about a mile. Dindigul district is mountainous 
and woody, elevated about 400 feet above the level of the ocean. 
Its towna are not so well built, and its inhabitants not so com** 



78 On He Epidemic Fever in India. Jan. 

fortable. Madura is still lower. It is an open country, and 
very dry. Tinnivelly is considerably lower than any of the 
others, as it forms half of the point of the peninsula. It is, ge- 
nerally, an open country, but contains several waste and jungly 
tracts. 

' The same peculiarity is to be observed in this, as in the Madura 

Erovince, viz. that all situations lying at a certain distance from the 
ills are much higher and drier than Uiose which are nearer to them ; 
— a fact we had occasion, in several instances, to remark, on our 
journey from Madura to Courtalum, {M Strivulputtore), as well as 
to note the consequences of it, but particularly with regard to the 
villages of Tewancootsie and Culpettie, in the northern part of the 
Streevulputtoor talook. The latter, standing in a fine elevated coun- 
try, was comparatively comfortable, and die inhabitants healthy; 
whilst the other, due west from it, and close to the high lands, was 
found nearly surrounded with wet ground, damp, ruinous, and almoat 
dq^pulated. ' p. 17. 

Towards the southern and eastern extremity of the penin* 
aula, are many salt marshes, four of which, formerly distinct, 
are now united together, owing to the late inundations} forming 
one great marsh ten miles in circumference. 

^They are separated from the sea by high sand-biUs, have no na- 
tural'dDmmunication with it, and lie at unequal distances, of four to 
thirteen miles from it. In common years there is not much water 
collected in them; but, smce the heavy monsoon of 1810, and more 
especially since the rains which fell out of season in February and 
March, they have been filled to a considerable depth, (five, seven, or 
ten feet ;) and the water, by remaining long in a state of stagnation, 
has been productive of infinite mischief. In December 1810, the in- 
habitants of the different vilhiges which are contiguous to Uiese briny 
swamps complained that their houses were rendered uninhabitable ; 
that most of their cultivated lands were flooded; and that the water 
had risen so high on their palmyra-trees, that they were prevented 
from drawing toddy. To remedy these evils, Mr Hepburn (coUec-* 
tgr of the province) gave orders that a cut should be rasde from the 
fQur united marshes to the Cumyar River, which rises in the Cal- 
caud Hills, with a view of diverting the 8iq>erfluous waters from th^ 
dplpged country. The cut was made, and for a time ansyi^ered the 
purpose intended ; but the spbs^uent rains in February and March 
last, unfortunately, by occasioning fresh floods and a new pressure, 
choked up the opening. Since that period, and from the time of the 
weather becoming drier, every exertion has been made to drain the 
country, and reheve the suffering inl^bitants. ' pp. 21, 22. 

. The climate in common years is next minutely detailed, and 
well deserves the.penisal of all who intend to visit our Indiai) 
settlements, or who are inlerebted in medical geography. W« 



n$i7. Oa Oe Epidemic Fever in India. 7» 

«Klract the fioUowiiig description of a ringolarly favoured situa- 
tion in these torrid countries, in the hopes of rendering it more 
geiMraUy known to the invalids of India. 

The cool retreats of the province of Tinnivdly are Courtaluin 
and Tritchindoo. Earljr in June, after the beav^ rains of Ma* 
labar have commenced, is the proper time to visit the former. 
The climate is then truly delightful to the feelings of Europeans, 
and continues so till the midole of October. 

^ Previous to the conflux of the Tamba-rapournie and Sytar, the* 
former is joined by several tributary streams. The latter, which is 
the smallest of the two, rises amongst the hills immediately north of 
Poolieiy, at the eastern opening of the Airangowel Pass. Soon af- 
terwards, it is united with seveial rivulets : The most remarkable of 
tiiese is that which, by its Falls, creates the celebrated Courtalum 
Cataracts, and which rises in the mountains that form the southern 
nde of a kind of recess, here produced by the retiring of the great 
ghauts, and distinguished for Uie singularity of its climate, particu- 
larly to be described in another part of this work. This recess is in 
width about twenty miles, and at its greatest depth, from its eastern 
opemng to the Airangowel Pass into the Travancore country, about 
half that distance. The pass itself through the hills is very narrow, 
and may be reckoned in length, in a direct line, about ten miles i 
from its eastern extremity to the western ocean, it is nearly forty. 

^ Courtalum is not only the name of the Falls, but of a beautiful 
Sheva Pagoda, situated close to them, at the foot of the mountains. 
The Recess, or Valley, as it is called, has, of late years, been suffi- 
ciently cultivated ; and the hills, which bound it on the north, west 
and south, are grand and lofty. The scenery about the Pagoda and 
Falls is sidilime and picturesque, and bears a strong resemblance to 
some of the most romantic situations in Switzerland, where wood and 
water, rocks and mountains, combine to aggrandize the landscape. 

* The greatest height of the lower fall or cataract is nearly 200 feet. 
There are two others, formed by the same stream, higher up the 
mountains, and not less beautiful and interesting, though much more 
difficult of access. ' pp. i8*-20. 

* Owing to the great depth of the Courtalum Valley, as already 
described, it approaches so much nearer to the Malabar coast than 
other situations along the colirse of the hills, that those clouds, which 
under other circumstances would have expended their waters amongst 
the immense mountains, here pour a great part of their rains ; ex* 
tending to this recess, in a considerable degree, the climate of Mala- 
bar ; with thia &vourable exception, that it is not at this time by any 
means so damp, notwithstanding the very luxuriant vegetation which 
is seen in every direction, and the showers that fall £uly, attended 
with a strong cool west wind. 

* The difference of the thermometer betwixt Courtalum and Pai 
lamcotah is, in general, about 10°; that is to say, while in June or 
4uly the tempcrjiture at the former is 75"* at 7 A. M, and 79"* at 2 P. M. ^ 



A On ike Epidemic Fever in India, Jan. 

it h ftt I^alameoUh, at the same hours, 85^ and 89^; so^thni, dttiing^ 
tbe hot weather at the last mentioned stadan, the feelihgof com&rt 
expcriencvd on quitting it, and visiting Uiis channing retreat, k won- 
derfaU Such is the bracing effect of the cool air b^e, that exercise 
ean be taken without doors at any time of the day,, and amu^pients 
pureued >vith as much pleasure as in England, as the sky is sJmost 
constantly overcast ; and if a person does by chance get wet io a 
shower; there is no danger of hi^ taking cold in consequence, so great 
is the natural dryness of tiie atnio^here. 

* What conducts much to the restoration of invalids at this shi- 
gular abnde, is the little waterfal, under which most of the Europe- 
ans daily bathe. This cataract is, by a division in the rock above, 
jreparated from the greater one; and is not more than thirteen or 
fourteen feet high. The falling of the water, after the first shock is 
over, gives an indescribable feelrog of pleasure- By its constant 
beating, it quickens the circulation, and produces a fine glow all'over 
the body; and has, besides, the further good effects of dispellmg Ian- 
gnor, raising the spirits, exciting appetite, and promoting digestion, 
in a superior degree to any other kind of bathing that we are ac- 
quainted with. It has, in consequence of these virtues, together with 
the delightful cli.nate of the valley itself, been the happy means of 
rapidly restoring many to health and comfort, who, previous to their 
visit to Courtalum, appeared to be hastening to their graves. 

* But it will be necessary to remark, before taking leave of this 
wonderful recess, that, however excellent may be the climate here in 
the months of June, July, August and September, it is far otherwise 
^Turing those of February, March, April and May. Partaking as it 
does of both monsoons, there is much rank vegetation in it; but, 
from its singular topographical position, it is altogether, or in a great 
i^oa'^ure, deprived of the salutary influence of the southerly winds, 
which alone, at this season, could purify the air, distempered as it then 
becomes by much moisture and unventilated jungle. The conse- 
quence of this is, that, in the last mentioned months, the valley is hot 
and sultry to the greatest dogree, and never fails fo be most unhealthy. 
Indeed, endemic fever, at such times, is as certainly met with here as 
at Gambia or Senegal. 

* This peculiarity in the cKmate of the Valley of Courtalum we 
particularly beg leave to impress upon the minds of our readers, as it 
bears an exact resemblance to that whi^ shed its malign influence 
crver the southern provinces of the Pem'nsula about tlie end of 1810, 
and during the first months of 1811 ; when unusual rains occasioned 
inordinate moisture, and the deficiency of the southerly wind pro- 
duced stagnation and morbific miasma. ' pp. 56-«-60. 

The committee next describe, with much precision, the pe- 
culiarities of the climate during November 1808; and the re* 
suit is summed up in the following paragraphs. 

* From the account which we have given of the climate of Coim« 
batore; Dindlgul, Madura, and Tianivelly; for the last Jthree years^ 



2M7. B^iieEjridehiie F^eer in Udla. 81 

k nOl r«adiif.be allovred, that the di&reiit seasons, duting that pe- 
riod* hai^ varied much frem their usual course ; inordinate rains have 
Bucceeded to unooaunon drought ; the N. £. wuid and Land-wind 
kave beep weak* as weU as of unusual duration ; the moBit distressing 
kills have alternated with sudden and chill blasts from various direc* 
lions ^--and, bat of all, and what apfiears to have brought the mis* 
chief to a. crisis, heavy rains and close sultry weather have been seen 
to take place at these times which are usually distinguished by dry- 
ness, and those ventilating breeses* which exhale the superfluous wa- 
ters fromlow and marshy situations, and dispel the dews and vapours 
whidi wt sure to pesvaii after the ceasing of the N. £. monsoon. 
lAkut there has been oonstiluted mi extraordinary and uanatunii state 
of the ataHiisphere,'ever3rwhere unsalutary, in the. tracts in which it 
vraa produced, « or inte which distempered miasmata may have been 
caffned by partaeular teurk^nts ai air. 

* ThestaghatioD, vege^ble putrefaction, dampness, filth, and of" 
fieasive eAuvio/ the natural consequences of what we have just stated, 
have ptoved evilft of ^no small consideration, particularly in low or 
ill-ventilated situations^ 

< The second. Member of this Committee, in travelling from Dara- 
poram to Dindigul in the beginniug of June, and on passing along 
the haokf ^ several marshy tanks, as well on the western frontier of 
the first-i9eDtioned district as in tjie Toddy-Comboo taLook of tlie 
second, was assailed bya^ noxious and sickening exhalation, which 
somewhat resemUed bi{ge*wiater. And the President and tliird Mem- 
ber experienced exactly the saa»e eflect» from similar causes, towards 
the end of the same mouth, . in passing from Towerincourchicto Cot« 
tampetty m the Madura province ;. tmd again, for several mile$» on 
the road leading through, and on the. north side of, the large and 
beautiful town of Streevulputtoor in the Tinniyeily Qp'untry. 

* It can be easily supposed that a continuance of unseasonable 
weather, for several years together, must, with other bad consequen- 
ces, have proved injurious to the cultivation of the soiL In Coim- 
batore, however, which is diiefly a dry graib country, in which su- 
perfluoui water is quickly carried off into rivers and nullahs^ this 
has not been conspicuous ; and, by Mr Garrow's returns, it does not 
appear that any particular sicAmess has prevailed amongst the cattle 
of that dislrict, of which he is the Collector* 

* With r^aid to the Dindigul country, we had'oocasion, while 
there, to observe, in t&emoatb of April last, that so general was the 
Btckuess, and^ao great had been the mortality, tlial Uie ^umbali crop 
of pa d dy wa s actuary, in some: places, rotting on the ground, from 
want of hands to cut it down : and Mr Peter (Collector of the Ma- 
dofa and IKiidigul districts) informsTUs, that many< thousands o^ cat- 
tjehave died in the different divisions under his management, since tlie 
epidemic first commenced; as much, we are inclined to think, in 
consequence of the unnatural state of the air, as from a scarcity of 
hands to feed and ^ake care of them. 

vuL. xai. NO* *y. f 



8S OmOeEj^demieFeoerinBiiku 3nu 

* In TbrnnFeUy we imdentand, firom Mr HepiMini» thai not few* 
er than 44,273 builocki have died imce the beginning of FcbrMry 
last ; not so much from anj piiticular disease, as from an excess of 
moisture in the air, and a want of people to take care of tbsm. Mr 
Hepburn has further infonned us, that the great oMofiMi or la oilflt 
crop, which is gathered in February and Marcfs was got v^ in • 
much less perfect condition than usual, fVom its being so Aequenti}^ 
wetted, and from the inhabitants being under the neoesuty of eultfay 
it down before it was quite ripe ; owing to the dread they entertain- 
ed, that, if they allowed it to stand longer, dieywould lose grant part 
of it, from die violence of the rains. Such stunted and tnanalurs 
grain, when stacked, was apt partiafiy to fimnent and get heated^ 
whidi rendered it a modi less wholesome filed than if it bad been 
cured in a better state : and he further iaferms us, that so genenl 
has this calamity proved in the TInnrvelly district, timt the gi e alest 
difficulty has been experienced in procurinff the small quantity of 
sound grain required for seed for the cuMvadon of the oreseat year. 
Tbe dry grains, for the same cause, have also suftied mneh^ and 
must, in consequence, have been rendered less nutritieos. 

* Having deemed it proper, at this plot of our Report, to notfoo 
the cireumstanoe of the crops of these countries hating suftred muda 
from unseasonable rains, and that the quab^ of tbe edible prodocta 
had been thereby injured, we must here observe, that though the ne- 
cessity thus induced, of eating somewhat lass wbetesome grain than 
usual, cannot be considered o&erwise than as a great nnafbrtune, yet 
we conceive that it must not be induded amongst the causes of tbe 
epidemic fever, which had commenced as a period antecedent ta 
the failure of the harvest: it certainly, however, may, by induoag 
debility, have contributed mudi to sender the disease more frequent- 
ly fataL' pp.7S— 77. 

Fever was first noticed by the Conector of the Coimbatore 
divi3ion» Mr Garrow, in October 1809, in a marshy and pro- 
verbially unhealthy situation near tbe bills. From January to 
June 1810, it was peculiarly destructive. It received a dieck 
in January 1811$ but, after imtrmely rains in Februaryt it 
recomiuenoed its work of dealmction witb gaeat sev^y» aud 
spread not only amon^ those villages, tbe most liahle from tbeir 
low situations to be nsited by such maladjei^ but to <^eii ly^ 
ing muoh further east, hi(^ drvy and, in )commo& seapeas^ 
h^ihby. It is alasost the uoiversal opinion in CoiabatDn^ that 
it entored that district from the diiweiion of the Pylncgr monn-^ 
tains. 

In Dindigtt!, wbeM it was not noticed Ull April 181<^, tke 
same opinion tbat the Pylney mountains gave btrth to the evil 
is also general. In Madura, Dr Christy observed a fever to 
irrevail as early as 1809, but only among the roost miserable 
part of the inhabitants. In 1810, the disease became more ge- 
Mial and abrming, and now spared neither the wealthy iU« 



rSlt. On the Epidemic Fever in India. 83 

tivesy nor Earopeans ; but it was most fatal in February, Marcb, 
and April 1811. 

' In this district, like the others within our range, the Pylaey 
mountains ase considered by the natives as the great cause ei all their 
misfortunes. But here we ind an eKtmsion of the epidemic, not, tm 
in Coinibatore, from south to north, but from north to south. Here 
it has also been invariably remarked, that k was in low situations, 
close to the hills, such as at Towerincourchie and Sholavandum, tba^ 
the fev« first attracted notice, and that the rains and close weather, 
in Febmaij, March, and April, had the unhappy effect of diffusing 
the mmbific miasniata o^er tracts fiirther east than they had before 
readied, and conqparatively high and dn. Divisions, however, near* 
er to the sea, or, rather, fiirther from ue range of mountaifls in this 
Collectorate, such as those of Shevagunga and Ranmad, hove, ia a 
great, measure, escaped the disease altog^er. ' p. 83, 84w 

' The Collectorate of Tinnivelly seemed, for a time, m if l&ai 
Providence had averted from it the mischief which was destroying eo 
many thousands in countries lying but a short distance from it ; but 
it soon appeased that the evil was Only retarded. It is true, that, in 
the months of Marsh, April, and Mi^, 1810, as we am mfimned b;^ 
Mr Hepburn, lever luad attmcted oosioe in the northern and western 
parts or the district : it was however triflings and blit of short dnnN 
turn ; and no more was heard of it till the montb of FebnHury Idll^ 
when it showed itself very generally in the talook of Streevulputtedv 
(which is contiguous to the Madura province), and in Tencoushie^ 
both of which lie near thi» aioUiitains* Soon afiier tUs^ it broke o«S 
in the vicinity of tl)^ sea and saU marshes, and committed great r«va» 
ges in the Punjmahal and Calcaud talooks; and, lastly, it extended 
itself from Tencoushie to the more southern traft^ includiag the Pol^ 
lams, and kept on its course all the way to the sea, but infariably 
proving most destructive in thos^ villages situated neaf sat to tm 

*' From the above account, there will be obs^ved this singularity, 
that, in the neighbourhood' of the salt marshes, the disease made it» 
appearance at a period prior to that at which it first began in places 
lying betwixt them and Tencoushie {•-*>a dfeumstMlce w^ich leaib uA 
to conclude, that, in these briny swasaps of tbe Timiivelly district, 
a separate source ai the disease is to be looked for, from, that which 
occasioned the sufferings of those inhabitiilg the more northern divi* 
sioiis of the same province. * pp. 84 — 86. 

* With regard to tlie two opposite directions in which the distem* 
pcred exhalations scetn to have extended themselves in difl^rent parts 
of the B^insoi^ and the cause or causes of these varying courses, wo 
confess that we give our sentiments with great hesitation ; as the 
subject tiot only involves in itself considerable difEculty, but natural- 
ly li^ds to some yel undecided points, and to the theories and opinions 
of certain ingenious men, respecting the pr<^g^ofi and dmuon of 
miasmata and contagion. 



84. 



On the Epidemic Ftver in India. 



Saa* 



^ We have repeatedly noticed, that great irregularity of seasoni^ 
had tnken place, throughout the whole of the southern provinces ; 
and it is certainly allowable from a universal cause to look for a ge- 
neral result : bat while the same deseliptidn of unusual cRmate may 
have prevailed in all these territories, yet the lands themselv/es ma/ 
have had loctflities or peculiarities, of such a nature, a», aHhough un- 
der a common influence, to have proved productive of effects differing 
much in degree. Thus it is that a long-continued unnatural state of 
die air, operating upon the close and overgrown woods of die Pylney 
mountains, upon their unventilated valleys and stagnant marshes, 
could not fail to engender a more rapid and dangerous condition of 
the atmosphere than that brought about by the operation of the same 
causes on the drier and less woody plains of the eastern ranges of the 
Peninsula. In the same manner, and for the same reason, the changed 
GODstitution of the atmosphere has been creative of ill effects in the 
vicmity of the salt marshes of the Tinnivelly country, differing much 
in degtee from those experienced in other states, which, though at 
no great distance from them, are otherwise circumstanced wiUi re- 
spect to nature and situation. 

' ' The Fever, whidi has occasioned so great a mortality on the 
Coromandel coast, was first purely endemic ; and, in all probability, 
had the irregularity of seasons been of short duration, it would not 
have been much heard of beyond the sources from which it sprang : 
although we find, and that from high authority, that even the causa; 
of endemic fever are sometimes carried, by particular currents of air, 
to a considerable distance : but on the disease having be^n rendered 
epidemic, by the same means which bring about this change in every 
quarter of tiie world, its nature, as usuaJ, became in some respects 
iihered. ** Fevers of this sort " (says Dr Jackson) " arise in particu-' 
<^ lar countries, or districts of a country. They travel in certain 
*^ tracts : sometimes confined to narrow bounds ; at other tiroes they 
*' are more widely diffused. " pp. 88—91. 

The mortality was enormousi as appears from the following 
table. 

Comparative View of the Popidatumy and Death during the Epi* 
demiCf and the Deaths in common Years. 



Coimbatote, 16 months 
Madura, 12 months 
Dindigul, 12 months 
Tinnivelly, 5 mdnths 



Poputeiion. 



596,606 
245,654 
295,654 
690,696 



J,828,610il,06,78 9l 



Kpidvmic 
Deaths. Ccn(«ge« 



2^2,451 
24,626 
21,510 
38,202 



I Common Ycftn. 
[Death«< Centjigc 



3.7d 
10. 
7.25 
5.5 



3.933 
3.438 



5.84 



1.595 
1.163 



1817. On tie Epidemic Fever in Indicu 95 

In the fourth section, the authors of the Report proceed to 
examine into the causes of the epidemic, with suggestions re* 
specting the circumstances that may have rendered it peculiarly 
f^tal in particular aituations, and to certain descriptions of 
people. 

AIJ the acknowledored causes of intermittent fevers exist in. 
these provinces, — marshes, impervious wood and salt marshes, alf 
ef which bad their influence $ but the extraordinary iylcrease of 
moit&iity atiil indieates the cooperation of an occasional cause 
ef greet power. This our authors think they ha?€ discovered 
m the great irregularky of the weather in the sickly years. 

* We have now seen that three great remote causes have been aat 
^gned for remittent and intermittept fever ; all of which, we conceive* 
have contributed to produce the calamity which has proved so fatal 
in this province. But m^hy situationa do not appear of themselves 
to be sufficient to render such affections epidemic ; to produce thia 
effect, there is recjuired the superagency of a close, moist, and sultry 
heat, and imperfect ventilation. Hence it is, that, in common years, 
there is not produced, in many of the low situations we have particif- 
larized, a miasma of sufficient malignity to excite the general disease ; 
because, in such cases, the exhalation of superfluous moisture takes 
place during the cold months of December and January, when they 
are comparatively innocent : but rains falling out of season, and in 
great abundance, at peripds when t^e weather had become hot, and 
when there was so distressing and unnatural a deficiency of .free ven- 
tilation in the atmosphere, occasioned evaporations of a very different 
nature ; and which, we conceive, became a positive source of mis- 
chief, by bringing on that corrupt and stagnant state of the air which 
is ever closely connected with the decay or decomposition of vegetn 
able matter.' pp. 106, 107. 

* Nearly a similar departure from the common course of seasons 
took place in the Tinnivelly province in the year 1757, as ismention^q 
edby MrOrmeinhis ^'Historyof Hindoostan;" and that it was fol- 
lowed by a like calamity. He tells us, that, in the montli of March, 
the south-west monsoon was so violent, as to break oonq>letely over 
the Western Ghauts, and descend in vast floods into the Coromandel 
side of the Peninsula, where the rains fell, without intermission, for 
two days,--destroying crops just ready to be cut, — sweeping away 
many of the inhabitants,-Tand(, ultimately, by creating a powerful e- 
vaporation during a sultry h^at, producing an epidemic disease very 
fa^ in its consequences. * p. ^109. 

The disease was invariably most fatal among the poor hard* 
working inhabitants, ill fed, badly clothed, and miserably lodged^ 
vhile the troops, and even the prisoners in jail, comparatively 

The fifth 8e(:tion treau of the nature of the epidemici and iu 



86 



Oh the tlpidmic Fever in India. 



Jbo* 



ymoun tjpeBt and the notions of the native medical pradkioners 
regarding it Our readers will have already seen, that this epi- 
demic was no new disease* but only an agsraVation of tbe ordi- 
nary endemic fever of the oountryi called Jungle or hill^/ever^ 
which is either remittent or intermittent, according to circum- 
stances, the latter being infinitely more common ud tractable 
than the former. 

* The types under which the intermittent has appeared are the 
fellow]ng.»l«/, The simple tertian. 2dy The double tertian, which 
would seem to consist of the junction of two single tertians, that rua 
each a separate and independent course, with similar paroxysms on 
alternate days, S</, Quotidians. 4^A, Quartans ; and, 5/A, Irr^u* 
lars. To show which of these has roost frequently occurred amongst 
Che natives during the present sickness, we cannot do better than here 
subjoin a report of the sick in the Regimental Hospital of Dindigul, 
taken on the Ist of June 1811 ; the effective strength of the detach- 
ment being then 255 men. 



Simple 
Tertini. 


Double 
DittOL 


Irregulsvs. 


Q|iotidiAQ9. 


QjuarUni. 


Convales- 
cents. 


TotaL 


80 


96 


M 


IS 


4 


20 


117 



Of these, 58 had been in the hospital for one month, S9 for two 
Months, 29 for three months, and 2 upwards of three months. * pp. 
126, 127. 

The essential difference between this fever and the vellow fe- 
ver of America, and the ardent fever of the South of Europe^ 
cannot ffiii to strike our readers, and will not be easily explain- 
ed by those who consider the latter fevers onlv as a bisher grade 
Qf marsh remittent fever, depending upon hign atmospneric tem* 
perature* 

In the sixth section^ the mode of treating tbe disease, and the 
best means of preventing relapses, are treated of. And here we 
have another strong proof of the essential difference of this epi- 
demic from ardent fever. Instead of requiring, as the latter, 
copious blood-letting, which is not even mentioned as an auxili- 
ary in the treatment of this epidemic, cinchona and arsenic have 
produced their usual specific effects. Cinchona, with a proper 
attention to the bowels, is what seems to have been most relied 
upon. 

When the cinchona purges, a few drops of kudannm are to be 
added $ when it has an opposite effect, a few grains of rhubarb, 
or a laxative injection, may be administered. The bark is to be 
continued for eight or ten days after the disease has diappearedf^ 
to tbe extent of three er more doses on the days whee the fever 



1817. Of$ikel^ndemkAnb^inLtiuu 87 

Hied to TeUn. The praodoe of giTing repeated purfKee intimg 
the oootiatitnos of ihe dipeoro is not ^^prored oL Tlic foDow- 
hig obserrations on the efiecti of adomel ahow^ that» even ia 
India, its use most be subjeoted to limitation* * 

' There are a description of medical men in this coontrjr, who sup- 
pose that, in hot climates, bark given for intermittent feven has the 
eflect of bringing on abdominal obstructions, if calomel is not a£ the 
same tone daS;jr administered; but to this opinion we cannot, from 
oor own experience, . subscribe. If full and proper evacuadons are 
procured at the commencement of the disease, if over-secretions of 
hUe are purged off, and if great care is at all times taken to keep the 
bowels open, we see no goml reason why this acrid mineral should be 
given, however necessarjr it maj be to idter the habit in more serious 
attacks ; — it is an irritatmg and debilitating medicine ;— it is very apt 
to sicken the stonuch, and produce dyspepsia ; and must therefoia 
prove particularly objectionable at all times in deiioate habits, and q& 
ten in others too, when we should, bb much bb possible, preserve tho 
tone of the stomach, and prevent it from rejecting the bark«^-No z 
obstructions of the nature above-mentioned, we are rather inclined 
to think, arise from other causes ; such as, a neglect of timely and 
free evacuation by stool, and perhaps more certainly stiD, from re^ 
peated, long, and severe cold stages having been aUowed to take 
place, before the mabdy was checked ; and hence the almost con* 
stent affection of the spleen or liver, which we see consequent of ob-» 
stinate quartan agues, and which was particularly instanced in the 
native hospital ^ Dindigul. In support of what we have here adU 
vimced, we shall bring the authority of one of the most enlightened 
pl^sicians of the.present age, Dr Jackson, who, in speaking of bark» 
eays, ** 1 was early aware of these objections, and watched narrowly, 
*^ tibst I might discover its real effects ; and I am now warranted ui 
«< saying, t£tt it has every ri^ht to be considered as a spedfic in ague 
^< and iev&t^ while it is totally free from the imputation of occasionr 
*' ing dropsy, dysentery, or visceral obstructions. These complaints 
*< were always the roost frequent when this remedy had been the most 
** qwringly employed. " pp. 139—141. 

Sulphuric aether and laudanum were occasionally tried with 
advantage. Arsenic^ a remedy employed hg the natives from 
time immemorial, in some instances succeededi after many other 
things bad failedi although its general usa is net approved of. 

< In reeenmendiog the use of the cold affusion during tbe hot fit, 
we can vpeak without Citation, being firmly of opinion that it is n 
vary powerAd xemedty ; and what frequently, when judiciously used» 
jBnests the progress of the intermittent ;— nay, we have, in several inr 
stances, known daily immersion in the sea prove the happy means of 
iJiecJcing agues which had ba£9ed eyery other ^:;(;ertion that had bee^ 
made tp conquer thenu ' p. 143. 



88 On thi Epiimk Bmr in Iniim. htu 

For the treatment of the various modifications of the disease^ 
we must refer to the Toltime itself, and oonchide our extracts by 
the following concise, yet satisfactory directions, for the core of 
the fever in its more dangerous form of a remittent 

* When, from the appearance of the symptoins formerly descried, 
it is evident that a fever of the remittent kind is expected, the stomach 
is often in so irritable a state, that it would be highly improper te give 
an emetic. In such cases, we order at once the foBowing pftls. 
T^ Calomel gr. vi. 

Pulv. Jacob, gr. vi. . 

Misce. Fiant pilule tres ;— » ' 

the whole of which may be taken in the course of the twelve hours* 
These will produce copious evacuations; and may also, perbi^s» 
bring on a degree of diaphoresis, which ought to be encouraged, by 
taking frequently a little tepid drink. On the second day, when the 
paroxysm will, in many cases, be found every way more severe thai^ 
on the first, no time is to be lost in having recourse to mercury — the 
remedy which, at such times, can best be rdied on for producing a 
proper mtermission. Seven or eight grains of calomel, with three - 
grams of camphor, are to be well rubbed together, and made into 
four pills, one of which is to be taken every thiee hows during the 
day. These will often have the desired effect, if contmued for twa 
or three days, by producing a desirable change in the habit, and so^ 
favourable a remission or intermission of fever, that the bark can be 
taken with safety. 

' Notwithstanding this mode of treatment, however, we have found 
that, in some instances, the epidemic fever, in its remittent form, bar 
proved a very severe and dangerous disease. Should no positive ad-, 
vantage appear to have been derived from the use of the pills just 
mentioned, although the gums show evidently that the habit has been 
affected by the mineral, we think it advisable no longer to delay the 
use of the cinchona, even before a regular intermission has been ob- 
tained, as the surest means of sustaining the strength of the sufferer. 
The deoootion or infusion, with a small portion of the fine powder in 
it, and a little of the tincture, will then be the best ibrra, giving from 
time to time what light nourishment can be taken : — or the pills of ca- 
lomel and camphor may be given during the night, and the bark by; 
clay, in the way just mentioned ; taking care, should nature appear to 
be sinking, to endeavour to raise the vital energy, by means of blis* 
ters to the legs, feet, or back. Indeed, in all extreme cases of thia 
malady, blisters are often of great service, by rousing to recdlection, 
and exciting the vis vitte. The bowels are te be kept openbymil^ 
injections, to save the stomach ; and grateful, but light cordials, are. 
to be united with the bark. ' pp. 15£-156« 

The last very short section contains observations respecting 
the measures to be adopted to prevent the recurrence of so greab 
f^ mortality from a succession of irregular seasons. 



1817. Dr Stewart on Uterine Hemorrhage. 89 



IIL 

A Treatise en Uterine Haemorrhage. By Duncan Stfwart^ 
Fhjsician-Accoucheur to the Westnainftter General Dispen- 
sary, aod Lecturer on Midwifery in London. dvo» London, 
1816. pp. 151. 

IV no department of medicine can industry and talent be bet* 
' ter employed for the relief of human distress, than in the 
improvement of midwifery. Notwithstanding the danger and 
anxiedes to which the diseases of the female give rise, it is astcH 
nishing to think, that, in. these circumstances of peril, their 
fives, as weU as their children's, should be entrusted, in so many 
instances in this country, to the most unskilful empirics. The 

gractioe of midwifery, from being attended with unusual bodily 
itigue, is one great cause of the reluctance which medical men 
have to practise it \ and, perhaps, another reason has been, the 
supposed hmited knowledge sufficient to qualify the practitioner. 
But let it be jremember^, that under no circumstances can a 
minute acquaintance with the human frame and its diseases be 
more important, and promptitude and decision more necessary, 
than in Uie various situations of difficulty into which the ao» 
coudieur is consCantly placed. Whilst these causes have been 
<iperatiog, it may be expected that this branch .of medicine haa 
not kept pace in its advancement with others where the path 
to improvement has been more smooth. Those, therefore^ 
whose abilities and opportunities have enabled tbem successfully 
to prosecute the oractice of midwifery, deserve well of the public, 
and they merit tne approbation of their profession, for commo« 
nicating to them their information. Impressed with these 8^n<« 
timents, the ' Treatise on Uterine Hemorrhage, * now before 
BS, claims particular attention. • 

^ The object of the following treatise, * says our author, ' is 
to point out a mode of treatment which has been found very 
beneficial in alarming cases of Uterine Haemorrhage. ' In the 
introduction, our author, in a clear and ingenious argumentf 
points out that the contractions of the uterus depend on a mus- 
cular structure, and that it resembles other involuntary muscles, 
differing only in the power which it exerts ^ in the intervals be* 
tween its difierent actions, 4nd in the stimuli which excite these 
actions. * Bnt all the other involuntary muscles, as those of 
the lieart, the stomach, the urinary bladder, and the intestines| 



m^ Vt Stewsit vn Vterine Hamonh^. Jm^ 

also ditkr from esch other in those qnidities ; exerting different 
d^ees of power, contracting at ditFerent intervak, and bein^ 
excited to action by different atimuli. ' The uterus resembles 
the other involiinta]7 muscles, not merehr in the causes which 
excite its natural actions i it is likewise affiscted by those causes 
which produce morbid acUon in muscles. Troublesome cases 
frequently occur where the uterus has contracted spasmodicallj 
i|nd irregularly ; and the effects produced <Hi die utcms at the 
time of parturition by the depressing passions, or ^ny cause in- 
ducing general debility, are well known. Our author also ob<* 
serves, in pioof of this opinion, that the means which a|liqr im^ 
Biodenite action in other muscular parts, have a aimilar efieel 
|n moderating yiolent uterine action, — that the divisioD of the 
muscular fibre forms a chasm bv the retraction of the divided 
s^es, — that it is capable not onl? of contraction, but of retail^ 
ipg itself in a contracted state, till that particular change in tbf^ 
econony of the parts takes place, which requires its relaxation,-*- 
and that, like other muscles, it is impaired in its action by die* 
eases, and injuries of the brain and spinal marrow. 

The work is divided into four sections. The fa-si secihm con- 
tains observations on the practice generally employed in uterine 
haemorrhage. After pointmg out the evils which arise from 
puncturing the membranes in uterine bannorrhage, before the as 
$fUri 16 completely dilated, and from introducing the hand after 
the liquor amnii has escapedi and the child's head is forced againal 
the OS uUri^ causing oonsiderable irritation and produciog spaa* 
IDodic contraction of the uterus, some remarks are made on the 
|uractice usually recommended in uterine haemorrhage from de* 
fentioQ of the placenta. 

The se$im4 sMion treats of the causes and treatment of tboae 
faaes of uterine hiamorrhage which occur in the earijy montha 
ef pfegnancy. Haemorrhage previous to the sixth month of 
pnq^nancv, is very apt to Mtke place at those periods when the 
voman should have menstruated had she not been pregnant. 
In such cases the discharge varies in quantity, is aecompaniad 
with oonatilntiooal derangement and irritabiuQrt and with pain 
jnthebedu 

* When the hsemerrhage is not vety profuse^ by confining the pe* 
tient to a horizontal postilre, keepinj^ her in a cwA temperalure, Meed* 
lag her if she is of a plethoric habit, allaying irrkation by opiates, 
keeping the Jliowels regular, adhering strictly to the antiphlogistic re<» 
gimen^ and applying cold wiUer frequently to the back, pubes, and 
iruba, the discharge will ffeneraily disq^^iear. But if^ notwithstanding 
)he use of these means, the hsmiorihage should coalinue, considfir^ile 
a^vantige may be derived from iiyectiag some cold mtringent fluid isr 



1817, Dr Stenrt m Uierine Btemorriage, 91 

to the T90na; or from gifing a oold clyster, coosgdng of one pound 
of lime-water and one or two drachms of laudanum. Sometimes all 
these remedies will prove unavailing, the discharge still continuing^ 
and even increasing; a proof that a great part, or perhaps the whole, 
of the ovum is detached from the uterus, and that abortion will ino- 
vitably take place. In some cases, although the discharge appears^ 
it recurs at irregular intervals, and in considerable quantity, till, at 
the fourth or fif[h*month, or perhaps at a later period of pregnancy, 
an ovum of two or three months is voided. In these cases, confine* 
ment to a horizontal posture, injecting some cold astringent fluid into 
the vagina, applying cold water to the back and pub^, and givinffp 
two or three thnes a day small doses of sulphuric acid, will gewraUy 
be found to diopk the discharge, tSl the ovum escapes from the ute«- 
ms. The strei^th may likeroe be supported by moderate quaoti* 
ties of wine. 

* When abortion is attended with very profuse hsemorrhage, the 
discharge can be easily commanded by stufiuig the vagina. 

' When this remedy is employed, it is necessary to fill the vagina 
completely; and to avoid, as much as possible, every thing that will 
cause pain and irritation. Soft rag or lint, soaked in oil, is to be cau* 
tiously introduced into the vagina ; and a firm compress, wet with cold 
water, is to be fixed by a T bandage over the external orifice> so aft 
to prevent the plug from being displaced. By this means, a coagu- 
lum 18 allowed to form at the mouths of the bleeding vessels, which 
prevents any further discharge of blood. It will likewise be neces- 
sary to confine the patient to a horizontal posture, — ^to apply cold to 
the thighs and pubes, — to admit cool air freely into her bed-chamber^ 
—and to avoid the use of stimulants. 

' As a complete state of contraction of the uterus is the only meana 
which can permanently stop a profuse hsemorrhage from that organ, it 
will be also necessary, whilst remedies are employed to moderate the 
discharge of blood, to excite the uterus to contract, in order to ex- 
pel its contents. For this purpose, stimulating clysters will be found 
very beneficial ; but when they are given, the practitioner oi^ht al« 
ways to be in attendance,' as, if the plug be displaced, a sudden and 
alarming increase of the hsemorrhage may occur. When the utema 
begins to contract frequently and powerfully, the bandage and com- 
|MPe8S may be removed; but the plug should be allowed to remain till 
It is expelled, as it will keep up a degree of irritation on the os uteris 
vrfaich will tend to increase and continue the expulsive efforts of the 
uterus; and by retarding, in some degree, the expulsion of the ovum^ 
it wtU also favour the complete contraction of the uterus. 

* Fluent fits of syncope are apt to accompany abortions, although 
there has been no previous great discharge of blood : but this sym- 
ptom generally proceeds more from an affection of the nervous system, 
than from debihty. If the discharge of blood, however, has been veijr 
profuse, the strength reduced, and sjrmptoms of great debility super* 
▼ene ; whilst means are employed to suppress the discharge^ stmdulants 
lA moderate quantity must be also given to support the strength* 



92 Dr Stewart on Vleriiie Hanunrhage* -Jan. 

Opium in large doses, either in a solid or liquid form, seems best cal* 
culated for this purpose ; for, whilst it quiets the anxiety which the 
patient's apprehensions are apt to produce, it allays the state of ge- 
neral irritation, which always attends a sudden diminution of the 
powers of life, supports the strength without accelerating the action 
of the heart and arteries, and never prevents the due contraction of 
die uterus. * pp. 34^ — 37- 

Id the third section are considered the causes and treatment 
of uterine hcemorrhage, when it occurs in the last roontfas of 
pregnancy, and during labour» till the child is delivered. Dan- 
gerous uterine hceinorrbage generally proceeds in the last months 
of pregnancy from a partial or total separation of the placenta. 

* When the placenta is situated over the os uteri, hsDmorrliage al- 
ways precedes the expulsion of the foetus ; and the action of gestation is 
seldom continued to the full period of pregnancy ; for in the last months 
of pregnancy, as the cervix and os uteri become dilated, the vessels which 
connect the placenta to the uterus are ruptured, the process of gestation 
is impeded, the uterine fibre begins to contract, more vessels are ruptured, 
and, if assistance be not given, the woman either sinks from loss of blood, 
or in some rare cases the child is expelled, preceded by the placenta, 
and she recovers. In some cases the expansion of the cervix uteri, and 
tlie growth of the placenta, seem to go on together, and no haemorrhage 
takes place till the os uteri begins to dilate at the fiill period of preg- 
nancy. In other cases, although during the last months of pregnancy 
considerable haemorrhage continues to taJke place, and the patient i^ 
much exhausted by loss of blood, the process of gestation goes on with- 
out interruption, till at the full period of pregnancy the os uteri begins 
to dilate, and the discharge increases in an alarming degree.* pp.42, 43. 

* When haemorrhage takes place, and the placenta is found situated 
over the os uteri ; if the patient has not arrived at the full period of 
pregnancy, if the discharge of blood does not produce any evident bad 
eftects on the general system, if the os uteri is rigid, and not much di- 
lated, and if there is not much pain from uterine contraction, an at- 
tempt must be made, by palliating the most urgent symptoms, to enable 
the patient to go on to the full period of pregnancy. She must be 
strictly confined to a state of rest in the horizontal posture; cold as- 
tringent lotions must be frequently injected into the vagina; and ice, 
contained in bladders, must be applied to the pubes and thighs. If 
she is of a plethoric habit, blood must be taken from the arm ; pain 
and irritation of mind must be quieted by opiates ; and all stimulants, 
and every thing which would produce irritation of the mind or body, 
must be carefully avoided. Although stuffing the vagina, in such c&ses, 
might at first c*heck the haemorrhage, it is not a remedy which could 
be employed with safety or advantage, as it would be apt, by irritating 
the OS uteri, to excite the uterus to contraction, necessarily rupturing 
hiore vessels, increasing the discharge, and destroying the chance of 
enabling the patient to go on to th^ full period of pregnancy. 



1817. Dr Stowtrt m Uterine Hamonhagr^ 99 

< M the iHemorriuige be considerable, producing symptoms of ex- 
treme debilitjy although the patient has not arrived at the full period 
of pregnancy, the child must be speedily delivered, as no other reme^ 
dj can save the life of the mother. At the full period of pregnancy, 
when labour comes on, the discharge of blood being always very great, 
no time ought to be spent in the use oi ineffectual remedies, as no plan 
of treittnient can with safety be d«lpended on, but the delivery of the 
child* Before commencing this operation, great benefit will generally 
}fe derived fron giving the patient four grains of solid opium, or one 
hundred drops of laudanum. This icmedy will be found to relievo the 
v4Mnitiog, and state of irritation of the general system umialiy attend* 
ing this disease; and it will produce in the patient's system a degree 
of listless ooinposure, which will render turning and delivering the 
child compdkatively easy. As in cases of uterine hiemorrhage, the 
effiscts of opium on the system are generally very fugitive, the dose 
must be repeated as often as symptoms of irritation recur ; and it must 
be increased according to the urgency of these symptoms. When the 
stomach is so irritable, as to reject the opium, when given in a li- 
quid form, solid opium will generally be retained, especially if com- 
bined with an aromatic, such as the aromatic confection. 

* In turning and delivering the child, the hand well oiled, and form- 
ed into accmical shape, must be cautiously introduced into the vagina, 
carrying it steadily forward, with a semirotatory motion, bMt resting 
during the remission of the labour pmns; the os uteri should be slowly 
and completely dilated in the same manner ; the placenta should be 
separated at one side, the membranes ruptured, and the child s feet 
gnwped and brought into the vagina. In dilating the os uteri when 
^gid, slow and cautious procediure is particularly necessary; but, for- 
tunately, its strui^ture, when the placenta is situated over it, is more 
vascular and spongy dian usual ; and when it becomes necessary to 
dilate it t|uickl^, bad effects are not so apt to be produced. In ex- 
tracting the chdd when the breech comes to occupy the os uteri, no 
further assistance ought in general to be given, till uie head begins ta 
enter the pelvis : but as at this time there is considerable danger that the 
circalation in the umbilical cord may, by pressure, be suspended, the 
delivery should be accomplished as soon as possible* Danger need not 
be apprehended firom following this rule of practice; for fhe child's 
body, by4pressing against the open vessels, will restrain the ha^mor- 
rhi^e; and if only part of the placenta remains attached, its functions 
will be continued in a degree sufficient to preserve the child's life* 
The advantage^ to be gained in these cases by allowing the child to be 
partly expelled by the contractile efforts of the uterus, are important.^ 
It favours tlie regular contraction of that organ, and the complete di- 
latation of the OS uteri. If the placenta is perforated instead of be- 
ing separated at one side, these advantages will be lost, as the foetal 
▼easels will be torn, and Uie child will perish, if not speedily delivered* 

* As soon as the child is expelled, die hand must be introduced 
into the uterus, and retained there, till that organ, by contracting^ 
feparates the placental and forces it into the vagina, ' pp. 4^-^2. 



M Dr Stewart on Uterine tlc6mx>rrhuge. Jan. 

Uterine htttnorrfaage also arises before the delivery of ike 
childy from an accidental separation of the placenta ; and this 
generally arises from sudden and violent affections of the mind^ 
exertions or concussions of the body, or any thing that increasea 
U)e action of the heart and arteries. 

* When a diadiarge of Mood takea place from the uteraa^ in the 
last months of pregnancy, and the pUioenia is net ibund at the ea 
Meri; there is reason to expect, if th^ patient has not been veiy much 
deduced, that the use of the means akeeidy mentioned will enaMe her 
to go on to the full period of pregnancy. Bat if these sboukLiail, as 
H complete state of contraetion is the only mean which can effieetual- 
ly stop a great diioharge of blood from the tfterus, aiid«|ia this state 
cannot be produced whilst its contains any pan of the ovmb; the 
great practical object in these cases is to evacuate it a» soon aa p0B- 
■able. If the discharge be very profuse, or if a great quantity of bioe«t 
has been lost, produchig afaurniBg coaatitutiotial symptoms, the first 
thing to be attended to, is to aseertain the slate of theos uterk If it 
be in seme degree dilated, or sofl and yielding, a large opiate ought 
to be instantly given; and, as soon as it^ sedbtive efife^ on thegtee- 
ral system are perceptible, the hand should be introduced into the 
vteraa, the membranes ruptured, aifd the elnld turned and delhnered. 
When the os uteri is in a rigid state, slow and eautious atteo^ts te 
dilate it will be found necessary: rude and violent endeavours toeffeet 
this purpose having abiost always been attended with fttal cctone- 
quences. Expedition^ in thoflie cases, is very seldom necessary; fbr. 
When an attempt is made to dilate the os uteri) i« alwajw excitea die 
eterus to eontract vigorously, and the hemorrhage is cOftlieiiiiently se 
much restrained, that, if the strength haa not bcfen pi^ously veiy 
ihuch reduced, the delay which arises fhnn dus cautious mode of pro* 
ccdure will not increase the danger, Large doses of opimli are par- 
ticularly useful in such cases, as they not only support the patienlla 
length, but likewise allay the irritation whicn is unavOidiMy ex^t- 
^d by dilating the os uteri when in a rigid state. 

< if profuse hannorrhage occurs when the membranes have been for 
some time ruptured, and if the os uteri be at the same titiie rigid and 
Contracted, it presents one of the most perplexing con^inations of un- 
toward circumstances. In those oases, much benefit may be derived 
ft'om staffing the vagina, if the patient be not very mueh rednced be-^ 
lore assistance is oiSUed; and whilst the os uteri continues rigid and 
contracted, internal hannbrriiage need not be dreaded* If, howeVer, 
d)e patient be verv much redi^Ded by the hsnnorrhagev it win be ne*- 
Cessary to proceed immediately to deliver the child by turning. Re* 
Solute, eautious, persevering attempts, are in these casies iDdt9j>ensabl^ 
necessary ; for, mter dilating the os uteri, the utei*ua is often fbimd to 
embrace the child's body so dosely and firmly, that in passiiig die 
l^nd to get hold of the child's ibet, ther^ is con^derable i^px oF 
i^apturing that organ ; and even afler the child's feet have been brought 
into ^ vaginal a continuaAte of very oonnderable extractiytlbKee m 



IBI7. I]»Smfwnml»erm$ammrktgk 9i 



often teqintt^ before its httd am be made to recede. In many t 
of tlw kind it will be found impoMible to aee^Hnpluli the ddivery, 
wtthoat eillwr injuring Uie utenu or tbe child, tiH tbe padent has 
ifated with fktiigfae and loas of blood. But If tbe as uteri be rigid 
and contracted, and if the patient be not very much reduced by the 
loaa of Mood, means must be employed to rettndn ilie haanorr hage» 
till ibe OS uteri becoflies more easily dilatable. Sbennst be confined 
to a state of rest In die horiaontal posture ; the ▼Agiaa liiast be care- 
fidb^slttilBdyasbeforsdhecleA; cdd air must be ruBSly admitted kn 
tohcrnportaseBt; odd must be applied to her tbi^ and ptiies: usii 
tins plan of treatment should be continued, tiU diere is reas<in as bo^ 
Keve^ either Ibat the os meri has become dilated, or ^tbepati^Dt 
ita eemidain of a sense of distension of the abdomen, aceom^ 



panied by those constitutional symptoms whidi ttre generally pTodlioeii 
ny a great loss of blaod, and which indicate that interml hftfiuffw 
rhage is taking i^aoe. 

'Thedelimyofthediild, afterlt is turned, is not «ob^hiirtiedi» 
dbose cases, except the discharge of blood is very profbse, and die 
symptonBa of general debility are very urgent ; for, by adloWSng it ta> 
remam partly m the uterus, it favours the eoaiplete and regidsr tdn^ 
MMtfon of diat races. But it is necessary to bear in tthid, tittitwheil' 
tise head enters die pdvis, it will be necessary to assHit the diefiveiyy 
otberwise the lifo of the child will be lost, by comjM^ession of tike urn* 
MBcid oerd. X^uge and repeated doses of opium w9tb6 found parll^ 
eokiriy benefieial m aHaying the hrritation wbldi is fdiitojrs pfodiiced 
in tfaosecases, by dHating ths rigid os uteri, and by the presMil^ wMeb 
die band neeessadly iliafcss upon the iatemsi surfoee of tef ^iterus.'' 

In the Jbarth teetim a^t author treats of the Gauges and treat* 
meat of uteri&e bicmorrhage, when it occurs after the child It 
deiiversd. Heemorrhage seldom tak^s p)ac^ until A fe^ minutes 
after dbe chiM is delivered, except when it begins in the former 
Btwes of labour, ^hen it occurs after the delivery of the 
d|ikl« it is caused either by a want of contractibn in the ute« 
xiaa fibres hjf its irregular contraction,* or by a chaoge in the 
atnctDre of the placenta^ causing a morbid adl^esioo of thai 
to the uterus. 
Inbaemmnfaaga psooeefing from torpor of the itterus, when tha 
of bkxsd is verjT great, in sddition to the applioation of tl)« 
^_ one hmidfod orofis of laudanum should be giveti, and thsr 
weU otted, shoidd be gently introduced into die uterus, it 
dumld be kept in mind^ that the o^eet to be accomplished by intro«« 
dodng the hand, is not to bring away the placenta, but to eaoite thai 
siteana lo oontract, that it may separate the phu^enta, force it int^r 
Ae l'as;fau^ and thus permanently check the hsBnorrfaage. 

* AJthoi^ in general the stimulus, oonananirated to the nterua &y 
<ba bandy vhen passtug divough tha^os uteri, wiU-bafoaud to excicei 



96 Dr Stewwt oi». Vkrine UmMrhagi, 3axu 

it to contract ; yet». when it iai in a very torpid statCy it oaay be neces* 
iftary, after introducing the band into it» to make pre^stire with .the 
fingers on its internal durface, an'^ even sometimes to move the haqd 
^or some time in its cavity, before it can be brought into a state rf 
contraction. 

* In every case where it becomes necessary to introduce the hand 
into the uterus> after the delivery of the chiid» it must not be withd^wn 
till that organ has completely conUacted ; and if a fit of syncope ta);ea 
place during the operationy.the hand^iust stiU. be retained, in the ute- 
rus, that advantage may be taken of tlie first sigps of retttzaing liie 
to excite it to contract. 

* No occurrence is so much to be dreaded after the deliveiyi^of tl^ 
child, and before the uterus has contracted, as a fit of syngope, as it 
always prevents the contraction of that organ ; and although at the 
same time the flow of blood may be in some degree retanded, yet.jthe 
ruptured vessels being large, blood in considerable quantity will coa- 
tinoe to be poured out by them* In this way the sj ncope may prove 
&tal, or the patient's system may be so far sunk, that she recovers on- 
ly to draw a few convulsive insfNrations, and' then expires. Those au- 
thors have been rather unjostly blamed, who in ^uch cases have advis- 
ed the firee use of stmiulants. The fault, in general, dcies not sean to 
consist in the assiduous use of restorative means, but in not taking im- 
mediate steps, when life is returning, to stimulate the uterus to con-, 
tmct. When the patient faints* idiilst the hand is oetained in the 
Uterus, every mean should be employed to restore her ; cold air should, 
be freely admitted into her bed-chamber ; fomentations should be ap- 
plied to the epigastric region, and to the extreipiities ; cold wateK.sheuld 
be sprinkled on her face, stimulants should be applied to her nos^ils ; 
her head should be laid very low ; and, jf any liquid can be got into ^e 
stomach, hot brandy and water ought to be given in considerable 
quantities. As soon as signs of returning life are perceived, by gently- 
moving the hand in the uterus it will begin to contract, and hy sup- 
porting it with a bandage drawn tight round tlxe abdomen, it will re- 
tain its contracted state so as permanently to check the discharge. If 
the patient's general system has suffered, large doses of opftun should 
be given ; and when a state of great irritation of the general system' 
takes place, the opium should be repeated according to the urgencj^ 
of the symptoms. Small quantities of strong soups, or wine, shouttt» 
likewise be given, at short intervab, to support the strength. 

^ The application of cold, in the form of ice, snow, or vinegar ao& 
water, to the thighs and pubes, has been recommended as a very ^fC 
cacious mean in the cure of uterine hemorrhage^ arijiting from a statei 
of torpor of the uterus. This remedy may succ^eed .when; the uter ut iftt 
nearly contracted, in checking the discharge, by retarding the flow oC 
blood tolhe uterine vessds. The sudden application of cold may like^ 
wise, by giving the general system a shock, have 9ome e&ct in stimu^« 
lating die uterus to contraction. But when the hsemorrhage h very 
great, and the uterus in a torpid state, this remedy cannot witli safetji 
be trusted to, ai^ superseding the necessity of introducing the hand. 



!817. Br Stewart on Vierine Hamcurhc^ei S? 

And that sargeon would not be more blameable who would trust to 
st^rptics, in suppressuiff a hemorrhage from a wounded femoral artery, 
tiian the aceoucheur wno would trust to the application of cold alone, 
for suppressing profuse luemorrfaage, arising from torpor of the ute*^ 
rus. The application of spirits to the abdomen has been found use- 
ful in those cases, producing, by its sudden evaporation, a great de- 
gree of cold ; and by stinwJallng the skin, it has been supposed that, 
by syrapathyr it stimula^ the uterus^ 

* When the placenta is forced, by uterine contraction, into the 
-vagina, it ought to be immediately removedi and the patient should 
be carefully watched; for if the uterus has not completely contract«> 
ed, the blood which will be poured out may form a coagiuum in the 
vagina, and the uterus may yidd till it becomes completely distended 
widi blood: This some^nes occurs even when the bandage has been 
previously applied. * 

These important practical doctrines are ilhtstrated by weU 
chosen and concisely stated cases. The beneficial effects pf 
opium, — the extent to wbich it may be given, — and its exhibi- 
tion in diseases where its use is Uttle known, renders the work 
extremely interesting. It is written in a distinct and unaffected 
style, and is evidently the result of a thinking and observing 
mind. 



IV. 

Sj/ntqmis Nosclogiaf or Outline of a new ^iem of Nosology t SyU 
tabus of a Course of Lectures on Nosology ^ Parts IL and IIL 
delivered at Leicester in December 1815. By T. Par&ikson> 
M.D. 8vo, London, 1816. 

Tn this Kttle work Dr Parkinson has attempted a task, which 
**- he admits to be arduous and difficult, but which, we are firm^ 
ly persuaded, is impossible,-— to reduce nosology to a progressive, 
methodical, and logical system, fixed upon solid and just princi- 
ples, governed by acknowledged and inflexible laws, and divested 
of fiincifnl and delusive hypothesis^ In proof of this we need not 
analyse the principles and detail of this sinprular system, but shall 
content ourselves with a single quotation, premising such an ex- 
planation of the new terms which occur in it, as will render the 
whole intelligible. He divides all primary diseases into two 
classes, Hyperbiosfs and Catobiosis; in the first, the natural 
functions are exercised Bl>ove, and in the second, they are de-"^ 
pressed below the limits of health.^ Each of these, again, is sub^ 

VOL. XIII. NO. 49. Gt 



BS Hr Parkinson on Nosology* Jan* 

divided into three orders, derived from anatomical construction 
and composition, as having diffusively arranged fibres, spheri- 
cally arranged fibres, or both together. The genus be states 
to be dependent upon, and limited to identity of diseases, — tiia 
species to situation, — the varieties to introduction of poisons,— 
and the types to intensity. In conformity with these views, he 
has invented an appropriate language ; and from their combined 
influence he anticipates a radical reform of medical science ; 
but we shall let our author speak for himself s and lest we should 
be suspected of selecting partially, we transcribe the whole of 
one of the divisions of his syllabus. 

RECOMMEND the ADOPTION of this NOSOLOGICAL LAN- 
GUAGE in THINKING, SPEAKING, and WRITING oa 
DISEASES.. 

The path in pursuit of Medical Science will be illumined* 

The judgment will be corrected. 

Confidence will be strengthened. 

Argiunents will be logicd and incontrovertible. 

Conversation will be dignified and admired. 

The profession will be exalted and reverenced. 

HOPP TO OBLITERATE the TERM FEVER from NOSOLO- 
GICAL LANGUAGE. 

Fever is never an idiopathic disease. 

Is always symptomatic of local HYPERBIOSIS ; therefore, it 
cannot be allowed any separate or distinct appellation. 

Typhus Fever is a symptom only ; or rather, is composed of an 
assemblage of symptoms inseparable from a given type of HYPER- 
BIOSIS ; the identity of the disease is inflammation of some solid of 
the first ORDER, PLATYMORPHIA; and the increased SEN- 
SIBILITY, the increased MOBILITY, the increased CIRCULA- 
TION, and the increased CALORIC, the component parts of in* 
flammation, are the evidences of its existence. 

Intermittent and remittent Fevers are of the same CLASS as Ty- 
phus Fever, and of the same identical GENUS, differing only in de- 
gree of intensity of local inflammation, that is, in Type. 

A given intensity of HYPERBIOSIS DIFFUSA ENCEPHA- 
LIC A will intermit, and the fever will correspond in intermission. 

With greater intensity it will remit, and the fever will correspond 
in remission. 

With greater intensity it will be progressive, and the fever will cor- 
respond in progression; and this is Typhus Fever, 

By elevating HYPERBIOSIS intermittens it becomes HYPER- 
BIOSIS remittens ; the symptomatic fever will, therefore, be remit- 
tent ; and by elevating it to progressiva, the symptomatic fever wU^ 
be continued. 



1817. pt Parkinson m Nosology. *99 

I have to add, that, if what b usually called TYPHUS FEVER, 
terminates in death ; on examiQation of the dead body, the seat of 
local HTPERBIOSIS may always be discovered, and will be found 
»ther in a highly inflamed state, or peihaps, more commonly in a 
state of gangrene. 



V. 

A IVeatise an the Nature and Cure of Qout^ comprehendhig a 
General View of a MoMd State of the Digestive Organs, and 
of Regimen i with some Of^servations on Rheumatism. By 
Charles Scudamor£» M. D. Member of the Royal College 
of Physicianst of the Medical and Chinirgical Sode^ of 
London, &c. &c. 8vo. London, 1816. pp. S89« 

XIKTe must candidly confess that this book has surpassed oar 
^^ expectations. We have always looked upon gout as a 
roost unpromising subject, and did not expect that any book 
could be written upon Gout containing so much new or useful 
information as that before us, or so totally free from every thing 
like quackery $ no small recommendation of a treatise upon a 
disease* which has always been the hotbed of empiricism. 

Dr Scudamore begins his inauiry by examining the definition 
and nosology of gout by Dr Cullcn, and points ou(, in both, va- 
rious inaccuracies* He objects to its bemg defined to be a he- 
reditary disease, not from bewildering himself and his readers 
with metaphysical quibbles about the meaning of the term here- 
ditaiy, but because gout is more freouently acquired where no 
hereditary influence can be traced, tnan where such influence 
does exist. 

Of 77 patients, the number of those in whom the disease was 

Hereditary from the father - • - 21 

' mother - - . 5 

■ father and mother - - 3 

Of those whose grandfadier only had gout - - S 

- grandmother only had gout - - 1 

■ aunt only in the family - - 1 

Not known either on the father's or mother's side - 43 

From which it appears that the cases of acquired gout were to 
the rest as 4S to 34, and to those immediateiy hereditary, as 43 
to 29. 

02 



100 tir Scadamore on Oaui. Jan* 

Cullen^s next character is also not very correct, for Bjlrst St 
of gout is often excited by evident ejtternal causes^ as vicissitude 
of temperaturei a sprain, contusion, or any kind of local injury 9 
although, in a person not disposed to gout, the same caOises would 
produce only common inflammation, or some other diseased ac-* 
tion, accoraing to the specific disposition of the individual* 

The next clause of I)r CuUen'a definition * pein at a joints 
and, for the most part, affecting most violently ihe great toe i 
certainty the joints of the feet and hands,' Dr Scudamore 
thinks implies too strongly that a joint is the only seat of true 
gout, as, especially after repeated atucks, the disease attacks not 
only the articular structure, but also the tendons and bursse mu-* 
cosas. However* from Dr Scudamore^s own statement, it ap* 
pears that, of 7i examples, the gfeat toe was the seat of the first 
attack in B5 cases $ some part of the foot alone in 64 cases 1 the 
knee in two^ the hand and foot in two, and the hand alone ia 
three. 

In the same manner Dr Scadamore proceeds to comment 
upon Dr CuIIen's division of goUt into regular, atonic^ retroce* 
dent, and misplaced ; and, in pkce of a definition, he gives a 
concise description of the disease, and proposes to divide it into 
Acute, Chronic, and Retrocedent gout. 

Dr Scudamore treats of acute gout at great length, detailing 
in succession the premonitory symptoms ; the paroxysm in a 
first and in subsequent attacks ; Uie sequete ; the remote causes, 
predisposing and exciting $ the proximate cause ; the ratio sym^* 
ptomatum, diagnosis, and prognosis* For the particulars con* 
Ceming these, we must refer to the work itself, and shall content 
ourselves with extracting a few detached observations. 

It has been often generally stated, that gout seldom comes on 
before the age of puberty % bnt the following table by our authoi^ 
almost settles this point, or at least adds much to the accuracy 
of our knowledge of the subject. In 64 cases the first attach 
took pUce between the ages of 

20and2^in 6 
25 — SO — 17 
80 — 35 — 14 
35 — 40—13 
40 — 45— 2 
45—50— 6 
50 — 55— 3 
S5 — m— 3 
60-65— 1 

By vyhich it appears, that its invasion is restricted to the p^ 
riod between 30 and ^5^ and that more than two-thirds of the 



Females. 


Totil. 


7 


48 


8 


15 


2 


21 


1 


11 





6 





9 


? 


9 



}^17. Dr Scudaraore on Goid, 101 

whole nunber were attacked between 25 and 40, or in the 
prime iof-nanhood. Dr Scudamore has also given a tabular 
view oftbe form of M8 sufierers from gout. 

Males. 

Tall and corpulent ' * - - 4-1 

Shaft and corpulent * - ^ - 12 

Middle height and corpulent - - 19 

Middle stature and bulk - <f 10 

Tall and middle bulk ... 6 

iShort and middle bulk * « * 9 

Short aod filigbt - - - 6 

In speaking of strong liquors as a predisposing cause of gout, 
our author clearly shows, that it occurs less frequently in those 
countries where spiritous liquors are abu<;ed, than where wine 
or ale are habitually drunk. Thus diabetes ia more common iqi 
Scotland, goat in England. He accounts for this by suppos- 
ing, that the abuse of spirits destroys the appetite and impairs 
the digestive proeess. Gout, indeed, he considers as being 
truly a disease of repletion, which, however, in its consequences, 
leads to relative derangement and debility, as indicated by all 
the symptoms of dyspepsia. The state of the urine has always 
been considered as an object of importance in gout, and ha^ 
even been connected with theories of the disease. It has been 
very attentively considered by Dr Scudamore, and the results of 
his nnmerou« experiments furnish some new facts. In particu- 
lar, they tend to show, that, contrary Co the commonly received 
opinion^ gouty urine does not contain an excessive proportioa 
of uric acid, and that Berthollet is also wrong in asserting that 
the urine of gouty persons, when in health, contains less of the 
phosphates, than the urine of persons in health not subject to 
gout, and that in the fornjer the phosphates are increased di|r« 
ing the paroxysm to the usual quantity. The circumstanpes 
giving rise to these errors are satisfactorily explained^. 

^ With reference to the morbvd state of the functions of the ali- 
mentary canal just considered, the urine also is an abundant source 
of information, when attentively examine^dL The quantity secreted 
IS usually scanty, or, even when in natural proportion, is much con- 
centrated. That portion which is passed the first in the morning, 
should be the particular example for medical observation and exami- 
nation. A copious deposition of pink or brick-coloured sediment, 
together with an excessive quantity of mucus, is a frequent appear- 
ance; or uric crystals (commonly called gravel) with mucus; or 
the phosphates mixed with l^e urates, or separate; or mucus chiefly, 
with scarcely any other matter' in the sediment, also occur. The co- 
lour of the mcffbid urine is varkius, and modified by different causes; 



103 Dr Scodamore on Gout. Juu 

buty whether more or less deep, it b found, under these circum* 
stances, much increased in specific gravity beyond the natural stand- 
ard of health. This, from my experiments, which have been veiy 
numerous, I should state from 1010 to 1015. In the morbid urine 
to which I have referred, I have found the density sometimes in- 
creased to 1055 and 1010, and very commonly to 1025 and 1030. Its 
natural acid character afanost universally remains in the recent state ; 
but such highly animalized urine soon becomes alkaline and putrid* ' 
pp. 67, 68. 

But the deposition of a pink or lateritious sediment, or of crya- 
talsy is neither necessarily nor regularly attendant on a paroxysm 
of gout, and occurs in other circumstances of disease in conne- 
xion with unhealthy chylopoietic functions. In proportion, there- 
fore, as gout is associated with such disordered functions, and 
not further, are these sediments connected with that disease. 

* Returning now to the Question of an excess of uric acid secreted 
b^ the kidneys, as indicated by the deposition of the crystals— or the 
pink or latentious sediment, and its relation already mentioned to the 
proximate cause of gout — I have to observe, of the crystals more par« ' 
ticularly, that they are not to be considered as a proof of an excess 
of uric acid ; but rather as a separation of this principle from the 
urine, and a new combination with some other of its elen^ents. If 
nitric, or muriatic acid, be added to urine of moderate specific gra- 
vity which has deposited these crystals, scarcely any further uric 
precipitate is produced; and having in different experiments care- 
fully estimated the quantity so obtained, with that procured froni 
healthy urine of the same specific gravity by thp same methods, I 
have found the position ' in question to be fully manifested ; equal 
portions of such healthy urine, furnishing an equal quantity of uric 
precipitate, with the whole of that spontaneously and artificially 
precipitated from the morbid urine, with which it was compared. * 
pp. 88, 89. 

Dr Scudamore also proves by experiment, that uric add is 
only deposited in an abundant quantity from urine of a high spe- 
eific gravity, which likewise cbntains the other principles com- 
posing this secretion, as the phosphoric, sulphuric, and muriatic 
acids, and urea in preternatural quantity. 

Our author, in bringing Berth'ollet's opinion to the teft of ex- 
periment, examined the urine under diiSerent circumstances in 37 
mstanices. " , . 

* In these experiments, nitrate oC lead was the precipita^ employ* 
ed ; and the urine was diluted with distilled water. . A portion o^ 
the urine, first and separately passed in the morning, was, in each 
case, chosen for examination. The precipitate was carefully dried 
9n(| scraped from the filter. Of this, a certain quantity was boile4 13 



1817. 



Dr Scadamore on Gout. 



103 



water, that the mliriate of lead might be removed ; and with it also 
the uric acid was separated. It was then burnt in a crucible for about 
half an hour, that the several animal matters should be destroyed as 
much as possibie. It was next bailed in diluted nitric acid ; and, 
being dlowed to rest, the clear liquor was decanted from the sulphate 
of Imid and some insoluble animal matter. To this, ammonia was 
added in excess ; the precipitate was collected on the filter, dried, 
and weighed. This was the phoophate of lead, frcnn which the rela« 
dve proportion of phosphoric acid was estimated, by means of Dr 
WoUaston's logometric scale. Equal quantities (four ounces) being 
always employed, and all circumstances of experiment being alike, 
it siay, I hope, be presumed, that this investigation, by compara- 
tive experiments, is entitled to confidence, ' pp. 106, 107. 

The result is expressed in the following tables 



£kp. 

1. J. W. gout 

2. Ditto in besltb, sod two 

numthft after ;«ooTery 
9. A. Ia gout 

4. JXttp in health, and two 

months after recovery 

5. J. C. gout 

6. Ditto in health,' and three 

months after recovery 

7. C M. gout 

8. Ditto in health, ten weeks 

after leoorery 

a £. P. gout 

10. Ditto m health, teq wee^ 

after recovciy 

11. Vr. W. gout, one day be- 

fore the attack 

12. Second morning after 
IS. Srrenth day of gout 

14. Eighth 

15. Ninth day of gout 

16. Tenth 

17. Eleventh 
Twelfth 

18. In health, about two mont||i« 

after recovery 

19. J. O. hepatitis, with gouty 



50, Ditto in health, many months 

after recovery 

51. J. W. gout 

Ko opportunity of compari* 
eon. 
S^ J. M. gout 

Kg opportuni^ of comparij 



2. gravity. 
1.016 


Nit of lead. 
Oraips. 
22 


Fh. of lead. 

Grains. 

15.7 


Fh.ad4. 

Grains. 

2.88 


1.0199 
1.0S8 


18.4 
66.2 


4.6 
43.7 


.96 
9l2 


1.0168 
1.014 


26^ 


14.1 
4.8 


2.97 
1J02 


IJ01S7 

i.oao 


16.9 
50.5 


4.3 

20.'2 


.91 
4.3 


1.0107 
1,089 


23.4 

7U 


7 

3a4 


1,47 
6.41 


1.0191 


40 


19.2 


4.05 


1.0096 

1.0201 

1.0099 

1.0242 

1.012 

1.0105 

1.0106 

1.0085 


13.8 

£5.2 

30 

46 

24 

28 

32.8 


25.4 
15 

7 
16.4 


.8 
SJ56 
3.17 
3.8S 
1.0S 
1.47 
3.47 


1.9.172 


26.8 


13.3 


2.8 


1.0207 


57.6 


19.5 


4.1 


1.014 
omitted 


20.4 
42.5 


10 
16.1 


2.1 



omitted 



5S,q 



10.6 



f'?t 



IM 



Dt jSradamore an Ooui. 



JmOm 



Spt gravity. 

S5. T. A. in health, not sub- 
ject 10 gout or rbeuBKft- 
tisDi - lAUS 

84. L. & in boalth, not svh- 

ject to gout or rhcuraa 
tism 

85. A. J. in bMlth, subiccf to 

acute rhenaMtiim 
^. £. J. in Health, not mb. 
ject to gout or rheuma- 
tisni, but plethoric, and li- 
able to toniillary inflanw 



Nttoflaad. 
Gjains. 



25 



Fb. of lead. Fb.adi)^ 
Grains. Grains^ 



13 



8.5 



27. H. T. chronic hepatitis 

88. Ditto ' vben in impro^ad 

beiKh 

89. J. T. continued ftrar 

30. Ditto many months after in 

ftill health 
?1. & P. acute hepatitis 

32. Ditto, feeling in general 
. heakb two months after; 

but certainly not frea fton 
hepatic allbmon 

33. J. B. nephritis 

34. L. S. acute rheuwatisai , 
95. Ia M. tabes mesenterial 
36. H. G. continued fever 

97. Ditto in health, tvo mombf 
after TCCOVC15 * 



1.0183 


40.8 


90i5 


4.33; 


1.0173 


n..4 


5.0 


1.18 


1.0217 
1.0334 


49.8 
49.8 


8a4 

82.8 


4.3t 
438 


1018 


37.8 
32 


13 
18.5 


2.75 
3.9 


1.023 


48 

38.4 


24 
24 


5.0T 
5.07 


1.024.7 

1.018 

omitted 

1.0263 

1.023 


40 

56.<J 
29.8 
51.2 
44.8 


28 

17.7 

5.1 

23^ 

•mitted 


5.02 
3.7,T 
1.07 
4.96 
omitted 



I.M54 



86.g 



ditto 



ditto 



The next aet of experiments which we find introduced inu> 
tbit volume, prove that the actnel temperature of a part, when 
affected with goutv inflammation, attended with severe pain,^ 
is by no meana so high as the feelings of the patient would in^ 
dicate. 

We have endeavoured to ^ve an abstract of the results of 
these experiments, by contrasting the temperature of the aiFect- 
cd part, with that of the conresponding part i|) the other side of 
the body^ 

Affected side» acute gouts S^» ^^l 9S.5; 87.5; 75.5; €7.5; 
^lealthy side, 8S; 70.5; 81.7 5 75.5; 69.5; 75.5|| 

Affected side, chrotie gout, 96.5 ; 86 ; 95 ; 96 ; 
Healthy side, 84 ; 74 ; 93 ; 93. 

From these facts it is evident, that although a part affected with 
gouty inflammation, and giving a sense of intolerable heat to 
the patient, has its temperature actually increased in some in^ 
stances by many d^reesj^ in no case diu the ac;tual tcmper^^e 



1817. Br Scudamore on Qautf i05 

amount to tbe heat of the interoti or central parts of the bodf, 
as indicated by the thermometer placed under the tongae or in 
the a3ull«« llie same (4>servation was made in regard to rhea* 
matic inflammatioo, whitlow, and ulcer from a burn« It even 
apipears, that tbe increased temperature of an inflamed toe or 
finger, giving rise to the sensation of burning pain, is seldom so 
great as that of a soond part of the same Umb a few inches near- 
er the trunk* 

The treatment of gout is considered at very great length. 
He begins by observing, that * the prohibitions of Sydcuham 
against the least interference in the paroxysm, long exerted a 
powerful influence on medical practice — an influence which still 
continues to this day to have a considerable force. ' But thia 
opinion, he shows, was derived from tbe humoral pathology ; 
and although he admits, as a general position, that nature is 
peeking a remedy for herself in a fit of the gout, -and also that^ 
if her purpose were always accomplished with as much success 
as m a first fit, the physician might, with propriety, stand by 
as a looker on, merely admiring the vis medicatrix nature; but 
as, in truth, the disease not only returns frequently, but re« 
tarns with constant increase of strength, and the remedial ef- 
forts of nature, which were at first so satisfactory, become tedi* 
ous, irregular, and uncertain, our author thinks 

— ^ that we ore paying her sufficient respect, in attentively seeking to 
discover the kind of evil which she has to remedy ; taking all her in- 
dications for our guide, and acting truly as her servants ; but not 
with fettered hands* 

* I would assume it therefore as a principle, that we should at« 
tempt the prevention of a fit of gout, if warned of its i4>proach, and 
interrupt its progress when formed, unkss such a state of the consti- 
tution exist, that the gout has taken the place of another more seri* 
ous disease, or may be expected to prevent one which is threaten^ 
ing, and more to be dreaded than itself, ' p, 146, 

He then proceeds to treat, first, of the premonitory symptomSf 
and then or the paroxysm $ and, under the last head, he passes 
under review all the remedies that have, at any time, been re* 
Gonmiended, as well as the various local applications. For his 
judicious observations on these, we must refer to the work itself; 
and shall only observe, that he is hostile to the use of the Eau 
medicinale, and all tbe pretended specifics, upon grounds which 
are perfectly satisfactory, Although he opposes the practice of 
})r Kinglaice, as derived from erroneously considering the dis- 
ease as being entirely local in its nature, yet he recommends a 
less active application of cold as a palliative remedy against the 
bnming sensation of tbe affected part, 



106 Dr Scndamore m 6oui. Jan. 

* It had long rinoe appeared to me, timt a more gradual exhaos-p 
tion of the inflammatioD, and a more soothing mode of efecting this 
than can be obtained by active cold, might be free from dl the ob- 
jections and disadvantages of the treatment in question. It seemed 
also not unreasonaUe to expect, that a moistened evaporating sur* 
£ice would procure very different sensations to the|Mitieot» from those 
whidi accompany the dry and burning heat of skin which gouty in* 
fiammation so certainly produces. 

* I have now the satisfaction to state, that, in about forty cases, 
I have made trial of the following lotion, i^ith the best success. 

]g^ Alcoholis |viii. 

Mistone camphors f xvi. M. — Fiat lotio, modicc tepe- 

fiicta ab additione pauli aqus calidse, et partibus af- 

fectis constanter adhibeatur. 
The evaporation which the alcohol alone would occasion, is advan- 
tageously restrained by this dilution ; and the addition of a sufficient 
quantity of very hot water, is for the purpose of producing a tempe- 
rature, just agreeably lukewarm, and furnishes a prompt and con- 
venient method of employing the lotion, on the principles on whidi 
I recommend its adoption. If it be applied either hot or odd, the 
intention of the remedy is frustrated ; and I have observed, that, 
from being made too warm, its operation has been injurious, rather 
than beneficial. ' pp. 184, 185. 

Dr Scudamore has printed eight cases, at considerable length, 
illustrative of the principles of his practice, which, our readers 
will anticipate, do not lay claim to any novelty, bat only to rar 

tional selection. 

The following note on the action of reagents on nrine, whick 
^occnrs in th^ fifst case, deserves notice, as generally applicable 
where the chemical analysis of the lirine is of use, and especial- 
ly to be kept in view, when examining dropsical urine, in re- 
ference to the opinions of Dr Blackall. 

< I have Invariably found, that the first urine of the morning, 
such even as is secreted in good health, immedintely becomes turbid 
y^'ixXx infusion of galls, and with the solutions of oxy-muriate of mer- 
cury, and of alum. The precipitate which subsides is more or less 
abundant, and dense and coloured, according to the proportion of 
saline and animal matter present, and the consequent high specific 
gravity of the urine* The galls occasion the darkest coloured preci- 
pitate. That from the oxy-muriate of mercury is usually tl^e most 
^ense, and is oflen coloured of a reddish hue. It has the appearance 
of pus mixed with water, and a little coloured. The precipitate pro- 
duced by tlie solution of alum is more white and flocculeut, and pos- 
sesses also uric acid, deposited in crystals. 

* Mr Cruickshank has erroneously described the effect of the oxy- 
muriate of mercury, as being an indication of disease, in the fol- 
lowing words (Rollo on Didaetes, 2nd edition, ^.^^S)^^ The cor- 



1817. Dr Scudamore on Gout. 107 

* roave muriate of mercury is a very useful reagent, as it has no im- 

* mediate efect upon recent healthy urine ; hut in ever^ case of in- 
< creased action of vessels, more particularly of the mflamroatory 

* kind, a greater or less milkiness, and a whitfsh precipitate, is en- 

* tirely produced.' This erroneous statement is copied by Berze- 
lius, (Vieir «f mkaal Chem. p. 98.) That the effect is greater in 
urine of high n»ecmc gravity, and therefore in certain states of dis« 
ease, I have aueady granted ; but the very material mis-statement 
to which I have referred, deserves, I diink, to be pointed out. Dr 
BlackaU (on Dropsies, p. 15.) speaks in drabtfol terms of the eflfect 
of the infusion ci galls, as to Uie nature and extent of its indication 
in ^Usease, or * in some circumstances of apparent health. ' Here, the 
powers jof this reagent ^iSie not correctly oonceiviid.' pp.806«2O7. 

lo the sixth case there are also some good remarks on the 
same subject, suggested by the ready c^igulation of the pa» 
tient's urine even at 120® or ISO®. It is also worthy of notice, 
ihat it contained very little urea» or uric acid, while, on the 
other hand, an extensive secretion of uric acid was continually 
goine on in the hands and the feet. 

This part of the work is concluded with a detail of the pro- 
pbyla.ctic regimen to be followed, which is characterized by the 
same good sense conspicuous on other subjects. 

* Upon a review of the whole of the present subject^ we arrive at 
the conciuston, that the prevention of gout consists rather in doing 
little, than much, by the employment of medicine : and that, in the 
same way as in regard to all other diseases, the cardinal rules of pre- 
serving the health are founded, on temperance and exercise ; on the 
choice of all those means which are found by the individufd to invi- 
gorate the system ; and the shunning of ivhatever injures ^xA en- 
feebles it.' p. 271. 

Dr Scudamore subjoins, as intimately connected with this 
part of his subject, an abstract of some unpublished experiments 
made by Mr Astlcy Cooper, to ascertain the comparative soU 
vent power of the gastric juice on different articles of food. The 
experiments were made in as uniform a manner as possible upon 
dogs, which were killed when a given time had elapsed after the 
substances h^d been forced down the throat, and the loss which 
100 parts of each had sustained by digestion, ascertained by 
weighing. Raw food, and the lean parts of the meat only were 
given, except when the contrary is expressed ; and the form in 
the 1st, 2d, 3d, 4th, 6th, 7th, 9th, and lOth experiments, was 
long and narrow j in the 5tb, it was square, and in the others 
it i% not stated. 

Exp. 1 . One hour. Pork lost 10 ; mutton 9 ; veal 4 ; beef 0. 

2. Two hours. Muttoii 46 ; beef 34 ; veal 31 ; pork 20. 

3. Three hqurs. Pork 98 ; mutton 87 ; beef 37 ; veal 4^« 



108 Dr Scudamcrc ati Gout. Jan. 

Exp. 4. Four hours. Pork 100 ; mutton 94 ; beef 75 ; real G9. 

5. Four houre. Cheese 76 ; mutton 65 ; pork 36 ; veal 15; 

beef 11. 

6. Two hours. Cod-iish 74 ; beef ; rabbit 0. 

7. Time not specified. Fat 70 ; cheese 29. 

8. do. Beef 100 ; potata 43^ 

9. do. Boiled Teal SO ; roast veal 7. 

10. do. Boiled veal 31 ; roast veal 2, 

1 1 . Four hours. Fat 1 00 ; muscle 36 ; akin 22 ; cartik^ 21 t 

tendon 6 r bone 5. 
. 12. Three Jiours. Thigh-bone 8. Six hours. Scapula 100. 
Six hours and aa half. Thigh-bone 30. 

Each of thest experiments was, of course, made upon a dif* 
lerpnt animal, and the irr^ularity of the resulu shows, tbat^ 
notwithstanding the able manner in which they were conducted, 
n frequent repetition of them would be necessary to enable us to 
draw condusions with any degree of confidence* Besides, it 
may adroit of a question whether quick solution in the stomach 
be a proof of tfOjy digestion. As far as we can judge from these 
experiments, the following is the order of solubility in the sto- 
snachof tbedogt cod-fish, (at, cheesei pork, mutton, beef, veal« 
akin, cartilage, polatoe, tendon, bone. 

Cjironic and retrocedent gout are .also treated of with great 
judgment i and thia part of the work is concluded with a table 
of die analytical mode of investigating a case of gout, and.the 
general history of the disease, which waa adopted by the author. 

As connected with the subject of goat, Vr Scudamore has 
lastly subjoined some obsenrations on rheumatism, chronic and 
acute I and, from the whole performance, be has established faia 
character, not only as a judicious observer of disease, but aa a 
scientific inquirer, and good writer. 



vi. 

practical Illustraticns of Tjfplim and other Febrile Diseases. By 
John ABMaTROMq, ^f • D. 8yo« London, 181 6, pp.305. 

THE theories of fever which so much engaged our attention 
some twenty years ago, are now quietly entombed with their 
celebrated inventors, Cullen and Brown ; and as, very happih*, 
no tub^o allnrii^ and seductive has since been cast out to the 
frhale, he has gradually recovered fropi his delirium, and h^ 



1^17. l)r ArmstroDg^^ lUusiratians of Sfjj^ies, <fr. Id 

come at length infinitely more quiet itnd sober than when wA 
first had the honour of his acauaintance. 

It was die erro^ of those splendid theories to regard debility, 
which does constitute a very remarkable part of fever, not 
simply as one of a concourse of symptoms, but as the cause of 
the whole series of phenomena which characterizes the disease, 
fivacuafions of every kind were therefore much dreaded, and 
cantioosly and sparingly used in the treatment of idiopathic 
fevers; while wine, bark, and opiam, were administered with 
indiscriminating liberality. A very different practice is now the 
order of the day* This reform has not indeed been sudden, but 
gradual and progressive. It is now, however, so complete^ 
Uiat there is, we apprehend, some danger of the practice verging 
to the opposite extreme* But a few years ago, and it seemed 
to be the ambition of every recorder of his practice to tell us 
how many bottles of wine he had been able to persuade his fevet* 
patients to swallow, and to boast of the wonderful cures he had 
thus effected t And now every journal teems with the successful 
result of the evacuant plan of treatment, and records the sur* 
prising effects of arteriotomy and venesection, followed by 
monstrous doses of calomel and jalap. It has been bur fortune 
to have seen fevers treated according to both these fashions, and 
we have known mainr patients to die, and many to recover 
under both modes of treatment \ but our experience is never* 
theless favourable to the antiphlogistic method. Evacuation^ 
even of blood, we are friendly to in the beginning of fevers, or 
when signs of brganic inflammation are present \ but we are 
nevertheless equally satisfied, that the lancet cannot be employed 
with the same freedom in the idiopathic fevers of this climate, 
as it may, and indeed must be, in the successful treatment of the 
pure phlegmasifls ; and that debility is a symptom far more in* 
stant in the former than in the latter order of pyrexias. 

We agree, however, with Dr Armstrong, the author of the 
very interesting volume now before us, that the most formidable 
symptoms in fever are those of increased vascular action, and of 
visceral inflammations and congestions i and that the best reme* 
did agents are such as are adapted to restrain, to obviate, and 
to remove these. These agents are, general and local blood- 
letting, cold and tepid afiusions or battis } blisters, purgatives, 
and salivation by calomel j-^and these are the remedies chiefly 
employed bv Dr Armstrong, and the utility of which it is the 
object of these practical ulustrations to estaUisk But these 
powerful agents are not indiscriminately or incautiously ap» 
plied by our enlightened aathon His work, on the contra* 



110 . Dr ArmstroDg^i lOuttraiians ^ J^hus^ ^. Jun. 

77, abounds in judicious reflectionst refined distioctionsy and 
practical illustrations of the highest importance. 

Thedifierent forms oftyphns fever are arranged under three va- 
rieties, — the simple, the inflammatory, and the congestive typhos. 

The simple typhus, as described by our author, differs in no- 
thing from the Typhus mitior of nosologists ; and as the disease 
runs its course through its different stages of oppression, excite- 
ment and collapse, without the occurrence of symptoms indica- 
tive of visceral inflammation or congestion, the more power- 
ful remedies are not necessary. Emetics, in the beginmng ;— 
an antiphlogistic regimen, — the cold or tepid affusion, and pur- 

fatives during the stage of excitement, — with the cautions ex- 
ibition of wine during the stage of collapse, are the only reme- 
dies in general necessary. 

The inflammatory typhus is distinguished by the greater ex- 
citement, and by the symptoms of acute, or subacute inflam- 
mation of some of the viscera of the brain, of the lungs, or of 
the liver or intestines. Dr Armstrong's obaervatioin on tkia 
variety of typhus are highly important. Debility is here indeed 
a very secondary consideration. Life is endangered by the ge- 
neral excitement, and by the visceral inflammations ; and if these 
be not obviated and removed, the symptoms of maltfnancy, pu^ 
trescency, and debility, necessarily follow. It is here that a 
prompt and decisive practice is most eminently uselnl. When 
symptoms of acute inflammation of anv of the viscera are pre- 
sent, it will generally be necessary to have recourse to general 
blood-letting ; and as it is only in the earliest days of die dis- 
ease that this can be done with safety and advantage, Dr 
Armstrong is urgent in recommending the obsta prindpiis. 
On the same account, too, when he has recourse to venesection 
jn typhus, he prefers taking away a sufiicient quantity at once, 
BO as even to produce some degree of faintness, to a repetition 
.of smaller and leas effectual bleedings. Local bleedings, by 
cupping or leeching, and blisters, may afterwards be advan- 
tageously had recourse to. With these, his principal confidence 
is placed in repeated purging, especially by means of calomel, 
which he uses in large doses, with a view to secure also its alter- 
ative effects. Thi«, indeed, seema to be Dr Armstrong's fa- 
vourite remedy, his anchor of hope in inflammatory typhus, and 
in all visceral inflammations. 

* For many years, ' he observes, * it was my practice to confide 
entirely in the co-opcratipn of bleeding, purging, blistering, and an 
antiphlogistic regimen ; but since I have had such numerous demon- 
Btrations of the efficacy of mercury, 1 have never omitted to admi- 
nister ciUomcl, »o as to insure its purgative and specific effects at the 
same time. My general plan, therefore, has been, to give one very 



1817. Dr Annstrong'tf lUusiratioM cf Typkus^ ^ci 111 

kife dose, or two tokrably free doses of it in the day, followed bj 
some other active cathartic, that plentiful evacuations might be pro« 
eared before bed-tame ; while, during the night, I have given it in di- 
vided dosesj with opium, by way of accelerating its more complete 
abaorption.' 

Again*, heobserves^ 

* The dose of calomel and opium should be varied according to the 
nature of the symptoms, and the effect -intended to be produced. 
Where, from the violence of the acute inflammation, or from the long 
continuance of the subacute,, the structure of some vital organ is en« 
dangered, calomel should be given in large doses, combined with a due 
proportion of opium, that the system may be saturated as soon as 
possible. To fulfil this intention, in some cases, it will be best to ad« 
minister a scruple of calomel, with two grains of opium, for the firsi 
dose, and afterwards to give small and frequently repeated doses of 
both those medicines/ 

The practice of asing this combination of calomel and opiam, 
for the purpose of subduing inflammatory action, is acknowledge 
ed by our author to be due to the late Dr Hamilton of Lyno 
R^is. Dr Armstrong seems to have had very extensive expe- 
rience of its efficacy, and to have acquired the greatest confi* 
deuce in the power of calomel, empbyed as a salivant in aQ 
cases of phlo^osis. His general practicei in all acute inflam- 
matiotis, consists in early and copious venesection ad deliquium; 
brisk purgatives, and then calomel, or calomel and opiuoi ad 
salivationem. 

' The congestive typhus is distinguished by the hot stage not 
being at all, or only imperfectly developed, and by simultaneous 
signs of congestion in one or more of the internal orgnns, ' This 
is the fever in which the powers of the system seem mastered and 
subdued by the causa morbi, in whith the reaction or excitement 
is imperfect, and in which it is supposed by our author that one 
or more of the internal organs are in a state of venous conges- 
tion. He thinks, moreover, that, in this variety of fever, there 
is a general derangement of the balance of circulation, thnt there 
is an enfeebled action of the heart and arteries, and an accumu- 
lation of blood in the venous system. 

The want of reaction, and the oppressed and congested state 
of the internal viscera, are necessarily accompanied with great 
apparent debility. 

* In the severest cases of congefitive t3rphu8, there is, from the be- 
ginning, great apparent debility, which speculative men have consi- 
dered as real, and which they have attributed to the direct iiiHuence 
of the ctntagion as a sedative, without ever reflecting that it chiefly 



1 19 Dr Afmstrong^s tUusltations tf J}fphust 4t. Jan. 

depends upon tfie changes which take place in the cfrcahition ; and! 
that it IB no more to be accounted positive exhaustion than the loss 
of muscular power which precedes and accompanies the threateninga 
of genuine apoj^esy, to which disease, in fact, this form of typhus 
has often a most forcible resemblance. ' p. 227* 

Instead, therefore, of having recourse to stioiQlants, t)r Artt- 
strong recommends venesection, the warm bath, brifik cathar- 
tics, and calomel, as the most safe and efficadoos means of r€* 
lieving the internal ooogesiicms, and restoring the reaction of 
the arterial system. 

< It is in the first stage only of the highly congestive typhus, that 
general blood-letting is admissible with a view of relieving the local 
congestions, and of restoring the natural balance of the circulation. 
The practitioner must not fix upon a determmate quantity of blood 
to be drawn, but rather be guided by the effects produced. Some- 
times eight or ten ounces will be quite sufficient, and, at other times, 
sixteen, twenty, or even more, at one time, may be requisite to re* 
Ueve the topical engoi^ements, and to put the genu-al circulation in* 
to proper pay. ' p. ^0. 

After blood-letting, the pulse generally rises ; if it do iiot» 
and the tide of the circulation docs not return to the surface, a 
little wine with warm water should be exhibited, and the warm 
bath and frictions are to be employed. The bowels are next to 
be evacuated by stimulating enemata, and then by jalap and ca* 
lomel ; and a large blister should be applied over the stomach 
or liver. In this form of the disease, our author has generally 
given a scruple of calomel at first, repeating smaller doses three 
or four times on the first day of the attack ; and he thus ob« 
tained at once the purgative and alterative operation of the me- 
dicine. For a long time he overlooked one of the principal ef- 
fects of calomel in congestive fevers, till, at last, be tells us, it 
was forced upon him, * by patients almost invariably recovering 
mth rapidity vohen ptyalism was excited. * 

* The power which calomel has in equalizing the circulation, is 
nowhere more conspicuously displayed than in diseases of a conges* 
tive character. Before its exhibition, the skin will be cold, wan, and 
shrunk ; the pulse feeble or oppressed ; and the whole system appa- 
rently relaxed :— but, as soon as the mouth is made sore from its^ in- 
fluence, the skin becomes warm, reddish, and distended with the vi^ 
gorous circulation, while the pulse is full, soft, and strong, and the 
general energy in a great measure restored. * 

Besides these means, Dr Armstrong remarks, that, in the 
vrorst cases of congestive tophus, the moderate exhibition of di& 
fusible stimulants is sometimes really necessary, not only to sup* 



1817. Dr Arfostrong's lUH^tratians of Typhus^ ^c. 113 

port the vis vitas immediately under depletion^ but also to contri- 
bute» after its employment, to rouse the heart and arteries, that 
the natural balance of the circulation may be restored? Our ai|« 
tbor has drawn a parallel between typhus fever and the plague ; 
andy from a collection of the best authorities, he endeavours to 
show, that all the forms of plague are also reducible to the con- 
gestive^ inflammatory, and simple; and he infers, that the same 
active system of earlv depletion, and purging with calomel, which 
has been useful in the inflammatory and congestive typhus, will 
one day be the means of robbing the plague of its terrors. 

In the course of these illustrations of typhus, many other dit« 
eases are incidentally commented upon, such as dysentery, erysi* 
pelas, and the pure phlegmasias. The general scope of his ob- 
servations, is to inculcate the necessity of early and large evacua- 
sions at the very onset of the disease; bleeding ad deliquiumy 
cathartics, and the specific efi&ts of calomel and opium. 

And his peeuliai^ views of congestion are extended from typhus 
to the illttstmtion of some cases of apoplexy and mania. He 
furnishes us idso with some good observations on the delirium 
tremens, or fever of drunkards, for which large and repeated 
doaes of laudanum have been 90 much recommended. Dr Arm* 
strong's experience renders the universality of this remedy more 
than doubtful. Bleeding is sometimes, and purging always, use* 
fol; and the cold affusion, even when the patient is drenched in 
aweat, he has found both safe and useful. 

We have given pur readers but an imperfect and hasty out- 
line of this volume, as it is not one of those books we would 
wish to saveUiem the trouble of reading. 



VIL 

A Memoir on the Cutting Gorget of Hawkins. By Antonio 
Scarpa. To which is added, a Biographical Account of J* 
B. Caucano Leone, Professor <rf Anatomy in the University 
of Pavia. Translated from the Italian by J. H, Wishabt, 
Member of the Royal College of Surgeons, Edinburgh. Edin- 
burgh, 1816. pp. 88* 

IT is but justice to the surgeons of the present day, to admit 
that, in tiieir professional researches, they have been much 

VOL. XIII. NO. 49. K 



IH ScurptL onthe Cidlifig Gorgei. Jan. 

more zealons in the advancement of medical sciencei and in the 
discovery of means to save the necessity of performing opera- 
tionsi than to the contrivance of mechanical means to execute 
them. There may be still a great inclination in some to make 
frivolous alterations in the form of insruments; but the more 
experienced part of the profession pay as little attention to these 
improvemeniSf as a skilful mechanic would be supposed to do to 
the inventions of an apprentice, whose contrivances are suggest- 
ed only to remedv his own awkwardness. These observations, 
howeveri do not hold true as far as regards lithotomy. There 
' is perhaps no operation which has given less renown to the sur- 
' geons ot this country of late years. In a short period we have 
seen gorgets and knives of all forms used by different surgeons, 
some changing the instrument every time they had occasion to 
perform the operation. Hence have arisen uncertainty and 
want of confidence in the operator; and if the reports which 
have reached our ears be correct, it is dreadful to contemplate 
the scenes of confusion and mismanagement which have ot late 
been exhibited, in performing this operation, in some of the 
London hospitals. 

In the memoir now before us, there are some observations 
well worthy of that consideration which has been bestowed on 
whatever comes from the pen of the celebrated surgeon of Pavia. 
There are two points on which our author chiefly dwells. The 
first is the direction and extent of the incision of the prostate 
gland, — the other, the dilatation of the wound for the extrac- 
tion of the stone. 

* In every operation of lltliotomy in the perinieum, the apex of tlie 
prostate gland must be completely divided, as it opposes the greatest 
resistance to the introduction of the forceps, and to the extraction 
of the stone. But with regard to the body and base of the prostate, 
a lateral incision to the depth of five lines through the whole length 
of this gland, and therefore including a small portion of the orifice 
of the bladder, is sufficient, with the assistance of a moderate and 
gradually increased dilatation, to allow the extraction of a stone of 
more than ordinary size, without the parts through whicli it must pass 
being violently contused or lacerated. ' p. 9. 

He adds, ^ 

• There are, therefore, limits to the lateral incision, beyond whicIi 
*it caunot be carried, without exposing the patient to affections (infil- 
trations of urine) more severe than those which may arise from the 
presence of tlie stone in the hladder. This fact, together witli that 
which follows as a consequence to it, viz. the absolute necessity of 
CMnploying, in every case of lithotomy in the perinsum, a greater or 
loMs degree of dilatation of the orifice of the bladder, and of the 



1^17. Scarpa on the Cutting Gorget. 115 

base of the prostate, in order to supply the want of length and depth 
of the incision in Uiese parts, performed even in the best possible 
manner, constitutes, in my opinion, the fundamental principle of litho* 
tomy by the lateral method, and. furnishes a certain rule for appre- 
ciating the value of the innumerable instruments proposed for the 
quick and safe performance of this operation. * p, 10. 

After making some observations on the gorget of Hawkins^ 
and of its advantages over the scalpel of Cheseiden, he adds, 

^ I have found that the defects of this instrument consisted in the 
excessive breadth of the conductor, especiallv at its apex ; in the 
want of a sufficient elevation of the cutting edge above the level of 
. the groove of the staff; and in the inaccurate inclination of the cut- 
ting edge to the axis of the neck of the urethra and of the prostate. 
The calibre of the neck of the urethra in a man between thirty and 
forty years of age, is only three lines in diameter at the apex of the 
prostate ; four about iu middle, and five lines in the vicinity c^ the 
orifice of the bladder. The size or thickness of the prostate at its 
apex is a little more than two lines; four at its body, and six or even 
eight lines at its base, where it surrounds the orifice of the bladder. 
' In the middle-sized adult, from eighteen to twenty-five, the thick- 
ness of the base of the prostate is two lines less than that of a man of 
forty, and of large size. The precise line, which in an adult the la* 
tend incision of the prostate ought to have, is found to be inclined 
. to the longitudinal axis of the neck of the urethra and of the prostate 
at an angle of 69 degiecs. According to principles deduced from 
the structure of these [larts, the conductor or director of tlie cutting 
gorget of Hawkins which I employ, is only four lines in breadth, and 
two in depth, and the breadth decreases at the beak. The cutting 
edge of the instrument is a straight bistoury in the vicinity of the 
point, but it gradually becomes elevated and convex above the level 
of the grooved staff; so that its greatest convexity is seven lines in 
breadth. Lastly, the inclination of the cutting blade to the longitu- 
dinal axis of the conductor, is exactly at an angle of 69 degrees; 
that is to say, the same which the left side of the prostate gland has 
to the longitudinal axis of the neck of the uretlira. 

* The following is the method of emj^loying this instrument- 
Having introduced into the bladder the grooved staff, the curvature 
of which corresponds exactly to that of the axis of the neck of the 
urethra and of the prostate gland, and the beak of which is a little 
longer tlian that of the ordinary grooved stafl*, so that it may pene- 
trate about an inch and half into the bladder ; having made in the 
usual manner tlie external incision, and that of the membranous part 
of the urethra, not touching the bidby the surgeon, with his left h;uid, 
must hold the grooved staff very firmly in a perpendicular line to the 
body o£ the patient, and pressed against the arch of the pubes ; tlien 
taking in his right, hand tlie cutting gorget, and having inserted itn 
beak into the groove of the staff, so that the convexity of the con- 

U2 



116 Scarpa on tie Catting Gorget* Sm^ 

ductor is placed directly dver the rectum, he will make tfie g<»rget 
run in a line as much as possible parallel to the horizontal extremity 
of the staff placed in the bladder, and he should net stop witil he 
feels the beak of the gorget reach the closed extreoiity of the groove 
of the staff. After this, he withdraws the staff from Ule bladder and 
urethra ; and along the gorget, as a director, he will introduce the 
forceps ; and close to them draw the cutting iostruxnent ^ntly to« 
wards him, removing it in the same direction as that in which it waa 
introduced. Finally, having ascertained, by means of the forceps, 
the position of the stone, he will carefully open the blades, and, with 
th^m, gradually dilate the neck of the urethra and the orifice of the 
bladder^ as much as to enable him to lay hold of the stone with feci*- 
lity, and extract it without bruising or lacerating the pmts through 
which it must pass. * pp. 17*^20. 

In general, with regard to surgical instrumentSf and^ in par- 
ticular, those which have been proposed for the lateral opera* 
lion of the stone, Dechamps is of opinion, that the most perfect 
and useful are those in which no improvement has ever been 
proposed. The shape in which Scarpa reintroduces the gorg#t 
of HawkinSi * is less an improvement than a modificaiion of* ks 
original form, because it fulfils more accurately than it did in its 
primary form, the indication of cutting the prostate iateraliy, 
and to a proper depth, as Cheseklen did, without running the 
risk of wounding the deep pudic artery, or the rectum. ' p. 90. 

The biographical account of Carcano Leone, a celebrated a- 
natomist and surgeon, who was born in the year 1586, {<& inter- 
esting; and we consider ourselves much indebted to Mr Wishart 
for presenting an elegant translation of the two Memoirs to the 
English surgeon. 



Ui7. 



117 



' PART IIL 

MEDICAL INTELLIGENCE. 



REPORT of DISEASES treated at the Hdinburgh Neut 
Town DiSPENSARr^ from June Ut to September 1j/, and 
from September Id to December \st^ \%it. 



Pfrbris continua * • 

■■ ephemera « - 

.« Intenuittens • 
> infant. remitteiM 

dentitionis 

Mydroobphalus - - 

Cephdiea - - • - 

Mania - - * - - 
Delirittm tremens 

A^popiexia - ^ - * 

Bpilepfiia - - - - 

Conviilsio - - - - 
Ophthalmia aeut. 
" ■ dirotiic^ 



Sum. 
19 
14 

Q» 
36 

3 
34 

2 



4 

2 

491 

54i 

2 



Aut 

28 

6 

1 
41 
36 

4 
J6 

1 

a 

1 

5 
8 

81 

2 
"2 
1 
1 

4 



Catacaeta • • • 
Amaurosis- • - - 
St^fayloma - . • 
Fistuki lacryraalis 
Otalgia .... 2 
Surdiias - - - - — 4 
Epistaxis - . . . 1 
Ozsna - ... - 1 
Odentalgui ... 25 21 
Suppuratio sinus maxil- 

laris 1 

Funguahcmatodes sinus 

maxillaris et oris - 1 
Ptjaltsmus ... 1 
Apiithie et aleerafaucium 9 7 
Cynancbe tonsillaris 20 19 
I tracfaeaBs 4 



Catarrhus ^ * m 
Pneumonia • - 
Pleurodyne - • 
Phthisii9 - - - 
Haemoptysis ^ - 
Asthma et J)ppnoA 
Pertussis - - - 
Palpttatio -- - - 
Pericarditis - <> 
Aneurisma aortas 
Syncope . - - 
Hepatitis - ^- • 
Icterus - - .- . 
Scirrhus pancreatis 
ventriculi . - - 
Scirrhus cardise - . 
Haematemesis >• r 
Dyspepsia - -- 
Hypochondrias^, * 
Hysteria - - - . - 
Enteritis - . - . - . 
Peritonitis - - * 
ScirrhOB coli - - . 
Colica .... 
ObstJpatio . . - 
Tormina - - - 
Cholera - . - 
Diarrhoea - . • 
Dysenteria • • 
Scirrhus recti - .• 
Vermes • - - 



Sum. Aut 
5S 107 
23 19 
29 



32 J 

5 

54 
2 
2 

1 
1 
S 

s 



17 
20 
8 
17 
91 



6 

6 



B 


2 


'1} 


90 


H 


90 


5 


2 


1 




1 




„} 


6 
2S 




11 




2 


25 


4S 


7 


4 




1 


50 


4 



118 QsmrterlyBepwtqftJuNemTamnDitperuarj/. Jatu 



Tabes roesenterica 
Physconia - - 
Hiemorrhois - 
Hernia - - 
Prolapsus ani • 
Hydrops - - 
Anasarca at oedema 
Ascites - - 
Hydrops ovarii 
Diabetes - • 
Dysuria - - 
— ^ urethralis 
Hsematuria 
Nephralgia 
Gonorrhoea 
Paraphymosis 
Phymosis •> • 
Hydrocele 
Inflammatio testis 
Hxmorrhagia uteri 
Leucorrhoea • 
Scirrhus uteri - 
Pk*olapsus uteri 
Retroversio uteri- 
Amenorrhcea et chlo 

rosis ... 
Dysmenorrhoea - 
Rheumatisnms 
Podagra . - - 
Paralysis . - • 
Asthenia ... 
Rachitis - - - 
Scrofula ossium et arti- 

culorum 

■ gfauidularum 
Morbus spinalis • 
Syphilis - - - 
Pseudo^syphiHs - 
Phlegmon^ • - • • 
Mastodynia. - - 



Sura. Aut 
2 2 

3 
7 6 
7 2 
1 

4 
8 
2 
2 
1 

4 8 
2 2 
I 
4 
4 
1 



1 

19 

3 

1 



8 
3 
57 
2 
7 
3 
2 

21 
11 

4 

1 

28 

7 



6 
2 
2 
1 
2 
14 
8 
2 
1 
1 



38 



8 

23 
4 
9 
4 

27 
7 



Sum. AuL 
Paronychia - - - 4 7 
Anthrax - - - - 1 

Gangrxna brachii •» I 

Erysipelas - ... 5 7 
Erythema - ... 7 6 

papulatum 3 

Variola - - - - 
Varicella - - - - 
Rubeola . . - - 
Scarlatina - • • 
Miliaria ... - 1 
Urticaria ... - 3 
Strophulus * ' - 8 
Lichen 7 



5 

7 

7 

1 12 

16 298 

5 8 



Prurigo 
Lepra - 
Psoriasis 
Roseola 
Purpura 



haemorrhagica 



3 
3 

4 

1 



5 
2 
3 

7 

13 
1 

1 
1 
4 
11 
51 



Ecthyma - - . - 3 
Impetigo - - - - 14 
•Porrigo - - - - 32 
' decalvans -- 1 

Psora 34 44 

Rupia - ... - 1 • 
Herp^ ..... 9 10 
Acne - - - - -I 
Lupus -.--•- 1 1 
Eruptiones variae * 3 
Aneurysraa per anastora. I 

Tumorcs .- - - . 8 

Ulcus 26 43 

IJstio - . - . - 8 9 
Vulnus .... 14 18 
Luxatio - - .- . 1 
Contusio et subluxatio 42 51 
Fractura - - - - ■ 2 



Observatiam on tie Beportjram June 1. to September !• 

Ko suonmer is remembered in whiph the weather bas been 
more unfavourable than in that vhich is included in the period 
of this report. Dttring its continuancci there bas been no con- 
tinued warm ordry weather i cold winds from the east, varying 



ISl 7. QMorUrly Report oj the New Tamn Dispensary. 1 19 

occasionaDy to the north and north-westf with a doaded akyi 
and almost daily rains, have prevailed. During August, there, 
were slight thunder-storms, with cold rains and hail- showers, but 
without the heat which usually precedes these storms, or the set-' 
tied weather which commonly succeeds them. In the beginning 
of September, when, in ordinary seasons, the harvest here is ge» 
neral, the corn crops are this year still green, and the ear imper* 
£ectly filled ; and, in the higher grounds, the green crops nave^ 
been checked, and, in some situations, materially injured, by the* 
intensity of the cold which has prevailed during the night. 

This state of the weather, together with the privations and 
hardships necessarily arising from the want of employment among 
the labouring poor, seems to have added to their other miseries 
an unusual degree of disease. Inflammatory complaints, in. 
adults particularly, of the chest and of the throat, have been as 

aeneral as in the spring, requiring the frequent and free use of 
le lancet ; and the proportion of rheumatic complaints is equal- 
ly great with that in the last report. The applications on ac- 
count of phthisis have been numerous, and our consumptive pa- 
tients have experienced little of the alleviation of their com- 
plaints which is usual during this season of the year. The in-^ 
fiammatory catarrh among children, however, seems to have en- 
tirely disappeared ; but, amon^ this class of patients, the numr-^ 
ber of diseases arising from a disordered state of the bowels has 
very considerably increased, as is evinced in the list by the heads 
febris remittens, vermes, diarrhcea, &c. Among adults, dyspep- 
sia, and other diseases of the alimentary canal, which deficient 
nutrition and depression of spirits contribute to produce^ have 
been exceedin^y prevalent $ but there have, been no cases of 
those diseases of the bowels, which arise from a disordered state 
of the biliary and digestive organs, produced by the exposuiie to 
heat. 

Of the continued fevers, a considerable proportion arose evi- 
dently from conta^on. Several of the cases occurred in Stock- 
bridge, a village in the suburbs, and the others in famiUes re- 
siding in different and distant parts of the town. The contagion 
did not readily spread ; and Uie fever, though frequently long- 
continued, has not been of a malignant nature, and has yielded 
in all the cases to the use of the cooling treatment, with purga- 
tives, in the early stages, and a very moderate use of wine and 
light diet, after the heat of the skin began to abater and the 
tongue to become moisL 

The hooping-cough, which exists almost constantly in Edin- 
burgh, has prevailed to a great extent during Uie last summer i 
but, if we may judge from the cases which have come under our 



IfO iSiuarlerty Report of the New T<mn Dispensary. Jan. 

c4kervation, It may be said to have been miM, and ba» but very 
rarely been attended with convnhions, ivhich are so commonly 
a consequence of this disease. 

' No other contagious disease appearSt fVom the records of the 
Dispensarv, to have prevailed epidemie&IIy ddring the first eleven 
months ofits institution. Cases of the ^mall-pox bdve occasion- 
aliy occurred among children, who, either frdtti the prqudice or 
carelcssne&s of their parents, have not been vaccinated ; but the 
very general confidence in the antivariolous powers of the cow* 
pox which happily exists in this city, and the stimtilus which is 
given for its inoculation, even among those who had neglected 
it) by the appearance of the smaH-pox, h'mit vei^ itivch the 
operation of this contagion. During the last two or three years, 
we have had an opportunity of seeing, and have heatd of various 
insulated instances of scarlatina existing in different families 
among the higher classes, a^ well ss among the poor, and seve* 
ral cases are mentioned in the records of the Dispensary ; bnt 
we do not know that it has prevailed during that time, or that it 
at present prevaib epidemically in any quarter of the town. It is 
singulaTt thati among the numerous applications to the Dispen- 
sary, no cate of measles presented itself from its commencement 
in September last till the end of July. At this time, we heard 
of $Ome children having been brought from Glasgow affected 
with t,bc measles, and soon after had occasion to see several caies 
in various parts of the town ; and, from the crowded sitnatioVis 
in which it had appeared, and the readiness with which it seems 
to have been c6mmonicated among the neighbouring familiesi it 
18 likely that the contagion wiH be extensively and rapidly dif» 
fused. It affords a curious subject of inquiry, to investigate what 
the causes are by i^hich different tontagtous drteases, existing 
at the same time, or even the same contagioos diseases at dif« 
ferent times, are disposed to extend themselves more or lesa 
readily, in circumstances apparently very similar. 

It will be observed, that the number of cases of ophthalmia, 
which have occurred during the last three months, has been 
very great. This disease has beeft in a certain degree epidemic, 
and in some instances has prevailed in particular streets and 
doses, and has successively attacked all the individuals of fami- 
lies, so as to excite a belief of its contagious nature. It has been 
in general mild, and has yielded to moderate bleedings, some«» 
times assisted by blisters, and the antiphlogistic regimen, foI« 
lowed by the application of slightly stimulant and astringent 
collyria. In some cases where small pustules had formed on 
the conjunctiva, or ulcerations were present on the cornea, tfa^ 



1 S IT. 43^wr/er/j^ Rtport &f tike jSTen Tbtwi Di^ensary. 12 1 

tntt ^as much promoted by the division, by the scissars, of the 
▼easels by which these were nourished. 

' In the Midwifery department, 87 women have applied be^ 
tweed the 1st of June and Slst of August last. The number 
of deiiveries ddring that period has been 61. Of these, there 
were 5t natural iabours ; one preternatural, in which the nates 
and feet presented \ and four complex, viz. two in which the 
placenta was attached over the os uteri, both delivered by the 
operation of turning; one case of twin^, in which the head of 
each presented ; and the fourth, complicated with hsemorrbage 
from induration of the placenta. Of the 62 children produced^ 
40 were males, and 22 females. * 



Observations on the 'Report from September 1. to Decemher I. 

The very variable, but generally moist, cold, cloudy weather 
of the last autumn, and tne conseouent imperfect ripening of 
fruits and grain, and lateness of tne harvest, which, even in 
some parts of the Lothians, was retarded until the middle of No- 
vember, must be in the recollection of all our readers. 

The leading feature of the practice of the Dispensanr, withia 
the last three months, has been the prevalence of measles* 
irhich have generally been severe, and, especially'ia young chit 
dren, in many eases fatal. 

There has been much variety, both in the appearance and 
duration of the eruption, and in the nature and urgency of the 
concomitant symptoms; and death has occurred in different 
individuals in very different circumstances; an enumeration 
of which, as pointing out the occurrences most to be dreaded 
in the course of the disease, may probably be more instructive 
than any practical suggestions we could c^en 

Where the eruption has lasted the usual time, or at least 
fully three days, and death followed, that appeared to have 
been owing, in some cases, to the exhaustion produced by 
hooping-cough, with which the measles have been often com- 
bined ; in otncr cases to spasmodic attacks, approaching or even 
amounting to convulsions, which seemed to be the effect of the 
irritation of teething superadded to the disease. In three casea 
it proceeded from weU marl^ed croup, which supervened sudden* 
ly at different periods, within a fortnight after the decline of the 
eruption, and proved quicklv fatal, notwithstanding the free use 
of calomel, which operated fully. In three other cases, in 

* In the last quarterly report, instead of ' the first class of la^ 
hours, ' read, of the first order of laborious labours ; and instead of« 
f qS the tbir4 class 1, ' read, of the third order 1, 



122 Qjiarierfy Report of the Vem Tofwn Dttpensarg. iuu 

which these causes were out of the question, death seemed evi- 
dently to proceed from the affection of the lungs, marked by 
very quick, short, oppressed breathing, with coi^ and fever^ 
^ but without acute pain in the breast, which came on, or wa& 
much aggravated, soon after the eruption faded. In the only one 
of these, in which examination after death was possible, the mor- 
bid appearances observed were, a highly inflamed state of the 
whole extent of the bronchia; a copious effusion into them^ 
which had partly the appearance of mucus, and partly of bloody 
serum ; and a more partial effusion of this last kind into the cells 
of the lungs, "^I'ith some adhesions of these to the pleura costalis. 
The subject of this dissection was a boy eight years of age, who 
had been twice bled. 

But in a majority of the fatal cases of the disease which we 
have seen, as well as in several who recovered, the eruption 
disappeared much sooner than usual, generally within the first 
2i hours ; or, if it was visible for three days in succession, it 
continued so only by extending itself gradually over the body^ 
not by maintaining itself where it first appeared. This could 
not be ascribed to exposure to cold, nor to the use of ca- 
thartics during the eruption ; * indeed, it was often easy to fore- 
tel, from the appearance of a patient before the rash came outt 
that it would soon recede. 

Those affected in this way were chiefly infants, but a feiR^ 
were children from four to seven years of age. They were ill 
longer than usual, generally five or six days, before any erup- 
tion appeared, having the usual catarrhal symptoms, with much 
debility and drowsiness j frequent vomiting ; generally frequent 
and sometimes bloody stools ; quick pulse, and white tongue^ 
without much heat of skin. When the rash appeared, it was 
at first less distinctly circumscribed, and afterwards less elevated 
than usual, of a darker colour, and attended with less heat of 
skin. After its recession, the patients were more or less dis- 
tressed with cough and dyspnoea, generally with diarrhcea, and 
almost always with a frequent ineffectual attempt to vomiL 
The pulse and breathing became very quick ; the tongue, after 
losing the white crust which had covered it at the beginning of 
the disease, became dry and hard ; the posture indicated much 
debility ; the countenance had the languid vacant expression of 
typhus ; atid a dark^coloured fur usually gathered on the lips 
and teeth. In ail these cases there was a degree of drowsiness 
approaching to coma ; and, in a few, this state appeared to be 
blended with delirium. 



♦ Which are th^ causes assigned by systematic writers for such an 
opcurrence. 



1817. Qjmrierlif Report of rife Nem Tamn Dhpensatyt 128 

Some of these symptoms, p^rticulnriy the indications of un- 
usual debility, the hard dry tongue, and the black far on the 
lipa and teeth, appeared to a certain extent in patients, particu- 
larly in close ill-aired situations, in whom the eruption lasted the 
usual time. In two or three instances, infants exposed to the 
contagion of measles, became affected with catarrhal symptoms^ 
fever, drowsiness, quick and oppressed breathing, and died, 
without any eruption being observed. 

In the cases of speedy recession of the rash, if the cough and 
dyspncea were urgent arter its disappearance, death almost uni- 
formly ensued) at different periods, from the 1st to the Udi 
day after that change. But those in whom the pectoral sym- 
ptoms were less distressing, recovered from the state above de- 
scribed under the use of wine and cordials, which, as far as we 
could judge, were as decidedly beneficial in these, as in any other 
cases in which we have seen them used. It should be mention- 
ed, however, that one or two, who could not be prevailed on to 
take either food or medicines, gradually mended without any 
crisis being observed. 

On opening the bodies of those who had died of this form of 
measles, a considerable accumulation of mucus in the bronchia 
was always found. In two infants, under a twelvemonth, there 
were marks of inflammation of the lungs themselves (which in 
one of these had proceeded to ulceration), and a good deal of 
water in the pericardium ; and in one child, four years of age, 
there was such a congestion of blood in the lungs, that a large 
portion of them sunk in water. 

In several cases, in which the eruption had almost or entire- 
1v disappeared on the second day, it reappeared that night, after 
tne use of the warm bath, and an opiate, and continued nearly 
the usual time. 

An aphthous state of the mouth and tongue occurred pretty 
frequently, but was not confined to the unfavourable cases. 

llie greater part of the children in whom the measles had this 
irregular form, were in ill-aired dirty rooms, but thev were al- 
most all in the same rooms with others, in whom the disease had 
its usual course. Most of them were children of feeble habit^ 
or weakened by previous illness ; but pthers appeared to have 
been quite healthy when exposed to the contagion. 

The circumstances of the livid colour, and rapid recession of 
the eruption, of the succeeding typhoid state, wd the irritably 
Uty of stomach attending that state, seem to point out a resem- 
blance between the cases of measles now descrioed, and the worst 
cases of scarlatina. 
The simultaneous occurrence of measles and hooping-cougb 



12* Quarterlif kepofi of the Zfer Tcfwn Diq)ensafy. Jan. 

in many ot the cases under iSter care, has enabled us to-satisfy 
ourselves, that the doctrine of tbe * hooping-ccnigh being super* 
seded by the occurrence tit measles, ' does not generally hold. 
In several cases in which hooping-cough bad been going on for 
some timp, the paroxjsms of it appeared to us to be as distineU 
ly marked during the whole course of the mfeasles, as at any 
fermer err subsequent period; and in others, in which it had 
nearly subsided, the characteristic mode of cougbffig Wfes renevr* 
ed by the occurrence of measief, and continued darings aad for 
some time after, that disease. 

From the Hi September to the 90th November, tbe number 
of app1iention« in the midwifery department were 84 ; the num- 
ber of deliveries 53, Of these there were 43 natural iabours ; 
four preternatural, vi2. two feet, and two breech ptresemations.| 
two laborious, in one of which, delivery was effected by the for^ 
ceps { three complex, vis. one case ^ twins, and two attended 
by convulsions 9 and three cases of premsrture Iab6bn Tw«iity« 
aev^u of the children were males, and 29 females. 



Medical Dejmriment qf'fke Army. 
. We leel much pleasure in assistinfjr to circulate the following 
pecent regulations respecting the qualifications necessary for en- 
tering into tbe medical department of the army, and the eir- 
cumsunces which are in future to be considered as recommend- 
in<i a candidate for promotion. 

* The Army Medical Board, solidtona for the improvement of the 
department in iu vaneus branches^ and coosidering the present a fa- 
vourable opportunity for tJie selection and encouragement of weH 
vdttoated persona, have thought it advisable to promulgate the coursea 
of instruction, and the quaiincations required from gentlemen enter- 
ing the medical department of tiie army, and during the progress of 
advancemant in the service. 

For tlospiial Assistant. 

* Tbe candidates for this first commissioned appointment in the 
inedical d^artipent, must produce certificates of regular study, in the 
following braiKhes of professional knowledge, at an established school 
bf eminence, viz. 

Anatomy. \ 

fSSotKS;e|^«^i^ 'l^Mr-^of Truhe Months. 

r Chemistry. } 

Materia Medrca* I 71 • c- hvt ^7 
Botany. yDunng Six Months. 

*■ The practice of medicine and surgery in an hospital or infirmary 
*at letet one year, with k regular afqpcentioeship, or tliree vears with- 
out an apprenticeship ; in which case a pertifip^te of liavmg studied 



1817. Mtdka Ikpmim^^^^ 4rmy, 4^. ItS 

practical pharoiacy wU) be Feq(ure4- BegimeRtsil medical oflSceci 
should oko be acquainted with midwifery. It wiU be considered an 
i^ddidonal recommendation to gentlemen entering the service, to have 
attended public estidblishiiients for di^e^ses pf die eyes, and mental 
derangement. 

* A liberal education is indtspensabty requisite; and the greater the 
attainments of the candidate are in the various biimches of science, in 
addition to competent prof^ional knowledge, the more eligible wtJI 

> he be deemed for promotioi^ ; as selections to fill vacancies will be 
guided more by reference to ^ch acquirements than to seniority. 

* By the established regulations, every gentleman must have senr* 
ed five years at least in the junior appointments, before he can be pro* 
moted to the rank of regimental surgeon ; and he who gives the best 
prooft of diligent exertion in the performance of his public duty, and 
of attention in the acquirement of practical knowledge, will be noted 
as the most eligible candidate for advancement* 

* Gentlemen already in the service are earnestly recommended to 
avaQ themselves of every opportunity of adding to their knowledge, 
by attending universities or schools : for which purpose, every facili- 
ty will be afforded by the Director-General. Tney are especially de- 
aired to transmit to this Office, certificates of such classes as they may 
liave attended subsequently to their examinations before this poan^ 
either on professional or other branches of science, that the same 
niay be duly registered : and every gentleman must be prepared for a 
second examination, if called upon, before he obtain farther promo* 
tion. 

* Medical officers are encouraged and recommended to look for- 
ward to the appointments of surgeon to the forces, and of physician 
to the farces ; and to end^^our esjiecially to qualify themselves for 
either, according to the bent of their ingUnations, and tp their pre- 
vious study. 

* For commission of Surgeon to the Forces, it will hereafter be ex- 
pected that the candidate shall have attended a public hospital three 
years, one of which must have been passed in London ; and a diplo- 
ma from the Royal College of Surgeons of London will always be 
respected. 

* The rank of Physician to the Forces requires, in addition to the 
knowledge and experience to be gained in the regular progress df 
study and of service, that the candidate should be a licentiate of the 
Royal College of Physicians of London, or a graduate of the Uni- 
versity of Oxford, Cambridge, Edinburgh, Dublin, or Glasgow. 
The license of the London College of Physicians will always be 
considered a great recommendation to those who have the other rc- 
quimte qualifications. 

^ Although the British schools are specified, it is to be understood, 
that candidates who have received regular education in foreign uni- 
versities, or other schools of acknowledged ^celebrity, will be admit* 
ted to examination. * 

Atmtf Medical Board Office^ September 30, 1816. 



126 Medical Benefit Societies. « Jan. 

Sodetyfor the Benefit of the JVidomofihe Offcenofihe Hospital 
and RegimetUal Medical Staff cf his Majesty's Army. 

The activity and philanthropy of the present chief member of the 
Medical Board, extend their beneficial influence to every object con- 
nected with the important situation he fills ; and we are disposed to 
consider the institution of this Society as one whose good effi;cts will 
be uninterruptedly progressive. Such an institution was the more 
necessary, because, at Uie common hfe insurance offices, the lives •£ 
medical officers either were not insured at all, or only at premiums to- 
tally disproportioned to the risk. For, we believe, it has been as- 
certained, that the life of a medical officer is, upon an average, not 
%jiiorse^ to use a technical term, than the life of a civilian. 

The resolution to form this Society was entered into at a numer- 
ous meeting of officers of the general and regimental hospital sta£^ 
held at the British Coffi^chouse on the 22d December 1815, Sir James 
Macgregor, Knt. M. D. in tlie chair; and a committee was appointed 
to draw up the rules and regulations for the management of the So- 
ciety. At another general meeting, held on the 2d March 1816, 
Francis Knight, Esq. In the chair, a code of regulations was finally 
adopted, and the various office-bearers were appointed. The deed of 
settlement was aftern'ards printed and circulated, by which it appears, 
that the Institution is stated as having been established on the 1st Ja- 
nuary 1816 ; and the first half year's Heport, which we annex, gives 
a satisfactory view of its progress. 



Report made at the Anniversary Meeting of the Society for the Be* 
nefit rf IVidoxKs of Officers of the Hospital and Regimental Medi^ 
col Staf of the Army, held at the Thatched House Tavern^ St 
James's^ on the Sth June 1816. 

Every one who feels an interest in the success of the Society 
lately formed for the purpose of establisliing a fund for the beneiit 
of widows of medical officers of tlie army, will learn witli pleasure, 
that tills Institution has already met with a greater degree of support 
than had been contemplated by the most sanguine, notwithstanding 
the very great reduction of the stall' consequent to peace, and other 
circumstances unfavourable to the advance of money. 

In order that experience, rather than speculation, sliould form die 
basis of this Institution, the regulations by which die most prosper- 
ous establishments for similar purposes are conducted, were carefully 
consulted ; and, as the productive powers of money in accumulating 
capital are subject to tlie unerring principles of arithmetical calcula- 
tions, it was deemed expedient to submit the resources from which it 
was proposed to create a fund for the benefit of widows of medical of- 
ficers of the army, to the rigid scrutiny of gentlemen eminently skil- 
ful in such matters. 

from such excellent sources of information much has been gained, 
which it will be^U^e interest of tliis Society to imitate, while some 



1817. Medical lienefit Societies. 127 

things have also been learned^ which it will be the duty and care of 
its managers to avoid. 

The Society has for its first object the creation of a capital, the 
interest of which shall be adequate to pay the stipulated yearly pen- 
sions to the widows of contributors. 

The next object is td extend the benefits of the fund to the or- 
phans ci£ contributors, as soon as the association shall po5;sess a suf- 
ficient capital to enable it to accomplish so desirable an end, without 
decriment to the widows. 

The stun of money already accumulated by the Society has enabled 
the managers to purchase L. 1671, lOs. 9d. in the 3 per cent, stock ; 
and| in addition to this, there is as much now receivable as will, at 
the present rate of that stock, purchase L.800, making a capital of 
J^*W7\y lOs. 9d. in the 3 per cent$.y the increase of which will be 
the more r^id, from the resolution recently entered into of freeing 
the fund from the expenses of management, by a voluntary subscrip- 
tion. 

The number of subscribers already amounts to 230, of whom 153 
are subscribers of the Inghest rate, * and 77 are subscribers of the 
lowest rate ; f of these 159 subscribers are unmarried, and 71 are 
married. % * 

It is to be observed, that the fund in possession of the Society has 
accrued almost exclunvely from officers of the medical staif in Great 
Britain. — ^It is therefore but reasonable to look for a \ery important 
accession of numbers from tlie East Indies, Ceylon, the Isle of 
France, the Cape of Good Hope, St Helena, tiie numerous islands in 
the West Indies, Canada, and France, 

From the countenance the Institution has experienced in its com- 
mencement, which is, even at this early stage, sufficient to insure 
success, there is every ground for confidence ia the result. 

JV. B, Since the above report toas made, there are ncarlj^ thirty 
more subscribers added to the list. 



Society for tlie Relief of JVidoyL^s and Orphans of Medical Men in 
London and its K>iciuitif. 
This laudable Society, which was instituted in 1788, held its anni- 
versary festival on the 29th October 1816*. By the printed lists, it 

• Subscribers of the first clas*?, who are married, ^nyfve guineas 
annually ; those who are not married, trvo guineas. 

f Married subscribers of the second class pay two guineas and a 
half; unnSirried subscribers one guinea annually. 

X Married subscribers of the first class pay a fine of ten guineas, 
and of the second /?Df guineas, at the time of tiuhscribing. l.'n mar- 
ried subscribers, who afterwards marry, pay a fine of twenlj/ guineas, 
if of the first class, and ten if of the becond. There is also another 
fine imposed upon subscribers married or marrying, for every year 
above five that they are older than tliuir wives, regulated by the age 
af theaubscriber. 



138 Medical NiWSf 4^« Jan. 

%ppwn tbat it now conaiiU of 328 of the most respectable iniividufjs 
in every branch of the profession. Since its bstitution, 144 meiQ- 
bers have died, and 32 of their families have applied for and received 
relief, in all to the amount of 5282/. The annual subscription is t«o 
guineas ; but many benefactions and legacies have been received from 
die friends of so laudable an Institution. The allowances to widows 
and orphans, or to mothers and sisters, seem to depend upon circum- 
stances ; but, to entitle any of tliem to receive relief, they must be 
left a widow with less than 40/. a year, and lil. for each child ; pr 
orphana with less than 20/. a year. 

Medical Netos. Communicated by Dr von Bmbdek, 

Gattingen, — The Royal Society of Sciences has just published Co«- 
menttUtones SocieMis Regiae Sdentiarum Gbtiingeusis reeaUiores^ Vol. 
III. ad annos 1814 et 1815, with 16 plates. After an annual report 
of the particulars of the Society, such^as the decease of many of the 
members and correspondents of the Society, and the election of new 
ones; the fate of such prise-questions whose terms have expired, and 
the new ones that have been proposed, with a retrospect oif tibe lee* 
tures ; the volume is divided in three parts, viz. 

I. Comtnentationes classis physicae^ which containsthe following in- 
teresting articles. 

1. Blumenbach, specimen archaeologiae teQurb terranun imprimis 
Hanoveranarum alterum. 

2. Osiander de homine, quomodo fiat et formetur, sevies observa- 
tionum una cum descriptione staterae portatilis ad examinandum in- 
fantum neonatorum pondus nuper inventae. 

3. Blumenbach, specimen historiae naturalis ex auctoribus classicis 
praesertim poeds illustratae, eosque vicissim illustrantis. 

4. Hausmann, observationes de pyrite gilvo s. hepatico ac radiato 
cuctorum. 

The following two parts, not belonging immediately to our depart- 
ment, we only mention the names of the divisions, which contain 
equally interesting subjects. 

II. Commentationes dams maihematicae* 

III. Commeniationes dassu Ustoricae et phiMogieae* 

Prize Quetiiont, Communicated by Drvon Embdex. 
St Petersburgh* — The academy of sciences has oftercd a prize of 
100 Dutch ducats, for the best answer to the following question, which 
is to be sent, before the 1st of January 1818, to the perpetual secre* 
tary of the academy, in either the Russian, French, German, or Latin 
language, with a device; and accompanied by a sealed paper, haying 
on the outside the same device which is upon the treatise, and enclos- 
ing the autlior*s name. No treatises coming to hnnd later than 
the mentioned period, can be admitted to the concurrence for 
the prize. To prevent any ambiguity, we give the words of the ori- 
ginal programme.---On ne sauroit nier que, nonobstant les redierches 



• IS 17. Prize^Qiustions^ ' 129 

multipH^es institti^es sur 1ft melange des alkalis et Aeg teirfes/si noOs en 
exceptons la potasse et la soude, les autres nous laissent Encore beati* 
coup a desirer, pour arriver d une connoissance complete des especea 
<le metalloides rtellement existantes. L'academie couTaincue de 
Timportance de ce sujet, d'oik dependent les progrds uHerleurs des 
sciences physiques, propose un prix, qui sera adjug§ auphysicien qui 
lui aura conmiuniqu^ la serie la plus satisfatsante d'experiences pr6-> 
prejt, institutes sur les melanges des alkalis et des terres, qui jusqu'ici 
n'ont point encore M compl^tement examinees. L'academie desire de 
dinger Tattention des physiciens principalement sur les points suitans* 

1. Faire la revision des toutes les experiences institudes sur le k^li 
«t le natron, et sur les bases metalliformes qui y sont continues, et 
examiner plus exactement les resultats qu'on en a tir^s. 

2. Soumettre TammoniaqBe k nn examen particolier et plus soig- 
neux, a fin de prouver d*ane manidre decisive, laquelle des opinions 
^mises sur son melange est la mieux fondle, et si le pr^tendu metal* 
loide qu*il contient pent 6tre repr^ent^ isolement 

S. Examiner d*une manidre plus complete qu'on ne Ta fait jusqu*ici, 
les substances metalliformes des differentes terres, voir si elles peuveht 
^tre produltes dans leur etat pur et isol^, connoitre leurs propriet^f 
tant dans o^ etal, que dans la eombinaison avec d*autres substances^ 
et indiquer les rapports differens et determines dans lesquels elles 
peuvent etre presentees. Outre le prix qui sera decerne & Tauteur du 
memoire le plus satisfaisant, Tacademie lui promet un norabre de cent 
exemplaires du memoire couronne en dedommaffement des fraix que 
pourront occasioner les experiences & faire sur des terres rares. 

GoUingen, — Thb physical class of the Royal Society of arts o£brs 
the following question — ' To prove unequivocally and decidedly, by 
experiments, wlicther muriatic acid, and oxygenated muriatic acid, be 
really oxygenated substances, that is, combinations of a combustible 
base with oxygen ; or, whether these bodies do not contain oxygen, 
and that, consequently, ox3'genated muriatic acid is to be considered 
85 a simple substance, analogous to oxygen ? ' 

The prize is 50 ducats. The question is to be decided on, In No» 
vember 1818 ; and the treatises, which are to be in Latin^ to be sent 
in, post paid, befor&the end of September 1818. 

Paris. — The Cercle Medical offers a gold medal, value SOO francs, 
for the best answer to the following questions. 

* U What is the nature of hydrophobia, and in what does it con« 

iUSt? 

* 2. What are the characteristical symptoms of it in men and ani« 
mals? 

* 3. Does any state exist, in which this disorder spontaneously un« 
folds itself in mankind ? 

* 4. Are there any more kinds of it than one, and what are they? 
^ 5. Are they all of them contagious to mankind, mid how ire tbey 

communicated/' 

VOLi xiu. NO. i9» I 



ISO . PHxe-QMedUfit. hms 

* )S. Are die ^mptoms foUowtng the bite of a rabid imimd to be 
attributed to a peculiar poison, to the nature of the bitei to the le^oit 
of the bitten part> or to fright? 

' 7. Do the fluids and solids exhibit any particular change pecU-' 
liar to the disorder, during life, ot post mortem f 

* 8. Which is the best treatsient, as well for the prevention atf 
cure?' 

A prize of 200 fbniks was e&red already by this Society for the 
same questions in 1813, with an additicm of 100 franks from the Pre- 
sident Professot Bosqmllon's private purse; but no satisfiictoiy answer" 
being sent in, in 1814, the question was re-propoaed for April 1815» 
when likewise no answer being found to deser/e the priae, the ques- 
tions were again put up for i£d end of 1816; against w^idi time* the 
tieatises, written in Latia or Freneb, are to be sent to Dr Chardel, se- 
cretary-general to the Cerde Medical, rue Lapette, No. 13» with an 
inscription, and accompanied, with a p^>er sealed up, eontaining the 
aame inscnption, and the author's name. 

N. B. The ordinary members of the society are excluded from the 
concurrenoe for the prize* 

Paisdnous Mj^Ms from the Sting of a See. 

Jamss Grierson of Daboner was taken suddenly widi sick- 
ness, 88th June 1814, which begun like severe water«brash, aris« 
ing from the bottom, or pervading the whole stomach* He left tbe 
imrlonr, wb^re ther« #ere strangei^, to lie on the bed. He had 
not been on tbe bed fnore than A minute, wtien he bad a call to 
^mit| but be #afl scarce at tlie bAdn^tand, fadr yards distance^ 
ivfaen his stomach was completely emptied, like the shot of a ffxh. 
In ^^reat distress he sat down on a chair, leaning; his head on tbe 
, baam-stand, wbich is tbe last thing be remembers: Hatring faint* 
' cd, and, falling on the floor, be lay therd dnnoticed tiU called to 
dinner : the fall of the basin was n6ard, but tiot attetided to. 

Tbe first thing be retoHects, was noticinff the b&sin broken, 
ike stand overturned, and himself on the noot% when he must 
have fainted. Tbe next thing noticed was thd sobnd of setefal 
Tdccs speaking, and persona rubbing his bands and feet ; tbis 
Ivaa while he felt himself as sbwiy awaking, and recollects that 
aereval times he opened bis eyes, but cotfld see no light. It 
Ivaa noticied, that be k>oked very high then. At this time he 
kad a call to purge, which was almost as quick and Tiolent as 
the vomit. 

When put to bed, he kept sweating, with a low pulse, shak- 
ing violently at times, more especially one or two hours after, 
than at first: in about six or seven hours he recovered. He 
was much at a loss what to ascribe all this to; for, though in his 
69th year, he is perfectly healthy, unless that a bowel complaint 
comes frequently and unaccountably oti bimi but it seems to 



Hi7. Efedsffthe StingqfaBee^ 4v« fef 

carry cff all others. Though subject to cholics and colds iB 
early fife, he has had neither for a dozen years at least. 

At first he imputed his illness to ind]|^stion, though his break* 
Cut had been, as often, a plate of porridge and milki with a cop 
of tea, and one &Iice of bread; but he thou^t the Hoilk tasted 
anusually strong, and having been a fortnight immediately pr^i^ 
ceding from home, be tiad had no porridge during that time. 

Also, immediately before^ he bad been walking ki the fieldif 
when rain fieU, and had got his feet wet, and his clothe^ a littlii 
ao; but he washed his feet and legs, and put on dry stockiitt^ 
which seldom &ils to prevent injury to him ; but he though^ 
hunytng to be wttfi the straogers, Ke might not have sufficient* 
ly attended to drying bis feet, aad he was then, as usual, in wi^ 
ton clothes, thovgh, when from home, dressed in warmer wool 
dothes. 

None of diese causes, however, seem equal to such an effisct*; 
But he had been stung with a bee on the back of the middle. 
fin|ser of the left hand while drying his feet, which caused fittla 
paiii and no swelling, though formerly sudi a stin^ caused great 
swellings on him. He sometimes thought of the stmg, but could 
not alkiw himself to diink thai could occasion so much trouble^ 
He is now of a different opinion ; for, on the 6th July, he^wus 
stung by another bee on the same part of the middle finger of 
the right hand, which produced similar effects, but not nearly 
so viokat)— no^ fainting, but considerable sickness and nausea^ 
sweatingi and aome shaking; beudes, so nuich asthma, that 
when he was in the one room, the difficulty of breathing waa 
beard in the other, and a cough produced expee^ration that was 
extremely salt- tasted; and Miss IS , his tiieoe, who happen- 
ed lo he present on the 6th Juk, said the sting of a wasp had 
1 considerable akkness to oer. 



Analytit of the Excrememt af ihe Boa Qmdridot. 
Two Boa Constrictors were lately exhibited here. The keep- 
er, as a part of their hiatory, mentioned that they very rardy. 
passed any excrement, and that only when they were put in a 
xesset of water to reAttsh themselves by swimming. He also 
showed the excrement itself, thinking it curious from iu resem* 
Uanee to chalk. A small portion was analyzed, at the request 
of the ]Sditar, by Mr Da Costa, and found to consist of 

Phosphate of lime, i« 

Carbonate of lime, 5?. 

Albumen^ * 5. 



lf$f Mf hpiVs Que ^ Jmmirtms. - Jan.* 

S^mfie tjf QmgenUal Amawmif as it Family Disease. By 
Mr Lyall, Surgeon. 

At a meeting of the Paisley Philosophical Society* bdd 22d 
Vabroary 1813, Mr Lyall gave the following accoont ofa Tamily, 
in which three of the children were born blind, apparently ow* 
ing to insensibility of the retina. David Suwart and wife are 
healthy people; have had seven children, all of fair Goniplexion,r 
and with blue eyes, and generally healthy. The three oldest 
children, who are dead, saw quite well; the two next were born 
Uind{ the sixth sees; and the seventh was also born blind. The 
laist four are living. 

Case L — Margaret Stewart, aet iO. At a little distance, one 
would suppose her eyes were ouite perfect, wt(h respect to vi- 
sion. When eocamined more cioaely, the eyebaUa are often seen 
rolling, not being fixed on any object They have a glossy ap-« 
pearanee. The pupils are large; and, when die eye is suddenly 
exposed to a strong light, they contract a little. When the 
candle is held still very near the eye the pupils seem in a small 
degree to contract and dilate alternately. Vision is so imper-* 
llM^t, that it is with some difficulty she can distinguish the candle 
or the fire. Eyeballs large, and seem a Iktie sunk in the orbit. 
Meter had anv disease of the eyes. Passed through the small- 
pox and measles in an easy manner. 

Case IL — Jean Stewart, set. tight years of age^ Gieneral ap-« 
pearance, and eyes similar in every respect to her sister's, ex* 
eept that the ey^Ndb are more sunk in the orbits; and she is 
unable to dtstinffui$h a candle or the fire. 

Mrs Stewart thinks they both saw a little better when younger^ 
but cannot be positive. 

' Case III. — bavtd Slewatt, a child rather more than two 
years of age. Eyeballs very much sunk in the orbits, similap 
to the other cases in appearance^ - He follows a candle steadily^ 
but distinguishes none but very kiminous bodies. 

Ifoie h^ the £AVor.*«-There is a umiiar occurrence in a faniily 
of high rank, resfdhig in this city. It consista of ei^ht cbil« 
Aren, three of whom are afieded with congenital amaaroeis^ 
Nehfaer father nor mother are afteted with* the disease, nor can 
it be traced to any csme^ 



We hasten to prinj, for the informatio^i of 4he profession af 
large, the following biO^ introduced into the last session of Partia<» 
mcnt, and which has only lately reached us. We have not room 
at present to investigate it in all its bearings; but it appe^s ta 



1817. BiUfor JS^gidaiing He PraOke qf Surgery. ISd 

Vf not at 911 calculated to attain its professed object, buti oo tha 
contraryi to be fraught with multiforioas evils. 

A Bill, for Bepdating the Practice qf Surgery throughout the 
United Kingdom of' Great Britain and Ireland. 

Wu^EAs ignorant and incapable persons are not restrained by 
law from practising surgery, whereby the health of great numbers of 
persons is much injured^ and the lives of many destroyed ; 

May it therefore please your Majesty, 
That it may be enacted, and be it enacted by the King's Most Excel- 
lent Majesty, by and with the consent of the Lords Spiritual and 
Temporal, and Commons, in this present parliament assembled, and 
by the authority of the same, That from and after 

it shall not be lawful for any person to practise surgery, 
for lucre or profit, unless he shall have been personally examined, as 
to his qualifications and fitness thereto, by the Royal College of Sur- 
geons in London, or by the Royal College of Surgeons in Edinburgh, 
or by the Royal College of Surgeons in Ireland ; and unless he shall 
have received a diploma or testimonial of his knowledge and ability 
to practise surgery, under the seal of the Royal College before whom 
such examination shall have been made ; for which diploma or testi- 
monial the usual fee, and no more, shall be demanded and received. 

And be it further enacted, TTiat every person who shall have 
been so examined, and shall have received such diploma or testimo- 
nial under the seal of either of the said Royal Colleges, shall be en- 
titled and shall have, the right to practise surgery in any and every 
part of his Majesty's dominions, any law or custom to the contrary 
potwithstandingf 

Provided always, and be it fUrther enacted. That all and every 
person or persons who shall have been duly examined, and shall have 
obtained a testimonial or qualification as a principal surgeon in his 
majesty's army or navy, and who shall have actually served in that 
capadty, shall be entitled to practise surgery in any and every part 
of his majesty's dominions^ 

And whereas by a certain statute of the parliament of Ireland^^ 
passed in the thirty-sixth year of the reign of his present majesty, in«* 
tituled, * An act fbr the further regulation of public infinnaries or 
hoapitah, ^ it is ena<:tcd. That fVom and after the passuig of that act^ 
no person should be capable of being elected surgeon to a county 
infinoary or horoital, who should not previously have obtained 
letters testimonial of his qualification under the seal of the Royal 
CoU^e of Surgeons in Ireland ; and that no other qualification or 
eaamination should be necessary to n^ake any person capable of 
being elected surgeon to such infirmary or hospital : And whereas 
by another act, passed in the fifty-fourth* year of the reign of his 
preaent majestv, intituled, • An act to amend several acts for erect- 
ing or establishing public infirmaries or hospitals in Ireland, so far 
fia reli^tes tp the surgeons or apothecaries of such in^rmaries or ho6i« 



1S4 BUI for Bigtdating the Practice if Sktrgety. Jam 

jntnU/ it 18 provided, that Icttrrv tesdmonial of the College of 
Surgeons in Ireland shall be laid before the grand juries in the said 
act mentioned, previous to the requiring or making any presentm^t 
of any sum of money to the surgeon to any infirmary or hospital by 
such grand juries : And whereas it is just and expedient that the 

SroTisions of the said acts should be extended to the members of tlie 
loyal College of Surgeons in London and in Edinburgh ; be it 
therefore enacted, That the members of the Royal College c? Surgeons 
in London, and of the Royal College of Sui^;eon8 in Edinburgh, 
shall be eligible to all the offices and ^ppoiptments mentioned in th^ 
first-recited act, and shall be entitled to all benefits and advantages 
giv^n and intended by the second-recited act, on the production of 
the diplomas or testimonials under the seal of their respective Royal 
Colleges, in the same manner as the members of the Royal College 
of Surgeons in Ireland have been since the passing of the said recited 
acts. 

And whereas surgical aid is frequently required in the practice of 
midwifery, and it is expedient that male persons so practising, shpnld 
be qualified to render sui^h ^d ; be it therefore enacted, Tnat from 
and afler it shall not be lawfiil for 

any male person tp (H^ctise midwifery, unless he shall have obtaine4 
a diploma or testimonial of his knowledge and ability to practise sur? 
gery, undpr tlie seal of one of the said Uiree Royal Colleges ; or un- 
less he shall have obtained a testimonial of qualification as a principal 
surgeon in ^e army or navy, and shall have actually servea in that 
capacity. 

Provided always, and be it furtjier enacted, That nothing in thi^ 
act contained, shall be deemed or taken to extend to any person re^ 
aident in Great Britain or Ireland, and actually practising surgery 
or piidwifery at the time of the passing of this act ; but Siat every 
Bttch person may continue to practise su^^ry or midwifery respec? 
tively, so far as any such person lawfully might have done ii this act 
had not been passed* 

We readily comply with the request of an anonvmous correspond- 
ent, to reprint the Regulations at present followed by the Univertt^ 
of Edinburgh, in conferring degrees in medicine, as they have nnder-t 
gone material changes since we formerly assisted to give thep publi- 
city. (Edin. Med. and Surg. Joum. Vol. I. p. 391.) We have alsq 
subjoined a copy of the Sponsio Academica, signed by each candi* 
date on receiving his degree^ as we hiiye frequently been q^plied to 
for copies of it under ^ yery erroneous notion of its import. 

Q. jF. F. q^ S. Statuta Sdennia de Doctoratus in MeeUdna Gradu 
in Academia Edinburgena Ctqxssendot n FacuUate Medica propomtm^ 
et in posterwHi jubente Senatu AcademicOf oUervanda* 

^ I. Nbmo ad DOCTORATUS in medicima gradum promoveatur^ 
fiisi Die Solemn, nempd jprimo measis Au^;U8ti| vel die proximi se? 



-1S17. lttffihii(m/prGraiuatKatSdinln^ US 

quente ; nee prim qnim ipie mnuna aetatis siue unum et Wgesimuiii 
complererit. 

II. Nemo Candidfttorum nttmero adsciibatuf priusquam tribH** 
KiiTM, saltern per sex menses quotannis, in hac aut aJi4 academu^ 
medicinae studio impenderit« et omnibus quas scientia medica com* 
plectltur disciplinisy scilicet, anatomise et CMiRURoiiB,— chemise,— 

BOTANIC^ MATERIA MEDICA et PHARMACEUTICA,^--MBI>ICINJ£ 

T0EORRTICA» — MBOICINA PRACTICE, — PRJELXCTIONIBUSQUE OLI^ 

KICIS9 sub medicins professoribus habitis, operam dederit. 

III. Quicunque honores medicinae ambient, ante diem XXlV^^nn 
Martiiy consilium suum cum Facultatis Medica* Decano commum'cet, 
et illi tradat i>iss£rtationem msdicam iNAUOt/RALEU, i seipsA 
compositain> ut Professor aliquis, a Decano designandus, earn perle- 
gat, si opus fuerit emendet, et perlectae scriptam suam testificatio- 
nem apponat. Cum dissertatione^ tradat etiam medioinae studiosus 
Decano Facultatis, studiorum testiraonium in hac aut id alia acade- 
mic ; atque autograpbum his verbis ; ' Ego ■ gradum 

* DoctoratCis in Medicina ambiens serio et sancte Medicinae Profes- 
' sOfibus et AXwBS Academiae Edinburgenae assevero, et hoc scripto 

* meo testatum cupio. me unum et vigesimum aetatis annum jam 

* complevisse, (vel, si ita res se habuerit, ante diem solennem esse 

* completurum), et esse liberum hominem, scilicet nuUius chinugi^ 
' aut pharmacopols, aut alius cujusvis ardficii magistri senritio ikl* 
^ dictum, at discipulum, vel tiroDem> Tel ministrum, quaUs Anglici 

* dicitor Apprentice,* 

IV. Postea quasstio d Facultate Medic^ vel TivA Tooe, rel scrip- 
to, priTBdm habenda est, de variis qua scientia. medica complectitur 
disciplinis ; ut nemo nisi literanmi et medians sdentift probe imbii* 
tus, candidatorum numero adscribatur. 

V. Die XXtVto mensis Junii, candidatus, coram Facultate Me- 
dica, a duobus professoribus interrogatus, progressum suum in VA* 
Riis disciplinis mxdicis, supr& enumeratis, ulterii^s ostendat. 

VI. Candidate hactenus probato proponatur, ab aliquo profet- 
sorum, unus ex aphorismis Hippocartis ; et simul^ fub alio pro- 
fessore, auiESTio medica ; quorum prionim k seipso explicatum et 
commentario illustratum ; posteriorem, un4 cum responsione idoneia 
argumentis confirmata, die IVto mensis Julii, professoribus pro- 
ponentibus candidatus reddat; suumque demum commentarium et 
responaionem, die Vlto mensis Julii, coram Facultate MedicC de« 
fendat. 

VIL Si, his rite peractis, candidatus, promovgri merebitur, ilU 
tradantur, i>vjr morborum Astoria, cum qujsstionibus sub- 
JU28CTIS, ut, scriptura, illas illustret, his commoda responsa reddat ; 
turn historias ita illustratas, uni cum responsis suis, die XlXno Julii 
professoribus proponentibus tradat, atque eadem, die XXII^ Julii 
coram Facultate Medic4 defendat. 

VIII. Candidate, si, post primum periculum factum, probatus 
fiierit, dissertationem suam iaauguralem prelo subjiceve licaat, cujui 



Tie Segulaiions fir Graduates ai Bdinburgk. Jan. 1817. 

ticcuratd ex cose octo exempldria, FacidltaitJfl Medicc Decano, die 
XXI Ido Julii, tradat. 

IX. Si candidatus, dissertatione jam excus^ terdd a Medicinae 
Facultatc fuerit probatus, ejusdem Facultatis Dccanus omnia quoe 
gesta fuerint senatui academico renunciabit; cujus apprabatione 
et auctoritate candidatas dissertationem suam edere, eandemque in 
comitiis academicis die anted, statuto, nempd I«> August], defendere 
jubeatur : Tiun, si senatui placuerit, labons tandem et studioruro prse- 
niium, summos in medicina honores, grapum nempe doctobalem^ 
more solenni, consequatur, 

X. Facultas Mcdica, quo major sit horum omnium solemiitasy 
' semper intra academis Poniceria, hora non& ante meridiem, diebos 

supradictis, conveniet Et si quis candidatus, sine gravi causa, ho- 
ti abfuerit statuta, occasione neglecta, ei, hac vice, ve) ad ulteriora 
'pericula progredi, vel gradum doctoralem assequi, non Kcebit. 

XI. Exerdtationes omnes anteadictft, lingu& Latina peragendte 
sunt. 

Spdnsio Academica^ administered to Candidates on receiving the 

degree of M. D. 
E^ A— B Doctoratus in arte medica titulo jam donandus, 

.aancto coram Deo, cordium scrutatofe, spondeo, me in omni grati ani- 
mi officits erga Academiam Edinburgenam ad extremum vitae habitum 
•perseveratumm : Tom porro artem medicam caute, caste, et probe 
exerdtaturum, et, quoad, potero, onmia ad aegrotorum corporum sa* 
Jutem condttcentia, cum fide procuraturumy quee denique inter meden- 
dum visa vel audita sikri conveniat, non, aine gravi causa vuigaturuai. 
Jta praasens spondenti adsit Numen. 

A promise to the same effect is signed by candidates belonginff to 
the Society of Friends, whose religious principles do not permit tEem 
to take an oath. 



V* Comrnunications have been received from Drs Von Embdex, 
H. Dewar, W. Gibney, M.Hall, R. Moulson, and K. Mac- 
XBAT ; Messrs Newman and Comrie : — and Publications for Revievr 
by Professors BRtrcNATELLi, Nocca, Fakzago, and Marzari ; 
Drs BoDEi, Griffith, and Male ; Messrs Kootsey, Howship, 
-and Hutchison. 



*^* Communications may be addressed to the Editors, to the care 
of Messrs Constable & Co. Edinburgh ; Messrs Longman, Hurst, 
'Rees, Qrme, & Brown, London ; and John Cumminoj Ihiblin. 
And we have to request our Continental friends to send any thing 
larger than a dngU letter to the care of Messrs Perthes and Besser, 
Booksellers, Hamburgh, as the expense of sending journals and pack* 
ets by the post to this country is enormous. 

Vo. L, mil be published on the \st ff April 1817. 



THE 

EDINBURGH 
MEDICAL AND SURGICAL JOURNAL. 

!. APRIL 18J7. 



PART L 

ORIGINAL COMMUNICATIONS. 



I. 

Critical Review <^ the State of Medicine during the last Tm 

Years. 

(Condnded from No. 49. p. 84*} 

. IV. Materia Medica. 

TH£ theory of the action of medicines was, durmg this pe- 
riod, still pardy treated of accofding to the doctrine of 
excitement, as by W. H. G. Renter ^^ E. Hom^ f and F. War* 
zer. \ The Italians added to the principles of the Brunoniaa 
school their coritro-stimuli, under which they include all di« 
rectly debflitatinjr powers,— a doctrine which may, indeed, be 
defended, from tlie consideration, that all e^tternal agents rather 
restrain the organic powers than excite them to reaction. XfJ 
however, the restraining action continue, and no excitement 
follow, the process is undoubtedly that of depression. The 
prussic acid, digitalis, and various other substances, act in this 
way. But it is no less certain that this doctrine is carried to 
excessi and misapplied by P. Ra&ori and Borda^ by inclading 
among the contro-stimuli all metallic medicines except iron. 
To this was added a crude empiricism, which led the supporters 
of this school to give, often arbitrarily, such remedies as they 
maintained were sedative in those diseeeei which they ccmsider- 
ed as sthenic § 



« H4ii6lmch<krH^MttdIehre. Brauntchw. isos- 8. 

•f Handboch dcr praictiacbea Arzneymittenehre. «te AniL Beri* 1805.' s. 

i Gmndm der ArznejmutteUehre. Leipae. isos. &• 

I B&adioii enlle forme ]iudcolari daUe malattie univenali, in the Memorie 
ddbt toe ital. Vol Xn. 

Rajori in the Annali di sdenze e lettere. Vol. II. p. 189- Vol. III. p. lOit S75. 

Rojori proH>etto de' resDltati della clinica medica nello Spedale di S. Am* 
hrogio. Mihmo, ISOS. 

rou Xllh KO. 50. K 



188 Beceni Ptagress rfMedidne. . April 

In Gennanyi also, the division of stimuli into positive and 
negative met with assent Not only £. Horn adopted it aft a 
principle, but also 6. A» Bertele^ * who classed as positive sti- 
muli those which contained carbon and hydrogen, and as the ne- 
gative those which furnished oxygen, directly or iDdirectly, 
among which he included, arbitrarily enough, the evacuants. 
The work of IL F. Burdachf was equally fanciful, and be» 
moreover, subjected the remedies containing azote to a perfectly 
arbitrary hypothesis. J» A* Schmidt* s postnumous workf was 
written in the same spirit His dynamic views are founded oa 
hypothetical relations of the elements ; and only in a few places 
can it be remarked, that experience triumphs over them against 
the will of the author. In striking contrast with these hasty at* 
tempts is 5. Hahnemann's work, so rich in indexes, $ which J, A, 
NeuroAr || also seems to have followed as a n^odel. C H. JPfajff^ 
treated the materia medica in a classical work, according to their 
predominant immediate principles. C. H. Mynster^ ** and Jl 
J, Bernhardt J and C. h\ Bucholzj the latest editors of Gren^s phar- 
macology, proceeded upon similar principles. A purely practical 
and very useful work, in alphabetical order, was published by 
JFn Jahn i ff but the manual of J. Staiidt^ XX although also 
practical, was less commendable. Among the foreign manuals 
we know by name only those of C. Aliba't^§§ J. Jlfim*ay,||| and 
J. de Matheis. ^f 

As many very active drugs had become much scarcer and 
dearer, in consequence of the obstruction to commerce, the pro* 
posal of substitutes for these became very frequent Even go<» 
vernments, such as the Austrian, proposed considerable prizes 
for the discovery of a perfect substitute for cinchona. Among 
fifty-two answers sent in, the first prize was conferred u)x>n the 
treatise of K. H, Sander^ •*• who recommended the Tellow 
Lichen parietinus, and the second to Dr Zsoldos at Paxa in 



* Handbuch einer dynamischen Arzneymlttellehre. Landsh. 1805. a. 
+ System der Arzneymittellehre. B. l — 3. Leipz. ISO? — 1809. 
% L«hrbuch der Materia Medira. Wien, 181 1. 8. 

i Fragmenta de viribus medicamentorum poeitiv'h. P. l. 2. LipA. 1805. 8. 
T| Versuch einer unfachenundpraktiacheuArzneymitteHehre. Zweyte Aufl. 
Ueadelb. 1811. s. 

f Syttem der Materia Medica. Th. 1. — 3. Leipz. ISOB. 1614. s. 
** PfcarmakologieB. i. Kopenb. 18 lO. 8. 

ij- Auswahl der wirksamsten Arzneymtttel. Neue Aufl. B. 1, ?. Erf. 1 807. 8. 
i P^krische'Heilaiittellehre. Th. l,?. Wien, 1809» 1810. 8. 
§ Nouveauz eltoiens de th^rapeuttque et de mat. m^dicale- Paris, 1808. 
y System of Materia Medica and Pharmacy, Vol. I, II. Edinb. 1814. 8. 
^1 Analisi della virtii de' medicamenti. Romi 1810. 
*** Sakb. med. Zeit. it LI. B. S, &288. 



1«17» Recent ProgtOs of Medicine. 189 

Hungary, ^vbo reoommended the bark of the Rhus cotinus. * 
In 1805, Hi^eland\ gave encouragement to the employment of 
the known, and to the discovery of new, substitutes for cin- 
chona; but, at a later period, :( he assented, with propriety, 
to the opinion of an anonymous author, who altogether reject- 
ed the substitutes. S. Hahnemann $ expressed nearly the same 
opinion. On the contrary, another anonymous author || admit* 
ted much too easily the substitution of the cheaper native re- 
medies for the foreign. In opposition to which, it is only ne- 
cessary to quote the severe satire of an anonymous writer, f 
P. J. Piderii*^ examined the subject seriously and thoroughly \ 
and a similar work by J. S. Frank ff also deserves iionourabie 
mention. Besides the substitutes lor cinchona proposed, in oon- 
sequence of the Vieona prize-question, a great many native aro- 
matiq and bitter plants, |j: were recommended by «/. C Renardg 
others of the same kind $$ by F. ff . Heller g the common cha- 
momileilll by P. J. Piderit / the bark of the sloethornllf by Juch g 
and even the alburnum of the pine ^**by Berzeliuss lastly, 
spider's-web by several German, Swedish, and English physL 
cians ; which led Autettrieth and l{auschenhuschj\W almost iron* 
icralJy, to maintain, that powdered wood of any kind cured ague. 
Among the foreim substitutes for cinchona, the greatest notice 
was taken of cof&e, and especially of the extract prepared from 
it unroasted, as directed by Grindel g XtX and testimonies in fa. 
TOur of it were given by Pai^Azmitf, $$$ >^(fMmaiin,|||||| and We* 
her* f f f Strong coffee, as usually prepared, was also reoom- 



* Salzb. ned. Zeit. 1813. B» 3. S« SSS. 
j* HafihtuT g Joum, B. Si. St. 8. 
J Hufilamd'g Joum. B. 84. St. l. 
J HufelanJ^s Journ. B. S3. St. 4. 
11 Der Medicimsche StdWertreter. Gotba, 1809. 8. 
\ ROben und Kartofieln ale Surrogate der Rehbraten. Teltow, ISOS. 8.^ 
** Venuck einer Danteliun^ der auslSndischen Armeymittel, in Rucksicht 
ihrer £nt«oder Unentbehrlichkeit. Cassel, ISIO. 8. 

Surrogate fur mehrere auslandische Arznejnnittel. Wien, 1809« 8. 

Die inlandifchen Surrogate der ChinauiBde. Mains, 1809. s. 

Hufihm^s Joum. B. S7. St« 4. 

Uebcr inUndjache Surrogate fBr die Chinariode. GdttiDgait 1807. S. 

Salzb. med. Zeit. 1808. B. 8.S. 44?. 
••• Hufikm^s Joom. B. as. St. i. 
-ttt Diis. de manifettis in organinno mutatwnibttir aia chinas^ qacrcns et' 
tarmeniiUae prodocttt. Tubing. is09. 4* 
tit Ckina-Surrogat. Leipz. 1S09.S. 
iti Bonfi Archiv, 1809. B. 8. Heft. S; 
IgQ Am*/ Archiv, isu. May. 
lit Hmfs Archiy, isls. May. 



140 Receni Progresr tfMeiieine. April 

mended by W. ZnmbelU^ and Lab(mnardiere.\ The fmd of 
thfe pomegratiftte was recomtoended by •/. Rekmann;^ and 
Hildenbrandt § praised the bark of the tulip tree. Animal ge- 
latine, form^Hy recdmmended by Oautieri^ was again praised by 
W, Renter i || who gave it in conjunction with charcoal made From 
the wood oF the lime tree. Ati anonymous writer f subjected 
the history oF its exhibition to a careful investigation. Bretner^i^^ 
I'fcCDmtnendation oFthe bark oFthe Prunuspadus attracted much 
attention, add iicqui)*ed the assent oF several practical physieinns. 
Lastly, the l^hatany root (probably got from the cinchona cordi- 
foUa oF Vahl) was praised in England, ff 

Our knowledge oF the natural hinoir oF cinchona was much 
elucidated by the ihformation which F, A, Zea ^J gave oF the 
inquiries of the Venerable Mutis^ and especially by HumholdTm 
remarks. $$ 

Like the citichona, optHm is a Foreign vegetable prodnct, ibr 
which a substitute can scarcely be found. Indeed Loiseletit^ 
Dedongchamps \\\\ was oF opinion that as good opium could be 
got iVom the poppy in this country as» that of the East ; and 
Widberg iff made experiments on the manuFacture oF opium 
On the Lichtenstein e^tates^ nhich are said to have succeeded. 
But the want oF the almost tropical sun oF Egypt, and other 
tittumstanceS) render the goodness oF the home made opium 
doubiFul. The extract of the Lactuca virosa was recommended 
&s an antispasmodic by M, M. StMesinger ; ♦*• but this substance 
could not be a substitute for opium, any more than the Datura 
stramonium, which was again recommended by Harle5f\f in 
hydrophobia, and by the English lately against asthma. Xit 
We also received evidence in favour oFtbe efficacy oF the Sola- 



* DiaUibe de vi febnfuga fabae irabicae sive eofea«. Vienn. isil. 8. 
- - Journ. de StdiHot, Tom. XXXi V. Mara. 

; ; Notice sur un remede proprc k remplacer k ^iBq[uina. Molcav. 1809. 8- 
I Salzh. med. Zcit. 1809. B. l. S. 342. 

tHufitUmd's Jotrn. B. 95. St. S. 
Neues Journ. der £rt St. l«» 19* 
•• Iforn' J Arcbiv, 1812. Jan. 
t JL Retn practical rrtatiie oh tbe radU Rhataniae. Land. 1808. 6» 
Tromnudorf^s Journ. der Phannac B. 14. St. S. * 

Plantes equinoxiaL Livr. S. 
Journ. de SediUot, Tom. XL. Jamr* 
Salzb. med. Zeit. 181 1- B. S. S. 78. 
••• HufelaiuPs Journ. B. 25. St. 1. 

ttt Ueber die Behandlung der HufldtwUtli* iMkf* ^ MliB. lio^. 4. 
Mi Bt^tlanfs Jouni. B« 36. St. 8. 



aoBj^ CfUEgiiDeiiBe m HUmm$ in itm tropical district^ of AnKeri^* 

JStfm^ j: praised Ibe efficacy of fi>i(g)ove in prisveptlpg abor« 
tioQ I tnd Aeusinger § irkd il in g^^rol. 

Bwrne || recommended th« leaves of live Arbutus uv^ ur9J, 
formerly known an a remedy in uephrilie Bympioai^, against 
consumption when combined with c^um. 4f. M^tternich f 
again coaSrmed tbe effieaqy of tfae Kbodode^dron obrysauthma 
in arthritis. A decoction of the viola tricolor was recommended 
in syphilis by J. H. G. SckkgtL ** Against tliis, aj^i a loompo- 
silion of vegetable substances was announced with grei^t pomp by 
J^. </• Besnard. ff It consij»ted of opium, gum ar^bic, potassf 
and tincture of cinnamon, and was fouud by C. Jf^. Hufelafid ^ 
and £• Jlom $$ to be insufficient. 

Vio^^r was lately reeommendied in typhms by Ptftrot ^^ 
and Flemming praifled tbe use of camphor in Qmauriosis ff 

Of mineral sabstances, graphite or plumbago ivss recom»iend* 
ed as an admirable remedy, externally and interuaUy, against cu- 
taneous diseaseSf by X A. ITeinhold i^** and /ft/A<?/ uiturated it 
with quicksilver to an aeihiops i fff and tbe fetid oil of coal 
was CI led up emptrically by J. G. JLticas, XXt 

E. Lobensteiiu Lbbd $$$ madeaome interesting observations on 
phosfdiorusj and phospJbjDric acid wa« praised by LUt^tlbcfger j||||| 
in asthenic ha»nonrbagies* TtmmaUnU Ont^fd^ and others, f f f 



* Coup d'oetl tur les difEMns mpdiBB de trailer k t6tS8iM en Amaiiqiie, p«r 
. Falentin. Paris^ 1811. 
' Emkj oo Epilepsy. Lond. 1800. 8. 
; Efltay on Abortion. Lond. 1806. 8* 
Hortifi Archivy 1811- Sept. 

Cases of pulmonary consumptiooi treated bv Uva urst. {^ond. 1806. 8. 
Ueber die gute Wirkung der sibirischen Schnecrose in der Gich()Lrank^ 
heit. Maynz. isio. 8. 

•• Materialien fiir die Staatsarzneyw. nnd prakt. Hellk. Sacnml. 3. 
"ft £mstfaafte» auf Erfahrung gejpiindete Wamungen an die Freunde dgr 
Meoicheit gegen den Gebrauch des Quecksitbers in ver«chiedenen Krankfieit^ 
€a. Muncneny 1808| istl. 8. 
tt Bufilan^s ^ourn. B. S6. St. 1. 
J J Bonis Archiv, 1812. Nov. 
fill HufilamfiJoum, B. 36. St. 5. B. 57. St. 1. 
t1 Hufelanifs Joym. B. S?. St, 1. 

*•* Der Graphit alb neuentdecktcs HeilmitteH gegen me Flecbten. Le^T- 
8. 
Salzb. med. Zeit. 18 ll. B. 5. S. 282. 
Ueber das BraunkohlenOL Halle, isos. 8. 
Hor.fi^s Archivi 18 10. May. 
Hufikin£s Journ. B. 26. St. 1. 
fiarJ^^Jottra-dsrauiL Ut B. 9. St. 2. B. la 8t i. 



U2 ReeM Progress tfMedieme: Api9 

found the oxymuriatic acid, formerly so praised in the care of 
the venereal disease, insufficient. The operation of acids, in ge« 
neral, on the human body, was well stated by H. G. WHsim 
ney * Carbonate of potass was recommended in diseases of 
the urinary organs by Mascagni ; f and caustic ley by EUer % 
in hydrophobia; frictions of ammonia, with eau de Cologne, by C. 
F* Harles § in dropsies. J. A. Aibers || made more precise 
triaU of the sulphuret of potass, recommended by Chaussier 
and others as a specific in croup, ai^d ascertained the cases for 
its use. 

(?. L. K. Kapp published on the metals in general, a very so* 
perfluous book, f C. If. Huf eland praised anew the com- 
binations of the metals with ether $ and A. Henke ^* the 
mercurial ether especially. 

No metal, used in medicine, attracted so much attention 
during this period as arsenic, concerning the mode of action 
of which, in general, we have already quoted JSgers obser- 
vations. The remarks of Betij. Barton m America, of Pear- 
son in England, of Brera in Italy, and of Foderi and De^of^ 
ges in France, on the efficacy of areenic combined with potass or 
soda in intermittent fever, ff gave occasion to Harles || to re- 
commend strongly, both on the authority of these and ofhis own 
observations, the combination of arsenic with soda, not only in 
intermittent fevers, but also in other chronic and obstinate dis« 
cases. From personal experience, this praise was acceded te 
bv E. L. Heim. $§ Rehjeld, ||i| Schnaubert,V& Hiidebrandi, ••* 
jJltwstf, ttt iiofmann^ WX Reiner^ §§J and others. But there were 
not wanting contrary observations, of the unsuccessful or even 



* Die wohUhatigeff Wirkungen der SSLuren bey innerlichen und Aiif8erliche& 
Krankheiten. Roetock, 1806. H. 

+ Memor. della soc. ital. Vol. XII. Gehlen*j Journ. B. 8. S. 269^ 
t Salzb. med. Zeit. I8i2 B. 3. S. 26. 
Jahrb der teuttchen Med. B« 3* Heft. S. 

II Salzb. med. Zeit. 1812. B. 2. S. US. f. Jaura. deSedillot, Tom. XLVI. 
f^vr. Biblipth. medic. To^i. XXXIX. Mars. 

^ Lchrbuch der praktiscben Arzneymittellebre. Nurab* 181 3. 8. 
•* Hufeland*j Journ. B. 29. St. l. 

Harlcj'j Journ. der autfl. Liter. B. S. St. 2. B. 9. St. l. 
Abhandl. der ubys. med. Soc. in Eriangen, B. 1. n. 9. 
HarlitJi de arsenic! usu in medicina- Norib. isil. 8. 
Der Arsenik als Fiebermittel. Berl. 1811. 8- ^9rn*i Archivy 1810. Nov. 
flfl Horn* J Arch, < 810. Sept. 
IT Horn* J Archiv, 1811. Jan. 
♦*• h'orn'i .»rcbiv, 181 1. Sept. 
t++ Harlei* J Jsihrh. B. i. S. 148. 



tt 



lit Abh der phys. medic. Societ. zu Erlans. B. 2.n« 14< 
$$^ Horn* 4 Archiv, 1812. Jan. recommended in syphilis. 

5 



1817. Secent Progress of Medicine. 14S 

injurious efiects of arsenic taken internally^ as mentioned hf 
the- Swedish, physicians, * C. W. Htifelandj \ Thiebault^ j: 
Reche^ J Ebers^ |j and others. Hence K, L, DonneVy f and 
C. W. Hvfeland*^ entirely rejected arsenic; and the Prussian 
government thought it necessary to prescribe a determined for- 
mula, and the necessary precautions for its employment. Mean« 
while, the advantagt^ of the external use of arsenic against can- 
cer of the fice were confirmed by J. A. von den Steinen and an 
anonymous observer, ff 

F. F. tVait/ur Xt and G. Zeviani §§ investigated the effects 
of mercury in amaurosis and hydrophobia ; and calomel was 
not superseded by any other internal remedy for the cure of 
croup, mi « 

The efficacy of sugar of lead in asthenic haemorrhagies, from 
ulcers in the lungs especially, in combination with opium, was 
confirmed by Amelung^%% J. H. Kopp^ *♦• ji. Osann^fff 
Gistren^ XXi the physicians of Philadelphia, $$$ and by Wolf/Wj^ 

The external application of tartar emetic, in the form of a 
salve, for exciting inflammation and an eruption in the skin, 
was first recommended by J. P. Auihenrieth f f f against the 
cfaincough \ but that it was not an infallible, though often a 
very efficient remedy, was proved by the observations of Schnei^ 
da-f ***• Kelchy fttf ^^^de^ tttt and ^^^^- M 

Sttlphat of iron was praised by Marc and .some other 



* Hatftkm^s Journ. B. 33. St. 1. 
4- HtfiUuuPi Journ. B. 34. St. 5. 
1 Journ. de SeMot, Tom. XXXil. May. 
^ ^ Kausch Memorabilien der Heilkunde, B. 1. 
j Hirfelan^s Journ. B. 37. St. J, 4. 

% Abh. liber die hitecbt verderblichen Folgea dss innern Gebrauchi del 
Arseniks im Wechtelfieber. Berl. isis. 8. 
•• Uitfelan£j Journ. B. 32. Sr. I. 

^hold's Saxnml. cbirurg. Beob. B. 3. N. 1 1, 88. 
Abhandl. aut dem Gebiett der pract. Med. B. 1. Landthiit, 1810* 8. 
Memor. della soc. iial. Vol. X. iiarUs^s Journ. der auiL Lit. B. 9. St. t* 
Saehjte in HufilaruPs Journ. B. 81. St. 1. 
HufeUmd's Journ. B. 22. St. 1. 
* HufekuuTj Joum. B. 29. St. 5. 
' Diss, sistens satumi utum ined. internum. Jeo. 1809* 
Hufekm^s Joum. B. 3J. St. i. S. 144. 
Harie/j Journ. der Ausl. Lit. B. la St. l« 
Htfilan^i Joum. B. 34. St 4. 
^Versnche ffir die prakt. Heilk. Th. I, 
••^ H^m^j ArduTy isos. B. 4. Heft. «. 
+++t Bmfilan£s Joum. B. 2$. St, 4. • 

illl Hufilan^s Joum. B. 35. St. 4. 
ffjf a^tUm^i Joorn. B. 36. St. 2. 



I4i il§ee9d Progress of Uedinnu Afwii 

Ffench physicians * in btermittent fever, and by C Stei^^f 
against consuniptive coughs. Rich. Carmcbael\ recommfitndea 
Hxe otrbonate of iron jn cancer i and £. Hijm $ praised the 
^fects of iron in. the mercurial disease. 

The nitrate of ulver was recommended anew by Fauckier || 
in epilepsy, and by R. Fawel% in other convulsive diseases. 

Lastly, gold itself was again tried, especially the muriatet 
which Odhelius ** praised, in doses of the quarter of a grain^ 
given three times a day or oftener, in the most obstinate venereal 
casesi 

The use of the external application of cold water in the cure 
of febrile diseases, which J. Carrie particularly recommended, ff 
was confirmed by J. Stock, %% ^^^ ^* Jackson. ^ It was found 
very useful in trismus by IT. Dalrywqde ; |j|| in scarlet fever by 
J. keidi %% Paid Kolbany,*** Nasse^ fff Reich, and others; and 
in intermittent fiaver by Giannini, ^XX It was particularly re* 
commended in tvphus by Hirsch, % Kolbant^ HH £. Horn 
(Archiv. 1811. May), and most writers on the late camp-fever. 
An able review of this subject was given by J. F. Hecker 
(Annalen, B. 1. & 48. £). 

C Taylor %^% wrote on the use of sea-water externally and iii» 
ternally, and S. Fogel published the new Annals of the Sea- 



* Journ. de Scdiliot, Tom. XX^UX. Sept. 

y Medi^ cnir. Abh. der Bied. clur. Getelttch. zu London^ tlbfrt. t. OmuT^ 
n. «• • 

t Essa^r on the effecti of carbonate of htm upon cancer. DubL 1806. 8. 

i Archivj 1812. Jan. 

II AnnaL de la 8oc. de mtiic prat, de MontpelIier» Tom. VIL 1 806. Juin. 

I Medic, transact, pubf. by a soc. of phys. at London^ VoL IV. 
** Suensk Acad. HandU 1813. P. II. p. 965. 

ft Femere Nachrichtea vrni der glucklichen Anwendune des kalten Badet 
in adynamiKhen Fiebem» translated by F. H. Hegewijch, Leipz. 1807. 8. 

Xt Medical collections of cold water at a remedy in certain diseases Load. 
1805. 8. 

^§ Exposition of the practice of afiusing coM water on the surface of the 
. Edinb. 1808. 8. 
Edinb. Med. and Surg, Journ. ISOS. n. 8. 

II Med. and Phys. Journ. Vol. IX. 

*** Beobachtungen Qber den Kutzen des lauen und kalfen Waschens im Schar- 
lachfiebery und fomere Nachrtchten von der glQcklichen Anwendung desael>en» 
Presb. 1808. 8.— Abhandl. der phys. med. soc. zu« Erl. B. i. 
|-t+ Hufelaruts Journ. B. S3. St. 4. 

Harlcj*j Journ. der ausland* Liter. B. 10. St. 1. 
Horn* J Archiv, 1808. B. 4. St. 1. 

Bemerkungen uber den ansteckenden Typhus, Pittb* 1811« St 
!1if Remarkf on sea^water. Load. 1805. 6. 



Utbg at Dobbcrasu* TMei^ pxtmA the effeoto of the briao* 
bath (SQoIbade).,t 

Directions for the use of mineral waters and baths in general 
were given by J. C. Meyer ^ % JP. Speyer^ § and K. A. ZwiVtv 
lein. II WmiU described the subsequent effects of cures by these 
means* % And C. JT. Huf eland examined the principal m^ 
dicinal springs of Germany in an excellent dissertation ( Journ. 
B* 27. St. 1. f.)- Some of the best descriptions and directions 
for the use of the German mineral waters, are those mentioned 
in the subjoined note. ** Those of France were described by 
B. Peyrilhe^ ff and one in the Russian government Twer by 
J. H. Zedu tt 

The application of galvanism as a powerful stimulant in sus- 
pended animation, was recommended anew by Struve. §§ G. /f. 



* Ntoe Aanalcn dei Seebadct zu Dobbenuu Heft, l-— 7. Rostock^ 1804— 
1810. 8. 

j- BafeUm£s3cwn, B. 26. St. 3. 

X Der Rathgeber vor, bey und nach detn Bade. Pirna 1 805. 1 2. 

$ Ideen liber die Natur und Anwendungsart nacOrlicher und kOnstlicber 
Bider. Jau 1805. 8. 

II VoRllge der CurenlnBadem bey langwierigen Krankhciten. GothSf 
1811.8. 

T BufeUm^j Journ. B. S4. St. 4. 

•* Retimonf% analyse des eaux sulfureutes d*Aix la Chapelle, 1810. 8. ; 
Akwasjer and teiac Htilquellen, beschrieben von J, H. Htme^, Bresl. 1805. 
& J, H. Hhnse Arnialen der ntintraliichen Kurtntralt zu AiPwasser. J. i. 
Brvil. 18ia 8. Badetif beichrieben von A, Schneiber^ 1811. k. DieMinml- 
quellen zu JSx//»» von F, A, Reuss. Wien. 1808. 8. Uber die Mtneralquellen 
bey BranutedU von C /f. Pfaff, Altona I8ia 8.9 and on the same by 
7. F. Suerssen. Hamb. 1810. 8. K. A* Ziw$erlem*s neueste Nachricht vom 
fiade Bruckenau* Fulda I8it.8. Uber die Gas-u. Schlammbader bey den 
SchwafelqueUtB zu EUjint von J. C. Gtbhard^ Berlin I8II. 8. K. W. Bkk- 
mahns BeKrhreibung der Getundbruonen und Bader GrUikack* PeUnthal and 
Mtofati, Kirisphe is 10. 8. Versuche und Beobachtungen mit dem Mbumer 
Sauerbmnnen. von Amburger. OfTenbach 1809. 8. Mtnler's neilaste Nach^ 
ricbt TOO Imitau. Freyb. 1 8 1 1 . 8. Das Krumbacher Heilbad. von 7. B. Wetter. 
Augsb. 1811. IS. J.F. A, Koch*s £r£ahnxngen flber dia Wirkunskrflfte dss 
Gesundbrunnens und des Bades i^i Laucfutadth^^i.* 1806.8. U, M* Mar* 
card tlber die kochsalzhaltigen Mineralwasser zu JPynnM/. Hamb. 1810.8. 
3. A, Albert fibsr das Rehburgtr Bad in Hom^s ArrJiiV| isil. S^temb. 
y. Fenzert freymOthige Briefe iiber Schwalbach. Frkf. a. M. 1807. S Dsr 
saliniscbe Bisenquell im SelittkaU am Harz, voti iC F. Grijfi, Loipz. 1 809. 8. 
FaMam Uber deo Sehtur Brunaen in HiffifUmd^t Journ, B. 84. Sr, 3. F, 
fFegtIerj einige Worte uber die MineralqueUe zu TaiuifiJtem* Kohl. IS 11. s* 
C C. Crev^j Bescbreibung des Gesundhrumient zu fTeUiach, Wissbsdea 
1810. 8. Fabridus Manuel du baigneur aux eaas de Witbadtf Paris 1813. 
a* WtMd aai liyn mit leiaen Umcsbaagw. Nannb. isis, iS. X, G. 
Heifuj^j Beschreibung des Wolktrnteiner Bido. Freyberg 1808, a, 

ff TAlfStt liJii«riqiie 4'aa conn d'kistoiie nAtuieOe mMci^ •& Pot a 
Uasse les prindpales eaux min6^ct de la France. VoL U ft* Fus 1805^ 

11 Diss de aqua WissokoentL Domt ia08.4. 



146 lUcem Progrm ofMedieine, April 

SckiAefi * praised it in deafneas. F. B. OHander f propoied 
ttnall phtes of silver and zinc» introduced under the eyelids^ aa 
a remedy in amaurosis. K. A. Wienhold X recommended a 
very ingenious contrivance for the application of galvanism, by 
which tne opposite streams are conducted to the eye by -spirit of 
ants (Ameiseogeist) and spirit of earth worn)s(Kegenwurmgei8t). 
G. A. Mongiardini and V, Lando % described the effects of 
galvanism on the production of stone in the bladder. Lately 
P. J. Westring || proposed encreasin^ the galvanic power by 
means of metallic points of gold and silver. 

Y- Therapeutics and Practice of Medicine. 

On general therapeuticsi a classical text-book was published 
by P. J. Horsch $ % inferior to which are the works of </. A, 
Schmidt^** F. L. Augustin^ ff C. Schbne^ XX K. G. Naumann^ §^ 
and even the abridgement of^. JP. Hecker.^\ However, the 
new edition of the last author's Manual f f maintained its for* 
mer reputation. 

5. Hahnemann advanced a new maxim in therapeutics, de* 
rived from the principle, in itself true^ that the medicinal stimu- 
lant often annuls the morbid one, which he extended to the re» 
▼akive efiects of medicines, and, at the seme time, established, 
that each distinct disease requires a corresponding remedy, 
capable of producing a similar action, lliis idea, wnich, thus 
extended, becomes absolutely false, and leads to ^osa empi- 
ricism, he denominated the homoopathic therapia.*** A. F. 
Hecker^s f\f objections to this doctrine were answered in an un- 
becoming manner by F. Hahnemann, XXt 



* Von der Anwendung des Galvanismus bey Taobgebomen. Leipz. 1805. 8« 

4* Abhandl. der phyi. med. Soc. lu Eriangen. B. i . N. 8. 

i Ueber die Heilung eines zerstdrten Auges und eine neue Anwendongtut 
ies Galvanismus. Meissen 1817. r. 

§ Mem. della soc. roed. di emulaz. di Genua, TonO) 2« qtudrim. 9« Harks** 
Journ. der aubl. Liter. B. 8. St. 2. 

II Suensk. acad. handl. I8i3. P II. p. is. 

f Handb. der allegemeinen Therapie. Wnnb. 1 81 1. 8. 

** Prolegomena zu der allgemeinen Therapie und Materia Medlca. Wiea^ 
1813. 8. 

Handb. der medic. Therapie. Th. 1. Beri, 1806. 8. 
Versuch eines systems tischen Entwurfea der gesammteh Medicin. Th. l. 
Generelle Therapie. Berl. ie06. 8. 



■eneri 

§i Allgem. Therapie. Leipz. 1 808. 8* 

11 n Kurzer Abriss der Therapie. Berl. 1807. 8. 

Yi Therapla generalise oder Handbuch der allgemeinen Heitkande. Nene 
Ausgabe £rh 1805. 8. 

*** HuJttan^M Journ. B. f6. St. 8.— Orgaaon der ratioodlen HflUkunde. 
Dretdtti 1810. 8. 

++t Annalen isil. JuL— ^ept. 

\iX Widerlegung der Anfalie Becker's aof das Orgaaon dor fStioneUen 
Heilkunde. Dreid. isil. S* 



1817* Seeent Progress of Medicine. 147 

Of practical compendiums, J. P. FrasiVs is the best \ * the 
two volumes last published^ contain the profluviae, dropsiest and 
retention of urine. The second volume of C W. Hufelatuts sy^ 
tem was published, t That of ^. H. Hecker% is also a valuable text- 
book. Far less commendable are the productions of E. Hortij § 
Jos. Frank, || and of C. E. Rasckig. f Those of C. F. Ober^ 
reick, ** ana an anonymous author, ff ^re founded on the theory 
of excitement F. Jr. v. Hovetfs Manual ^t &nd his Treatise 
on Fevers $$ follow the maxims of empiricism. 

Among the numerous collections of practical observations^ 
those made in clinical schools must be first noticed. J. V. v. HiL 
denbrand explained the general principles of clinical practice ex- 
<^ently. im His observations, ^f and those of C. If, Hu/e^ 
land, *♦♦ J. C. A. Clarus, ftt ^. L. Brera, t$t Baume, % 
E. J. Ihomassen a Thuessink, |||||| J. K Thomann, %n P. J* 
Borsch, •^^ J. Fran*, tttt and F. Wendt, tttt are the best 
prodqctions of this kind. 



* De cuondir liomlnam morbis epitome lib. 5. P. 9. lib. 6. P. 1. 
-HaniilL 1807. Tubing, isii. 8. 

f Syiteni der piaktiscliea Heilkunde der zweyteBand. Jtm, 1805. s; 

j Kudu die Krankbeiten der MenicheB zu heilen. 4te Aufl. Tiu l-«-J. Err. 
1S18> 1815. 8. 
' i Aofangsgraiide der medicinscben KTinik. B. 1. Erf. 1807. 8. 

g Praxem medicae universae praecepta. Vol. I. Lips, isi 1. 8. 

1 Haadbncb ciner innem praktiicben Hrilkiinde. Heft 1—3. Leipi. 1S08» 

isias. 

** Haadbucbder Heilkumt. Tb. 1—8. Riga, 1805» 1806. S. 
'I'f Venucb eines nacb Grundsatzen der Erregungstheorie abgefascten medi^ 
oiaiscb-praktiscben Lettfadens bey Heilong einiger Krankbeitsfonnen. Tb. l| 2, > 
.1806, 1807.8. 

Haadbncb der prakdscben Heilkunde^ B. i, S. Heilbronni 1 805. s. 
Versuch einer prakt. Fieberlehre. Numb. 1810. 8. 
Initia Institutioiium CUnicaruiDy Vienna, 1807. 8. 
Ratb medendi in scbola practica Vindobonensi. P. l, 2. Vienn. IS09| 
1818. 8. 

*** Jabresbfricbte der polykliniscben Anstalt bey der UnlversitUt zu Berlin, 
1811. £ 

Annalen des Uiniscben Instituts in Letpz. i8io — 1812. 
Aanotazioai OMdico-praticbe sulle malatte trattate nella Glinka nsdica 
avia. Vol. I. II. Crema 1 806. 4. 
Rappotto di resukati ottenuti asUa dinica medica di Padova. aan. i«— S, 
Padcnr. 1810» 1811. 4. 

^§i Annalet cliniquefl de Montpellier, 1810. 8. 

II II II Waainemineen omtrent de zeikten, welke jn betKoeocomium clmtcam 
van de booge icbooi te Groeningcn zwn bebandeld. Qroening. 1805. 8. 
n^ Annalen der kliniflcben Anstalt zn Wurzborg. Amstadt, 1805. 8. 
^^*** Annalen der kliniscb-tecbniicbeD Scbule. KudoUudt. 1809. 8. 
tttt Acta institttti duud universitatia VUnensit. ann. i. Lips, isos-— 
2819. 8. 
tilX Annalen des IdiaiKbea Institnts za {^hftgen. Hef^. 1. 9. ErUqg* 

1808, 1809. 8, 



'M. 



14$ Hecp$t Progrw ofMtdiqm. A|nl 

On tfae diMaies of fixates, exceQent worl^ ver^ pubVifaed 
by E. V. SieboUj * J. C. G. Jorg, f . and J. Hamilton. ^ lW 
iw £. J. C. Mende $ is less comniendable* 

. On the diseases of childreni the work of F* John H was moat 
Approved j those of J. J. ». Pleni, H JT. B. F/eiscA, *• and wrf. 
Aenke ff less, and that of G. W". -B«*^r least of all. ^ /f . X 
fioer'M publication $$ is an ex^iE^Uent introduction to the diseases 
of childhood. 

VI. Surgery. 

K^.Sfrcngd wrote the history of surgical operations ; || and 
in anonymous author commenced a history of surg^iy Quring 
the last ten years, f f Different views were taken of the relation 
pf surgery to medicine. The opinions of J> J. WaltheTf *** who 
■aw no mutual high connection of medicine and surgery $ and, 
because the surgeon might dispense with the knowledge of the 
organisation, would not allow the latter to be called even an art, 
but considered as being merely mechanical, were easily refuted. 
With more propriety J. C Retl fff limited surgery to the ap- 
plication of mechanical remedies only, and ./. A. SchnidtnnUUrX^ 
justly esteemed surgery very highly, as did also A> F. Hecker. $$$ 

Several general works on surgery appeared. The third ei^- 
lion of if. 2e//'5 system limi maintained its acknowledged value. 
C BcU also pubUshed a system, f f f B. Sckreget's prindples of 



* Haiufl). nr Erkea&tniM und Hdliuig der FnuenkimfBO^KruUititeii. 
Hi. 1, H. Frkf. 1811^ 1814. 8. 

Handbuch der Krankheiten des menslidicn Weibet. LeipK. iao9. 8. 
Treat, of the management of female complaints, Edinb. 1809.S. 
i J>ie Krankheiten der Weiber.Th. i^ f. Leipz. isio, isi 1. 1. 
' Neaet System der Kinderkrankheiten. Rudolstadt, 1807. 8. 
Lehre von der Eikenatniss und Heilung der KindcrknoUKiten; l^eo, 

1807. 8. 

** Handbuch uber die Krankheiten der Kiadery B. i-Ht« Lfips.* 1805— 

1808. 8. 

f f Handbuch zur Erkenntniss und Helluog der Kiaderkrankbeiten. Fraakf. 
18t9. 8. 

±1 Krankheiten der Kinder^ ihre Kenntnias und Heilung. Pima, 1807. a. 

CO Versuch einer Darstellung des kindllchen Organiimut. Wien, 1818. §• 

II II Oeschichte der wichtigsten chiriirgtachen Opcrationen. Halle^ 1805. S. 

W Neuestes Journal der Erf. St. I. 

♦*• Die Oiirurgie in ihrer Trennung fwi der Mtdicin. Numb. IMJS. 6. 

\'\ t Beytrage zur Bef brderuug einer Kurmethode auf ptychischem Wqge^ & 1 • 
S. 161. f. 

Itt Beytr. zur Vervolfkomnung der Staatsarzneykunde. ' Landsh. IFOS. 8. 

yjy Wodurch retste die Chirurgie ihrer gegenwiirtigen Vonkoowcnhtit eat- 
gegen? Berl. 1806. 8. 

Welches ist der wahre Zweck medic rhinirg. Lehranstalten } BerL 1807. 

mm LehrbegriifderWundarzneyknnst.B. 1—7. Leipz. 1804*^1810. 8. 

^tt A system of operative surgery, founded on the bate of auoatoiDy. VoL 
I. II. Loud. 1808— 1611. 8. 



Itlt. Rfctnt Progress of Mtdidne. n1 W 

surgical operations are systetnfitically arranged. ♦ But the best 
work of this sort k C. B. Zang\ f A. Rickerand^ % ^assus^ $ 
JB. Horn, II PT. E. Berger, % ./. A. Tittmann,** and F. X. v. 
Ru^Uatfer^ ft endeavoured to explain the theory of surgical dis- 
eases. 

The treatitient of wounds was so much simplified by f. J&r;i,^ 
that he recommended universally cold or tepid water, with rest^ 
as the sole dressing, and rejected entirely all cleaning of 
wound*. C. B. Zang criticised admirably this mode of treat- 
ment. §§ A, P. Jleckei^s thouglits on it deserve also to be read. || 

The doctrine of bandages was treated by J. G. Bernstein^ %% 
arid systematically by B. G, Schreger. **• 

Directions for the application of oil and warmth in the use of 
cufting-instruments, were given by B. Fausi and Ph. HtmolcLm 

AbernethifXXX and Rust^^ wrote on tumours. F, S* Atexan^ 
der published some remarkable observations on such as cma- 
press the nerves, to which that described by Mqjon and Co- 
vera^di also belong. [|!|i| H. J. BrUninghausen f Iff removed 
eticysted tumours of the neck, by li^ture and escharotics, which, 
from containing a fluid, could not be extirpated. 

H. F. Grdfe *♦*♦ wrote of dilatation of the vessels. G. F. 
Harks derived from its various causes aneurism, which Scarpa^ 



• Onindriss der chinirg. Opcrationca- Furth. 1 806. 8. 
f Darftellnng heilkundiger biutlger Operationen. Th. 1. 9. Wiea 1814^ 8. 
t Koscgraphie chirurgtcale. Tom. I; HI. Paris i805, 1806. 8. 
8 Patholagie chirurgicale. Tom. 1. 11. Paris 1805, 1806. 8. 
\ Handb. der medic Chirargie. Th. 2. Berl. 18o6. 8. 
f Ueber die Erkenntniss und Cur der wichtigsten und faaufigiten avfseffi* 
chen Krankhdten. Th. i. 2. Erf. 1808. 1809. 8. 

•* System der Wundarzneykuiut. Abthl. i. s. Zwejrte Aufl# Leipc 180^, 

1810. 8. 

f \ Koner Afariss Att specieUen Chirurgie. Th. I. Wwk, 1818« 

XX Avis aux chirurgiens pour les eagager i accepter et h, tmroduire vim 
flietbode phis sinpie^ plus naturelley et rooins dispentueuse daas ie paoaeaieiit 
detblesi^. Vieun. 1809. 8. 

§§ W&rdigung der von Hm. Kern in Vorschlag gebrachtco aeuen Medmle 
Wunden zu behandeln. Wien, 1810. 8. 

y Becker* s AnaaIen.Th. l.S. S6£. f. 

1^ Lehre des chirurgischcn Verbandes. Jena, 1805. 8. 

•*• Plan einer chirurg. Verbandtehre. Erl. 1810. 4. 

f ff Ueber die Anwendung und den Nutzen des Oels und der Warme bef 
dururgisclien Operationen. Leipz. 1806. 8. 

!%% Med. chir. Beobacbt* iibers. Ton Meckel HaUe 1808. 8. 
«« Harleij Jahrb. Th. 1. S. 155. f. 
Illl Chtrou B. 1. 9t 5. — ^Diss. de tumoribus nerronmi. Leid. 1810. 8*' 
ft Ueber die Extirpation der Balggescbwuistcam H8lie. Wunlii 1805. 8. 
•••* Aogiektasie. Leipz, 1808. 4. 



150 Recent Progress rf Medicine. ApA 

too generally, wished to attribute solely to the laceration of . 
the muscular coat of the arteries. * A. Winter cured aa 
aneurism by compression alone i f and on the subsequent dis- 
section of the case, P. £. JVoHher X made some interesting re- 
marks on the cure. DesckampSf for a popliteal aneurism, ope- 
rated on Humerus plan. (Mem. dc I'insdt. 1806.) ' Fleiay $ 
made the remark, in operating aneurism of the femoral artery^ 
that it was necessary to tie uie vessel below the tumour, and 
that the disease often cures itself by the effusion of the blood 
from the ruptured sac into the neighbouriuff cellular membrane. 
Asitey Cooper performed a most remarkable operation for a 
carotid aneurism. || He effects of ligatures on arteries, and 
the process of nature in suppressing nemorrhage from themt 
when divided, was investigated by «/• F. D. Jones. ^ 

«/• N. Rust was successful in his pathological and practical 
treatise on ulcers. ** K. A. Weinhold treated old cutaneous 
sores by metallic oxides, ff The dependence of obstinate ul- 
cers of the feet, on a morbid state of the livar, and other visoeray * 
was well exposed by J. i*. Jiebentisck fHom*s Archiv. July 18 1 1.) 
Falconer f^ and Latham^ §§ published new dissertations on 
the disease of the hip-joint. 

On the treatment of wounds of the head. F. ./. J3ft<fi9ier publish- 
ed an insignificant essay. |||| That of /. J. Canin is of as little 
importance, ff Larrey trepanned at unusual places. **^ iL 
JF*. Grafe recommended some useful processes in this opera- 



* A. Scarpa fiber die Plilaadergeschwabte. Ueben. tod Harki* Zoridi, 
1808. 4. 
t ChiroD, B. 1. S.S57. f. 

I Chiron, B. S. S. 100. 

$ Journ. gen^. de la soc. de med. Tom. XXVIII. a. ISS. Hark*s Joorn. 
derausland. Lit. B. lo. St. i. 

II Med. chir. Bemerk. elner medic, chirurg. Geaellsih. in London^ tlbcn. voa 
Osann, n. 17. 

t Ueber den Pirocet, den die Natur einachlSgt, Blutungen aus zenchnittenes 
Arterien zu heilen, und fiber deren Umerbindung. Aut dem Engliicken voa 
l^ngejiberg, Hannov. 1815. 8. 

** Helkologie. B. 1, 9. Wien, 1811. 8. 

ft Die Kuntt veraltete Hautgeschwarezu heileo. Dretd. 1807. 8. Zweyte 
Aufl. 1810. 8. 

XX Mem. of the med. loc. in Lond. Tom. VI. Samml. fur prakt. Aerzte. 
B. SS. S. J57. 

H Medjc. transact. pubL by a toe. of physic, at London. Tom. IV. 

fill Vorichlage zu einer zwerkmXssigep Heilart der Kopfverietzuugen. Du^ 
•eld. ISOS. 8. 

It Considerations sitr le trsitement de quclques plaies de t^e. Piriib tail. s. 

•^ J>enkwurdigk, 8. «07. 



16i7« Beeem Prognu of Medicine. 151 

tioiu ^ It was saoceiifally performed at Berlin for the cure 
of epilepsy* f 

In regard to diseases of the eye» an introduction to their 
treatment was pohiished by K. Himij/. ^ J. Wardrop also de- 
scribed the morbid anatomy of the human eye. $ W* G» 
Benedict Jl^ edited a complete treatise on the inflammations of 
this organ. An insignificant treatise was published hy J. , 
Spindler. f Ttie purulent ophthalmia of children was de* 
scribed by J, Ware •* and W. F. Dreyssig. ff The Egyptian 
ophthahnia proved contagious in the English army, and occa- 
ftioned many interesting inquiries. 4t ^* RMni and CoUa $$ 
made some curious remarks on an epidemic ophthalmia in 
Parma. For the treatment of hypopion, P. F. Walther gave 
untenable rules. |||| B. J. Beer %\\ attempted to explain the 
formation of staphyloma from inadequate causes. J. W Hein^ 
/etn considered this disease partially.*** G. A. Spangcnberg fff 
examined more accurately the changes the cornea undergoes in it. 

The indications for the ibrmation of an artificial pupil, in cases 
of concretion of the iris, were accurately and fully given by B. 
J. Beer. XXt •'• ^- Schmidt reviewed the dififereut methods 
of dividing, detaching, and cutting off part of the iris. $${ 
Pcrlenze is less accurate. ||{|]| K. Dmegana proposed, in this 
operation, a transverse division of the iris, to prevent its sub- 



* Hufelan^s Journ. B. 27. St. 3. B. SI. St. 5. 

t 7* ^' Theinej diss, siitent casum epilepsiae per terebrationem craudi 
feliciter sanatae. Berol. 181 1. S. 

X EinleituDg In die Augenheilkunde. Jena» 1 80S*. 8. 

§ Essay on the noorbid anatomy of the human eye. 1808. 8. 

iDe morb'u ocuU humani inflammatortis. Lips. isii. 4. 
Ueber die Entztindungen der Augen und ihre Behandlung. Wurzb. 
1307. 8. 
** Remarks on the purulent ophthalmia. Lond. 1808. 8. 
t+ Hu/eL Journ. B. 23. St. 3. 

%% JSdmatuton observ. on the varieties and consequences of ophthalmia. Edinb* 
1806. 8. Wl 77;cin«i on the Egyptian ophthalmia. London, 1808. 8. Mongiardim 
in the Mem. della soc. med. emulaz. di Genua, Vol. L Larrey'j Denkwur- 
digkeiten> S. 54. 262. f. 

i§ Hark/s Journ. der ausland Lit. B. lo. St. 2. 
11 jl Merkwurdige Heilune eines Eiterauges. Landsh. 1806. 
tl Ansicht der staphylooiatdsen Metamorphosen det Augci« Wieb) 
L805. 8. 

Abh. der phys. med. Societat zu Erbngen, B. i. n. 7. 
Horji^j Arch. 1809. B. 1. Heft. l. 
: Ansicht der staphyloroatdsen Metamomhosen des Auget. Wien, 1805. 8, 
Schmidt und Himly^s opthalmol. BibL B. 2. St. i. 
Ginsiderations sur I'operation de la pupule artificielle. Paris, 1805. s. 



152* Recent Progress of Medicine. AptH 

sequent union with the ciliary ligament ♦ P. A^salini f and 
Benj. Gibson % gave the latest instructions on this method. 

F. P. Watther § described the diseases of the crystalline 
lensy and claimed, as his own discovery, the formation of cata- 
ract as a consequence of its inflammation, a circumstance previ* 
ously mentioned by others. Becquei \\ made some good obser- 
* Tations on the tremulous cataract and on the falling of the lens 
into the anterior chamber. S. Cooper f published a good dis. 
sertatton on the operations for cataract in general. H. F. 
Etsdsser recommended Scarpa*s method of couching ; •• and 
JT* A. fVeiftholdy ft a peculiar modification of it. 

Directed by a proposal originally made by A. G. lUchier^ and 
which was repeated by J. C. ReiU W^. f/. J. Buehorn was first 
led to a new method of operating cataract by puncturing the 
cornea. Xt ^' ^f' ^- Langenbeck $} and K. F, Urafe M examined 
this method, and confirmed its easiness and utility. J. B, v. Sie^ 
Jo/rfff recommended a peculiar needle for it But Th, A. TF'ein'- 
hold declared himself its opponent •*• 

Useful treatises on the diseases of the nasal cavities and maxil- 
lary sinus, were published by J. £. Deschamps^ fff P. V. 
L^nkker, XXX and JT. A, TVeinho/d. §J5 

The preservation of the teeth and their diseases, were illustrat- 



Dclla pupiHa artificiale. Milano, 1809. s. 



t Ricerche tulle pupille artificiali. Bfilano, 18i I. s. 



^ Practical obserrauont on the fbrmatioa of an artificial pupil m aeveral de» 
nmged states of the eye. Lond. 181 1. 8. 

j^ Abhandlungen au8 dem Gebiete der prakt. Medicin. B. 1. Landsh. 
1810. 8. 

II Journ. gener. de la soc. de medec de Parity torn. 27. n. 134. Harle/s 
Journ. der aust. Liter B. 10. St. i. 

t Critical reflections on several important practical points, relative to tlte 
cataract. Lond. 1805. 8. 

** Ueber die Operatbn des grauen Staart. Stuttg. 1805. 8. 

If Anleitun^ den Terdunlcelten CrystalHcOrper im Auge des Menschen 
nm^ulegen. Meissen 1809. Zweyte Aufl. 1812. s. 

It Die Kerxtonyxis. Magdeb. 1811. 

Jl Prufung der Keratonyxis. Gotting. 1811. 8. 

Il II Diss, de cataractae recKnattone et keratonyxide, resp. J. A S* SfSri* 
Berol. 1811. 8. Htekef's Annalen, B. 8. S. 541. 

M Salzb. med Zeit. i8is. B. i. S. S77. 

*** NachtrSge znr Anldtung den rerdunkelten Cryitallkdrper umzulegem 
Meissen isis. s. 

tf f Abh* liber die Krankbdten der Nasenhdhlfe. Aus den FranZ. Ton J* F. 
IDomer. Stutt. 1805. B 

tit Diss, de sinn maxUlari ejasqne niori>is. Wirct^. 1809. s. 
' §§§ Ideen fiber die abnormen Metamorphosender Righxttore's H^hle. Lcips. 
1810. 8. 

4 



ed by K. SOmidi • and J. F. GaUfUe.i G. W. BtdcerU pub- 
licaticNi X is flcarcely worth mentiODing. 

A remarkable aiid successful operation of an enormous hare- 
lip was described by ./. H. G. Oitmar. § J* B. o. SUbM made 
some observations on the amputation of preternatural large 
tongues* (Chiron. B. 1. St. S.) In the same volume were in- 
serted the observations of ^. IngUs on the ligature of diseased 
portions of that oraan; 

ISmfyf without Knowing of jL Coopn^s previous operatioii> 
pmictured (1805) the membraiia tympani in dea&ess from cio* 
sure of the Eustachian lube. However, he did not dissemhla 
Uiat this operation coukl be of no service in deafness from other 
causes^ and that the puncture easily closed again. || Mau^ 
noir and CeUieXf used a trocar to prevent its healing up quickly^ 
(Chiron. B. 1. St S.), and restored the hearing completely 1^ 
this operation. Michoilis in Marburg, and Hwio/d in Cassely 
made the puncture with success, f But Huf eland pointed out the 
evil that might arise from wounding the chorda tympani, apd 
stated the operation to have been performed fruitlessly in the 
Berlin institution for the deaf and dumb. ** The observations 
of C. P. Nasst, ff and J. <S. Sick^ ^ put proper limits to the 
liaises bestowed on this operation^ particularly by Hunold* 
J. h\ Fuchs^^ would only puncture where, with a morbid effusion 
of fluid into the tympanum, the Eustachian tube is not present* 
<He dreaded no bad effects from wounding the chorda t^mpanij 
but greatly the wax's passing through Uie puncture into the 
tympanum. Hesze recommended the extraction of diseased 
teeth in deafness. || 

D. X. J. Merrem^s proposal to extirpate the pylorus in in- 
curable indurations of it, shews how little the surgeon dreads 
the most difficult operations. HH 



^ Theorie und Erfahrung uber die Zahne. Zwerte Auflage. Leipz. 1807. 6. 
j- Blicke in das Gebiet der Zabnarzneykunde. Mainz isiO. 8. 
t Ueber die Zahse und die fichenten Mittel aie zu erbalten. Leipz. 
ISOS. 8. 

SKachricht von eioer auMerordentlicben Hasenscbarte. Helmit. 1805. 8. 
Salzb. roed. Zett. 180C. B. 4. S. 37. ij^Hufilan^s Joum. B. S5. St.«. 
8. 175. 

t HtfelamP^ Joum. B. 34. St. 8. 
*• mfelan£i Journ, B. 24. St. 5, 

BHufelan^j Journ. B. 25. St. 4. 
Diss, de tympani perforatione in tttrdluds cura cautiui rariuique ad* 
bibenda. £rl. 1806.8. 

~ DSsquititkmes de perforatione tympani. Jen. 1809. 4. 
HuftL Joum. B. 39. St> 2. 
Ammadveniones quaedam cbinn^eae. Gieit. 1810« 4. 

TOL. XIII. NO. 50. L 



loenc 

if 



15V RkM Pff^m of UsdidfU. AptH 

F. K. Hisutbach described more accurately the atiAi and 
treatment of inguinal hemiie. * J. Hull wrote a good disserta-^ 
tion on Femorftl hernia. (Chiron. B. 2. St 1.) "Die operations 
i»r inguinal and femoral hemiae were described by F. X, Rudtorf*' 

Jn. f P. W^ O, TrttsAier investigated the occurrence and causes 
of hernia of the ocBcuro. % Classical works on hernia were pub- 
lished by A, Cooper^ $ A, Scarpa^ || and S. T. Soenmerring. f 
Sander twice met with the rare case, where^ without being 

. congenital, the intestine was contained in the tunica vaginalis 
testM. (Chiron. B. 3. St. i.) B. G. Schr^er^^ made some 
excellent remarks on hydrocele complicated with hernia, and on 
oonffeoital hydrocele, ff Ingem observed an encysted hydrocele 
ef £e spermatic cord. ^ /.arrr^ described his plan of radically 
curing liydrocele by the introduction of a piece of an elastic- 
catheter. ^^ H. J. Brtmrnnghauserfs popular instructions on 
ruptures and the use of trusses deserve praise. |||| 

BarUm examined the difierent operations for lithotomy, and 
even ;*eeommended tlie hirii apparatus in certain circumstances, 
endeavouring to impriMre the instruments by a concealed bistoury 
or his own.ff la v renna, PqfiJa^s method attracted a great deal 
of attention, though it must be owned the use of X^Ca^'i lithotomy 
knife has many inconveniences. It was alkywed the advantage 
of permitting the sure evacuation from the bladder of all stony 
concretions. F. X. Rttdtarfftr accurately criticised tlus me-' 
thod. *^'* Klein made some inteiesting remarks on his plan* f)-^ 



* Anatomiach-chirurgifche Abkindf. fiber den Unprung der LeliteiH 
br^cbe. Wurkburg^ 1806. 4b 

t^ Abhandl Uber die einfach«te und ticherste Operations-Meihode eiiig> 
•perrter Leitten-und Scb^nkelbriiche. B. 1 . S. Wien, 1 805» 1 608. s. 

± Observ. in hernias, praecipue intestini cocci. Tubing. 1806. 8. 

§ Die Anatoznie und chirurglsche Behandlung der Leiitenbrttche und 
angebornen Briicbe. Ueberieizt von Kruttge. Bretl. 1809. foL . 

\ Suir emie. Milan. 1809. foh 

1 Ueber die Ursacbe, ErkenouuM und Behandlung der NaMaruohe. 
Frkf. iHll. s. 

•♦ Horrfs Arcbiv, 1809. B. i. Heft. i. 

tt Hon^4 Archiv, B» 5. Heft. S.— Abh% der. pbys. medic. Socictat zu En 
langen, B. l. S. S57. f. Schregfr chirurg. Versuche, B. i. Numb. ISII. s« 

it Chiron, B. i. St. 5. ond y. B. v. SicMdj SammU von Beobacht. B. a^ 
N-fi. ' 

U Denkwilrdigkeiten, S. 585* 

II II Gemetnnatziger Unterricht fiber die Brfiche^ den GebraucK der Bnich- 
bander n. t. f . Wurzb. isii. s. 

Tt Chiron, B. 9. St. 3. 

••• AbhandL uber die Operation del Blaieatteifti nach Pajck'j Method^ 

Leips. 1808. 4. 

ttl /Wrf^/ Joum. B. 4. St. 4p 



I8i>. Recent Progress of Medicini. 1 i4 

Rxjlbiri AUan * opposed the use of theooTget. /. 'Jhomscn recom* 
mended the method oTDouglas and Cbeseiden anew, f Tregeran 
rebtMl Gaerin's procedure, and described the improvements on 
tt» t wbicb, with proper alterations, C F. Michaelis also r^om^^ 
mended. $ To alleviate the pain of stone^ B. G. Sckreger 
praised the injection of warm water. || JF*. t^. P. Gruithuisen 5f 
proposed diminishing and totally removing calculus from the 
bladder by the injection and affusion (Perfundiren) of water 
and dissolvents. 

C« JP. DSmrr made some judicious observations on the treat* 
ment of strictures in the urethra (Chiron, 6. 1. St 2.). Fetit** 
recommended the application of nitrate of silver by means of a 
bougie* J* H» Thaut-ff and B. G. Schreger IfX investigated am^ 
putation of the penis $ the latter recommended removing the 
ne«nber, by repeated tugs, close to the ossa pubis. He also 
published an excellent dissertation on indurations of the anus, 
which are different from hemorrhoidal swellings; and de- 
scribed a new method of applying the ligature in fistula nnf, $$ 
on which operation, one of bis pupils, J. B, J. Berndorff^ bad 
previously given a more literary essay. || || With this, Larrttfs 
method f H ought to be compared. 

A new work on fractures and dislocations in general was pub* 
lisbed bv £• Lammerhirt ;*** aqd another onTractures specially 
bv L. Aampe. fH P. J. Uydig Xtt published a description df 
his contrivance mr raising patients with fractures. A new ma^ 
chine tor reducing dislocations of the shoulder was recommend- 
ed by «/. F. Warnecke^ at Nuruberg, in 1810 ; and another for 
the same purpose by «/. /'. l^reytag^ at Cbcnmitz, also in 1810. 
A very useful dissertation oh fractures of the olecranon, with 
a new method of treatment, was published by ,J. Fcilery at 



* Treat, on the operation of lithotomy. Edinb. 1808. fof. 

f Obflcrv^on lithotomy. Edmb. isos. 6. 

1 Chiron, B. 3. St. I. 

I EtwBs uber den BIjuensteimchnitt. Mtrb. 1818. 4. 

g Hon^s Archiv, 1809. B. %. Heft. I. 

t Ssteb. med. chirurg. Zeir. 1 81 3. B^ i . S. SS^^-^di . 

*« Joam. de SeMJht, Tom. XLII. Not. 

ff Diit. de rirgae virilis statu sano et morboso ejusdemqae imprimis am* 
putatkuie, Wirceb. 1808. 4. 

t± Ckimrg. Vcrsuche, B. l. Numb. 1811. 8. 

li Chiron, B. S. St. l. 

M Dim. deligarura iSstutae ani. ErI. 1806« 8* 

tY Denkwflrdigk. S. 589. f. 

— Taachenbttch uber Beitibr6che und TerrenkungeA. Berl. 1805. 8. 

ttt Ueber die EntstehungyErltenntniitiBeurtheilung undKur der Kopchcii^ 
brfiche. Brem. iso5. 8. 

tii Krankcab^bcr bsy Knoshipbrtlchaii Mstnv, IS ifl, 4. 



]^ Meceni Progress of Mf^icini^ Apri 

Sah. in 181 L J. M^ Laurer * rcpommended a new. lund of 
aplinU mode of lixpe-treei and considered the. best method of 
IreatLDg oblique fractiMres of the thigh. M. Hage^om iKoy^rate- 
\y illustrated the diagnosis and treainieot of fractureB jof ike neck 
of the thigh bone | f and J. N. Sauter % deicribed a method c^ 
curing fractures, without the use of spiipta. J. G. Heinf made 
some excellent observations on artificial feet, and the way oT 
using them. $ 

J. C, G. Jarg g gave a description of club-feetf arising irpm 
continued abductioui and the best method of euriotf them by 
Scarpa's contrivance At the same periodt E> F. Laiblin t^ 
commended Autenrieth^s machine for this purpose. K The 
treatment of curvatures of the spine and limbs was improved by 
tPdrg^ ** whose certain method gained him extensive reputatioD* 
Although Thilenius had previously cured the ckdvfoQt by di- 
viding the tendo Achilles, yet the proposal of C. F- MifhaeUs 
was new, by incision of the tendons to relieve stifihesa of the 
joints, arising not from real anchylosis^ but from preceding in- 
action and inflammation of the muscles, ff 

Amputation was submitted anew to an accurate exaoiinatiooL 
by C. J. M. Langetibek^ H and K. F. Grafe. ^ Larrey admi- 
xwly illustrated the advantages of immediate amputatiou on 
the field of battle, |||| and proved the benefit of amputation oSk 
the joints; which wus also done by P* f. Haltier.%% G. //. 
Wachter accurately described amputation at the kMegointp *** 
and fF. Iraser that at the shoulder, fff 



• Mursinnn^s Journ* B. 4. Su 5. 

j* Ahhandl. ttber den Bruch dei Schenkelbemhaltcs. Letpx. isos. s* 
\ Anweisunf die Beinbniche der diedmawen, vonuglicli dit ccNnpII- 
^oh und den Schenkelbeitihalsbnich, nadi einer neucn, leichcsn^ einfscKoi 
«nd wohlfeilen Methodc, ohne Schlenen, ticher und Cequem zu hal<n» 
Conskinz, isis. a. 

§ Betchreibung einet neaen kOnstlichen Funes fOr dea C)b^«uad Untor-; 
tehenkd. Wttrsb. isil. s* 

II Ueber Klumpfiisie und eine lekhte und iweckmUsslge UeiUct dend- 
ben. Leipz iso^. 4. 

t Din» de tsnstioiie talipedum varorum ad virilem jam aeutcm provee- 
torum. Tub. I8O6. 8. 

** Ucber die Verkruininuogea dcs mentcbU K^^rpos uad ttms ntioodle 
and tichere Heilart derselben. I^ipz* 1810. 4. 
' Hufikmd^j Journ. B. 5S. St. S. 
Bibliothek ftlr die Chirurgie, B. S. St. 9. 

Normen fikr die AbtOfung gratstrer GUedmasaicpf Bed. ISU* 4. 
Denkwardigk. S. 354. f. 

Abhandlungen aus dem Gebieta der prakL Medicin* B. 1. Laadtk. 
isio. 8. 
*** Dm, de articuljt exttirpandu. Groning. isia 8. 
ttt £iM7 oa tkc fkauldaPJoint-opentiM. Loni* iSif* «• 



Kllt» ibneht J^rogmi of JUedicimt. ts( 

VII. Medical Police. 

' AtiiM^ tbe general works cfn medical jcirispnidetice and me- 
^cid police, the* fifth voUme of </. P. Franl{?s classical pub* 
fierition* iMriM pafticniar mention; likewise his first sup* 
irfemteMy Tbhime, published at Tubing. 18 IS, 8vo. The pro* 
doeiiMis of T* A. Ruland, f F. Kornatcmky, t and Frams Bene, 9 
Mre fasignifieant, and that of P. A. Rubers || does not render 
MperritfOQs the.pHhdpaI work on this subject. The chief parti 
jot rikedicsd police w^e lately aminged in alphabetic order bj^ 
i/. P. Niemann. ^ 

Ootiectiona of tracts, notices, and ordinances, concerning 
health ftaA medical police, were pobh'shed by J A. Schmid/mUl^ 
Jer, •^ J: Ntederhuber. ft J- «• G, Schlege/, tj J. C. F. bcherf,^ 
C. Knape^ A, F. Meeker, % .L H. Kopp, %% JP- L. jfugustin^ ♦•» 

S. HSH, and Jf. Jacobi ftt 

The Tfthe of medicine and physicians, as connected with na- 
tfodal administration, was considered by (\ F. L. Wildberg-^Xt 
vsnA 6. V. Weiekind. \% An anonymous autl)or|||[ published on 



^ Shrsteffl der medicinischea Polizey Tubmg. I8t4. a* 
t Voli dcm BinflaM der StiAUaraaey^oade aaf die Sia att ver wal tdi^ 
Rttdolstadt 1806. 8. 
. 1 Uebersidit dcr getammten Scaatiarsneykunde. Zerbst, 1 805. 8u 

i Elemenu pofitiae inedicae. fiftid* 1807. 8 

g Von der Sorge de« Staatt far die Oesundheit leiner Bfirgtr. l>rcid« 
S806. 8. 

5 HandbudiderStaatMnneywitienschaft. B. !• S. Ldpz. 1813. 8* 

** Beyt«3lge sur VenroUkorooniing 4k StMttanEneykuiide. LaiKUMC*. 
1806. 8. 

ft BeytiSge zur CuUiir der medictnxscben und bQigerlichen Bevdlkcr* 
fngikunde« Mdndien, 1805. 8. 

XX Materialiea fOr die StaaUarzne^wistenKhaft und prakt. Heilknnde 
flamnil 1^-6. Jeast l80O-«Lf09. i. - . 

^ AUgemeinet Archly der Gjofuiu&eiu-PoliMy. B. 1. HanaoT. 1805« 
1806. 8. 

II g Kritiidie Jahrbacher der Staatsarzneykiinde fur das ocimKhnte Jahrk. 
B. 1-— s. Berl. 180S*-t809. 8. 

%% JaMwch^StaatnrKneyktmdt. J. l.«*-5, Frkf. )808-*isiS. 8« 

*** Repertoriom far db Wentiiche tind gerichtliche ArzneywtaMnidbaft. 
St.1. Berlio, isiO»8. 

ftt Jjdiri>Qeher.d^ Saaitftttwewni im Konigreich Bayera. B. 1. LtndA. 

1810. 8.. 

XXX Kurse Awweiwng» wie dat PuUicuflB von der Aiuabiinp dcr Aixueyme- 
. fltackili duidi die Aerate den mogliclur auodesten Vortkeii aishn Juam Gat- 
tingen, 1808. 8. 

~ U^erilHiWertbderHeilkawlr. Darmit. lait. 8. 
Bricfe mcdiffairtcp MMte> Riga^ laes. 8. 






thMgubject tome naefol tnilbsf in a dew and euMi muuier. 
Kon^s emaj is insigiiificant * 

On the education of phjaicianB, P« X Hcruh gave an aseel- 
l^nt essay > f and K. PatUus nno^ber % of equal merit. A ipre* 
ceding writer, on the oontraryy keeps within tbo^docrines of the 
pbiloM>pby of nature. $ True and useful remarks on the neoes* 
sity of secondary schools for practical physicianst and on the 
dislidvantage of separating medicine from surgeiyy wave 9>ade 
by A. F. NaUe. || The education of oottotry practilionerst 
which MoUe proposed to entrust to these special sdioolst J. C, 
Beil previously thought (we can scarcely believe seriouslj^) ought 
not to be at all scientific^ And gave a description of learned 
physicians^ which, for the honour of mankind, we hope is not 
often to be met with. Th^ absurdity of this was dearlj; 
shewn by C. W. HufeUnd^ \ who, notwithstanding, subsc<}uent<^ 
ly ** proposed to permit the clergy to practise medicine m th^ 
country, which actually was allowed in Sweden at th^ diet of 
ia09. ft- To this place bek>ngs OsAofs excellent essay, tt Thai 
of A. M, Vering $$ is insignificant. StUtz^ |||| and before him ^B«r 
iemacJier^ then C. F. WUdbergf f f and recently 6. v. JTede^ 
kindt *** opposed ReiPs erroneous ideas. The Philosophical 
Society at Gottingen having made this the subject for a prize- 
essay in 1810, gave occasion to a valuable refutation from £. Hm 
tV. MUnchmeyer, ff+ 

The Prussian ordinances concerning medical police were col* 
lected by J. C G. Liebecke ; XtX the Austrian by r. J^v. Ferro.^ 



•\ • Der Arzt, wie er tst und wis er seyn loilce. Zuricti, I seff. s* 

t Ueber die Bildung des Arztes als Kliniken und all Staatsdienen. Wmft. 
1807. 8. 

j: Dantellung einiger Hauptmomente aus der Heilkunde zur Bildung pnkt. 
* Amte. Stuttg. ] 8 1 1* 8. 

Brtefe uber dat Studlum der Medicin. Leipzig, iSOSa S. 
Die Schulen der Aerste. Brsumchw* Isog. 8. 
BufeL Jmim. B. SI , St. i. 
' • •* Hufel Journ. B. «9. St. S. 

tt Bf*fii- Journ. B. S5. St. 6. 

XX Uber die VerhUltnisse det Gttstlichen sum Ante pnd dem KraalDeik Berl« 
1806.8. 

(4 Versuol) einer Pkstoral-Medicjn. Monster, 1809* S, 

\\\ BwftlanJfi Journ. B. SS. Sc^ 1. 

y\ Knopfs und Becker* t krit. Jahrb. der StaattarKaeykonit^Th. I. 

*** tfeber den Werth der Heilkunde. Dsrmitadty 1st?. 8. 
* tft Ueber die beste Einrichtung dei Medtdnalwewnt fur Fkckni and DBeftr. 
Halberet. 1811. 8. 

IXX AuBzuge aut den ISn. preoM. Fblbef-Getetzen in Benshimg snf Ocrand- 
heit und Leben. Magdeb. 1805.8. . * . 

^§ Sammlung aller SsnitSti-Yerardniuigea imErzhcnogthun Oatara^ 
Wisn» 1807, s. 



J:E. ^eifdif pahMwA first a projeet,* and tfm a daKrip* 
don, t of ^uit of Bararia. J. J. SehutM wrote a •doceMRiI' 
pri ic aw a j t OD the best arrangeimnt of the malieal pr ofewi on 
for Soabia* j: Medical ofdinanoes were pablished in SeJtzbiugh} 
and Baden. H The medical laws of Mecklenbor^ Schwena 
were collected by 6. H. Mastus* (Rostock^ 18 1 1» 4to.) 

The miierable state of the medical constitation in FVaiice was 
poonriMred by G. v. If^edekind^ in his work already referred to, 
and Sdimke9,% The hiws and ordinances of the French go» 
▼emment were cdlected and published by «/. C Renard. ** 

A reform of the medical police in England was proposed b^ 
Ed. Harrison t but the proposal failed, from the London CoU 
lege of Ptqraidaiis being solely entitled to regulate the practice, ff- 

In regara to (Mirticular impreveraents in medical police, we 
considertheprecaucionsa^nst eontagioas diseases to be tbeclnef. 
The small-pox, once a Iri^itftil scourge, is extirpated, by the 
universal extension of vaccination. Compulsive measures and 
penalties lor neglect of vacdination were ottlered by the German 
go^mmento, 1^ and these measures approved by J. E. Weizkr. % 
«/• G, Bremsen ^ also^proposed punishing the omission of it with 
losS'ofcivil honour^ and to commit to the country clergy, in gene^ 
tai, the extending it by word and deed,— achai^ they have ao- 
tualiy undertaken in several states. Oneof the best and most jodi- 
eious authoritative ordinances for the practice of vaccination is 
the Austrian of 1806,f f with which that pu^Ii^ed in Saltzburgh 
corre^xmds. *** In the kingdom of Westphalia, likewise, vacci* 
nation was ordained by law. fff 

Foreign states promoted the inoculation of cow-pox with 
^eat z^ \ the Danish government with uncommon energy. 



* Entwvrf der medidaitcheti Einrichtung fur die kurpfalzbayenchsn 
Staatea. Ulm^ 1805. S. 

f Damellcn^ det Mediciaslvrcidis von B^yero.. Austb^rg, 1909. 8. 

X Ueber die besteii EimichtuDgra des Medidnalwetent in Schwabe^t* 
Mann]^ Th. t, S. 1808. s. 

f Sabb. med. Zeit. 1S05.B. 1. S. 859. 

II Sahb. med. Zeit. 1805. B. >, S.. 3t€p 

t Salzb. ined«Zett. isi-S. B. 1. S. 188. f. 

** Sammlnng der Gesetze uod Verordnangeo* Frankreichs, in Bezuf auf 
Aerzte, Wundrnte nnd Apotheker. Mainz, 1 8 1 S. 8. 

8Edinb. med. and tuig. joiirn. VoL IL p. 487» 489. 
Bayer^iche Verordnung vom. SS. Ang. 1807* in der Sabtb. msdic« 
XCR. 1807. B. 4. S. s. 

i§ Aktenitncke uber die Schotzpocken-Iropfimg an der bayencben IVovinz. 

bwabeofl. Ufan, 1807. 8. 

II U Die Ktthpodcen, ala Staatiangelegenbek betrachttt. Wico, 1 80^ f , 

n Salzb. med. Zeit. 1808. B. 4, S. S89. 

•*• Salzb. med Zeit. 1809. B. 1. ^. 181. 

ttt ^<^^ ia MttffUmXj Joum. B. SO, St.ar» • ^ 



H«M0^ already^ m 1805, not A*tipgkiihM'dMt«^i«nA^& i^ 
IkfMohagen. • Id Francei where, at fiftt^itb^ wqs great 0^ 
ppgitioiii by the profesiioii, tki% bmfficMil dutca^Ty beMne aiib* 
•ervient lo the most infamoua daqpotiwi, wbioh preterfttf the 
lives .of mem onl^ to saerifice then at iu pleaaore. The repoift«f 
the committee ot the Natiaaal Institute on this aiilyeet dcserrea 
to be read, f Connected with tbia are the ordinaacea of the 
Frepch government for the l40wer Rhine, j: and for Illpini.§ 
JP. G. Friise || described the passioiiate and disgraceful coise 
troversies on the value of vaccination which were carried on ia 
Great Britain, till the dedsion of the College of Physician^ on 
the 8ih July 1807, put an end U> the diapaie. I,ale(jr UAerdm 
finally aHowed, that the mortality among childien haa dinrinish* 
ed by vaccination, as IS I 12. % 

. J. Rehmam •* related bow it has extended even in Siberia | 
W- ScoltW on the coast of Coromandel 1 and U. LkkUmkin 
OB the southern point of Africa, tt 

The relation of cow<f)ox to other diseases was belter deter- 
mined, and more knowledge obtained on tha nature of the vkp 
.rus. The difference of genuine and spuxious cow«pox was 
4iitabUshed by G. UAerlacher^ %% Hanb^^ |||| and J. Timttom Vl 
Charcoal was recoropiended for prdperving tlie ettcaqr of the vac- 
one matter by K. F. uiuber,^** who.observed» that quartan fever 
Viras cured by that which vaccination oceasions* 6. VAerMnAfr fff^ 
shewed how inocuhition cwi be performed witli the aeab of the 
. eow-pox. A. Carl invented an inoculatiog im^roroent. $^ Somq 
good observations on the rdadon of Cow«>pox t6 other eruptive 
dfaeaaes were made by A. F. SehUn^.wA by P. J. H^mKUW 



• Pfaffixsi neuen nord. v. Ardiir, B. l. 

* Stlzb. med. Zeit. ErgSnzb. 8. S. 401. f. 
Salzb. med. Zeit. ISil. B. 1. S. I09. 
Salzb. med. Zeit. }8l l. B. 1« S. I4i« 
Versuch einer hiftoriaclikritischenDarstellupg der VerBandlungen ubtr die 

ICuIipocken-Tmpfung in GroMbritannien. Breslau, 1809. 8. 

1 Med. chirurg. traanct publ. by a leedico^chtf. 8oc« at London. Vol. lY. 
** Salzb. med. Zeit. 1807. B. i. S. 1S6. 

Edinb Med. and Surg. Journ. 1815. p. S07. 

HufikuuPj Joum* B, 31. St. 1. 

De vaccina antivarioloia epitome* Yieoo. 1807. 8. 

Huf Journ. B. ss. St. s. 

Preuvea de TelBcacite de la vaccine ; trad, par Dujbur* Pansy 1 i07. 8. 
** D6couveitenottveI]ed'unpit>ccd^ simple et facile^ pourcoaserverpeadant 
pkiieun ann^et le flutde vaccin intact. Paris^ 1805^ 8. 

ttt Nachncbt uber die Wirksamkeit und Kfitzlichkdt derKuhpockcasi^sp^ 
funic mit dem Shorfe. Wien, I807. 8. 
tit Art zu impfen. 1807. 8. 
<$$ HufiUuuTj Journ. B. 99. St. Y. 
Hy Annalea der dlniiclieaScliuIe. Heft ^4 



Iftll necmiFiftigmM^Maidim. iBf 



psnied by general cutaneous redness, of which the ctold dM., 

H^hAog preundcd in: Eog^nd^ Aat, in aome initanoes> the tu^ 

tufal*pn liad take|t pltee after vagoi nation, G. F. MUhrg: tram- 

ImkI R. WMatiB dissertation on* the cow-pox ioaciUaiion. 

(GoltfageB, ia08:) In it are related cases in detail of the ap^ 

paaraaee c£ steait-Fiex ^subseqaeat So vaccination i hot, as in 

these tiie crvption scabbed on the sixth day from its appear* 

ante, ViUan cDncIaded that . smalhpox after oow»pox does not 

USkm its usual coarse, thcdispcnitioil ta it b^ng destroyed tqr 

vaccination. WendeUtait^ also obserrect, in 1M7, the natmd 

poK take place a yeuTiand a half after vaccination; MUhry^ in 

November ]80a^ amir an eruption of md*pox in a.diild wfaidi 

bad passed tbrmigh cow-pox in 180^ ; here ahto the seabfafaup 

Allowed on the siKth day.ji Heneupon £. L. H€m% declared 

^s enption. to have been sparioos smalKpox $ but Muknf^ 

in a rep^y \ h^ it fi>r modified suiit-pox, because its virus, by 

inoculation, r^roduced genuine amaJl-pox. In Berlin, where m 

similar case happened, Bremer and Zencker% considered the 

^emptknassporiolis snatt^pos. Thekst work of L. Smc^^* on 

coW'pox, grease, and sheq>>pox, determines the relations ^thesa 

animal eruptions, the chemical and microscopical constitution 

of' the vaccine virus, and informs us of the great success of vac 

cinatsoii in Italy* Arimitiva aosr^pox* which Smce^ dso ob- 

servedf were discovered in Germany by Brenur^ Fisdhir^ «id 

Mende.\f 

The inocubition of measles, first tried by Ho9M^ was perform- 
* ed successfully with the bfeod of the eruption, by F. £. Hda. '^ 

The means of preventing the spreading of the plague and yel- 
low-fever were considered by K v. Schraua, §§ Fr, JL. Augustin^ H 



• Hufekm^s Journ. B. SO. St. 6. 

\ &iii«nDl. medic, ond chir. Aofii^tzei B. 3. K* S^ 

iHufil Journ. B. 88. St. 3. 
H<rm*s Ardiiv, 1 809. Br i. Heft, f . 
HufiUm^s Journ. B. 30. St. t. 
hom*s Archiv» ysiT#Marv.-*«IMpf in (lie tame worib for Sept. 
^^ 14ene Entdeckotogen Qberdie KohpodEntk die Maxike onddisScIiaaf- 
pocken. Aus dem Engl, von HT, SprengeL Leipz. 1 8 is. 
tf His^/. Joorb. B. 85. St 5. 
ti Salzb. med. Zeit. 181 1. B. 1. S. S05. f. 

J} IToTBchHfireti der hflSndi^cheA Fofizey gcgea die Pestuttd dsi gdbe Fieber. 
ITien, 18059 8. 

(|]f Was hat DeotscMifld ond lAaoAderiielt dsr IVetnt. Staaf Tom gelbeit Fie- 
her za forchten, und welthe Mittel aind gcgen die Ausbreituog di«icr Kr«ik« 
fvot Hh efgrnsBA ? oen* 1805* s* 



J 

Wei 



X G. Lm^*mm;^ 3. Fdh^f* Si 8. NiOht ^^ C P. 

. Aft a general aoeant of ititrojiag amtagiaiit Chgftm Manm 
acottVinecbod of prodnoing muriatic acid Tapours waa recoB^. 
ottiidad, and proved b^ experienee, || This ncaiis, with other 
peenrehtive measures, was jsoommeiided by C J. KUitm^ oa 
ibe appearance of the camp^iever of i80S»7| S and on that 
of 1809, by P. K. Hartmann^ ** and M. J. Gutberitt. ff P. 
J^ Casiberg %% proposed varipns regulations. And in $h^ last 
eamp«fever, L, W'. Gilbtrt^ and J. F. GrSfe^ gg recommended 
anew Gabion MotveHu^s method. 

6. Bichr Bmin exposed the harm of having bn 
in town& Hf The means to be eraployedin suspcn 
w«re well and deariy explained by •/. C. FUtcUkmi* *** Forial 
described the treatment of asphyxia from mephitic gases, fff 
The reports of the Hambargh Hmnane Socie^ are Tery in^ 
structire i ttt likewise the pnbUcation of/. J/, j/. Pppp.^ 



* Usber dtt gelbs Fkbsr, ww X>ettt«chlsiMl daton zs btmrgttk, 
fur Vorkehrungcii su trefftro hat ? Hof» }ft06. S. 

{ Aufruf an die sanuDtl. RegieruDgeDi Polizeybehorden und Aerzte Deulicli* 
lands in HinBicbt anf die gegen die gclbe Pest zu treffenden Vorkebrungen. 
Ntkrnb. 1805. S. 

X £ntwiiif einer P^l u e yv stordiwng gsgtn die wehsiis Ymbnkam^ dsr 
wciteodischen Peit. Frkf. ISOS. S. 

. § Die gerechten ne-^orgnisse und die gegrfilndeten Vorkebrungen Deatich« 
lands gegen das gelbe Fieber. Numb* 1805. 8. 

H Abbandlung neber die Bfittel die Lnft za relnigen, der Ansteckong* 
'vorztikommen und die Fomchritte derselber va ^mmsn. Ant dun F^vn. 
TOB F. y. Martens ; nebic cioem Aahange von C F* BmehhUm* WfUnar* 
2805.8. 

t Was soil man in den jetzigen Kriegszeiten tbun, nm sack gegta die 
Gefabren des Nerven^oder Faulfiebers zu schutzen ? Leipz. 1897. 8. 

** Sicbeningsanstaltea und Verwabrungsmittel gegen ansteckende Nerven- 
vnd Faulfieber. Olmutz, 1 8 1 o. 8. 

ft Versucb fiiber die Sickertingsaffstalten gegea die Batstebong und Ambret* 
timg contagidser Krankheiten unter den Soldaten inn Felde. Wurzb. isn. 8. 

fX Forslag til Medisinalpolitiek under £pidemien Graseern. KiSbcohayeay 
1809. 

^ Fur jeden verftlndiiche Anweisimg. wie man tt ananifangen babe^ on 
bey bOsaitigen Fieber-Epidemisen alter Art sich gegen Aatteckung sa schOtseiu 
Lieipz. 1815. 8 

II II Die Kunst licbt tot Ansteckung bey Bpldemieen ta skbem* is. BerL 

1814. 

n VbndeBNacbtbeik&derBegrabiifMsinStidCeo. Brem. isil. S. 

*** Ueber die Bebaadlun^ der Scbetntodten. Carfonihe» 1806. 6. 

Iff Instruction inr Is traittmeiit des aipliyxies par lee gaz mepbitiquee. P^urii^ 
isos. 8. 

({t J, A. Gunthers Geschkbteund Einric)itttng derHamburgtscben Rettuag* 
mistalten. Haunb* 1808. S. 

m Das allgemeiBe RjettODgsbuch Toa J. A if. Ptfp^ Pyrmon^ iSOS. s. 



- HeasitM far ithe better manngpimt of mad^faiiiisei were 
pvspoaed by J. C.Reilt in an ajqiendh: :to a translation of Ji^ 
son Cosii practical observations on insanilgf, fnibliahed at Halle, 
lai 1» Byo. He pveiers the public to isU private inBtitntions. 
Of. the latter there are several in Englaod ; one in particular 
at Yodk« of which S, Tuke has given an admirable description. * . 
G\NisseHUPs essay cm the .prevention and cure of insanity^ i 
Lond. 1813. 8vo. is also to be noticed here« , 

B* Medkal Junsptwkuce^ 

Among the text>books on this subject, J. £. Meizgef^scom-' 
pendiumf stttt maintaiost if not the.fintf at. least a very distin-' 
goishod ^acei With him ^ies C i^. WUdberg^ % who has in^ 
Gontestably given more references, and has earned the invest!^ 
gatkm'of some si^Uects &rthen G. H. Massius% is only re- 
markable for adtil^reat arrangement of the subject,. and an 
'^ected pinlosophical language.. A.UenieW likewise attempted 
« difierent arrangement, and to have something peculiar, dH 
gressed into the science of laws. : l^till more insignificant are 
£r. Ben^i Elementa Medleki8B''Fofensii. Bud. 1811. 8. . 
. Single contributions w^e given by W. F. tT. Khse,^ W. 
J. Schmiity B. L. Backmann, J. K. KOitUnger^ •♦ and F. G. H. 
lielUz. ff . 

Judicial dissections constitate a cUef practical part of this de* 
partmenU And to these, A..K. HesstUmch %% gave an excellent 
•guide ; w&h which that of M. Hqfner ^ cannot bear a compa» 
•risoh* But that of T. G. A» Roose, \\\\ however, still preserves its 
distingnisbed value. A4 no improvemiant of the medical juris- 
prndence in the kingdom of Saxony had taken place, JP. G. 



^ Dsi cript ioa of tbe Refretty an inttitution near York for insane penoni. 
York, 1813. 8* -. 

f Knrzgefaiates System der gerichtlkheu'Arzneywissenschaft. 4te Auflage, 
VOQ C'.G. Grttner. Konigsb. ISU. 8. 

t Handbueh der g^richtl. Arzneywioienschaft. BerL isie. S. 

f Lehrbuch der gerichtl; Arzneykunde fur Rechtigelehrce. Th,] 1. tf. 
Akona, i8io» 18I8. m. 

II Lehrbuch der geriehtliphen Medkin. Berl. 1813. s. 
'7 Beytrage zm* gerichJ. Arzneykunde. BrcsL 18II. 8. 

** Einigeauaerlesene medicmitch-gerichtliche Abhandlungen. Numb. 1815. 4. 

8Arcbiir der gerichtlichen Arzneywissenschaft. St. I. Leipz. isil. 8. 
VoUMindige AoieiUing zur gesctzmSssigen Leidienoffn|mg. Wurzburg, 
1819.8. 
§§ Kenca and nttuliches Taschenbuch fur Baaime, Aerzte und Wundllrzte. 

AttOb. 1809.8. 

m Tn A. G. Root^j Tascksnboch lur gsrichtlicke Aeote. Viecte Aufl. von. 
f. uhnlsf bcsorgt* Frankf. isu, Sw 



]0». RmhiiProffwafMidkim. MfA 

BiBim imUidhed hb jqliBiam on an »tClidrftiltiY9 Older far Ae 
preoedore to be foUovwd si jndwal diMctionk. >> Bj cdnmiMid' 
of the. WunembeqfvgKMfeminmy the facnky of medicnife at 
Tubutgen, gave a i^andate to thegoveroment^physiciaoe for tbe 
gMHer accuracy in tuch iiwrartynicww ; and thk gave oceasiod 10 
•!» //. P. AuUnrktlii adnirabb <* guide for physiciatiB ik casea 
of k^ inspectioflu Tab. l^Q%^ l^vo/' Tliat of G. H. C 
Crmiut f is also corameMidble: 

The degree of mortality of wounds was considered by C F. 
JVUdierg^ X J. E. LieiMou^ $ and 7. Xi^. || !>. S. Osiandir pro- 
Aieed an excellent dissertation eo suicide. % F. We^sbr ** 
jpoUiahed several instructive documents on a doubtfnl case of 
avicide. F. B. ImmiseUs . judgment 4111 a similar case ia ako 
veiy aocorate and instructive, ft 

The detection oF poisoning hj arsenict waa ifostraled fagr C^ 
B.Pfaff, Xt R9kf, ^ but in particular hv B^t. I 

On the proof of child-'morder, derived trom the swlmikriai; of 
Ae iunos, which has so often licen disputed, Jr if. S€bmidtmMkf 
justly coserved, that all depends oti the presence of the natural 
quantity of blood in the lun^. %% W. X Sfhrnn ^^ instituted 
important experiments, wiiicfa taught him, that the weight of 
tlK longs does not always correspond to* the weight of the body 
ao accurately as the strenuous defenders of Pioucqjiefs test give 
cut ; that a child can breathie when the head aloneis bom^ that 
putrid, lungs do not float, and that the colour of the Insigt ia 
fidbicious. On the test of child-murder, from oompfcted respi* 
ration, as well as upon several judical ouestfons ooneemmg chikti- 
l»rth, accurate investigatioiis were maoe by C. F.L. WiUbnig.^\ 



* Arch, der gerichtlichen Anneyw. St. 1. Leips. isi i. s,> 
t VoUftandigt uad dcudiche wMtomiicke Aawebung fsr gerkhd^. Aante 
an Leichenuntersuchungen. GduiQg. 1 806. 8. 
± Wis die tddtlkhetf Vcrlecsanfcn t>eurtheilt wtrdsn nditaen. L^ ISLO. 8. 
t VoQ der Todlichktit der Verlcczixngen. BerL 1811 • 8» 
S Ueber kdrperKclio VerletmiifSB, ia sowcit ab tis das V^riiredicn der 
Tddtai^ bildcs. Frkf. ISIS^S, 

t U^erden Selbstmord, seine Unachen, Arten» medlciiui^h^enclitficlis 
Vntenadiuog, und die Mitfeel. gcgen deniellMfn. HunoTer, 1 s 1 5. s. 

** FOnf mediciniach-gcrickUidie GuUchtcn fiber siaen eriiSagt gefuadstaca 
KaabcB. Koblsin* ISia. 8« 

Soicidtum dubhiia caiu nngubri ittuttntuoh Jcn> 1&08« 8* 
Kcaes aord. ArelliTy t. !• 
Salzb. med. Zeit. 1811. B. t. S. 18S. 
GdU^'i Joonu B. 2^ 8» €65. 
Hortifs Archive 1805. B. S. H^. i. 
*•* Ksns Ycnachs and Erfshraagsa Oltfdis Fk»c4Qet*icLe uad kydmta^ 
titche Lungenprobe. Wten, I806. 8* 

f f f Decitioaei medico-lq^ct quacstioDttm dubiannn ds laEuitibdt neogsni- 
tts. Getting. 1808* s. 



1 8 J 7* Recent Progre$s of Medicine. W6 

W* A. PUliTf by rea^oniDgand his own experienoe, endeavonml 

to fthew thai the fioetus cah oreathe in the ut0ni». • In consequenot 

cf the pulmonary test having indicated respiration to have takes 

place in a bydroHoephalic cbildy which, however, gave no distinct 

•igu of fife, Jaenedia concluded that this proof is <^no weight whera 

bydrocephalus i? present, f To us this induction is not aatis* 

ftctory; for respiration can undoubtedly take place withoiH 

other saguf of litea and does not. depend on the integrity tof 

Ibc brain, bat on the influence of the par vaguin. In a child 

hoevt before the full time, which, howe? er, lived twenty houi» 

after birth, MenMX Ibund that ^e lungs partly sunk in waler. 

jl. llenh likewise stated several good objections to the pulmo- 

nanr test} 

Anally, on impotence in man, and on rapq^ B^ G. E/vart^gniy^ 
lished a dissertation which was not altogether satisfactory. | 



II. 

Reports on the Ardent Fever of the West Indies^ as occurring #r 
board his M^jesttfs Ships Raven and Iftobe^ in the year IS 15. 
By Mr Petee Combie, Surgeon, Royal Navy. 

« O nsdid, msdism pertundite vcasm l"«-Jvvi«AU 

L Fever of the Raven. 

WHEN I joined his Majesty's ship Raven, in Carlide Bay, 
Barbudoes, on the 7th April 1815, there was only one 
man sick of fever on board ; but I understand that, pvevioudy, 
Mr Black, my predecessor, and a few others, had been attacked 
with fever, ana sent to tlie royal naval hospital at Barbadoes. 
In a few days afterwards she sailed for Surinam, arrived there 
on the 16th, and was lying off Paramaribo until the 23d, when 
we sailed for Demerary, and were in that harbour from the 
S^th to the SOth. We afterwards went to Trinidad, and re- 



* Salzb. med. Zeit. IS 10. B. 8. S. 305. f. 
t Sftlzb. med. TkiU 18 IS. B. 4. S. SS7. 
i HufiL Joorn. B. S«. 8t. 4. 

$ Revision der Lehne von der Lungen*uBd Athempr6be. Berl« ISII* 8. 
U Die UnzuiStsigkeit Sratlicher finoclieidang ttbcr vorhapdmet iSlnalichflf 
TcrmjDgea. Tubing, isos. S. 



iW . Mr Comric oil ffe ' Aptlt 

mained there about two days. Wliile at Surinam, the rain al« 
most continually fell in torrents, accompanied with much ihun-* 
der and lightning ; the atmosphere was almost always dark and 
haa^, and surcharged with electrical matter, and a great many 
flashes, of lightning appeared in the evening and during the 
course of the night ; but at Demerary we had fairer weadier* 
At both colonies we were plentifully supplied with Terr excd- 
lent fresh beef, and, at Demerary, with vegeubles. At SorinaiD 
no fruit could be procured $ but at Donerary and Trinidad it 
was plentiful. At IVinidad no fresh beef for the ship's com- 
pany could be procured, but fAcnxy of vegetables. On our pas* 
sage to Surinam six men were affected with fever, and foih; 
more durinffthe time the ship remained there, and two whilst 
we were in Demerary harbour. On our passage to Barbadoes, 
eighteen were talren ill of fever, whereof five were discharged to 
duty, and the remainder sent to the hospital, on our arrivid 
there» the 15th May, in a convalescent state. 

They were taken ill on our passa^ from Trinidad to Barba- 
does as follows^ viz. : On the 9d May, one ; on the 4th, two ; 
on the 7th, one; on the 9th, one; on the 10th, one; on the 
11th, eight ; on the 12th, one; on the 13th, two; on the Htb, 
pne. And, while the ship was in CarUsIc Bay, Barbadoes, from 
the 15th of May to the 27tb, the number of men taken sick was 
as follows, viz. : On the 15lh May, six ; on the 16th, eight ; on 
the 19th, two; on the 20tli, two; on the S2d, one; on the 
24th. one ; on the 25th, two ; and on the 27th, two. 

The total numl^or attacked with fever is, therefore, (including 
relapses) 55y and the number sent to the hospital, 36. All these 
patients were cured, viz. at the hospital, 36 ; on board, 19. 

The ship's company had been formerly almost always on cold 
stations, and most of them were natives of cold climates, and of 
very plethoric habiis. Tills vessel had been, for some time be- 
fore I joined her, in the Gulf of Paria, oft* Trinidad ; and the 
ship's company had been exposed to much the same kind of 
weather as I mentioned above to have been at Surinam. 



A Genera/ History of the Fever as it appeared in the Raven. 

It generally commenced with alteraating cIriUs and heats, ot 
a 8ens.ition of chilliness when the body was preternaturally warnv 
and sometimes with cold shiverings, succeeded by preternatural 
heat, which lasted very often two or three hours, exactly re- 
rambling the paroxysm of an intermittent, excepting the ab- 
sence of the sweating stage. At other times these incipient 
symptoms were wanting ; but it was always attended with ver- 
tigo and headach (the pain particularly referred to the foreheacff 

12 



ISI^ Jrdent Pever of the W»t Indies. Wt 

^eballsy aad temples); ireqaeDtfy a stiffioiess and obtase paia 
about the nape of the neck, and pain^ in the back, loins, and 
extremities, resembling acute rheumatism (the pains ki the lum- 
bar regions vibrating on each side as far as the linea alba) i 
pains in the thorax and abdomen, increased upon respiration ; 
and pain in the abdomen very much increased upon presisure ; 
#r upon being toi^cbed (particularly in the region of the sto- 
mach), and occasional anxiety about the pnecordia and hypoi. 
condriac regions, accompanied with much thirst, nausea, and 
sometimes vomiting; a very bitter taste in the mouth, and 
other synmtoms of pyrexia. In some cases there were only ver* 
ti^ and slight headachy and some anxiety about the preBcoi^ 
dia, accompanied with increased ^heat, thirst, and frequency of 

Eulse. Pulse, m general, above lOO* or 120, and someivhat 
ard and full ; sometimes above ISO, and weak ; but, after ve- 
nesection, full, strong, and vibrating. Tongue often of a dir^ 
yellowish colour, sometimes clean, out red, or white, and dry, 
smd oooasionally moist. Mouth generally dry and parched. 
f*ace flushed. Eyes suffused.^ Bowels mostly costive, but now 
and then, though rarely, there was frequent purging of a f^reen- 
jsh sobstancej and then tliere was always vomiting. Without 
discrimination, this state of the disease might have been mis- 
taken for cholera morbus. 

The treatment applied was large and copious bleedings^ 
sometimes to the amount of 200 ounces or more, in the course 
of three or four days ; and, when the skin continued preterna- 
turally warm after venesection, the cold affusion was repeatedly 
applied, until the morbid heat was somewhat removed, giving 
immediately, when the stomach could retain them, large doses 
of calomel andpulv. jalap $ in general, Submuriat. hyd. gr. xviii« 
Fulv. jalap ^s. and repeated if the bowels were not previously 
freely evacuated* When the mouth began to be the least ten^ 
der, frequent doses of the neutral salts were given, provided the 
•tomach could retain them. If the fever was attacked early^ 
and the treatment I have mentioned above rigorously applied, it 
generally terminated favourably on the third or fourtli day ; but, 
if neglected in the bq^nning, by the patients not making appli- 
cation, or othemirise, it was always protracted until the seventh 
day, and often much longer. This happened in cases, which, 
from their sli^tness in the beginning, the people thought they 
(M>uld work off (as they termed it.) 

Whilst the ship was at Surinam, I had an attack of fever, 
amongst the first that were affected there, and performed several 
times phlebotomy upon myself (there beinff no medical gende- 
mep at hand), and the relief I experienced was incredible^ . I 



Ifii MrConliri^oiilM Apvit 

was for * tew miaate* ulnoil: fr«e from {»in, bat. a Ibde on* 
tasjf in consequence of syncope that wfu produced. After thia^ 
I WHS abl^ with a little a«iUtance» to attend the sick pretty re-> 
gnkriy* 

II. First Fever qftie Nicbe. 

The ship's eompaiiy>' since I joined this ^ship, on the 28th 
Mbj ISlSf has been, comparatively spealung* pretty healthy, 
until we arriyed, on the 14th September* at English harbour, 
Antigila» to refity where we remained until the 25lh. During 
this interval a ^eat many of the ship's company were attacked 
with ^he endemic of this country ; and. Captain Deacon seeing 
it increase more and more, and being informed, that, as it in« 
creased, it was attended with more violent symptoms, witb 
much prudence and discenunent went to sea, and cruised to 
windward of all the islands, and until we were in latitude 19^ 
89^ north, and longitude 61^ 45' west, when the fever began to 
decrease. We then returned to English harbour to ooaipleta 
the refitting of the ship, and scarcely any were again affected 
with fever, although we remained' at English harbour from the 
$d of October to the 14th, and although the ship's company^ 
watch by watch, had liberty to go on shore frequently. 

While in English harbour the wind was first east, E. SL E.^ 
and, lastly, N. £., with occasional heavy squalls, and the atmo- 
sphere was sometimes very warm and sultry, and then, suddenly, 
cold breezes would occasionally come down from the moiintainsy 
op each side the harbour, when the body was preteniaturally 
warm and eovered with perspiration. On any day that was 
wery warm and sultry, and the sun very scorching, there waa 
generally a great &U of dew during the night, but particulariy 
towards morning, and, oonsequendy, that niffht was a litde 
colder than usual. I am very sorry that I had no thennome* 
ters» that I might have observed the sudden changes of tem- 
perature, both of the atmosphere and of the living oody. On 
the 18th of September there were constant strong gales of wind 
during the day. The wind was finit north, afterwards N. N. W.» 
N. W.t W. N. W., and then 8. W. ; and, in the afternoon, 
die wind was from S. W. by W., and then varied to S. S. £» 
and S. S. W. The atmosphere seemed to be surchamd with 
electric fluid, and had every appearance of an approaching hur* 
ricaue. In the evening there were frequent squalls, accom* 
panied with much thunder and lightning, and then the weather 
became more moderate. From the 19th to the V5th the wind 
varied from S. E., E. 8. £^ and E. to N. £., with occasional 
squalls, but generally moderate breesas* 



1817. 



AriM Femr qfthe Wed Indies. 



16t 



Early in the morning oF the Gib of October, there was so 
moeh thunder and lightning, that the victualling storehouse, at 
Falmouth Bay, Antigua, was set on fire by the electric fluid, 
and completely reduced to ashes, and several houses in the yi-> 
cinity were struck by it, and received a severe shock, but not 
having materials so combustible internally, sustained very little 
damage. 

An Account of the Number daily attacked mth Fever, and the daU 

thereof. 



Datr. — No. 



September 6 
. 7 

13 

15 

17 

18 

19 

20 

r- 21 



1 
1 
2 
1 
1 
4 
3 
2 
4 

19 i 



l>al€-. 



September 22 

23 

24 

25 

26 

— ^ 27 

28 

SO 

October 2 



No. 



35 



^Dmle. 



October 



6 
11 
12 
13 
15 
16 
18 
21 
22 



No. 



11= 65 



A short History of the Fever as it appeared in the Niobe, at 
English Harbota^, Antigua. 

In most respects it resembled the fever as it appeared in the 
Raven $ but, as it difiered a little from it in some of its symp- 
toms, and although it may be attended with several repetitionSf 
it may perhaps be worth while to give an accoun^ of its symp* 
toms as they appeared in thi": epidemic. It commonly com- 
menced with alternate chills and beats, or a sensation of chilli* 
neis, though tlie skin felt when touched by another person pre- 
tematurally warm j and sometimes with cold shiverings, sue* 
ceeded by preternatural heat, exactly resembling the paroxysm 
of an intermittent fever, excepting the absence of the sweating 
stage. These incipient symptoms were frequently wanting f 
but it was always attended with vertigo, often to such a degree 
as to cause the patients to fall down suddenly, and apparently 
without any previous indisposition ; and, generally, with vio- 
lent headacb, (the pain particularly referred to the eyeballs, su- 
pejTciiiary processes, foreoead, and temples) ; a stifiness and ob- 
tuse pain about the nape of the neck^ and distressing pains in 
the back, loins, and extremities, resembling acute rheumatism, 

TOL. auii. NO. 50. M 



IM Mr Oomm m Oe April 

nnd die pftiiit in die lumbftr regbn vibntmg, en eech wide» as 
far as the linea alba^ and as it were mingling with one another 
there. It was ako attended with pains in the thorax and flbdo»> 
jpeo, increased upon respiration ; and in the abdomen, tQcreaMd 
upon being^ touched, often to such a degree^ thai ike patiesi 
i^ricd out it I did not lay my hand very gendy upon the abd»* 
men 9 when examining, or by accident, (particularly upon the 
epigastric region.) There was usually much anxiety about the 
pnecordia and hypochondriac regions, accompanied with much 
thirst, nausea, and a very disagreeable bitter taste in the mouth ; 
and always vomiting when the abdomen was tender upon being 
touched. It was very often accompanied with despondency or 
hypochondriasis, sometimes with furious and wild delirium* af- 
terwards succeeded by coma and coldness of the extremities* 
In some cases the-e was only vertigo and slight headacb, with 
some anxiety about the praecordia, accompanied with increased 
heat of skin and frequency of pulse, but not always. Puke, in 
general, above 100, or 1S20, full and somewhat hard ; sometime^ 
above 130, or ISO, small and weak ; but after venesection from 
a large oriBce, and in large quantity, full, strong, and vibrating^ 
Tongue of a dirty yellow colour ; often clean, but red or white | 
sometimes dry, and furred, and occasionally moist Face flush^ 
ed. Eyes suffused and watery, or of a shining glossy appear^ 
ance* Bowels obstinately constipated ; but sometimes, though 
rarely, there was frequent purging and vomitiug of a greeniah 
or yellowish substance, resembling cholera morbus. 

The treatment adopted at the commencement, was to have re- 
course tolarge and copious bleedings; sometimes above 100 ounces 
in the space of twelve hours, and repeated until the urgent symp- 
toms were removed, such as headach, pain in the thorax and 
abrlomen, heat of skin, &c. The first bleeding was generally to 
the amount of 60 ounces or more, and was always continued 
undi syncope was induced. The patient was, for the most part^ 
placed in the recumbent posture $ and, when vomiting came on^ 
more blood generally could be extracted, though syncope had 
been previously produced. When there was much pulsation of 
die carotid and temporal arteries, and consequently a great de- 
termination of blood to the head, the head was shaved and kept 
continually wet with cold saturnine lotions j and the temporai 
artery was opened, which generally bled very freely. When 
the skin continued preternaturally warm, even after venesection, 
(which sometimes nappened), or even if it was not below the 
natural temperature, tne cold allusion was repeataily applied^ 
and with evident advantage. About two or Uiree hours after 

4 



t«lV. Ardent Fever of the We$t Indies. Iff 

vmesection. (proYided the stomach could retain th6m)i lam 
dotes of calomel and jalap were giveoi and repeated until ih« 
bowels were freely evacuated: in general 3i. of calooieli and 
38S. pulv. jalap i the calomel in the form of a bolus, and the 
puly. jalap' made into a drau({ht| with the 9q« menth. piperit* 
Whenever the mouth became the least tender, small doses, fr^ 
quently repeated, of the sulph. magnes. dissolved in the a(j. 
menth. piperit. were given* and gargles, composed of alum and 
other astringent substances, were very often used. After vene- 
section the bowels were generally freely evacuated spontaneous* 
fy, thouj^ previously obstinately constipated, and ho cathartic 
medidne woaid operate. 

In some protracted cases of fever, which were very evidently 
combined with symptoms of gastritis and enteritiSp enemata 
cathartica were very often used 1 warm fomentations, and ihe 
warm bath were frequently applied; and afterwards blisters^ 
still having recourse to venesections though not so very freely 
as at the commencement. 

If nausea and vomiting coBtinued for any length of time, thd 
carbonate of ammonia was made into an effervescent draughty 
aiid taken in effervescence every two or three hours. Whea 
the extremities were cold, warm fomentations were frequently 
applied, and warm bricks or stones to ihe plantss pedum. 

When there was much debilifv after the fever Was nearlj 
subdued, (which seldom happened}, the camphui^ted mixture^ 
combined with the carbonate of magnesias Was given every 
three hours. 

These latter symptoms very tfeldont occurred in a very violeni 
degree^ provided timely application was made, and the proper 
steps taken to check the progress of the fever. 

When the disease began with violent svmptoms, the patieni 
always complained immediately j but the disease often begins in 
a very insidious manner, sometimes scarcely any perceptible 
symptoms of fever appearing at the beginning. In these cases, 
the patients are frequently tuhamed to complain 1 and then, and 
ibeo onlyi it is iKMnetimei neglected in the beginning. But, I 
believe, tb^ dtseaie may generally be disoovered by the patient's 
dfdl and languid appearance, aiid by pressing upon the abdOb 
metL In msm oases, I have sttnelimes seen the fever assume ita 
rupilar type and forms by taking away quickly 60 or 70 ounosi 
Oiblood from a Very lAtge orifice. 

The captain and most of the oficers, all the warrant-oflfeer% 
md almost all the midshipmen, and others that are included ia 
tibia t«port» were severely attacked with this ftveri and, by 
^wwiiiig /%orooily the ftbova pfaui of treatment! they all ra^ 



1731 JAr Comrle tm ihe ^ Aprft 

covered very rapidly ; and all the men that were sent to the 
hospital at Antigua have returned, and are now in perfect 
health and spirits. 

*' .In shorty 1 have never observed debility produced by large 
and copious venesections, when urgent ^symptoms indicated 
them i buty on the contrary, strength and increased vigour* 
//. At. S. Nicbey Barbadoes^ DecewAtr \st^ 18 IS, 

111. Second Fever of the Niohe. 

Very few cases of fever appeared on board since September 
last, (though we were previously some time in English Har- 
bour), until about the period of our sailing from Barbadoes for 
Bermuda, on the evening of the 14th of December, with the 
officers and non-commissioned officers of the Ist West India 
regiment. But, immediate^ afler we went to sea, the most se- 
vere concentrated type of fever that I ever saw made its appear- 
ance. It is probable that several were indisposed for some time 
previous to their making application, as some of them had can- 
dour to confess so to me ; and the reason they assigned for their 
neglect was, that they were afraid of being sent to the hospital^ 
and, on that account, not be able to get home so soon ; as thej 
knew the Niobe was to proceed from Bermuda to England. 

As I have frequently observed some change of weather, and 
particularly the wind changing its usual direction considerably, 
previously to fever appearing as an epidemic in the West Indies, 
it may, perhaps, be of some use to give a brief account, in the 
form of a journal, of the state of the weather, during the time 
we were in Carlisle Bay, Barbadoes, and until the fever disi^ 
peared. I shall then give the number that were daily attacked 
with this disease ; and, lastly, a short outline of the fever, and 
the method of cure adopted. 



A Journal of the Weathbr« 
. Nov. 28th, arrived at Carlisle Bay from Antigua, where we 
were previously for about ten days. Moderate breezes and fine 
weather. Wind K N. £. Nov. 29th, A. M. moderate, &c. 
Wind £. S. K and N. E. At noon, fresh, and fine weather. 
P. M. fresh breezes and fine, but at 8 P. M., constant rain, which 
continued, with very little intermission, during the night. Wind 
E. N. E., S. E. and S. S. E. Nov. SOth, A. M. moderate 
breezes, accompanied with rain. At 10 A. M; fair weathen 
Wind E. S. £. Dec. 1st, moderate breezes and fine. Wind 
K E., and £. N. E. Dec 2d^ A. M. moderate and fine 
'weather. .Wind at first variaUe, then cahn. P. M. wind 



1617. Ardent Fa^errf the md Indies. ITf 

W.N. W, Dec. 8d, moderate, &c. WindE.N.E. D^. 4ith» 
moderate, ficc. Wind at first variable, then N. £. Dec«.5tb^* 
light airs and fine. A. M. wind N. E. P. M. variable; 
Dec. 6tb> moderate, &c. A^ M. wind variable, P. M. N. £^ 
Dec- 7th and 8th, moderate, &c. Wind N. E. Dec. 9tbi, 
moderate, &c. A. M. wind N. E. P. M. W. N. W. atid 
N. E. Dec. 10th, modtrrate, &c Wind E. N. E. lUh, 
moderate, &c. Wind S. E. Dec. 12th, moderate, &c. Wind 
S. S. E. Dec iStb, A. M. moderate and cloudy. At nboa 
squally. P. M. fresh breezes, and squally, accompanied » with 
rain. Wind, A. M., S. S. E. and & W. P. M. & by IL 
and variable. Dec. 14th, A. M. light aira and cloudy.. .At 
8 A. M. moderate, &c. Wind early in the morning variable^ 
afterwards S. E. by E. and S. E. by S4. S. P. M., S. E. by SJ S. 
variable, and afterwards east. At 5 P. M. made sail for Bermuda. 
15th, A. M. light airs and cloudy, accompanied with lightning. 
P. M. light airs and fair weather, and occasionally caun. At 
midniffht, moderate, Su;. A. M. wind east. P. M., E. by S^ 
variable, and at 7 P. M. northerly, and continued so during 
the night Latitude at noon i)i° 46' N. i6th, A. M. moderate 
and cloudy. At noon squallv, accompanied with rain. P. M« 
squally, accompanied with heavy rain, afterwards moderate 
breezes, with rain. At midnight light airs and fair. A. M. 
wind north, N. E. by N. N. E. and variable: P. M., N. by W. 
and afterwards calm and variable alternately. 17th, A. M^ 
light airs and cloudy. P. M. light airs and variable, att^ided 
with rain, and afterwards calm and cloudy. At midnight 
moderate and fine weather. A. M. wind variable, E. by N. 
and at 4r A. M. east. P. M. wind variable, N. W. by W. 
calm, variable, E. N. E. and E. by & Latitude 15° V N. 
Dec. iSth, A. M. moderate and fine, afterwards calm and cloudy. 
At noon calm and fine, afterwards lisht airs and cloudy. 
A. M. wind east, calm and variable, r. M. calra» and oc- 
casionally variable, then E. by N. Latitude 15° %2' N. ; Ion* 
gitude 60° 41' W. 19tb, A. M. light airs and cloudy. At 
8 A. M. moderate and fine, and continued so during the d^t 
A. M. wind E. by N. variable, and N. E. by N. P. M., N. E. 
by E. Latitude 16° V N. j longitude 60° 45' W. 20th, 
moderate and fine. A. M. wind variable, and occasionally 
N. E. by N. LaUtude 17* 08' N.j longitude 61° 35' W. 
21st, A. M. fresh breezes and cloudy, but occasionally clear. 
P. M. at first moderate and fine, then fresh breezes with squalls 
occasionally. A. M. wind N. E. variable, and N. K by £• 
P. M., N. E. by N. Latitude 18^ 20' N. j longitude 68° 45. 
W. 22d, A. M. fresh breezes and squally, moderate and 



174 MfComrieafflXr April 

dondyt and modeiPBte and fine tltermtely. A. M . wttid K. E. 
1^ N. and variable. P. M., E. N. K and N. E. by E. Lati- 
tude 19^ SO" N. ; longitude 63^ 16' W. 2S(], A. M. fresh breexea 
Mid cloody. At noon moderate and cloudy. P. M. light aira. 
At £ 90 P. M. squally. At midnight fresh breezes and cloudy. 
Wind N. E. by £. Latitude 2P 02' N. ; longitude 63^ 3^ 
W. 84tby A. M. fresh breezes and cloudy, at 8 A. M. moderate 
And fine. P. M. light breezes and fine. A. M. wind N. E. 
by £. and E. by & P. M., £• by N. and inclhable to be calm. 
Latitude 88« 84' N { longitude QA"* SST W. 85th, light airs 
and fine. At midnight cloudy. A. M. wind £. by K. calm, 
and again E. b; N. P. M., E. bv 8. LatHnde i»' 14" N. ; 
longitude 65^ 58' W. S6th, Hght breezes and fine. At 8 
P. M. moderate and cloudy. A. M. wind W. S. W. P. M. 
variable. Latitude 9S^ 6V N ; longitude •«* 1»' W. 87th, 
A. M. light winds and variable^ at 4 rainy, at 8 moderate and 
cloudy. P. M. light breezes and fine, then cahi», and after^ 
wards squalhr. At 4 moderate and cloydy, A. M. wind Tari- 
d>le. P. M.9 E. by N. calm, west, and variable from 5 P. M. 
Latitude 84^' 58' N. ; . longitude 06"* 48^ W. 88th, A. M. 
light breezes and cloudy. At 8h. 45m. squally, at 4 fresh 
breezes and cloody. At B fresh and fine. Wind Tariabie and 
north occasionalh^. Latitude 85'^ 53' N. ; longitude 66^ AST W. 
20th, moderate and cloody, and moderate and fine alternately. La- 
titude 86« 47' N. ( longitude 66* Oy W. 90th, A. M. mode- 
rate and cloudy. At 8 fresh and squally. At noon fresh and 
fine. Latitude 29^ 09' N. $ longitude 67^ 45" W. 31st, 
moderate bveezea, and occaaionftlly cloudj, attended with severe 
aqualia. Latitude SI"" 88' N. ; longitude G?"" 10' W. Januaiy 
Ist, IB16, firesh breezes and squalty, accompanied with much 
zmin. Latitude 38^ Oy N. ) longitude 65<> 33' W. Jan. 8d, 
firesh breezes and cloudy, but occasionally moderate and fine. 
Latitude 3P 59' N.} longitude 64^ 39' W. 9d, frerii 
breezes and squally. At noon arrived at Bermuda. Jan. 15th^ 
at 1 1 A. M* sailed for England, with 76 marinea (officers in* 
duded) for a passage home, and arrived there on the 9tb of 
Februaiy 1816t 

On reading over the above journal, it would appear that the 
wind wasoocasionaliy diametrically opposite to its usual direction, 
and was southerly when the disease was most prevalent. We 
ought likewise to recollect, that, previously, for some time, the 
vreather had been more rainy than usual. 

Does a considerable change of wind, attended with variable 
weatheTi in tropical eUmatesj any way contribute to produce the 



MI7«* 



Ardeni Fm»r of the Wnt Iniies. 



17S 



miflMUla tk*l are sapposed to be cne of the xemote caasei of 
thie disease? 

And, do die southerly winds« blowing from the lend, carrj 
ihem on board ships lying at anchor ? , 

Or, is the great evaporation that happens after much rain of 
fltijr e&ciiji producing the disease ? 

An Accmni of the Nrntber daily attacked with Fever^ and the 
date thereof. 



Date 1815. 



NoTember 



December 



No. 



Date 1815. 



1 II December 17 

19 
20 
21 
22 
24 
25 
26 
28 
1 
10 




1816. Jan. 



No. 



22 



Total 52. 



A Short History of the Fever ^ and the Method of Cure adopted* 
This fever, 1 think, may be divided into three stages. 
The first stage generally commences with chills and heats, al- 
temately^ horripilatio, accompanied with violent headach, and 
vertigo, sometimes to such a degree, as to cause the patients to 
MI (K)wn suddenly senseless, without any previous indisposition* 
These symptoms are soon afterwards succeeded by delirium, wild 
and furious, very hot skin, frequent pulse, and very much thirst. 
At other times it commences with cold shiverings, which I have 
seen continue above twenty-four hours, (and perhaps they 
would continue much longer if not checked), with other symp« 
tomS) as they are described in the former reports. Pulse and 
skin frequently almost natural, but generally the pulse is above ^ 
100, somewhat hard and full ; sometimes above 150, full, strong, 
and vibrating, but generaJlv small and weak ; tongue, face, and 
boweiss as formerly described ; eyes suffused, wild, prominent, 
and as if they were going to dart out of their sockets, and vefy 
inipatieiit of light ; Itequently of a shining glossy appearance. 



176 Mr Comrie on ihi AptH 

The second stage commonly commences about the second or 
third day, if the disease has not been checked by very powerful 
evacuations. 

This stage is characterized by vertigo, and headach very deep 
seated, great restlessness, or constant pervigilium, anxiety about 
the praecordia and hypochondriac regions, and constant pain in 
the abdomen, increased upon the least pressure ; frequent vo- 
miting of a greenish or yellow substance ; much thirst; a very 
bitter taste in the mouth ; and great oppression of strength ; 
pulse sometimes ahnost^ natural, at other times very frequent, 
weak, and oppressed, almost impossible to count its pulsations ; 
face sometimes flushed, and then there is great pulsation of the 
carotid and temporal arteries ; eyes of a shining glossy appear- 
ance ; heat of skin generally little increased ; bowels obstinately 
constipated, but, when moved, the fseccs excoriate the anus and 
its vicinity. Sometimes, in Uiis stage, the paUent is affected 
with coma ; is insensible of surrounding objects, and does not 
know his former associates, and others that he formerly was ac- 
customed to recollect ; tosses and picks very often the bed-clothes ; 
imagines he sees various black spots upon them, and various 
frightful appearances or ^ectres around him. At other times 
he is apparently pretty well, and answers distinctly questions put 
to him, but wavers occasionally if he talks much ; talks inco- 
herently, and always says that he is very well, if asked concerning 
his health $ but his countenance is very wild, and expressive S 
great distress ; and he complains very much if the abdomen be 
gently pressed upon, and now and then of pain in the thorax* 
increased upon respiration* Towards evening there is general- 
ly a considerable exacerbation, accompanied with increased de- 
lirium, and occasionally singultus $ and, during the night, the 
patient often gets out of his bed before his attendants are aware 
of his intention, but fails down instantly senseless, like a corpse. 
Sometimes he rises out of his hammock, and turns in again with 
apparent ease. He is occasionally very much harassed with 
distressing pains in the lumbar regions, and extremities. Last- 
ly, the tunica conjunctiva oculorum appears of a yellow colour, 
which soon extends all over the body. 

The third and last stage of the disease. — In this stage the skin 
is covered with a dark yellow suffusion, and a great many large 
black blotches, particularly upon the breast and back ; the ex- 
tremities become cold $ the skin is covered with a cold daromy 
sweat ; the abdomen becomes excessively painful upon the least 
pressure^ accompanied with ahnost constant vomiting of a dark 
jellow-coloured matter, and sometimes pure blo^ in lafge 
quantities. Sometimes the patient wHl answer distinctly qaes- 



IBIV. Ardent Fetter of the Wist Indies. 177 

tioiis pot to loin, and is not a£fected with deUriam \ bat, in most 
caacBy towards evening, he is affected with constant deliriuniy 
sncc^ded by coma ; talks and mutters very incoherently ; picks 
and tosses the bed-clothes ; does not answer distinctly questions 
put to him, but talks of something else ; for the most part he 
will give no answer at ail. The features shrink ; the counte- 
nance assumes a cadaverous appearance $ the eyes appear as if 
Bonk in their orbiu $ the teeth, gums, and lips are covered, 
fint with a brown, afterwards with a black crust ; and a disa- 
greeable smell is exhaled from the body. Lastly, the pulse 
sinks, then singultus, tremors, subsultun tendinum, and laborious 
breathing, succeed. No pulsation is perceptible ; the breathing 
gradually becomes more laborious and noisy ; and death termi- 
nates the scene. 

Tie method of cure adapted. — In the first stage of the disease 
laree and repeated bleedings were instantly had recourse to^ 
and strong cathartic medicines repeatedly given, until the bowels' 
were freely evacuated. The bleeding was always continued un- 
til the urgent symptoms were considerably alleviated, to effect 
whid) frequently required the abstraction of 60 or 70 ounces 
of biood at one bleeding ; and, in plethoric habits, even more* 
The more severe the symptoms were, so much the more blood 
could with facility be extracted without producing syncope. 
The venesections generally induced syncope, vomiting, and 
occasionally free evacuation of the boweU, though previously 
obstinately constipated, and no cathartic medicines could move 
-them. As soon as the irritation of the stomach, caused by the 
bleeding, snbsided, which generally happened in the course of 
one or two hours, a strong cathartic of calomel and jalap was 
given. In the evening, and in some cases in the middle of tHb 
day, if headach, beat of skin, and other symptoms of reaction 
returned, the venesection and cathartic were repeated, and v^ry 
often 40 or 50 ounces more of blood could be extracted before 
fiaiinting came on'; but the bleeding was always continued until 
syncope was induced, and no more blood could be extracted. 
Jjuring the interval betwixt the bleedings, whenever the skin 
continued pretematurally warm, the cold a£fusion was now and 
then used, and the skm frequently sponged with cold water, 
whenever there was much pain. When cold shiverings conti- 
nued for any length of time, (as often happened), the patient 
was immediately put into the warm bath, which soon put an 
end to the cold fit, and bled while in the bath. On the second 
day, if there was great determination to the head, evinced by a 
deep seated headach, and great pulsation of the carotid and 
temporal arteries^ accompanied with delirinm, the head was 



17$ MrCotttieMAtf JLfirfl 

tbayedf and kept oomtaiitly wet with cohi aatonn&a IdtioMN and 
blood taken firon the toiaporal artery occnionaUj^ Int maaat 
commonly from the arm. In short, the bkediog nba had t^ 
course to as long as any considerable rsactien coniinaed^ so 
that* in the course of three or four days, above 250 ounces c£ 
Uood have been taken away^ and always with snecesSf vim tim^' 
fy application was made, * 

in the second stase, when coma aopervened, and the akia 
had become of nearly the natural temperature, a km blister 
was applied to the nape of the neck, and oocasionaSy to the 
crown of the head, and blood abstracted from the temporal ar» 
teiy. When there were symptoms of gastritis and enteritis, 
evinced by distressing pain, very much increased apon touching 
the epigastric region and other parts of the abdomtn, acooBt* 
panied with almost constant vomitings and a very small, fre- 
quent, and oppressed pulse, bleeding was still had reoMirse to, 
* uuM^ not so larsely as at the commencement, betwixt 10 and 
16 ounces being Uien the usual quantity ; the warm bath and 
eoemata cathartica were very often used i the carbonas nmmonise 
was made into an effervescent draught, and taken in the apt of 
a&rvescence, every second or third hour, to prevent vomitira i 
a very large blister was applied to the upper part of the aboo- 
men, and the bowds were daily moved by the milder cathartics^ 
such as oL ricini \ and about ID grains of calomel were given 
three or four times a day, ao as to afEsct the mouth and eva- 
cuate the bowek ^ the same time. Whenever the mouth be* 
came in the least tender, small doses of the sulphas magnesis 
or sodas, dissolved in the aq. menth. piperit. were very ofien 
^ven, and astringent gargles of alum very frequently used. 
* In the third stage, when singultus was very troubleaomc^ 
ssther suiphuricus, to the amount of 30 or 4?0 drops akme, or 
combined with the mist camphorat« I thought to be somctimea 
of a little service. 

Wiien the pulse began to sink, stimulants of various kinds 
were had recourse to, such as winei and sometimes even ardent 
spirits ; but nothing generally sucoeeded. 

I am happy to say that I never saw the disease in its third 
9ttafg^ provided timely applieaiion was made at the cmnmemement^ 



* Th« Uood that was A tt r acted was nmmutdf m every cass^ with oas of 
the «picting«{>ott previoiulv correctly meaiured; and no allawaocc is mads for 
what was spitty or for wnat came away during the time the vessel was belsg 
emptied. The blood waa measured through cariosity merely, for it was dfr- 
wacted, uadt uvjent tjmjfkmm were raioyed^ aid sot in cmdn meaeofei 



ml Jlrdeta Ptm 6f the Wtk India. 19» 

and the pnjper stepi taken to cbeck iU progress i unless, indeed^ 
there was somelbiDg peculiarly uniavourable in the eonatiuitba 
of the patient 

When the disease terminated favourably, particularly in thoit 
cases where the abdominal viscera were affected, I bave seea^ 
after venesection, the pulse become most remarkably full and 
frequent, but very soft $ at first gener»liy about i20 or more, 
then about 93« and afterwards gradually regular. * 

Sovie of the 1st West India regiment, on our passage to Ber* 
muda, were affected with this disease, and one of them, who is 
not included in this report, died on board. When I sow him^ 
the disease was in its third stage ; he was attended by the medi^ 
cal offieef s of the regimcot. The previous treatment 1 am not 
Mqoainted with, only the evacuant plan was not pursued, 1m 
not having applied in time. 

1 have been the more particular in the history of this diseasa^ 
(ardent fever), as it is almost the only one of consequence that I 
snw while I was on the West India station, and a disease I have 
several time* been severely attacked with. 

On the 2Sd of November last, at Antigua, I had a severe at- 
tack of this disease, and by the assistance of my friend Mr 
Espie^ surgeon of his Majesty's sloop Diisber, the fever was 
oompletety subdued by venesection, but I nearly had a relapse 
during its prevalence on our passage to Bermuda. 

On our passage to Bermuda, the captain and ataiost aH the 
eficevs, and most erf" the midshipmen, were again severely at- 
tacked with this diasQse ; but by timely application they all ra- 
coveied, and are now in perfect health. 

Although the small proportional mortality that took place isi 
the last fever of the Niobe, cannot be considered as detracting 
firom the value o( any particular practice had recourse to in a 
eevere eptdeasic ; yet I am anxious that it should be understood 
that, ia the fatal cases, venesection ha4i not so full and favouf- 
able a chance of doing good as in almost all the other 
where it was employed. 

* On this account 1 subjoin a short notice of each of the ( 
that terminated fatally. 



* This itatt 'of the pukt^ when it wu observed, cams on about 13 or 14 
iKiori tftcr all bleeding wm laid aside, and was always a favourable symptoms 
but when I felt it firet* I was nearly deceived by it, and was going to abstract 
more blood, which I think would have done much harm. ) desired on the 
patient memianiug that he had no pahi, and upon petcefrmgthatJte had retMd 
Weill and had a plesMmt csuatcaaiictw 



180 Mr Comxie an the April 

NoUs oj the Sup Fatal Cases. 

Cas£ I. — ^JoHN Herrop, ffitatis Si, of rather a spare habit and 
dark complexion. Had a severe attack of fever formerly. Was ill 
two days without complaining. First seen on 1 1 th December. 
Evacuations were freely used after he applied, but without 
effect, and he sunk on the ISth at midnight. 

This man's case was remarkable as being unaccompanied 
with the delirium, dark-coloured vomiting, and yellowness of 
Burfece, which were constant symptoms in all the other fatal 
cases. 

Case IL — Robert Williams, astatisSO, of a sallow complex- 
ion, stQUt made, and somewhat plethoric ; had been severely at- 
tacked with the 1st endemic that appeared in the Niobe,andsent 
to the royal naval hospital at Anti^oa. This time he was in- 
disposed for some time previously without making application, 
until the I4th December, in the evening, when I round him 
affected with the usual symptoms of pyrexia. In this case, 
after application, the antiphlogistic regimen was most strictly 
used; but all efforts were unavailing, and he expired on the 
19th December, at 7h. 50m. P. M. 

Cask IIL — ^Joun Jomes, aetatis 28, very stout made, about six 
feet in stature, and stout in propoition, of a dark complexion, 
and somewhat plethoric. Was indisposed one whole day, without 
making application ; but had not been previously sick since I join- 
ed the ship. Complained, on the 15th December, of the usual 
symptoms of fever. With very greatj)ersuasion I prevailed upon 
him to allow me to detract only about 32 ounces of blood, and he 
would not afterwards consent to let any more be taken away ( 
and at that time I was very much occupied, and had not time 
to use much persuasion in order to induce him to submit, as I 
had others to attend to, who allowed themselves to be treated as 
I thought proper. He expired on the 19th December, at mid- 
night Some days before death he vomited a vast quantity of 
blood. 

Case IV.— Joseph Hurst, aetatis 28, very much emaciated, 
and addicted to intemperance. Was severely attacked with the 
first endemic that appeared in the Niobe, and sent to the royal 
naval hospital at Antigua, where his life was for some time despair- 
ed of. Was attacked on the 15th December with fever, accompani- 
ed witli delirium. I only detracted about 20 ounces of blood at the 
commencement, and was afraid to take any more away, dread- 
ing he would sink under the operation, and the remedy be dis- 
f raced, and thereby others be deterred from submitting to it* 
le expired on the 19th December, at 9h. SOm. P. M. 

5 



isii. 



Ardent Feoer rfihe Wed IntUet. 



181 



Case V. — Johk Taylor, statis 23, stout, red-haired, and ple- 
thoric. Was attacked, on the 1 5th December, with the usual symp- 
toms of pyrexia. He was attended by the assistant-surgeon of 
the 1st West India regiment ; but evacuations were not so freely 
used as I directed, and through fatigue and indisposition I was 
not able to attend him and some others as I would have wished. 
He died on the 2Sd December, at 9h. 30m. P. M. dreadfully 
delirious. 

Case VI. — Bartholomew Rodoers, statis 44, stout mada^ 
red-haired, and somewhat plethoric, and had been a long time 
previously in the West Indies. He was attacked with the first en- 
demic that appeared in the Niobe, and sent to the royal naval hos- 
pital at Antigua, where his life was sometime despaired of. Had 
been indisposed for two or three days before I was informed 
thereof. December 16, when I first saw him, he was con- 
fined to his hammock in the lower deck, with symptoms ci 
a severe fever. Though evacuations were pretty freely used^ he 
expired on the 18th December, at 7h. 40m. A. M. 

H. M. S. Kiobf^ March 1816. 

TABLE showing the number of cases of West India Fever 
treated by Ah- Comrie, and the result of his treatment 



Epidemic of the Raven. 


No-ofCMCt. 


No.ofD<»«tbs. 




P«ffectR«co- 

Tciict. 


55 







55 


- 


First Epidemic of the Niobe. 




65 







65 




Second Epidemic of the Niobe. 




52 


6 




46 


Total 172 


6 




166 



Its Mr StewMt'n CMt ofB^argment ^tbe Heart. Api? 



in. 

Ca$eof Enlargement of the Heart with PofypiyJS^. which occurred 
^m bourd the Houow able Eu%t India Company s SJiip Camatic* 
By James Stkwart, Surgeon. 



M' 



[AT 5th, 1816, WauAM CoopBKi seaman, aged 90, mid- 
^ die stature, peculiarly full, broad cbest, fair cumplexioni 
aftd plethoric habit of body ( Mnce leaving Bengal, about thret 
Vionihs ago, has not enjoyed his usual slate of Iiealth | appetita 
being variable, and a dull pain, or rather sensation of weighl 
mider the ribs of his left side, frequently anno}'ing him. These 
oonplaints were, however, so trifling, as not to prevent him 
lirom doing his usual duty. A lew days ago, he was very 8ud# 
deiily attacked with a severe pain in the Ml hypochondriumi 
which was nearly removed by the operation of a smart pur^ 
gative, followed by a di.iphoretic. This morning it has f^n 
returned with increased severity, and now extends to the front 
of the left shoulder { not increased on pressure i pulse not aa« 
oelevated, but full and strong $ tongue furred brown $ consider- 
aUe thirst i countenance pale, and features shrunk. 

Capt. calomel gr. viii. pulv. jalap. 3ss. misce et applicat emplas. 
YfUm part, dolent 

Maj 6th. After the operation of the puigatiTe and blister, 
the state of hb tongue improved considerably, and the pain al- 
ittost ceased. 

Last night again, a severe exacerbation suddenly took place, 
and neafly as suddenly ceased, about seven hours afterwards. 
During the paroxysm, a draught of tinct. opii, and mther 
salphun was given him without any beneficial result. The 
situation or the pain had, however, now changed to the region 
of the heart ; no pyrexia ; geDeral health little affbcted ; pulse 
to-day 88, fun and sudden, but perfectly regular. Detrahat. 
eangub ad ^^^xiv. 

Hay 7th« — Nearly free from pain all yesterday. During Ihe 
nig^t a smart exacerbation again occurred, and situated im- 
medtatriv over the region of the heart ; sympathetic afl^tion 
of his shoulder annoyed him much { cannot now lie on bis left 
side, and feeh most easy when leaning forwards, or lying on 
his breast with his arms extended, so as to enlarge the cavity of 
the thorax. During the attack of last night, his countenance 
was pale, and features shrunk, with increase of thint^ and finil* 



]Bi7. Mf Slftwii^s Cm ^ Enbxrgement of the Hmrt; 183 



of (bongue, but scarcely «Dy change in the t9Qipei«t«UB of 
bis skills or state of bis pulse. 

Habt Stat, ext colocyntb. comp. et calomel aa. gr. vii* et repet. 
V, & ad 5xvi, 

May lltb. — Scarcely any pain in his arm since last report, 
but bis shoulder has been extremely uneasy with a sensatioii <^ 
numbness, extending nearly to his fingers ; be has been using 
stimulating anodyne linimenti without rdief; tongue moi^ 
fiml; qpirks unusually depressed; pulse 80, soft and regular | 
gave him yesterday seven grains of pilul bydrarg. wbicS pro* 
cured three easy evacuations. Repet piluL bydrarg. et contt 
liniment. anodyn« 

May 12tb. — ^Yesterday evening, had a slight increase of pain 
in his breast, with a most tormenting uneasiness in his shoulder 
and arm. Pulse was S6, more soft and natural than usual 
Countasance and spirits ware much depressed ; foulness of 
tongue and thirst inereased. Gave him gr. vi. calomel, and gf . vw 
pulv* scammon. ; which soon excited vomiting, about an hone 
after which, the medicine beginning to operate, he went upon 
deck, where he dropped down and expired without a strogsrle. 

S^ciio Ca^btvri^.— Upon opening the thorax, observed the 
pericardium prominent, and occupying a much larger space 
than natural ; its cavity was found to contain about fineen 
ounces of serum, with two ounces of coagulated venous blood, 
discharged from some of the small vessels on the surface of the 
heart, all of which were peculiarly enlarged and turgid. The 
heart itself was prctematurally large, weighing at least 2^ 
pounds. A small surface over the left ventricle, showed marks 
of slight superficial inflammation having existed, and around 
the exit of the aorta from the heart, an effusion of blood into 
the cellular substance, to the extent of about half of an inch, had 
taken place. On examining the interior of the heart, the size 
of the cavities, columnar carneae, &c. corresponded with its eoc- 
temal magnitude. The right auricle, right and left ventricles^ 
contained each a large pohrpus, attached by three or four pe- 
dicles. The one in the right auricle weighed upwards of an 
onnce, the others about an ounce each. They were of a pale 
red colour, a solid firm consistence, and when cut into, pre* 
aented a highly vascular and organized appearance, so that np 
doubt remained, or yet remains, on my mind, as well as th^ 
mind of another medical gentleman present, that tluy must fiavf 
0;pUted a considerable time previous to death* The one in the 
nuricle was lying against the mouths of the cavae, and conse« 
quently opposed to the course of circulation. That in the right 
ventridcy of an oblong shape, was carried by the current of blood 



184 Mr Stewards Cose of EtUargement of tie Heart. April 

into tbe pulmonary artery ; the other was firmly bqnnd down 
in the left ventricle by its pedicles. No other morbid appear^ 
ance presented itself in the thorax. In the eonients of the ab- 
domen, nothing peculiar was observed. 

This case I have wished to make known to the public as pre- 
senting some symptoms which I conceive worthy of particular 
notice $ and also as a case of polypi, which, from their vascu« 
larity and perfect organization, must have existed for a consid^- 
able time previous to death. From the seat of tbe pain in the 
left hypochondrium, when he first applied for assistance, I con« 
eelved his complaints to arise from some visceral obstructiony 
the consequence of service in tropical climates. Its removal 
shortly afterwards to the region of the heart, and especially the 
occurrence of the sympathetic affection of the ]eft shoulder and 
arm, soon excited suspicion that the ieart was the seat of his 
disease ; still, however, the pulse remaining at all times perfectly 
regular, and being seldom if ever accelerated, led to some obn 
scurity with respect to the nature of his complaints, and doubt 
how to proceed in the treatment. 

Lame, County Atiirhn^ Dicember iOth^ 1816. 



IV. 

Case of Pnetimonia^ mtJi Observations on the practice of Bloods 
letting in that Diseate. By William Gibnet, M. D. As- 
sistant Surgeon l5th King^s Hussars* 

T^ovKMBER 25th. — Hugh Evams, private 1 5th Hussars, aet. 
-■-^ 25 ; sanguineous tem{>erament. This man has been these 
three or four days labouring under feverish symptoms, without 
reporting himself. Last night he became worse, being attacked 
with frcouent cough, rigors, and hcadach; At present he has 
slight pain at the scrobiculus cordis, somewhat increased on in- 
spiring, each inspiration being succeeded by coughing. His 
cough is unattended by expectoration, and is aggravated towards 
night I he has slight nausea and headach, which he attributes 
to the cough ; his throat is somewhat sore, and he is a little 
hoarse'; he lies well in any position, but with greater ease on 
the right side. Pulse 96, not full or strong ; bowels costive ; 
skin hot ; face much flushed* He thinks his complaint arises 
from cold. 



1817. Dr Oibney^s Case of Pneumonia^ Sfc. 185 

V. a ad gxxxv. 

T^ Extract, colocynth. comp. gr. x. 
Calomelanos, gr. x. 
Ft. pHulas ii. statim sumendas. 
Pain relieved by the bleeding) which was followed by partial 
mioope, sickness at 8tomach» and frequent yawning $ headach 
diminished ; at present inclined to perspire. 

26th. — Slept tolerably weU| yet has still slight pain on in- 
citing ; cough rather looser ; skin still hot, and face flushed ; 
sweatal a gooid deal ; three stools ; pulse 90, and stronger than 
last ni^t ; hoarseness considerably diminished. 
V. S. ad animi deliquium. 
Fall 47 ounces of blood were drawn without producing faint- 
^iig> y^t the pulse sunk to 80, and became very feeble. Imme- 
diately after he expressed himself considerably relieved, although 
very sick at stomach, in the evening he was still better, with 
no pain, and but slight cough ; perspired a good deal. Blood 
slightly buffed. 

Habeat pulv. antimonialisi gr. iv. h. s. 
27th.— Still better; copious expectoration ; no pain"of chest 
or head; pulse 80, of natural strength ; sweated a little; belly 
inclined to be costive. 

Habeat pil. purgant. i. statim. 
28th. — Improves j no return of pain j cough nearly gone } 
functions natural ; pulse 72. 

Habeat pulv. antim. gr. iv. h. s. 
29th— Nearly well ; is to-day up, doing part of his duty, 
and only complains of slight weakness in bis knees ; belly open ; 
pulse natural. 

No medicines. ^ 

2d December.— Continued gradually to recover his natural 
strength, and he this day returned to his duty. 

This case strongly exemplifies the necessity of a sudden and 
copious detraction of blood in cases of pneumonia, and it will 
shew, that neither the weakened state of the pulse, nor the ap- 
parent mildness of the symptoms, are, in pulmonary diseases, to 
prevent us from immediately pursuing active measures. This 
man's puke was, from the commencement, neither quick (com- 
- paratively speaking,) nor yet so full and stropg as to indicate 
violent inflammation. The pain too, on inspiring, was not so 
acute as it generally is in cases of pneumonia. He had not 
mach difficulty in lying in any position ; his appetite was still 
good $ he had no debility ; he slept weU. In factf there were 
jDo Ibnctions so oomnletely disordered, as would )iave led 
ene to suppose diat inmmmadon wi^ making rapi4 pK>|p«ss« 
VOL. %uu jio* {fO. If 



186 Dt Gibnej'8 Case tfPkeiimonia^ /jfc. April 

Indeed, the disease more resembled a case of common catarrh 
than of pneumonia. 

I was, then, in a great measure^ guided in my practice more 
by external appearances, as, the heat of skin. Furred tongue, 
flushed face, so peculiar to pneumonic patients, &c and by the 
report of others concerning his recent intemperance, than br 
the urgency of the symptoms. Indeed, his history oF bis ail- 
ment was so imperfect, that, were it not For these collateral ctr- 
cumstances, I should hardly have ventured upon bleeding him. 
Although I conceived that ii^ammation had not yet made 
much progress, yet, by allowing these incipient symptoms to in* 
creai^, I mought the result might be attended with unpleasant 
consequences, if not a fatal termination. I was determined, 
then, to bleed him copiously, which I did until syncope had su- 
pervened. 

On seeing him next morning, (for he was bled the preceding 
night,) he expressed himself wonderFully relieved, yet he had siitt 
slight pain on inspiring, and headach when he coughed. From 
former experience, I thought a Further delay, under such cir- 
cumstances, might render the case still more precarious. I 
judged it best, then, to continue the bleeding, notwithstanding 
his repeated assertions of his being m»c// better. I feared^ when 
the vessels recovered their tone, that the lungs, being still sus- 
. oeptible of inflammation, might be yet easify afiected. I was 
determined to reduce the action of the heart and the arteries to 
such a degree, by a second bleeding, as to render further mis- 
chief to tne lungs improbable. I whs encouraged in this by 
finding the pulse rather stronger than on the preceding night, 
by observing that there was itill some pain on inspiring, or, in 
fact, by finding that the most urgent symptoms had not alio^ 
getker vanished. The event Fully ansipv'ered my expectatrons. 

I took, in the second bleeding, /u// 4? ounces of blood, with« 
Out producing fainting. Indeed, diis co|)ious depletion was on- 
]f felk>wed by slight vertigo and vomiting, and he bore it much 
better than the fii^t From the history, too^ of tfaistase, it may 
be observed, not only how necessary it is to bleed copiously at 
the outset, but also how expedient it is Co follow up the practice 
attf short interval^ where there is not an evident and great abater 
ment oF the most urgent symptoms. This decisive modeof pro- 
ceediQg is more particulaHy necessary in pulmonary oomplaitits, 
where organs oF such vital insportanoc ere concerned. 
. It i» afitoirishing wliat rapid progress inflammation will tM^ 
in the lungs in ashdrt period, more So, i diink^ then in any other 
qrgpan. We should^ indeed, be hlmost eonstantiy in tJie room 
with a pneumonic patient, as there ts no >diseafiiie, wheM the fn« 
crease or decrease of bad symptoms is more apparait than *ia 



IBpf. Ih OtbiMi^s Ceiie €f PneitmomM^ 4c. 187 

iniannQMion of theJongB, and oertainlv no complaint where a 
prompt decision is mbre requisite. A row hours may decide the 
rssulty so that if, in four or five at most, after the first bleeding, 
there be not an evident diminution of diseasei I would recom- 
mend it as a rule to draw blood again as cc^iously as at first, or 
at least until the pulse has so far sunk as to render a recurrence 
of the disease improbable. As to mentioning the specific quan* 
tily to.be drawn, it is absurd. You are to stay by the b^ide 
of your patient, keep your finger on his pulse, and let the blood 
flow until there is an evident and most decisive change for the 
better ; until the pulse become slow and feeble ; until the flush 
of the face is nearly gone, and in most cases until syncope su** 
pervenes. The fears of your patient, his expressions of benefit* 
and the apparent great quantity already drawn, are not to deter 
us from proceeding, for we should always remember that the 
danger of losinflp much blo^d is by no means so great as the 
danger of the disease. The bufifed appearance, too, of the blood 
is a fallaeious criterion to go by, when we wish to repeat th^ 
depletion. In Evans's ease, it was, in tte first bleeding, of a 
natural appearance, and in the second but v^y slightly bu£fed* 
Tbts'case likewise shews how much blood we can take from a 
roan of strong constitution, and gross habit of body. In the 
space of sitleen hours he lo^t 82 ounces by measure^ and so far 
was the first bleeding from weakening him, that he sustained a 
Joss of 47 ounees in the second, without producing sync<x>e^ and 
with no farther inconvenience than a slight vomiting. Indeed, 
so far from any debility existing after this great depletion, the 
man actually asked my permission to do all his du^ two days after 
the second bleeding, idiich, however, I did not think proper to 

Sranc I am aware, however, there are constitutions otherwise 
ealthy, which could not bear so copious a depletion, and that 
we site to regulate our practice accordingly ; yet I think there 
are few men of the weakest constitutions, who will not bear a 
loss of 90 ounces of blood in pneumonia, and lliat too with evi^ 
dent advantage. I recollect this time twelve months, attending 
the eteward of a gentleman in France, at whose house I waa 
qoartered. This man had been three days ill with pneumonia* 
and was ordered weak broth and oonfinemwt by the provincial 
surgeon who attended him. He became much worse, and I 
was requested to see him. He was dangerously ill, and had not 
had ^ass^ge in his bowels for three days, nor would his surgeon 
give him any opening medicine, until (as he said) the fever had 
•ubsided. I Ued him that nu;ht to the amount of 52 ounces, 
next morning was again obliged to take SO, and again the morn- 
ing after to draw 20 more ; so that in about thirty-six hours he 



288 DrG'Amey'BCaseqfPneumofBa^Jie. April 

lost 82 ounces of blood. He fainted after each bleediogi so that 
I drew less than I otherwise should have done. This man was 
scrofulous, of a very weakly constitution, and had but one 
arm. I fear the supposed 4anger of inducing too great debility, 
has often deterred practitioners from taking as much blood at 
ance^ as the danger of the disease requires. Yet I am convinced 
such danger is imaginary, not grounded upon facts, and most 
frequently the result of theory in the hands of timid practition* 
ers. The immediate debility induced by one or two large ^ 
depletions, is bv no means so great, at least certainly not so 
permanent^ as that which is produced by several small bleedings^ 
superadded to the length of confinement^ with which the latter 
are always followed. 

At this time (December 1816,) pulmonary complaints are 
more or less prevalent amongst the soldiers at Shrewsbury. In 
every case where there is a sagh^t, though evident determination 
towards the lungs, I bleed largely at first, which in the end ge* 
nerally supersedes the necessity of a second bleeding, and saves 
much anxiety to the patient* I have indeed seldom to repeat 
the operation, unless the patient faints before a sufficient quan« 
tity is drawn at the commencement. I have at, present a soldier 
sick with pneumonia, where the pulse was never* from the be- 
ginning, more than 90, and extremely feeble, yet, from other cir- 
cumstances, I was induced to take 25 ounces of bkx>d from him, 
which induced fainting. In six hours after, he was, as he said,. 
** much better," yet he had siiH some pain, and could not lie 
easily on his right side. His pulse was rather stronger than 
before^ so I immediately bled him again to the amount of 30 
ounces, which depletion he bore much better than the first 
This man is 25 years of age, of a very weakly constitution, and 
has but just recovered from a course of mercury. 

I have thus, gentlemen, sent you a few observations on tliis 
case of pneumonia. They are perfectly at your disposal. The 
practice is that pursued at present by almost every suigeon in 
the army. Perhaps soldiers require a more vigorous treatment 
than civilians, at least they are more subject to acute diseases. 
From the rules, too, of the service, you seldom find men of very 
weakly constitutions, so that perhaps the practics here recom- 
mended cannot be carried to so great an extent iu private life, 
without injury to the practitioner's character ; yet I am convinced 
the principle is good, and I think we should not se^so many 
cases of phthisis and other sequelae of pneumonia, were medical 
men more cautions in superintending the venesection in thi^ 
disease, instead of mechanically ordering a certain number <^ 
yunces to be drawn, and leaving the rest to the apothecary. 



1817. Dr Hall on Cutaneous Diseases. 189 

In Evans's case, I used but few other remedies except the 
bleedingi as a military medicine chest is rather curtailed $ and» 
indeed^ I am convinced, no medicine will avail unless bleeding 
is carried to a proper extent. The purging: pilis I ordered may 
appear too strong, but that formula I find gripes less, and opens 
the bowels better than when a smaller quantity is used. 
. Shretpsbmy^ December 5, 1816. 



V. 

^ JSLe/tectiovs on the Arrangement of Cutaneous Diseases ; tcith the 
suggestion of a Practical and Diaguosiic niode of Classification. 
By Marshall Hall, M. D. &c. 



T-J 



IE object of every arrangement in natural science, is to ren- 
der the ktiowleiige and distinction of the subjects of which 
k treats, easy of attainment. In medicine, and in the difficult 
department of cutaneous diseases especially, that mode of ar« 
mogement must be deemed most eligible, by the aid of which 
their discrimination or diagnosis is most promoted. Consider* 
ing diagnosis, therefore, as the great object to be forwarded by 
means of the classification of diseases, a few reflecticms on the ar« 
rangement of the cutaneous affections, with an immediate view 
to their discrimination, may not prove uninteresting to the read- 
ers of the Medical and Surgical Journal. 

It is impossible to revert to the subject of cutaneous diseases, 
without making a direct allusion to the splendid and valuable 
labours of Dr Wiilan, and of Dr Bateman, in this department 
of medicine. Perhaps the only defective part of the works of 
these authors is their classification ; and to their classification 
there are numerous and serious objections. 

it is unnecessary to state, except for the information of some 
of your continental readers, that the arrangement of cutaneous 
diseases adopted by Dr Wiilan, is founded on a principle simi- 
lar to that of Plenck ; a work with which they are, still, more 
acquainted than with that of the former writer.^ This classifi- 
cation comprises eight *<orders; 1. Papuiss; ^.Squamas; S. Ex- 
anthemata ; 4. Buite ; 5. Pustular $ 0. Vesiculae ; 7. Tubercular 
8. Macube. 

But, to form an artificial arrangement of cutaneous diseaseSt 



* M. Atibert told me, when in Paris, thst he undintood that two English 
phyncians had tiko trcaed the subject of cutaneous diseases! 



190 Dr Hall on Cutaneous Diseam. ApHl 

oil the plan of Plenck or WiUen* it is neoessanr to fliraoie that 
the diflSerent genera and species of euuneous a£(ectiofi are real* 
ly and purely pa^iulous^ soaly, exanthematoosi pustukr, vesica* 
lar, &a It is, boweverv well known, that the cutaneous diseases 
are frequently^ nay ffeneraHy^ of a double or mixed characteTg 
papulae or vesicles being coexistent with eKanlhema, pustules 
with vesicles, &c. From this circumstance, a sort of coDtnuiic- 
tion is frequently implied, either in the arrangement itself, in 
the speci6c denomination of the affection, or in both. Consis- 
tency of classification sometimes deroapds, too, that the same 
ffenus of cutaneous disease shall be arranged in different orders, 
irom the occurrence of some difference or variety in its form. 
This point is illustrated by a reference to the arrangement of the 
Eczema impetiginodes, the. Ecthyma, and Ropia. And it is im- 
possible not to observe, that the objection urged against the ar- 
rangement of Plenck, exists also in full force against that of Dr 
WiTlan. ** Such a classification," it is stated) ** mast fail to an* 
mrat its end, because it requires the different stages of the same 
disease to be considered as so many distinct maladies, and to be 
arranged in several dosses.'' See the preface to the Sjynopsls of 
' Cutaneous Diseases, p. xi. Now, at p. xv. of (he same preface^ 
we are informed, in reference to the classification of Dr WiHan, 
that " diseases which commence with one generic character, 
are liable occasionally to assume another, in Uie course of their 
progress: — thitt, some of the papular eruptions become scaly, and 
still more frequently pUstulark if their duration be long protract* 
ed ; the Lichen simplex a^d ctrcumscriptus, for instance, some- 
times pass into Psoriasis ; the Lichen agrius and Prurigo foitni- 
cans are occasionally converted into Impet^ i and the Prurigo 
mitis is changed to scabies." 

Such olgections are, hdwever, in the estimation of the writer 
of this paper, of very little importance ; inasmuch as they relate 
more to the discussion concerning nosology and nomenclature, 
than to the accurate and practical diagnosis of cutaneous dis- 
easeS) the only point, respeirting their arrangementi of real mo- 
ment* There are other objections, however, to an artificial ar- 
rangement of cutaneous afiections, of a more serious nature; 
namely, such as constitute an obstacle and impediment to the at- 
tainment of the object of all arrangement, — discrimination • For 
an artificial classification, of any kind, inevitably separates affec- 
tions which agree in general simtiarUj/f and which are, consequent- 
ly, of difficult diagnosb, when they do not happen to comddc 
in that particular feature or circumstance, on which the classi- 
fication is founded. For instance, how diiScuIt is the distinction 
between Variola and Varicella i between Liobeni Scabieii Impeti- 



ItlT. Dr HaU on OUanema Disetuei. 191 

go, and Eczema ; between Ecthyma and Rupia. And yet these 
similar aibcCions, requiring such accurate examination, com^ 
parison, and contrast for their diagnoBts, are severally separated, 
and arranged in diflmnt and distant parts of the classification 
ofDr Willan. 

In fact, the arrangements of Pleack and Willan may be apt- 
ly compared to that sort of symptomatic arrangement adopted 
fay Sauvsges and Cnllen, in some parts of their systems of no- 
sology, as in the Dolores, Debilitates, 8piismi, ftc.,— a mode of 
classification which must necessarily separate the similar, and 
assemble and unite dissimilar and discordant infections. The 
tenits papula, squama, exanthema, &c are, in effect, merely de- 
nomtnations for symptoms which characterize^ but do not con- 
stitute, diseases, and which are frequently, as has been obserred, 
coexiiteRt or consecutive in the same disease. 

An ol]yection miglit plso be raised against the use of the term 
^^ataneous ; first, because many of the diseases noticed in Dr 
WillaanTs arrangement are not striclly cutaneous, but principally 
beeaose the employment of t)»is word has led to the omission of 
some affections of the surface of the human body, having great 
ufflmty'whh the cutaneous diseases, and highly deserving of 
-fresh examination. Such, espeoiaHy, is the order of ulcers, 
which is nearly allied to some of the genera of the Bullae, Pus- 
tulse, and Tubercula i and tlie works of Corvisart and Pinel ffive 
Bs sufBcient cause to hope that no future writer will be guided, 
in treating or classifying disease, by the particular textures of 
the human body, or its organs supposed to foe affected. 

From all these considerations, it appears desirable that some 
mode of arrangement less liable to objection, and, what is of in- 
finitely greater importance, more pruoticatly HsefiM^ could be de- 
mised. With the view of promoting the important object ^ the 
discrimination of diseases, it is thought that it would, be of the 
greatest utility to arrange cutaneous diseases on the principle of 
genereU timMtudCf — a principle calculated to correct many of 
the imperfections of an artificial arrangement, to unite many of 
the advantages of classification in general, and especially to pro- 
mote its main abject— <liagnosis. 

For, in this manner, the acknowledged objections to the ar- 
rangements of Plendc and Willan are obviated. Diseases si- 
myar m geno^, and, therefore, liable to be confounded, mis- 
taken, and mistreated 4br each other, are brought together into 
one class or order, and admit of being aptly and advantageous- 
ly compared mid contrasted, with a view to their distinction. 
ill ^is nanner, too, the partiottliir difficulties in the diagnosis 
are panted out io a way calculated to arrest the atlentioni and 



IM Dr HaU on CtOaneous Di$ease$. Apctt 

excite inquiry into the points of discrimination ; and in this 
jnanncr much important information is conveyed relative to the 
||eneral form, appearance, and duration of the differ^it affec* 
tioos, the ciiaracters of which are thus made mutually to illus- 
trate each other. 

If it were necessary to add any other circumstances in recoro- 
mendation of this mode of arrangement of the cutaneous dis* 
eases, it might be stated, that it b particularly adapted to cer- 
tain cases where the specific or generic character of the aflfectiou 
cannot be distinctly ascertained i for ** the natural progress of 
many eruptions is to assume a ccmsiderabie variety of aspect, so 
that it is only at some particular period of their course that 
their character is to be unequivocally decided. Thus, in the 
commencement of the Scabies papuliformis and lymphatica, the 
eruption is of a vesicular nature, although ito final tendency is to 
the pustular form. And» on the contrary, in all the varieties of 
Herpes, the general character of die eruption is purely vesicular, 
yet, as it advances in iu progress, the inclosed lymph of the 
vesicles acquires a considerable degree of opacity^ and might ba 
deemed purulent by cursory observers. In like manner, the 
original pustular form of the porrigo is frequently lost in the 
accumulating crusts, the confluent ulcerations, or the fiiriura- 
ceous cxfoliationa which ensue, and which conceal its true na- 
ture from those who have not seen and are unacquainted with 
the whole course of iu advancement." — Preface to the Syn<^>8ia 
of Cutaneous Diseases, p* 16. In such cases, as in a multitude 
of othersi the general appearance of the disease most determine 
at onco Its nature and its arrangement. 

In adopting the mode of arrangement proposed, the mind is 
also at perfect liberty to perceive the real iq>pearances of dia- 
ease, cuch as they present themselves. Those who have most 
studied cutaneous diseases according to an artifidal classifica- 
tion, will be best aware of the tendency in the mind to set an 
undue and artificial value on the particular circumstances oa 
which the arrangement is founded, to the n^lect or exclusion 
of other particulars not less important in themsdves, but ren- 
dered less so by being less essential to the particular mode of 
classification employed. 

In arranging cutaneous diseases on the principle of general 
similitude^ it may occasionally occur, that some particular a£feo» 
tion is so peculiar in its form, and so different from any other» 
that it may occupy an insulated station in the classification. In 
such cases this important information is conveyed« namely, that 
the disease in question is not liable to be mistaken for any other, 
no other being arranged with it And thus a drcomstanc^ 

10 



IS17. Dr H«ll Off Cuianeaus Diseases. 19S 

wbidi might be deemed an imperfection in the mode ofarnmge* 
ment proposed in the eyes of the philosophical nosoloffiiit, ia 
really the means of imparting important instruction. On the 
other hand) as the same aiTectioOi in its different forms, or in 
different stages of its progress, may resemble two or more dis- 
tinct and dissimilar genera of cutaneous disease, it is deemed 
advisable to arrange it in two, or even more, distinct parts of 
the classification, according to these similitudes, when the diag« 
nosis can be promoted by such a mode of proceeding and thui 
make the sacrifice of appearance for the sake of utility. 

According to this mode of arrangement, the terms Strophu* 
las. Lichen, &c« will be employed to denote the genera of cuta- 
neous disease, whilst the words Papula, Squama, Kc. will be used 
in the sense of their several definitions, as characteristic and ex- 
pressive of the appearances or symptoms of the different affec- 
tions of the skin $ and, probably, the employment of theses or 
aimilar terms, tpectfically^ might be more frequent, and the ge- 
neral denomination be thus further characterized, and made, as 
in chemical nomenclature, to convey definite ideas of the nature 
or appearances oCtbe different species of cutaneous disease. 

In exemplification of the mode of arrangement proposed in 
this paper, the following hasty sketch of a classification of the 
•genera of cutaneous diseases, is offered for the consideration of 
the medical reader* The general similitude between the species 
of cutaneous affections may also be denoted by a modification in 
their arrangement of a similar nature. Their affinity may be 
further pointed out, too, by attaching to them certain characters 
or cyphers, accoixiing to their similarity in external form and 
appearance. 

L — The Acute Cutaneous Af- 2- VariceU*. 
fectiona. ^ Vaccinia. 

Order First. IL—The Chronic Cutaneous 
1. Scarlatina. i^: ^ 

SL Rubeola. Diseases. 

3. Roseola. Order First. 

4. Urticaria. 1. Lichen. 
6, Strophulus. 2. Prurigo. 
6. Purpura. 8. Scabies. 

Order Second. 4- Impetigo. 

1. Erythema. *• Eczema, 

s. Erysipelas. 6. Ecthyma. 

3. Herpes. 7- Rupia. 

4. Eczema. 8. Pompholix. 

5. Mfliaria. O^hhil Secqnp. 
Order Third. !• Acne. 

1. Variola. 2. Sycpsii, 



19i Dr Han on Cutamous DiMMset. Ajml 

-e* Forr^. Order Sicovd. 

»4. PitvnaMS* 1. Herpetic ringworm. 

5. Ephelis. 2. Impetiginous ringworm. 

Oeder Third. I' Porrjginoun ringworm. 

1. Lepra. ^- P»^'"« gY^ta, Ac. 
«. Psoriasis. Order Third. 

8. Icthyosis. 1. Psoriasis palmaris. 
4. Verruca. 2. Psoriasis diffusa, f 

Order Fourth. 3- Ecxema or impetigop ( on Ow back 

The Specific Uwrrs. ^l ^^^ ^^^: 

4. Eczema solare. 

III.— The Local Cutaneow '' ^'*^'"' *'' 
Affections. Order Fourth. 

1. Psoriasis. 
Order First. 2. Prurigo, and, 

1. Aphtha. . 3. Other affections of the pudenda. 

9. Herpest orw. 

labialis. Order Fifth. 

anginosa. 1. Herpes preputUlis. 

3. Other affections of the mouth or S* Other affectiom of this part, 
throut.* 

By casting the eye over this classification of ciHaneous dia- 
«Bses, bow Euiich ioionnation, of advantage in the study of their 
dbgncsisy is acquired ! We leani at poce that Scarlatina^ Ru- 
beola, Roseola. Urticaria^ Strophulus, lichen, &c. that Lichen in 
its inveterate form, PrurigOi Scabies* Impetigo, Ecaasma, See* mu- 
faally resemUe each other in different instances* are liable to be 
confounded together, and require the utmost attention for their 
discrimination; that Varicella, Vaccinia, Herpes, Rupia* Miliaria, 
&a broufi^ together on the principle of artificial ciassificatioii 
adopted by Dr Willan, are not thus mutually similar, aUIiough 
they agree in a point of classification and nomenclature, and 
that they are not, therefore, liable to be confounded together. 

This arrangement alone, too, furnishes a useful plaa and or- 
der, according to which those who are about to b^in the study 
of cutaneous diseases may pursue the inquiry ; for uiej will thus 
be gradually conducted Irora one cutaneous affection to that 
which most resembles it, and led to recognise and distinguish 
them ; for slight differences between similar objects are best per- 
ceived by their approximation. 

. The arrangement proposed may be compared to the natural, 
in (q>position to the artificial classification in botany. The fer^ 



* Wilian's Reports of Diseases in London, pp. 3, 11, 17, 35, 37, itX), 111, 

Its, SOS, 2S7j SSSySeO. 
f The baker and washerwoman's itch, 
j: The grocer and brickla^rer'a itch. 

5 



ISlf. Dr HaU m Cuianeous Diteaseg. ' liS 

.mer assembles in one class plants of general similitude. Like 
the latter, the classification of Plenck brings together objectir 
agreeing in one particular point indeed, but whpse general ap- 
pearance is altogether dissimilar. And how is the student to 
identiiy the objects^ of bis research, when the bkissom is shed, or 
when the original cliaracter of disease has passed away i 
. Ncv. 10, 1816. 



VI. 

JRjemarks on the Preservation of Lvne-JVaier. By H. Daw as, 
M. D.» Fellow of the Royal College of Physicians, Edin- 
burgh* 

V^lSAft SkR,-«Oonsideritiff the present mode of preserting 
-^^ lime-water* as susceptible of improvement, I shall, in a few 
words, communicate to you my observations on die subject, tbst, 
if you see proper, you may insert them in the Edinbuigh Medi- 
eU and Surgical Journal. 

According to the plan usually followed, the water, after beinff 
impregnated, is filtered, and put up in large bottles, from which 
it is removed to smaller ones from time to time, as it is needed. 
These smaller bottles are still of such size, that they must be 
repeatedly opened and stopped faefi>re their contents are ex- 
hausted. This evidently brings along with it the frequent ad- 
mission of atmospheric air, in quantities proportioned to the 
space left above the solution in the bottles. Hence we gene- 
. ndlv find the bottle in common use is more or less dimmed 
with a precipitate of carbonate of lime, formed by the car- 
bonic acid of the atmosphere, which renders the solution tur- 
bid, and gives us reason to conclude, that it must be impaired 
in strength. 

Wishing to have a quantity of good lime-water constantly at 
hand, for the sake of experiments, I have found the following 
method completely satisfactory : Instead of filtering the solu- 
tion, to keep it in contact with a quantity of quick-lime, in a 
tall wide-mouthed bottle, and to decant from the upper part, as 
much as is at aqy lime wanted ; to fill the bottle immediately 
again with water, and shake it in the some manner as when the 
lime-water is first made. This excludes all carbonic add, 
and affords a fresh supply of the solution. It is preferable to 
the plan of keeping quidk^lime bottled qp in a diy stat^ which 



196 Dr Dewar on the Preservation qfUme^Water. April 

is apt ta break the bottles^ andi when at any time exposed, 

exliibits a more extensive surfiice to the action of carbonic 

acid. 

When the simple plan now described is foUowed» even 
.though precipitatioo by the carbonic acid^ should, in a sl^ht 

d^ree, take place» the solution thus weakened is quickly re- 
saturated by the presence of the quick'lime. Thus it is always 
kept in its strongest state, and miiy be obtained perfectly 
limpid, llie trouble of inquiring frequently for fresh burned 
fimestone, which, in some situations, may be considerable, ia 
avoided, as well as that of filtering. This would, indeed, be 
a paltry reconimendation, were it not that the trouble is of no 
utility, every oUcct being more advantageously obtained with- 
out^ iu The filtering, besides^ implies a degree of exposure 
which must be injurious. 

I can conceive no objection to which this Kttle plaihof cbeml« 
cal and pharmaceutical economy is liable. On the oontrary, 
I trust that it requires only to be mentioned to have its advan- 
tages appreciated, and to be generaUy adopted. Apothecaries 
aiiu druggists may keep their stock in very tall and wide*mouth- 
.cd bottles with quick'lime at the bottom, from which it may . 
from time to time be drawn off, either by the use of a s^phoii» 
or by careful decantation, and put aside in vials contaimng the 
quantities most generally asked for. 

George Street ^ Edinburgh^ Dec. S, 1816. 



VIT. 

An History, zcilh Remarks, of an Aortal Aneurism, conjoined 
with a Pulmonaiy PlUhim. Extracted I'lom u Clinical Lecture, 
delivered February 10, 1817, by GbonoB Pi:arson, M. IX 
F. R. S. 8cc. ill a Letter to Andrew Duncan, Sen. M. D.. 

Professor of Physic, 8cc. &c. 

CHBisTiAK Merlhoff, aged 3^ years, a native of Piednfont, 
a bassoon performer in the army, was received into St 
George's Hospital, December 2?5, 1816. He declared repeat* 
ediy that his health wals perfect in September last, when he ar« 
rived in England from Canada. Without any assignable cause» 
illness commenced in the latter part of November, and not ext^ 
lier* According to the account given, he was first attacked by 
a pneumonic amotion, especially of the left lung, having acute 
pain of the left side, oppression about the heart, cough, dyqp- 



1817. Dr Peargon*s Remarks on an Jorial Jneurim. 197 

nouLf and cxpeCtocatioD, with chilly, hot| and sweating fits, as 
well as debility, and other symptoms, occasioning confinement 
in bed. 

On admission, the patient seemed to be in a dying condi- 
tiooy so that no distinct disease could be ascertained. The 
dyspncea was considerable, but the weakness seemed to be so 
great that he was unable to expectorate, and only made efforts 
to cough. The beating of the heart and pulse at the wrist 
were very feeble, but synchronous. 

Wine^ cordial medicines, and nutritions matter were ordered^ 
merely to palliate and support life. 

Contrary to my expectation, strength was gradually recover- 
ed. The breathing became easy while recumbent on the back ; 
4yonid also lie on either side, but not comfortably ; became able 
to cough and spit up much mucopurulent matter. The pulse 
was between SO and 90 in each minute, but sometimes not mpre 
than 75 ; the tongue from foul became clean ; little complaint 
was made of pain of the region of the heart, but there was a 
feeling of obstruction in its pulsation. The countenance looked 
materially better in four days' time. However, on the 80th 
jDecember, there was much pain of the left side, and a good deal 
u>f difficulty in breathing, with frequent coughing. The wine 
.and cordial medicines were discontinued. 

Blood-letting to 10 ounces was ordered ; a purging draught ; 
a blister to the left side ; and an opiate at night. 

The pain of the left side contiuuing, although the dyspnoea 
was reUevedf the blood-letting was repeated ; but the blood was 
not bufiy. 

In addition to the pleuritic pain, much complaint was made 
of pain between the Moulders. 'I'he painful feelings subsequent- 
ly to about the 7th January were confined to the region of the 
heart, which increased, tlie bund being frequently applied !• 
it to denote the seat More and less sputum continued to be 
coughed up; weakness increased; blistering plasters were re- 
peatedly applied, and, from the urgency of tlie pain, also blood- 
letting ; but the blood was never sizy. Ipecacuanha, squill« 
opium, and demulcent medicines, were the internal medicines 
recommended. 

From the 20th January all the symptoms grew more and 
more unfavourable; then much distress was denoted by the 
countenance ; great restlessness ; the body was often desired to 
be raised, and also bent forward from time to time to relieve the 
anxiety and painful feelings of the chest, but the weakness con- 
fined the patient generally to lyiog upon the back ; the respira- 
tion grew quick; the cough. more troublesome; the qputum as 



i9B Dr Petnoa'g Remarhi on an Jorial Jmurum* April 

before ; the appetite for food totally failed, and tlie t&int, widi 
fiial tongue, increased. 

One night, in a fit of deliriunit the sufferer suddenly got out 
of bed, and walked about the room^ saying he ** was now well** 
It was particularly observed, that the pulse varied only betwean 
80 and 90, excepting rarely under this rate. It had been also 
observed, that no morbid action took place of the heart, excepc- 
ing a little throbbing. 

On the SI St January, in the evening, during a slight 
coughing fit, a little blood was expectorated with the muco- 
purulent mattery and the patient expired almost witliout a 
struggle. 

Dissection. — About 16 hours after death the chest was open- 
ed. Ttic lungs appeared oFa whitish colour, like those of brute 
animals which die by hsemorrhagc, as commonly seen in 
butchers' shops. There was less charcoal than common on the 
exterior parts, but the bronchial glands were black as usual. 
The left lung was contracted to nearly half its natural bulk $ it 
felt firm instead of spongy, and totally sunk in water. The 
right lung filled the cavity of the thorax ; was extremely light f 
contained much air, which readily passed fix>m one part to ano« 
ther by slightpressure. To the extent of several square inches 
Uood was efiused under the puhnonary pleura from a bkKxi- 
vessel, probably ruptured on the surface. Though double the 
bulk ofthe left lung, it weighed rather less, namely^ 14 ounces. 
There were no adbe6ion^ nor membranes thickened in the 
thoracic cavities ; but tfierc was about half a pint of serum in 
the left cavity : in the right was most unexpectedly found a large 
quantity of black blood slightly coagulated, amounting to about 
two pounds, besides half a pound of serum. This blood, after 
standing, exposed to the air 12 hours, exhibited a thin sU^atum 
of red blood on its surface, as in the case of venous blood so ex- 
posed and coagulated. 

The pericardium contained four ounces of water, l^e heart 
was in its usual position, and of its common form, magnitiide, 
and consistence, weighing nine ounces. Its cavities were almost 
entirely without blood ; and the interior structure was liealthy. 
The right lung, being cut into pieces, was seen in a sound staCe ; 
but it contained very little blood. 

The left lung was also found almost bloodless. The air 
tubes were filled witli pus throughout, and innumerable tuberclas, 
ofthe size of pepper corns, were found in the substanee 4if tliis 
viscus ; but tiiere were no vomicae nor large masses of coaiescad 
tnberde^ nor masses of condensed lu^g without tubcrdes. 

Some of the blue and black bronchial glands contained chalk- 



1S17. I^ Pearson's Remarks on an Aortal Aneurism^ 199 

fikecoHcretkms Wliich appeared on a slight examination to con- 
aifit of pho^hate of lime) with a little phosphate of magnesia and 
carbonate dflime. 

The source of the effused venous blood was the next olgect 
of inquiry. It was discovered to be from a large aneurismal 
cyst of the aorta, just below the descending arcaoe. This cyst^ 
several inches in width and breadthi had been burst in its supe- 
rior part; and so had the contiguous membranes of the poste- 
rior mediastinum into the right cavity of the thorax ; and of 
course the gush from an aperture nearly two inches wide, in- 
fitantly drained the lul^gs and heart of their blood ; probably, 
too. Mood was transmitted through the lungs for a very short 
time after respiration had ceased, and hence the great quantity 
of eflused venous blood. In the ruptured sac was contained 
a firm reddish coagulum of a roundish figure, which, being 
easily detached, was found to weigh eight ounces. It consisted 
of iamiDseor leaves, which, with little trouble, were separable of 
such tenuity as to be semitranaparent. By maceration in 
cold water they became white. Depositions of the self-coasu- 
lable, or live lymph of the blood, had probably successively taken 
' place from the bottom of the cyst, in an horizontal position, till 
* the large mass of layers occupied ereat part of the cavity. It 
was remarkable, that the coagulum had received part of its ex- 
terior form, apparently from presure, on the 2d, 3d, and 4th 
costal vertebras, over which the sec extended. The inside of 
the aneurismal aorta was coated with self-coagulated lymph 
to a great extent, but a large part was abraded so as to be 
quite transparent, and in that portion the rupture was produced. 
The arch of the aorta did not seem diseased, but the de- 
scending aorta, at its mouth in the sac, was cartilaginous and 
thickened, so as to be annular, and the vessel was contracted 
for several inches in length in its descent, with rugae within 
aide in the contracted part. 

A most irtrikiftg e£R?ct of the pressure of this aneurism w«s 
the entire disappearance of the osseous matter of tl^e anterior ' 
part of the 2d, M, and 4th dorsal vertebrae, although the 
cartilages remained whole ; thus leaving large cavities from the 
loss of bone between these cartilages by absorption. The ab- 
anrptionof bcme, but not of cartilage, although subject to 
equally great pressure, was noticed as a curious pathdogicfd 
fact. As the large sac with iu coagulum was situated, one 
n^ht.hsre expected injury to the contiguous organs from 
pressure, but they escaped unhurt ; seemingly from tnar yield- 
ing and distcnsile nature. Accordingly the heart, lungs, 
trachea, Sic. before death, appear to have been undisturbed by 
file unearism, tatd subseiniently no altered structure was ob- 
served, except the state of w left lungi just noticed. 



£00 Dt Pearson's Remarks an an Aortal AneurUm. Aprii 

Remarks. — 1//9 Taking for granted, from the hifitory^ that a 
pleuro-peripneumonia subsisted In November^ it wito thought 
most probablcy from tlie symptoms» that this disease had prcH 
duced the pulmonic affection^ the subject of my treatment i bat 
for want of diagnostic symptoms, it was only a matter of con- 
jecture, that the disease might be either water in the chest» or 
condensation of the lungs, or tubercles. Of aneurismal affection 
not one of numerous observers, many of whom are not Tyros, 
who had paid daily visits for six weeks, suspected such a dls* 
case. The circulation was carried on as regularly as in healthy 
and with no considerable augmentation ; although there was a, 
dilatation, with great disease, of a large part of the grand artery, 
containing a coagulum weighing eight ounces, situated directly 
under, or very near, to the basis oiHhe heart The su£rerer was 
questioned very particularly concerning the time and progress of 
the illness ; hut it could not be discovered, that there was any 
disorder previously to the month of November, yet the aneurism 
must in all reason have been forming from a much earlier pe- 
riod. It seems, however, true, that, notwithstanding the great 
improvements in the pathology of diseases of arteries, we have 
not yet observed the symptoms which, in numerous instances, 
manifest their presence. To my knowledge, a case occurred 
which was treated, without the least suspicion of aneurism, by a 
very experienced and accurate physician, one of the first anato- 
mists in LfOndon, in conjunction with another physician of still 
longer experience. The disease was consideral to be a pulmo- 
nary affection, with disorder of the liver. The patient died sud- 
denly. On dissection, the pericardium was found full of blood 
from tiie rupture of aneurism of the ascending aorta ; the lungs 
being perfectly sound, but the liver was diseased. I understand 
that two aneurismal cases lately fell under care in the hos- 
pital, not suspected to be such during life. One of them was 
of the arteria innominats, in which the blood was effused into the 
right cavity of the thorax. The other was aneurism a little be- 
low the curvature of the descending aorta j the adjoining parts 
were diseased, so that the blood was effused into the left bifur* 
cation of the trachea, and, of course, into the left lung. In fii* 
ture these examples may lead to observations by which this ar- 
terial disease can be distinguished. No one thought of inquiring 
whether or not there was pulsation in the posterior part of the 
thorax ; although it is not probable, from the seat of the tumonr^ 
any such symptoms would have been perceived. When the pat 
tient is able to walk, some information may be obtained by at- 
tending to the action of the heart and pulse at the wrist after 
bodily exertion. 
2%, The coagulation in the form of laminas seems to have 



VAf. Dr Besnon's Kemarks w an Aortal Aneurism. 201 

Uketk place from tbe bottom of the 8ac» by succes9iye depositioDs 
of tile setf-coagnlable lympb borizontallv $ yet leaving very suf- 
ficient spftce for the transit of blood : hence there was no in- 
flammatory action to occasion sizy blood, nor to accelerate the 
circdation. This large ooagulum no doubt distended the arte- 
ry, but the artery itself was much diseased, so that in the 3upe- 
rior part of the aneurism the coats were eroded, till at li^t a 
moderate exertion occasioned the rupture. 

Sd, I see no way of accounting for the diseased state of tbe 
left lung, but by referring it to the pneumonic affection in 
November and iSecember ; a very common sequela of which ia 
a tnbercnlous state; but, what is unusual, not being accompa^ 
nied by condensation, nor bv thickening. of the pleura mem- 
branes, nor by adhesions ; also the tubercles were of i^n equal 
anee, small and granular. No vomicao were found, because tbe 
patient did not live lonff enough for the tubercles to coalesce 
and suppurate. It is also a rare case to find the air tubes filled 
vrith pus secreted from the membranes without any breach of 
the coats, and unaccompanied apparently by inflammation ; al- 
though it is ascertained, and now generally admitted, that pus 
ia secreted from membranous surfaces without ulceration. If 
, the patient had not been destroyed by the haemorrhage from the 
aneurism, he would, in all probability, have died by pulmo- 
nary phthisiis in the course of the winter or spring. 

The respiration must have been carried on by meims of one 
lung only for some weeks, and with less dyspnoe^^ than might 
have been expected, and seemingly with little impediment to the 
pulmonary circulation. No symptoms manifested this disease 
of the lunga ; this will not be, however, matter of surprise to 
persons of much experience who have found that tubercles, like 
other extraneous bodies, in certain constitutions, take places and 
subsist for a long time without producing any observable dis* 
tingnisbing symptoms ; especially when some other more urgent 
disease is present, as in the case under explanation. The dysp- 
noea and muco-purulent expectoration, were too equivocal to 
denote the secretion of pus in the bronchial tubes. 

4^^, Notwithstanding the vicinity and connection of the 
heart with the aneurismal tumour, this organ does not appear to 
have been excited to any extraordinary action, being of tbe na- 
tural usual size, structure, and texture ; for the water in the pe- 
ricardium does not imply preceding inordinately great action* 

4^9 llie acute pain referred to tbe heart by the suSerer for 
several weeks, now appears to nave been mo^t probably occa- 
^ned by the destruction of the dorsal vertebrce, owing to the 
pressure of the aneurism with a coagulum half a pound in 
we^t, as well as by the erosion of the coats of the aorta. 

VOL. XIII. NO. 50, o 



S02 Dr Pearson's Remarks on an Aortal Jneurism. Ap^ 

6M9 The case here related, is one among many, others so 
frequently occurring, by which men of eTcperience fed mortifiedf 
not only on account or the little power they possess over the 
diseitse, but also from not having the satisfaction of knowing the 
diseased state (although irremediable) till after death. The 
best comrorts in such cases are, Isi^ The consciousness of havine 
employed every known efficient means afforded by science. 2^. 
From well directed investigatioDi furnishing materials for tb& 
discrimination of disease in future. Of what value these may be 
cltnnot be foretold. The history of philosophy instructs us, that 
mnny facts were discovered for ages preceding their useful prac^ 
deal application, owing either to mere n^Iect of contemplation^ 
or from requiring other facts, subsequenUy brought to light, in 
order to render them beneficial. 

In the particular history before us we learn, tit. That the 
symptoms of certain aneurismal diseases, throughout dieir whole 
course, are still to be discovered. 2d, That dyspnoea unon bo- 
dily exertion ; a palse not much more frequent than in health ;. 
lying on one side with more ease than on the other, or lying 
easily only on the back ; the absence of buffy blood 1 acute pain 
iA the back of the dorsal vertebras, and of the region of the 
heart, (the known characteristic symptoms of other pulmonary 
diseases being absent,) may perhaps contribute to manifest dila- 
tation of the aorta just at its descent from the great curvature. 

If this disease had been known and fallen under treatment ia 
its earlier sta^e, the most likely means of benefit would have 
been employed, viz. 

Ix/, The strictest injunctions to avoid bodily exertion. 

2df To take food of easy digestion, and in small quantities at 
a time. 

3d, To avoid entirely fermented liquors. 

4rM, To occasionally diminish the circulation by blood-let- 
ting. 

5ihf To constantly keep the bowels in a lax state by saline 
purgatives. 

6tA, To preserve tranquillity of mind. 

Ttkf To keep up a determination of the circulation on the ex- 
terior parts by flannel or cotton clothing. 

8M, Perhaps it may be thought advisable to use various ex- 
ternal applications to the chest. 

There is good evidence of aneurisms in some instances disap- 
pearing by tne natural powers of the animal economy. If so ; 
although it is not pretended that any means of art are of power- 
ful agency, yet they may become humble assistants, or, at leasts 
it is practicable to render negative services by avoiding the no^ 
centia. 



l8i^ 303 



PART 11. 
CRITICAL ANALYSIS. 



I. 

Trditedes Poisons tires desRegnes Mineral^ Vegetal^ et AnimaU 
ou Toxicologie Generalcy consideree sous les rapports de la 
Physiologies dc la Pathologie^ et de la Medecine legale. Par 
M. P. Orfi]% Naturaliste pensionnaire d'Espagne, Docteur 
en M^icine de la Faculte de Paris, &c. Tome 11. en Deux 
Parties. Paris, 1815. 8vo. pp. S40, and S35. 

WE proceed with pleasure to give an account of the conclud- 
ing parts of M. Orfila's classical work. The first volume 
treated of the corrosive and astringent poisons ; the second vo- 
lume, consisting also of two parts, contains the history of the 
acrid, narcotic, narcotic-acrid, and septic poisons ; and concludes 
with poisoning considered in a general manner. In his classi*^ 
fication of poisons, Orfila has followed preceding writers, parti- 
cttlariy Vicat and Fod^rfe ; but he is perfectly aware of its great 
and numerous defects, and has only retained it, becaui^e, with 
the diffidence characteristic of a truly scientific observer, he lelt 
s^ongly the difficulty of offering a satisfactory arrangement of 
poisons derived from their mode of action, and postponed even 
an attempt at such a classification, until he had repeated his 
experiments in thedifierent climates of Europe (Vol. II. p 1 1 9. J 
Last April he even set out for the coast of Africa to study the 
poisonous productions of that qu^irter of the world, but was de* 
tained four months in the Balearic Islands by the breaking out 
of the war with Algiers. But although we must condemn that 
confidence, which lead^ many from very partial considerations, 
and with very limited knowledge, fo overturn systems which 
have acqciired some degree of authority, and to substitute theii: 



204* Orasi^ Traiie des Poisons. April 

own crude and hasty speculations ; still, in our opinioni M. Qrfila 
has been over-cautious^ and we r^;ret that be, who, of all men 
living perhaps, was best able to ao it, has not reformed^ if he 
would not destroy a system so glaringly wronf;, and that he has 
contributed to continue and propagate obvious error by his 
high authority. In proof of this, we need only state, that he 
closes among the acrid poisons, the hellebores, which he him- 
self afterwards adduces as the best example of the narcotic 
poisons. But we conceive he has been led to this by bavins re-> 
printed in his first part, Fod^r^'s classification, without alter- 
ation, in regard to the cksses to be treated of in his second 
volume, and which M* Orfik had not then^ we suspect, exa- 
mined so accurately as he has since done. An^error in mere ar* 
rangement does not, it is true, Invalidate the accuracy of the 
history of each individual poison, to which M« Orfila's experi- 
ments have contributed so much, but it interferes very much with 
the general conclusions drawn with regard to each class. To 
remedy this in some measure, he has subdivided the first class 
treated of in this second volume, and as this subdivirion of the 
acrid poisons is founded chiefly on the circumstance of their 
being absorbed or not, it is necessarv to state by what characters 
M. Orfila determines this point, which has often been a source 
of obstinate controversy. 

It is evident, he says, if a poisonous substance, when ap- 
plied to the cellular membrane, excites very little locsl action* 
but produces, in a short time, vomiting, vertigo, and convul- 
sions, and death in a few hours, that it has been absorbed. The 
same condMsion may be drawn with still more certainty, if, ia 
addition to these symptoms,, inflammation of the lungs or intes^ 
tinal canal be found on dissection, when the poison was affiled 
to the cellular substance. It seenis also to have been absorbedy 
but slowly, whtn, being a substance sparingly soluble iq water, 
its application to the cellular tissue is not followed by any ne» 
markable symptoms for the space of twenty-fi>ur or tbivty*six 
hours ; and death does not take place for two or thcee days» 
provided it excites only very slight local iuflammatioa, incapable 
of accounting for the fatal event. 

. It is not aosorbed, when its implication to the cellular sub* 
stance is not followed by any general syn>ptom, but is limited to 
the production of an extensive scar, and death only follows firom 
the subsequent inflammation, for the purpose of tbrowinff off 
this foreign matter or dead part. M. Orfila is even ineumd 
to think, that the poison has not been absorbed, when it pKO* 
duces a very violent inflammation of the ceUular membrane of 
the part to which it ip iypplied$ followed by deal;h on thefirat m 



1817. Orfila, TVaHe da Poisons. iOS 

tecond day, provided the animal has not vomited, and no le- 
sion of organs to which the poison has not been applied* is to be 
discovered on dissection ; even although the substance is dis- 
solved in water, and applied to the inside of the thigh in the 
neighbourhood of numerous veins and lymphatics. 

The first division of acrid poisons, are those properly so called* 
They excite violent local action, confined to the part to which thejr 
are applied, and the immediate vicinity, and cause death from mere 
nain and irritation, without being absorbed, or producing any af- 
roction of the system, except from sympathetic irritation of the 
nerves. In this case, the animals almost always dieinastate of great 
depression f and general insensibility, and the action of the poison is 
more rapid when it is introduced into the stomach, than when 
it 18 applied to the cellular substance. According to the experi- 
ments of M, Orfila, bryony, gamboge, hedgehyssop, staves acre, 
sedum acre, various species of daphne, euphorbium, iatropha, 
and ranunculus, and nitre, belong to this division of the acrid 
poisons, 

Anodier division of acrid poisons consists of those which, be- 
sides exciting local inflammation, are slowly absorbed, and pro- 
duce mixed efiects, depending upon local and general action. 
Some of these poisons seem to possess a specific action on the rec- 
tum or lungs, which are affected even when they are applied to 
the cellular substance- Elaterium, colocynth, sabine, pulsatilla, 
squill, celidon, and hembdc dropwort, belone to this variety. 

Lastly, other substances, very incorrecuy referred to the 
dass of acrids, produce little or almost no local effect, but seem 
to be rapidly absorbed into the circulation, and give rise to vo- 
miting, vertigo, total stupefaction, or convulsions. These poi- 
sons act more quickly when applied to a wound, than when in- 
troduced into the stomach ; and after death no particular lesion, 
either of the part, or of any other organ, is to be discovered, 
The.heUebores, both black and white, Rhus radicans, and toxi- 
codendron, narcissus, pseudo-narcissus, and aconite, belong to 
this class. It must, however, be confessed, that although these 
divisions arc sufficiently marked in most Instances, some substan* 
ces seem to hold an intermediate place between several of them^ 
The oxymuriatic acid, sulphurous and nitrous gases, which M. 
Orfila has treated of among the acrid poisons, evidently act 
upon a totally different prinaple, and ought to be removed from 
theiD ftltogiether. 

On the treatment of the disease produced by the acrid pbisons, 
M; Qrfik shews, that we have not that acquaintance with the 
chemical constitution of these vegetable matters, which would 
enMe us to point out any substance capable of decomposing 
them in the stomach, and rendering diem inert ; and he reduces 



266 Orfila, Traite des Poisons. April 

all our knowledge of this part of medicine to the favooriqg of 
their expulsion by vomiting, by means of copious mucilaginous 
drinks, in case nature has not effected it, and to the treatment 
of their secondary effects according to their kind. 

The fourth chapter treats of the narcotic poisons, opium, liyos- 
cyamus, prussic acid, lauroccrasus, bitter almonds, lactuca virosa, 
&c. The symptoms produced by this class of poisons are nearly 
the same, whether they be taken into the stomach, applied to the 
cellular substance, or injected into a vein, except that death is 
caused most quickly in the last, and most slowly in the first 
way, as if their nature were changed by digestion in the sto- 
mach ; or rather, because they enter the circulation more slow- 
ly by absorption from an entire surface covered with mucus, 
than when applied to the divided mouths of absorbents and 
veiub, or directly injected into veins. 

The symptoms commonly produced are well known ; but, in 
regard to opium, which is generally considert^d as the chief of 
this class, M. Orfila entertains opinions somewhat peculiar. 
He thinks that opium> in a large dose, ought not to be con- 
siilcred either as a narcotic or as a stimulant poison, but that 
it exercises a particular mode of action, for which we have no 
faame. L induces, first, a marked degree of stupor and paraly* 
sis, alter which the pulse becomes full, and often quick ; convul* 
sions and tetanus come on, and continue at intervals until death, 
without any remission of the stupor, from which, however, the 
subjects of experiment are easily roused. These symptoms differ 
on the one hand from the effects of hellebore, which are purely nar- 
cotic, and, on the other, from those of camphor, which are sti- 
inulant. Opium, in a small dose, produces in general only the pri- 
mary narcotic effects, although, in some cases depending on idio- 
Byncrasy, it excites violently. Lastly, M. Orfila does not ad- 
roit any identity of action between opium and spirituous liquors 
taken to excess. 

The narcotic poisons, when swallowed, produce no pathologic 
change upon the intestinal canal ; and when applied to the eel- 
lular membrane, only excite the same slight irritation as any 
foreign body. The veins of the brain and its membranes are 
frequently rendered turgid with blood, and the lungs are often 
gorged with blood, an effect also of some of those poisons clas- 
sed among the acrids. The blood in the ventricles of the heart 
and in the veins, contrary to the assertion of some authors, is 
often coogulated soon alter death. 

M. Orfila has investigated judiciously the effects of the re- 
puted antidotes of the narcotic poisons ; and, in regard to vine- 
gar, he found, that, when undiluted, it accelerated and aggra- 
vated the efiecis of opium in the stomach, and always excited 



isrr. OrBia^ Traite des Poisons. SOT 

inflammadon of that organ ; but that, when the opium was pre- 
"viousliy expelled by yomiting, or when it was applied to the cel- 
hilar membrane^ water acidulated with vinegary gr the other ve- 
getaUe acids, taken into the stomach, diminished and corrected 
me symptoips of opium. From the experiments from which 
these &cts are derived, we are disposed to conclude, that the ve- 
getable acids are in reality correctives of the bad effects of opi- 
um ; and that their effect in accelerating and apparently aggra- 
Tating the poisonous action of opium in .the stomach, are refer- 
able to hs dissolving the poison, and to its own action upon the 
coats of the stomach when employed undiluted. 

In regard to coffee, M. Ornia is of opinion, that neither the 
infiision nor decoction accelerate or aggravate the effects of opi- 
um as a poison ; and although the innision, when well prepared^ 
and repeatedly administered, rapidly lessens the symptoms, it 
cannot be considered as an antidote. The oxj^muriatic acid, 
.which some writers have recommended as. an antidote, is 
itself a corrosive poison when employed sufficiently strong to 
decompose the opium, and when sufficiently diluted to be safe, 
it has no advantage over the vegetable acids. Camphor given 
along with opium, does not prevent its sedative effects, and wa- 
ter, and mucilaginous ^uids, rather accelerate them by dissolve 
ing the opium ; while blood-letting never produced any injurious 
eTOCts, but, in some circumstances, seemed to save the life of 
animals und^ the influence of opium. As the result of his ex- 
f)eriroents, M. Orfila gives the following directions for the treat- 
ment of a person poisoned by opium : 

Istf To expel the opium from the stomach by vomiting ; lor 
which purpose, three or four grains of sulphate of copper, five 
or six of tartar emetic may be given $ and ^i cases wherr.^ 
from the guantitv of opium swallowed, these hav^ no effect, M. 
OrSia suggests the injection into a vein of one or two grains of 
tartar emetic as a last resort. 

2dly^ To avoid the administration of watery liquors, with the 
view of promoting the vomiting, as they dissolve the opium and 
promote its absorption. 

d<%. To open the jugular vein immediately after the rejection 
of the pQi3on, and to repeat the operation, it necessary. 

^thftfj Afjter this, to administer alternately water acidulated 
with any vegetable acid, and a strong infusion of coffee warmed. 

Bthly^ In ten or twelve hours to administer aglyster with 
camphor, and the .bed of the patient should be warmed, and hia 
arms and legs w^Il rubbed. 

6Mif, To ffive purgative glvsters if a considerable time has 
elapsed since Uie opium was administered, and there is reason 
to believe^ that it i^till remains in the large intestines. 



£08 Orfila, TraiU iit Poisons^ April 

The same mode of treatment is adapted for all the narcotic 
poisons, except prussic acid, and vq^bks which contain itt 
especially bitter almonds* launx^erasus, &c. On Ais sul^eot 
M. Orfifa has not made experiments himself but he adopts the 
conclusions of M. CouUon and Professor Emmert. The former 
published an inauf^ral dissertation on prusaic acid at Paris, in 
1808, which contams many interesting tacts, some of which led 
him to conclude, that oliye oil and milk in no way counter^ 
act the poisonous effects of prussic acid, and that ammonia^ 
oxymuriatic acid, and theriac^ haye yery little effect against 
ihem. The poisonous effecsts of prussic acid, were also the sub^ 
ject of the inaugural dissertation of Professor Emmert, published 
at Erlangen in 1805, and the disooyery of an antidote to them 
has since been a favourite object of bis researches* llie re- 
sults of these which he has yet published, he liberally communi- 
cated to M. Qrfila in the following paragraph: 

** I liave not been able to discover any antidote for prnssic aeld. 
Caustic potOM does not in any way counteract its eflects, nor those of 
the distilled water of cherry-Iaarel or bitter almonds, which is the 
more extraordinary, as the two latter liquids lose their poisonous proi> 
perties when they are treated with muriate of iron and potass, aad 
there Is iron In caustic potass. Fontana already observed, that com* 
mon caustic (potass by lime) combined with oil of cherry-Uural, did 
not prevent its effects, whether given Internally or applied externally. 
Among all the remedies which I have tried, oil of turpentine seems 
that which was most powerful in counteracting the effects of those 
poisons* The saihe observations are applicable to the oil and bark of 
the prunus paduSf whose action on the animal economy b tile same 
with that of prnssic acid/* 

In the preceding observations, there is some apparent 
inconsistency, unless Professor Emmert meansi that although 
muriate of iron and potass (combined, or each separate^ i) 
deprive the distilled waters of cherry-laurel and bitter al- 
monds of their poisonous qualities when mixed with them 
before they are administered, still that caustic potass, wbidi 
contains iron, in no way counteracts their poisonous effects 
when the alkali is not administered until after the poison 
has begun to act Dr Schaub, who pubUshed an inai^ral 
dissertation on this subject at Marburg, in 1792, and Dr & B. 
Scott, who published an excellent dissertation on laurocerasns 
at this University in I8I5, and many of whose experiments we 
witnessed, both convinced themselves that the poisonous quali- 
ties of these substances were destroyed by being combined with 
alkali pdote. they were administered. 



1«17. Qc61% TVaii£ ies Paisoks. 909 

The daasificatioii of aaote, and the protoxide of azote among 
the naTcx)ticpoi8on% is eridentlv erroneoas. 

M. Qrffla next considers the substances which hare been 
dassedi as combining the effects of acrids and narcotics (narco- 
tico-acresX M. Orfila is fuUy aware, that it is a very incoiH 
ipmoos assemblage of substances, some of which properly b^ 
£>ng to some of the classes already examined, while the othei^ 
should be separated into different classes, their action is so 
diversified. One subdivision consists of substances, which have 
a striking analogy, in their effects, to some of those poisons im«> 
properlv termea acrid. They produce little local action, but 
are quickly absorbed into the system, producing vomitings 
agitation, excitement, or trembling, with stupefaction. As 
examples of this kind, we miEiy quote belladonna, datura, 
digitidis, woorara, rue, tobacco, anagallis arvensis, aribtolochia 
clematitis, and oleander. The poisons of the natural order of 
umbeUiferee differ only in producing a greater degree of delirium 
or frensy, while the poisonous fungi seem to act chiefly upon 
the stomach itself, giving rise to mflammation, cholic palns^ 
cramps, and deliquium. 

Alcohol and ssther produce a greater degree of excitement 
and intoxication than any other substances, and when they 
prove fatal, the stomach is violently inflamed. 

Another very distinct class of substances consists of those 
which excite violent paroxysms of convulsions, as camphor, 
or of tetanas, as the upas tieute, and antiar, ticunas, nux vomi* 
ca, faba Sancti Ignatii, coculus Indicus, and Angustura pseudo- 
. ferruginea. The experiments of M. Orfila upon the poisonous 
variety of angustura bark, suggest the propriety of giving a 
pretty full account of it, as we consider it very important tnat 
it shottld be universally known to the profession* 

Poisonous effects produced by the use of a decoction of an« 
gustnra in a patient at Hamburgh, attracted the notice c^Dr 
Kambach, who first distinguished two kinds of angustura baiit, 
to which he gave the name of genuine, and spurious or poison- 
ous. Afterward it was stated that they were known in com- 
merce as being different, and the genuine called West Indian, 
and the spurious, East Indian angustura ; and we find this states 
meat adopted by Dr Piaff * and other German authors on 
materia medica ; but as both kinds often occur in commerce 
mixed together, it is more probable that both come fi'om the 



* System der Materia medics nsch chcmiwliea MaeipMiy 8 velit 8vo. 
Leipzig, isiif VoL II. p. los. 



210 



OidSIa, Traitidet Pmoms. 



April 



fiame country, than that the importers and droggists should 
generally mii^barks coming from such distant countries, how- 
ever similar m appearance. Be this as it may, the genmne 
angustura may be distinguished from the poisonous, by the 
folk>wing characters, for which we are indebted to the labours 
i>f Drs Rambach, * Pfaff, and Planche, f who gave it the name 
of pseudO'ferruginaa. 



Genmne, 
The produce of the Bonplandia trU 
follata of Humboldt, a ogBtxft of South 
Ainenca* 



Size from ) to ^ of an inch broad ; 
9, 3, or 4, ioches long ; half a line 
thick. Outer surface uniform greyish 
white, at if covered vrith an uneven 
mealy coat» which is easily removed, 
and exposes a brown surface beneath. 
Inner surface greyish-yellow, or light- 
brown. Texture fine; very brittle. 
Fracture even ; much darker and 
browner than this inner surface ; some* 
what shining, and evidently resinous. 



Smell, afomatk ; somewhat nau- 
teous. 

Taste aromatic bitter* but not at all 
disgustingly bitter, or astringent* 
eucceeded m some degree by an arc* 
matic flavour like mace. 

Bark, on being chewed, becomes 
dork brown-yellow. Powder, when 
fresh, yellow, like good rhubarb, be- 
coming paler by keeping, with a more 
aromatic smell than the bark. 

Concentrated infusion, clear, of a 
fine reddish brown or orange colour, 
and a bitter, only slightly acrid, taste. 

Diluted with water, its colour be- 
comes yellow. 

On Uie addition of an alkaline car- 
bonate, it is changed to dark-red* 
and after some time deposits a clear 



Spurimu, 

Unknown, i^aid by some to 
from the East Indies ; and one kind 
suspected by Planche^ bur contrary to 
probability, to be got from a ^'ariety 
of the CiHchana magmjolia of Bon- 
pland. 

Size generally of greater breadth 
than length; two lines thick. Out- 
er surface covered with a web of dis- 
tinct small white warts, not easily re- 
moved, or with an uniform rost-colou»- 
ed lichen-like covering. Inner sur- 
face, dirty yellowish-white, or grey, 
or most commonfy^ black, without 
visible fibres. Texture coarse; very 
brittle. Fracture even ; partly whiti^ 
rr yellowish- white, or even clear 
brownish ; not shining and resinoust 
but more mealy, and partly exhibiting 
two distinct layers. 

Smell, resembling somewhat that 
of the genuine kind- 

Taste, in the highest degree di^ 
gustingly bitter; very durable, and 
not at all aromatic, or astringent. 

Bark, on being chewed becomes 
paler. Powder clearer yellow. 



Concentrated infusion, not so dear* 
more of a dirtv- brown colour, and of 
a most disgustmgly bitter taste. 

When diluted, it does not become 
yellow. 

On the addttbn of an alkaline car^ 
bonate, it becomes greenish, and de- 
posits a flocculent greyish- yellow pre« 



* Hufeland's Journal derprakt. Heilkunde, Vol* zix« p. 181. 1804. 
t Notice chknique 8ur les angustures du commerce lue a la Seci^^ de 
Iledicine de Paris, fe 2 Juin lB07i par L. A. Planche* 



ISlt Orfila, Trake des Pdtons. 211 

Qenmne. Spurious, 

citron yieUowy tomewhat flocculenty cipitate, and the supernatant liquor be- 
precipitate. comes gradually dark-brown, begin- 

ning at the surface. 
A aohition of pereulphat or per- A solution of persulphat or perniu* 
mnriat of iron imparts to it a higher riat of iron imparts to it a dark green 
red colour^ and after some time throw9 colour, and soon throws down a co- 
down a rose-coloured precipitate* pious sattin black precipitate, verging 

8f»mewhat to ash grey, which is per- 
fect!) redissolved by nitric acid, and 
forms an olive solution. 
Is not rendered turbid by solution Is not rendered turbid by solution 
of gelatine- of gelatine. 

Saturated decoction of a fine red- Saturated decoction, brownnh«yel- 
brown, on cooling becomes turbid, bw, and, on cooling, dqxMits a very 
and deposits a deep-yellow powder. copious grey brown precipitate^ 

Saturated tincture, dark-red-brown. Saturated tincture, much paler ; and, 
becoming very turbid by the addition on the addition of distilled water, only 
of dtstined water, and depositing a gets a pale-yellowish opaline appear- 
dear yellow resin* ance, without becoming red, or depo- 

fiting any pr^ipitate. 

.Besides (he observations made at Hamburgh, by Dr Ram- 
bach) &tal efiects from tbe use of spurious angustura occur* 
red in Hungary a|id at Bern. The Austrian (jovernment, 
after obtaining proof of its poisonous e£Pect8 on animals, or- 
dered all the angustura bark in the empire, genuine and 
furious, to be burnt, and interdicted its future importation. 
Its sale was also prohibited in Denmark % and in Russia and 
Wirtemberg, the danger connected with its use, and the charac- 
ters for distinguishing the genuine from the spurious, were pul)« 
lished by authority. * 

The Medical Faculty of Vienna had found, that dogs and 
rabbits were not afiected by large doses of genuine angustura, 
but were speedily l^illed by small doses of tne spurious kind, 
given internally. Tbe experiments of M. Orfila confirm these 
observations. A few grains of tlie powder or of the extract^ 
whether given by the mouth or applied to' a wound, were suffi- 
cient to kill a dog in 20 or SO minutes. A solution of the ex- 
tract injected iiito the jugular vein operated instantaneously. The 
yellow bitter principlp extracted from the bark by dissolving 
it out of the alcoholic extract by means of water, also was more 
active than the bark itself. The symptoms preceding death ex- 
actly resembled those produced upon dogs by the nux vomica 
and St Ignatius's bean, and the upas tieut^, viz. violent convul* 



? Kopp's Jahrbnch dcr Staatsarzneykunde, Frankfort, svo. 1809, p. 4S«. 
1910, p. 384. 1811, p. 347. 1819, p. 582, 1815, p. 938. 



fid Orfih, Trarte dtt Pouons. Aprii 

61009 resembling tetanus, occurring in paro^sms, in one of 
which the animal expires. On dissection, there is no inflamma- 
tion of the part to which the poison wasapplied, or of any other 
organ. Lastly, M. Ofila was informed by PrDfisssor Emmert 
of Bern, that a child which was poisoned by a decoction of 
spurious angustura, preserved its faculties to the last, and only 
earnestly entreated that be should not be touched, as every 
touch excited terrible cramps. He perspired copiously, but 
did not vomit. 

For the general account of the symptoms produced by this 
class of poisons, the pathological dumg^s induced by them, and 
their general action upon the animal economy, as weU as tiM 
mode- of treating persons poisoned by them, we must refer ta 
the work itself; aithough it is evident that they can scarcely 
be advantageously considered in this way without subdividing 
them. 

Under the head of septic or putrefying poisons, M. Orfila 
includes sulphuretted hydrogen, Uie poisons of venomous and 
rabid animals, animals which prove poisonous when eaten, and, 
in short, all poisons derived from the animal kingdom. As 
there are few original experiments in regard to these, we shall 
not take further notice of this class, which also is not vety na* 
tural. 

The second part of M. Orfila's works treats (^ pois<ming lA 
a general way ; and, first, of the means of proving the fact of 
poisoning having taken place. He descriBes concisely the dis^ 
eases which may be confounded with poisoning, viz. indigestion, 
cholera morbus, black vomit, and diarrhoea, malignant fever, &c; 
points out the strong points of resemblance between them 
and the effects of certain poisons, and indicates those circunh- 
stances, which, in some instances, enable us to distinguish be- 
tween them. This is a most important subject, and cannot be 
too strongly recommended to the consideration of medical meti 
in general, who, on this subject, are apt to be either too deci- 
fiive or too sceptical. 

He next proceeds to examine the means by which we majr 
recognise the nature of the substance which has caused the 
poisoning, when any remains of it are found. This requires an 
examinaticm of its physical and chemical properties ; and M. 
Orfila has entered into details, which will give considerable as- 
sistance to those to whom so deficate an inquiry is intrusted. The 
symptoms observed in patients, also often lead to the presump- 
tion, that they owe their origin to a poison of a particular kind, 
and M. Orfila has here rec^iitttfaited those peculiar to each. He 
has also described the p&thological state of the body after deeth 



1811^ Orfilay TraUi des foisonf: 21S 

induced by each kind of poison, and has indicated the best 
mode of dissiectin^ the body, to ascertain the truth. 

In the next section^ he has placed, in its proper point of view^ 
the information to be derived from experiments made on ani- 
mals, whh the remains of the suspected food, and the contents of 
the stomach and intestines of the deceased, or the matter rgect- 
ed by vomiting. His cliief object here is to show, that, to ren- 
der the experiment conclusive, it is necessary to adopt his me- 
thod of injecting the substance to be tried by a hole pierced in 
the esophagus of a doff, and then to put a l^ature on the 
oesophagus, to prevent its being rejected by vomitings 

In our review of the former volume of this very admirable 
work, * we made some objections to the second of these methods 
of experimenting, which was very much employed by M« Orfila, 
and we are glcKl we did so, tiecause our author has been in- 
duced by diem to show that they were groundless, and that we 
may safely confide in the results of his experunents made in this 
way, avdf ia fact, that it is indispensable for the investigation of 
a poiseii in all ita jehtiona. 

<^ Several reviewers, *' he says, ^' both French and foreiga, in 
giTiDg an account of the first volume of this work, have stated, that 
an operation so painful might produce severe symptoms, and, con. 
seqaeatly, that the results obtained by means of it might not be so 
caDcIu^te as they might at first appear to be. But," he asks, 
<^ could I be supposed to have prosecuted such a teborious under^ 
takiiy, wUhout havlag aadsfied myself, by rigorous experiments, of 
the infiueoce of this operation ? These, in &ct, demonstrated, igt, 
That the cooclusions I have drawn ought not to be modified in con* 
sequence of the tying of the oesophagus ; 2dly, That it is impossible 
tp write a complete treatise on poisons, without practising it often. 

*^ It is superfluous to mention, that this must be understood of the 
operation as skilfully performed, in which case it occupies, only a 
minute, or a minute and a half ; for, unquestionably, the efOects of this 
operation may be severe, if, by ignorance or want of dexterity, the 
animals be tormented fifteen or twenty minutes before it be complet- 
ed." 

From the detail of twelve experiments, it clearly appears, that 
dogs, from trying the oesophagus, only experience, during the 
two first days, slight fever and depression, and when killed at 
the end of this period, there is no organic lesion whatever to be 
discovered in the body. Sometimes eleven days elapse beibre 
they expire from want of food, and, in this case, when opened^ 
the appearances discovered are those which are characteristic of 



* Edinbur^ Medical and SurgicalJouraalf Vol. XI- p. iss. 



214 Okffla, Traiig ies Pouonr. ApnT 

starvation ; and with the view of preventing the unnecessary re- 
petition of these orueii but necessary experiments, we shall ex- 
tract them : 

<' The Tcntriclcs of the bniia contaiocd no serum ; the external 
Tassels of the right lobe of the brain, gorged with black blood; the 
lungs, of a fine rose colour, had some brownish marks on theirsurfaoe; 
the heart,8onfiewhat softened, contained coagulated blood ; the mucous 
membrane of the stomach presented, here and there, some spots of a 
rosy -colour, (in healthy dogs, as well as in those killed by starva- 
tion, the folds formed by the macoas membrane are often of a violet- 
colour,) and near the pylorus there are roost commonly small ulcere 
with the edges black ; the intestines all tinged yellow witb bile ; 
and sometimts red spots on the rectum. Upon the whole, it is erw 
dent, that violent symptoms, quickly succeeding the exhibition of any 
substancc by the oesophagus, death in the course of a few days, and 
the appearances discovered in the body, are the unmodified e&cts of 
the poison." 

It has also been objected, that experiments made on dogs 
are not conclusive as to the effects of any subetance on the 
human body ; but the contrary is firmly established by M. 
Orfila's numerous experiments. Vol. II. Part II. p. 222, tifOe. 

The next section is important, and contains many origioai ex- 
periments to determine the characters by which it may be known 
whether a poison, found in any part of the intestinal canal, was 
introduced during life or after death ? This, to some thought- 
less people, may seem a frivolous question, which never can be 
of any practical use; but, besides that knowledge in itself is al- 
ways valuable and desirable, the possibility of its serving to de- 
termine, even in one instance, upon the guilt or innocence of an 
accused person, is sufficient to give it a hi^h degree of interest 
in the minds of all who would be prepared tor every occurrence. 
M. OvRh even mentions, that the case has occurred in Sweden 
of poison bcinp; introduced into the rectum of a body after death, 
for the purpose of criminating an innocent person. It has also 
great analogy, and may serve to elucidate a question which has 
tVec]uently occurred,' and upon which the writer of the present 
article has twice been called to give evidence, where the Ufe of 
the accused depended upon the fact, whether the deceased had 
been burnt to death by accident, or had been burnt after death 
to conceal murder perpetrated in another way ; and the perusal 
of the experiments of M. Orfila excite considerable doubts, 
whether the evidence then given was correct, and whether a hy- 
pothetical opinion regarding the difference of the action of fire 
upon the living body^ and upon the body soon after death, did 
not save a murdereri in one instance, from the gaUows. 

n 



1 617/ Orfilat Traite ies Pvisons* 9 IP 

The aubjiect deserves to be brought to the test of such lexpe* 
riments as those which M . Orfila has here related with regard 
to poisons; and particular attention should be paid to the length 
of time which has elapsed between the killing of the animal and 
the application of the fire, ii point which a very acute judge, 
now no more, sug^sted as of great importancci for it oc- 
curred to him» that fire japplied to the body immediately after 
death, would produce effects not to he distinguished from those 
of its application to the living body. 

The result of M. Orfila's experiments on this curious subject 

is* 

li/, That corrosive sublimate, arsenious acid, verd^ris, and 
the sulphuric and nitric acids, introduced into the rectum some 
minutes after the death of an animal, produces alterations of 
texture which resemble, in a certain degree, those produced by 
the introduction of the same substances during life. 

2i/, That, however, it is always easy to distinguish them by 
the following characters : 

a When the poison has been introduced after death* a con« 
siderable quantity of it is found at a little distance from the anus, 
unless when it has been used in solution ; whereas little is 
found when introduced during life, as the greater portion is ex- 
pelled bv the stools occasioned by it 

b When applied after death, the alteration of texture extends 
only a little beyond the part to which the poison was applied, 
so that there is a very sharp line of division between the portion 
affected and those not at all changed, a phenomenon never 
observed in the other cases. In fact, these poisons act on the 
living system by causing a violent irritation, succeeded by in* 
flammation of variable intensity, but which always extends be« 
youd the place to which they are applied, and which graduaUy 
decreases as it recedes from that place, so that there never is h 
perfectUf distinct line of separation. 

c The redness, inflammation, ulceration, and other lesions, 
extend much farther when the poison has been introduced dur« 
ing life, than in the other case ; thus, if, after death, we find the 
rectum, or stomach, covered with a considerable quantity of one 
of tliese poisons, and the lesion not much marked, there is very 
strong reason to conclude, that it has been applied after death. 

3^, Some of these poisons, such as corrosive sublimate and 
nitric add, when applied after death, produce changes so pecu- 
liar, that it is impossible to mistake them. 

4M, When introduced into the intestinal canal twenty-four 
hpurs after death, they produce neither ledness nor inflamma* 
tbn, because the life in the. capillaries is then entirely destroy. 



^ 



816 OrBisLf^nraUiies Poisons. April 

ed, and, oonse^jaently, the efecUin this case cannot be mistakm 
for those ofpoisoning. 

Lastly^ They are ktill capable of prodacino; inflammatory 
phenomena when applied, one or two hours after death ; but 
the observations already made w^I enable us to decide cor« 
rectly. 

M. Orfila^s work is concluded with a few observations on the 
poisoning of several persons at one time ; on suicide by poison ; 
on slow poison ; and on the sequelae of poisoning. 

There are various circumstances incidentally noticed in the 
course of this extensive work, which possess an interest indepen« 
dent of their immediate connection with its chief object One 
of these, as of great importance in regard to pharmacy, we think 
it proper to extract. The great inertness of the extract of ac- 
cooite, as procured from the shops of the best apothecaries of 
Paris, and of many other extracts, prepared by making a strong 
decoction of the plant, and evaporating it at a high temperature, 
led M. Orfila to make experiments, with the view of investi** 
gating the circumstance, and he found, 

1//, That certain extracts prepared by expressing the juice of 
the recent vegetable, and evaporating it in the water-bath, are 
infinitely more active than those obtamed in any other way. 

S<f, That they are of a yellow colour, strikingly different from 
the black colour of those found in commerce, which is produced 
by the decomposition of the substance. 

Si{, That the extracts of these plants, as found in commerce, 
difier remarkably from each other in regard to their action on 
the animal economy, and that there are many which are pps- 
sessed of no virtue whatever. 



II. 

A General System of Toxicology , or a Treatise on Poisons, drawn 
from the Mineral, Vegetable, and Animal Kingdoms, con^ 
iideredas to their relations with Physiology, Pathology, andMe- 
dical Jurisprudence. By M. P. Okfila, M. D. (Translated 
from the French.) Vol. I. Part I. London, 18I5* 8vo. pp. 3i6« 

Vjl^B notice this merely tQ advertLie the translation of Qrfila'a 

^^^ work, of which we understand a second part has been 

published, and to express our hope, that notwithstanding the little 



1B17. QrfBst nrM ia Potsms. 817 



gtwen to tranditions from the French, it may 
||^ com p l e tedt and to reoomqvenid it to those who have not 
il^oess. to the originar; and we trust that it is sufficient to say, 
that. we have no work on the sufajtet in the Enj(lish language, 
which can in any reiqpect compare with it. ^ 



€)burwiti€m m ikepr^eeted BiH for reariOing the Pradiee of 
Surgery and lUdwiferj to Members of the Royal CoUeget of 
Jjondon^ Ediniurgh, and Dublin ; and to Army or Navy Surm 
geons: mih some Modifications proposed^ by which the Me&m 
Ptre vriU be more compatible with the true interests of the Pub" 
Up : and not cppresstoe to the present Race of Pypils Jbr the 
PhfesAm\ By a Oemeral I^AACifiTioKEB. London. 8vo/ 
' ppJ 31'. 

Ws have hitherto declm<3d entering into any discussion of 
the variolis propositions for Medical Reform^ because 
w^.cpiisidtfed them merely as idle speculations, generairy origi- 
Hitting^ in interested views, personfd or corporate, in the prcjeo- 
tQiTy.fis jBvinoed by his evident desire to bring down to his own 
level aU tfie danesof the profession above him, while he is no 
Il9s careful to contrive insuperable barriers to prevent any of a 
lower dass from rising to be his eonal. But, when we find hia 
l^^alCf% ministers legislating for the profession, — ^when medical 
r^fiMrm is no lon^ a speculative, but has become a practical 
qpesdonof vital importance^ it is no lonser proper to remain si- 
lept. At the same time, we must honesSy declare, that we are 
neither prepared, nor have we leisure at present, to enter fully 
into the very wide and intricate field of inquiiy before us. The 
itftore of our [nrofesnon is suchf that its reffdlation, even when 
the sdgect is considered abstractly, is involved in peculiar dif- 
fipilties ; bat, complicated as it is with the jarring rights of cor- 
porationB and individuals, and the iocoiigrubo^ usages and pre- 
jodiccai of various pla^sesi we can hardly determine upon the 
ooors6 we should fouow to unravel the matter. 

It is, however, evident, that the primai^ ot^ect of all 1^^- 
IkA^indndisg tne r^uliition of the me£cid profession, is ike 

TOU XIII. If o. 50. p 



fiia ObseppaUom on BM for rtstriiting April 

good of the ccyinmQnity at large, and that the rights and infee^ 
rests of individuals are to be held as entirely subservient to* itr 
This leading muxim is more true in regard to our profession 
than perhaps in regard to any other^ as the chief effect of mo* 
nopoly or privilege conferred upon certain penons exercising^ 
other professions, is to operate as a kind of tax, rendering the 
article in demand somewhat higher priced ; but eveiy rqphtion 
or law which has any tendency to prevent the free exerciee of 
medical skill, or to diminish the amount of that skill, brought, 
as it were, into the market, affects not the purses, but the health 
and lives of his Majest/s liege-subjects. As vested or ac^ired 
rights are justly held to be sacred, it may often be less oppress 
sive to the community to allow a monopoly to continue in oth^ 
professions, though its existence be a matter of r^ret^ than ta 
bay it up from those who possess it ; but, in regard to the rae- 
di^ profession it is qaite otherwise, and wherever cdrporatioa* 
rights and privileges siand in the way of the public good, they 
should be abolished, restricted, or modified, and their posses* 
sors indemnified for the loss they may sustain. But, if this pp* 
sition be well-founiled in general, it cannot be disputed that na 
new privilege should be granted, no new enactment made» 
which has, or may have, the effect of favouring any class of tfce 
profession, except as a means of benefiting the public. 

By these observations, we are* far from meaning that the 
practice of the healing art abould be exempted from all restric-. 
tions,. or that its exercise should be thrown open indiscriminate- 
ly to all who might venture upon it ; for there* is perhaps no- 
profession which, in the hands of the ignorant, h s^ hurtliil, or 
where the public are so apt to err in judging of the merits of in* 
dlviduals. It is upon these grounds that the erection of rovat 
colleges, and of privileged nodical corporations,- and the rignta* 
acauired from academic honours, are rational and expedient % 
and if the titles connected with them went no farther thantopoint 
out to the public those individuals of the profession who were. 
sufficiently skilful to exercise it benefioiaUv, muc^ good, and no 
evil, would arise from their instituticm. But, when the rif^ts ao» 
quired from any of these sources become excludve, it is Irauglit 
with daiiger to the community^ and is frequently oppressive IB- 
regard to individuals. 

The pamphlet before us contains many strong objections to 
a bill introduced in the last Session of Parliament, for reffulat-^ 
ing the practice of surgery, which we thought of so mudi im*. 

Eortance that we reprinted it in our last number, to render it 
nown to the profession at large. 
The object of the bill is to restraiui by laW| ignorant and iii^- 



Itlt^ thePraeike of Surgery and Midrnftry. 2 19 

CBpeblefteTBObs from prflctteiiig surgery, Whei-eby, it is said, thc^ 
health 4>t' greit numbers oF peltons is mdch injured, arid the 
Kveft of many defltroyed. Theiheans by which it is'prbf)osed 
that this derirabie end should be attained, are, to give a mondpo* 
ly of the practioe of surgery, for ]ocre and profiti' to persons who 
soall have been personally examined as to then- qualiBcations 
and fitness thereto, by one of the Royal Coll<^ of Surgeons of 
London, Edinfoursh, or Dublin j and obtainecf from it a testimo-' 
Bial of their knowledge and ability to practise surgery, having 
paid the usual fee, and to persons who shall have been duly exa« 
mined, and shall have obtained a testimonial as a principal sur« 
geon in his Majesty's army or navy, and ' shall have actually' 
aerved in that capacity, and the same individuals are the only 
maUi to be permitted to practice midwifery. - ' 

Upon these provisions, iUe Obstrvatiuns before us are jiid!^' 
cioas, and deserving of the ntotice of our legislators, before ^ey^' 
sanction a measure which we fear will have no other effect than' 
to increase the power and enrich the treasuries of the Royal Col-' 
leges of Suxveons. It is ho doubt extremely plau^tible that the 
skiItU only Miould have a right to exercise a profession of ,so 
great difficulty, and affecting so materially the lives anti bc>di6d- 
ci hta Id^jesty's Kege-subjects ; and that, as the public in general,* 
and Ibe lower chmes in particulafi are very incoinpcteiit jiulges* 
of professional attainmenea^ ^me* criterion of these shnulti be' 
estabiiahed : and that no better criterion din be devised than an' 
examination by tlM>se who ^ are 'the best jud^ex of pror^hsibnal 
merit Bat we aro firmly convinced, that it is imposi^ible, by 
any regnlaitions, to prevent the ignorant from practising surp;ory ' 
to a certain ext^t. We can scarcely conceive a ^rtntcr en-' 
croachmenton Uie natural rights^ of man, than to prevent, by 
law, a perton requiring surgical assistance, from obtaining it 
whefcver he can ; or, wb^n he has the power of soiocttn^ his 
surffical' assistant, to prqvont hitn from exercising his juclgnunt 
or discredon in the selection, it is needles'- to state imagiiiary 
cases of hardship, oppression, and cruelty, which miuht rt\su(t.' 
We preler resting the argument upon the violation o( u natural 
and iudetieasiUe ri^t. in the same manner, it woulJ be con- 
traiy to justice and humanity to prevent any pers^on from giv- 
ing aasistancein asurgical case, when it was required or .soiicit-* 
ed, especially if such person was* able to give it in reahty, - 
tibough not qoidified by law, and If no better, or, at let'st, no 
Other immediate assistance Was to be had. It will be stated, in 
reply yi that the law. is not i^ended to pre^'ent any person from 
* occaaooal surgical assistance, or, in fact, from rendering 
ii^hkli humaBiij reqoires; but only to prevent ignorant 



•00^ dbsmMOhtuonBaififralnetii^ Apnk 



penmift from ezerdsiiy the profeMM qf mxmerym^nmMof 
livdiiiood. In this view, it is materkd to otetmmM whife M 
meant bv the practice of soivery, whether it is moMlsBrtood to' 
inchKJle oleediog, cuppii^, cfeaninff and pnUinff teeth, e xtr acfc ^ 
ing cofnsy paring nailsi syrin^g the ears, or & application of 
^e-salves. atad cancer remedies i in short, ail those mmor o|m>. 
nitioos which are sometimes performed by the educaitd suigete^- 
tiut.are commonly declined bv him as dierogatory to hk di^iky,f 
end are executed with mat deKteritj by a lower daas of prao» 
tJtipnersy ^ho devote theinselves almost ezdusiiiely to one or* 
otb^ of them, or are seized upon by the empiric or nostrum* 
Vender ; or, if the meaning of the wocdsi pfactipe^of amrgery^ ia 
to be limited to ths^ operations which are the pedili^ pro- 
vince of the well-educated surgeon* If the kitter intergtretatiomt 
lie adopted, we are convinced Uiat tiie restrictions of the act ire 
altogiHner unnecessary } for such impottantoperatioDs are, e9b» 
oiSpt by a few hereditary bone^setteni never attempted bj' 
persons who do not possess ertough of surgical knowledge^ 
to pass an examination before theJEloyal Cdl^ges* Inde^* 
country practitioners, even when qiHilified hjr the tk)iaession of > 
i| diploma^ are very much diBposed to save memsaves from iun 
curring the responsibility, by sending patients requiring operas 
tion- to the nearest hoqpital, or even to, die metropolis. Those- 
who practise the higher department of suigery, either abeadjr* 
possjBSs diplomas, or mightr obtain thefti, unless their coline o& 
study has been such as not exactly to fdfil the bye-laws of the* 
colleges. In either case^ compelling than to take out diplomas: 
will not have the effect of restraining the iffnoraqi'or inrapaUe^/ 
ot of incr^asine the quantity of soigical skill difiused over the- 
country, but win have the very opposite eftect» of lessening the 
utimber of able and competent surgeons^ or of patttng^ ificm tor* 
unnecessary and oppressive expences, Which they must reeovdr 
l>y incrcasting their charges upon dieir patients. As* to* Ae few 
faone-s^ters to be found in several.p^ of the oountmiliey^ 
c6mm(5nly confine themselves to the treatment of eeetiliii aect^ 
dents, in which, from practice, they heve become dexteroes^ ariff 
as the Roval Colleges do not n<m ikiterfere with them; or ifae 
venders of surgical nostrums, ^ven when thdr power ei^teiidrlo 
theni, there is no probability tj>at thi^:will think them more dr* 
serjmg of^heir notice^ after the passing of the new vtL 

\\e shall next consicjcr the propoMl rHtrktM 9M iatendei/ 
to ^tend to the jower departftientof surgery. The peo|H)si«idie^ 
is monstrous. Evesi in. the: metropstsv it would ittepiite the* 
public of the s^vices gf ihfi most dexterous ciippen^ 
arid chiropedis^,, «Bd it) iW .rsmolet pactB c^ the 



itti; iheFhteiktofSurg&y^ndMidittfefy. S£l 

would acmet&neB depiife the people nf the only surgiGal aid 
wUbin their rttch $ tad in the instance of eome dperanons^ by 
grrkig a monopoly of them to those who will not condescend 
to per&fm them, and by restraining those willing to perform 
ibgmf k win amount to an absolute prohibition. 

But tiieact is directed against the ignorant and incapable, pn- 
kr when practismg surgery for lucre oirprofiif Upon this qualir 
ncalion we shall only dbserve, that we have heard of a Reverend 
M. D. m^o enjoyed great rq^ntation, and received a very hand* 
some income inprtserUs^ so long as he dedin^ taking tet^ but 
who lost both, when he could no longer re^t the temptatiop of 
tuofoey pressed upon him. * At any rate, such a modincation is 
easily rendered altogether nugatory, and could only operate in 
preventing such unqualified person from recovering payment 
m a court of law. 

So for as mere surgery is concerned, the act will ther^i;^ be 
dmost nugatory, or oppressive only upon individualf ; that is» 
it wiH have no eflfect in restraining the ignprapt from doing all 
that diirjr do at present, idthough it may comp^ persons capable 
of payBsinff the examination to pay the coUeff^e fees, however un« 
able, and that without any advantage, eimer|to themsdves c^ 
^public. 

With regard to the practice of midwiferv, the bOl leaves it vi 
be exercised bv any woman, no matter pow ignorant ^r in« 
capdble^ as if the difference of sex in the person ^y whom mi 
injury is committed, should have an eifect in rendering the in- 
juxy Iq^ or illegaL In the next place, it concedes the prac- 
tice jU> a class of the profes8ioI^ who are not particularly called 
iqpon to study it,-*«who undergo no examination as to their know* 
ledge .of it, — and many of whom, the naval surgeons especjaOvt 
firom the very nature of the siervioe from which their rigiii 
is derived, have had little opportunity of practicing it. And, lastp- 
ly, ^us bUl, under pretence of restraining the ignorant and in* 
capable from practising surgery, interdicts the practice of mid- 
wifery tO'What the law considers as the most learned and able 
dass of the profession, because^ forsooth, surgical aid is frecnient- 
]y required. By the same argument, the treatment of fevers^ 
and bf all inflaihmatory diseases, internal as well a^ externa], ii^ 
vrfaich bleeding is almost indisjpensable, — of dropsies, in which 
tapping or scarifying is Occasionally resorted to, — in short, pf 
all diseases whatever,— might be prohibited to all physicians. 
Unless oufdi^ed by a sumcal diploma. ** It. is underst<K>d, that 
the Rc^al CoHege of Physicians ot* London dedine licensing 
any mdre of t^eir men^bers in midwifery, and any interference 
iktti the obsteric art.*^ If the author of the Observations be 



288 Obunatiam w Bill/vr ruirieiing Apifl 

correct in this Btatement, aod if the Fellows of the LoBdkm.CoI* 
k^ are so vain as to think themselves degraded by any assoda* 
tion with suoh men as Hunter, Denman, and Clarke« the sister 
collates in Dublin and Edinburgh must protect themselves, and 
the universities defend the rights of their graduates. In Gdin*- 
bnrgb the male practice of midwifery is almost exdusively con* 
fine^ to members of the Royal College of Physicians, in' Dub- 
lin we believe it is the same. The practice of midwifery is one 
of the chief sources oi professional income of physicians ever 
the country \ and we should think it necessary fi>r the fraaer of 
the.biil to prove, that^the health of great numbers of persons is 
much injured, and the lives of many destroyed, by their igno- 
rance and incapability, before such an invasion of their rights 
as that proposed, should receive the sanction of the Legislature. 
If this were a mere coq)oration question. Whether the practice of. 
midivifery should be in the hands of the physicians or surgeons ? 
we should care very little about it $ but a much more material 
consideration is, that the proposed bill will deprive the pnUio 
of the assistance of a large proportion of the weU-qualified of- 
cot/c^n/r^,— that is, of all those physicians who do not this^ 
themselves degraded by the practice of midwifery,- and who, it 
cannot be denied, are fully competent to give all the surgical 
i^ssistance its practice requires. 

3ut tlie greatest ol^ection which we have to this .bill, and^ 
que which, in our opinion, alone ought to cause it to be defeat-' 
ed, is its giving to the Royal Colleges of Surgeons, which in 
fact . are mere local corporations, or are ingrafted upon local 
corporations, the extraordinary power of Ic^slating for the 
general practice of the healing art. In its terms, indeed, it 
grants the monopoly only in Surgertft but as the public have 
round it expedient to employ, upon almost every occasions ^ 
general practuioners^ a class of the profession not recognised 
by law,— as the Colleges of Physicians interdict their members. 
from practising surgery, and do not prevent the surgeons from . 

5)racti8ing medicine,— it is evident that those who have diplomas- 
rom the Colleges of Surgeons, and are thereby authoriased to 
practise Mirgt'vy, are best qualified to become general practi* 
tioners ; and accordingly surgeons have become possessed of 
the largest share of the practice of medicine, even in the 
metropolis, (rom this usage, we do not think the public 
suiTt r any ii\jury, but, on the contrary, derive great bcaieBt ; 
although these surgeons have not b€«n examined aa to their 
skill in medicine. It is, however, from considering the siu> 
ffeons as the best general practitioners, that we have insupenK 
ble objections to increasing the power of the corporatioBSi ani^. 



t 



16 17« the Bmetke tf Surgery end Mideoifery. 2^ 

cf nanrowiBg Ike monMoly. If the bill we are examining is 
la ha've any effect, it •will subject the whole general practitioners* 
of die empire to such regulatioDs and bye^ws as the CoUeges 
of Surgeons choose to enact, to undergo such examinations, and 
wX sack times at they may determine,— «ven^ qualify themselves 
by such a course of stedy, and at such places, and under such 
masters, as they may fix upon, and to pay such fees as they 
may exact. It would betray an utter ignorance of the in* 
Aien<;e of corporation spirit on men, liberal and enlightened 
as indiTidualSt not to foresee that such powers may Jead to 
great abuse ^mid serious evils, for which, at the same time, 
▼ery plausible reasons may be easily alleged. If a high fee be re- 
quired, it will be said to render the profession more respectable ; 
or, if a member of sudi corporation, whom it is wishbd to support, 
' re lectnreson any subject connected with the profession, it may 
alleged, that, rendering attendance upon lectures on that sub- 
t ifioispeiMable, will improve the education of the candidate. 
e will not, for a moment, suspect any respectable corporation 
capable of wilfully framing their enactments so as to favour 
their own teachers, to the exclusion of others, whose lectures 
are equally instructive, but diffisr in some insignificant point of 
fonn. Yet it might iiappen, and a pretext would not be want- 
ing. We are, therefeffe, decidedly of opinion, that the quali- 
fications necessary .for ^becoming a xandidate, and the amount 
of fee to be paid on receivinga diploma, should beiixed by the 
same enactment jsrhich grants the monopoly. 

To return : It seems quite inconsistent, that legislative pro* 
teotion should be given to the public, in regard to that branch 
ef our profession, in which ignorance and incapacity can do 
least harm I for the cases in which surgical aid is necessary 
War no comparison, in point of number, with those where medi- 
cal aid is required. Besides, ignorance and incapacity in surgery 
cannot Jie concealed, and are thus prevented irom doing ex- 
tensive injury, while there is absolutely no criterion of skill in 
the practice of medictne, except education, examination, and 
the esteem of the professioiv U is from ignorance in medicine 
that << the health of great numbers of persons is much injured^ 
and the lives of many destroyed;" but what would be thought 
iX a proposal to hive it enacted, *« that it shall not be kwful 
lor any person to practise medicine for lucre or profit, unless 
he shidl have been personally examined as to his ipiaiifications 
and fitness thereto^ by the Royal CoU^ of Physicians in Lon-^ 
^oOf Edinburgh, or Dublin $ and unless he shsJl have received 
a d^ifomay or testimonial of his knowledse and ability to pruc- 
iM ne^nef under the seal of lbs fioyalCoUege before whoni 



«M Ohkrv^hmm BVIM rmtfM^ Apiil 



■ndi cxBiQiD^tion thall bate beta inidi> S» ^MA < 
testimonial, the ntual fee, and no more^ ebaU be < 
and receiyed." Now, as die Colleges of Pimk 
only those who have reoeiTed the degree M. B«, or M* D. in 
an university, it is evident that the injniy of this monopoly to 
^e public would be incalculable, and yet the reasons for pasa* 
log such a bill, are much stronger than for that before us. Ja 
place of attempting to guard the public against the evils oC 
Ignorance and incapacity, in those who are fwndidatiPB for gene^ 
m practice, by rendering a knowledge of surgery the only 
criterion by which they are to beju(%ed, letit atoncebai^ 
cognised by the l^dature, that cmers than physicians maj 
Ugalfy practise meuidnef, and let the education and fflramiha^ 
don for a surgeon, or rather what we would call a general 
practitioner, have a reference to medicine, as well as midwifery 
and surffery. 

Decided enemies to all monopolies, the necessily of wfaich 
may be questioned, and friends to usefid competition, we ap- 
prove of that clause of the bill before us, which opens a fim 
competition among the several Royal Cdkges, and leaves the 
candidate for meoical practice, in any part of the empirSf to 
obtain his diploma from anyone of them.* TUs oompetitaoii 
promises e&ctually to prevent Uie introduction of v^ op- 
inresttve relations, at the same time it is liable to the ob^ 
jection, that the several colleges may diffiar v)ery much in the 
qualifications required for getting a diploma, ana the ign<R«na 
will soon find out where they run least risk of being rqeeted* 

The last observation we have to make In rifiud to die hiB 
itself is, that it imposes no penalties for conttmvening its enact- 
ments. 

Upon the whole, we are convinced, that tbisbiO will nerer be 
enforced, S9 as to have any elect in restraiiiing knqrant and in* 
ciipaUe persons from practising surgery ; btit that it may, and 
if it become a law, probably will, bei carried into e^^ so for as 
to render the education of a eeneral practitioner moiw o^Mii* 
aive, and, of course, reduce thcSr number, an^ deprive the poe^ 
^r, and more thinly inhabited-parts of the coui^, of ffgdar 
professional assistance altogether. 

We hkye the authority dP the Stadstkal Account of ^ooflaml^ 
that, when it was wriliten, there were whote districts a|id isiandk 
without a resident medidsl practitioner. But the argmneni 
whidh such a stated of the country would h^ve fomiUied mi, ean- 
pot now be urged with candotir,' when s6'many' able candidates 
for practice Imdw not w&eretb MA a snbaisteBoe. B«lf bp!the 
tthtfr hand, this Mas tf mikAMvoAm'^ UB at pment 



m9n aePrMiaof8$irgm9ttfaMiim^ay. JtS 

awtrnflkilfnl loesay aiid of imdeniable jBerme to ihe pobiiiv 
wb0 can r^tam any nnctioey smgiGal or medical^ against snoh a 
hoit of weD-edocatea rivals. 



IV. 

A Vindication of the Univenitjf of Edinburgh, (as a School of 
4fmcinejfrpm the ^Vcrsiom of *^ a Manlier of the Univer^ 
dtjfof Oxfordr With Metnarh on Medical Reform^ Bj 
(iAWso^ WhallbTi M.D. 8ic. Laucii9ter, 1816. pp. 49. 

WB flhoold neferiwTe haard of tfie attadc upon oar! Alma 
MateTy if this satb&ctory vindication had notiaUen^in 
our way s bat the charges against it^ as reported by Dr Wl^lley, 
are of so carioos a nature, that we are tempted to reprint did 
extracts he has made from the production of this unworthy mem- 
ber of die University of Oxford. 

^< The Oxonian commences by ^yinf 9 ^ it vAg^t patar^lly hav^ 
been expected that the morbid tendency of the present gcneratiob'io 
^onn, wonld hare Ir^iTed such a dheck from the dreadful examples 
that haye exhibited themsdves in aiaoy situations, as at least to deter 
dm pr'adent' from dangerous attempts. Those examples, it' is true^ 
baTe.bsNi chiefly displayed by political reloripersj they hare run 
Unst eeunsi their day is past^ and most of them hacre ^pjerisaced the 
lot ikty de^^rved. There is, howeter, a ^gn of t^e ^m^, 9 pqrtpii- 
touB contempt of the great nuisters of ancient genius^ which xx^^ me 
suspect that the political reformer has only changed his garb ; tl^t he 
^aa descended from palaces and courts^ to colleges and aGidemieS| 
plily'to play asurer game.^" p. i. 

What the writer means by the << portentous contempt of die 
great masters of ancient genius^f we cannot divine. All that we 
bam from the whde paragraph is, that the Oxonian b an in* 
discriminate enemy to all reform, probably because he feels con«- 
scions, that he is, by the present state of thirigs, placed above 
his level, and would su&r by any reform, and that be consider^ 
^erv reformer a» a Jacobin. 6ut bigots of this description 
Iturdur do i^ot ^ect, t))at ministers are petpetuially employe 
^ WA^ they considfer reform, iflii our Q^cpnian, (we oo noi 
use ^ teirm wijh th^ fi^yir of qpeaking co4i:emptqQu$ly of kii 
PjimKlyfliBr. whii4& m oatartfwi high Miogp of mpectt but 



fits Dr Lawaon Whdle^s FiniietaiM bfthe Aptik 



as tlie mfy denominatian by which we can easily avoid cotifii«' 
•ion between him and our authori Dr Whaliey,) jnoflt set down* 
as a ranic demagogue^ the present Attorney Oenend, who has 
undertaken to reform the practice of surgery* But with this the 
University of Edinburgh has nothing to do» as it Q^ther pro- 
jected nor supported any of the late wild and impracticable 
schemes of medfical reform. 

The first charge against Edinburgh is, that its school is mo- 
dem. We cannot deny it f and if this circumstance should ap- 
pear to any a matter of importance, Eklinburgh still may boast^ 
that it is tbe oldest medical school in the British Empire. 

The next charge is of a more serious nature. There is no 
University, but only a school at Edinburgh, and the teaching is 
elementary, and the students rabble. 

*• **In the School of Edinburgh, for it is miscsHed an UniTcrsiCy, 
the tcachiog is elementary, sdaptcd to the understanding of those who 
have had little prevaoiis iastructien ; and, indeed, whoever has sat 
among the rabble attending the anatomy class^ or has seen the classes, 
as they are called, let loose from the several lectures of the College of 
Edinburgh, must instantly be aware of the necessity of the insiruction 
being placed upon this footing.' *' p. 15. 

Is this pretended Oxonian, for we begin to suspect he is a 
very revolutionist in disguise, — is be really so ignoran^ ap not to 
know, that the L^islature of Gr<:at Britain ha^, ever since th^ 
tJnion, recognised the University of Edinburgh equally with 
Oxford* in every act regarding such institutions i . 

For his further edification, and as a matter of curiosity, wa 
reprint the following extract from an act of the Parliament of 
Scotland, dated 4th August 1621, ratifying the charter granted 
to the University of Ii^nburgh by James VI., on the Uth of 
April 1582. 

« Lykas his Bfajestie, off his princlie and royale favour, and for 
guide service done to him be the saids provost, bailzies, counsall, and 
communitie of the said blirgh of Edinburgh ; and for their further 
encouragement in repairing and reedifying of the said colledge, and 
piscfaig thairin sufficient professors, for teaching of ali liberal sdenoes^ 
ordaining the said col ledge, in all time to come, to lie caiiit King 
James's Colledge: And also with advice of the saids estaitis, hes of 
new sgain given, grantit, and dispouit to thame, and their successors, 
in favours in the said burgh of Ediobor^ patrouns pf the said coU 
lodge, and of the said col ledge, and of the rectors^ regcntis, burs^fis, 
and students within the samcn, all liberties, freedoms, immunities, and 
privileges appertaining to ane free colledge, and that in als ample 
forme and lairge manner as any colMgehos or bruikes within this his 
Majestie's realme: And gif ne^ beis, ordains ape new charter to b^ 
ejcpede, under hh Hienes great sealoi f or erectbg of die said colledgsi 



181V. VnhmUf^fEdMvrgK SST 

witb all UberlMS^ priTiI^gBS, snd inmraoldet qlk my €olladf(e withitf 
Hm fealme bntikiSi joises, or to the nunen ts kmwtii to apiiertain^'* 

"We Admit tkat, in the Uniyersity of Edinburgh, there is a 
real and effectiye school of medicine, which our &oniian seems 
to consider as a proof that it never enjoyed the rank of an Uni- 
Tersity, or, at least, that it should be disfranchised. We confess 
that die teaching is elementary, and adapted to the understand* 
ing of those wno have had little previous instruction ; and 
such we conceive, that the teaching of every thing to those who 
commence its study ought to be, even to the gownsmen of Ox- 
ford as well as the rabble of Edinburgh. This rabble, we are also 
proud to add, is no less remarkable for general propriety of con- 
duct, than for zeal in the acquisition of professional knowledge. 

Another charge is, that, at Eklinburgh, the medical education 
may be finished by graduation in three years. We might an« 
swer, that at Oxford it is never b^un* The reproach of the 
shortness of the period required to get a degree in Edinburghf 
eomjpared with that required in the English Universities, we 
have often heard, but it is not altogether well-founded ; for in 
the English Universities, the period is reckonec) from the first 
enrolment of the student' at an University, whereas, in Edin? 
burgh, it is firom their bq^inning to study medicine ; and if to the 
three or more years of professional study were to be added the 
time previously spent in the study of literature and philosophy, it 
would be found, that m^ny of the E!dinburgh graduates had had 
as long, and evei^ a longer course of academical InstructioUf 
than what is su^cient to obtain the degree of M.B. in the Engw 
lish Universities. 

But our Oxonian seems to question the right of the Univer« 
i^ity of ^inburgb to grant degrees. 

<* liondon has more anatoinical advantages and better cbirargica! 
means of instruction than Edinburgh ; bat it wants the same show of 
a sanction, thodgh I believe degrees conferred by the different physi* 
cians of the hos^tals of London, i^oold be equally legal.*' p. 27. 

Edinbm^h, a^ well as {jondon* afibrds excelleqt of^xurtunitiea 
qt studying anatomy and surgery $ but the idea of the physidana 
of the London hospitals granting d^ees is so excessively ab-! 
surd, Aat it would be wasting time to comment upon it. 

This Oxonian also seems to pride himself upon the attain* 
ments necessary to undergo the examination of a candidate be- 
fore the Royal College of Physicians of London, akhougfa, in 
comparing ^ford and Edinbtirgh degrees, the comparison 
should have been of the examination before the universityt when^ 
we appreh^nd,» the advantage woul4 lutye appeared on the sid^ 
^ftEdlnbiirgh. 



DrUwiotalinU^'ftFMyMl&M^fAe ilpiil 



V Tlili eiamiaatlon is perlnpftOM of ^ aotl aid^ote HMt caa te 
knposMl. For three set^rmi dajrs tlio cuididala is ^aMtionsd in LMm^ 

Jranc 1C3 of mejfical sofsncfi, fnd i^T'cp ;* J^ ^^W W.4W 
K^owled<:(e of Greek hlcratare, bj remiiff pM^icIy and ^extern p9f|,- 
iiieou8ly difficult passages of Aretaeds, or some otKer ^eidical classic*' 

p. 3, *. * " I ., .-» ^, .. .... 

Wc believe that the graduate of Edinb^rgl^ uxfdfifipl^ Hifi 
Tery same examination for his licensey with U^e e;u>4)tii?Q of |io;t 
being allowed to shew his knowledge pf Greelc j f^r it isjilut^pctJv 
in our remembrance, ^at» upon one occasiop; in^by orto^ ^ 
centiatesi feeling hurt at the title of p/uf docti fssumed \^y tti^ 
Fellows, prayed to bie examined in regard to tl^^rjikiill in jOje 
Greek tongue, and ^erc refused. The ifSetpi^f:/^ jU pb?M?i^ 

Another dreadful stain upon the £dinbi|x]|^ dejp^ is^ tJ^ 
the education required for it is pot su£ScieiltIv e^^^iye to pi^ 
Tent aD but the wealthy from obtaining it^ th«t |t sm^Be3 ^ 
less opulent parts of the empire and the cobpjies w jytb physic^ns $ 
and nnally, that Scotch doctors often dis^p/ce ^ tit]je by cqa* 
descending to give their professional assistance tp those in^ 
txpoBe themselves to the dangers of dimate fH)^ pi W^p i^ tw 
service of their country I 

^ $uch schools, (alladiQg to Edipbnrgh,) }n Hfi pnfiinii ef$tf^ 
spate of colonization, and martial temper of the i9ffMP^ §^^ heODisg^ 
absolutely r^qaisitc. Were the school pf Ediiflf^rgb p^ th^ f^^^K 
4lt the English universities, few would be the lappiijrers giving ffUf to 
ksrtflst. For what highly accomplished physickn would^ deda^ 
sit down to be frosen in Newfoundland, Hudson s Bay^ W the pr)tr 



aeys, or broiled for a pittance in the West Indies, orstafyed in a 1}^ 
dirty Scotch, Irish, .or Welsh borough, or waste Bis health, bis vigour, 
and his talents, amoagst the outcasts and couf icis of New UollaMf 
fcr. be" p. 35. 

^^ It is well kuowQ, also^ that Scotch duciors oftei) become s|Sf« 
geons in the army and nsTy. Now, no such instapq^ yas pr^f ^ov^ 
of an Oxford or (Cambridge doctor, and indeed it Ifoo^'d 1^ a degra- 
dation,' as the English aniTersities in their doct9|rate give a rankmppvo 
colonels in the army, or capUins of ships.'* p. 88. 

' We bate more of this nonsense about rank, ^ if die respecft- 
ftbiliqr of a physician were independent of his!)adiyidual ^haraCr 
ter and attainments. - . • - 

. ^^^^^.Pkj**^'?^ *WWr, i?WtRecpiSfrjly«i«ocmc 7^E«- 
Ush Upfvefsities m^ ^raQt lM»nses u^ prapti^ to if^stei? jrf Aff^ 
JSj^tlemen w)io pr^tise p|i saph \ic^nm fm PlfyjMci^, m| lif/^ 
wnk IS Uie j«in^ a?, thatfjf BarrTs.t^q^ ^pfewfl^^^ 
)fank as Esquires. But in order to give QUgouy to sp Ic^rnM ua 

vefdl a jprofesdon^ itsi English Uhiversittei grant theVauk oTI^ 

19 w ....... ...... .^. 



1^1^ VahmU^qtBiMurgik «Z» 

i^ to fhoM of nskm ugfi^noi to beardless vputlis or striplings and 
4ld9 nuriL elfTate^ the indivldoal above all Lsauires not honourablet 
aaid abofoaU Field«Oflieers not Generals or Adminilai'* pp. 89, 40. 

W€ aM almoet ushamed of having wasted so Diany pagei 
inpoii this OxDiiiatt'i btrt as he is also a reformer, we must quotd 
Urn phn of #e&rniv Which has at least the merit of mmplidty. 
^ ^<^ Let Ubi Coik^e df Piiysicians sit as a quoriimi ia erer^ part oi 
£o|j1an^« wbeie ihrdefeliows can be assembled^ to grant licenses. iM 
tbfise licenses lie grantedf witbont ex pence. Let none but Engbsff 
gnwdnates practise wftbout tbeise licenses. If three fellovrs candot hi 
abembled mbntlily', In eaph countyi to examine and to' grant license^;' 
let one feHow and two M'* Ds. of Oxford* or Cambridge be a ({noruta; 
Kordi of tfie Tweedy and for the colonies; let Edinburgli and GlaSi^ 
^w graiit licenses to practise^** p. 41. 



V. 

T'ldht^Ucdl Trdhsaicfioti^ 6/ the Rcfjr^l Sdetet^ of Lond<m. 
For the, fear 1816. ^art L and tl. 4to, Loudon, 28l6. 

WB musl coDfea^, that, as. jouniftliats, we have been very 
negligent in not regularly inserting such « notice of the! 
tsdfesy «t kasty of dt the eonimtmiciitions^ relating to our plrbf^f 
sion, which are inserted in this fitet of periodical works, as migltf 
atleMtjKrve^thepaipDsesofaaindex. In the volume before 
ii|> Iw^ E. Home^ wi^ Ifiudable in4u8tryy contributes* no fewer, 
than aeven papers, chiefly on his fkvoorite subject of comparar 
tive anatpmy. 

ifo. IX.'^Sbme account 6f the feet' of diose loiitnats Whose 
progressive itiptibtl can b^ carried on in opposition to gravity^ 
pp. V4t9^\ 56V illustrated by two engni vines, 
' .XXIII. — Further' 6b643Vvations^ on the feet of animals whose 
l^rogressive motion can be; carried on i^gainst' gravity, pp. 329^ 
331.lt illttiitriitQd )>y five engravings. . 

. XXII«— Some furthar account of the fossil remains of on* 
afiimal of whidi a description was given to the Sodetp in' 18ilf^* 
pp; 318, 3fi2 ; illustrated by four engravings. 

XX.— On the forhuttiM of fhtih-theititMin^ of th^ tadpole»' 
aodon tl^ use df lixe y^Orili'tfe^fot^lAlbM <tf the'^btyd iti* 

Tfir^'df:th^fr6((h8«nb}fe1k) it consists <^ a , substance 
ih'tenhk^te lEJsftween JeQy and albumen^ upon whidi tlie'tad- 
|{6le9 ^ *^^'. 4^. ^^ is formed, seems to feed. The progressive 
^a^ge of tlbe tadpole, until it. become n-perfe^t frog^ ie coriowu. 



<< The spawn of the English frog was collected on the IMof Aprlfj- 
1810. On the 15th, the tadpole left the egg, bet the fifamenta 
or external gills were npt visible^ only a deep notch on each side, 
nearly separating the head from the body. On the S3d, the lea 
Alaments on each side were distinct ; on the 87th they disappeared* 
In June, thceaternal orifice on the left side, for the wa^r to pass off 
from the gills, was very distinct, but nune was seen oo the right. 
On July the 8th, the hind legs be^^an to appear, but the toes wero 
not separated. On the 14th of July, the hind legs were seen exter* 
Dally completely formed, and on opening the skin of the chesty, the 
fore legs were equally so ; but there was no external projection bjr 
which this could be kuown. The lungs were com,jletBly formed. 
On remofing the intestlue, there was no fat deposited on the loiiis. 
On the 16th, the contents of the intestine were roided in consider- 
able quantify. On the I8tb, the elbows of the forelegs projected 
under the external skin, and so much of the contents of the intestine 
had been voided as to give a taster form to the lower pai(.t of the body. 
On the 19th, the fore legs wi^re completely disengaged, and appeared 
externally; the mouth had become wide like that of a frog. 'Tlia^^ 
tail bad a notch at that part where it afterwacds separates ; tbe intea- 
tYne was reduced in diameter, and to the length of that of a frog ; an 
appearance of oil was seen on the loins. On the- t23d, the. tail had 
dropped off, leaving the projecting root. The animal had left the 
water and remained among the grass. : Behind the Intesthies upon tha 
loins were several small membrauons appendages in an empty state. 
. ** On the ^th, tbe root of the tail had wholly disapjieared ; tlia 
appendages had become more oiiaque.*' 

- An examination of tbe tadpole of the Snrinan frog, from its 
aize, permitted some circamatanpea to be more accurately ob* 



^* Upon examining the tadpole of tha cana pandoza, jnst when 
ihe hind feet ap|)ear externally, I found the month very small^ and 
ikearly round, the teeth cnticular, the upper ones oTerlapping the 
under, the o&sophagus, stomach, and intestine, forming one uniform* • 
ly continued canal, which passed down'to the lower part of the 
abdomen ; it was bent upon itself^ passed np again, and then made a 
.great number of coils in a circnkir form; its coats were Tery firm, 
its capacity very small: lliere were throe gills completely enclosed 
<|n each side, and a little way below the eye on the left side, a amaU 
round orifice, for the water, by which the gills are supplied, to pass . 
out ; but none on the right. When the tadpole is arrived at its hiW 
growth, and the hind legs are completely formed, which takes plaoe^ 
according to Mr lasLAvo's obaervations, in 14 days after their 
first appearance, tbe cavity of the abdomen had become exceedinfely 
enlarged, th^ Intestine very capacious, its coats almost as thin m- 
cobweb : it was compU5tcty distended, through its whole extent, 
with a soft substance, which when' burnt had the smAl o.f bay. Be* 
bind the inteatiney all along the posterior part of the abdomeni a' 

11 



l«il pi^sophical Thtmacium, 1B1& 9S1 

large quantity of fat was met with of a yellow colour, enoldsed ia 
Jong^ thio, transparent merobraoous bags ; no part of tbis fat waa 
net with In the prior stages of the tadpole's growth. The lungs 
were completely formed. 

' <* Wlieo the mouth of the tadpole has been changed into that of 
the frog, and the fore legs completely protruded, but the tail remain* 
iog entire, which happens 21 days after the last mentioned change, 
the large coils of intestine were found' contracted into a canal one 
fourth of its original length ; the coats had become as firm as those 
of an artery, the external surface was corrugated, and the canal 
empty. The stomach had become a distinct cavity, and there was a 
contraction, where it terminates in the intestine. All these parti 
were embedded in fat, which filled creryr part of the abdomen, not oc- 
cupied 6y the Uver, which had acquired a large siza T-he lungg 
were filled with air, and the gilla had entirely disappeared. . 

^^ When the tail has dropped off^ leaving the projecting root, 
which' takes, place in seven days more, the only internal ohaiige met 
with was, that no fat whatever was found in the cavity of the abdo* 
men." p. 303, 4. 

From tbese facta Sir Everard condudes rather hafitily, that 
such utiusnal length of intestine is required to admit of so large 
a quantity of fat being formed in so sboit a time, and therefore 
that the intestine is the laboratory in which the fat is formed. 

The second part of tbis paper contains also some good ob* 
servations, though not very well connected \ but we do not 
quarrel with this haste to communicate to others every thing 
one beara or sees, as much information is lost by those of an 
opposite tuni of mind, withholding it from the public until it 
shall be rendered as perfect as they think it can be made, which 
of course seldom happens. 

The ova. of the frog, of the shell-«naii,. both of those 4hat 
have a shell, and those that have only a strong membraiioai 
covering, of the lobster, crayfish, prawn« sea cray-fish, and 
erab' baf e no yelk, and they contain no oil $ the ova of salmon 
and pike have no yelk, but contain a little portion of oil; the 
ova of the cartilaginous fishes, of the lizard and snake, bave^ 
lihSe the egg of the hen, a regularly formed yelk^ which consists 
principally and essentially, according to Mr Hatchett, of a. 
butyraceoua oil, combined with a small proportion of albumen. 
From these facts Sir Everard concludes, that in all ova, the 
embrvds of which, have bones, there is a certain portion of oil, 
and in:thdse whose embryos coneist entirely of soft parts, there 
is none: 

*J This conclusion is much strengthened by the peculiarity, which 
it hiia been ray object in this paper to point out, of the tadpole lay. 
Ing' up a magazine of fat before the metamorphosis into a frog takes 



^aoe $ it is, therefoi^, twieinfi pndN^blf, that a o«rtaii| pfMriioi^ <if 

oil is,. necessary for the formatiQa of bone, and that tSe proportipii 
in difl^r^it ova corresponds with th^ greater or less degree of hard* 
ness of the bones of the fcetus.*' p. 310. 

We vn%V Sir EvenxfU had pto^ecMbi thu investigatioay and 
itofonoed tkfe to whM fStote of &t the bones of the emhrfo of 
iban ahd other maViimalia owe thdf hardness^ and whence this 
fat is obtained ? 

XII. — E^tperiments and Obsery^tions to prove^ that the be- 
neficial effects of many medicines are produced through tl>e 
mediam of the' drcul^iting blood, more particularly that of the 
Colchicum autumnak upon the gout pp. 257, 262. 

XIIL— An appendix to the preceding paper, pp. 262, 265. 

It is much to be regretted, that medical men should so often 
frsosgreas the rules dH sound logic in drawing inductions, and 
tfmt they should adopt so loowly the statements from which 
tbieir concluuons are drawn, A remarkiMe Instance of bo^ 
obtruded itself upon our notice in the introduction to this paper. 

* ^* For the cung of the gout," says the Honourable Baronet, ** Hot 
eaunedicioale of Ilu8s6n has been most fortunately discoTered to bea 
specific remedy, and it is now ascertained, by experiments on diU 
fenSai people, that a Tibous infusioa of the Colchicum ^atttmnal^ of 
xpeadow saffron, is equally so, and therefore the two medicines must 
be considered as the same." 

Here we have a conclusion without a fiuffor propo^tiom bu^ 
not oiily is the conduaion illogical, but the two miior pn3|)osi« 
tiotis.are fklse. 

The dau medidnale of Huslon ia iio^ a specific remedy for 
the cure of ^ut 

A vinbus mfbsidn 6f the CblchilBum autumnale is fio^ a spe^c 
remedy for the cure of gout 

Th^twojnedicines are not the same. 
For satia&ctory proof of our negative assertions, we rete- 
to Dx' Scudamore's treatise,, noticed in ottlr last number. . At the 
aamd time, ^e have no doubt of the truth of the ioidtriduiil 
fads asserted by Sir Everard, regarding the action of these t^ 
miklies* upon himselt 

As to the observation and experiments tbeiQselvesb they cwi« 
silt in an 'account of the effectaof 60 dt^pa of toe eau inedici^ 
nale on tha author himself, when under the influifrnce of a. vio- 
lent fit of the goitt, and. the history of three experiments, in one 
of which 60 drops ot the vinous infusion of colchicum (owado hgt 
infusing two pounds of the fresh roots in 24 ounces of shqny 
wine, in a gentle heat, for six days, the spfrit being p^^ufljF 
cftrried off by h^t^) were ^yen to'a'dqigi and' in £e ofbenT 4 



■1817. Philosophical Tramaetions, 1816. €SS 

wofl injected into the jugular vein, in the first in the dose of SO 
drops, diluted with a dram of water, and in the other in the 
dose of 160 drops. The smaller dose produced a tremulous mo* 
tion of the muscle and fluttering of the pulse, with some nausea. 
In H minutes the pulse increased in frequency, from 140 to 
180 in the minute, but became intermittent. In four hours it 
fltin intermitted, but had fallen in frequency to 120, and was 
of natural strength. In seven hours the pulse was in every 
respect natural; the dog had a natural stool, and appeared 
in perfect healdi. The larger dose proved fatal at the end 
of five hours, ailer having produced, first, loss of voluntary 
motion, then tremors and great debilitv, with nausea, vomiting, 
and purging, the pulse being also rendered irregular and weak» 
beating, at the end of 10 mmutes, 84 in the minute; of 20 mi- 
nutes, 60 ; in an hour 115, and in two hours 150 ; the inspira- 
tions varying in like manner, being, in 10 minutes, 40 in the 
minute, which is the natural number } in 20 minutes SO, and 
1^ hour 54. 

*< Oq opeiiiDg the body, the stomach contuned mucns tinged with 
blood, and its internal membrane was inflamed ; the duodenam had 
its internai surface unitersally inflamed, the same appearance in a less 
degree was met with in the jejunium and iliom, and more strongly 
marked in the colon than in the ilium/' p. 264. 

These experiments are sufficiently satisfactory as to the action 
of colchicom, but the importance attached to them by their au« 
thor is perfectly ridiculous. 

** If these observations shall be confirmed, they must lead us to con* 
elude, that the diflerent kinds of substances, which produce specific 
diseases, are first carried into the circulation, in the same manner as 
mineral and animal poisons, and that the medicines by which they are 
acted upon, go through the same course, before they produce their 
beneficial effects ; a material step will thus be gained in the consider, 
ation of diseases, and the modes of treating them." p. %!• 

Now we must confess, that we are at a loss to discover in what 
this material step consists, Is it in the conclusion, that spe- 
cific diseases, and their speci^c remedies, operate through the 
medium of the circulation 7 Or is it in the fact, that poisonous 
substances, such as colchicum, act in the same way, but more 
^edily, when injected into a vein, than when introduced into 
tne stomach ? As far as we can judge. Sir Everard means to 
give the merit of the latter discovery to his father-in-law, and to 
claim the former to himself. 

'< That oth^r medicines can be received into the circnlatioo, and, 
as soon as they arrive there, produce their effects upoo differ^ t parts 
of the body, is proved by experiments made by the late Mr llunier, 

VOL. XilU K0» 50. ^ 



934 Pkiynofhical Tran^iictioM^ 101(1. KptA 

^Uhougb he bad no Idea of their being uuially carried iben hefove 
they produce the difierent actioDt »o well known to follow their ezhi^ 
bttion by the mouth. He found that infusions of the foUowtog sub- 
stances recciyed into the circulation by the jugular vein, imaiadiately 
Produced the same effects which more slowly follow their being taken 
y the mouth. Infusion of opium brought on drowsiness. lofusion 
of ipecacuanha, vomiting. Jalap, Tomitingand purging. Infusion 
of rhubarl., a profuse flow ot urine. These effects ci*ascd in a few 
hourS) and appeared to have in no respect injured tbeaoimal^to health*" 
p. 968. 

We have the charity to hope that the sentence last quoted 
was written in ignorance; and yet it is a strange thing, that a 
vice-president of the Royal Society of London should be igno- 
rant, that it was not reserved for Mr Hunter to prove, that ine« 
diclnes injected into a vein, immediately produced the same ef- 
fects which morc'slowiy follow their being taken by the cnouth » 
or for himself to draw the inference, that they are usually car- 
ried into the circulation before they produce the different ac- 
tions which follow their exhibition by the mouth. Not to men- 
tion the hundreds of experiments made by Orfila, for the very 
purpose of ascertaining whether each individual poison was or 
was not absorbed and carried into the circulation, oefore it pro- 
duced its effects, of which Sir Evcrard might be perhaps really 
Ignorant, when he thought he had made so great a discovery in 
the knowledge of diseases, and their mode of treatment ; the 
opinion, that medicines taken by tlie mouth enter the circulation 
before they act, is an ancient and a common opinion. Haller,* 
in order to prove that absorption takes place from the stomach, 
says, <* Ostensum est, vim venenorum tunc potissimum operari, 
quando in ventriculo haerent, etiam belladonnas, opiiy cicutae, 
penanthes succo viroso." Haller believes the absorption even 
to commence in the mouth. ** In oleum nicotianae in os felis 
instiilatum, animalculum necat, totumque corpore, etiam cor, 
odorem veneni retinet, argumento^ in vcnas fuisae resumtmn.*' 
p. 63. 

Nor is Mr Hunter better entitled to the discovery which 
seems to be inscribed to him, for Haller occupies no less than six 
pages f of his immortal work to narrate the results of simikr 
experiments made before he wrote, and subjoins above fifty re- 
ferences to different authors ; but though we may conceive, that 
Sir Everard may not be in the habit of consulting so obsolete a 



* Elements Physiologue, Vol VI. p. 557y 4to> Bem»> 17C4. 
t Vel. I. p. «S©— 28S. 



IBin Jn^os&pMM jy^msaeiidns, 1916. iiS 

Sytk as iSidt of the learned President of the Royal Spciety of 
otliAgetl, or so hehvy ^ pabliddition as the Repertorium of 
Plouoqaet, where he would have found five long closely printed 
dOltfmtiB of l^erebcc^ oil this 9ttbject5 1^ eannot conceal our as- 
MifalMettt, tlii^ h^ shdUld be so imoi^nt of the history of the 
R^aifi«eiety<»f L6Qddn|dflvhich hehasMiiiboilouf to be !& Vice^ 
president, as not to know, that, shortly after its ibundation, 
m BoiM^'ptonMJbA ih^ petfbrrtiaiM^ df ejepeHmehts of this 
kind ; Alld' ttiBl Wtltf deruM^ pafaiii Were eVen taken to make good 
tik^iiiim of «6n)e«f its^»Wh memb^ra to the invention df inject^ 
iftg li^ O la ibt^ the r^i of fltliMnlh, Us #ell ris of transftisling 
biMd> ftottt ode atiitnii Mto aiiotberj wbfdh is a clOclffieation of 
the same ex]^meM. Rdbert Boyle was the flNt who pubHsh« 
6l all HcMMt of <« Esperittients of i^onveyiiig liquid poisons 
iiftiMdiktely into the miiss of MMd:" ^ Mr t>ldenki^g11 theii 
gave << an Account o^ the i^se tihA dtteitipts df a vftsf td con- 
vey liquors iMMdiately ifito the itiiiss of %k>dd."t Theti we 
have ** Ml Acoount of seme exp^iments of injecting liquors in- 
to the veioB of aaimals,. lately made in kaly by Stgnior Fracas^ 
aati^ iVofessor of Anatomy 4it Bi^''$ In No. 80, there is ait 
account of injecting medicated liquors into the Veifis^ together 
with the considerabk cures perfortned thereby, by Dr Fabritius 
df Dant^ic. $ Other etberittients of the saitie kihd, made at the 
game place by Dr Smith, ate mcntioiled in No. 39. || But the 
most distitict account of the origih of the discovery is in No. 35, 
by !0r. Timothy Clarck, one of nis Majesty's physicians in ordi- 
nary, f 

^ €i#«a iiiedi anhi 1*056, aut cifcHer, tnaehemsticUs ilte insignissi- 
BlttS, iXD* dfristniphevlw Wreti priifHis Itifasionciin variorum liquoram 
In MMlssaiii sangafntiam viventNiifi aiiittialitnfi eiicogitavit et Oxonii pe. 
Mgit^ Afiao saqaeotl^ via. 1657, idcdi miHi tunc 4empori9, Sanguinis 
natuiadi previi^lti indagaoti^ qass ijiM feoelM, dtiafn cotnmunicavit^ ex 
4«o Utaf[Mm (Hligeaiar addivetm liHJilsmedl etptirkaettta facidnda ma 
acciagelnm*^ p* 678. 

<* 1S/li&\ tuHh.p^ plus 4aam dti<> annoram lustra prset^ita, diligen- 
tcr in miseendts variis cum animalium viventium saaguine llqnonbus 
iuAiverlio, aee solum potulenta di versa, usqoe atl I'lbras duas, hi mas- 



* * taOit CoMidettAlbiu tonchlfig the tit«fu1ne<s of Experimental Natunl 
ftitloNffby. • By the Honourable Robert Bofle/Bsq. F.R.6. 2d edition, 4to. 
OacftMrdy 1664. Vdl. Di p. 53. 

'- JPhllMOplocal Tramactnatf Mo. 7$ Dcceaibsr 4^ iee5. VoL L p. isSi 
Do. Nv. a7« Septeinher. 1 067. ¥oU li. p. 4S0. 
fDo.Mo..3^Dfceiaberfl4>«67« Vol. )I. p. S64. . . 
[ Do. Ko« S9» SeptemUr 81, 1668. VoL III. p. 766. 
Do. No. 3Sf May rs, 1668. Vol. 11. p. 677. 



SS6 PhilQiophi€aiTrmimii^m,Wl6. Apiil 

Mm saBgoineam infundi et miteeri CQimTerioi) aed etwm flnetici^ cm- 
tbarticai dinretica, cardiaca, et opiata isto modo eihlbuerim." 
p. 677. 

The controven^ about the diacoveiy of the tranaftuocm of 
blood from one animal into another, and into nian» is notidedy 
and Boraetimea at great leogth, in Nos. 19» SO^ S2» 25, 28, SO, 
. 92, $6, 37, 42, and 5i. 

No. XXL On theatmctureof theciyataUinekiiainfiabeaand 
qoadrupeds, aa aacertained by ita action on polarised l^t Bjr 
David Brewater, LL.D. Stc. In thia paper the ingemooa 
author provea, that the crystaHine lens in fishes is not symmetri- 
cal i and that the variationa of dend^ in ita atnactnie oon^ 
spond to the diameter which forms the axis of vision. 

No. VI. Some obsenations and experimenta made cm the 
Torpedo of the Cape of Good Hope in 1812. By Jolin T. 
Todd, late suraeon of his MafesU's ship Lion. 

We quote the conclusions as drawn by the author. 

l! That the electrical discharge of this aolmal is In e^ry lespeet « 
vital action, being dependent en the life of the animal, and having a 
relation to the degree of life and to the degree of perfection of atroo* 
tare of the electrical organs. 

2. That the action of the electrical organs Is perfectly Toionlaiy. 

5. That freqaent action of the electrical orgaos is iajnrlons to the 
life of the animal ; and, if continued, deprires Uie animal of it. la 
this only an Instaoce of a kw common to all animals, that by loog-i 
continned voluotary action they are deprived of life ? Whence is tSs 
cause of the rapidity with which it takes pbure In this instance ? Or 
is it owiDg to the reaction of the shock on the animal ? 

4. That those animals, in which the nerves of the electrical brfpina 
are intersected, lose the power of communicating the shock, bvt ap- 
pear more TiTacious, and li?e longer than those In which this change 
bas not been produoMi, and In which this power Is exerted. Is the 
loss of the power of communicating the shock to ^ attributed to the 
loss of voluntary power over tbe organ ? Does this fact bear any 
analogy to the effects produced by castration In animals } 

5. Ihat the possession of one orgpm only ib sufficient to nroduoe 
the shock. 

6. That the perfect state of all the nerves of the electrical orpna 
is not necessary to prodace the shock. 

And, 7. From the whole it may be concluded, that a more Inti. 
mate relation exists between the nervous system and electrical organa 
of tbe torpedo, both as to structure and functions, than between the 
same and any organs of any animal with which we are acquainted* 
And this is particularly sho#n, 1<^, By theUtge propordon of nervea 
supplied to the electrical organs ; and, 2if , By tbe rehUlon of the ac. 
tion of the electriod organs to the life of the animalj and vjcv vers4« 
pp* 125, 120. 



1817r TrantOiHmfofiie Jfcjjfcrf Society gf Edinburgh. 287 



VI. 



Transaeiians of the Hicjfal Society of Edinburgh. VoL VIIL 
Parti. 1317. 



rVlHS same iflaaon ^hich indaoes us to give an analysis of 
-*- the papers in the Philosophical Transactions connected 
mill our profiession, renders one of the pnblication of the Royal 
Society, of this place, ezpedient, and it is even more necessary, 
as the papers wluch it contains are less generally known. The 
part before us is of great interest. Besides containing papers 
of great ingenuity ara ability, in other departments of science, 
we find the following connected with our own. 

No. VI. — Additional communications respecting the blind 
and deaf boy, James Mitchell. By John Gordon, M. D. F. R. S. 
Edin. 

VIL-*-On the Education of James Mitchell, the young man, 
bom blind and deaf. By Henry Dewar, M. D. F. R. S. Edin. 

These chiefly relate to an unsuccessful attempt to teach him * 
to read, and the proposal of another method which has not yet 
been tried. 

No. XI. — ^An anafysis of sea*water ; with observations on the 
analysis of salt-brines. By John Murray, M. D. F. R. S. Edin. 
AlV. — A general formula for the analysis of mineral waters. 
By John Murray, M. D. F. R. S. Edin. 

These papers must be carefully studied by those who are in- 
terested in chemical analysis, as the ingenious views and accu« 
rate observations found in them, do not admit of being con- 
densed into a short space. Besides pointing out various processes 
and precautions to obtain greater accuracy in the results he 
shews, that the apparent ingredients of sea^water difier accord* 
inff to the mode of analysis employed, or according to the view 
taken of Uieir supposed state of combination ; and from Sr 
Murray's remarks it is evident, that the best way of stating the 
compoeition of any mineral or saline water, is to mention the 
quantity of the elements of itfi salts. Thus, in a pint of sea* 
water of the FirUi of Forth, taken at a distance from any fresh 
wiiter, the cdements were. 

Lime, 8.9 grains. 

Magnesia, 14.8 

Sochi, 96.9 

fiulpfatttiG acidf 14,4 

Mmi#<icacid» .»7.7 

226.1 gndo^ 



23# Tr^maakm^U^ Bfi^a 9oHei^9fM^iitmgfu Afutt 

The general fonnula for tbe analysis of mineml waters pos* 
sesses so many advantages! that yre woald suggest to Dr Mur^ 
ray the propriety of printing it separately, with its application 
to each kind of mineral water, for the benefit of those who ar^ 
not Tory conversant in chemic^ opera^ons* 

No. XlII— -Account of the remarkable case of Margaret Ly- 
ally who continued in a state of sleep nearly six weeks. By the 
Reverend James Brewster^ Minister of Cnug. Commnnisalife^ 
by Dr Brewster. 

This is a very sii^^ojUr but wril anlhentieated «iae of Mnr^^ 
recurrii^ several times ifi the same individaa)| a girl of Si 
years of age, servant in a respeotabk family* 1& perioda. 
during which it lasted were, 

li/, From the momitig of Juno 27^ 1815, to die aCtemooii of 
June 80. 

24i From the morning of July 1, to the aftetnooii of July SO. 

^df From the morning of S4>tenibar 97, fifhr koms. 

4M, From the morning of October 11, fifW hours. 

This unfiutunate girl enjoyed good heidth during the femaiii- 
der of her Itfe^ to which she put a period by soickle, «a Stp 
ten^berSl, 181& 



YII. 

ObsiToationi and Inquiries infe the Naitm and Treatment qf tike 
Yellow, or Buiam Fever ^ in Jamaica, and of Cadiz ; partkufat^ 
ly in what regards its primartf cause aud a^ifff^d confUigumiS 
ptmers. Ultistroted by Casn and Diaaatiam^ mUh o vtm io 
demonstrate that it appears diwsted of those qtUdities assigned 
to it by Mr Tym, Syr J. Fellofpes, a;nd others. In a Series qf 
J^pnoirs, By £dwajm> Dovghty» Member of tk^ B^oysL 
Colkgf) oS Siyrgeooa of London, and Surgeon to the VatooB. 
London^ ISia. Svo^ pp, 989^ 



YELLOW fever, its capMs and method' of ^re, are subjects of 
such importance, and upon which the opinion of those 
aualified in every respect to j4idffe, are still so much at variance^ 
lat no apofegy is necessary lor mtrodncing to the notice of our 
readers every respectable work which treats of it. 



1S17. MrDoti^fjMtktYiamRter. SS». 

Tile piAfieadoii9 of Sir Jamies J^^Uowes and D)r Ptrm made i^ 
stroDg imptessron <m the pubRc. Many anttcontagionists were, 
conveitedy we mean among t&osc who bad not themselves wit- 
nessed the disease tdi- we may observe, that those who, uoon 
such points, form their opinion from personal observatton, 
scarcely ever alter it. We, however, who have no experience 
in this instance to appeal to, — who only know the disease from 
the writings of others, — who have not regulated .o.ar prattiec by 
our theory, and can, therefore, renonnce the one, withont re^ 
gretting the other,— we are less steady in our opinions — we Are . 
perplexed with opposite experiences, and discordant statements $ 
-—we suspend our judgment on account of -the supprteioli 61 
ciraunitances, which, ifdetail^t would perhaps have no d&ct 
in directing it ^ while, on the other hand, the minute obserc^a- 
ti<His whicn decided the opinion ofonr authorsi are either over^ 
looked by us, or undervalued. The actual observers all seem 16 
hecome pariies in the caosd; we, who never saw it, pretend to 
Judge. ; 

Upon us, therefore, we acknowledge, that the high situation, 
the great opportunities for collecting information, and the extesh 
sive personal experience of Sir James Fellowes and Dr Pym, to* 
glldier with the arguments and reasoning by which they sup« 
ported their opinion, had very great weight ^ but we williAgly 
xaceive and attend to further evidence. Mr Doughty is con* 
vinced, that contagion has little or nothing to do in the prodito^ 
tion of the fever which is so fatal in the West Indies, and iA 
l^)ams and his opinion, wfardi deserves great attention, is the 
result of considerable personal experience and observation. Hd 
arrived in Jamaica in September 1800, as a remmental assist- 
ant-surgeon, and remained there eight years. He was a staff- 
surgeon in Lord Lyndoch's brigade, on the unfortunate expedi- 
tion to Zealand ^ and he was in Cadiz during the fatal fever of 
lis 10. His opportunities for observation then have been am^ 
plcf and he has zealously taken advantage of them. Indeedt 
we are sorry to find, that he was for a time removed from the 
atrvice for a &tl# excess of zeal. Having applied to his sope- 
loot for leave to open a body at Cadiz, under peculiar cirtum- 
stowci»i» he got a refusal. 

^< Disappointedl in my wishes, aad thwarted in my endeavours to 
acquire every possible information respecting so destructive adidcase^ 
J, ia a moment of irritation, expressed i»y sentiments too warm'y, ja 
.a letter addressed to Sir James Fellowes, wHich were considered^ and 
which I now admit to be^ incompatible with military decorum. Nc* 
momortalium omnibta horu sapit. The sequel of the busiaeis was a 
dismissal from his Majesty's service." p. 89. 



2i0 MTj)a9i^tjm4keYtamMm^ : ApsiL- 

We are hajspy^ however, toleun, diatt fa^the kindbess of Sir 
James M^Gfiflor and the libeni coDsideration of die Duke of 
Yoik, he has lately been restored to the rank of ataff-siu^jeon* 

The first part of the work contains << General Obs^ yationa 
on Yellow Fever, its cause and treatment*' The second part is 
^ Memoirs of the Fever in Cadiz in 1810, illustrated by cases 
and dissections;'* and the last part is a *< Recajpitulation." 

We do not mean to enter into any detailed analysis of this 

Eublicatioo^ which is very well deserving of attentive perusal i 
ut shall content ourselves with a short extract from the Recap 
pitulation, in which the opinion of the author as to the cause of 
the disease is briefly expressed. 

*< It will be seen, from what I have stated in the two piecediDg 
parts of these memoirs, that 1 consider the general cause from whidt 
the feTers in the West Indies and Andalusia arise, to be generated by 
^ particular quality of the earth ; and that marine exhalations, pr 
marsh miastnatay are not necessary to explain the sojirce of Yellow 
JFever ; but that this order of disease may be produced where no 
marshes are to be found. 

<^ Any surface of earth exposed to a degree of heat and drouth for 
ihree or four months, equal to that which prevails between the Tro- 
pics, may, by the concentrated accumulation of that principle in 
nature, from which vegetation is produced, engender a power, which, 
in the extrication of that principle, is capable of producing fever. 
I do not by this argument mean to deny that marsh miasmaiaj or any 
other iRMima, from decomposition of vegetable and animal substances^ 
will not produce fever of the same order with the above* 

^^ in inter-tropical climates, or others, where a certain degree of 
temperature prevails, in which fevers predominate, whatever may be 
the cause, the effects I infer will be the same. 

*^ But I lay it down as a general principle, that heat and drouth do 
produce in the earth the power I have supposed ; and which power 
varies in degree from the several, circumstances of fertility, loodity^ 
and season. I repeat, in proportion to the excess of heat, 'continu* 
ance of drouth, and quality of the soil, whether by nature, or ren* 
dered so by the habitation of man, will be the relative virulfoee of 
the morbid principle. 

* ^^ In proportion to the age, sex, vigour of constitution, and tiaie of 
xesideoco within the sphere of action of the exciting cause, wUl be the 
susceptibility 'to its influence and consequent efifects predueed* 
IVhatever may be the degree of fever hence created, whether of the 
mild remitting, or most aggravated form, named Yellow or Bulamf 
I deny that it has a power of propagating itself < by a specific con- 
,tagion,' directly applied. That is, a person labouring under yellow 
or Bulam fever, in its most concentrated form, will not cbminunicatD 
the disease to another in perfect health, who, by duty or inclination^ 
remains for a short time, or during the progress of the disease^ 
M hetlier fatal or otherwise, in the samie apartment with the body so 



:l8l7i Mrlkfa^tfmaeYeBamFiver:; 241 

aibcted ; note specially if the uck person is renoTed After lits at. 
imck to an apartment beyond the sphere of action of the general 
cause, and the person in attendance has not been exposed to that same 
l^eial cause. 

<< I know, by long experienGe, that the emanations from an indi- 
l^idnal body attacked with yellow feTcr, in its most Tiolent degree, are 
seldom noxious to the seaseS) and I believe never prejudicial to the 
system, neither are they for a considerable time after the body is en- 
tiiely (iivested of the vital principle; as I have witnessed in the exa. 
mination of mora than a hundred, by dissection, who had fallen vic- 
tims to this 4isea8e. I have said contagion directly applied^ because 
I am not prepared to say, wiiether a grrat number of persons labour* 
lag under Yellow Fever, in its violent form, and crowded into an ill 
yentilated apartment* or circumscribed space, as on board of ship, 
might not create a morbid atmosphere, of power sufficient to prodnce 
6ver sui generis. At least the atmosphere, impregnated with a 
general cause, might be rendered more virulent by the accumulated 
effluvia arising from numerous bodies labouring under the disease* 
As, for insUinoe, a person exposed to the exhalation from the earth, 
or any other miasma j which has created fever in several, but, whose 
snsceptibility to its influence being less, has escaped, may, by the 
further exposure to the accumulated cffluyia of many bodies affected 
with the disease, have febrile action produced. This, however, 1 on. 
ly state from supposition s I am not acquainted with any. instance of 
it from actual observation." pp. 207 — 310. 



VIII. 

jI Treatise on Tetanus^ Illustrated by a Number of Cases. By 
JoMN MoBRisoN, M.D. Newiy, 1816. 8yo, p. 1^?. 

WE liave been much pleased with this little treatise. It is 
totally devoid of pretension, and, at the same time, is 
commendable, both on account of its plainness and perspicuity, 
and of its being the result of much actual observation. No- 
thififf can be more concise, yet satisfactory, then the following 
medical topography of Demerara, which was the scene of our 
aiUhor's practice. 

<< I was led to the following observations on Tetanus, by its fro 
qnent occurrence in the colony of Demerara, where I practised me. 
^dne for eight years. This part of the continent of South America 
is in latitude & W, long. 55. N. The knd is low, flat, and marshy, 
abeuding with swamps, and (witii the exception ofa stripe along 



S4f Dr BCorrism m T<*iim AptH 

tlM cotst and oo tin banks of the river, in the caltifailfMi of ngav^ 
cofiee^ and cotton) is coverrd irith trees of Tariouji dimeuieniy 
whose roots, for a gnsit part of dbeyetr, lie bedded in water* 

^^ The seasons are divided into the wet and drj. Tlicn se cco ei 
esch other at uncertain interralt, and am of difleient dnnlians in 
dilQferent }*cars. Moist and rainy weather is by far the most ueuni ; 
jet there are, now and again, woelLs or months of almost mtoleiable 
drought. 

<^ In ISO49 the ^ dry season ' was so intense and long continued, 
that the woods inmediately adjoining the celtifation took &re^^ 
communicated their flames to some of the cane fields, and a consider- 
able part of tite country continued in a blaze lor several months. 

^^ The thermometer, during the nuitjr season, i» sehloaik beiow 79, 
or in the ofry, abowe 86* The diseases most prevalent are intennia- 
tents ; fever, attended with an inordinate secretion of bile ; hepatitis ; 
enteritis ; rheumatism ; dysentery ; and among children, hydroee* 
phales is a very common compkint. The subject of thia tseadse la 
in that part of the world (compared with its occarrenee in GrenC 
Britain) frequently met with." p. ^*7. 

The first section trests of the symptoms, progtiosis, and diaj^- 
nosis, of tetanus, the next of its treatment, and the last containa 
the detailed report of nine cases. For many curious facts in re* 

Sird to the history of the disease, we must refer the stodept to 
e work itself, and we shall only guotet aa a specimen of the 
style, Dr Morrison's observations on the effects of the cold and 
Lot bath in this disease, as they are at variance with a very 
popular q)inion. 

*^ For the first two or three vears of my residence in the colony 
of Demerara, and in the first eigat or ten cases, I invariably used tho 
cold affusion, as directed by Dr Currie, in his excellent * Keports ;* 
but I cannot say with any thing like that success which I thought I 
had reason to eapert ; by degrees, my faith in this so much extoHed 
remedy became shaken, and I httterly (and in bj mnch the more suc- 
cessful Instances of my experience) left it entirely off, and have re- 
peatedly used a dhectly opposite mode^— the warm bath, with macii 
happier results. 

<<^ At a time when I was beginning more than to question, the effip 
eacy of the cold affusion, a circumstance occurred, which rather con- 
firmed me in the opinion, that it was by no means worthy of that 
confidence so generally phced fn It. A stout Aealthy man, belongrng 
to plantation New Hope, got an attack of thfe dlKase In Its idiopa- 
thic form, and had been treated under my own direction, wHh large 
quantities of opium and wine, which seemed for several days to have 
at least arrested the complaint. I now directed the cold affusion to 
bo used with him, aa a possible means of assisting the other tceatmeni, 
conceiving it, at the same time, a fair opportunity (as for as oao- in- 
stance goes) of ascertaining die Tirtne of the means revived^ aad s* 



lilfu Dr Munbon &n n§am». f4^ 



iMwh racoBiMBM) bj Dir Wright, t sio6d hj wMIe lie iinderwent 
tte «ffmsioB twee, bat htd tlio mortlficatioo of witnessing my patient 
ditt a very fewmtaiotos after be bad undergone the second opeia. 



4< ThiB was tba tb)rd ca$e of tetanus which I had met with on the 
saae plaststion, within a few months of each other, with all of which 
I had ordered the cold affusion, and they all died. This circumstaace 
madesuob an impression on the proprietor of the pfetntation, a most 
hiunaDeatid welMnfeniicSd inan, that he requested me nerer to use the 
cold b«th again with any of his negroes in this disease." p. 40^48. 

<^ The warm bath should be regarded rather in a fatonrable point 
of ^w ; it has afforded much present telief in sereral occasions un- 
der ny^wn eye; where especially the spasmodic twitchings were 
fiefMBt and tronblesome, I think I have witnessed eyident benefit 
arise frotn its application ; these startings became less frequent and 
severe, and thesnfferings of the patients much alleTiated. In a case of 
that wuiaty of ^ complaint, termed OpisthoionoSj the warm bath 
war MteniM with the most soothing eflbcts. The patient was put 
into a bogsbeed of hot water, three times a day, and remained in it, to 
Ins gieatsafhiliction, for eight or ten minutes, when the spasms were 
evidently much relaxed,^ and his sufferings relieved. Doctor Chat. 
laers speaks very fkTonrably of the warm bath, and adTlses his pa« 
tients ' to lie borizotttally in the bath, and while in it to have the 
whole body extremely well rubbed ; when taken out, they are not to 
be dried, but immediately put to bed, wrapped in the softest blank- 
ets, and while they remain there, the belly ought to be stuped^ or two 
or three bladders flHed with warm water kept constantly to it.^ Thls^ 
with large doses of opium, is what Dr ChsUmers principally dependa 
on. 

*^ Patients most commonly express themseWes relieved while in the 
warm water ; and of the two, I am decidedly of opinion, that it ia 
attended with better effects than the application of cold water* I 
roust observe, however,, that- the greater number of cases that latter* 
ly dune under my charge^ and which ia the end recovered, undqr* 
Yfmt J^eiximr the c»\A nof the warm hath ; and I an persuaded the 
^i^ects of cither aie far infejriot to the use of opianiy wiM» and mer- 
cury .'• p. 59 — ol. 

In praise of opiuni Dr Morrison speaks in the strongest 
terms: 

^ Offmmr^Tihk whBtanw, cither In the soMd form or in tihat of 
iiif^tuf^ HiU.be fpwi(V of all*4>ther8^ the most valuable in this borr^ 
iile di«ee^. ] hane WKt with mQre than: a doaen instaaees^ where I 
CQMi4 fair^ly attributi^ the cucq to this medicine alone, and I haie n^t 
wjiik UQ iasi9^)oe of sc<;o,vary,.i«i which I did not conceive that it boea 
a very, pritti^ipal j^xt. It qia^t be grtci*,. however, in much htfger 
dofit's than are usHally practm4, 

^f Xh^re need he.littie or nq apprekenxion of any uapleBsant eon* 
sequences from quantities^ wbich^ in any other disrase, woald bring 
on very alarming effects, the system under tetanus being little aflbct- 



tU Dr MoniMi en TOamti. . Apifl 

ed by doses of this nedidoc^ which| at first .yiew, would appetr ea- 
ormoas. A practitioner, for whose acateoess anddiscennneiit I have 
great respect, gave to an old man, in my preseaos, who was in an in. 
cipient stage of this disease, abont haifan onnoeof tincture of opium, 
in four ounces of rnm, as ajiradosey directing, at the same time, the 
spirit to be frecpiently repeated, and the man got perfectly OTer the 
complaint in a few days. 

^< In most of all the cases of cnre attributed to the cold afinsion, 
opium, in large quantities, was given at the same time. Dr Coch« 
rane's patient, whose recovery is attributed to tlie cold bath, got no 
less than two hundred drops of tincture of opium a day ; and in the 
twenty-three cases so hastily run over by Mr Dickinson, those that 
Tecovered, with very few exceptions, swallowed opium, as we are to 
suppose, in very considerable quantities. To an adult in Jthis disease, 
I would never begin with less than one hundred drops of the tincture 
of opium, f bowels being opened) increasing each succeeding dose one- 
third every two hours, unless sleep or stertor in the breathing ensue : 
ordering, at the same time, wine or ardent spirits, in as large quao- 
titles as the patient can be induced to swallow. I have genmlly di. 
Tected the tincture of opium to be given in two or three ounces of 
brandy or rum, and my patients most commonly took, on a mode- 
rate calculation, a pint of spirits, or double that quantity of wine if 
preferred, in the course of the day. In addition to this, I have fre- 
quently ordered the spine to be well rubbed with the tincture, throe 
or four times a day. 

<' Some think highly of the vapours of opium inhaled, as a good 
means of introducing this substance.— Of this I liave not made trial.**, 
p. 50 — 69. 



IX. 

Jn Answer to Doctor Kinglake ; fhomng the Danger of his Cool', 
ing Treatment of the Goui, By John Rino, Member of the 
Royal College of Surgeons in London, and of the Medical 
Societies of London and Paris. London, 1816. 8yo, pp. 165: 

AVERT shoit extract from this work will serve to give an ex- 
ample of the temper in which it is written ; and to shew the 
strong conviction in the mind of the author of the trath of what 
he advances concerning the danger of the cooling treatment. 

*< Let Dr kinglake rail as long as he pleases ; but should I ever 
be so unfortunate as to be tormented with the gout, I wonkl rather 
endure that tonnent, or even put myself under the care of Dr Reece^ 
and take his gout cordials, or the saturnine poison which be so libeiml-* 
ly recommence as a panacea, than follow the advice of so rash and 
indscreet a practitioner atf Dr Kingkke^ and plunge a gouty limb in* 
to cold water." jh 4, 5. 



1M7. 



SW 



PART III. 

MEDICAL INTELLIGENCE. 



REPORT €f DISEASES treaied at the Ej>inbur6b Vewt 
ICHTN DiSFMNSAMT^ frwn December lit I8I69 to Marck 
W 1817, 



Na of Cant. 
Febris Gontiami - . 40 
■ ephemera - . - 13 
— ^— intermittens - - 1 
«— — - dentitionts, et infant re- 
mitt. 79 

Apoplezia « .... 2 
Hydrocephalus . . - S 

Cephain 29 

Conmlsio « « • - 2 

Epilepsia 6 

Chorea 1 

Ophthalmia 54 

Cataracte 1 

Amaurosis .... . 1 
Epistiuds .... . S 
Otalgia et surditas ... 9 

Odontali^ 17 

Aphtlue et nlceia fancium - 6 
Cjmanche tousilkris . • 14 
Djspbagia • . • . • 1 
Catarrhns ..... 139 
Pkieamonia .... 23 
Pleurodjne .... 22 

Phthisis 33 

Asthma 19 

Hjdrothoraz ..... 7 
Pertossb . .... 29 
BalpiMio ..... 2| 
Caitlitis 3 



No-ofCusi. 

Scirrfans mammas - « - 1 

Hepatitis acuta - . - • I 

■ chronica ... 7 

Icteras ----- - 5 

Gastritis i 

Dyspepsia - . - • • 99 

Hysteria l8 

Enteritis .$ 

Peritonitis ... - . 4 
Obstipatio et colica - - 41 
Cholera ----- 3 
Melsena ... - - • I 
Diarrhoea . - - - - 52 
Dysenteria. - • - • ; 4 
Scirrhus recti - - - - I 
Vermes ... - - 2« 
Fistula in ano ... 3 
Uaemorrhois . - - . 2 
Tabes mesenterica . . - 9 
Hernia . «... 3 
Tympanites . - . . - i; 
Hydrops . • . • . 8 
Ascites - - . . «- . 6 
Hydrops oTarii - - • 1 
Dysuria - ... - 6 
Gonorrhcsa .... 3 
CystitU ..... I 
Faraphymosia ... 1 
Hcmorrhagia i^teri . • ^ ^ 



10 



tM Qfiorterfy Beport of the Nifm Tdrnn Dispensary. ApA 



NaofCaiet. 
Sappressio lochiae • - - 1 
LeucorrhcMi . - » • 11 
Scirrhus uteri - - - - 1 
Prolapsus uteri . . - 1 
Amenorrhoca • - - - 1^ 
Dysmenorrhcea . - - 6 
Rheamatismus - • -^ 58 
Paralysis ----- 6 
Asthenia - . - « • 3 
Morbus spinalis - - - - 4 
Cartas et necrosis • • - 1 

Rachitis 1 

Scrofula articalorum - . 3 



M ■ glaiidttlarum • ' •> 

Syphilis ..-.-- J 

Pseudo-syphilis . - - 4 

Tnmores ----- 11 

PkkgiaoQ - * - - 26 

Paronychia - - • - 3 

Mastodynia • - - . 7 

Erysipelas - . • - 6 

Peraio . . - - - 3 



No. of Cases. 

Varicolfai 2 

Urticaria 3 

Rubeola et aequelse - - 173 
Scarlatina .... .4 

Strophulus - - - . 2 

Lichen . - * » » 9 

litertrigo - - . « ^ 

fjepra • . - . - ^ 

Psoriasis - - . . « 9 

Purpura ..... 1 

Irapeligo - - - - . 11 

Porrigo . - - '. . 2g 

Ecthyma • .... 3 

PSoia 34 

Herpes *.-*.. i is 
Acoe - . . - ^ « I 

Vttlnns 13 

Ustio 10 

Contusip et sobluxatio «- 3# 

Luxatio - - . •* - .- 1 

I'ractura .^ . - . .• % 



The weather which has previuled during the winter nlontlia 
inust be considered as mild iti tUa climate. The falk of anow* 
and the frosts which have occurred have been so modA*ate ana 
transient, that, notwithstanding the extreme lateness of tb^ pr^. 
ceding harvest, agricultaral labour is now as far advant^ aa {% 
Common at ihis season of the yeta*. 'There has, however, bee&t 
no season 'more remarkable fbt sudden and* great fluctuationS| 
both in the temperature and moisture of the atmosphere^ 
and these, as miffht be expected, have been procfuctive ot 
moch sickness, xhis has been increased among our clati 
of patients, at this time, by deBcient diet, scanty cbthing, ai^ 
ternate hard labour and total idleness, with the depresaion of 
gpirits arising from want of employmcBt. HeiN^, catarrh and 
pneumonia, rheumatism, and diseases of the alimentary tatiali 
con^itute the most prominent features of the present report. 
' The cutarrh whicn has prevailed has been decidedly rnflart- 
iflatory, approaching, in some instances. Very nearly to pneu- 
monia I but, in almost all the cases where it was early notijcedt 
it has yielded to a ainde full bleeding, moderate evacuation 
from the bowels and aiaphoreticst with confinement to the 
house for a few days. * la some cases it was found necamaiy 



* This Utter point was much faciliuted by the Committee of the Fund for 



^817. QimtUrfy liqfart <^thi Jtfm Tm9f Di^pentaty. t47 

to follow thk up by blisters^ and in others, again, where the 
cough was moderate, and the pain of breast or side seemed lo- 
cal, a blister, without previous Ueediiig, was sufficient In 
a few cases^ where the disease occurred in a worn-out constitu- 
tion, or where it extended to lungs already impeded in their 
fiinctionsi by old adhesions, or organic disease, the patients 
have^ in spite of all remedies or care, become phthisical* The 
same dreadful consequence has followed in previously healthy 
constitutions, where apathy and ignorance nave neglected ap- 
plication, or disregarded advice, tiU too late. Of this cuIpaQf 
Diligence on the part of patients or their friends, we have seen 
some fatal examples. It is this neglect or indifference on thi^ 
part of patients to apply early, Und to give regular attendancCf 
which forms one of the p;realest obstacles to dispensaries being 
as useful as they otherwise might be ; but there seems to be no 
better means of obviating this evil, than by afibixling every facili- 
Xy of application to the indigent sick, even under trifling ail- 
ments. 

In the cases of decided pneumonia, the most marked benefit 
has been derived from the rapid abstraction of a large quantity 
of blood at first. lb some, even severe ca^es, it has appeared 
to arrest at once the progress of the disease, by the very deciued 
relief from pain and ease of breathing which it conferred on the 
patient,. both immediately and permanently. In two cases, con- 
tinued fever foIUAred the remission of the inflammatory symp- 
tOBiB, and rendered it necessary to support the patients very as^ 
siduoiisly. Both recovered. 

While inflammatory catarrh and pneumonia have bren thus 
tifq, we have seen nothing in our dis)>ensary practice like an 
epidemic or influenzal form of the former disease. Catarrh has 
•Iso been much less prevalent among children than, we ha4 
occasion to remark in our last year's report of this season ; and, 
indeed, except as one of the sequelae of measles, the children of 
the poor have erijoyed a remarkable exemption from it. 
, The measles, of which 90 many cases appeared in our last 
report, continued to prevail very generally during the month of 
December, and the early part of Januar}*. Since this time the 
epidemic has very rapidly declined ; and, of tlie cases which 
have since occurred, a large proportion 'have been at Stock- 
bridge, and in the other suburbs of Edinburgh. They were, in 
general, mild, and easily managed. In one case, symptoms 



tiieRelief of tke Lafaouriog Fd^, laving liborslly allowed their wages whe^ 
cMifiaed by HCkasM. 



dM Quarterly Report <fH^ Nlem Tom Diepenmrg. April 

closely resembling croap took place about the sixlb day of the 
complaint, but soon yielded to leeches, the warm bath, and the 
nsuaJ antiphlogistic treatment In the higher classes, amone 
whom this epidemic spread very extensively about Ax weeks aN 
ter it prevailed amon^ the poor, and where the children en- 
joyed superior advantages of care and accommodation, the 
symptoms were throughout its course generally mild ; and even 
among the poor it woukl seem true of wis, as has been observed 
of other epidemics, that the disease assumes a milder form to- 
wards its decline than either at its rise or during its progresa. 

The usual sequels of measles still prevail, and require much 
of our attention. In some cases they have appeared in the form 
of an inflammatory affection of the chest, so weU marked, as, 
notwithstanding the previous debility of the little patients, to re- 
quire repeated small bbod-Iettings, both general and topical* 
and the reiterated application of blisters. Though this is a 
practice which requires to be managed with caution, we have no 
doubt that it is tne only one whldi can be adopted with prcw 
priety in such cases. 

A few isolated cases of scarlatina have come under our notice 
during the last three months, three of which were very oitalig- 
nant, and two of them proved fatal $ yet the disease has not 
spread epidemically. 

Dysp^ia and rheumatism form also a considerable list in 
this report. Dyspepsia is perhaps at all times the most generally 
prevalent chronic disease, both among rich and poor; but, 
among the latter, it is increased and aggravated at presoit by 
the circumstances in their condition, to whidi we have afa-eady 
alluded. Dyspepsia is always diflBcult of management, and of 
cure, but when arising from such causes as we have stated, it 
can be little benefited by mere medical treatment, and can be 
cured only by a removal of the causes which give rise to it* 

The rheumatic attacks, though not strictly chronic, were 
very generally confined to the back and shoulders, and occnrred 
chiefly among those who were driven, by want of employmentg 
from sedentary and in-door occupations, to labour at the public 
works in the open air. The exertion of digging and using the- 
pick-axe to those unaccustomed to such laoour, and their ex« 
posure to rain, snow, and cold, in the stooping posture, while 
inadequately clothed, are sufficient to account for the prevalence 
of these rheumatic attacks. Relief from work, con&iement to 
die house, with gentle diaphoretics, soon removed the complaint 
in most of the cases. 

It will be remarked, that the number of cases of continued 
^ever, is much greater than in any of our former reports g and 



1 8 17. Cbiorterly Report of the Veoi TbtDit Dispensary. 249 

we have reason to believe, that this disease has prevailed more 
generally in Edinburgh for these last three months, than for 
several years past. In several instances, it has appeared to be 
contagious, but though, in a few cases, it has proved fatal, ap« 
parently from afl^ction of the brain, it cannot be considered as 
a malignant typhus ; as, in no instance, have we known it to 
have been accompanied with putrid symptoms, such as petechias 
or vibices. In most of the cases, the symptoms were miJd 
throughout the disease, and required almost no medical treat* 
ment, except due attention to ventilation, to keeping down any 
slight vascular reaction, by sponging the body, by diluent drinks, 
and by giving laxatives, so as to keep the bowels open. It is 
somewhat extraordinary, that, in several cases of this apparently 
contagious fever among the higher classes, which have come 
under our observation, the disease has been more severe and 
more fatal than among the poor. 

In the midwifery department during the last three months, 
the number of applications has been Hi, and the number of de« 
liveries 116. Of these there were 105 natural labours; one 
preternatural, in which the breech presented ; three complex, 
viz. two cases of twins, and one of flooding from atony of the 
uterus after the extractioaof the placenta ; and seven premature 
labours. In one of the last mentioned, in which, as near as we 
could ascertain, labour came on about the sixth and a half 
month, the child lived eleven days. On the fifth day after its 
birth it weighed two pounds, nine otifices^ and three quarters^ 
avoirdupoise. Of the children born there were 62 boys and 
56 girls* 

Exlraets from a Letter from a Physician in London. 
1. Poisoning by Oxalic Acid* 

This year (1816) two pretty decisive cases of death have been 
occasioned by oxalic acid. In both of them it was swallowed 
by mistake for sulphate of magnesia, and, as the purgative dose 
ol'this salt is well known among the common people to beat least 
halfan ounce, although we do not know the quantityaccurate- 
ly of the acid taken, it is most likely the quantity was not less 
than three or four drachms. In one case, death ensued in a 
few hours ; most acute pain being produced. The stomach after 
death was found studded with large black spots, the texture 
was as if broken and gangrenous, from very rapid inflammation. 
It seems the oxalic acid is much used for cleaning boot-tops, but 
whether it is prepared from salt of sorrel, a comparatively small 
commercial article, imported, I believe, from Swabia, or is made 

VOL. ZiII« Kp. f 0» & 



95a l^idf^olim. Av^ 

from sagar and Qther tiuDgs by me^qs of oit^ ^dsi, I dp nol 
know. 

It is tlie great quantity which is dekleriqus. We liave ^buivi 
dant experience of the harmlessiaess of small qoantkiQs of aak of 
^rre] in sauces, in medicines, and in drinks. Wpuki i^ot eitiioy 
it^rt^riic, ma)ic, and other vege^U? acidsy be equally aoxkms i« 
large quantities ? 

|t seetpa quite useless, and a nq(^^ of oppofUipitiea of ion 
proYen|e^t» to continue to employ th^ best B^ea^ures in Kepute^ 
such as blood-letting profusely, opiuniy mercury, babiea, mud^ 
pulvis aniilyssMs, 8^. There \^ no credilJ^ ^vidfMe tb«t wy 
oi)e of these, or several conjointly, have succe^decL Th^ few 
f^serted cures by the best pf the eyidepces, ar^ ^ow beUeved by 
tlie most judicious, to have bee^ deo^pUonai^^that tfa? catqi 
{»ired were inflammatory affe^tioos of the pha^nx, of <mc»4ia- 
glis, or (»rdia» producing the dy«phi^ia, resemblinj^ that; nrom 
the contagion of a mad animal of the canipQ or feUee genus* 
New measures should be tried i I wiU s^ggeftt epme oew mode 
at a fqtare time, 

A .boy of \4t years pf ag^ fell a victim to thia horrible^ dis^aae 
in one of our London hospital^ tl^i^ very iveek* I was *;infonn^ 
ed he had been bitten by a mad-*dog fiv^ weeks be^i^ th# hy- 
drophobia came on. Inhere was nothing peculiar or oiaw in the 
symptoms I ex^^t that, by very resolute eKortions, hfi ^uM 
^wallow three or four ounces of ijouid^ fli^yei^ tiEie& Death 
relieved the poor sufferer in about three days time. 

Dissection shewed the pharvnx. in a state like that from in* 
flamrogtion, extending to the Urynx, and down the aspera ar- 
teria, and its bifurcation to the lungs, but this appearance did 
not take place, as is usual, in the {eso|)hagiis down to the cavdial 
region oi the stomach. 

Nothing morbid was seen in the braini Qor io wy Qtber ▼!»• 
eera. 



^ Sjffhili$ Cured without Mereiay. 
A very respectable surgeon, who h^ the be^t ipea^aof de- 
termining practical questions, has reported, that so mimy c^^aea 
of venereal ulcers, and venereal sore diroats^ hfive got well with* 
out a grain of mercury, that h^ considers the hiWAQ ccmstiti^ 
tion, as possessing natural poweira adea^ite to the cure of a d|SH 
ease, in which it wa^ believed to b^ ^|y i|«9^tM}ed the( 94^tiire 
was utterly insuffiqi^jM^^ Th«B(8 repoi^ frow 9Q romottM^ # 
man, have staggered many physicians^ have pco<|pjml faiQiyi^ia 



afbw persppsf fuad af^ i^ot cK4ited by otb^re $ but, perhaps, th# 
VOB^ jiidioioiis opiitfoQy at prosent, is» that ia certain Tarieties of 
the lu^ff or ill cenaiik censtilutionsi ifa^ diseases are r^mediaUe 
withput nerouf}!. Xhia liniitatioa of the use of incrcury, if 
estabittbed, will be a great practica) imppovemeDtt tor obvioua 
reasom* It 19 spn^e confirmaf joii of the new qiiaion, that the 
proportion of cases deemed formerly to be venereal, is of 
late much diminished in the practice of the most experienced 
aod skilful men of the profession. StiUj however, opposite 
opinions are given in certaiu instances, by physicians of the first 
rank, as tp the disease being syphilitic, or not,, and of the fitness 
of the use of mercury. Of consequent, the distinguishing. 
characters of BQa»y ulcers aad eruptions, are not yet inye$tigal(ed». 
QTy at least, a^ not evulgated, aUhough more observations bav# 
baf n made la the united empire, tbw in any other country* 

If ' ■ " " I 

♦. Fv€qi^enc^ ^ Chronic L^^gid 4ffi^if>ni^ 
EiTHEa CuUci»v and other i^ystematics^ overlooked these dfsi 
caxl^s, or they have become,, of late, much more frequent oc^ 
curreaces. Many of theae cases are vary ixiaidious^ for the 
laryiuc does not appear to be so sensiUe an organ as hath beea 
siipposed* I have known the cricoid and arytienoid cartihi^ 
gjBs, with the epiglottis, become so thtf^kened and indurated, 
that a very little aperture was left for the admission and exit f£ 
aiir, yet no pain was ei^prosscd, even on handling the part rough- 
ly. The voice waa greatly affected, and there were frequency 
coughing fits with a pieeuliar sound. The patient ate and drank 
aa naual, and walked about. In an instant suffocation look 
placop 

■ M 'I 

5.- RJteum^iic Hearts* 

CuixsK also, to the best of my memory, had no notion of 

' the oonneetion betwees rheumatism of the joints and of the 

heart. The late Dr David Pitcaim was the first observer and 

reporter of tlie affection of this vital organ in the acute rfaeuma* 

tism* This accounts for many unlooked fot deaths and sudden-*^ 

ly in this disease* Ht Fordyce, and othora, referred these in«" 

jstaaces to metastases, without any proof, however, but the de- 

lirium sapervening and preceding dissolution* The superven* 

lag affieoioB of the heart does not always kill during the 

yhcnmittism ; it frequently remoins as a chronic disorder for 

xnaoy mapt^, or » year or two, and now and then, durinff this. 

timef the patient dreps down dead unexpectedly, viule wdking 

sU> a iMd^iraleipaaei but raieralfy deatk is occaaioEied by water 

j0 the pericardium and o£er cavttiea v by adhcgioBy with tfaickv 



252 Does Opium prevent Bxpedoratlon ? ilprif 

ening of the pericardiuniy to the heart ; or by a great quantity of 
cxMigulated lymph, upon the surface of the heart iind pericar- 
dium ; and generally too, this organ of the circulation is en- 
larged. Latterly these affections have been observed very 
commonly^ but without proving fatal. Even in chronic cases, 
subsequently to the rheumatism of the joints, I have succeeded 
in remedying some of them. 

6. Is the opinion founded on facts^ thai Opium prevents or 
restrains Expectoration f 
In practice, where it is believed expectoration would be 
beneficial, as in inflammalory affections of the secreting mem- 
brane of the air tubes, and of the intervening connecting cel- 
lular substance of the lungs, it is very usual, in consultations, to 
hear the objection stated, that opium would be injurious, by 
. preventing expectoration, or, if it has taken place, that it wiU 
produce mischief by restraining it. Hence it is not prescribed, 
akhough the poor patient is harassed by watching for many 
days and nights, is much exhausted by a teasing cough, or is 
exceedingly debilitated by pains of thie chest, or by ^spnoea* 
Such occurrences are common in phthisis, in peripneumonic, 
in pleuritic, and in catarrhal affections. Having, in hundreds 
of such cases, been induced to exhibit this drug, from the con- 
sideration, that more mischief would Hxise from not exhibiting 
it, than from its administration, and that without any cause 
for subsequent repentance on the accounts just mentioned, but, 
on the contrary, with frequently the most decided benefits from 
subduing disease, and even a more easy and copious ensuing 
expectoration, I should, to speak from my own evidence, as- 
sert, that the opinion of the restraining power of opium on the 
bronchial secretion, is not founded on accurate observation. 
The same experience inclines me to believe, that, in many pul- 
monic inflammations, it ia quite out of the power of the physi- 
cian to exciie expectoration, by any means hitherto discovered ; 
and that, if he were able to produce it, the discharge would be 
of no service^ supposing the disease to be seated in the interven- 
ing substance, and not in the secreting membrane of the bron- 
chiae. If then the fact be established, that opium, in certain a& 
fections, promotes expectoration, it will not be difficult to pro- 
pose a reasonable theory to account for it. This is perhaps 
obvious, from the consideration that this drug, by allaying ir* 
ritation, allows the secreted mucus to accumulate in larger 
quantities, and become of a thicker consist^ice. Id coarse, a 
Uiicker and larger mass must be coughed up, with more fadlky 
than smaller and thinner irritating masses. 



Id 17. Comparative Ntdriiive Substances^ S5S 

7« If^mmaiion of the Stomach probably mistaken for Dyspepsia*. 
A gentleman was affected with sickness ; generally vomiting 
of every kind of nutritive ingesta, and of the usual drinks ; 
failure of appetite for every sort of aliment ; much pain of the 
head ; the tongue rather dry, but neither red nor foul, and the 
pulse was only 58 to 60 in a minute ; so weak as to lie in bed 
for a fortnight, or three weeks. The usual tonic and evacuat- 
ing medicines for the bowels, with leeches to the temples, were 
employed, but without any benefit, except relief of the head. 
Having oftentimes found inflammatory appearances on dissection 
not suspected before dissolution, and knowing that a slow pulse 
attends some cases of visceral inflammation, this case was treat- 
ed as inflammation of the stomach. The blood was sizy, as in 
such a disease might be expected. The pulse rose to 72 after 
the first blood-letting. By this treatment the stomach com- 
plaints were immediately relieved or removed. 

8. Comparative Nutriti'oe Substances, 
A table, with a sliding scale, exhibiting the proportionate 
nutritive powers, and intended to answer an indefinite number 
of Questions, chiefly for agriculturists, similar to Dr Wollaston's 
table of chemical equivalents, with also a sliding scale, has 
been issued by Dr Paris. According to the common opinion, 
ixfheat is placed as a more nutritive substance than the oat, as 
indeed might be concluded, from its containing a large propor- 
tion of vegeto-animal matter, not in the oat. This, however, 
is contradicted by experience. In Derbyshire, the labourers 
in the mines declared they could not perform their severe duty 
at all, or so well, if 'fed on wheat as on oat bread : and the ex- 
periment has shown that a horse, a superior hunter to another 
horse, became inferior by feeding him with wheat; but on re- 
turning to the oats he recovered his superiority. 

Q. Must of Wheat. 
Fortunately Mr Hatchett has discovered that this defect of 
wheat may be removed by first scalding the grain in hot water, 
and then immersing it in cold water. After these ablutions, by 
kiln-drying. 

Extract of a Letter from a Gentleman^ on the propriety of attend^ 
ing to the Fancies of Patients affected with Delirium^ and 
sometimes complying with them. 

Ik attending to the progress of a nervous fever of consider- 
able daratioo, in the months of July and August 1808, under 
which my son John laboured, then in. his fifteenth year^ while 



854 OnlkSfium. April 

receiving a Medieal edacitian ib Edi&bttrjg^ where the iri^u^d^ 

and atflifltance of reFpcolable tsedieal prftctitionerB vere obtain- 
cd| I made tome observatioDc, one of which I beg fefeve to 6ul>- 
niit to the puMici fondly hopine, that, by attention to it, great 
rdicf may oe adsiinistered to the sicki and much pence and 9t^ 
tisfftcUon to their connections and attendants. 

I have often beard, as evidence of the violence of a fever, that 
three or four persons scarcely sufficed to keep »uch a patient in 
bed* What I mean to suggest is, that the person under fever 
he ntH farced to remain in bed. What m the reaaon the patient 
is so anxious to leave his bed, and exerts his utmost strength to 
accomplish it i It is because he imaffines tiiere is aome immi- 
nent danger awaits him there, aud, in that case, who in heahh 
would not do the same i 

His healthy attendants know there is no such danger as he 
dreads, but, while they cannot persuade him of thb« his mind 
continues agitated in the extreme, and he believes his relatives 
and attendants, who obstruct his desire, to be his most cruel 
enemies, and perhaps they are uniAtentiotialiy such. 

The better to iUustrate this« 1 wlU shortly state some cifcum-^ 
stances which actually occurred. 

In the fever referred to, the patient orie time imagined he Was, 
with some others, taken prisoner by the Indians ^ he believed 
that the others were sacrificed ; that he was saved at the inter- 
cession of an old man ) and, in a more lucid iifterval, iuik^ a 
little money to reward him^ which he seemed fo be much grati- 
fied in receiving and giving away. 

Again, titat there were snakes in the bed, and he kept his eyes 
as actively employed in searching up and do«vn for them, as any 
one in his sensel woukl^ if snaketi had really been attacking him 
on all sides. His attendants bad soothed his mind considerably 
by giving him a little stick to deieod himsdfi with which he be- 
lieved he killed many. 

After I had arrived and consider^ the matter, I had him re* 
jnoved to sofa, where he lay in peaOe fipr sotarte days. A^N the 
snakes cnmc across his mitid, and be was shifud to the bed, 
without imagining for a while that ((iiakcs were there. In time 
he called for these changes, and was much gratified by tbe in- 
dulffence. 

Once be thought a snake had bit his leg, and Called out to be 
carried to tbe surgeon. Alter a while, he said, now they have 
cut out the bit ; and made groat coCnplaiDt of pain in that leg ; 
could not bear it to be touched, or scarce the bed-clothes to lie 
on it } and, even when recovering, wonkl with dlAfftfky ndftiit of 
a loose stocking to be drawn on, so deepljr waa tbe iden idfprefti* 
fled on his imagination. 



19 tr. <M DeliriMik iS5 

Wfaed M (kf fe6bVered &6 tx) wa]k a little, (I had for several 
chiys to catff him in liiy af ttis, which, as he iras Inudi redu&ed, 
was not ffifficttlt ; bat he had a I'apid recovety sd sooii as h^ 
%a8 broti|[ht to hi^ iiatite country nir,) he stiU r&t^in^d the ideas 
dififtiMtly, and related his distresses. 1 desired hitt to thibk no 
more of it^-^it was only a bad dream he had had He declared 
that tras not die case, and pitied my incf eduiily j-^tiamed stieh 
li sarsecm who cut out the bit wounded by the snalce, and severid 
who had seen the Hrhite bone^^as evidence 6f (he truth of his as^ 
sertfon. 

K6W, if ihifting a patient from one blate td another^ thoa£;h 
it were to k palUass on the floor, in the garret, or even in the 
t>afn» or f^omoiReto another,--^who Would hesitate if that would 
relieve his mind, while under ^reat alarm and distress ? This I 
should think whs gaining a pomt of great ittipoilan^, and the 
ob|ect!(>n of dahgdr frotu eatching told, if the present systeui of 
feVef ttmnagetiicttt is coi-recti cannot be great in orditiary w^a^^ 
tbet*. 

I do not pmftbd to sby that this plan of changing the bed^ 
Ike. as a patient of bis attendants may suggest, will always suc-^ 
ceed. Most likely it may not; but if it has oflen, or sometimes^ 
a good efiect, it is worth attentioU. besides, the advanf^ef of 
a cool bed, Ahd a fresh apartmetit, if it cdn be obtained, tnetf 
much further the eflects of afflision of water dh the b6dy^ 

^tfMjhm ti Letter toiomi Hay, Esq. Sutg^n^ Hon. S. I C« 
Artillerify Madras^ with hh Reply. 

« Poondamalie, September 23, 1816. 

*» A case of hydrophobic^ occurred here the olheV ilay^ dar- 
ing my ilbse<ice at Chingleput, in the per^fi bf Mrs Mac- 
daniel, late s servant of Mra Trail!, whilst ttiat fathlly I'esided 
at the Mount, and which was very successfully tl'eated by Mr 
Gibson, by the plan of cobipu^l depletion, so th^t therfr is at this 
momeitft every pnrospect of perfect recovery. 

*< We ate, however, itt a Ios4 to discover in whftt m^ntaef the 
disease has be^ri cotnmaniefited. ll'he woman feCoHeCts having 
been very tfmch alarmed by a dog jutfiping on her dbofrt cfighl 
or ten weeks iigo, btit h^ Hot Atiy tetnettihtsthte Of a bfte^ oi^ 
mty snmjlaf cause, by which £he trh^us Could baVe beetl coftteyed 

'* WiB you altew toe to inqtfie of you, if it tti^ be ifl yout 
recollection that a mad dog was about thftt tilh^ at the M^unt^ 
or if Mh TtAUl nilght have; made any ihtimatioi!i of ^dt to oc- 

^mrenoe hafUQ^h^ipened in her familjr f 

(Signed) Jno. Sieddt/' 



£56 On Bloodletting m Hydrophobia. April 

Mounts 2bth September 1816. 

My dear Sir, — I had last night the Favour of your's of Moo« 
day, respecting the illness of Mrs Traill's former servant* 

1 have distinct recollection of mention having been made of a 
mad dog having been seen here about 10 or 14 weeks since, and 
I rather think it was told me by one of Mrs Traill's family ; 
but I remember nothing of hearing that any one had been bit- 
ten at that time, and had Mrs Captwick * been so, or knffton that 
she had, it is most unlikely that the circumstance would have 
remained unnoticed. 

It will be curious if real hydrophobia has been produced by 
a rabid animal having jumped on this woman without wounding 
her. Or may it not nave been an instance of spontaneous hy- 
drophobia? 

'There are many curious facts connected with this disease 
but little known. One is, at Trichinopoly, in 1805 or 1806, a 
Serjeant of the 94th regiment was taken ill with every symptom 
of hydrophobia, and died in the greatest misery, while the dog 
by which he had been bitten was cdive and wcU then, and for a 
length of time afterwaifds, with his master, who was an officer of 
the same regiment 

I attended the man with Mr Tait, but we did not at that time 
know the efficacy of bleeding in the disease, or otherwise the 
poor man might perhaps have been saved also. 

1 wish you continuance of success in treating Mrs Macdaniel, 
and shall be much obliged by your letting me know how she 
goes on. — Your's very truly, J. Hay. 

Experiments on Croton Tiglium^ or Purging Croton Nut. Ex- 
tracted from a Letter from William iNGLEnow, Esq. Sur- 
geon, H. E. I. C. at Mysore, to Mr Rumsey, Surgeon, 
Amersham. 

The Croton or Jemahlgotta, is the most common purgative 
that is employed by the native physicians in the^ Deckan ; but, 
owing to the inaccuracy of their weights, they are liable to ad- 
minister it in very ungual quantities j and from over doses 
being frequently' given to their patients, the severe drastic ef- 
fects of the croton have been experienced to a degree that have 
endangered life, which circumstances chiefly have brought tho 
medicine into dispute, and have occasioned it to be considered 
of a hifihly dangerous nature. 

In the native books of physic, the croton is ordered to be 

* Mrs Macdanid wis, when here, the Widow Captwick, and hat ubc^ 
married agaia. 



J|gl7, Mr Ingledow's Expertments on Cndcn li^iumr 857 

prepared by boiling in cow dung and water, after the central 
filnii which unites the halves of the nut, has been removed. 
. The thin filni inclosed within this seed is said to be of a very 
poisonous nature ; the operation of boiling renders the medicine 
milder in its effects, by extracting part of the oil which it con- 
tains ; and to prevent vomiting, griping, and excessive purging^ 
pepper, ginger, and borax, are usually combined with it. 

Seeing a satisfactory account of croton as a purgative in Dr 
Ainslie's Materia Medica, and having a good opportunity of 
employing that medicine in the Charity Fever Hospital of this 
place, I began to use it early in the year 1815. I preferred to 
commence with the native mode of preparing it to any other, 
until I might obtain some correct knowledge of its effects from 
personal experience ; and it was accordingly administered, as 
above prepared, to twenty-six persons, giving to each adult, 
male or female, one grain made into two pills, with a few grains 
of powdered ginger. Upon nine of these the purging com- 
menced one hour after the pills were taken. Upon six others, 
two hours afterwards ; upon six, three do. do. ; upon two, four 
do. do. ; upon two, six do. do. ; and Upon one it had no effect 
whatever. One person was purged twice ; nine do. do. thrice ; 
nine do. do. four times ; four do. do. ; five do i two do. do. ; 
six do. One of these individuals was griped severely ; and ten 
others had a little griping. 

Having derived a little confidence from the above trials, I, pre- 
scribed the croton to nearly the same number of sick, after pre« 
paring it by extracting the film and boiling the nut in plaiq 
water merely ; and its effects were similar to those of the former 
preparation. 

I now determined to make trial of the croton after having 
been exposed to the sun only ; the film was removed, and the 
seed bruised and exposed for three days, by which means much 
of an oily substance was extracted. 

This medicine was given to two hundred and forty-one per- 
sons, in doses of one grain to each adult, joined with a few grains 
of camphor, and made into two pills. Upon seven individuals 
it had no purgative, nor any sensible effect Upon fifty-three 
others^ purging commenced one hour after the pills were taken. 
Upon ninety-five, two hours afterwards. Upon thirty- sue, three 
do. do. Upon thirty- five, four do. do. Upon six, five do. do. 
Upon six, six do. do. Upon two, seven da do. Upon one, 
eight do. da. Nine of these were purged once ; thirty-two, 
twice; thirty .seven, thrice $ fifly-seven, four times; forty, five 
do.; twentv-two, six do.; siXf seven do.; deveui eight do,; 
ftpei nine do. ; eight, ten do. live others were purged eleveOf 



f 59 lift Ingfeddw^ Bxperi»mii tm Crokm T^^idm: Aprii 

i^^hf^i ^kf«efty fimtceeily and tirewty timesi Md twd bad eadi 
Meeii ptit)^{y« evamlitiiins. 

Of th« Abote individoak ftinty'flve ^ere Tomited ftbbi otMg to 
fbtif titti^d ) oite of tbcm bad sia and an6ther eight vamitiiigi 
hotti rtie pilh. 

Thiity-^^rcfti ln^dro griped in a trifling d^ree ; fottjr oiben 
experienced i)nori> gHping pain^ and some df Uiew latter wera 
fp^terelj griped. A tew had both vomiting atid gripiiigsi of 
ftese two iaMI deMripttons of safferens. 

' In thi» above Kst ten ware boys and fpAs^ seven and teiriit 
^ai^ old ; they took the crolon in smaller doscii propoi'tloned la 
their ftgesi 

Being satis^ed that the croton was an excellent purgative^ 
Md eoatd b6 fi^d with perteot safety^ I wished lo astfettaiQ the 
powers 6f tb6 expressed oii^ I proenred a smaU quantity that 
nftd beeHi sMie time prepared \ but aa it was dd| its operatioa 
trfis y^ty tiBCeftaln^ am it frequently had no stosiUa effifct 
tifh«e*tef* 

Aflftr obtriining ft supply of newly expressed oi)^ I prescribed it 
to tmrty-fotii* adultSy in doses of five drops to each $ and undeN 
statidiag that the oil of croton was more violent in its operatico 
than the prepared nat, I declined administering it to any but 
fhll groi^n persons. Ten of these patients were pafged in one 
hour after taking the oil ; eleven others in two honfs aitief wards i 
feeveil in ihtm OO* do. ( six in four do. do« ; two wore purged 
twite $ Sbut do. three times ; seven do. ; four do. ; tbrte-d<K i 
five d6»; deven do. | six da} one do.; seven do^; four do* i 
^ight dO< Three wefe purged nine^ ten^ atid eleven times i one 
eighteen, and two twenty times. 

Of ^ose %lMi took thti oil df cfoton, thirteen had from on* to 
fbtrr vonlitiflgsi six experieticod a liule^ and Iwelva rouek 
grtpihg. A few of this number bad both voiaiting and grip^ 
ing. 

Tbti oil wat hid asidei as its effocts were oompleifted of 9 and 
fbef tomifiog and griping it occ^ioned were both mor^ btqatmH 
ftAd niore s^ere tmn when the pills were used 

The Iriak of the croton^ from which these remarks hav* bta* 
takeb) ^efe made prio^ to the month of February last, sinoe 
Irhidi perk^ thd same pfeparatbn of that purgative has hoek 
ikdtninlsl^ed to two hundred and twenty<^evan pertona laore $ 
but as the effects were very similar to those above detailad^ the^ 
were not partietttarly noticed in the raktions of the dasesb 

Id June, Joly^ and Aogast last, I have prssartbed the crotosa 
to One Irandred And six^<*fonr other patieiits^ but iMtead of 
ft«n4ngit€6MiMd|tlMf««MiS| having tbt ttia tabm ra^^ 

11 



JIB17. Mr Ingledow^ Eaperhmds 6n Croton TtgUutH. fiW 

exposed entire to the sun until they became hard, and so dry as 
to admit of being divided into minute particles by trituration. 
This process requires a litUe attention to secure the proper 
quantity in every dose, and the oil which the croton contains 
prevents its bein^ reduced td an impalpable powder. 

The croton for this preparation was exposed during three 
days ; the doses were the same in <)uantity as were previously 
used, and the effects similar, except that the number of pur- 
gative eiteOations was frequently flpmrteri owing to A larger 
proportion of oil being retained in tne nut by exposing it whole 
to the sun* 

Having prescribi^ the cfototi to upwards of seven htindr^ 

fsrsons, I can pronounce it to be a vainable atd'saie purgative, 
have not ventured to ^iv\e It either Do childreo under sevto 
years of age^ of to any iuditidual npucth advanced m Jife^ The 
above ti^iab have been made atmodt entirely upon sick potr 
irota this tOwH and neidibouridg villages ^^ lepoys and others 
in th^ sertice of the Rajah, t^ho touglft relief at th^ ("ever 
Hospital Som^ of the fotmer • wer^ ill provided, with the cbm- 
nion necessaries of life; and upon such subjects the effects of the 
croton dcri^ be expected Ui hd ikiote screr^ than With Uie other 
natives liberally supplied with good food, or upon Europeans, 
who possess naturally much stronger ecmstttutions. A fe^ i>f 
these patients were Company's sepoys. 

Croton purges should be eiliployed with caution to persoils 
debilitated by mercury, or infirm from long-conCinUcd sidcness, 
as their cperatlon is sometimes exiremely severe upon such 
patiently and occasions them coQsidefaUe distr^fis. 

Whenever this inedicine ptirges t6o violently, the native 
practitioners employ ghee, or butter, internally, nlong with 
congee, or rice water, or, insteaii of thcBe, ^okl batter milk to 
check its operation ; and sometimes they use affusions of cold 
water upon the body for this purpose* I have tried the former 
in a few instances^ and was told with good effeitfl^ 
Mys^-e^ September 10, 1SJ5. 



teo 



Statement^ ifc* 



April 



STATEMENT of the Sizes of Men in different Counties of Scot- 
landf taken from the Local Militia. 



l8t Argyll Regiment of Local Militia, of 686 Men. 



Heighti. 



Number 
of Men, 



ThickneM round the Chett, in Inches. 



Ft. Inch. Ft Inch 
5 ^ & 5 5 
5 6 5 7 
5 8 5 9 

5 10 5 11 

6 6 1 



SS !i4 35 % 37 38 89 40|4i '^'M^ H ^5 4-6 4-7(48 



79 
221 
245 
107 

34 



1320 



16 



617 



2011 
4946 
1'257 

1 



1 

14 
36 
23 



2 

3 

2010 

14 7 

8 



Sd Argyll Regiment of Local Militia, of 736 Men. 



5 4 & 5 5 


77 


S:'. 


3^ 


;i5 


:ib 


37 


38:39 


40 


41 


4^ 


43 


** 


4.5 


V647*«| 






1 


3 


12 


'nWi 


15 h 


2 














5 6 5 7 


28S 






'^ 


7 


37 


4867 


59 


46 


19 


3 












5 % 5 9 


2H4 








1 


10 


21 


30 


47 


5h 


48 


12 


6 


I 








5 10 5 11 


109 












1 


6 


19 


2t> 


^7 


16 


7 


6 


1 






6 6 1 


28 


















f> 


10 


S! 


; 6 


9 









Lanark Highland Local Militia, of 633 Men. 









353435 


3fi 


37 


3^ 


3& 


40 


4! 


42 


t^ 


44 


45 


46 


47 


48 


^^4^55 


122 


' 


1 


5 


1.5 


QCJ 


27 


ir 


IF' 


n 


t> 


2 










~ 


5 6 


5 7 


218 




I 


7 


i7 


'Ih 


■ifi 


50 


:i3 


2;''} 


15 


3 


2 


1 


1 






5 8 


5 9 


199 


1 


1 


11 


IG 


39 


3'i 


35 


iiD 


29 


Ji 


2 


1 


1 








5 10 


5 11 


81 






2 


£ 


14 


15 


lb 


n 


11 


4 


4 












6 


G 1 


13 








1 


3 


1 


3 


3 


S 





J 


I 











1817. 



Sixe of Men in different Countia. 



261^ 



Annan and* Eskdale Regiment of Local Militia, of 493 Men. 



Height. 



Number 
of Meo. 



FuIndL Ft Inch. 
5 4 & 5 5 
5 6 5 7 
5 8 5 9 

5 10 5 11 

6 6 1 



58 

193 

141 

78 

23 



Thickneu round the Chest, in Inches. 



3313+ 35 36 37 38 39 40 41 42 43 44 45 46 47 48 



414 
30 



23 3028 



3 
26 
28 
2017 
9 



2d Fifeshire Regiment of Local Militia, of 621 Men. 



5 ^ Sc 5 5 


121 


33 


34 


35 


::6 


37 


38 


39 


40 


41 


ti: 


43 


1.4 


^5 


i6 


47 481 


1 


1 


6 


17 


17 


25 


20 


22 


9 


2 





1 










5 6 5 7 


218 




1 


3 


5 


15 


36 


61 


40 


29 


23 


Q 


2 










5 8 5 9 


213 








2 


3 


17 


40 


34 


35 


40 


27 


12 


3 








5 10 5 11 


36 








1 


1 


4 


7 


6 


5 


6 


2 


3 





2 






6 6 1 


S3 












S 


2 


8 


5 


8 


3 


8 


1 









2d Edinburgh Regiment of Local Militia, of 506 Men. 



5 4 & 5 <5 


37 


3^ 


34 


35 


m 


:i7 


38 


39 


lU 


\] 


t2 


4^3 


H 


45 


4d 


n 


4b 








1 


5 


12 


11 


6 


'I 
















5 6 5 7 


173 


1 


4 


12 


18 


32 


46 


i2 


Tl 


5 


1 














5 8 5 9 


192 




1 


4 


9 


15 


45 


U 


m 


2'2 


11 


3 


3 


2 








5 10 5 11 


76 




1 


2 


3 


5 


10 


15 


16 


y 


5 


6 


2 


1 


1 






6 6 1 


28 










4 


1 


i 


1 


4 


J 


1 


2 


I 









Peebles-shire Regiment of Local Militia, of 224 Men. 



3 ^ & !> 5 


10 


33 


34 


35 


36 


37 


38 


39 


40 


41 


VI 


4^^ 


-H 


45 


1^ 


47 


4b 






2 


I 


1 


2 


1 


3' 


















5 6 5 7 


69 




2 


i 


9 


5 


14 


21 


10 


2 


4 














5 8 5 9 


90 








3i 


5 


S 


21 


i7 


14 


14 


3 


3 


2 








5 10 5 11 


35 










2 


4 




9 


i 


i! 


3 





1 








6 6 1 


20 










2 


1 


J 


3 


' 4 


5 


2 


I 





I 







f(St 



Sizn 0fMe» Ml dffiTa»t Ctkntie^ 



ivril 



Qtk UmrkslMT^ Kegirnqt •( Um) MHIt«i fif 979 JUm 



Heights. 



of Meiu 



^i^iiiMiTiS^^pF^ 



ThTckness round the C)|«9U Ml Tochet^ 



Bt. Incli. St. Inch. 
« 4 &| 5 
5 6 5 7 
$ S 9 9 

5 10 5 II 

6 0(1 



59 
20 
179 
83 
S8 



4i 



813 



610 



t 

7\iHb9h^f4\90\n 



¥ 5\ 



"2^3 



6 

ajsl 



KiDms.^tfe Ragiment of Loeal MUitia, off 10 Men 






5 * & 5 5 


SI 


33 


J4 


3^ 


:k^ 


rJ7 


5^ 


5U 


hi 


n 


^2 


i:i 


tt 


15 


46 47 


"S 






4 


U 


5 


U 


U 


I'J 


5 
















5 6 5 7 


a^ 






1 


9 


i 


[^ 


'10 


w 


^ 


^ 














5 8 5 9 


47 








I 


:^ 


S 


V^ 


iu 


Ji 


t 


1| 












5 10 s n 


s: 










h 


* 


i 


h 


iT 


3 


4 












6 6 1 


4 




















S 


; 1 


f> 


I 


- 







East Stirlingshire Regiment 


of Local Mahia, of 647 Men. 




5 4 lb S 5 
£657 
5 8 5 9 

5 10 5 11 

6 6 1 


67 

^m 

207 
125 

40 


33 


M 


5,^ 


3(j 


57 

16 
\^ 


3& 

li 

X 
4 
I 


.J 

1 


«3 

J 


H 


42 


Jl3 


44 


45 


*0 


*7 


♦» 




I 


I 
1 


9 


1 




i4 


N 
1 

c 


lU 
4 
3 


J 

I 


I 

4 







Kirkcudbright Regiment of Local Militia>of 596 Men 










Sii 


34 


::J5 


'SKy 


57 


Sh 


it> 


!<>' 


VI 


4:d 


41: 


t4 


4o 


46 


47 


4& 


5 V ^55 
5 6 5 7 
5 S 5 9 

5 10 5 11 

6 4> # 1 


34 
I4^jf 






1 


1 
1 




J 

20 
4 

1 


10 
27 


7 

39 
'57 
It 

6 




6 

7 

11 

^^ 

{4 


1 

5 
JO 

10 


4 

10 
7 


1 
1 

4 
H 


3 
2 





1 



xt». 



Compgraim ^Memnt, 4Ff « 



m 



Cotnpar^tiiH $t^iemmi ^ 1A9 H^^ht ^nd Thklmm tf Men 
round the CheUy in difiereni CQuniiea* 





Avenge 1 


'Avera^" ' 


ACClnBCBxl* 


Inche* round 


Inches in 




ibcChMt. 


Htigbt. 


QigMand Lanark, 


S8.71 


67.a» 


^d Edinburgh, 


98.79 


68414 


Kinross, 


39.07 


67.20 


Peeblos, 


30.55 


6838 


UVif^ 


318.89 


&7^ 


6tk Un^rkf 


39.91 


6&60 


^Ar^Ji, 


40.07 


67.7* 


l5t ArgjU, * 


40.09 


67.T6 


East Stirling, 


40.09 


68.06 


AnnaiL am) Eskdale, 


40.64 


68.15 


Kirkeudbright, 


41.01 


68J9 



Average Heights of Men. 





Number of 


Height*. 


the diSercot 




Size* in 100. 


Ft. lack Ft. lacfa. 




5 * & S 3 


15.2 


5 6 5 7 


37.? 


6 8 5 9 


81.2 


5 10 5 U 


13.5 


6 6 1 


2.0 



Comparative Sizes of Men'a Headsi as aseertained by aetiuril 
Measurement, upon an extensive sciJe, in Retail Ebt-shops in 



OD «nd luiiQtHii:) 


B". 




InehMcireum- 


Edinburgh. 


London. 


fcresee. 


Number in lOO. 


Nninher m loO: 


19.5 


0.000 


.450 


19.875 


0,285 


.164 


20.25 


2.285 


4.942 


20625 


6.285 


ii.e96 


21. 


16.428 


25364 


21375 


27.428 


28380 


21.75 


21.571 


13.S44 


21.125 


13.000 


10349 


22.5 


8,428 


3.788 


22375 


3.142 


0328 


2S.25 


0.857 


0388 


23325 


0285 


0164 


\ 94. 


OuOQO 


omo 



!264 Comphraihe Statement, tfc: April 1817. 

For these rery curious tables, we are indebted to an army contiao 
tor, a gentleman of great observation and singular accuracy. They 
furnish documents of much interest as to the comparadve iieight and 
breadth of men in different counties in Scotland, from which in- 
ferences may be drawn as to the influence of the nature of the coun- 
ty and climate, food, and occupation, upon the growth of man. Be- 
fore, however, any general conclusions can be Mfely adopted, more 
focts of the same kind must be accumulated. 



A second edition of Mr Parkinson's Hospital Pupil is an- 
nounced. It contains addresses to the patienUi of those intend- 
ed for the medical and chirurgical profession, as well as to the 
pupils themselves, on the necessary previous education, and pe» 
cuniary resources ; an unproved course of professional educa- 
tion ; with suggestions as to the order of their studies, &c ; 
with hints on enteringinto practice, and on medical jurisprudence. 

The Transactions of the Medical Socistt of L0ND0N9 
VoL L Part II. is in the Press. G)ntaining Cases commu- 
nicated by Drs Adams, Blegborough, Lettsom, Clutterbuckf 
Woodforde, Roxburgh, VVfdshman, Sims, Squire, Moody9 
Green, Damant, Dale, Jackson, Andree. 



*^ Communlcatbns have been received from Dre M. Hall, Howison, 
Mr Douglas, Hay, BiaviEi and Scott ; and we have to return thanks for 
the following publications : 

A Practical and Hiitorical Treatise on Consumptive Diseases, deduced from 
original observations, and collected from Authors of all ages. By Thomas 
YoUMG, M« D. F. R. It L. S. Fellow of the Royal College oi Physicians, and 
Physician to St George's HospitaL IfOndon» 18 15. 

Practical Observations in Surgery and Morbid Anatomy, niustrated by 
Cases. With Dissections and Engravings. By John Hows h if, Member of 
the Royal College of Suigeoos in London, and of the Medico-Chirurgical So* 
dety. London, 1816. 

Review of the Alnwick Diipensarvy with a proposal for extending its Bene- 
fits, respectfully submitted to the Patron* Presidents, Vice-Pk-esidents, and 
Governors. By Charles Wightman* M.D. Physician to the fostitotloQ, 
Member of the Royal College of Phystciaos, London, and ExtraordiDoary Mem* 
her of the Royal Medical Society of Edinburgh. Alnwick, 1 8 1 7* 

Report of the Managing Committee of the House of Recovery and Pever 
Hospiul, in Cork Street, Dublin, for one year, ending 4th January 1816. 
Dublin, 1816. 

Gerbaux on the Teeth, with Observations on the most frequent Diseases inci* 
dental to the Mouth, Ace. Bx. Ace A Popular Treatise, addressed to the Fa- 
culty and Heada of Families. Translated from the French by a Member of 
Faculty. Edinburgh, 1817. 

%* Communications may be addressed to the Sditcirst to the care of Mem* 
CoNSTABLB Ac Co. Edinburgh ; Messrs Longman, Hurst, Rbes, O&m, ft 
B&owN, London ; and John Cummino, Dublin. And we have to request 
our Continental friends to send any thing larger than a single letter to the care 
of Messrs Perth Si and Bbsser, Bookseller^ Hamburgh, as the expenoe of 
tending joumalt ami packeto by the poat to this eountry is < 



No. LI. wiU be Published an the 1st of Juiy 1817. 



THE 

EDINBURGH ; i 

MEDJCAh AND SURGICAL JOl^NAL. 

1. JUtY 1817. i 

r 



PARTL • ^ 



ORIGINAL COMMUNICATIC^^ 



I. 



*.! 



/>!» tie Staiisiical Pathology ofBriad and^fCUfion, GkmeeOer^ 
shire. By C Caisholbc, M. D. F. R. S. &g. &c.&c and Se- 
nior Physician to Clifton Dispensary, 

Hoc aiKcm modo iiec csngua nee infnigiferi art! medkae acceasio facta est— nam 
extern expcriemia faciti exeinploiwNMtrante yiam. 

I WAS induced to contemplate the sulject of the following 
paper, as it relates to facts abstracted from speculation, by 
liie resnh of four years' observation of the diseases of Ciiftbn, 
as th^ passed in review before me at the Clifton Dispensary* 
The facts which farther investigation of die subject brought in« 
to view, appeared to me highly important, and almost, if not 
wholly, conclusive, as to the question, whether the infection of 
typhus is specific or not ? In the adduction of facts^ I have 
carefully avoided those of a doubtful nature ; and have given 
preference to those, of which I (icqnired a knowledge, from the 
mfbrmation of gentlemen connected with, or in the immediate 
medical management of, large Hospital, Dispensary, or Public 
Sdiool establiSiments, within the limits <^ the city of BristoL 

There is, perhaps, no mode of acquiring a knowle^gpe of 
what may be called Statistical Pktholo|3r, so perfect as a pa- 
rochial or district dispensary. ^ The otgects of such an institu- 
tion are confined to Uiat description of people who are most ex* 
tou xizx. Ka 51. s 



266 Dr Cbisbolm's SidMcal PaiMogy Jaly 

posed to the action oflocal causes of disease; whilst thdr mode 
lof Kfil removes them from those of an aitificial nature. Lnxory , 
widi all its attendant erils, has no place in their domestic esta- 
Uishments ^-^superfluity of eveir kind thev are unacquainted 
with i«-»unless it may, unhappily, M that of distress and poverty ; - 
—•whatever morbid caiiies prp^oatf ffopx the nature of situation 
ami soil i— from the chniges ot the atmonihere ; — from imperfect 
vcotflation}— »from the accumulation of filth;— from crowded 
amdl nxna is'ipand ftpm pMr and scanty diet ^nnthese people 
are the subjects of :•— and, hence, a correct and well digested 
rqpster of their diseases hiqm^ek ^fv^k6fl record of the patho- 
lo^r^ of such parish or districtv 

rully penmaded of the truth of this obsmi^pn, §pd knowing 
that the poor of the parisji pf dl/ipp had no means, a scanty 
parochial annual stipend paid in jrotation to the apothecaries of 
the parish, 0fQm^, but the hvun^nt^ q( in<||ii]|i49als, to re* 
sort to, for relief^ when under the affliction .QldUeaye ;?— I sug-, 
gested to a few respectabte and benevolent inhabitants, the.b^^. 
nefits which woula arise from ^ di^nsary in the parish^ An, 
institution of this kind was immediately resolved on ; and by 
their exertions and contributions* estah^sbe4 t9W^d|9 the end gt 
1 8 19, and opened on the ) st of January fiillowing. In order to have 
# nuure distinct view of the result, during the four years viuch 
have elapsed since the opening th9 m^lUtutiQPf /Hlfnfi vitirp^o- 
tory remarks may be useful on those local cifcurostanoes alj^^ed 
m. With regfMt to the localities of Qristol, T shift .|i«79 
ample occasion to bring some of die most f emarkable into view, 
in the course of the examination of its pathology. 

This pari^ of Cliftpii lies in the S, W, pfGi 
fprn^Wg }k ^^^^^P angl^ hy the ^vpn o^ qpq, i^, 
^trcMet Qf Tf?n> p;? f^e ptbpn ^d haying i|wcii.., , . 
of four nilcs^ la the tiff^ pf JSJr Uf^n AjtoflV^fl^ 
tUe begiming pf t|]e last Wltwry^ t|ie ff^^fab^ jS^fiwl^ ^ 
jO^e parish w^ only po, and pf ffae inh^^it^nj^f ♦w |f jnwl ,^ 
t)ie$e pnlv ^0 w^r^ freehaJderp. (%e ^^959ijq| pf,thP-,J|Hr 
fi^nt ap4 pTfesem eta^ Qf Glfluc^ter^hjf^, JlII^^ f9V*^rJ?* 
Wf) Iff the vfifff 1779, Ur ^vt^der infoiripf v^ tm X^ 



^ffm|)er of inbabittWfa FW J???, (ffi^t- ^pf Qtejjw^ p, 98»,) 
Jq f^eye^r 1811, it ^^pp^rs fypm ^^e jre^ffl A^ Wwtellf^ 
ih^ pppulation qf Clifton pfyrislr b^ incre^fk^ tp 689^* Tb.9J^ 



is tp^pn hf befieving, howpv^r^ Jthft jhi^ r^mjm yrm V^.. ^,i, 
ably less thap fhe apMia} nu^b^r; fof in IQl^ when ^ jDiV 
pepsfiry was ^tablished^ thf^r^pre gppf) grpgpds ^r l)^ng i|^- 
sured p^t Uip population had ]nsen tp $opp. j^^ th« c^qitlQP 
of the jubftee, pearly three years b^fows, i^prp (hw^ .SOWftgb- 
plied for and received relief, from a liberfil #i})lM^r/p^<>n ^^^ 



If 17. qfSmM and aytm. 26T 



enteved ihte. Tha iMR^octiop of iBOfta% m Ait , , 
Gtaam be acoutpleiv Bt^tadt '^ •PP*vi09 that the ff^gpater kepi 
t^ ibq mioistBr of flie pensb is necwMiriy defN:tiTe» meny be- 
iBcb^xied oot <»f the {Nirisbf of whom h^ us no koowledge^ 

uxeai Britain psesenti almost Ak estfeme of iMrpgaJari^ ia 
her dimate I aad prQbi|bl}F the w«|tem comities aee the mos^ 
dittin^aishdl for that vcvsatiKt]i» that capricioiisiiesv of tem^ 
poralure so oeculiar to the ^fAole of Eoglaodi «b4 which al» 
most without a hypeiiM4^ 

- gfv^ Oe lb te dl lititSonr. 



Qv. jfcjF fM on all caloois, Mwhiog iieiir^ 

;W lowfriw^ !'*kp a fifffw^rd pf^ ?l»5|4j 

71u9 mp 4 peptyr* ^4 ^^ next % ^torqau 

Aq^ and placitf b^ to. ■ ■ fObserfoer^ No. 05.^ ' 

TliiB fefir, bowffTT^r. ^]iihits § gr«4^iQ9 pf s^^it^Di;^!^ the 
mdation is singuli^ri^ ftbirupfc, pr ^fisg^^i infeimiprt4^: 

So i^angpil^irf it¥J^ n pur pIUn«(9» ip U^m (^herfiru^ iqiHt 

iisvqurf4>pp(t, t^t ^j/^ ^ery h^mr (jf ^e 4« Is ffi^lwd ^V H 

sa4(|» 1% <oip fell » ibp tb^rwpRft^* To cfwwpl^ ^ mir 

tw;MP of p«r ifr^hi^^bfl)^ i^ fm miiforwtjf to pe pl^serye^ ill 

sfpicJ^clff pf giiic^li #u(3p§e4illg PU?v«itMfief» ftsjen^wg ftp|9 Jav 
naeiff tp funep epd.^^^adipg ffpni Jmp^ »> Jaoiuwy» ^siog 
and sioUng by plunges. Thus, in mi^r to n^'m 9t nymw^^ 
faeatv yoa must climb with difficulty, and often experience a 
apd^V^ M » ^intef poJ4 i,a«Ml m dj^emppi to^miwy « 
SmonV WW .severe .c»14 8))fml4 iMrt H»P WBA of winter, 
ydn lUn^e At a moment, wb^i^ l^a^t fi?V^(^p^ « CQiWldefi^Ie 
ascdtt to mrpomt of summer temperature. In Fisbmary mid 
Mawh, ^^es, Mackbird§,,jw)f| ^nm the mAtij^ffkf ofteft 
^W j *iMHl^snes^in%cs, ^Ider, h^iafic^s^ apd (Wep eiurfy plants, 
aie^^Iino^' fupy evolved, * In snoiti, such is tbf precocity. of 
^tii^g, il^at in tlvese months of ^me yprf, ^be jde^pfion of 
j^elia^ ^f ^^i^lfl liter%l/x appQcabl^ . 

■ i m i j I waponitr «en| floctntia paii4uiit ;^ . I. 5. a5s. 

' ^l^hg eicpands ber Qoinrery .canpet ; 

aild|ret Hke following April i^sumes the features apd garl^ of Ja* 
iHiar^. |n tl^e mouths of .Junei ^uly, apd Awu^t, fires are 
often necessanr. There is one fe|itur<$ of our Bristol climate 
-mhiqik ^i^s tp bl^ pcyculi^ tp it iDuripg fpjQirtecm ye^rs I have 
ob¥«fv#d snow tp jhll, }^ more or )ess quaitfity, .some days hei^ 
tvp^ j^e li;t|i and 35th of April pf eveiy year* The thermo- 
]Beter|^pp6e|},tp xhe ^iriect rays of t^e sun fit nopn, oftj^n rises 
to 10y% wd yet j.a the same month, as I bare eiready remark- 



S5S 



Dr Chisholin*s Statistical PaAoiogy 



July 



ed, often indeed^ on the succeeding dajt snow falls witK com6«- 
apondiog oold« In Jane of the same year, the thermometer has 
not been higher in the sun than 84^, and such frost takes place 
as to cut off the eariv vegetables. I bare nevor sedn the ther- 
mometer higher an the sun than 120. The range of the ther- 
mometer in^the shades daring fourteen yean» has been 80^:-~ 
thus the greatest coU occurred in the night of the 12th Ja. 
nuary ISi^^ viz. 18% and the greatest heat at 1 P. M. of 18th 
July 1809, vis. 92^ The greatest diyree of cold in the 24 
hofursjs always about day break* The cold of winter generally 
makes a regular progress from K to S, *, and I recollect only one 
remarkable deviation from this, in the year 1814^ when the 
heaviest and longest continued storm of snow, j^er remember- 
ed fA the west of England, fell. On the 2Ist of Jiinuary of that 
i^e^r, so. much were the communications with the rest of Eng- 
and, particularly Exeter and the west, cut o% that thirteen 
mails with 80 bags were due at the post-office. 

A tolerably correct t^&bl of the nature of our weather in Btis* 
tol, Clifton, and their immediate vicinity, may be fomied by the 
consideration of the following tabular statement of the cloudy, ' 
dear, rainy# and snowy days, which occurred during a residehce 
of' fourteen years in those places ; together with the avera|p of 
the thermometer at 1 P. M. of each month,, and the number 
of days in which the wind was easterly or westerly, that is, in 
which it blew at any point from N. to S. round by £., and at 
any point from N. to jS. round by W. 

General State of the Weather at Bristol and Clifton, and im-. 
mediate Vicini^, of each month of the Year, from I'st JTanii- 
ary 1804, tp Slst December 1816. 



Moatlit. 


Cloud, 


Clear 
Day*. 


Rainr 


Snowy 
Days. 


VrnA 
Eart- 
«ly. 


Wind 
eriy. 


.ItuMnmncicr.ai 


h- 


fl. 


M. 


Feb. 
March 

April 

June 
Jufy 

Sept' 
©ct, 
Ntfv. • 


ai9 

192 
175 
174 
157 
)63 
173 
MS 
158 
SSUi 

2ro 

247 


817 
200 
249 
246 
877 
*257 
859 
889 
262 
30ft 
- 210 
187 


160 
150 
120 
124 
149 
161 
175 
145 
158 
826 
169 
180 


59 
48 
55 
52 
8 
2 

12 
6^ 


224 
162 
214 
188 
184 
183 
127 
181 
182 
189 
181 
146 


212 
2S2 
880 
887 
850 
897 
907 
308 
838 
841 
889 
288 


21 
27 
30 
38 
38 
80 
51 
54 
44 
40 
86 
88 


58 
54 
69 
77 
78 
80 
92 
81 
84 
66 
56 
58 


39 
40 
49 
55 
<58 
65 
78 

<» 
64 
53 
46 
43 




2241 


8861 


1916 


897 


8046 


3064 









1817.; dfBri^oldndCliftm. 969 

' The w^le parish of Ci&fton is a beautiful and romaaticas- 
•emblage of woods, rock^ water, pasture and down. It seetDs, 
indeed, singularlj well adapted to the maintenance ^f heakh^f ^ 
the soil resting on immense beds of limestone rock, exposed- ta 
the soutfaerly'and westerly winds for nearly tfaree-fourms t»f the ' 
year ; with an atniospheiAs ebstic, Tivifying; hot humid, tiou 
withstanding, about five-eighths of the year are rainy, in a great- 
er or less d^ree ^ and, on the downis, free from all contamimK 
tibn ; being only six miles from tlic Severn Estuary, from 
whence it is by the prevailing winds perflated by breezes from 
the sea during the largest portion of the year ; and having n 
river running along its whole extent, subject to the action of the 
tides, which rise sometimes thirty feet In a mincralogical and 
geobgical view, cartaioly few places exhibit a more curious and 
instru^uve AM ;-*few more iBustrative of the truth of the M<h 
sale obsmogooy. • The rock formations are thus exhibited by a 
very able geofogical friend, my present colleague in- the Oliftoh 
Dispensary, Dr W. H. Gilby. <* There is no rock which more 
frequently gives rise to bold and picturesque scenery, than the 
grey compact mountain limestone. The immense cavems which 
jnanv parts of Enjgland are remarkable for, and the abrupt and 
contipuous chasms as seen at Cheddar, Ciil|6n, and Chepstow, 
have been, at some distant epoch, the result of catastrophes in 
this rock. The flat table-land, or downs, whidi it cen^ally 
forms, have always been resorted to as a delightiu} and healthy 
situation. No where is the limestone, vietved to greater adtanv 
tage than at Clifton, Durdham, Leigh j and Ashtbn downs, 
wbiGh.it exclusively forms. The nature and appearance of its^ 
8trata,4ure iMmirably displayed by the sectaon whidh 'KHile grand'- 
convulsion of nature has made ofthis rock t>elow BrisUd.' TKe 
rock forming the commencemeht of this i[iost'<5uribu6^§teticnt, 
ocmtfaecdisruption, . at. Xlownham ferry, isa very faighiy indu-*^ 
rated sand-stone, of. a > greyish, and oftentimes oiPai redms|),.iccK' 
fotfr, >and . sniali splintery fracture. It seems entfrd/ composed 
of 4 eongieries of siiicious parddcs ; and> according -to the Wec>*- 
xierian. nomenclature, wouKI better d^s^^ dbebanie'bf a quart-* ■ 
zy sand-stone. It is extensivelv distribiited $botk Clifton, fonfi* - 
ing. much ^of , the . high ground ; and omst; pf , the wtills aBobt 
the place are constr^icted of this material. It^vtrj^ wheh*e re- 
peat iippnir and dips in^ a direction conforin^bfe mm the lime- 
atone^ ^ »Tbus, |he$is twoorocks form. cbn}oij|itj^ thel yrhole of the 
l^i% igreiind lipoii w)uq)i Clifton slanfdfk j Tlie plre^a^ng soil 
about *eiiftoB itself if si* «1^, very deepi^ jgipr^gP^ied with 
oxide, of i^Mk, < it is somieaiines quit^ a^eompaor clayistone, and 
safiill^^of jron, that its speci4c ^av^tyr>ia. cf^oattoinifilQF of the 






woiUUb iran orwi InislwDlMiB^iriiohtbrlXyirhi^AiiiiM 
of red giband ii ^nnAag^ nd ^kmt oMjr <Mtan n d 



tai^^ teiiilling fitmi the dUmegradoh df the lidntOBe frtai 
CKflewre to feuv and nunAiAre* At iBKAini^ tharB atetwo Toajr 
diffielrmt kiiKfeor #Rt^i one iR*»b immm ftdm tte lUiiitmM^ 
ofBhardquftBtifs^ tiw olhwr tliiWi|||h tiw uaiiJ iloM, tf m aweh 
softer iwtvr& It is w^ kilo#m tbai tho mMr of fSmm HOi 
pmnpCTom^ wlridi ia di tUib ntei tllwwigh great pait of GliikA 
far Ao nwrtio ^lyoac^ dafiotiti a gredtimatiy oC oafbckialo of 
Mmei wWn tba Aqfetabiiiidaitt cariaMc aakiywUolikeptitiK 
aolmaoii^ & driTea off % faoUiog4 1 MM eig|kt ovate oFlliia 
ivdtdr 6Mr half all faoai^ ^0x1^^ at die eitd of tkat tiiaei Ilbmidit 
qokomilk^ aod^ upaH filterifeig^ I toHeated ImV ag^ of ohk 
isioons eartk i boikd Aa tame qoaOtitjr of the wohv of Jb« 
cob's wdliwftiakflMraoot of dm warf otaiii, far hitf m iwnir» 
and fdiiod drat the traotpareiMj of tfaa ^vatelr wataaamlf at«H 
laifMuxed 9 neither Witt L able to oaiktet «n)r i 
of carbonate of Itme.*' (M SGk) 

An iogotHoni and ehgimt tekekrf Ibi^ and veH i 
with die paaoliar oifciinHttfioet of die dtutkni of Oliftoii» ^ 
dodaaUeinttt'teting remniU on it dim; » TItefiaitdMtJ% 
we here brteith a li^t lea ab'f tonpeiad wkk a sdftdqr bmobp> 
tain kir* Whak cttn an eteicdhra mafe nktUtftaoiCt nnd i 
sahibrioaa. To no one ripot in onir Ungdoii attii thai * 



narian fly^ ctr cate due ol^rnaitei oooiign Ma ptek 
oitablithBient of kem unparod \xf diioBsa^ op4 
jnooe attainable dian in tho ttdaUkliixhoid Ixf. 



^opdke[ 
^Qoe attainable dian in dio ti^k&bdiixhoad Ixf. 6t VinomA 
Bo^k.'' f'JMaftmKAeBMMiri^ fcc p.«4 anddft^ HidDr 
Nok advened to tbe iaAnnee of mbincoiMMit lioMtenii^ in 
cdbstittitiii(g tho tefabnte of aii ataoiphtto^ Us jii ia n w i w oi d d 
have boen more eaiapfete. The nbMioa of itteay drio)^ Hke 
loiarrtiy flMdit oerteinljr iOOhtribHtei Jhrtiidy 'to die porite.wid 
whoieBOQienesa of die Ciliaon air» ior it wiii bo aeM* ift Ibe 
tid)le of djbeaate admitted dniing ibaflr jfoam into the i.liipiiinteffy» 
diat only one ctee of intermittent faver appaalocb and that caie 
was from the fimtiy dlitriet^ near GoagimbaiT, abont Moloe 
niiks to the wtetfi^avd of (Xfton. 

Sneh locidiadiiaQti«emHDabahly^wDQ]d be ofEtetdal i 
ing a morbid ocdstitution^ had 
tiimted tbair (^wn olwtionik Bnt bcM ore «the 
ftatarcfedf d^pfetofe^ tfcari^ dw o e ^i bmd n tf ^ha ^i i i i dmit m 
of dm iMondi ar^ oonfinad tadM |teii dr it teAod the 1^^ 
Hoadt oitepdiiy afaant o mfla inteagdi oldimiitfmndl Utei^in 
hank of dm Avoa, fiwntha immniteiu ^dtSy of-Brfatel » the 
Hotwtth»amilwiiwwod on op e M ia»ydmitteg4mii»til<fce 



1S17. ^MriaaMdOii^kk^ «ff 



«Mi^ by GiiAta hiB)» Ugb ml flcdif mte, hiid a bmOth bTttot 
ftflM iliiB fims ^a 19 A» iMk4 AIldH^hMii* lA^ef adapted 
(6 «h6 coMtauteiiofk oi; the Jo^Mr dMM ; or^ ^t«r^ fteqctetiN 



Si far llw pvime ^rf* emfABgrini^ dM itfrihw iirlbe ntosc teiefa- 
^ way» Ai MBd iota imiM^ emifte or bHiycMtej^, in wliidi 
dwieata sd itrtni.ofe «h<m>i^ vMtHiifon^ ttid M #Mftb, fic^ 
dffeflMMtiMift»lUaitfiafii»fti3ryiiiiiail^^ Th^bolMes 

«e cooqiiad^ fa meal ioebdic^ «ieb bftmoinf #tr^ tit«ikeh>tiii 
fi MHi i ii Mj nn ttiif nnr rmrm finrnimttj imrrirthrt pmi iiifiiii nTfffn 
icNur»'bed»«tom» Uttsbeii, arndkits; i«i4 wMfk^iloMfe^ lo Mlt Or t«ki 
iaATidorib* JkB^impttrt mt^ wbA wcMMflfttM fitah^ are fke ne^ 
latMiy wiM^untaif and tbe fetid aniaU^ wbidi astaiiicsih^ 
alhtagvav floleiiag aajroT time roMMi ^nOdefttl^ Mdittfte^ 
Ibiir flftnsiraiev. The diet, indetd^ ef tbeae fftopte ttay, in 
MiaimfoiMllenfail <fae ttflaeooe «ff €k6 t««f>Qritv of the 
iJiiliij^chitf^ eoMfting of t^^fitable focM and waMf. 
Aid docs jioi eiier very ofta» laM te toihpMtknh ; 
14 ivfaen it den^ k ischiefly baoen.' 11» petWM cif tite in- 
ntattii tMM'inDiaBa.ai' twif 'OirfnaiMffifiMM^ afi6,'ex6epl eif Sixn^ 
AajaaiMiMiliday^fltattliBifli^ tqaaM, fidvy HMtt Ih^ tii^^t 
efsMvtiom and acndld freaB ihe niMrriUl f^aittetttf fhty are 
^vf^Ndmdi. Thaiia^beaiM le be dMdfr (MicMt^Me;^ 
fln^ ahwytifi and I bakbva v muumMy ^ ^MMMtdti Mi Hkt^ 

nd /M«^ ie^aiteuriy teof m amaf k myi ^^*^ «MMChiimiA ^^ iiihid, I 
ipgr Jn jUibtJuu g, etftiibaiBbta td tbeaMi^tM «6itoiMdCf 6f 
d^owftubeJiaae babn the itkitAWBerw (Ht €h« (>aifish Tot 
yeAii. 1 hare ^idfed ibe d#elMiigt effh^ iM)f at' all tiiftes 
df«lha Ay pflamd bi the nMtt >a«i0lthed^ M Sunftlayir, ahd not 
ljr«n anaHbdaya, I bava bMideKghtdl io fmi^etve 
e^ibty Awe aicbUdted ia tmUPig theW Mbl«s, and 
ioat beoloa' AfanaporfiofH aOtbe ind^^t fifale in- 
habitaoii^arti daaayad or iiMnwpbyed aat^hai, Mikrt^, trade^^ 
«iD^ia«>iab<NBMa ;. oC tba ftanale^ tim^fit Ba » »m ^ tiy ^ decayed 
aOT«Miii»4MrJirtiav'<oaoaprtien ia #iubbig aMi ftPMfn^,i-&4i fre* 
aaiait winioie uiw ■int*ig<bam of fibditeh pohflmililw. 

in soah a tiate df thiagt, wcae^re ta ftMtfMf ^hrion by tbe 
iimalii|jtiialaittin famnliri in ftiiiirrftn trinltitfimi^ onth^at'^ 
MMriaiun if fliifct r^ — ^^^ haUtaitoiM and rootn^, and the 
«fBi4» ef Ifae p^Mans iAabitna pitrntf ifokij^et to stifeh nttp^ 
lMMdJ«iMiM«rjritoaM^>«e'BhmiM kifeptb^ Road^ 

ar^biiiw; waa ahaireky aMIa^' ifaa ^knf ^itmM df InfclctMn. It 
Mft'edMir, MimdiNgrftMidw a^fteadad mUt0 ^dis^mse^; iftat» 
' VdiMMbaMitiMd^«ia*4iHi||M^ 

i bive'4t«M, JyfiR^ of ^itfiHstioh, hav 






and read of ilia ftvagm 4if siidi dkaaMa kr auay of ibe lainr 
of £ai ' 



cities and toimt of mb uutad kmgdivn ? It moet brcoa feo w d » 
indeed, ihat die flootaiation aad inttabiHty of opinion, letpectiMjt 
ittfectiooy bare been as great aa tbcy are •onaoequntable& 1^ 
nay, bowever, trace iMir origin to pretcriptspe idcM; fSMi 
and in£ectJon seem doidy allied^ 'MPm ta. bear tbe op 
nity to each otber, aa cause and effiMrt;— end kenoe h i 
that a belief ipm^diki that d»e aoounnktion of fikh» &e;M 
necessarily be the cause of ^hia8,«-f^ behef faanded^doini« not 
ioquiied into* and consequently coBferted into.an-eslablisheA 
£K)tf--»an axiom in physiea. Little aeeeatoh^insliliitedfjand 
mankind continne to ihnk and act an a faitbrnot'sanctioneii b^ 
true philoso|diical prineiplesb 

On a former occasion (see Edinbnrgh ittfadical and Suifpeal 
Journal, VoL VL p. S«9), I endeavoned, by the adduction of 
faolsy to shew cause for belicrii^ that the amanaiiom finnt 
the putrefiu^ion of animal matter are not a caose of infisotiana 
diifliiBCs |-<-it is my purpose to take the pnesent oocasioni to ieffisr 
to the consideration of die Toader some frets, the tandenoyaf 
ivhich seems to be^ to shew equal cause for bdiering, diatt where* 
eter ^hns«.OF*a fcTer of anftctiont dnt is, a fe«er capabbnf 
(Bommuaicating itself from, the person, aoffering under it, a»« 
healthy one, aH>eaffS| it must be ^efsaaltof & s|mnfierivas, and 
notiihe pBoduBt of the fortuitous caBOurrettete of tboae dsvuaa* 
stanoer, to which it has been generally attributed* In sodhan 
inquiry, a oarioas bet presents iteslf,»*^tbat'fareia'.of infiKtion 
anr observed to be oiore preralent in manufaettarinff than oom<» 
mercial towns. This, I helieve^ is a generid remaek, .to; whidh 
there are doobliess esicsptiona. If it is founded on odmot oh* 
senratioik^ and there aeems no reason to doubt its beii^ so^ jhoii 
is it to be aoeouBted for J A very is^genioua «ad> acote oh s fr? as 
of mankind, onc& ramarked, in canvciaatton^ thaatheretiaa mrf 
obTious.and important diierence iir tbe -dispcisitienB of the uditu^ 
bitants of manufacturing'aad oommeroiBl towns**; innlie focmts^ 
there is alwaya a necessity for great esertbn ofiintdleet^ atidaaoiw 
espedaUy of the inTenChre faonky^i in the. latter, thereKestion if 
chiefly of the physical powers.* The line of eoodiict o^Aaiuhniii 
tantsof oommeraial towns, is always the aame $-*-henoe,.hfi conkb 
nued to obsenre, the miod is lest engaged in that qwdesof pur»> 
suit, which requires much Higmmity and.inventio& % ^hitt dme 
is, at Uw same time^> more coiUsieQ, more mixture of difcrwliad 
sodetj, and more occasion for suaritjr of manner:: 1%. foHows^ 
he added, tluit, in mannfiieiuring towns, liftentnie k more 4sAh 
tivated than in oaauneroiBli among; tiiehigher 



1817. ifSpistdandCl^i€0u 27$ 

^udBotj oocBpfttumamcnig tfaekiiycr aadlaboiiruigi but that 
in oosBBiefcifii Umm an oppodte atete of things may be ob* 
tarved. Now, if the obaermtioi} majr be extended to^ the patho* 

S;y of thes&difibring aociatiesof men, pacha|i8 a step tamrds a 
odon of die properition may be obtuned : &r k is not im-* 
ftanaiiiiblc, that the nmiatnral state in which the inhabitants of 
mnnofiKlarii^ towns areplaeed, may dispose D» the geoenition 
in their systems^ of that anknown viras, or poison, eaHed 
tjrphona ii^MStion 9 whilst the active busding, and more nataral 
aondition of the inhabitMits of 'oommerdal towns^ pfeserves a 
^e bahmce in their systems, fagr throwing off those secretions 
iMieiess in the organisation of the haman body, and injun^us to 
ks heaich a4ien retained, is^ th^^^ typhons infiection, or rather 
the *viras or poison so called, senented in, anddepend^it on 
<he iitato of the hooum body itsm, and not the resale of the ap^ 
plieation to^ or inhalation cf/ soy thing eattraneous i Ev)ery ob^ 
servacionmade with due. precision and aagaraty^ seems to prove 
llmt it is. • Reason and religion' unite in oonfirniing tt^ What 
is petnicioiia to the system and economy oPthe body, is ita 
nataral state, ia separated from what is beneficial ornecessary to 
k, and is thrown offi I^ Imwever, from- pursuiu or oocapa* 
tions, for which the human bod^ was not intended, batmto 
which the artifieial wants^ the caprioe^*' or the smsuricaof man* 
Und, thaTe involved 'it, the fuddions cannot beyropeily exers^ 
ad, and, eoosequentiy,* what is pemidottstoity cannot be thrown 
off, fant k retained^ then thatpemidotiasabBtanoe is ooniwrted 
into a poison desmidtiYe of health 1 aad may be considered as 
vetrtbnd«e of the perversion of thefimctionsandipowcrs, im» 
phkdted in tho body for its^ saf^rt and maiatenaeBoe:«-Ut nuvy 
be OOBsUered, in truth^as aifortber, and.stiiliiaoieiintmetffo 
IHnitradantof that^groat and imivaral low by 1 which sttflatnco 
k'lnpiMMiiadcandaecaved'finom fiulnm, theiawofenrnpensalibn. 
(See Udrnbai^b Idedieal and 8argical Jbnnni/iVob YL p. 4ft9.) 
^Qt it'may be said,' that sach a view of thegtneratton of the 
vinis-of t3^ihoos infection j k ioooosktant with she proposition 
meaBteo be proredx No snah ineonsisteacy exists^ as die piw^ 
position af^plfestoi^the habitations^ of the indigent in common 
iiftf^-A^M^Qefty asnd»s activity with <ham^ ^ nec pssai y ^ . land thars'* 
tfilre,>tne oiKaininene-Joi -the moaiMi ofisttbwsience, cannot'ciik 
-caitt with macii and ooqtiBttedoottfiticmentto their filthy and 
Md: dweHuigs. • ' Indigenoeoand sloth are often found in .the 
name peiaons^ and arlien they ave, than ths'.nstvibutioanoceskujt- 
Jy attached to snob .aO/ tmfaappy wnms^. imay*iiofietasived,.iaBd 
may be) felt. ".Soeh* annnicsa l*«MeeiaaitO'beiiibe<parant of 
^cbo..v9riia<of^<9phonsii^t^ VJSach^anjmJonitthBMibr^ t^]s 



S74 J)r OM^Oi^'hStaikiiMrMthologf Jt^ 



ibe WMlnogt» md obgkt to te «Iie diilgr ^drt$€Kl[|^btaMd.Mid 
allpOT8ibkiDteite» foroitlwqgh it»iyirtetdiff»trsbA€eal>»ttiiw? 



is aWayt m^ to All Irlio odme ^ritlm ibif J-adms of Ibo iBfaWMb 
wkkb cto^nlitei fifoiil it* BmdB iim epceriyMrtfir^iir of aoiiye 
0iil«o(Uooc isdastajry olnong tbe isdigw^ sumI be 4hnatt%r^md 
aboold.bo oUigntorjrckiflOMlp ItdiffiUtesbeokki by th^dio- 
npolioa of Ibe obumb of die— ie^^i^ wlMmi the iiitfit abwHtHilhe 
inerliMso^f MOitbilityi-Hil kindleft die i|rtMA»of tfitaei imitei^ 
;cd bgr aatiiFe^ I tmai luAferMj^ in tke htaMU iMMt^.taHi a 
.flame p^^ihaket Uro^odiel'viiieliioie^hali bwdMitaniwy iMtt 
wkM i pila KiB of fleeiety$-^il netlm tkehodv^ il1iiim^hra» 
oftan aioBiine^ tba mkkA Ttkt deMeinjr of Ibia oipifr itifMufr- 
«H peiooiple^ pc»lldoa% okI tuahSif doniifcrtfj ii aliyaffigl^ 
when di6 etib of pofav^ fluid acaiMf {vita a^ ttiPCBeigp <» die 
karar o rd»i ofaocieljF^ a^wo eapaaially ihtoi^^lnwi^the owitn J 
iBiiigdom^ waD imdanitaod aad judfaioidgF «p^M. P»H>w 
« More oi)l|XMite illatlnitjoo df its udiiljs tikeit^m iftl^lMafe«»* 
damdt be fettody^than idM* die taiuk of the lalo 



iMMUffy into the state of the wm^iaxflloy^ fooer iki di^.oity^ 
Bnstoli ilutitntei mkb the hhM banetoklit JailiMtioilty Mr 



Hqrftboraa the meyor> aod the.eflhpoMliMi^ iiod dated ImkMrf 
10i7, fliaanititooa. By tlie letiifBliotiadAy it appease diataMt 
o£ eightatft pansfaas^ and- a^ popabiddft oatftain^ Miieh waffrtrl 
iDgf 8O1OM4 aMmigb ratuoied kit IM I ody .7^5% odpLdOU; 
>«Mlio.tMHfiiad^>of ptfar out bf m^k^ or net Adjy oa ap hyod , 
XotwilfastaiidiBg dM^ ditvoai^ few piaeaa iDoie tUbf% oiiAla» 
psafoedy.taaiilstod^ dilMawigrwiiBkiembkp*rt|«ii<thotibo 
thoaariBipopsditta^ofdieeilfl^ofBristok In tkeiaddMsoioflir 
Hsythilai^ ^ thifc id k lto o s di^ o<Msioii» to Uf fcUoiriidaiii^ 
k iiiiopossible' to ibrae«i asoi^ oonoet comeep^lhtt of tho>pBiB^ 
jdpio i. bate eMisrraoied totackosate^ nor Mntdw isMieof As 
•ofiliifsptiati be mot^ omi^tkdHyy aad at the sOtaie^BPe. oati- 
eisdly ^Kptaaed. ««^he «meqaivMal oh|M^'' sflgfUiae^ .<<^lr4o 
isvie the physkmi and meral pmmmti tbmf. iistinHp' asuwi 
of asdiaty t» du^ eodNMsiHiy^ As nldt'.aa «r ptoiolit^JBi 
4if the «ignidodoti of duit hoiieal' asBdoMit wUahf la 
birthwriritt of A««rt Bittea^ kAwAver bar bo iMHr>j«nbiti 
M^i'' Modfei%ooiisidered^diapiiiidp^ 
oAa^ aldM^b diei^ k ioasoar #cr balkvet. pnMlOi* tbitlle 
o oi Ofch t t of die b e net ok nt JJr Itu m mu^ mmo 
ifdatoi, foMmpa w4iariaaiaiioewelt isMbntaod. 
£foe dbao dit ptcMrigatM of dait geodaiBas'a Asooreiiea, 
An gW N wdBn of the vdviof utftodia Imb do^boa^MRh iiK 




un. ff^rkMmiaiifi$tU VIS 



tvdttgfttadiii lke«i^ri»kwliiMtaa lli*ii*)*ratknil,die< 
«MtaraftMi aad app]icdlia» Of fiustt } iMioiig^t (k MeM «]«Mit 
fMMd|NEiMl)i tbe niMto of pi^BventiMi have been ^taaSt$^ 
^ c ^iBo ei fe Jy di|^telf and eoiplo^cdi. Il lias been^ iadeed^ a 
aart of empinoinD in elMBusfl)r« In H^ enay «n llie Mafig- 
iMiit PtadleBlia^ kb|)re|)eify dsUed ^ YeUow" F^^ier^ I haw 
kMlveilled t6 ibis laode of geoeealion of tbe vkm df nftedm, 
¥oliLfi^S9l. <'Tbii^|bett# ihefiMMfif <iie fimdatadf 
is the dBimtt «HDaai4iH« diitetl^ fima btailan bodies 



iafeeted with aontagieiis 4r itolilmliat disci e B , w frtm 

•laDodB to which Ihe basis of these eOkitia has attswhed iiirif ; 

Jih^ ieamd proitetbjhm hMim fffbm'm mimt^ /rom AtoaMy 

ptrsonSf bid from tie peculiarity of the circumstatices in which 

Vug dte placed^ in d ante 4f m&r^d cmee9»alion^ and capable 

qfgmtBmiing u frineiph mmilar 4o thai prcdmed iy hffititotts 

4md fHtUemiiid ejffhmoi.^ Siaoa thcni I have ff W jUBalij r ebn- 

MUphiDfed IM ^l|J^i0C b)^ too ocdttiVcftiGeiif cJytTttittltltiifies atta(%i« 

cd tott» m faiths siluiKions, in a long doikfae oC Ib^ca) experi- 

eaoe-i hoi aKneiimQediately by the ooosid^iatioa of soase ill. 

laiiislilia factor ohieirved io Bnstol abd Oiftefls which go int. 

If Hot tne wnoie lengtii^ id piiife mac iBe luieeiioB of rtpiius is 

a ntetdfic viYus, that h, ti:^9,yM ixf t!he B^« ri&lflf e, firo^^eter 

.aaoinfied by adventitious cifcamstancea, and always Tflgnktad 

' 4iy Meto p e kw% whega»ar it awy appear t*Mhat k dWtmM kmit 

^^ weMif n dbMiKM hi enty dlf eeckflh ftfufetaig an aiMO^pIittfe 

w^tMd ftidr^ iiubndd ^th ^ its ^ttdilie^ and ttcpMk orWi. 

..! nwnkatfng diose qoaUties to bodies animate and inanianaley 

. |kboedwi£iniiBdiamateri*-*<hatdksaeb6dwssoiiri)aii^ 

I tfiiteotlakibted pbee^ $-»^thflit ilodi i f taa o&' ic tettttti fhitt Its ittftMfte 
^ what thoa coayeiy»d |-*-*that no tefiipefatui% Except a tc 
- or a :fery low.<^iie^is oipable of daoasposiog ili— F«ad 
MataankraraHfanMlii xi destrotiBf^'it^ ^oMspt the ialsode 

"^dMIdii'gasaiiy WnicSiy scdbj^tulig ^it ti^ -a tMHik^ flccbMpMltidAf 
< ^ dv^ H^ to new combinations, ifielt or hafnil6» in (hdf ilMlre. 
^ CNae >€f .thamoslTeQiadiab]^ iosUacesof 4his vini^ under jdl 
r'lfaas^ oondilioBa^ IjomaCqasiiMad with» iaidie MtiigmmA Visslf- 
£' Kiitial 'Ifavisfy Mho^ernelbtttid lo^ lntMldtii:^ iliMr «e 4ihiad %f 
( Qtailkdiftt itt tbe^<»ifeh Cif FebruflS^ dTflre^lsttr 17i^» eonisfrn- 
( Sow >w^di| so mndii utpkih m mnchpertucions dteai^num has 

-l^eBfiaea^ ^fiflift Essiiy^VU^ L aiidfL J^tttf toiXrHi^- 
•Mfin^t and^ Edki. Mad* Mad ««ig« JoMa^ Vol. XX^jb 4if.) 

; lA (ka iMmSL test tefeMribd to». I fattve t^nptmiA m i^tiitiik«Qfts ki 
the following 'exnlioit tnauoetv with whidli ^ shall oodeluda iAbX 

vl hate imj^MR ip safF «ili«i#idv«9ty jfltrfduaMsyj* 



976 Dr Caiiiholi&fa SiutidifuU Paiholcgif iu\f 

ment of. facts. << A dose and discrimiiiativ^ attmtibn to fiicta 
and eircumstances, render it evident that typbuii does exist 
within the tropics, Varjriog only from the same disease in other 
climates, in as much as a high temperature in the former, gene- 
rates a peculiar modification of its specific nature, and in many 
respects of its symptoms:— and that the Malignant Pestflentia^ 
or what has been most improperly called ^* YeHow Fever,*^ 
(an impropriety productive of ail the mistakes, all the oontro. 
Tersy, all the warmth of discussion^ exhibited by the writers on 
the subject), was really and truly the typhus of tempcarate and 
cold climates, assuming a monstrous, a new, and most destruc- 
tive form^ through the agency of a tropical climate.*** I shaft; 



* We are enabled to appreciate tlie value of tlie oba^rfatkms of ifaofe men 
who have gjven tlieir opinion against tha exittence of oontagum in Matigpuat 
Pestilential, or fioulain, called by them '' Yellow'' fever, by adverting \q what 
we are told were their real tentiinenti on the tubjecL Thw, a Frcndi writer^ 
M. Moreau de St M^ aaaertt, that Dr Roth declared on his deathbed, dlat he 
had dented contagion for a particular reason^ although he had never fot a nio> 
ment altered hit bdief in the infectioui nature of ydlow fever. He disavowed 
m his last moments every thing which he had written in &vour of non-contagioik- 
^ n a desavoue k son heure supreme tout ce qu'il avoit ecrit en faveur dehi 
Bon-contagton/' The first part of thb assertion relative to Dr Rush's denial of 
contagion, for a partiadar reasoth we have no grounds for believing. What* 
ever he s^ or advanced, I am convinced he belMved to be true at tneiiBeT**- 
but it cannot be deniad. because U is well known to all who were, best ac^naiat* 
ed with the Doctor, that his versatility of opinion, on this subject, was most re- 
markable and unaccountable. I have information which I cannot diibelievv 
that the deathbed confession and contrition stated by M. 4e St M^y arc true ;«^ 
and that his last, and weshottklMppose his inaestf asit'W«shisfimo|»aioBr 
was, that the tfefora whiph devastated Ifow YoFky^Phitodeliihiatito. wise ingfeitr 
contagious^ and not derived irom domestic or local causes* The jnm.piriiy. 
of. motive cannot be attributed to nuQiy others* The fact above stMed^is cer* 
tatnly very important ; for it may serre to thfx>w into light the sinister views.oT 
those who have actually eeea the disease^ aod witnessed its infectious. aature»<aad , 
yet have maiotaiaed iu aaaiODatagiaQ* The ^a^ority of the wriie«a{su()fci|;^^ 
tp the years 17»6 or laoo, have ^positively aot wrt nea m iil the nH|ligqaa|;nMiM^ 
tial, or. BouUm fever, but the yeUow remittent ; and» from some amnify of 
symptoms have believed themselves competent to affirm that what theysaw* wu 
the malignant pestilential fever s and' thatt consequently, the maligjuant pesti* 
lential fever was- not amngioas*' i believoDr John .^Anoftfongy in hb late 
mo^ valuable work on Typhus^ alludeji tp thismisconceptiont.iwjiea l)e<s^jH 
** an ecTQr of this kind, X coaoeivci has been jcommitted by some reqcnl^ ^^^ 
of note, who, in their respective Essays, have irequently confounded the biuboa 
remittent with the tme Typhus (every and thus unconsciously given the latter 
too high an iniammyory colouriagy^ pi* 1S5« Had this proceeded fippaa a mere 

coofosMMi of idea*>-had the whole been ** unps utriqae error* sed^ 

partibus^'^t would have been excusable i*—but» |o use the lapguage^ii 

the most eloquent statesmen of the present dayt applied to politiciaxis t 

mif ** it b indisputable, that the poison of doctrines, at once the most pcm^ooa 

aad the aaost.alMwdi badheea laag*<iiitthaiag ih^oughihe .body >f tha oon.* 




1817. - rf Bridd and CliJioH. 277 

npW proceed to flie statement of the facts which have occurred 
in Clifton and Brbtoli during the same period of time. 
• 1. It wiD appear by the table of diseases admitted into the 
Clifton Dispensary^ from 1st January 1818^ to Slst December 
1816^ that of 1699 cases of disease, only 16 were typhusj or only 
1. in rather more than lCf6. This fact of itself is an extraordi- 
oaiy one, when the circumstances of the indigent inhabitanta 
a^e considered, among whom it has been universally supposed 
peculiarly to prevail. But when it is further known that these 
16 cases occurred in situations and houses sufficiently well aired, 
cqpen and clean, and in persons by no means remarkable for 
aOrdid haUis ; whereas, in the various courts and alleys, where- 
in the. air ia corrupt for want of due ventilation, and wh^eia 
also the rooms ana persons of the inhabitants were such as to 
render them highly offensive, not a single case of typhus appear- 
edf at least not one was reported at the dispensary ; the iiiferGax:e 
seems reasonable, that filth, &c. are not the causes of typhus^ but 
that it proceeds fi-om a specific virua introdoced. 

^. Tlie word Typhus has often, it would appear, in Bristol, 
as well, as in other places, been misapplied, and made the deno- 
mination, not of a fever of infectionv but of one more obviously 
the product of emanations from a humid, a marshy, or an iir^ 
giHaceous soil. ♦ . . 



tabxSitf ; doctrines notexpreas^d in the (fiction of illitwnte iiisii» but penned in 
tKte wen wrmig^t periois 6f {itaettted wrktrii" Othei* 1mv« atramed the tX* 
fice of iiniplre«» with a moatsarpflfeiflsrtgnoriaeeof thetnbjeetof ^omravertjr. 
Thus, kBLLdUlB- Vakmin^hss most egregiooilycoAimittedhlaMlfy.by roand* 
ly twdtln^^d iit br Lhiing of ChsrieMown, and myself^ <* ont imprtoi^ sine ei- 
pdtt one fluravfeise d»reictioii,"— sad that h in pafticular, onty «w the yellow 
fev^ hi 1799 1'** ^ cMnmtf ttri Mtttkia mvigateur, •'ttt tfc^ prsiia d'ecrire ; il 
fWtibmp^ dan» pretque 't«ttf '^cr'qa'il aMHies/' Htiafthtr *dedaret« that Dr 
Cddwlflldf PhOsdtol^hia, faai» ia^^hit 'Aiedieal and Phyikal McfM)Sra,ao reliiked 
jyt (a&aMtnf thst the- laii«r'ha§'beMk unable to niplf ; and that Rushy Moselef, 
attd ly^er, have also shewn the sandy foundation of Dr Orishohn^ doctrino. 
Now, h 'ts dear that this wrfter; whdevsv he is, has never eonsuteed my writ- 
ings^^ilor ipade himself at sN aecfoalDted with the siAftcche thuv presumptuous* 
l/decides on 'y-^dr it^ls^eU known, diar the yff Mvene Of what he has said 
irthethkh; and ttiat no reply has as ytt appeared lo my letter to Or Hay. 
giiiOt, wherthi my prooft ind senthnents are * meet fully developed* But such 
oMtaense is unworthy attention^-Hior shoukl I have noticed it, were it not possi* 
ble (hat the %nbranr aifd 'dishi|enuoes asserchmi it demists ef, might make undue 
irhpresdhm on the miiids'of Aose who hive Mt seen my Essay or Letter, an 
't)iema^jnlantpesti%ntfll^fev«r. This notfr has been made in eooseduence of 
reisiding an'eitract fraii the'' French Iteport oir the Contagion of Yellow Fe. 
ve^^publifhed in the London Medical andPhyiical Journal for January isi?, 

'^^A cttriouf hntance of the mittppiieitioa^ the word Typfaos, I remaiked 



278 Dr Chwholm'ii SUUistiad PathOcgg Jdlj 

The Krietol lafiimaiy is a noble momitaieMt ef tte ■Ukgaift^ 
cence aiid beneveknoe ()f tke ialiabitanU, by the vofciDtBfy snbv 
sor^ion of whom it m ehief^ supported | an^ iu flenml ar- 
rmgeinent as a hospltol b well calculated to fulfil the objcfit^ 
of its iiMtitutipn. Therp are fifteen wards, seven fi>r iiie(!lieal# 
and eight for surgical cases $ and each of die Ibraieff vecttves 
Airteen patients, so that, although constantly ooeupiecl hjr mom 
Aan ninety individnak, there can never be any crowding, or im- 
proper aeonmulation of any kind. Certainly the goieral ap« 
pearance of the house is highly creditable to the immediate sa*- 
perintendents. In this hoqpita), tfa^ mode of arrangement dt 
patients, which is always adopted, I understand, tends moch ta 
eonfim the opinion, that tl&ose eases sid4 ^ ^ typhot barn 
been in bo instance infeotions. These cases are placed pioauaT 
caootly in the wanh with other patients labouring under very; 
dithrent compleints |n-and this is doi|e, not through any n|^<v 
gence, but from a oonfidenoe of their not beloa infectaoos. "Inia 
account) derived from the presoit very ^le and attentive fi|Mlhiiy 

W il . l l. ! ■ >i l I I .jj i I Ji » i '< LA .1.. i. . . . ■ j ■■■ I ■ t l ■■ ■ 

ia the iielglAouifu>od ef Tetnomoutli, in Duvoarfiirt, ia tlie autnam of IBM, I 
dM die len^sri u i iairrtal It in my JenniL ^f ^wv l|rftr9P-9mibel |f 
BjagNSteinten h thsdirtricc where die clay-piit are fitasted, d>e W^ iMl?^ 
betogcitlierab^orsbivwa.grsTeL Thii beiag remoned^ a tliick atntom «f 
pipe:cbfrfiiitaa|issii,hd^ T^bgwtf'^ 

of a wlntith ydlow colour, the latter a fine blue. When tae woAmen.pen^ 
tratt m these iiiita»thsf take cam to ievel the wrftce, ^4 jj^ diridf Wf 
iinlaaqiisr»ef alboreaih. Thii hema lionewitk #A mirwffn»ar 
fiordw iNif|SM0,ilw7iiii(mr«ar tawAw>nWpig w» ta nw w lfl i 




the dajr comiaiulJf with water* te Wfrmi- itf adkunM to 
Whca they l^ave wok to the proper 4eBlh, Aifv hf^ s PW W ^-^^^.^ 
the hijrer, wkeii of eoane^ early i^uare faUa out dbtiQCt. JCirigrat^tQii i 
OB • portioD of cfwie oatnihre el»y>>hed»i .i t m «|po «qM«sfl ao ^ e|rl| ' 
fMmaomo Msishyineta ao the siile of tfie ri«r(TeigM)»|^ m 
nluida whicli a«afcldoB» coveral hjr m^ffif*- A9A fa^ffeii tm^on | 
atandc, it higfat beautifolly di]rer»ifi«d, sod wfsop rtmf xgg^x^m ^ J 
a hedtky ataiQi|)hfre and iqU. The cpaiciiueaqi howev^ isf ^ 4. .., „ 
tama are thoitviived ; and after dbildrea wrive M tke age lof tea or tm^'^pk 
tfcoirGflartiliiiroaaafaaflofllodhf theaaisMi,«efiBevir«fir repoeerMail 
eCM^o£chen,wkkQiitaefaao8eofaillMli^ TMm'upmtVM^lltmWfr 
plexhHia of the lohabtattts, aod by the astooithiog aHrnfcer of grfitdfi io |%i 
ehardi^yard. Theie exhalatioas affeii the hahU by ppilfh^iag W^f MMtfytf 
leeeiip, aad dy«niteriea» which generally tefiainate la fofv)^ {!f|srf lnqjIrB^ 
absySodaieinfMSfitieadnnBadiewsiiaiaaiilMr tfdiiri|iatl|p||B|Qa4t||af |i^ 
»M»eaiiaoffiwte4 to cyea theahaptt s<eMaiae»illiig» of >tW"»f$tWI»rWti^hprf^ 
^tij«pfeote«taadtoJth aeeiifw^ Tks fcvwi whN^ 
eatted all over due daitfiet Typhuh aod mfcctipw m^*h Tim U \ <VIMfa^'- 
^de ili^^itradon of the jodiciout obscrrarion of Ppr |(itc)iell of Ife^ XlopK, U)^ 
eby countriesy however deep die strata from the tnrjfaoe, arencUy, and'4ii|&y» 
heakhy^p.^ npip'.ivriih af Ihiittd awy ht flMi^ 



mif Mr 8i«yiiet U stirngthened by that of |> ThooMs W. 
SjrfiTt w]v» disdbarged ^ba ftrduoufl dvilies of f peibeeaiy , wrick 
die bighd^ crsdiU fior more tbon twenty years $ durii^wbiok 
)0B|( jpemdf he i^&naf^ me, be almosl neirer knew an insUnce 
df inj^eua fever in the hooie^ Of the out-patienta none are 
eases which reqpur e «do8e attentien {r>-ihouId tbay bectonie ao, 
thejr ana ironscdiatdy nuide iarpatients. The Rnniber of outv 
patients during the last four yeprs, ending the Slst December 
18}€%, amounted to about 4000 medieal eases, of which ^re 
waf not lene of feven Of the medical in-padents, the following 
is. a correct statepseni : In a tabular return, in which the nmnn 
her of medical cases admitted into the Bristol InArmai^ frofn 1st 
Jannaiy 18 i9, tp Slst December lfii6, are stated, distin|;uishv 
log the lyunber reeeired from the di&rent parishes of the eit^ 
respestively, during that period, the following facts opcur. llbn 
lotal numbei of medical patients is 828i $ of these 74 wereea^es of 
Qp|ihtt8, so returned at Ifpst, giving a pritqportbn to the whole adv 
Biitted of I to about SI, or f to abeuft 85, inelnding out-patients i 
and 100 of f^ver so called. Of the 74 cases returned as typhus, IS 
duad,M 1 ]n5f8r ThennmherofiMMeBof&verih^refereis 174.1-9. 
Now« of this number 99 were sent irorn St |%ilip*s^ 34 from & 
James's^ Ifi kma Temple, 14 fym & Faufs, 12 from &^ 
MJflhaePs^ 10 ftmi^Bt Nieholas, 1§ bom £t Augustine^ 10 fisooi 
Be Stohei^a, 8 fimn SedeliA, 6 from fit Petei's, See. Th# 
first oTthese parishes, St Philip's, except the broad and spaeioni 
rtreet.oalled the Old Market, is extremely bw,-«-mar8by tov 
anuds the Froom, and aigiUaeeoiae l^waids the Aroni andl 
dnm;- where houses are not buik, bfick-fcibs and clayifils 
nboinnd. It is therefete more pnabaUe at least, that the nnmfaar 
of ^sor. oases sent to the infirmary, partodc more of the paturf 
^jieaiitteot than infactiiiua fevar» mora eflpeeially aa 18 of tho 
W osiwu'i cd in i hg smnnar ^md atitanuial months* A oonsidaa*' 
ible^^art of the parish of fit James's is in low ravines, (favougk 
IfjbiGB tha Froom runs, which, finr some years, has been daair 
mad up to constitute part of the floatipg harbour, and the wal^ 
^vhich if ooi|stantiy atapumt, and ipraed wttii erevy apeeies dt 
impurity, and in me varm months, emits n?ost pflfensivo eshalfr- 
^ns. Here, then, we And a much more probable agent iban 
^phus inibction. The same xuay he said of a large ^rtiop of 
& Aflffustiae'a palish, fnens srbieh etghtten oases of fiiver waaa 
aent^t^oecwrrmmepftwdfie of which was in thovarm mootba. 
CJdlli^e Street, and dl the adjmning small streeU and lanes ane 
hoflton inade ground, aeoorered from what is called Canon^s 
lifasnht the water in the drains of which i» alyrays stagiiant and 
pntiidi. Two of the parishes are more pfutiodariy dnerviiig of 



MO Dr Chisbolm's SiaHstieal Patiohgy J% 

attention, Temple, and Cairist-Chardu The fini 6FlhBmi9 
one of the most populous, and the most poor. It oMtahis oon- 
giderably more than 5000 souls, and oi these nuMW than SOOO 
are in a state of the most wretched indigence ; notwithetandhig 
which I am assured, that, although there is annually a great 
deal of sickness, the consequence of poTertyand defieicnt nu- 
triment, yet not a single instance of any thing like infection haa 
occurred to the knowledge of my infennant. Of the fiAsen oisas 
of typhus stated as received into the infirmary, eleren occiHted^ 
in the warm months. Within the limits of Christ-Cburdi pa« 
iish, is the street called the Pit^hay, the rag*fair of BrislxiL 
Tlie poverty, the filth, the closeness, the stagnation of air, and 
the crowded population of most of the bouses, are only to ha 
conceived by those who have witnessed them. The pastor of 
diis parish, always attentive to the comfort of the 'poor of hia 
flock, frequently reonested my professional services -for the in*, 
dieent sick of this district ; and, although I have vastted aopie 
ofthe most loathsome of the habitations, and seen fluniKes ooe^ 
sisting each of from six to ten individuals, inhabitii^ rooms not 
ten feet square, and breathing an air which lUmosC ebftcaled . 
me on encountering it» yet never did I see an instance of tj« 
phus. From this parish only three cases of fever were raeeived 
into the Infirmary during four years, and two of these were in 
summer. The parish ol' St PauPs is peculiar. The streets and 
houses are of recent construction The natural aurfece b veiy 
low and very damp, in many places marshy, and in most places^ 




joining streets, have been laid out. The streets ate veiw fcgsf 
Jar and spacious, and the houses, in genendf ans btttit wita wvetj 
attention to elegance, convenience, and vwtiiatioiib .Notaritlv' 
standing this, no part of the ci^ is more sut^act to fevor^ the 
product evidently of humid and marshy, miesmattu it»«eeniin|^ 
ly mixt state, and its frequency, have doubtless «Aen git«o rise 
to the mistaking it for typhus, the essential poepeKj of wliiab» 
however, contagion, it is not possessed o£ 

S. St Peter's Hospital is rather the general poor house of the 
city of Bristol, than a hospital ; but, nevertheless, .there is an 
ample and very suitaUe medical estaUishment fer such cases, of 
sickness as may occur in the house itself, or snchsiek poor of 
the city out of the houte as the committee of relief shall direct^ 
or such as may be occasionally sent to it,*-fbr it is thea^faim 
of the poor, who, bdng distant firom their own comtry, or pa«r 
rish, are destitute of parochial relief. In all these r^pasta li |^ 

I 



Mil tfBrisMandCUftm. £81 

V most imtMfMnt and TaluftUe institution. The house is caN 
cokted for llie eomfbrtable accomtnodation oF 400 paupers of 
idl descripiioifi. It h alwa3rs fiiH ; and the unfortunate, the su- 
penmnaaiBM, md the orphan poor, are perpetual inmates. The 
nialesaad fiNiiiile» have distinct wards; and such is the atten- 
tkm to fcdft i g g bf deKeacy artd dedoruniy the superannuated, the 
dicijwd^aild tiie chfHdrcnf have tlieir respective wards separat- 
e i >6 oin'<iMi-reitf, tHe latter with suitable superintendmg matrons. 
'nummtt dao dktkict wards for male and female lunatics, with 
attached and appropriate celh for the worst cases. The sick, 
nMe *ttp€eiaHy cases of fever, are placed in wards, spacious, 
chiB, Mid WU ventilated, which nave no interference with 
oiher parli of the house. " The estimate of the annua! number 
of'sids^ dl) descriptions is about 600, the greatest portion of 
wUckJawlreiilAiaus, that is, taken up as vagabonds and beg* 
gon I ihe retl' am caseb ocenrtlng amongst the constant in- 
nMac% ior McOMHetided by the conraaittee, although not in- 
BMtes.- Uikter such cirevmstancies, did much infection existt 
we iIkmiU not be slirprised. The truth, however, is, I am as« 
aiirad bir Mr Margan, the hoascf apothecary, whose merit is 
evvlodd Vp the excellent state of the institution, that infection 
hnrawer been generated m the bouse, but whenever it has ap- 
peaied^il kaa beeti introduced by some of those unhappy be- 
lli^ who ieera to be the Outcasts of society. A very interest* 
ngJilid tepotlattt dtcmbstance was stated to me when I visited 
t|»*4iteitn iiiver aiiice the conversion of that part of the 
jUl>nirtuebp^iiscetbmagh'Br(^oi, into a ** floating harbour,** 
SfcPclM^ Hoipittl ha* been hfiflnitelv more subject to sickness 
tfaaa al' ady pveeeding pteiriod. The house stands immediately 
ott 4fae mtthewt bank of this river, so fhat what formerly con- 
tributed grdttfy'te its* genetiil salubriiy, by fiicilitating a per- 
]MllniLKlreinaMflMf tkh, has now become a source of evil to it. 
lie diiease'<merred an more particularly produced by the ex- 
the 'almost stagnant water of the river, thus be- 
^ 4^fiMilg bsrrbotfr, is a low fbver, partaking much of the 
oiP ijyiwdiats, but merited with ihdistinct intermissions. 
The number of cases of typhus or infectious fever has been 
5tt^dlnriiig'theperi0d*4rom* 1st January 1819, to 9 1st December 
IM69 «mt>f tfiesesixtem btfve died, or one in rather more 
tlMibdnrec^ »MD|Mirtion' far exceeding what has happened at 
the^Anslol InfiroMa^, during the same period, and which seems 
gnlf'tto beacepiHitecffef, by the symptoms of the disease acquir- 
ing 'iiMire*WeleBce from the insalubrity of the situation for some 
yevftpaat^ aiid< Wthe eondltioA of many of Hhe subjects when 
bhMBighfcwio the boose* Tbia resultf however, furnishes on ad« 
VOL. ziii. vo. 51. T 



Dr ChUbokfy Siaiktieai Patiolagf j«^ 



ditiooal and aalUiictonr pfoof» tkat the nru» l ,^^__ -_,,_ 

is specific » ibr no establishmeiit of the kind am be k^ in- a 
more perfect state of cleanliness and Yenttlalion i and ia'tfrerjr 
instance the infection qipears ta have been traeed to * awivee 
foreign from the house itself. Since the b^amiiig of the p wm at 
year, i. e. from ist January to 12 th March 16i79 abmit .twenty 
cases of typhus have occurred. The infiection was iiit>odneiid 
by a wretched coloured man» foond destitute in the street* and 
received into the house, wiUioot the namre of the >disot»e he 
laboured under bein^ ascertained. 

4. The Bristol Dispensary, the bene6ta of wUdi extend lo 
the sick poor of the whole cityt is divided into two di^ot% as 
ecpally apportioned to the popidation as circumsfnneaareaa ad»- 
nnu I obtained information firom the medical ge^tm^ eon*- 
duoting tliis important iqstitution^ founded on ta^> req^eotive 
roisters ; and, as far as relates to the prevalence or* eyajTeneft af 
inteetions certainly it may be considered as s a t iai aotp ry*. In- the 
nortji branch of the Bristol UispwMary^ the oumh^ df patieots 
admitted from 1st January 1818 to 3 Ist Deeember't^SMtvas 
SS99. Of this number there were on^ lonrteen ofMs €if typhus 
so entered j three of these wti^e ftom St Jamei'% teu £niM St 
Fhilip*S| and one from St Paul'& Into the-soudi braneW dwr- 
4i^ the same periodt there were S^M patient! ad^^jftted^and 
ofthese twenty-six were stated as eaaeaof tgphnif allAeit all 
from the parish of Temple. Reoeiving theasK as w^ as the 
fourteen in the northern district,. aSiaeUMUv^ omiSB iff tjfk»H iv 
fever of infection, our astonishment must be excited m^ only 
forty occurred in a mass of sidcnesa amounto^ t# abeiii om^ 
thirteenth of the whole popolationof BdstoL 

It spears, therefore, Uiat of IQD9 patient^ admitted into the 
Clifton ^Dispensary, 2231 into the Bristol InQrmarj»4>Ml^M00 
into St Peter's Hospital, and of 6938 lata t)ie finstplAiipen- 
sary, or of a total of 15315 cases of sicknesa oocnpJQg dmivg 
the same periodt on^ 180 are stated as caies qf tap^MiN ^ <A® 
. in about 7i. But, when we consider Jiow doubtvu the eoirseet* 
nesB of the statement of typhus cases, as prooeediiw fironMnlee* 
tion, the lemtimate sense in whieb the wora shouloM eeeeined, 
is rendered by the information obtained at the infirmaigr more 
especially, we may estimate the proportion. <^eM^ of ii9$Mtion 
to the total number pf sich as infinitely M^ perhaM at <me ki 
UO. 

The forcing (acts tend to establish on^ one partitm of the 

proposition, viz. that Uphus infection is not the offipiuig of 

filth, crowded unventilated rooois, &c.--*it cemaina Uf^ adfiUiae 

; f^cts, which go to Uie establishment of the etber pwtitiODiiim thtt 



Ae mqsl deao, moft freely veiitiUted» and in al| fpsp^cta tbe 
\f&ft FMBlMod* If auch can be addncedt tb^ntb^propoaitkint 
I.appiwau}, may be deemed proved, iba;t lypbus infection k 
nedfiot and not the produce of adventiuous c^rouindtaivrQS. In 
V^ last r^4>ect, Bri^l is by no meam exempted from infah 
tioo i km of many instances which eoqld be givom 1 sbaH leieot 
tbe^ fojlovring from among psUjc schools, in a charitable fomndaa 
tioQi 09. it seepiM to pliu» tbe subgect in a particnlarfy deaf 
IJgbU 

Sn Thf w^sdiool in Christmas Street, and Colstoti^s in 9k 
AngyiflJoe's Piaoe, present a remarkable contrast in the .circun* 
atancea of a^ommodation, situation, ventilation, and mternal 
OWM^femeiit; and yet the latter, ip which evei;^ thii^ capidda 
of Gontfibntinc to the maintenance of healtbt codsta, boa beeD 
mupra snlyectr to tbe infection of typbm than, the formen, when 
many thipga, we shoold conceive, injurious to healtb> may ha 
observed, The qi^ «phool stands in, perhaps, tbe \wy lowest 
part of BriatoJf surrounded closely on all i^ides by bouass, maagp 
of the meanest description, and iamiediately on tbe hank of tm 
Froomfy ^iab, since the damipiiig of the Avon, and, the epq* 
veraioa of the channels of both rivars into a ^^floaiting haBhour/ 
contiains ^ profusion of the, most impure clennsingA of a popa« 
loqa bnt moat filthy djatriirt of tba aty» » always stationary, ak 
waya sti^n^aiit, alwaya c^pvered with a tbick layer of gross ioh 
purity^ aiui fr^^qutntly emit^ the moft ofensive odoiira. It ap* 
poam to have bqei;! originally tb^ ut^ and probably the verv 
building ^ed, in aadest Um^Sf St Bartholomew's Hoipital, 
fior laprousi andl I brieve, venereal (** Qnennynge^" siq^posod to 
be lues. a«aifrea) pntien^. Afc Barrett des^ates it by these 

nrm^opiaf ** the hou^e of St Bartholomew's, 4)ld, dark, apd in 
, 7W inaopvenienl situation." (Hist, of Bristol, p. d7d, and 
389*) t^iathsome as tbe situation is, the house itsdf is, certain^ 
hf oii|)abb» of impnov^mai^ by tbrowitig the small unventilated 
joraoMltoriea of fa(E^ floor into one tolerably spacious one» and 
alt^pidii^ to the deanjinesi of the house in general, and the 
parsons of the boys^ Colstop's school, originally a CanDelite 
firiesv, and call^ the Whit^ Friars, at one time distinguished 
bj Qu^an EtiaabetWiolding ^rconrt in it, and usually, in that 
age, the iwdsnce of tbanpmlUy visititg Breslot, (Barrett, 414.) 
i3 parbf^ not s^rpamid by ao^ similar estaMisbment in the 
ltt^^[dom, Poi|M|Ma4» #a ifiP ilHl|i4«m is» of every requisite to rea- 
d^ V(9l»ltf«itim wd alaaplm^w perfect, its natural advantages 
^wno been Mideia^lgabiy mawta^ied and improved by t|iat most 
Ott^NfUfy smitrj M? W. Ji^QSW* It fiimishea a high and 



284 Dr Cai]shoIin*B StaHdkal FMologif 3xAy 

pl^c^iV gntificstion to view this establishment in all its parts* 
Such has be^ the salubrity of this most excellent e^tabli^ment^ 
that in 56 years, no more than twenty have died, out of a con« 
stant average population of 96 boys, which gives an annual mor- 
tality of perhaps no more than one in about ^6H. This appears 
from the following detail. The establishroent is for the main- 
tenance and education of 96 boys ; 14 are annually discharged, 
and 14 new boys are received, so that the following equation 
gives the proportion of mortality stated— 96 xS6=5376-5-«0== 
267.16. Nevertheless, typhus has more frequently appeared in 
% than in the City school, where the establishment is for 40 
boys. I have reason to believe the infection has been in most 
inrtances traced to its origin. One instance may suffice. In 
the winter of the year 1811, a family, respectable in their dr- 
cnmstances, and residing in a health v part of Bristol, had the 
infection of typhus introduced into their house, by means not 
now ascertainable ; and, during the prevalence of the fever 
consequent thereupon, one of the sons, who was a boy in Col- 
ston's establishment, introduced the infection into the school bjr 
means of his clothes $ and, at the end of four days, the fever 
appeared, and spread with such rapidity, that before Mr Haynes 
was aware of the existence of infection, a number of boys were 
seized with it The whole number of bovs infected was 57, of 
wiiom only two died. Judicious means or prevention were em- 
ploved, but the extirpation of the infection was aocomplishiefl 
with some difficulty. Besides separation, and minute attention 
to general and personal cleanliness, an unusual mode of preven« 
tion was resorted to, with much beneficial effect All the boys 
apparently well were exposed to the cold-shower badi every 
morning during the prevalence of the infection. These inter- 
esting particulars Mr Haynes, the excellent master of the 
school, and Mr Maurice, the surgeon-apothecary, who so libly 
treated the disease, and who always professionally attends the 
school, favoured me with, when 1 visited the institution a few 
months ago. It is not, however, to be inferred, that want of 
deanliness, imperfect ventilation, ftc. have no agehdy. The 
present instance furnishes a proof of the contrary. ' Al- 
though typhus has much seldomer appeared in the city thaii in 
Colston's school, yet in the former it has uniformly teen more 
violent and more fatal. In general it may be observed as an 
established iact, that wherever the infection of typhus gets admis- 
sion* or is generated, iu violence and fatality are less in propor> 
tion to the degree of cleanliness, free vontilatflM), ftc. maintain* 
cd. Its propagation, however, is not prevented; consequently, 
vhen it unhappily appears in Uie jdwelluigK of the poor, it spreada 



1817. ^BfkM and C^bm. ^S 

j^ more nq;>i£C7, and is more derastatiDg in its efibcts, than 
in babitations more salubriou&ly circumstanced. From the pre-r 
mised facts^ indeed* it may be presumed, that the accumulalioa 
of filth, imperfect Tentilationi &c. produce of themselves no dis- 
ease, certainly no febrile disease, m the persons of those not 
consUmtbf confined to the rooms in which thev exist. Many 
9tanu&ctories, many prisons, many work and alms-houses, and 
many hoq>itsls, improperly regukted, or badly constructed^ 
whose inhabitants are under constraint, and necessarily confin- 
ed without interruption, and for a considerable length of timcf 
to rooms where filth abounds, and where the air is never chang- 
ed, and where ^le limits produce a crowded state of occupation^ 
are exertions,— *^ften most melancholy ones. Upon the wholes 
the consideration of the foregoing facts, and also of the table of 
dtteases vhicb occurred during mur years in the Clifton Dis- 
pensary, together with the state of the circumstances of the 
indent inhabitants, and of the locality both of Clifton and 
Bristol, givcss us sufficient grounds of belief, that filth, imperfect 
Ventilation, crowded rooms, &c. of themselves, and when the 
inhabitants are not in a state of cenfinement in such, are not 
causes of typhous infection. The table annexed exhibits chief- 
ly the diseases of active life, althouffh it appears that few places 
are more remarkable than many of Clifton, for the accumula- 
tion of filth, &c. the causes to which typhous infection is usually 
•assigned. 

I have thus endeavoured to shew what is not the origin of ty- 
phous infection. The facts I have adduced as evidence of this 
are indeed confined to a limited space ; but that apace is a large 
and populous city and parish ; and the causes which produce 
certain effects in such a space, must doubtless, according to the 
known laws of the economy of nature, produce the same in a 
laitter q>ace, the pirciimstances of both being the same. What 
is uie oriffin of typhous infection, — what is the composition of its 
viru% ana how generated, — I pretend not to know ; and, per- 
liaps, if we refer to the labours of the ablest chemists in the in- 
vestigation of it, we shall find that their researches amount, to 
the same conclusion : for, what certainty do we acquire in this 
laioivledge, by beine informed that <* the effluvia from the hur 
man body communicating infection, is hydrogen gas, charged 
"with same animal substances ?^ This indeed seems to be ** dark- 
ening counsel, by words without knowledge." 

6. Another source of error, or rather of misconception, with 
respect to the existence of typhous infection among the indi- 
gent inhabitants of Bristol, is tlie occasional occurrence of scar- 
city of provisions, almost amounting to famine^ and the substi- 
tution of corrupted or not sufficient^ nutritious articles of food. 



iW Dr Chiahidlii't tMikwa InOokgy 3dy 

I «i%a)^ pfetty Ikrgdj fb the diicatriM of Umb intamiiiigr 
wbU^ ^n a fosrmefr occauoH (see Edmburgh Medkol nd 8t»^ 

Sicaf >lotttMl| VoL VI. p. 419---«16) ; #t)d Ifairve reotfon to te^ 
are the tio^usioiis I ttiere 4rew are ccrmst and adiB&eMry. 
flteverai imtanora are on teMrd fif ^pidemios teing the eoiMe-* 
qwenoe of toardty of prnviftiolB and dcfteriofaled fMd in Brb* 
tat I bttt» fihoift Mihe^t hm beeta «lated m the work referred to, 
atid from die impeifttt itifbtttaitEoki I oottM obtain ef Ihi^lia- 
tare of those tepHkaanes, I ttsi induced to raUttkiaiah ei^Maa 
«r their orightating hi h«<fi^6tfc>to, althou|;h the mtal, itidetd (f^ 
Heral) ophyiftn entmakved i% that flbty were mfectioiab or tt^ 
phoB fearer, in the ttontia Hsf Bristol; Imtantes ^rt raoovdad m 
the veatB 1597, 1608, 1759, 1765. The most raocnt happen- 
ed, I b^Meve, in t795 and 1799. These Wene atteedad with a 
rery Ihtal epidemic fever. Many alKeling details of Che diiaa^ 
tv6u8 <eaiiB€Kf|utooes have beett given to me bf g^niiMicaij "Mtics 
IM agffUs of dharirafcl^ aodtties, took a verj active part in lAia 
inveMlgaticAi of ceases of distsresB, and in their rciife^ MMlry of 
ev^ry description pin^vaiied % but the iever^ «s &r as I cmM 
toHect faam tiris soaroetif faifoitnation, was^videMly aftvar of 
exblraflliMi, not of infection. From 43ie snedidd gfentlemen wh^ 
at that tinve pradtiaed in Bristol, I conid obtain no prtciia ^w* 
ismnt of this direfol ddanity^^a ^eficienqr maeh to be imgm- 
ted. Thtft fiuni>Be may sometimes be the precursor of pMn 
lence, I believe ; but it is not so from the mere privation or de» 
tetiortftibn of food ; it is from the sai^erindootion of mitBCtion, 
te ^Andkf tmder ^vtdt dtstressfdl dreomatances, dve poar ire 
vnere eiciposed. Rlverius has observed, << QmaMio magna adaat 
maoMtt daritas et penuria, nnde vu^itt'e^d, i y^mfi^i flm* Xifm 
pe^tis post fatnam.'' It is a vidgar observation^ but it is ako a 
Trigar error. A diseasei lioa^ver, equally fadid, ioea male fiom 
the txhansrion co(»sequent upon famine ; and, the symptans of 
it asaataing «he features, in some decree, of typbosi it it Aenoe 
too frequ^lJy *iai«taben for it, to tne ii^eBaediflMe lott af tlie 
nnfortunalte suftreh This disease is the AAhania jAatifleotiMi 
of ISauvages (Nos. M€«h.lV>m. L 905}— <« C«tis niMa, ftHra, 
rugoda, OS arescebat, lingua et dentes n^escabantyirox raatesee* 
-bat, mades maj^^a, nulTa perspiratio, daeotio, mktio, 4iic.'''**^r 
■dtsease which in Scriptnre is designMied by two worda^ 3^ ^> 
rob mui, fame combusti, which in the Efifflish version is trans* 
lated <<. they shall be burnt With huneer,' — (D^utr. xx»i. 24.) 
This is the denunciation of the Almighty himself, and is as aw- 
ful as it is grand. The expression hi» faieen variously rendered, 
according to the conception of the effect of famine formed by 
different nations. Thus in the Septuagint' it is niKOfUw Xi/^v^ 
liquesceittes fame i the latin version of ^e Syraic has it CoH- 

11 



ISIT. cfBristaiiinda^M. 2d7 

tm ba buH l nr iimei of the Ghaldaic, inffati erant Uxne ; but the 
origiiial in one word compr^ends the whole. Although ra^ 
tlier foreigto to the object ot this paper, I cannot forbear giving 
myself^ gratification of directing the attention of the reader 
to a Tidoable paper of Mr Bacot'9» in the 7th, Volume of the 
Tranaactions of the Medico-'Cfairnrgical Society of London, in 
which a most inatructiTe description is ^iven of this species of 
astbenia, as it btally prevailed in a battalion of the guards serv* 
ing in j^ain in 1812-S. I tbe more readily insert it here, be* 
cause it is a disease that I believe has never been accurately de» 
scribed before. ** The patients usually came to the hospital 
complaining of chilliness, languor, and depression, both of 
strength and spirits; the countenance wan and melancholy ; the 
imlse smallffrequent, and tremulous ; and the surface of the 
Dpcty unusnaHy cold to the touch. Giddiness of the head was a 
frequent complamt, and a deep and constant sighing was an 
univenad symptom ; vet there were none of the common attend- 
ants of die fint attack of fever, no violent headach, nausea, or 
Iftrint, no accession of heat, or marked rigors, in the first in-* 
stance. I have seen numbers of men brought to the hospital so 
attacked die in 84 or S6 hours after their admission, witfiout a 
promineat symptom, insensible to every kind of stimulus, and 
never .having .any accession of heat or increased aetioa <k the 
vascular inrstem, from the moment of the attack to the hour of 
their deani. In many men of* very robust habit the disease aa- 
aumed Oiore of the common forms of kver^ aad very soon put 
00 the typhoid character, with parched tongue, k>w nuttering 
-dcUrivmy and terminatmg, in some instances, in a suffusion of 
bile over the whole surface of the body.'' (p. S79.) This is the 
disease so often amon^ the poor mistaken for typhus, because 
.Srequen^y whole families are prostrate under its direful in- 
.flaoioe. Many inslanoes of this occur eveiy winter, but at the 
periods slated more remarkabfy, because the cause more exten- 
sively and more severely existed. ^ The present year would have 
pre-eminently furnished elucidations of this £uct, bad not the 
eanseqaenoes of famine been to a great degree averted by the 
eKtreraely judicious measures adopted 1^ the Mayor, and cheer- 
jfii]^ acceded to by the more wealthy mhabitants. It may not 
be irrelevant to reroarkf that the misapplication of the word ty- 
phiw» so frequently occurring in this lamentable species of as- 
thenia, may servC} perhaps, as a guide in detecting similar mis- 
application in those extraordinary accumulations of fever insert- 
ed in the reports of fever under the denomination of Typhus, 
which we hear and read of in other towns and cities equallv po- 
pafcos as Bristolj and e<)ually exposed to the causes pf asthenia 
abstinentiUmi 



288 Dr ChishoWa Siatiaical Paiiologg Jfdj 

8. I have no doubt in my own mind| thai tytthiia» pliyiOj and 
the malignant pestilential (** yellow ") fever, derive thor origin 
from a specific virus generated always in the same wav, what* 
ever that wav may be, and uniformly regulated by the same 
laws, but modified by dimate* This is not the place to enter on 
a discussion of the subject; but I may observe, that the affinity 
of their symptoms, the morbid changes produced on the organa 
of the bcdy by them, as well as the conformity observed in the 
mode of treating them which experience has proved to be the 
most iudicious, serve to sive stability to this opinion. The se- 
ries of temperature in which they are generated and may be 
propagated, seems to be this : — typhus in cold, plague in warm, 
and malignant pestilential (** yellow '') fever in tropical ; but all 
connected with each other in a regular gradation of violence or 
intensity of symptoms. Typhus is a native ot Great Britain $ 
plaffue is not a native, but may be extensively propagated. The 
malignant pestilential {** yellow'') fever diifers from both, in as 
much as the virus of the infection is generated in a cold, but ac« 
quires its peculiar features in a tropical climate^ or in a tem- 
perature equal to a tropical, and in that only can it be propa- 
Sated. It has been, tnerefore, hnppil]^ called by Dr Parr ^ a 
estructive monster." — (See Med. Dictionary, Vol. I* p. 246.} * 



* Were I called upon to deiignate the typhus of tropical cliaMtei hy pkj 
name uied in this country, so as thereby to express hs character more distuictly- 
than perhaps that I have assigned to it (maHgnant pestilential) does> I would 
aay it it what Dr John Annsutmg has so happily called <<CongesttTe Typhus." 
-H[See Practical Illustrations of Typhus, p. 60-^88.) The very judlckras ob* 
•ervations of this physician on the curative treatment of congestive typhus, puts 
this affinity in a still clearer light, (p. 230,) " For a long time,'' sap he, ** I 
overlooked one of the principal effects of calomel in congestive fevers* tUtat last 
it vMU farad upwi me by patient t almost invariably r e c overing with rapUitjf 
Qvken ptyalism was exchecl." (p. 955.) The confonnity of this gentlmaa • 
sentiments with mine is very remarkable^ although it probably escaped his me* 
mory at the lime. Two and twenty years ago I thus remarked on the effect 
of calomel m the malignant pestilential fever at Grenada : ** The effect of the 
medicine given in this manner (viz. ten grains every three hoursy with or with- 
out opium, as the state of the bowels required) may be perceived after the third 
dose in general, the patient becoming calmer* less restless, less anxious ; hia 
skin being softer* and possessed of an agreeable heat ; the stomach being pci^ 
fectly retentive, however irritable it mieht have been before s and the eyes re* 
covering their former lustre and sensibility. When at length salivation takes 
place, the patient is left free from disease* with a moderate warm moisture on 
the skin ; and very soon after signs of returning health are incUcatcd by raUa for 
food*'' &c.— (Essay* Vol. I. p. 355.) As ^ as I know, and my researches on 
thb subject have been pretty extensive* I have every reason to bdieve that the 
practice in fever, •* congestive fiever," of saturating the system with merciny, 
out of India, originated with myself. One of the first cases of levtr in which 
I employed it was that of James Laing* Esq. now of Straitham in Msddlesez* 
in the year 1789. Siace then I have unifonnly used it, and nevtry whea it has 



The MDOicb of Bristol present ns with nameroBs instanceB of 
epidemics called << plagaes.'* Whether they were really pesti- 
kntial or not, we have too scanty, materials to enaUe us to form 
a correct ofHnion ; and indeed it mnst be ccmfessed^ that few 
places so important in a political and commercial view as Bris- 
tol is, possess less information in thmr medical history. Thnsp 
in the calendary annals or corporation registers, of which there 
is an ancient parchment roll in the Bristol City Library, we axe 
toldi that, «• A. D. 1S48, plague n^ generally.'' «» A. D. 
156S, a great {dague; 2070 died.** •< A. D. 1575, a plagae.** 
<< A. D. 1603, in July, began the greatest plague that ever was 
known in Bristol; continued until January 1604; more thaa 
SOOO died.'' <* A. D. 1645, the pestilence ra^ in Bristol; 
about SOOO died." The onlv pamhes in whidi diere is any 

Krtieular mortality q)ecifiea are St James's and St Michael's, 
the former, from 25th March 1565 to 13^ February fol- 
lowing, 188 died ; from 8d July 1575 to 20th January follow* 
ing, 187 ; from 20th August 160S to 22d March following, 890; 
and from 11th April 1645 to 18th February following^ 840. 
These were buried in that part of the church-yard which, either 
from superstition or dread of infection, has never since been 
opened, but on which the Michaelmas fair is annually held. In 
the latter it is said, that, in the pestilence of 1645, 180 died, 
and were buried in its church-yard. Of these plagues, bendea 
the short records I have stated, I have obtained informatioii 
establishing the fact of their existence only in two instances. 
The first is that of 1848, so vaguely and unsatisfactorily qpoken 
of in eveiy history of England, ancient and modem. Froissart* 
altbouffh contemporary, and a most minute chronicler, does little 
more Uian mention it, in one of the MSS. additions in Uie Ha* 
fod Library, and placed in the 150th chapter by Mr Jones in 
his translation. In noticing some extraordinary fanatics who 
came from Germany to England at this time, performing peni* 
tenciies to entreat the Lord to restrain his anger, and withhold 
his vengeance* he adds, ** for at this period an epidemic ma- 
lady ravaged Uie earth, and destroyed a third part of its inhar 



«ctcd on the tystern, without racccn. .It hM indeed proved ittttf in my prac- 
tice ** requies ea certa labonim," and ^ medicamen munere Oivikm/'^Fn- . 
cast) Itt use in local inflammations in this country^ most certainly Dr R. Ha- 
milton of Lvnn Regis has the honour of. "With respect to the existence of ty- 
5hons infection ^hin the tropics, I may refer to that ezcdtent work of Mr 
amet Johnston on the Influence of Tropical Glimatey and also to <* ths Eatt 
India Vade Mecum" of Captam Thomas WiIliamson» in which we cannot sus- 
pect any hias to contagion or non^contagion* hot in which we find hooevt, cor- 
rect, and dUintcroited ohinratton,— {^l 1^* ?• ^^S*) 



290 Dr OnAOafM mmkOui^Maogy July 

bIcaaii/'^(Jami^ iVinil* VdL L p. SM.) Oraftoii uA fM>- 



ymve.iiottiKNwpvrticiihri but Heiifjr KnygbCDii, tttMUimrf 
Ltffoester, ami abo m ooMcmporary flod an ^e-witaen cf ka 
foBfffal vanragsay {|ivei the MkMring veiy fbll, perhaps exi^genK^ 
^ aceran^ nrfatch, not ha?ing ieen qaoted, only refiMred to» 
in may of the hfattoriea, I here timnaeribe firom the origimd» with 
a ^enion dmwB up by a learned fiiend. 

^ Anap DMDini ISM. kto aanaet aDDo aeqaenCe enttjge^ 
nendk mortaOtat hominiim in onfyeno mnndb* Et fomo 
ineipb 10 India, deinde in Tharris, deinde in fiamcenoi, po»- 
ttmnoad Ghrfstiaaos et ladaKM, ita %iiod in tpatio nniiH aBni» 
vis. a Paicha «Mqiie ad Fatoham, wi rmmr in Curia Remama 
penr^fiaerta^ 'flMttui eont hi ilKs remotis regienibua viij. M* It^ 
giomes pnaier CkrkOimos qmiti stAHa m&rte. 7\inc peatis do* 
UMroM penetrafiC nMririma per fiooriMrmptonaiA et venit Bris* 
toltam, 0t mtmiehantw fMii Ma vaUimh wlia ^ptari wbita 
morte j^fommtpaiif nam pood crant qui leetttm oceopabaat ul- 
tra iij diei 1^ daos diee mt dimidiiini diem ; deinde mora ipsa 
aaeva pvoropit ci icawq mmue teeundum eiarsum s&ik. Eodem 4b»» 
na mit magna hiee fMnm nbicpie in i^ae, adeo <|ttod an lain 
loeo morttSaniar in patkan ima plus qtiam ▼. m. ofnonit et in 
lantim putreaeebat, tpiod nee bestia nee «m tangere 9(dAat 
Et me$ et borea per campos et inter aegeiea iragabast erfantas 
et Bofi erat q« eas agendo fegaret aut ecAigere fed in aiilete 
de^ia et sepibns worte periemnt numero inoompntabile per oni- 
Tenaa regienes prae defeetu ottstodist qui tantus defaeiaw exiittt 
servwmm et fiini«lonini»-quod non erat quis qni seirei quid/a^ 
were deberet ? nam non oecorrit memoria tam rigide aaonalita^ 
lis, et (am aevae a tempore Vortigerni r^gia Britennm, in cnjna 
tempore irt teatatnr Beda de geatid An^bvmn, ^rM nan suflloe^ 
bant aepiKre mortaos,** 8be« (Henria de Knyghlan caHonici 
Lejrceatrenais de EfventANM Anglian, lib. iv. <ea. 5. Historiaa 
Anglioanes Bcrtptorea ex Tetnatis mannacriptis X. p. M9B). A 
ver9ion of^ueh barbarons Ladn most be difllcult. 

«« A. D. 19M. In this and the fUIowti^ year there laaa 
an ttniTersal mortality among manldnd.' It nrat brofae ou^ in 
India, spread to Tarsus^ then attacked the Saracens, and lastly 
the Christians and Jews $ so that in the space of one year» viz. 
^tMk Easter to fiaater, foe was emrenily reported at Rome) 
there died in those distant countriesi and as it were by a stidden 
deaihf thirti^two mUlioms of soulSf besides Christians. This 
grievaaa plegaci patetrataag the sea^coasts by Sonthamptoii, 
^saehed Bristol) vArrvafflim^Mtf^vxto ware aioi^iaBi!%« 
being attacked unexpeetedly, perished ; for few were confined to 
their beds more than three days, two, or even beyond half a day. 
This cruel mortality then diffused Itself through all parts /rom 



tkroni^ttt the Ungdom, to dwt '6000 pecuhed in <me qwnier 
tmkf^ and in one tingle keding gronnd^ v/Ubt nioh was cbe 
pfttt»MceDGe» dliat nodicr beui or Urd of prey would (oudi the 
cBftMes. Both 8bMp and cattle «tniggled afafont thrawh die 
BMb Mid^tandinff corn, widioiit restnant, or for waitt ^kenx 
ef«i ^ttd cUDMimed away in iacredifcie mimben, eidier io mh 
taiy dltdliea or under iiedges. The daalb of iomdmen .or of 

. htmsekBid 9ermmt$^ was socls ikst Mnevemained whoihMDiiaQe 
to MmihargB ike Heustatg Miei • For the inemary ef so dine 
and cmbl a moi^ity did neit occur sinoe the days of Voitjgem 
king of Brttaio, in wbose time, as Beda tcetifiea, the irang weee 
net soAciciit to fatoiy the dead.^ It mpffnnfrom the for^^aing 
parage tbalt fivistol ^as among the fint pkots in Kagtaad the 
plogatt tf sited. Ponhm, "wiio Sfed at the saaae tierjeidywlw waa 
shoa^itnesi of the honibie cahMilies ooeasionedhj it, bet 
wtiO'doss wnt mpfMt to faaveiknam«n^thia|fof Knjill^tony 
oMMponds pnfUf mtaedyim km descoipuon of shie piagna^ aa 
ktippMMd in Soaahnd in Ae foMawing year. ^ A»Dl iftM^ 
tmm peieihmtia et naoitatitas iamiinnni in 
et «tiiun tmnia pluribar pmaadentibneet arid 
Hurln toeo oriie pntvaloerit, iqannu n nmndi pnmnrdMJbne 
iw^ee tionqvam aadi^batnry Mt in codksibnsy ad fiiloraraii 
aMkian, est oonspsota. liiitanttMi .<eaias pestis ilia nalidam 
esMVoaft, w *fei« tertia pan generis hianani debiftnm snlonn 
atiiltere oomp^UeMtar.'* (aoetimranicon, Vb. xIt. c. 7.) fitenge 
AM no'reo^y besides the short noliee of ao direfBla.cdMiityi 
tbB voir be traced in Ae public orpifatte»oallectiens of BnistoL 
The^teMid fusmnceis the pbgne of tSM. Th6^ieaLeir« 
cMistances of Bristol «t this cahnoitons period were very nin« 
fkvowraMe to heidth* A populaiion stated at 9«,000 aads «ms 
ooflAned to the namrow diaiu-of die iuicient eityt with aubnrbsy 
«Aiidh then entended Mule hmnd the naare ckiafead part of the 
extrendty of liie peninsida fomed byihenonAnc wf the Avon 
and the Vroom, the lesntracl part mf the present^dty, asaUed in 
and foctiied, not non than about two miieB in dscwaferenee i 
Vhe sotefets extreoKslv narrow and very irrogahurfy, or rather 
wilboa(t«ny plan, laid oot, and ihe mppcr pert of theihooaes 
buHt df <«iiood, high and prcgecling, eo -ai alaaestto meet each 
oCbert^nsequeotly dark and dismal, and very imperfectlv ventilaU 
oA 'The'tfySe»«nn*OBndingneadytwoi-thiiMls of Bristol, through 
^Meblhe Avon and ilboom flowed, were tbsn, as they are now, 
40de«l, but In a <oottad«>ably less degree^ extremely marshy. 
'Md to this, the diitraeled polhical state lof the inhabitante,.and 
their ^miMTy ^tnn die heavy eontvibations iaipoaed npon tfaemi 
^«-Bui8y Toyaliitt, but a much higer portion influenoed by the 



SM Dr Chkhck^^B StatkOcal PaOohgy Jiafy 

l^oomy and fanatic entfattsiaflm of die pnritaoical party of di^ 
times, and a third 8^ ttill more dangeroas, pMudo^rojaliste^ 
styled by the author of Mercurius Rosticiu, ** The damnable 
eect of the Hothamites, those atate-hereticks," (p. I??), pro- 
ducing continual jarring^ and dangeroosi and even fatal con^ 
motions, during almost the whole of the time (from 2?th July 
164S, to 1 ith September 1645) Prince Rupert held the place. 
That these were alone sufficient to cause the destructive mslady 
which prevailed, we are not authorized to believe; — but no 
doubt can be entertained that thejr were highly so, either in 
prediqiosing the persons of the inhsANtants to suffer by the inu 

Grted infection, or in augmentinj; its violence. We have, I 
lieve, no proof of imported infection ;— yet that pestilential 
infection was imported or introduced into the city and garrison 
of the castle, we have no reason to doubt i for centemporary 
writen» and eye-witnesses, and even principal actors in the war- 
frre which at this time raged both within and without, the city, 
mention it with confidence. Thus Prince Rupert in his vinm- 
catory narrative addressed to the kinff, assies its ravages aa 
one of his motives for sumndering the city, for he speaks of 
the inefficiency of <* the auxiliary and trained bands by inter- 
ruption of trade and commerce, by the pestilence then ragmg 
ikeref by their poverty and pressures laid upon them*** The in- 
decision of Fairfax and Cromwell respecting the undertaking 
the si^ge, is attributed by Spriggge to this cause:—'* Against 
undertaking the siege of Bristcd it was urged that to go thither 
was to hazurd the whole army, ike plague being sore in the dt//^ 
200 dying weekly, and that it was in moat of tiie villages about 
the town. One of the kalendars says, *' there was tiien a mor- 
tality or sickness of pestilenoe in the city which continued till near 
Christmas.^ Anotner says, that <* 120 persons died weddy.cf 
the plague in the citjf." Cromwell himself in his official state- 
ment of the transactions of the siege, says, '* We had a council 
of war concerning the storming of the town, about eight days 
before we took it, and in that there appeared great unwiUin|^ 
ness to the work, throiurih the unseasonableness of the weathert 
and other apparent d^Sculties.^* There was no defidenqr of 
provision or ammunition in the pUce, for Cromwell, in the samya 
letter, says, << the casUe victualled for near half so bug,'* t. e. 
half cxf 320 days. It is, howeveis a circumstance not a little 
curious, and which may serve to explain the ambiguity of the 
expression, ^* apparent difficulties,*' that in the same important 
document, he poaitiveiv says, ** I hear but of oifeeman that hath 
died of the plague in ail our army, although we have been quai^ 
tered amongst, and in the mkistc^ infected perwoam and phcesi^** 
Our knowledge of Cromwell's character may indeed lead t^ a 



1817. </ Brisiol and Clifton. S9S 

saspicion that he wished to impress on the minds of his fanatic 
fellowers, that they were particularly favoured by Heaven, and 
thereby shielded from the plague, whilst their enemies, bereft of 
providential protection, were exposed to and suffered by it. 
The mortality among the garrison and inhabitants must have 
been much greater than that stated in the short kalendary no- 
tice above quoted, and if we calculate on the population, and 
the local circumstances of the city, and the most distressing pri- 
vations of the inhabitants, at the time, and for two or three 
years preceding the siege, we cannot estimate it at less than 
10,000. (See Rushworth's Historical Collections, Vol. VL 
p« 70-88, for Rupert's and Cromwell's official documents. 
Sprigge's Anglia Rediviva, for do.-— Anglce Ruinae, or Mercu- 
rius Rusticus, ann. 1647-48, p. 174-183, and Microcfaronicon 
September 1645, for the stale of Bristol.) Tradition furnishes 
a fact respecting this pestilence, which may be considered as an 
additional proof that mere filth, &c. are not efficient agents in 
the production of infection. About where Christmas Street 
now is, and conseouently ranging the banks of the Froome, oh 
one side from the Froome, now St John's Gate, to the eastward, 
were the stables of the cavalry, and said to have been remark- 
able for filth of every description, as indeed Christmas Street 
and its neighbourhood, still are. This spot we are told was the 
only one of the dty and its immediate vicinity, exempted flrom 
the pestilence. 

At several of the periods above stated, a plague prevailed 
most destructively at Edinburgh, more particularly in 1603-4 
and in 1645 ; so that the malady probably existed throughout 
the jsland ;— a proof doubtless of its having been literally and 
truly pestilential, and imported. Maitiand says, that the plague 
of 1645 was the last we read of in that citv. It is the lasi al« 
ao we read of in Bristol ; — and with him I heartily pray *< may 
the like never happen again, for the preservation of the citizens." 
{See the History of Edinburgh, &c by William Maitiand, F. R. 
S. &c. ann. 175S, p. 56 and 85.) 

I subjoin two Tables, one exhibiting the general state of the 
weather and sickness for four years at the Clifton Dispensary, 
iriz. from 1st January 181S,to 81st December 1816; the other, 
the diseases which occurred at the same Dispensary, with the 
events of eadi, during the same period ; — reserving such re« 
maiks as have been made on some of the more prevailing dis- 
eases, to some future occasion ;— those on Typhus Infection as 
it appears in liri^uA and Clifton, having extended much be- 
yond the limits I originally proposed. If they are found useful 
and important, my object will be obtained. 

Park Slreet, Bristol^ JprilUth 1817. 



294 



Dr QuHkM* SkOutbaiFaaelogg 



Julj 



J TABLE txhibUing the GeaeralStaU qf Wether and Skinea 
for Fwr Years at the Gifton Dispeuuay., viz, from 1st jiauuny 
1815, «o Z\st December 1816, and the Number ef Pvimmterg 
Cmplaints in Winter and S^tringt etcbisioe ^JPtiUfis, 



1815. 



1814.- 



£ 



k 



L. H. M 



20 t\2Z 



I 

-i 

s 



i 



I 



L. H. 



Beh. 

Mar< 

!my 

June 

My 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 



26 

ta 
It 

17 
15 
13 
13 
10 

Id 

2C 
16 
19 



5 

ICI 
19 
13 
T6 
17 

n 

21 
17 

n 

14 



12 
IS 
8 
II 
IS 
10 
19 
20 
15 
19 



39 28 29.5 



4S663 4S99. 



eois 



7461 



6451 



se 



52 74 99 29, 



.7 

29.6 
29.9 
29.5 
29.15 
9 
15 



50 70 SO 99. 
48 66 57129.5 
38 
134 



26 52 99 30^10 



3ai 

4590.15 



37 
44 

40 
43 
38 
93 
19 

as 

95 
23 
S3 J-U 

39 



10 21 
19 15 
15 16 

11 19 
24 

ITl 14 
13 17 



91 



298 95 9a. 

^5i«S8l99. 

OJl miQ AX ■^— 

9M an %v 99* 



9 
8 
9 2|42 62 5i 



I' 



91 



42 



66 54 29. 



24 

25 



IS 18 
IS 16 



10 



17 
13 
7 
5 
IS 
13 
12 



29-W 
.5 

49 70|S9|29.15 
98 77 67 2917 
48 70 9fl 29.19 
^5 08 56 2^15 



6047«9. 



35 

30 5442 
9 90 56 49^91 



29.8. 
9 



186 17816615 



13| 28 



l45USill3l55 



m4 40 



1815. 



1816. 



s 



L. H.M 



i 



3 



IN 



£ 



& 



SI 



In, H.M. 






an. 
Bob. 
Mar. 

^y 

Aine 
.ruly 
Aug. 
Sept 
Oct. 
Nov. 
Dec. 



22 

1j6| 12 
15 



9 22 26 



4 
Ifl 
12 
17 
17 
24 



21 
15 



16 

I0| 20 
27 
19 



19 
14 

IS 



IS 

1 

7 
16 
10 

4 
10 
1« 
16 

9 
90 



46 
88 54 



99.18 
29.9 



3? 



68 



52 30. 



9 386652 29. 



46 70 58 
327061 



29.6 
29.12 



54 70 62 8aS 
50 70|Go|80.4 
44 
44 

28 56 42(30.5 
4 2448 96 39.1 



73 58 29. 
60 52 



•13 

29.19 



95 
Vt 
48 
46 
3^ 
32 
22 
42 
53 
SO 
SO 
27 



I 



22 
29|| 15 
U 
15 
22 
17 
2S 

7 

lO 

15 
15 



•15 



9 
19 
19 

^^ 
9 

1:^ 
9 
94 
20 
16 
15 



32 
6 28 
3 20 



46S9 3a 
50 89 90.2 
54 90 99.10 



9 49465f98ll«9 



22 



20| 

1 



2 89 6559 29.12 
"^ ^- 'i29.l4 



50 68 



52 



59 
Tt 62 90. 



54 66 60 8ai5 
44 60 60 0U 

99 64|5S|j90«U 
24 
324 



54 



3l80. 

ssbsso. 



17A 191 



136 37 



f47U 



37||194 171 



\w 



«7 



ill 

■ ■ ' ■ 



isn. 



#95 



JiTABLEqf Disitmtwhiei trnttrrtitt Oe ajMrn Dt'tpeu. 



Amanrosis 
Ameaorrboea 
Abortus • ' « 
Anasarca 

ADgiiMl Pectoris - 
Anthrtlx «• • 
Aphtha « • 
Apople^ia ~ - 
Arthritis rheumat - 
- podagra 

■ retrocedens 

ADthrodynk syphilit. 
Ascitd 
Asthma 
Atroi^ia 

Brondiocele ^ 
Catar^has chronic. • 
Catarrhlis ' . '.. 
Catal^ia ' m • 
Cancer titefi 
t^pBalaea • • 

iryphilidca 

' r ib icta - 

Chorea sancti Viti - 
Cholera morbus • 
CoHTiiUio 
CardiUs 

. Copstipatio • . * 
Cootnsio hypochdtttf. 
e«Ke» pktonqni ^ 
Cyoanche laryiigaea - 

•^ stridnia . 

> parqtidoea 

tonsillaris 

' inaltgim 

i . ■■» ■ , . syphilittai 

IMUtttas senitia . 



1 

17 
4 
19 
1 
1 
I 
6 

4 

1 
1 

8 
54 

Si 
1 
s 

St 

t 

s 

VI 
1 

2 
4 
6 



13 

$ 

% 

i 

4 



Dud; 






1 
1 

1 

ft 

14 

ft 



t)iseues» 

Enteritis 

Epilepsia 

Epistaxis ' ^ 

Erysipelas • . 

Erythema . • 

Elephaotiasis 

Febris intermit. Infant. 

• catarrhalis 

-' : ■ " ■ qnotidiaaa 
Gastritis 
£rastrodynia . 
Qonorrhoea balani 
Hematemests • • 
Haematnria 
Hsemorrhois' - 
Hemiplegia 
Hepatitis acuta • 
■ typhoides 

■ chronica « 

— ^ gaDgienosa 

apostematosa 



Hepatalgla calcalosa 
Herpes 

Hydrops pericardii • 
Hydrothorax 
Hydtooeph. acnt. • 
chroiucus 



Hypochondriasis 

Hystsria 

** *■■ ' ■■ eoriepti^ 

hepatica 
Hysteritts 
Ictenv 

Iteus - « 
Lethafgna 

Lilcnteriii • • 
LencorrMfin «■ 
linnbogo • ' ' « 
LiBsio ulef£ « 
lichaa 

MaiaMiii • = ^ 
MhbiQV f i 



Cured: Se4di 
48 I 
13 

1 

16 
SO 

1 

3 

8 

1 

6 

C 

1 

7 

4 
1ft 

8 
64 

ft 
4d 

1 

1 
11 

1 

1 
15 
37 

1 

6 
26 

4 
23 

7 

1 

i. 
1 

3 
10 
^ 
1 
4' 
7 
1 



ft 

1 
1 

1 



1 

6 
8 



196 



Ih ChiMlmh SMkliea PMokff 



July 



Mdancholia rellgiosa • 

Maoia 

Blastodjnia 

MettorrhagU - • 

MeotoB cessantei • 

lloUities oninoi 

Mjocolitii 

Nephritis • •• 

Ophthalmia 

FkralysiB 

Pertassis ' • 

Peritonitis 

Phrenitis 

Phthisis pulmonalis 

■ put. incip. 

■ ■ — hepatica 
PiMiimoilia 

■ I ' '- typholdes 
Pyolapsns ani - 1 

, nteri . 4 

Psora . - . 9 
Pyrosis - - 5 

Proctalgia in llammat ' 1 
Psoriasis diffusa - 10 
Rhenmatismos acut. '76 

■ ■ chronicus 28 
Rubeola . - 65 



ComL Dead* 

1 

1 

1 

15 

1 

1 
19 

S 

10 
18 

4 

6 
64 
31 

1 
188 

6 



33 

1 
2 
1 



Cored. 
51 



ft 
1 



y 



Scrofula tnlgaris 

Soarfaitinft - • IS 

Sdrrhus h^patii • 1 

Synochna - « 36 

Syncope - - 1 

Senilitas • - • S 

Scorbutus • • 1 

Splenitja ♦ - 1 , 

-apostematosa X 

Stricture recti - - 1 

Syphilis . . ft 

Tabes nutricum • 10 
— — mesenterica • 2 

Tssnte . . - n' 

Tossis - - 34 

Tinea capitis - * ft ' 

Trismus dolorificus * 1 

Typhus . - la ilf 

Urticaria • * ft . . 

Variola "- - ft I 
Vermes in test'lumby ««-.,. . 

Garid« ' - - , jR)^ 

Vertigo • - ^ . . 

Miscellanea • m 55 



Total Nuffifber 
Of whom dk$d 



1699) or 1 in 
101]«bout 17 



APPENDIX. 



Gfokgical Description of the City of Briitok.^nd Pari$h qf 
Virion. CkunnMiBicated lo Dr Chish<».m, bjr O* CinfBS»- 
LAND, Esq. I 

DEAR SiRy-^Yovir reiquest to have a geological descripiion of 
the city of Bristol, and the parish of Clifton, I khall liith 
great pleasure comply with, as ikr as my oWn knowledge I^ads 
me. But to make that better understood,: we luust bMfi by 
extending our inquiries to the surrounding counti^* To toe 
aouth-eoflt, towmrda Bulh» thd new txxt runs through Ule «ed 
muad, lying on the whitie Lyas, whi^h exteadsirom Stodtatod 
rottirdamn m a drde northerly, api^ring partially at .BmoA» 
Upper Eatkm^ beyondSlokes (^roft tuhipike^ at Har^Mt iMt- 
7am, and Gotham^ indlitfing q part <X the north of tber'tiQN>f 



lan: ofBrhtolandCliftm. 291 

Brirtol ; slinost every where being fonnd in an horizontal po$H 
tioOf and containing in it beds of different shelb, and a few 
specimens of stallcs of the pentacrinite. At Stoke, we find the • 
▼enus$ and ostrea of a large size. At Bishport under Dandry, - 
(a branch (^ the Mendip), mya* ostrea,^ and large bivalves, ' 
cardiuBit &c.; at Bitton, some comu-amroonisy while other* 
beds are pure white without diells ; at Stokes Croji aitd ' 
HcrefiM with scarce any shells. And in the sitme parish, 
some remains of the bed called' the diamond-bed, have been 
turned up. 

From beneath these strata rises a hill of small elevation, on 
which the ancient part of the city was erected, consisting of 
beds of compact quartzoze sandstone, covered in parts with , 
the red sand* They lie generally inclining on an. angle of* 
about 60^ fix)m north-east to south-west, and after being parted 
by the l^roome river from the northern and upper part of Bristol, . 
ascend, divided from the lyas by St Michael's bill, where in the 
church-yard wall, and one or two other places nigh it, the- 
quartaoze rock crops out from under the lyas; — its division' 
being dlstincdy visible: the walls to the noitb of St Michaera 
hill being all built of the white lyas, those on the opposite skle^ ; 
of the qoartaoze sandstone. These beds of quartzoze sandstone 
continue in a north-west direction, lapping over each other, 
and cropping out sometimes, all through Mr TyndaPs park,*. 
Park StreeCi Brandon Jlill, and the village of Clifton ^ by' 
Clifton wood, and along the old sides of the Avon, the Hotwell- 
road, till at the wells they are found reposing their last beds on 
the limestone, and where, at Mr Powell's garden, we have a' 
beautiful secdon of the upper beds of the mountain limestone. 
At this transition are beds of yellow, red, and grey marl, sand 
and limestone intermixed. The most considerable beds of. 
these are oolite limestone. Of all these beds I have sent up a 
correct delineation, with tbdr measures, position, and specimens,* 
to the Geological Society. 

Thus we shall see that Bristol and Clifton are seated on the' 
red ground, white lyas, quartzoze ferruginous sandstone, and* 
the mountain limestone. ' ^ 

The onW opportunities of viewing these rocks in their beda* 
ace 1st, a fragment exposed in the wall of St Micbaers church* 
yar^ 2d, Another in Griffin lane. Sd, That remarkably* 
CQtjDtglomerate bed which crops out at the foot k^S Brandon HUl^ 
neaf the end of Limekiln lane, and which looks almost volcanic, 
4tllt Another remarkable bed was till lately exposed in the new 
O^fion burying sround, where the quartzoze sandstone, being 
mildt^decompMed, was found satanMd with a q^Mcies of largQ 

vou xiiXi no. 61. V 



wMjgpd HB^qniiib of the Productas kiodt with toij VM||ghMilf 
thenpw highlj^ bmffnamf una in put i^ompact. Thli ped U 
BOW huilt overt but the buiyiiu; gtonnd joins to a li|rge.qiuffi|r « 
of qqarlBMe gao d gton ig where beds are di^tinptly taeo l4>pilig 
over cs^ch 9ther nofth-westfrljr. Also on th^ ofrtb tide of 
Brandon W^ near Upper Berkely place, and «p fdiir patta 4if 
die hill» tbia lotk lies expoaed* 

,The lyaa quarries art no where ezp^iied, exoept where thcf 
avf alwava wprki w and filling np, as ufider Hpr^eU Mid ahc»a 
Stoke I but the walls, by their materials, exhibit dieir bomdHEief # 
on cJl the north side of the city beyond St Michael's hiUi aid 
upder a chapel in Somers^ street, iaiye Imjps of atraMiBn M ' 
of qfj^stids are found. At Refilund and at Cl^ion^ elsa^ atmntita 
it fennd in the veins of %\kp liniestope occasionally « amd mafm* 
tim^ ckisefy accompanied by ct^rstali of galena. 

The exact junction of the quartzoz^ aandUonis wHh |h(a 
Ibsfistone has not been aa yet ascertained with l^upcisidd, but ii 
ia mppo^ to be somewi^re under Prip^'s building ^r-ieod 
t^ere is iv> quarter opep till w;e coi|^^ to the weJis,Mh^^^ U Mir 
PoweV'A genleb, just b^nd St Vincent's parade, i$ the fiat 
aeplipn before mentioned) conaistmgof 50 or flOdilit^cilielfcti: 
Tkfi OPPI^ Cr^^nt is built of the anarttoae seiadftonpi fa4li 
i^^idifm^h the Mall there is, a first bed of linneskine, fis sffpostt' 
far the Ifige maffes of coralkiid bodies fopnd near the aamoe^ 
th# mycdaitie pf Woodward deeply impr^niMed w^ iron. lit 
4ieae upp^ be^ pf lim^i^tone are fo^nd veins of ironstone iW 
e^qpputc cfvstajs of a brilliant lustrei apd sQine thi^ are bnted 
mr crystals of strontian, but very rariejy. in th^ huit beds of 
ij^qoa^rtao^ sandstone, in dUggifig wells, Hre fonod cavftfaa fidt 
cif apicuise of iron, and radiated gbbpJar i^onccetions of no^ 
gan^ and iron, occasionaOy conhectied wi^ a Caleajoaona qaar,. 
sjp dear that they at jfir&t are tfdten for quartz i^ac tiO tb^ 
mgr oacqpe ^ctect their rhombic spruccure. These litestone 
strata continue on both sides the Avqu^ 'QlMpyiM the mAtar 
mn €£ pmrdhifn^Pcmn to HetJ^i^ ^^ Hf^iffiM^ ^and ttk the 
5. W. of Bristol, b^ond the Avon, to WwO^^hg WfuOw. wd 
ore^m tknm^ from iorliihead to the end of VTocfifprMnf^ tarvan 

acl^ that are l^autifolly e;^io8ed to th^ eye of tb^ geoJi^kt. 
^ttqm Leig^^btnm to Ckt^edon^ ^^ere ai:e abiindant eppor* 
tqpiiies of viewing iimestone b^^ds. From the Stuck rock titar 
€(Muf$fblly pa the Avon, a b^d iippregoated with enori^iud 
^^f]^MI^ migr be traced in a di^ecft. line to Glevedm Hiutckj 
WP VP^'^^^ beyond Clevedon Fbu 61 the bacLoC Wq^ 
apnng^ wlici^ last year i^^re 9ade miny disoo¥e;»es aflArhiatia 



IflilQ. 9f Bristol mti Cljfte^ 

Bo^ Aete k a niae of awnganaiB bdmigiiig to Sir Hagji^ 
Sndth ; aho lead and cakmine ace fbond mar the ^urfaca dm 
ttie ^^atar part of Diuedbaiii^Dowii. 

The Hot-springs are not peculiar to the well-hooie | they ari 
Ibuad springing up to the surface by th« river side under 
St ViiioHU*^ cavei about February and March $ and there k an 
abundant spring whose ttiBam issues in^> the river a quarter of 
a milje before arrmng at the Bktfk^roei^ one of the cotUgaa 
Aere having a well of it unikr the premises* It is well known also 
ta have beoi pieraed by the well of the upper pump roomy at m 
aonsidcrabia depth. It therrfore should seem to arise eithw 
fiNDOB some large fissure in these bedsj 09 froati some other straU| 
aai which they repose; and these strata shrndd seem to be thsp 
ooaglomerate^ firhich is visible on both sides the Avon beyond 
GilDke'a falhr^iii one plaae in a cpnsideraUe mass^ consistiag of 
quartzy pebbles in a cement of ochreous clay, by some sup^ 
}x>sed to be the Old Red rock of Weraer* 

On the Lyas to Upe N. £• of BriiBtoly in fowd reposing a coat 
measure, with us called j^ennant, a sandstone considerwly leia 
indurated than the quiUtzoze of Brandon Hill, whoee grey co- 
lour arises from an lotermfaUure of v^etables carbonSaed, and 
whose iVacture exhihits junk8,^and vegetable iidpresiions of leavei 
of considerable maguiiude. This mav b^ easily examined tit MtUf 
on the banks of^lhe FroOroe at Stapleton, and in tiie gitet quar« 
ries tbe^ei and at St Ceorge's, by the river side. But further on^ 
at Dowbend, lying unconformably, a true quartzoze sandstone 
is quarried for the roads, as hard as that ot Brandon Hill, but 
witnouta particle of iron in its oompositioa, and eontainiaig 
ferns iind junks of very beautiful forms, which are exposed on 
its fracture, the siir&ces of which are well carbonized when 
found, but whose interior is seldbin seen excqpt where there has 
been a pithy cavity. This Pennant is a sure sign of coal in tha 
vieinitf • 

The black rock having of late years been much worked for 
j^avTfig-stbne, hks given occasion to nlany neW discoveries of bo- 
Sites cStltein^ in it; bf tfai^ are fish naktes of forms hith'i^rto 
unobserved ; swords ot* ptk)bosei!!Ssat>f ^shesv ^^ rMUdnatctf CMst- 
acea ; togeUier with heads of encrinites, and plates and stalks 
Itoretoforanotd^strtbedt Thebkcsk twkisa«iasitlngedJkv|]i 
nsovi of pmnUeuft^ prbbabfy exud^ ftom iu Mm ammal x^ 
nndbs) and aometimiis it k Amnd aoUiaUy aiosit^ froHi uvrititti 
in the tfotds. Above, tbik ma^s of to&V is ^ey« or yeUow^ or t^ 
diAi and I have fbuhd smaU portions of a^ yelkiw sandstbai^ 
aam dattompb^ but contMbintt sheik woA parti of aAMMi^ 
lMitte;k 4tmmii mSAmmi i^tfek una is Mi^ and tM<*) ^Qel: 



SOQ Dr ChuliQlm'f StrntkHtul PaOehgg^ &a Mf 



tku thai wliidi whish J SuaA two jean ago at Witkfi i _ 
Mare, repotinfr on a bed of red limetU»e, aM both corvemad- 
with tbat which Mr Webster found at.ake back of th* Id0;or 
Wiffhtinl814. 

Thus you haf« tke general bases, aod^tbdc-constituent parts § 
but if you pass towards Leigh on the northern side ofthe AvoOf 
you will find beds of a species of qaactaoae ironstone like tr«|^ 
foil of caviiiesy and what may be conaidensd as a comiwct petixH 
silexy in a few places. Dmdry is also covered by tjbe ooKtet a 
species of coarse freestone^ full of casts of myat comn*aaimonj|^ 
and very remarkable oval belemnites» some three feet loog» ye^ 
scarce an inch at the base i and as singular short onesv witk 
^Fery conical alveoli* some quite perfect* yet scarce three iocbea 
long, and very tbidu Be«des these, this oolite contains qemr 
twenty rare shells, some very perfect, and many UUieKto undo*, 
scribed* 

Mrista^nthJprUlsn. 

Sketch of ike &nkr &f Radk. 



. , 11. , , 

Affie OlamNt^foftf reUtiioe to ike fum meAod of e^OnOkig ike 
Cataract > d^ ^rapond In Dr LHbenetein LSbel, in the January 
. Number qf ike Edinburgh MctUcal and Surgical Journal. B7 
£nwAm GiiAniMiirr£«4* Stti^ieon, B#)i» .. 



▲ BOUT six montha ift^or.to the dsfte of this communicntiony oijt 
'^^ consideriffg- the mnagr objectioi^Mi which . admit of b^ng 
ttfjged with much propriety, •gtim^ .tb(» .qperation.of extracting, 
the cataract through the , apertuie <9inse4 hj a circular incisioa 
of the transparent ooroea».midea HWggfltfdi itfflf to m^ who* 
ther or not there existed a.<sposBibi)|lj|p.of removipg tbo^opivier 
kaib by BOMans of. m incitioa ttox^^gh. t fc^actog o ti c ja^iW^roil, 

11 



t«7. Mr Cbfltnto m&eimdkig ike Caiknui: ISOi 



ijbttto, al'a k/w lines dfalaoMfiDia tlie jonetion of tfaesd toMdb 
wkh the coroM ittd£ 

• In order to agoeruin the pntcticriiility of mdi an opefatioii,and 
DO oppoitonity immediately occurring to me of making the expe- 
idmenton the eye of the aulgect pfevtom toiti removal from the 
ori>tt| I sabsdtnled the eyes of Tarions quadmpeds, and on sueh 
ai^de repeated trialsy in the presence of several medical friends. 

From these ei^>eiinient8, such were the results obtained in es^ 
tabtishing the facility with which the crystalline humour will ad^ 
asit of removal from such a situation, that I had anticipated the 
pleasure of shortly commnaicating to the profession, through 
the medibm of your periodical publication; the particulars of aa 
operation possessing, on the one hand, all the advantages, and 
obviating, on the other, the several disadvantages of the present 
metfied of ea^trajptfoB^ 

Is/, The annihilation of the olgection arising out of the pro^ 
bability of the subsequent partial or total opadty of the jtrans^ 
parent cornea, as a consequence of inflammation. 

2diy9 The injury which is not unfrequently occasioned to 
the fibres of the iris, by tihe passage of ihe opaque lens through 
its apertii^^>r pupfl, into the anter^r cham^r. • > 

Sdfyf I had conceived that an important advantage would #e^ 
anlt from the increased iacility with which in aU probability th^ 
divided part woujd reunite, in consequence of the certainty with 
which the edges of the wound would remain in oontact subset 
^nently to the operation ; and, 

4Myf That a poesibiliqr would be thus afforded us of remold 
ing the opaqne- leas, although union shall previoasfy^iave taken 
places betwixt the fibres of die iris whilst in a state of dilatation^ 
and the capsule of the crystalline | the pupil having commonly 
in soch cases soffisred pi partial oUiteration qr diminution of dia* 
aleter* 

Notwithstanding, however, the very flattering view irbieh I 
had taken of this sulgect, as the effect of the extremely favour- 
•able natijre of the inferences deducible from my experiments^ 
I determined, before giving it publicity, to pay it further don* 
aideration, reflecting, that as they had hitherto been confined 
to the eyes of oxen, sheqi^ &c. there might possibly exist 
eome triffittg chlference in the rdative tttuation of the ptiett^ 
.#i<h reelect to the hmnaa eye. Such a deflenakiation, 1 have 
eince esmerienced no reason for regretting { ftir in cpportw- 
liities which were frequendy shortly afterwards afforded me^ 
of rqieatihg the same eipdriment on the eye of the sula^, prior 
to ka lemoval fimn the <nHbit, the results vefy materiaUy diflhfw 
^ifkunttdif that the deg^ of difteidt^ exf^fieao^ in effi»Pl«' 



tm MrClM|feHfei0iARM«^li#<|M^^ ^ Mf 



indeed tliej occasioned to me such disappocotmenl, than 1 bs* 
\wm» tOMMHrbal diyirllfd from pma^og any fcrtber in nq^ in- 
veatigalion. 

In peiCmniiig Iha opsvatioii on the aabyeei^ ^ivWIsC the m 
ttmained in Um oilMlt I made an fneiaiui tl t t on gh tie «m- 
roUc Md choroid coals at aiew fnca dislxUipa finHtt« and p»- 
zallel to the edge of the li«ns|Mrent coraea, pnd eecapyintf an 
#Klent of betveen oM»haif and two^tbirdB pi an iaoh : witfi the 
^SUfwd^ of the iDatrttment haiang koenited -tlia eiyMjMm 
MMolei the knife was withdmvn ; bitt, aMioiigh n retj eonridc^ 
nUi d^grtf of prtiaura w made upon the ghib* of the ejre» it 
^itm not fidkyved by the cffwt, aa might h«v6 been eapected^ of 
mecationing the ^icnpe of the lent itadf. 

I found, tliat, in consequence of the rigicfity and Inelaatiofty 

[WBicai, and <' 



ndkAdk the 4^roid and tcMolie coats poe ie ti, and their 4onae* 
4|tNint incspabilky of yielding to the pvefsure of the le^s fimn 
withiot in iu endeavour to eic^»e, in ordav ta pKodnaa aneh m§^ 
4fli40t^ it WAS necessary Aat the incision shodd be aogmeiiliBd in 
itntent* I enlarged^ ha a very ineonsadevnUie degne^ the extent 
of the incision^ and, with the asaiatanoe of the fipfplhaatron of a 
9vt gentle wessiare, the lana apfKond i not he w mar alone, but 
^mmrtunalmr aceoespiniid by the vitraouii humour, a veiy laige 
lotion of Wbieh ymn akra^gnhted, and cnlanglad in the noHapae 
W' the divided edgw» 

I have several times, since that pened^«epcpited this eacpevi- 
nientt and firom the aum cf their rastfka, have found nmfda 4md 
Mikient reaaon for the ded n c t ien of the oDncfanion»i|ba(, tkttmA 
M opening lees in extent than ia aaffloiant m adaoit nf dmMn- 
^i^^d'thevitreouahnnioort.or a peattalproiruawrflf im Ub- 
atftpee, it ia in the generally oi tatm ipposaifaie, nilhouteKcib- 
ing a degree of pressure, which would be incompatible wilii the 



)iMtt)aentni8ifitiBniaa6e of vistbn in the 
Ibe veMnnval of the opaque lens. 
. Aa the oause of aoch diflkttky being eitpeiaanced by the hm 
in its pnisage through Ma indbcpn 1^ en|enaiiie> I can asainn no 
IKher thM the nayiuding Inda^tic properly mttb iriuck ifae t»> 
Hiffs avt themselves endowed, in' osf^ubctjon widi tk^ aetaaon^ 
JbdMd dSAculty whidi it,in ennMaou wkh afl othef haiNta «f n 
niMiar oq*v«ek fom, muit snevitsMy aetftri in ifae lihtarpmult of 
ale paasi^theough a »erety Hneai epertnee^oraealwnby irnil- 



i have eiMJB, endnurcMMEed, iqr vniying the ium ^f 



iMT. MH Cbflpman nH'BtiratHhg the Ganhtei. iSf 

Ae et^tilHbelitimour, but Have ftfled in d^rfthig any 9AHao^^ 
ffptti sach a deriatioiii in consemiedce pf the sroaiineBS oF mH 
distance sutntsting betwtxt th^ edge of the cotnea and the ca^ 
^ule of the vitreous humour. 

Adng convinced, therefore* and I think n6t wIAout sufBcIenC 
reason^ that circumstances (bus hostile to this Innovation werA 
tasusceptibl^ cf remedy, I had tome thne since resolvi^d on not 
troubling yqtl wrdi rni^ comu^unication, of even with a bare r^ 
tiiibii of mjr experiments, and from such a resolution should* not 
have deviated, had I not, to my utter astonishment, on reading 
tfie January number of your publication, seen a proposal totfa^ 
^jflftet, communicated by Dr Von £mbden, virherein it i^^ear% 
chat this new tnode of extraction had bec^n suj^ested to a D^ 
Ijqjbenstein LobeT, from an accidental occurrence. 

In cottduding, I beff leave to observe, that the object of tfair 
Mntnmnicatioti IS not t6 despoil or deprive this hitter gentlfemii^ 
irfaiiy merit he may himselt attach to his ^9oovery> mit merely 
to stitt^ the reasons for my o^it^ion, that the operation of ait<» 
trac^ff the cataract tf^us conducted, will tfeter ne deseiriitg ol^ 
tft obtflm, ft preference to tf^at in common use. 

Batk^Marth 11, tfill. 



\i0lHggmmis. % M^anuuL HittA» M. B«» %. 

Yl[^itt dlftj^os!^ of hydrothoKut, in ifM incipient stsge» liiutft 1^ 
•*■ extrtfmeiy diMcuIt And #ven in a state of 5)nsiderable 
advancement, its indications are frequentlv obscure, and its est- 
iiij^ence unsuspected. The dis^nCtions pointed out by M. Corvf- 
sm. CorpU. I iii. are not .much catcul'ate^ to diminisb the dii^ 
ncmty ofidentiifying this sdSection in general* attbough they tit 
ft^ditant ib diitinguisbing the simple hydrothorax,Trom a dij- 
i!tfe bf the heart Irith consecutive ^sion into the chest. It is 
fibssfble^ lbQwever,( thtft tiie stfte of bydrotlicrt'aJt tnay b^ fri- 
A^tlv ascertained % a more miixiite exaniinatio^ of the jpcMk- 
«tfe 6f ^(S nkttent, and« \ix pa^IcuW, &f the filternate' ^cUofls 
^ititf nioa^qti^fllie' cbeiii iii r^picafion, tfauli^d hithettp be^i 



of cou^b, md to the alate of poises and of the urinei maj tltobe 
useful in the diagnotis of bydroUiorax. 

With the view of elacidating this sabjects it is the writers, 
intention, in this paper, to detail the symptoms of several cases 
of hjdrcMtboraz, uken with the utmost accuracy ; and to add a 
summary of the principal characteristics of this disease. 

1. The first is a case of simple hydrothorax % the patient a 
female about 66 years of age. First rsport, June 14, IBIS. 
The countenance is pale and rather IeocopUe|^matic $ the lips 
ofa pale, livid, or oingy lilac colour. There is no expiessbn 
pf anxiety. The patient sits on the bed, on which she constant* 
ly presses forcibly with the hands, and, keeping the arms 
straight and extended, thus raises and supports the shoulders. 
Respiration consists in an inspiration made with great muscn* 
lar effort, in an expiration made rapidly, and, as it wer% by the 
spontaneous falling down of the ribs and sternum, and in a long 
Interval before the repetition of inspiration. Hie shoulders are 
still more raised in inspimtion than before ; the whole chest* 
the sternum, the clavicles, and the ribs, are much ele v ated ; 
but there is little protrusion or motion oiP the abdomen. The 
pulse is 108, and re^lar ; the cough is only occasional. Itiere 
M thirst; the skin is dry; the urine scanty; and the bowels 
oonstipated* The ankles are cedematous.— Second report^ 
July M. The covnienance appears of a mixed coloury 
leucophlegmatlc, with a darkish tinge, rDsembluig the odour 
of tea^paper ; the lips are slightly livid* She universally raises 
the shouldevs, by resting and pressmg the bands on herknees, 
or on each side on the bed. JAespiration consists in a full in« 
spiration» made with effort, -and by raising thejahonUerscon^ 
Aderably ; in a quicker expiration ; and in a long inteiwal be- 
fore in^iration is 'repeated. Pulse 88 ; full, moderately strong* 
and regular. Less cedema, and scarci^of urine. Thirst; 
bowels opcn« — Third report, July 10th. The countenance con* 
tinues as described. She now sits on the bed, supporting, her- 
self with one hand placed by her side^ and with the elbow of the 
other arm resting on a raised pillow. The res{»cation is nre- 
€»sely as before ; inspiration is performed by an elevation oi the 
chest; there is no protrusion of the abdomen. When i the 
fore-arms and hands are purposely made to lie along the thighs, 
inspiration requiring a much greater effort, the head is drawn 
backwards, and the shoulders are much elevated by moscular 
exertion. Pulse and other symptoms as before. It is unneces- 
sary to add the other reports, of which many wer^ made tA dif- 
ferent and distant periods. But it may be proper Jo subjoin 
, tktrpmtrist which were added to tbe caic^ attbq tinie si was 



1817. Dt H|jr& a$tr9MlimU^JJitgimii^ Mff 

takfln, now neaif 7 fear years ago. The fHUtndc lo peculiar^ ' 
and cocoDsUuDtly observed in tbU patient, wa« probably adopted 
at once to raise and fix the shoulders, the^sd^pulae and the 
Inimerii and the ribs and stemiiin were drawn towards these 
fixed points in inspiration. By assuming this position, and by 
employing this kiod of support, too, the diaphragm and the ab- 
dominal mnsdes were allowed to fall into a state of relaxation^ 
by which means also the cavity of the chest was enlarged. I'be 
enlar^raent of this cavity for inspiration seems, indera, to cpn« 
stitttterthe object of all the effort used in this affection $ whilst 
its beinj; occupied by the quantity of fluid occasions all the dis- 
tress ol the disease. In .the upright position, the fluid seems to 
press the diaphragm downwards, and thus the further contra^ 
tion of this musde, inducing a protrusion pf the abdomen ex* 
teraaUy, is prevented. 

/ 2. Tli^ second case is an instance of hydrothorax, succeeding 
jto several attacks of general anasarca Ifrpm cold ; the firm of 
which occurred forty years previous to the date of these reports, 
from exposure to a storm of sleet and rain 1 the last, from drink- 
ing copiously coU fluid, when in a state of profuse pen4)irati0n. 
David Ross, SBC. 63. The countenance participates, in some 
degree, in a general ^sdema } there is otherwise little peculiari- 
ty, either in the colour or expression. He sits up, raised in 
bed. The chest appears unusually high* There is considerable 
effort in inspiration i apparent rdief in expiration* The cough 
produces a rattling noise, from the presence of mucus in the 
bronchi ; the expectoration is copious, adherent, transparent, 
frothy, and tolerably easy. Pulse 72 i of moderate force and 
aize^ end rsgukr at this time. Tongue somewhat loaded. Bow- 
eb regular. Some thirst. Skin natural, and dry. These is 
general anasarca of the abdomen, scrotum, pa)is, thighs, legs, 
and of the lefl arm and shoulder. No fluctuation of we ab£>- 
men.^— Second report, July 29th. The nostrils dilate in inspire- 
don. He recHnes in bed, supported by pillows. Pulse 109.; 
full, strong, occasionally intermitting. Respiration, or the com- 
parative time employed in inspiration, expiration* and the sub- 
sequent interval, is thus represented in the writer's note-book. 
The inspiration is rapid, performed with much effort, slightly, 
atfixstyby the diaphragmi principally by the chest, attended 
with a descent of the pomum Adami, and a drawing in of the 
integuments between the ribs. No interval. In expiration, 
the chest seems at first to fall down, as it were, but afterwards 
its oontsaqtion is continued with some degree of effort, aitd a 
ntttling noiae* Cough in fits during a lonM^expiration ; expec- 
' teration as bef<a»^ ioiigh,>and.adhesive.>^Third r^igott^ August 



gib. TMi Mpdtt is ilot mftufc rt fcrtt iitt{§pl^dl«|rt<M^ 
of that of ittiy f9tll ; tli^p«be #« 1^ hwguW. 'nil'tiltt 
BMly be said or the sabeeqwdtotied. Hie fwtietlt mmk gtlidt iJ k 
Ijr, Md died Aagwt 31st Oti opening the body, betireiBii dItfM 
iad four pMBdi of fluid were fdand Ha eieh side of tliecbei(» 
flttd i^xmt nine dmces in the perleanllmd. iWe were no Ad^ 
liesions ^ no disease ef the heait. Four ponnds ftf fluid weM 
flaund in the iibd«Mtteii ; bat ad other diseased appeMnnoe. TM 
dififeretice between this and the ibrlner case, arises fhstti the dH^ 
lesent forms of the afftetion, the presence efanasatiba, dfcoafi^ 
attd nscid eiqpeeteratton, and of elRiiion into the peripardhM i 
and from the diiferont posture assamed by the patient 

a. It AW be sniBcieht, in the third pleee, to gtire oM i^Mtt 
gfa esse or simple hydrothm^Mi in which die irfltapfoins #rt« 
tery simifatf^ to those of the case last related. Anne GatnpKdf, 
»ge!d 5$f has been subject to cough, dyspnaM, ahd pectoral 
eDtapkint, during twn dr three yeani. These sytn plfH irt issfHnetf 
4HI aggratacisd fo^ai di«ee weeks ago. At presetit (he cMitte- 
Aanee is natitral hi cokttri with a shght expressieh of aiuAty. 
flhe lies on the back» with the shonldertL and espe d tf ty fuft 
h«ad» mudi elevated- illspihitioa is quick $ a sifidcin iflbft 
raises the ribs» Md protrudes the stemMi^ the abdbtteitf iMh^ 
litthi or not at all frioved. I^ratioii seefti* to be tfl^ mei^ 
tiOMng down of the ribs a«d sleiiium^ wMdi takes phiC» nmidHr» 
^rtthoiit effort or noise, eMcept afletle tMMihg at iU miMiA fi m^ 
Duthig ittspiradda^ the muscles along the hedb, , 
atemoffliastotds^ are seen to mH fereit^y, aiid the fa^, iif t 

4tt^ one side, is mofed in ibe direetion of these musdesk ^ 

hiaforeibieeotttfb, tdrafsesoMefiieid, Min^iaMrt:, l^^f <itt» 

•Mstoiratioil. llie pake is abeut ISO. ihbre ilfid less fhMlieM, 

4biii otharwise rsttular. Tongue tiMise, hot loaded. VtfinAiM- 

^tlte. On, assuniW the erect posMM ill <tod, the pe<friiar!rf Hi 

-wasplratlon, the suMett eleWttiM of the chest hHth tmOk mA^ 

:h» eflbrt, and Che tittle protruaJM of the iMoiMn, the srihie. 

Mient spotttaire<^ttS Mltig down ef the itertttM ahd* Mbs ^thiftttt 

IfeK, beeoBAe siiti more maniflwt. Ifl Mrtphemaenls MM, 

«he ooMftensnee is deeply snflhs^ 6r HyM i etplMtion, m iM 

.US liVBpiMtion, Is performed with gteat muscfildr eflbit 1 ^ the 

/MHSmi^o^ntent or iuspiration, the hMtoiM ^ ^ stenfMi Is 

•^sonieti«i« drawn fotisibly Awards, attd 4m ilfaiilodMtt Is i^nf^ 

'trudod. 

4. iMe l^th, l818.i^Wflfldnl Qrsdy^^ a^ 99$ aUbaHMh* 
* aaas veen oRsesBv win €iyspftaS8j|r nQ^raratjOA ttr 'ffiffitfeiif ii^* 
"fftsriSi oiitfM eweani yiaih ^Hn cSfxkfUwa rfyyih- J|rtHitfe 




fH9. Bi PdTs CmA Hm im la m^mtis. Mfl 



#M dbMPtfld • tnmour in the ^ig|istr». The MttDl(HMMlco i$ 
WDguiaetai) ihenisa litak ifeddma flf.tbe left «ye-ttdi mid ii 
4i|iht imdityof the Cps. He lito aI |»reteB(t on %b^ bod ytiv 
wreot, sad Aappoftt hiihaelf by placiiig aad wmtig tke kwem 
ibmiy OB the <bed <» •acch ttqe of Mm, Aet{NriitiQQ 19 pay 
Samacd by die ^best abiie ; in Hispiitttioni the tIMiOTiMiitMd 
fBiMBlts act fbrcfblyi the mfeefcoetah «re dmwn mwardot the 
etertram and ribs ase cbttWn npiMirds $ tlaeno u-some rattling bft 
^Etoieelion. The steniimi is vety protuberaiK^ In the epigMf 
tsfc^ ottdiiiioely kit fayp(icbondffiee> and opieolioal «fgion% eii 
AtoDMve, hard tamoari oneqaal on it».suffiM)l« h^olmt^ed e* 
«KiHDfai|U]an; <hene iseame fliiMmtion in the abdoaen 1 about 
n mch of fluid is preBMd theongb, before theliand arrivee aft 
ilm tmaoor laentwied. The Jeos ere eHleinatouiu June S4ltl|» 
'niflie i« a d^c iiwiditgr of the tipti end a venout eolour of tb# 
eheeks, vitb as espreBMai of anxiety and diilrest. He can Ue 
vb the left aide only. Ik the day be site ojpu He. bee req a ea tc 4 
that a ehair night be given him, and he ake conetaotly witb tbf 
«|iBe and ebin placed on the tep of its back paet. Wbex^ he 
^aes not metbeidbair^ he aapportebiiaaelf I9 placing Im handl^ 
on the bed, vatber bdiiod him ^ leans backiMtrdsi vilb the ,bea^ 
ako drawn baqkwatds, and the shoolders raieedi bet etii^rwii^ 
quite eeec^-^notwitbsianding mmk debility and e dq^ne tf 
Ipaciation. The. flternaia is more protttbevanl and 4|i^bir tbiMI 
patnealj the daviclef are drawn paeeUei to the boriecin. Inngir 
W ta an is performed by aatrong cffwl of all ike museiee wbM% 
nondttoe 10 Ihia e&ct $ the cnesi falls ^ain .Hianma»o»ly i^ 
IHipilttteon. Bespiraftieii k petfoemed prineipi% bgr tbe cbeifr 
He fotpsvienees long fiu of json gh in g , by which a oopicps vinr 
0id eppeotcntion ia raised. On di aM£t i oB> adh^ioee and f|Bi^ 
aion awe faand on both aidee^ ijbs dhssfci m^dihe Ui^fr wm 
enlarged fay the tobar^ ^fiiea. 

Hmq^ detailed the appearaneee in fotir eaeee of bydrolborai^ 
l»ldiidlitttMinklb« easy for the anther 4o add a greater AmWr 
bet, this paper may fcp properly coettliided by etating a ^iiiif^ 
mpiy^f the^xhaincleriitio oppeamc^ in tim diee^ee. T^ 
posture is peculiar. The patient sin xtpfitfuh ^ l^sna bMhr 
wards, and supports himself by placing the hands 00 his knees» 
on each side^ or badcwards, on the bed. The ahouUers are 
thus much raised, and become fixed points^ from which the 
auxiliaiy muscles of respiration act, to elevate the chest It ia 
interesting to observe, from time to time^ how naturally and 
bow constant! V this position is assumed ; and how certainly it 
ii feannuped, if the patient b^ made to change it purposely for 
IbntnaL If thn pi^ieM tte* down^ the ehonldm end heed are 



mncb railed by pflloww. In one of tbe cases menlioned, tife 
fiatient bc^sged a chair, on which, as has beoi staled, he lean- 
«d, and fixed the anns, elbows, and chin, without variation, 
alaling his complaints to be mitigated in the erect posturam, 
general, and still more in that just described. In an aggravatF 
^ case, which has not been ^iven, the patient, a female about 
BO, was at length incapable oi lyingin bed, or of assBmiQc tAj 
other position than the following : She sat, day and nigniv in 
an armchair, fixed the elbows firmly on the arms, and the 
ferdiead dn the back of another chair, placed imasediately be| 
kite her* Cushions were piaosd along the arms of the^finAf 
•Ad on tbe back of the second chair, to prevent the pressuiw* 
^btt*h was made agsinst them firam Inirting the elbows or the 
' forehead ; all el £e patient's osvn suggestion. ^Tbos the mae* 
toM processes, and tbe asapuhe, became fixed poioU, tuamtfjit 
others, from which the auxiliary rousides of respiration were «k 
lowed to act Hie respiration is liot less peodiav than thw 
posture. Every effort is made to Mise the sternum and the 
ribs, and so to*enlarge the cepacity of the'cdiest. Ilia effsrt^ 
made in inspiration only ; expiratieii is easy,'but» at its leraMia^ 
tion, often attended with a rattling noise* In long continued 
cases, the chest becomes permanently elevated ; the sttaiuni 
ig protruded, and the chest appears high, end somewhat d^ 
formed. In cases where much fluid is eSiised, and the erect 
position assumed, the diaphragm seems tp be weighed down^ 
^respiration is performed wholly by the eloration of the dKirax» 
and die abdomen b not moved or protruded. The cough la 
elsoi in some measure, distinctive. In-general, fits of coujpiag 
raise a copious viscid, tenacious, transparent, and firothy esa- 
pectoratioii. This repeated effort constitutes a fit of ooughingt 
performed in general during one expiration i it •is attended widi 
a rattling noise; the countenance is pale^ and phkfmatic; the 
cheeks generally not iBushed^ and the lips are of a pak lilac 
colour. The pulse is various, but when the patient is tmDi<|nil, 
it is frequently regular i the sleep, in simple bydrothorax, is not 
disturbed by dreaming} there is thirst i the urine is ecaAtyi 
and the bowels genenuly costive. 



I 



; »t » • J • 



IV. 

Case ofJUarbttS CceruUtu arising from Ulceration of the LungSf 
and accompanied with the Medullary Sarcoma of Mr Aber^ 
nethjf. By Wiixzam Howisoir, M. D. Member of the Royal 
Medical Society, &g. 



I 



HATS taken the liberty of pretendng to the pubhc the fel-' 
lowiag remarkable ca^ as it not only afibrds an instance of* 
Morbus Coerukug arising from a very unusual cause, and which 
tma detected by a very accurate and careftil dissection ; but 
froBft its also presenting an example of a tumour of the sarco* 
maloiis kindy under which the patient laboured at the sarae^ 
tune ; the nature and connections of which were also explained 
by disBectioDy and which, by its pressure upon the circulating' 
system so near to the heart, might, in a considerable degree, 
Iwve aggravated the suflfefings of the patient, and assisted in 
pradffcing the morbus coeruIeus« 

' A« B. setat 24, unmarried, was admitted as a patient into the 
Edinbur^ Royal Infirma^, on April 10th, 1816, under the 
cave of I)r Spens. She is very corpulent and plethoric ; is - 
shcuBt necked, broad shouldered, and has every appearance of 
a .woman of forty years of age. Her fiice is full, and turgid, its "* 
intt^mmts are of a florid red colour, and have an csdematous 
appearance $ her eyes have a dull and languid look, aUd are 
depressed, as it were^ in their sockets ; her shoulders are very 
broad I and her chest is full and prominent ; her abd<«ien is 
greatly swdled, particularly below the ombilious, and when 
struck, communicates an indistinct sense of fluctuation. The 
swelling is observed to extend a considerable way down the 
liiabs, and they also have a pufly cedematous appearance. The 
imsguments over difierent parts of her body, particularly her 
fiu:e, back part i>f her neck, breast, upper part of her abdomen, 
thighs, &c. are of a florid red colour, verging to purple, and 
dispersed over vark)us parts there are livid dark-coloured 
blotches, varyiuff in size from a sixpence to a crown pieces 

Stoated on the outer edge of the sternal origin of the left 
atemo-mastoid muscle, there is a hurge, hard, incompressible, 
aomewhat irregular, and moveable tumour, extending hence 
along the upper margin of the davicle, backwards nearfy to the 
trapezius mu^e, upwards to the angle of the fewer jaw, and 
vsaduDg anteriorly to the tradiea I its basis seems to be very 



extensile, and d«ep»8eated ; its invefting intcgDmenU are of 
tbdr natural appeu*anoe ; and its presence is reported to give 
no impediment to the performance of respiration or of deda-. 
tition. Pakadons, i^ncfaronous with the poise .at the wrist, but 
dbscore* are to be lelt ill the swellihg ; and the belly of tile 
itHtio*iiuntoid nusele s^ms to be intolVed in it. 

\ Che eonplains of fixed pain of beeast, aitaatcd dorsad to the 
cartUaees of the two inferior truct and superior fiilsei nbf ,of 
Ae len sidot accompanied with a strong irregular pulsation, and 
gfg^t difliculty of breathingi particular^ when in> the rec^nibeq| 
pofitioui which is i^^avated by a tickling cough, attended m 
tipifss with bloody sputa, with which. she is troubled, particulate. 
It durinff niffht } nulse about 80, fuU» and irregular i steeps io^ 
^l^en^jr $ bowels naturally costive i passes urine In niitun^ 
quantity i. thirst i tongue whitish towards tbie centre^ but red 
tpwards die edges} much dvspoquu Catameyiia pro mensis 
quatuordacem defuerunl. Is affs^ted 4t tiivies wilh sererr 
hes|dacb. 

' .From the abo?^ menUoned peripd* fhe contiotted gradu** 
sJly to get wone^ in ddBance of all remedies, a^ bliHem^ oM^* 
laginotts mixtures, squills, kc. till the evening of the 16lh, whoi 
s)i^ e^irad. For the two last da^s previous to her 4c»^f ^h^ 
wnld not lie m the rectimbent position for any p^'iod of lamth 
h^ braatiiiiig having gradually become so difficult 

As diis was a very interesting case, not oqly qu account of thfc 
gvoeval mearances, and medicai symptoms of the patients but 
us it was alsa o( great coo^ueace to dipcoixer the nature sod 
f^mnctions of dlie tumoari in a suigical point ef view^ permia-. 
sfon was vequesteci to open the b^y, which was imm^diati^jf 
gratttedf and was performed two days ^iler her death, with kreatk^ 
oire^ in presence of several of die medical gcntlmeu ef ihf; 
bosipitai 

fteto Cad0«tfrM.~The integmpsents covering the thorax b<&e^ 
diyidedt the ki was found to be of a firm consistence, and M 
extand about an inch and a half in depth. The sternum briog 
0ttl froin the rtbsi and laid back, a considerable quantity of aifc 
#^^^ with vi<dence from the ri^t cavity of the thorspc lllb 
right lung was compiessed to the size of a persw's hand^ and 
g|lOn examining its external surface, an ufcerated hole* about' 
tha size of a shiuipg^ was discovendy near to its centre^ thraii|^ 
which tlie air had asemed into the cavity of the tfaarax^and 
aspppiasBsd Iha hiQA The interna) substance of the luu|^ whan 
IM lAtOb mmaaim • tqbeiculaled ap|)eaiaQce throag^i ila 
i^^«oi<p«« TIm)^ kti«iiiiiiil|«faiAdt#hBmi(Atai»f 



«»iin«<iil |a^ MuUev diMi itntainl « and itt intatild titriHtwWi 
pDsMtit^ tl^ WM tnberoifaMt«d iQ)pwrwct^altbougb ia anvdi 

jPhe p«ricarf)ipi«» wntwMg tW \mxip ww finmil feraod aM 

the left luDg^ so as to iinpede» in a caoiideriU>le degraey its fiM^< 
•G^Q., Vpgn Iff 11^ opep k^fwyi^rv tb^re flowed frooi it aboot 
^vi. 9^ 9 traiuipvrept yellowish^colapr^ fluid. The heart mm * 
Jai^eir thaq 9iatura|> viiwfa lotaded with fat» aed its eoroiwrjf < 
▼fmll wer^ distendibd with bta>d.* Hie ri^^t auride was timn 
gi^irith Uopdi j^nlF ppfiiguJat^i aod partly fluid 9 the fi)Kir 
ntM !^^^ ^.9Sk tot^a Qoiupkteljr closed 1 both Teatricles warp 
a|ip ifUM ¥Ub b]wd I t^erv otb^r part ^f the heart, valves^ &e4 
^ei^ fpuiid tp be 4wnd apd healthy* The contents ctf the tb^^ 
W l^iiffg removiidi Itf inytenial cavity app^aaed la be kkine and 

FfPD^ want 0f time pKeiripas to the fitneral^ the eaiili^ of tba 
a^wivm aii4abdim«» were not opened. 



9Miq Tm^iJf^rrV^fm dis^eetiitt back tke aumsiiDdiDg lAt 
t«f i|iitieot9 bgm tluEi tumoni^. tb^ Dc% of Ibe atenuHmastoid 
i^HiclK ifiHiAr^ greatly diminished in bulk» luid thb muscular 
fibo^ ]ffmpd¥»t4y i^Vf r tb9 tiUnoMr were ahaost absorhid The 
s|^QO*tyoidi$Ws miiade win fiMnd ipbeina.shnibreefiditio«» 
Tha tuper6(»ri veiM in ^e neighbanrhood war* considerably 
enlirg^ and di»t^«pd6d with UiM. The eternnrinastoid bnis- 
cle bajiog .«^arAte4 ftoia it».altadunent with the sternnm andi 
cjavi^e^ 10^4 jriA99M4 upsraidtf, this tumour appeared to Gon«(gt 
of three masses, distin<$ b0m each oChefc^ exeqpting at one nde^^ 
^k»f^ ib^ W^r|i,.«li^U)y etmMOtcd* Undesneath, and s^retch- 
ipg i^|o w. «iJlW <^ sumbmr pf enlai^ged glands of differeotj 
SIMS epuld be d<ste9ted bfr |h^ fingerlu Aibr injecting thw 
Mft icxmtw^ «^irotid turtery^ at its ocigiu frbm the aorta, with, 
lortmifioo iflijafttjpot ita dianiatev was ioupd. tp be oonsidevabljF 
«nhii|fed» but ijU traok waa entirely unconnected with tiie tu^ 
Biour, e;^^tiiig by meani pf th6sa branches which supplied it 
wJlh Uf^, 9Pd wbijtJii Ivei^ considerably enlarged} celkdar 
sdbitance .eyety where intervening ijetwixt it aad the tumoosu 

Cppii dividing the largest tumour into two equal halves with 
a d^ ifcalpely it was found tP possess ail the characten of the 
saedidlaqr sarefcmm pf Mr Abbrnethy. 

Upon inquiring into the previous history of the above men* 
tkaiMpalieiftt^ we learned that she had kd a very laborious and 
aatine fl^ from bee earliest year^ as a fiu a n s erv ant in this 
^tentqr, in4ibai jdit Jfabd.aiyDy^ B^riectlyt jood hindcb, «ntil 



S12 Dr HowiiM*8 CofC efMm4mGtBn§km. Jwfy 

within these last two yetat^ when the above mentioiied qmip- 
toms eomnieiiced, and gradually continued to get worse. The 
tumour in her neck commenced six years ago» and, when first 
observed, was about the siae of a horse bean, and, since that 
period, it has gradually continued to enlarge, but particularly 
within these two last years. 

The cause of the livid colour of the integuments in this pa* * 
tient (or morbus cseruleus) appears to roe to have been owing 
to the very imperfect circulation of blood through the lungs, 
and, consequently, to its having been very impeifectly supplied 
with oxygene from the external air during respiration, The 
right lung, as appeared upon dissection, was compressed to the 
size of a person's hand, by the quantity of air t^hioi had escaped 
from the ulcerated hole in its surface, and must, oonsequ^tiy, 
have been rendered almost incapable of perfbMing its natdnd 
functions. The pressure of the air from the right cavity of the 
thorax upon the toedlastinuni, during the action of the ' ri^t 
lung« had also forced the pericardium and heart totally into the 
left cavity of the thorax, and, of course, greatly diminished the 
functions and siae of the left lung. The diseased toberenhAed 
state of the substance of both lungs themselves must also hkye 
contributed greatly to produce the disease. The action of the 
heart itadf and arteries, upon examirtatibn before death, appear^ 
ed to be irregular, stronger and fdRer at one time than at . 
another, which might arise from the pressure retarding tbdr' 
free action. The pressure of the tumour upon the trunk oflibe 
left internal jugular vein, particuhtrly when the patient. was ly^' 
ing upon her right side in bed, might have prdchiced the great 
turgescence of blood in the face, and headach. 

With r^^rd to the treatment of the tumour, in a sUf^ca] 
point of view, there most have been much hesitation UnA doubt, 
from the unoertarnty with regard to its nature, as by sotte peo^ 
pie it was supposed to be an aneurism, and its connection with 
the surroundrog parts, whieh were of such importance to the 
animal economy, FVom its immense siae,--*from the imp^ntant 
situation which it occupied, imbedded among the h^^ hjooji'- 
vessels, nerves, glands, supplying the head and neck,^-^frdni Aef 
uncertainty whether or not the common cifrotid artenr tiV(ght 
be immersed in its substance,-^from its depth,«^the s^od| iia- 
ture of the opcratton.-^and the delnMtated state of tfiepat!ent*a 
constltution,«-^its extirpation was delayed, and Ai6 Was' teebm- 
mended to the physicians, under whose care di^ eventually 
died. By the dissection, di these cbcumstances were ^scpbifk^ 
•d i and it became evident, that the tumour might haveWn ye» 
moved without risk, esiaoqp^g finom the extent of die^nttd. 



13 iV. Mr l)oiiglas's Case cf WaimAsd Bladder. SI S 

and ' the debilitated state of the patient's constitution, arising 
principallv from the internal disease under which she at the 
same time labourecL 



Case of Wounded Bladder^ terminating favourably^ By J- 
,DouQI«A^, SurgeoDi Hawick. 

#^APTAiN S. was wounded at tjbe battle of Chiraawa, in Upper 
^ . Canada, oh the 5tli of July 18 1*. The ball, hating pene- 
tratod the I^ft groin, over Poupart's ligament^ by the side of the 
hirg€) blood-vessels of the t|iigh, fractured the anterior part of 
the pelvis, passed through the bladder of urine, slanting oblique- 
ly acsoss the basin, ana terminated its course beneath ihe.inte- 
gaments on the ri^ht bqttock, over the tschiatic notch, from 
which place it was mstantly extracted. : , 

Immediately after bdng wounded,. Captain S. was bled co- 

?ioiisIy, and the catheter was introduced to draw off the urine, 
^his treatment affoi*ded him a little relief. On the evening af* 
ter the action,. the arn^ being ordered to retreat, he was con- 
veyed to Fort George, a distance of seventeen miles, in an open 
waggon, during the inclemency of the night, the motion of 
whicii gave him considerable uneasiness. . From thence he was 
carried on board a small vessel, conveyed across Lake Ontario, 
and landed at York on the evening of the fourth night after be 
received his injury, when, for the first time, he was committed 
to my care. When I entered his chamber, I found him stretch- 
ed upon a hair mattrass, his countenance pale and anxious, pulse 
Siuick; respiration hurried, and the urines tinged with bloody 
owing freely from the groin. The wound in the buttock, from 
which the ball had been extracted by a simple incision, looked 
clean and healthy. On the contrary, the wound in the groin 
appeared sloughy and inflamed, and the discharge from it wa$ 
fetid and offensive. He made frequent attempts to void his 
urine by the natural passage, but, after the most painful and 
convulsive efforts, he could not effect it He requested of me 
to introduce the catheter, for he had obtained con^ideri^ble re- 
lief by that operation at a former period. On attempting id 
pasa it^ he felt severe spasms in the perinaeuin, and I was ob- 
Kged to desist, having had the mortification of addipg much to 

VOL. ZI II. NO. 51, X 



SH Mr Doiig^% Case iff Wounded Bladder. f^ 

hja sufferings by my interference^ I directed aa enema to be 
given, and an opiate to be taken at bed-time. Oq die foBow 
ing morning, when I visited him, a longitudinal pieoe of boae* 
nearly an inch in length, and about the thickness of a crow's 
quilly presented itself at the urethra, which I immediately ac- 
tcacted. He had spent a restless night ; bttt the expttUon of 
this foreign body gave him a good deal of relief. For three 
weeks fo]k>wing he appeared nearly in the same state, only the 
wound in the groin looked more clean and healthy, from hav- 
ing its slough detached. However, he could now pass a few 
drop of urine by the natural pasrage, but in aocomptishing this 
he felt most severe pain. The discharge of pus and urine was 
also copious, and extremely fetid, so that it was difficult to re- 
main in the apartment for any length of time. The posterior 
wound now began to inflame and suppurate. A pieoe of cloth 
vaa discharged, and the urine flowed thnu^i^ both opeoii^B* 
At this time ako another piece of bone ipas passed by the ure- 
thra, which, when pressed between the fingers, mouUeved down 
like a piece of earthy matter. About a £;^ight after this pe- 
riod the season became extremely hot, and the wound in the 
groin was over-run with maggots, which for a short time in- 
creased the suffering; of ray patient much, and really seemed to . 
concentrate in one individual the highest dc«ee of boman mi- 
sery. They weret however, soon destrogred tiy aa iigaction of 
bnmdy and water. After this period the wounds beg^ to con- 
tract, and to be fiDed up with healthy granulatioiw, whili^ the 
fiinctions of ike bladder gradually resumed their dSoe* The 
final closure of the wounds was much retaided by fre<}uent at- 
tacks of intermittent fever, which indeed had proved, ietal to a 
number of the wounded in hospital Fowlei's solution of arse- 
nic was administered, as it was found most efiicacious in put- 
ting a termination to the paroxysms of the fever. After having 
sumred much by three or four relapses of fever, my patient was 
ordered to the lower province of Canada, for a diange of air 
and climate. He accordingly sailed on the 24tb Noveipoer fW»a 
York, with his wounds completdly closed, a period abpnt three 
months and a half after they were first inflicted* . Qn Iqe arri- 
val in tlie lower province, he was attacked with fever in the con* 
tinned form, which was also attended with catarrhal syniptaai& 
From the exertion of coughing, the wound in the groin was 
forced open, and the urine was again di8ohai||ed. The fever 
abated ia the space of eight or nine days i ap4 in sii: wedcs af- 
terwards the wound in tCe groin wM^fin^lly healed* i 



MIT. Mr Dougki'a Ga^ ^WmO^i Bladder. tlf 

a |pr€M 4«t) of medlod regard, fcr meej lai^ean wIm mw Gift^ 
tMi & despaired of bia recovery. TIhb case bemg complicalad 
wiUoi qprfiiitera of faoae^ was •one evidantly not auited ito the inw 
tfodnatjon of the elastic gum catheteft which has beea feand so 
oge&l ki wounds of the Uadden The longitudinal pieoei of hooel 
appeared to be a spliafier from the anterior brim of the pcM^ 
and it was sarely most surprisiaff how it eould find its waj iaiio 
a passage ie narrow as the urethra. The eodt of arioti bjr ito 
posterior wound had been pierented at first by the pieee of pasN 
lelooB^ which was afterwards diseharged by suppoillation« 

Captain S. is now in England^ andt since aijr artivil fkn 
Avarioa, I have had an opportunity of seeing bin. The pre- 
s^aet statement with regard to his wound is as fidlows :w- 

nrbe left limb is smaller than the right, and appean; Shonn 
^len he walks or stands erect, ^e can walk a distanced of 
dinSe* miles without vesting^ but is not able to ride oti kMNfse^ 
backf frpm a tinglms asnsation like the pridEmg of pins in tU 
perinseum, and which extends itself down the idside ctf the left 
kg. When he voids his urine, he stOops a good deal fcrwatdy 
presses in the abdominal muscles whb his hands, in ordet to fa* 
cilitate its expulsions He feels at times a pein in his gvcrin^ ei^ 
peciaHy in oold or damp weather, and complains of muck debi- 
lity abottt the Inmbar rsgion^ His bbdder is not initaUIe, for 
he ^im contain his i^tine rdnost for any length of time. Ifi.s 
urine. Upon standings depoiito a thick sedment of a lateritkid* 
colottt', bus there is tio i^^pearaqoe of piis in it. He has bepone 
ralher cocpuUnt, prohably owing to his not being able to take 
hia usual etereiae. 

Hawh^ Ut Vaomber 1816. 



-r?1f- 



VI. 

History of a Case (f Dislocation qflhe Loner Jam i "with Jte^ 
maris on the Sentence of a Court^Martial held to inves^at^ 
the nature of th§ (pauses th^t produced it. % Jp»N FoMPb 
Esq. Snri^QBi^ Bcf at Navy. 

IN die BMOtk of Jhmiary Ulfl, OaptaJD J» T. of Us H^eii^ 
aloop ML Has tried by a Court-Martisi at Bsrbedeei^ dft 
of Croats a^i^e ^ ^ m Bsri o |^ prafcn^ ^ffim Mp by Sir 



$16 UrF^r\m'tC4ueo/ Jiffjl 

Fhilqi DariMiin, Commander in Chief on ike Leewofd Idand tte-^ 
tioiL The first charge stated, that ** Thomas Pajne, belonging 
to his Mqesty's sloop M. had suffeied a diabcation of the jaw^ 
from the severe puoishment of gaggiogy inflicted on hkn on^ 
boaidy by direction of J. T. Esq; the commander of the said- 
sloop, on or about the SSd of last May (18U.)'' The ezisienw 
of a conqplete dislocation having been proved by the testimony €»f 
two medical men, the court proceeded to investigate the drcnm^ 
stanoea connected with its occurrence i and> from the evidence 
adduced on both sides^ the following seem to haiw been as well ' 
established as the law requires* ' 

1. Hie great degice of intoxication under wfaidi* Payne la* 
boured on the night of the iSd May, pretrioosly to his bmog 



2* The gagging by the captain's order ( who morsover ga^^ 
it was stated, particuhir directions that care should betaken 
that the pg were small, and that no iafiiry might happen to 
the man from the operation. 

S. The pieces of wood with wUch Payne was anGeeaavdy 
nncd were of fir, about six or seven incbBsbng, and of the 
w^aness of the finger or thumb. 

4. The mildneu with whidi.ihe operation was p^foravd. 

5. Pavne bit through one or moee pieces of wood soeoeistve- 
Iv introduced. One witness stated, tfaat, when he had faltteB 
tnnmgh the third piece, he appeared to have hurt hknself in so 
doing, as be cried out, <* I am jaw*hicked ! I am jaw-iodced 1^ 
Another evidence testified to the fact of his having oomfdamed 
of his jaw being hurt upon biting through one of the pieces of 
wood. It did not appear that any other piece, of wood or #l3ier 
substance was introduced after the destruction of this thtrd 
piece. One man stated that he was ordered «* to get the pumf* 
Imkf and- gag him with that," but that, while he was looking for 
it, Payne was otherwise disposed of. 

6. The statement ci the opinion of several witnesses who had 
assisted at or seen the gigging, that the dislocation was caased 
by the act of bitioff the ^ig-stick thromh, and would not hstve 
occorred without this act on the part orPayne. 

7. One witness, in reply to a question of the court, gave it 
as his opikiion that the ga^-stick was not deep in the nunUAf else 
Payne would not have had power to bite it through* 

8. The surgeon of the sloqp's testimony to the existence of « 
complete dislocation immediately after the gagging. 

d. The surgeon's testimoi^ to the feUowwg fiids :^11i0 iw- 
duQkion by him of die disk>canon on the.nigh^f ita oceomnce ; 
«-l^a opinion of .the jaw be}ng then ifBimci«8;cfibcCife «s bo- 



M17. DistoeaH^m of the Ltnoer Java. dl7 

fefethe injaiy i^— hi^ hieiviDg discovered next day, or the day af- 
ter, that tbe jaw was again in a state of dislocation, from what 
cause hecotdd not distinqtly sav ; — ^his repeated and ineffectual 
sobaequent attempts Co reduce the dislocation, 

• 10. The fact of Payne's jaw having been oui twice before this 
limei asd of his having replaced it himself, stated by the man 
himself in the following words :— ^* Coon. How often has your 
jaw been dislocated before the present circumstance ?** — Ans. 
*f Once on board' the Amfdrion frigate; it eatched the second 
tun« while. I was opening my mouth, and went in again withoat 
any assistance, on board the Belleisle.*' '* 

11. The greater fiicility of dislocating a jaw that had pre- 
loonslybeen dislocated, testified by two medical men. 
. These, I think, are the whole of the circumstances connected 
with tbe production of the injury of Payne's jaw, as well as the 
c^mons respecting its nature and cause, which were ddlv^red ' 
in the evidence before the court. On these, of course, the de* 
CBstan was grounded. It was in the following words : — ** The 
oourt is of opinion, that the di^cation of Thomas Payne's jaw 
was ooeasioned by Iris own violence iti biting the piece of wood 
through, and by a facility which he had of putting his jaw out 
and iU' himself, and not from the severe punishment of gagging.** 
The* other diarge not having been proved, the prisoner was ao- 
oocdingiy <^ roost folly acquitted." Shortly aftier the trial, the 
unfortunate Thomas Payne returned to Eneland in the Mos. 
quito, and Lam entirely un«icquainted with his subsequent his* 
tory and fortunes. 

Before ^proceeding to state some remarks which I propose to 
oSSet oU the^caases aliped by the Court to have prcduoed the 
dislocation 'of Payne's jaw, tt may be interesting to eive some 
acGoaotcif the condition to which his injury had reduced this 
unfortunate man, and also of the mode of punishment of which 
it was a cdnsequende. 

The long existence of this dislocation, in the present instance, 
waa not nkessavy to prove the iaisity of the strange assertion of 
Hippocrates respecting the fatality of an unreduced lower jaw. 
It IB not, however,. too much to affirm, that th^ continuance of 
this derangement will, in all probability, shorten the life of the 
sufferer. To be convinced how certainly it must ever render 
him an object of oonmiiseration, it is scarcely necessary to 
peruse the foUowing detail. 

The dislocation, at the time of the trial^ that is, about eight 
tnoBths after te oceurrenc^i was compfete; the coronoid pro- 
flesiei of the lower jaw could be distinctly ftlt fiUbg the natural 
ly hollow fdaee in the ehetk below thd xygomattc arch, while 



sift Mr Fbrb^'k Ca$» ^ SiAsf 

the i^Mence of tb« neck pf tbe bone before thb ear was my pnw 
oqplijpl^ Tlie lower jaw was projected to % considerable cHrtiinoe 
befop find bebw the u^er | aodi owjng to tbe pbaitioii 6f die 
oonayles under the arch of th^ c)ie^k, i|o part of it coifM fte 
npifide to touch tbe upper, e^qa&g^ |be baicluilost gritideali. To 
dS^ tills, eTen coiisid^r^blf prefUlMfe waa necessaiy •• the 
tlipder jaw. Of course, the paver of masticatiQa tras lotid|y 
lostf uokssip indeed, we eftU by this naole the power Which waa 
aiill jpermitted, fojr the very sMght giA|^yf|)oua motioB reaiainilil^, 
4w>r Wuising any soft body between the poalerior mdares. The 
band was reduced to the nec^wcv of pefformii^ this Ticsrioos 
oQpe ; andi ever since the production of the injury, the first 
and lon^t part of this poor miai's ip^UUlne hat been occupied 
ifi flupcpg and bruising bis foodt with his kinfe tad fioaers, 
[deviously to his swallowing it. Not to mention the kss of the 
aniaoia) gratification received during the process of masticathHiy 
tbwe rs no doubt but the digestive powers aiost sofier fimm 
the absence of the proper and niKtural quantity of siiiva, as well 
aa from the iipperfect comiiHniition of tbe fqad neceaurfiy ve- 
aiiktng from the want of this process. Accbrdli^y, it was re- 
iiuurked by the surgeon of the origi that this man had become 
much thinner since the dislocations and that he had grown 
Kulject to deran^ments of the intestinal canal ; — events which 
may with much probability be attributed lo ti^e uonatuvnl man- 
ner in which he is nourished. * 

The distortion and disfigurement of ooODlenande prodooed 
by this injury are very great, disgusting, and humiluting. The 
consUM>t^y op^ mouth, and dribbling of saliva Iran tiie de- 
pending jaw, convey the impression ol idiotism; and tbia im» 
pressioi^ is perhaps heightened by the unnatural length of viaaM 
and prqjecting chin, consequent on the iD^id poathm of the 
l(fw^j^w-bone. 

Thomas Payne niay be said to have Iqat articalate speech \ 
Ibr^ althowh be ceruinly can qp^> and mudi better even 
than couldlnave been expected a jirsbr^*-]^ett irikcn the relative 
position of the jaws and lips is qonsidered^ it will rectdsit^ ^ 
understood how iwry iro|ierfect his iirtwiU^pn moat be. His 
^efh are all encrusted wu^ tartar and sofrdfa for went of uaey-— 
Uke tbe stones of an unfrequented street balfUd in ilhpkiced 
f^getatiop« He coB^)l^ins of a GQiis(wt though di|^t paui m 



^ Simjkr tff(Kt8, 1 %d, wwo Q^Mryj^ \m IV^/lfMr TlmntoB, id csHa of 
uyury of the K^ivary> orgau ^m woMod, See his. Qbservsti^os «a tl» IMgisn 

Haipltib. 



1817. DidMOkmcfikeJM^Jtsm. Sj^ 

tbe pJaoB of the cradyieB; and this pain becomei severe when 
the jaw 18 attempted to be forcibly closed; or tbe bone moTed 
from its mmatural position. He particiilarly complaiin of the 
great sense rf uneasiness be experiences from the dryness and 
coUness of the mouth, evidently arising from the constant eva> 
poration of the fluids from that cavity, thus unnaturally and 
Goostantly subjected to the action of the external air. These 
uneasy fillings appear to be pecufiarJy severe during the nmht, 
and frequently prevent sleep, * ^ 

After this detail, it is unnecessafy to mention how many of 
the situations of life, be might otherwise be fit for, this man is 
rendered by this injury incapable of filling. 

The cqieration, tbitiug the performance of which at least, 
Payne's jaw was dislocated, and which, however it may be 
sanctioned by the " sterner customs of the olden time,'' » na# 
very rarely had recourse to in the modem discipline of our 
navy— Gflrgpnigr, I have seen performed in die following man* 
ner. A piece of wood or iron, f vwions in diameter ancflength, • 
is iotrodttced into the mottth,..exactly in the way tke bit h 
introduced into the mouth of a horse,— so that a portmi of 
it shaM project from each side. It it retained in this position 
by means of « cord passed over the projectii^ extremities, and 
behind the head. As this operation k never had recourse to^ 
but in cases where the culprit is not merely clamorous, but 
capable of uttering articulate ^eecfa, (for a gagged man caii 
make a noise,) — ^to ensure the object of ite employment, it 
is obvioua that the instrument, particularly if of smaD diame- 
ter> must be forced deep in the angle of the mouth ; fu any 
p^ven- may easily ascertaiut by experbnent on himself, that, if 
not de^ in tbe mouth, it will still leave the power of articuhi^ 
don. JiB the operation is one also which is seldom proposed, 
but when gentler means have failed to procure a cessation of 
ootrageoas conduct, it wi)l naturatty be concluded, that it is on^ 
which is ^ever voluntarily submitted to. Against the druzdk 
man's effi>rt8, accordingly, to keep his mouth uiut, considerable 



* This was the case in the warm elSnate of the West Ridies. It would be 
intei:estiag ta kaow the copditioQ of these dicuaiitaiices ia thie ooandy,-— the 
degree of approximation in the results, to wit, in the one case, of the action of 
awarmairaadcooMiiaentqokkevapficatiaB^ aad, ia the other, of a cold air, 
and conte^ent proportionally slow evaporation. 

f ^ A witness on the present trial stated, that he had anudly seen ** the pump- 
bolt," the iron bolt on which the handle of the ship's pump wprkii— *' bayonet 
and dxumstic V used &>r this purpose. 



8S0 Mr. Forbes's Case of . : Jolj 

force miut generally be eiii|]iuyed befere the baslnett can be 
- properly accompiujied. 

Id iiilly acquiuing Captain T. of all criminality in the case 
of this man, the couit doabtleBsIy proceeded upon the following 
' grounds : 

1. By the articles of war^ Payne merited puniafameiit. 
. 2. By. the same articles a discretionary power is left with 
captains to punish criminals ** according to the customs in saoh 
cases used at sea." 

S. Gagging is <' a custom in such cases used atsea.'f * 

4. Therefore, in directing this punishment, no criminality 
can attach to Captain T* 

And it it be a^^^^rted, that the law which sanctions die gagging, 
isanctiops this simply, and condemns as criminal any perma* 
nent injury inflicted on the culprit, by or throng this inode of 
punishment, the court, in acquitting Captain T. of crimina- 
lity in the perjorman^ of this punishment, (whidi at first sight 
.seems certainly to attach inevitably. to him,) in all probability 
conceived themselves fully borne out by the following coo«dera- 
tions: 

1. The precautions to lie observed in performing the opera- 
tion, directed by Captain T., prove that he bad no intention oi 
permanently injuring the man. 

2. l^he punishment was performed (according to the evidence 
adduced) with these precautions, and with more than usual 
mildness. 

5. But thus performed, or even more rudely, this puni^ment 
is not, and has not been, found to cause dislocation of the jaw. 

4. Therefore dislocation, in tlie prcM^ot case, must be attri- 
buted to some circumstance or circunrances foreign toy. or at 
least not necessarily arising from, the operation \ and, conse- 
quently, cannot be considered as ao event for which the person 
directing or performing the operation ought to be made respon- 
sible 

, The legitimacy of this deduction I do not intend to caD-in 
question: nor, when I consider the letter of the law whicli 

Sttided the proceedings of the judges ; the nature 'of the evi- 
ence brought before them; and, faoaliy, the undoubted pre- 
disposition or tendency to the dislocation wUcb exi^^d in 



* V^ h2^'e already obierred, (hat this cwtom is now hapjiHy one of Uiose 
moch more £reqsent]y honoured in the breach ihaa the observance. Yet it is 
one» — and, unfortunately, there are still among us some few whose iotersst at 
least, — if not whose pleasure it is— to be able, from the oblivioa of aatlent 
piactice, « revocare leges amaras/' 



1817. DidoeatioB o/iie Lower Jaw. . Ml 

Pifne {--^do I Bee bow tbej coaU have done otherwise than 
pronounce the acquittal of Captain T. Of the justice of 
Cbetr sentence^ therefore, as far as regards the acquittal of 
tlM» prisoBer» (admitting the traUi of the evidence brought 
before them) I can entertain no doubt. And if they had sim- 
pfy pronounced this acquittal on the grounds above stated, I 
i^idd have then had as little cause, as I have now inclination, 
to animadvert on their decision. But m acquitting Captain T. 
th^ have condemned Thomas Payne. B^their decibi<m they have 
not only deprived him of all daim ot reparation against the 
person who waa certainly the indirect cause of his misfortune, but 
they have done what they could to deprive him of that repara- 
tion which I conceive to be certainly due from a just govern- 
ment to the innocent victim of its imperfect laws. ^ The causes 
of the dislocation assigned 1^ the court, necessarily resolve 
themselves into the m^ortefir or crime of the suflferer; and if 
these causes are true ones, and truly stated,-^thofightless of re- 
dress or reparatioBf aM that. we can fael in contemplating die 
madefies to which he is condemned, is sorrow for the inflictions 
of nature^ or pity for the too dreadful consequences of erring 
passion* In the following pages we prop<»se examining whether 
or not.tbese causes are the true ones, and if these be the only 
legitimate feelings which the contemphtion of his miseries ex- 
<:ite8. 

. In fhe^rUphcCf it is stated in the sentence of di0 court, that 
Thomas Payne ** had a facility of putting hb jaw out and in 
himself;'' in other words, ^* that bepoasessed the power of 
di&localin^ and replacing hia lower jaw, at will, with facility, 
a^d. unassisted by any otSer person." This statement of an al- 
leged facft most of course be admitted as correct, provided suf* 
fieient evidence of its truth can be adduced $ but some part of it 
is. so rept^g^MAt to physiokwical science and silrgicsl esqciericnce, 
thatucwing short of soen evidence will obtain for it the cre- 
dence of a medical man. I particularly allude to the alleged 
powerirf' reduction of a dislocated jaw by the patient himself. 
In our remarks on this point we shall inquire. Firsts into the 
possibility or probability of a man possessing the power of 
reducing his own jaw f and, srooitcUy, admitting its possibility, 
lyhether the court was justified^ from the evid^ice. brought be- 



* Here I b^ not to be misandentood aa iiuimiatina tlie exiitCDce of any 
intmtimial mjarf on the part of the court toivardt Payne, I have the most 
.{jerfectjconTiction of the contrarv ; and if it should appearj £nom any oboerva^ 
tjODs tee made, that they really did unjustly injure this man,— Hhere can be 
ao doubt that they acted from imperfect knowledge, and not malice. ^ 



VrFdAtAOne^ J^ 



t0g9 iC» hi ililwig ikk pMrer to Ww bem j^ot i icil tbjr ' 

jpm mi^ weouuiot doiibt ; m we kaaw tluit almost ail tl» cw^ 
ponal iHjorifiB, ^hi^ are ordinmriijr lite ODoannetioe df aMi^ 
dental OGGunreiioei^ iDfty* in reali^^ be incboetf bjr jmmm febi 
lesfiionalljr ptooaml bjr the palienc himsolf: end^ imieed^ «ie 
kiow that this fiuality at actually poMeaMd bjT thoie anfartluuM 
peefUle wboee jaflu» fiNmi oiiginid peculiarity et slraetiiie^ pf^ 
laouederaogemeialiyDr other causes^ are liable ti^ tie dipleiattd 
by ya«nng» hiiig^g» Ice. ; aa it k ebvioos, that tuck pe«« 
•en* jBay toluataiil^ induce those ilates wbich eauie ibe die^ 
plaoeBMOft. But. thai after the dislooBtida haa takelk pkoe^ ^ 
aay person (the anaacsiea of whose jtm are not entie^fy polAretu 
ksa) should possess the power, alutb Ibss the •^tnnSiSl^ eT re^ 
lAniioff the boae to iti ptapar plaee^ appears la me mn 4mly 
inorediUe, but absohitely ia|Kissible. And in theease efaeab^ 
k6t» such aa Vwffie^ in whom the lenstles are mc paiftl^tic^ and 
in whom the dii|>laecmeat is perieot» I baine liMle doulbt but 
ihati m due opinioBt I will be jekied by cfvety ^urgeeiH ^^ 
CDoaiders the natural and moriiid aDUtoiny of the perls oeSMmi* 
ed in the di s l oeaibn» ' th e position of tlie eondyJes, io IhHiMe 
of disptaceBsent, up under tbe ^f^oaaatie aroh,»-«tfae atttiett m^ 
orted on the diRMaced bone bv the temporal, niasseter, tfad 
intemal pteiypfosd mnsclcs ; and who recolleeia tbe tfibett he 
hea had oocaaion to make, or haa seen otheM ttakJb^ ita Cb* tf e^ 
duction of this veiy bcme. 

Sd, Respecthig the proofr on wfaicii the edum veniMed to 
assert a oircunatanee as a £set» |diidh| after tbe #bsef«iatioiM 
hni made^ 1 cannot hdp eonsideriM as so exteetaelf iniipMbia<^ 
b]e^-**^roraU that is material of these, ifeiir t# Ate flhofS eticknee 
of Bsyne» as stated at the coasmeaeement of this papsr.f Ibia 
brief* and ttnokcnmitanthd aoeonat^ oontaina all fbe ittlbmiatiofi 
iMpecting the previous derangeaient of tUa mon^s Ja#$ wbkih 
was kid before the ooort. Severe) witaesse^y indeed^ Ad 
aa^ong others the snrgeasa of tbe slqop, hi rq;>ly to quetfrtoAe 
^ the oourtp stated the previous and uoassiated reduction o( cb^ 
ym I but they aU stated the eireuiBstance a» bridly a*d itt'^ 
determinately aa he did; tbey all beeamo aequuinted wM k 



* lyiJw^Maftesf dw towjtirf 1 aiesn, thtfeiighdtit M% fMrper, wtiabif 
aittfld by anat airgsmm a compbtg Mti$emknt nich as exibted in tlie case of 
Ps^na at die time «f tbe wul ; and tkia'b (be meamog tindoubtedly tmdcr- 
jii«od by tba eouct in iti seaieace* 

t Sec p. di7^ 



MIT. DidocdtiM 4f (Ae LMer Jm. SB: 

thfod^ hb duMi ind naortiwrliigri ccnnaiiiBadMt neM^ 
No questions were put by any of the Hlsmben of the court, to 
him or then]» respecting the reseiddanoe of tboBe former die* 
looations to the present ; nor respeeting die neaM he bad used 
to restore the bone to its proper places To men unacqoaintsd 
with physical science^ it was, perhaps, perfeetiy natund Aat* 
this ^evidence, however defecdve in quantity or kind, sImniM* 
appear perfectly conclusive, and demonstradve of the iwtiC^ 
particularly coming, as it did, from the sufferer himself, wlsr 
might naturally be supposed to be interested in the «oppresBiosi> 
of a circumstance,' which, more than any thing, tended to acquit' 
the prisoner. Accordingly no further explanadon was demand- 
od m the man, no medical opinion respecting the probability of 
the aU^ed fact was sou^t ;t-«it was nsceived, believed, and haa 
been promulgated as true. 

And yet, that Payne's jaw had prdviooelt been dfalocatsd^^i 
(in the sense in which the court understood this wovd,) w^ at 
leUst, that, having been dislocated, he had himself rq!>laGed it^ 
X think is not only not proved, bot absolutely false. And thw 
will be the more easily admitted^ from the circumstance I pro^ 
eeed to notice. 

When this man first presented himself before me on board 
the flag^ship, and requested my interference to proeure his dis« 
chaige from the service (the ciroumstaace which gav« rise tft 
the coutt-raartial), he stated to toe also, on inqoirv, Siat his jaw 
had been out before, and that he had put it in himsdf. S«r# 
prised at this, I asked him in what mamier he had put his jasir 
in, and was informed that it was by pressing the chin fercib^ 
upwards with his hand placed under :<*-at the same time he inu* 
Sated the adtion^ Well knowing that this manoeuvre could 
never reduce such a dislocatkNi as he then laboured under, I 
ipquired as to the nature of the iermer derangements, and was 
intonned, that, when his jaw had formerly been xw/, he was 
ai^re of it merely from the circumstance of his mouth remaining 
wide open, and of his being unable to shut it widiout the akl of 
the hand placed under the lower jaw and pressing upwards. By 
this statement, of which we can have no reason to doubt tbe trut^ 
as it is in itselifextremdy probable^ and does not in the least con- 
tradict that made before the court, we are at once made acquaint* 
ed with the real nature of the accident from which Payne's jaw 
had twice suffisred, previously to the present dislocation i and 
nil the apparent absurdity and centradicthm, in his evidence re* 
hrtive to these accidents, explained and removed. From origi- 
nal and unusual laxity of tbe liffaments of the joints, peculiantj 
of bony structure, or some ower causCf it is obvious that the 



924 . lArioAeA'BCasecf JUf 

condyles, in these inatonocs of supposed dislooilient bad been 
CBiTied out of the depth of the fossa upon the upper and an- 
terior edge of the surrounding promineooet but no furtlier. In 
this position of the condyles, and consequent direction of the 
Bedc and ramus of the bone, the lever, by which the temporal 
nasseter, and internal pterygoid muscles act in moving the jaw 
on the axis of its condyles, was almost destroyed ; it was so £u* 
destroyed, that tlie muscles could not overcome that additional 
venatance to the return of the condyles to their place, aflbrded 
Vy the edge of the prominence on which they rested. By the 
depression of the bone, ft few minutes of adegvee more, this lever 
would, most probablv, have been entirely lost, and the oontraction 
of the muscles would have forced, with a jerk, the eondyks from 
Uieir resting piaoe, and thus, drawing. them up under the aygi»» 
inatic arch, nave produced a real dislocation, such as took place 
during the operation of the 2Sd <^ May, such as still exists 
in the person of Thomas Payne.* 

From the above detail we are entitled, to conclude, that the 
court, in stating in their sentence that Thomas Payne possessed 
«* a facility of putting his jaw out and in himself"' are neither 
supported by reasoning nor by fact : On the contrary, I think 
it is now sufficiently evident, that, in troth, hisjaw had never 
been dislocated, previously to the 23d May. Inat previously 
to this time, that man's jaw was unusually weak, and conse- 
quently that it could be dislocated with more AtcUity than the 
jaws of most other men, I think cannot be doubted ; and had 
the court taken the precaution to investigate the nature of these 
previous derangements, and been contented with deducinir from 
these a predisposition or fatMii^ to dijlocatiomp they woulS have 
had, as already observed, an equal justification for their sentenee 
of acquittal, and would have moreover avoided the very-sef^imis 
error, into which I conceive they have fallen, of throwing, what 
I fear will be found to bc« an onsurmountable impediment in 
the way of this poor .man's obtaining some reparation for his 
grievous, and certainly most unmerited mis&rtune. 

The notice of this apprehended incorrectness in the senienoe 
pf the court, may be useful in another point of view« In the 
first place, it forcibly points out the errors that judges laiist be 



* That this latter injuiT'—coinpletf ditl<icatioa*«WBa >t1tt one wtiA the 
tnemben of the court believed to have happeaed to thii man oa {pmer oc* 
cafionsy I have the most perfect •assurance. And indeed, acttine a^ide pnhtr, 
ineans of infdrmatioQ on thii point, It ts' evident from the ^ole teoor of 
Aeir proceedings, thai they aever emeittiaed any doabt on the aol^t. 



1 sit. Dhtoadkn of Hit Ltrs^'Jam* S2i 

ever liable t6 commit, in forming decisions, froni their own 
judgment ahme, on matters connected with, or depending o% 
circumstances purdy medical $ and thus it points out the ne- 
cessity and importftDoe of medicnl jurisprudence. I think it 
will scaroelv be doubted that, had any medical man t)een con* 
suk^ on the cifeumstance in question, such an assertion could 
nefvr have iqppeared in the sentence of the court. In the second 
plaee, it may be usefol to notice it, with the view of preventing 
it being hereafter quoted as a fact or precedent, either in law or 
medicine, wbicb, as being contained in orje of the gravest, and 
most trust-worthy of puUic documents, it is very liable to be. 
And' its notice on the present occasion becomes the more 
imperious, as I know it was whispered about, although not 
directly suited in court, that Thomas Payne could, even at the 
period of Captain T.'s trial, replace his jaw if he pleased ; and 
that be kept it out merely from the desii-e of revenge or interest^ 
thereby hoping either to injure his Captain, or procure his own 
disdiarge from the service, or both. I am far from thinking 
that 'Such a false insinuation, although it must be allowed that 
some colour for a suspicion of collusion on the part of Payne 
waa affi>rded by the evidence of the surgeon of the brig, either 
did or cosid influence the court on the present occasion { yet it 
cannot be denied that the entertainment of the possibility of 
such a thing, as this *< facility of putting a jaw out and in" at 
pleasure, might, on other similar occasions, materially affect the 
justiee of judicial proceedings. And this circumstance is more 
likdytooccur in the Navy, tnan in other situations. For there, 
oflKoers are so much accustomed to see diseases and corporeal 
injuries feigned or formed, with the view of producing discharge 
from the servioeb that suspicion and scepticism as to the reality 
and Jegilimacy of morbid affections prevail to a degree elsewhere 
little known, and ^hich» on occasions like U^e present, might 
operate wkh most unfortunate effect. 

Inihe sectmdpiace^ H is stated in the sentence of the court, 
'* that the dislocation of Thomas Pajme^s jaw was occasioned by 
his own violence in biting the piece of wood through." Befi>re 
entering upon the examination of the truth of this alleged cause 
of the H^iry sostamed by Payne, it wiU be necessary to say a 
few words on the physiology or this species of dislocation in ge« 
neral. And I venture upon this with doubt and hesitation, 
weU remembering how long I have ceased to be familiar with 
such inquiries, and consequently how very liable I must be lo 
error, even in this not very difficult matter. I fisd, however, 
pretty wdl assured, that, however imperfectly or unscientifically 
stated, the principles upon which J proceed are just and true. 



SSft Mr Foibtt't Case ^ My 

litf la the ordinaiy depreBtioM of tbe lowor jaw, as in die 
volantarv act of opening tiie month, wbilt the fore paft of die 
bone is oapressed, the condyiet are moved forward and d oum w a rd 
fixmi the aepth of the fena towards or upon ito edge, formed fay 
the root of theagrgomatic prooesB j and this motion it pei ferm ed 
by the conjoint forces deriTed from the dtreet contraction of the 
CKtemal pterygoid and other depressing mascles, gfikled or mo* 
derated by ttie sluggish relaxation ofthe aiasseter, temporal^ 
and internal pteryi^. The forther progrfsd of the condylea 
forward, or from tne^ articulating cavity, is here stopped by the 
cq)salar ligament ; and, in moderate depressions of tHiejBmi these 
lemain rather on the wall than on the brim of the fosia, imtil 
the contraction of the elevating nmscles again foroes them iftto 
its depth. In this action of elevating the jaw, in other words^ 
of shutting the mouth, the muscles exert their pewer by meana 
of the lever afforded by that part of the bone wMeb Is pos- 
teiior to the msertion of their fibres. In these cases the line 
in whidi the muscles act, of course, always forms an ati^ of 
a certain estent with the line of the lever ; and the grteter the 
angle formed by these two, it is obvious the moffe power wiN the 
elevating muscles possess, both in moving the jaw upwards on 
the axis of its condyles, and in pressing these down Into the 
depth of their articulating cavity. When the bone is very maeh 
depressed, as in the case of yawning of laughing, the condyles 
advance still further forward upon the anterior edge of die wall 
of the fossa $ not so far, however, but that, in well formed joints^ 
the combined powers of the resistance of the capsule and con* 
traotipn ofthe muscles, are sufficient to restore them to their 
ptaoa In these cases there stiU exists an angle of some eottent 
formed by the elevating power and the lei^er acted on. And it 
is only when this angle is entirely or nearly destroved, when the 
line (k muscular traction becomes almost pamllel wkh that of 
the ramus and neck of the bone, that the muscles by contract^ 
ing, instead of moving the lower jaw upon the axis of its con- 
dyles, draw the neck of the bone upwards under the zygotnatlc 
aroh, in the directiiHi ofthe line in which they dMmselves con^ 
tracts 

Vfom this it is obvious, that nothing is wanting in any ease 
to produce dislocation but the depression ofthe jaw so ftr as to 
render the neck of the l)one psrdlel, or nearly pan^l, with 
the fibres ofthe elevating muscles. And, supposing the astis on 
whi^ the ec^dyles move were a fixed point, this degree of de- 
pression, it is evident, eonid always oe prodttced wy a pfOper 
4agree of fintewUeh acted only on the Ibie fm of the ^vw» 



Mlt Didofi^im ofih$ JUmer Jaw: 82? 

Qui m ^ otedflei fupetfceaifldvts omaMUcy mnil* eratcqa^t^ 
th^aiji 00 wlitflh the fapu moviBSy it fbUcmB that^ ta ideotifying 
Um^ Uw of QMMOiikur trttdion wil die line of the kver, the mo* 
tioD fii the iOooAyim iiMrwand «iU be eqanralent to the raodon of 
die fm» piMrt of the jaw, downward and beckwaid,— and mote 
tfaoft eqokebwt* in as aucb na the dklance firpm the centre of 
moltoo i& kti io the fisraMr than in the iattcar oaae. Heoce^ la 
oaaet wheve th^ capaolar Ugamenl is uimsutUy lax, or the fossa 
mMNSfiaQy shaUov, a leaser degree of dG|>re5sion, or9 at leasl^ a 
leasee decree of depressing power^ wiil^ assimilate or fippMMd* 
male the lines of vhich we have been speaking, and thus mord 
nsadily eaiiae a didocation, tl|an in i^ses wherein these pecali«- 
ariti«» do not exist. 

After this exposition of d>e principles on which disloeadon 
of the jaw is prodnced, — if, indeed, the matta* has been render* 
ed dearer by the expbnatien attempted, whidi I myself am <l»- 
posed todonbt^— it is unnecessary to take any notice of the 
causes which usually produce it. It is evident that tbqr aH 
pvesupnoae or involve, as a condition necessary to ^ir qpera* 
tioBf tne defxuuaa oi the jaw to a certain extent Indeed 
(always excepting the fracture or destruction of the jaw) the 
oni^ poaaiUe case thait oponra to me in wMeh this bone oonld be 
didomleii open other principles, b that of a blow from some 
amaltpointed body, iallinfr upon or above the angle of the jaw^ 
in a direction from behind and downwards. A strong impulse 
in this/dieection might, when the mouth was not iridely open« 
fiMoe dmcoodyks from their place, #nd produce a true dirioca* 
tion«, This latter species of cause certainly was not appKed in 
the oaaax>fi Thomas Payne ; ther^fore^ if the foregoing principles 
are true, in him the dislocali<iD must have proceeded fnmi some 
of those causes that act by dcpressiog primarify the fere part of 
tfae-boBOi 

- We now preeaed to inquire hear &r die cause assigned by 
the court of this disk>cation,-^vi2. thBoUof biiing tie gagsiict 
MMwgi,^T-nceo|Mk witb this oondusion. 

S^rom th^ physiok^ef thedislocation of the lower jaw> noticed 
idmve, I think it is certain that the act o/Uttng^-^thBt is, the con- 
trtation of the.|en^K)0al masseter and internal pterygoid mnsclest 
•«-rcaii tend to the prodmtionof thistdisplacement &nly ihtn^ when^ 
by tfie depression of the b<me to a certain extenty the line of mus« 
eokr tn^tion has heipoMi^ciMhr appronnated to that of the lever 
iormedby thexamuaandneexofthebotie. When this approxi- 
naadon Uabaenpaodtwedi ud atiU more pirticularly wtei it b 
l»r4»irw;#b3(Ltheiht«rwstS0ii of a solid-body between tfad upper 



S28 lAt Fofhmfu CoMe tf Jul^ 

and lower jawi» and antmor to tlie imertion'or Ike diftMn,' 
I think there can be no doubt that the contmctkm of the 
mufcles, in other words, ike ad of Mw^i will tend powerfoUy 
to the dislocation of the bone. Bat it is obvious, from the ana- 
tomy of the parts, that the degree of deprassion neoeseaiy to 
produce this degree of approximation must - be rmy condder- 
able, even in .cases where there is an unusual proclivi^ to dis« 
placement; tbat.it, perhaps, can never be less (except in veiy 
peculiar instances) than that produced in the act of full and on<i^ 
constrained yawning. In individuals predisposed to this aeci- 
dent,— -ibat is, in whom it had previonsly occurred,— we find 
that it only takes place^hen the jaw is much depressed, as ha- 
laughing, yawning, &c; therefore, even admitdng, that, in 
cases ot this kind, the presence of a solid body in the mouth, 
and the act of Inting it, will have considerable efibet in ftdli- 
tating the dislocation, still it will be evident, I conceive, that the 
degree of depression at which the muscles employed in biting * 
can assist the dislocation, must, even in these cases, be very 
little less than that produced by the acts of yawning, lairing, 
or whatever the causes may be, which, of themselves, occasion 
the dislocation in question. 

We have already seen that the predisposition to this dtsplaee- 
ment in Thomas Payne, though certainly present, exisled, eom-* 
paratively speaking, in no very great degree i only twice in his 
lifetime (as far as we can leani) had he suffered a very partial 
deraogement of the parts in which it takes place ; of course^ 
neither yawning, laughing, nor any such causes, were able 
of themselves to produce it. In him, therefore, I should oon- 
ceive, that all the additional power of fiicilitating dislocationf 
which we have albwed to exist under certain circumstances in 
the ad of biting a hard body 9 would be insufficient ta efiect the 
dislocation, unless the jaw were retained by this body at a degree 
^ depression equal to that above mentimed^ as emsUng in the 
acts o/yawnfngf lanigUngj and suck like. 

If this reasoning be correct, how are we to explain the state- 
ments, of Captain T.'s witnesses, as detailed in the beginning of 
this paper, vis. that the pieces of wood introduced into PayneV 
mouth, the biting of which is reeorded in the sentence of the- 
court as being the cause of the didocatioa» were of the ^fiameter 
only of the finger or thumb i 

2dj Qut, even admitting that the biting ^a pieeeof wood of a 
less diau^eter th^ that we have above considered neeessary to 
efl^t the pfoper djBgree of depresskm, eouULfrodmoe Aedistocm^ 
ttan^ still we a^ of opinion that, the same sximhUk' bites tie 



isn. DidocaikmtfiieLmerAtm. 82d 

Wfoi ikra^gk could not dMoeate tha bone $ in other words, that 
thedidoGaCionooiild not take plioe darii^ the time in whid& 
the ^raod la in the act of being bitten through-— and on this acn 
count : Akeribe detaiis ahready given, it will be adoMtled tnat 
the greater the angle whidi the lower iaw forniB with the upper 
— in other words, the nx>re widely the mouth it opened,«>*the 
more readily will thq ooadlyles tUp from their articuiadon { and^ 
consequently, by so much as this angle is decreased, by as nuidt 
will the facility of Imcation.be dinnished. Boc, as the process 
0fbiiing titmgk any snbsUuice is peribrmed by the approxima* 
tioQof tbe*jaws» it foUowsthat the facility of luxation is render^ 
ed less eveqi instant of time th|t intervenes between that insUot 
in which the tenth of both jaws, by the contraction of the 
musdtai' are brought into contact with the superficies of the 
morsel to be bitten, and that instant in which they meet in its 
centre. Hence it should foBow, that, if, in the act of biting^ 
dialocation do take pfaice» it ought to tidce place when the act 
begins^ <that is^ when the jaw is at its greatest degree of deprea* 
sioQ^ and not. when it ceases or has been completed, that is» 
when the Jaw is^at ita least d^ree of depreasicm. And, if we 
admit that it takes place when the jaw is in 'the former position^ 
we must ako;admit thatt in this case, the piece of wood cannot 
at the same time be bitten through, because, at the very instant 
the condyles ere forced from their socket up under the zygo* 
matic mikf at that very instant the power of bkmg is lost^ On 
the iother hand, if we admit that dislocation take^ place when 
the jaw is in the latter position, we. must admit that disbcatioa 
can oecur wh^n the jaws are netfly, or altogether, in contact \ 
for, as has been already observedt the cessation of the act of 6f^« 
iVfgMres^ any. thing is equivakmt to the near approximation 
of the t^th of both jawsb iBot, how sliall we reconciie these 
concbasiona with the evidence adduced before the court in the 
case of Thomas. P^yne, which, if true^ proves that Ms jam 'was 
dislocated in the act of biting tkroiigk apiece of fir of the diame^ 
terof'ihe faiger or tkumh f They are evidently irreooocileable ; 
and, ceoasqoently, either that evidence or our conclusions must 
(be fabe^ AVUch of thesetwo shall be deemed so^ I leave to be 
decided by others. I canoot, however, forbear remarking, that 
it is somewjhat eiegular^ that^ of the many other circumstances 
necessarily attending the operation of gaagingi many of which 
are admiisably cah^&red to predooe the mslocation in question^ 
the onus should have fallen on one so ill calculated to bear it« 
It is^ moreprer, remarkable, that^ considering the resistance 
whieh the man opposed to the, intnadP^on of the gag» and at 
the same time considering the weakness of the jaw which he 
you xiu. NO* 51. T 



MO. Mr FoilMrft Cmi qfJXdoMim^ ^. Jifly 

reiAy po8MSMd»-^I say it is remarkabb that the foiok MoesMrily 
uaed in the performance of the operation did not piodnoe waok 
a depression of the jaw as to cause the dislocation. Bat» had it 
taken place at this time, it is obfions that he never oonld haTO 
bitten the gag^stick through. If, tbeoi we beiieve thai he did 
Ute this through, and if we admit the truth of the leaaoning 
^▼en alsovc, we roust conclude that the jaw was dislocated at 
some period after the demolition of the piece or pieces of wood. 
A question here naturally occurs,— After the dntnictbn of the 
last gaff of fir, was another of a different kind and siie introdn- 
ccd r This question was not pot to any of the witnesses, and, as 
has been already remarked, the, general tenor of the evidence 
inclines to the belief that no other was had recourse to. Yet 
the difficulty of otherwise accounting for the disloeatbn oblmdes 
vpoo the mind the probability of this. Was the iron pump* 
bolt> which one witness acknowledged he was sent for, really 
made use of after the wooden gags had been demoGshed } Did 
the operators, irritated by the man's obstinacy and vioknoe, use 
more force and less caution in the introduction of the last gag* 
and thus depreis the bone to the angle of luxation ? Or, was 
the instrument itself of a sufficient diameter to produce this ^en 
aided by the undiminished violence of the man in biting it ? 

Before concluding, I may remark, in regard to the seoond 
dislocation of Payne's jaw, that there is oonsiderable difficulty 
in fixing on a probable cause for its occorrenee. The snrmon's 
evidence informs us, that, after having rednced the bone, he ap- 
plied proper bandages to retain it in its place. These bandages 
remained on. How, then, could the jaw amn get disk)cated9 
as these must have kqpt the mouth shut ? Did Payne secretly 
remove the bandage, voluntarily dislocate his jawj and th<aa re- 
apply the bandage ? Some part of the surgeon's evidence cer* 
tainly affitrds grounds for entertaining a suspicion of this kind \ 
yet, from the whole history of this man after the iqory, and for 
many reasons wbidi it is quite unnecessary here to state, I feel 
perfectly assured of Payne's innocence in this partioihur. Had 
there been no medical evidence delivered on tois case, or had 
ihe surgeon of the bri^ not positively stated the reduction to 
have b^n effected by himself, the probability of the bone nettr 
having been replaced, is that which certaudy would have pr»» 
tailed in the opink>ns of medical men:— .but nrach of the eve* 
,denee delivered on this trial stron^y sumsta the ancient adage 
-.^" Le vrai n'esipas tcujoun k vrmtsefMMeJ* 

His M4^nbfs Ship Venerable^ 

Leemrd Island SiaHon^ 

l9t Marek 1815. 



ISir. Hr1^nu»<mYil^m-Fner. SSI 



VII. 

Extract of a Letter from Mr George Birkie, Assisiant'Sur- 

. gean of his Mqfesty*s Ship Antelope, dated St Christopher*Sf 

^ti January 1817, coniaining Observatian$ on Yellow-Fever^ 

io James Robikbon Scorr, F. R. S. Surgeon^ Rpjfol Nmgff 

I NOW set mjself down to give you a brief statement of the ob- 
servations which I have made respecting the fever of the 
West Indies. We have suffered severely by it ) and I have to 
lament the loss of two of my dearest friends, who fell early vic- 
tims to its indiscHminating malignancy. My opinions concern- 
ing its origin, nature, and cure, differ in some degree from those 
ot all the other medical men on the station ; 1 am, therefore^ 
induced to lay before you the result of my experience, for th^ 
benefit of your friendly inspection, and shall expect your obser^ 
vations thereon with the greatest anxiety. 

Like every other non- tangible subject of importance, the fe« 
vers of the West Indies have engendered a vast variety of opi- 
nions. The utility and beauty of classification have given way 
to the rage of discovery ; and every one comes forward with his 
little bit of a hypothesis to set the world to rights, and daim the 
rewards of genius. Had 1 not matter of greater moment to 
communicate, I could give you great amusement by the recital 
of many an absurd explanation of the nature and causes of yel- 
low-fever. I shall here attempt to disprove all the sreat posi- 
tions of Mr Pym. His own words, the authorities he quotesp 
and the result of my own experience, have led me to a very di& 
ferent conclusion from that which he has adopted ; but, as I am 
a young man, and a very young practitioner, as my oppol*tuni- 
ties for observation have been few, and perhaps my attention 
ilifi;ht or ill directed, it would ill become me to he dogmatical. 
I shall, however, with a faithful, though feeble, hand trace what 
I have tee9i of these diseases, endeavour to prove their indivi- 
duality, and that they are generated in the West Indies, without 
a possibility of supposing their origin or increase to have been 
at afl connected with contagion. 

Mr lyn is the first, as far as I knew, who has attempted toi 
|nrove that the fevers of the Wiest Indies di&r with ri^rd to 
diefr nature and origin. He divideir them int6 three Idnds, the 



598 Mr Birnie on Yelkm*Ha>er. . July 

continaed bilious, die remittent bilious, and the Bulam or yel« 
low fever. His diagnostics are, that, in the first, as the disease 
advances, the skin becomes of a verjf deep yeUctm colour g in the 
second, of a deep yelkm : and in the third, of a pale orange co^ 
fottr, with the addition of a peculiar drunken appearance of the 
eyes. He says, that, in the first, there is never the black vo- 
mit ; in the second, seldom, if ever ; and in the third, always. 
The mere statement of these definitions demonstrate indubitably 
that the diseasev in question are but ffrades of the same aflbc- 
tion. Here the black vomit is the on^ characteristic ayittpli^m 
of Bulam fever (for the drunken appearance of the eyes takes 
place in fevers of every different type \) and he even allows the 
bkck vomit to appear sometimes in the remittent, thoifgh he 
denies it ever to take place in the continued bilious. It is a 

Symptom universally looked on as the immediate precursor of 
eath, and cannot be called a diagnostic. This is a brief state* 
xnent of Mr Pym's doctrine ; and I shall now proceed to lay be- 
fore you as short and clear a view as 1 am able of the forms un- 
der which I have seen the endemics of this country, by which 
you will be enabled to judge of the argument and its utility for 
yourself. 

Immediately after our arrival in this country, about the be- 
ginning of March last, when the inhabitants of Bridgetown were 
perfectly healthy, and no cases of fever on shore, at least I am 
certain that no one belonging to the ship had been near, or in- 
deed had heard of any, sick person on shore, a fever, charac- 
terized by all the symptoms which Mr Pym has attributed to 
Bulam fever, made its appearance on board the Antelope ; and, 
since that period, 110 cases have occurred in her, of which 
thirty- one only haVe died ; of those thirty-one, nine either lived 
entirely in the fore and after-cockpits, or messed, and, conse- 
quently, passed the greater part of their time, there. None who 
had black vomit recovered ; and of the thirty-one, seven only 
had black vomit ; and of these seven, six were of the nine men- 
tioned above as living almost entirely beloWf where the atmo. 
sphere in this country is thick and heavy, and produces a pecu- 
liar hot sensation on descending from above into it. The lem- 
perature is always about the same, is often below what it is on 
deck, and, from the continual burning of candles, the crowding 
together of several people, the debris of pantries and mess-rooms, 
not always exceedingly clean, together with the want of circula- 
tion of air, may have caused so great a proportional number of 
those who were obliged to mess or live below to die, and have 
black vomit. If we compare the mortality amongst them to 
that of the rest of the ship's company, I conceive the observa- 



Wt UtmaaiaonYelbrtihI'eoer: SSS 

tim ^ni bt of iofinife Uaportance in a future stage of diis vtivea^ 
tigation. The patients at first universally complained of a pain 
eai;ten4in^ across the forehead, confined to a line above the eye- 
brows ; treqoently the eyes could not bear the light, and pain 
^as always produced by slichtly pressin^r on the eye balls ; the 
pulse was sometimes natural^ at others hill, quick, or interrupt- 
ed; the skin always hot, dry, and pungent; irritability of sto-^ 
Kfuifih came on on the first, second, or third days ; the matter 
rejected from the 3tomach was indigested food or drink, bilious 
matter, and in Heveral, towards the latter stage, that peculiar se- 
cretion called black vomit. We have lost fourteen officers and 
seventeen men by this disease, .and it possessed, in an eminent 
degree, all the synptams attributed to Bulam /ever, particuhtrly 
black voinit Its course was from two to ten days, but generally 
terminated jn from three to ibar. This is a concise account of 
the disease, as it appeared in the Antelope, and it was called 
j^ulamffner,. 

In August last a disease broke out on board the Childers 
brig, wbue anchored in the Gulf of Paria off Port Spain, Tri* 
pidad, where the squadron had gone to pass the hurricane 
months. As her surgeon and assistant were both attacked, I 
was sent to assist Mr Brown of the Scamander in taking care of 
the sick. At that time twenty-eight put of ninety men were la** 
bouring under a djseaset which made its appearance by the 
same circumscribed pain of the forehead, affection of the eyes« 
variable pnlse, hot, dry, pungent skin, and succeeding irritabi- 
Utv of stomach, which ushered in the disease on board the An- 
telope. 

In the first ten days about thirty persons died s three women 
and two infants fell victims to it ; and this was called bilious 
remittenL But the only difference which to me appeared to exist 
between the disease on board the Antelope, and that on board 
the Childers was, that, in the former black vomit appeared in 
seven cases opt of \\% while on board the Childers 1 observed 
it in one case only. It was, indeed, said to have existed in the 
cases of two of the women, but, as I was seized with the disease 
myself beibre they died, I cannot assert that they had it on my 
own authority, a^d that the disease on board the ChiMers was 
attended with a much greater mortality. But, premising that 
the same causes do i\Qt always produce precisely the same effects 
on the human body» tliis difference of termination may perhaps 
receive some elucidations from considering the following cir- 
cumstances. 

The disease appeared in the Antelope immediately on her ar- 
rival in the West Indies. The i;hitder3 had been nearly m. 



S34 llr Biiiiie M YiOav-JlM^ ^dy 

nKmths ill die cmmtiT when AediwMe broke mrt; In lif^ 'The 
Antelope waa in gora order, dean, and wdi aired, with the ei^ 
caption of the cockpits, a$ already mentioned j the ChiklerB waa* 
the oppoaiie of a^ these. On board the Antelope twen^-fite 
died who had no black vomit i on board the Cbiiden one died 
who had black vomit. Can it be supposed, that the twenty* 
five who died in the Antelope^ without having black vomjt, 
were diflferent from those who exhibited similar symptoms and 
died about the same time, but who had black vomit i I tUink 
not yfhentbepeoiUarfycircumtcnbedpamqftkeforekeadfnskd 
&e great and almost unconquerable irritability of stomaisfa, were 
^c distinguishing and leading symptoms in every caw $ because 
a certain appearance takes place in a limited numlier, shall we 
call them by difierent names ? Let us pursue the comparison 
atffl farther, and we shall find that the mortality and Kability 
to attack was equal among those who were obliged to live or 
mess below |n the Antelope, and those who lived on the lower 
deck of the Childers. The lower deck of the Antdope, where 
the people mess, is always well airetl, except in a heavy sea, 
whicn does not often occur in the West Indies, and is uways 
kept in an exceedingly clean state, which accounts for the dis- 
ease not running through the ship's company, and for its com* 
parative manageableness v but, in the cockpits, every person 
was attacked, except two seasoned hands { about one*hait diedy 
while, in the other parts of the ship, not more than a fourteenth, 
vis. nine of the thirty- one who died on board her had either 
lived entirely or messed in the cockpits, and of the seven cases 
of black vomit which occurred on board, six were of those nine. 
The tower deck of the Childera, where the people mess, was 
dirty in the extreme. On lilting the hatches of the fore or after 
holds, a horrid suffixsting stench issued irom them ; it was con* 
finc^, kimbered with lockrrs, and the heat increased by the 
JSre-fdace being on It. It was in a nastv filthy oondMon, and I 
do not recollect that it was .attempted to ventilate it by wind- 
ImuIs. This state of the vessel, the want of accommodation and 
attendance, and the sudden fail of the medical officers, account^ 
for the mortality on board of her, and for the disease attacking 
all her crew, only three escaped an attack, and mtfOfd half died. 
Here we observe a remarkable coincidence between the extent 
and mortali^ of the disease in our cockpits and in the Childen. 
Vft see the influence of the climate modified by the different 
situation of the two ships, and by the difierent situatiotf of die 
parts of the same ship. 

From having observed that this influence is the leading 
dMuacterof these diseases ) that in every individual ease of diem 



1817; Kr Binm on YdUnhFem. »8» 

the ftit m^ftpm wis ike cir€mn$erilied pom i^He faniea^^ 
pain of the eyM» particularly oo prewure^— that all cases wer^ 
alike characterise by irritability of stomadi and rejection of 
great quantities of bilious matter,«-that six of the cases in which 
black vomit occurred, were placed in peculiar circumstance^'*^ 
that the other was in a bilious irritable habit, and took place 
immediately on our arrival, — that of the thirty-ope who died, 
nine were obliged to be almost entirely below ;--*I say, from 
having observed all the essential and cognizable symptoms to bo 
the same in boih these diseases (though I cannot point out ex-* 
actly what combination of circumstances, or modification of 
causes, produced so great a number of cases in our cockpits^ 
in which death was preceded by black vomit), and why a still 
more nasty state <^ the lower deck of the Childers so few, I am 
of opinion that thev are essentially the same, and fear that m^ 
dical observers, in the too eager pursuit of discovery^ have beeii 
inclined to look over the thousand phenomena which establislh 
their idetitity^ and to find out and magnify the irregularitm 
which occur in this, as in every other disease. For my own 
part, I grieve to see so much patient inquiry, and intelligent ob^ 
aervation, frittered away in the futile attempt to convert clas8e$ 
into speoies, or in the insiffuificant invention of a new name fill* 
an ola disease. As they all agree that the practice io boih must 
be the same, — that this difference, if ever so we)l established, 
would lead to no practical result,— why so eagerly maintain an 
hypothesis, with only one useless dubious argument pr fact to 
sustain it, and which is opposed by every charactejr of identity 
a4id principle of classification ? 

The Tigris and Scamander frig^ttes have also been vii^ed by 
this dreadnd scourge, but have not lost moiip than five or six 
persons e^ch, which exemption they owe jto tbcjf h^h state of 
discipline, their cleanliness and attention to ventilatioo, white 
the Brazen, under circumstances somewhat similar to those of 
the Childers, has lost twenty-Jour out of eighjty men* I do Mt 
mean to say that she was dirty or in &i4 dispiplipe, but hfsr 
lower deck, where the people live, is narrow, crowded, and has 
neither ports nor scuttles, with two decks above it* The dij9kr*' 
eqt degrees of mortality exhibited in the di^ept sliips of this 
little squadron, accordibg to their di^erent degrees of desprip^ 
tiou^ veniilationf and eleantiness^ 1 think sufficiently proves that 
allj^ various appearances of these diseases arise from the saqie 
oiigittt and are elfects of the same quise, modified, as we have 
ieeo, hy various circumstances. 

Dr ^oignaon, Inspector of Hospitals, whose experience of the 
f^Iiifiatt am feye|r» fi t)ie Wps( Indies Juu t^en yery €Xt(Bi|siTe^ 



S56 Mr Bimie on Y^lBV-i^^mr. • - h\y 

And entitle him to the greatest deference, has'iviih ntebh kind* 
ness and condescension communicated to me some GmsIs respect- 
ing the attack of this malady, as affected by local cvKumtimmoes. 
He says, «< that on the tops of the mountains, and in all elevated 
situations in the West Indies, the only fever known to eim is 
the ague or intermittent of Europe* As you descend, you find the 
remittent in a mild forms still lower it appears in an aggravated 
type ; until at last, on a level with the sea, in the crowded ill- 
ventilated towns, which, for commercial reasons, are almost all 
situated to leeward, over the beds ^ dried up rhers^ 4>r ramrnps^ 
it appears with all its dreadful and destructive malignancy, 
rapid in its course, and accompanied with black vomit. It has 
also been observed, that, in very dry seasons, the ague appears 
lower, and that, in very wet ones, the remittent occurs in higher 
ones." This gradation will account for these endemics prevail* 
in^ in different situations according to the season ; and I con- 
ceive it to be perfectly conclusive in proving^ their identity. 
Speaking of what he calls Bulam Fever, Mr Fym says, *< it Is 
a disease sm generis^ of foreign origin, contagious, and attack- 
ing a person once only during life." That it is the same as the 
bilious remittents, I think I have made sufficiently evident. 
With respect to its being of foreign origin, I ask. Do the same 
causes exist iip where for its production but in Bulam ? When it 
has disappeared for many years, or lor months, as it did in the 
Antelope, where did it bide itself, and being so fatal, how was 
it concealed and retained in existence i I consider the doctrine 
of contagion to be altogether unfounded, and eminently mis^ 
chievouSf and that none of these fevers, allowing a difierence, is 
Contagious, I think I may assert on the most solid proofs the 
subject admits of. On board the Antelope, no precaution was 
taken to prevent contagion, yet, out of 820 men, having the 
fireest interoomrse, . not mote than H or 15 at a time were 
iUtacked. The surgeon, two assistants, and surgery man, 
were 'always among the sick, and the three kst slept con- 
linually in the midst of them» and notie of them had the slight- 
est attack of fever, for mdntf months afterwards^ and only the 
two assistant surgeons, after being sent, one into the ChikkrSf 
and the other into the Brazen. The officers frequently came 
to see the sick ; thtir messmates were ajlowed- to visitt wash, 
and dress theiii; yet no appearance of the fever having been 
ever communicated by contagion occurred. On kii beins 
Mtackedi I lent a pillow to one of my messmates «rho diea 
eight days afterwards, having had Uack vomit^ yet I slept oh 
it'Jbr'fdur months without any other predaution than that 
of ehanging its cdse^ and without the leiEist attack cS fever 



Uin. Mr BJteie on 3lMmJmer. . S»7 

dnring^l tlMfc peridd. On boairf tUe Childer% where (key M 
the fenrer, which my medical siqperiorB called remittent, out of 
«Biet|rivien, only three eicaped being attacked, and every petten 
impelled by duty to remain for- aiiy length of time on boards 
was seized with the same disease. The surgeon of the Brazen 
sloop bad been left behind, and on the brig's arrival (lor she 
had been sent from Trinidad, that her men might be convqred 
to the hospital at Barbadoes,) he nobly voluulcered bis services^ 
and fell a victim to his humanity. Another suigeon and three 
assistants s^it on duty info her, had very severe attacks, and 
three clerks, made pursers into her, died in less than as many 
<weeks. This appeared like contagion but was not^ for none of 
the physicians, smq^ns, assistant-surgeons, attendants, or 
irarses, who were continually with the men and <^Bcers after 
their being sent to the hospitals, were ever in the slightest de- 
gree affiscted with anything like this disease. That the im- 
mediate and exciting cause existed on board the brig, is evi- 
dent from this relation, and from the fact, that her men were 
taken ill every day, until she was unk)aded.and cleaned out, and 
that the black Creoles employed in this service were also seized 
with the disease in a day or two ajier being on boards but that 
since this purgation she has had no new case of fever, and but 
one of relapse. I noticed above, that one third of those who 
died on board th% Antelope, either messed below, or lived there 
entirely, where they were in some degree under similar circum- 
stances with the crew of the .Childers ; and I have no doubt, had 
those strangers who were attacked in the Childers been sent 
into our hold, steward room, or oockpits, to breathe a close vitiat* 
ed atmosphere, loaded with every miasm which such a state 
18 calculated to produce, that they woukl have experienced some 
similar attack ; or, had our ship's company been crowded down 
there, so many would not have escaped an attack, nor so many 
who were attacked have recovered. I think sufficient evidence 
is here given to prove that these fevers are not at all contagious. 
The fever in the Childers was endemic, not contagious ; and it 
is by confounding the different ideas conveyed by these words, 
that many wander in a labyrinth of their own construction. 
This disease is 4n all cases endemic ; it is the result of the in- 
fluence of climatei modified by all . the circumstances which I 
have already mentioned, and perhaps many others i and it is the 
different nature of these modifying circumstances that determine 
its nature and appearances. There is no such thing as idiopa- 
thic fever. Every efiect must have a. cause; and no. cause can 
isct in the general system, but must affect it through an organ 
or set of organs. Disease^ as weU as mptiont must originate 



SSB M^4MiBi•M}M0V•J9li0r. j^y 



from ft siBgW points Md tbe powor thtl aftols thtt ^, 
point generates the di«eMe» and the diaate it that pmStI 
\¥ith reipect to the atatemeat tliat the diaeaae attacks a peraott 
once onl^ dnring life^ if the eridenoe I have adduced to prove 
the identity of these diseases, and tiiat they are not oonti^iotts^ 
be conclosive, this position falls of course } and it is well known 
that the remittents of this country atuck the same perwm 
frequei^tlyt though each succeeding attack is generally mikiery in 
proportion as the constitution becomes crfoli$ed. 

Mr Neil, sarffeon of the Antelope, for whose assidnity and 
abilities I have the greatest respect, thinks there is a difference 
between the Bulam or yellow-fever, and the bilious remittents^ 
and that he can distinguish the Bulam lever from the others by 
the tongue at its commencement being natural, clean, red, and 
smooth, and by its terminating in one paroxysm i but^ by refer- 
rlnff to the adjoined table, where I have brought a few cases 
under a general view, I find that six of the seamen who had 
black vomit (the grand criterion of Bulam fever) bad the tongue 
more or less fouL And on board the Chikiers» whene they h|id 
the disease called remittent fever, many oases occurred in which 
the tongue was clean at the commencement of the fever ; I took 
notice of one in particular, Mr Macquay, whose tongue and 
mouth were moist, and preserved tlieir natural appearance on* 
til the day before he dit^ ; even his countenance appeared ie« 
markably healthy- looking and 'cheerful during the first three 
days, and I remember calling the attention of Mr Brown tO' 
these circumstances. The same natural appearance and mois* 
ture t>f the tongue and mouth had place in Mr Burton. Mr 
Purey, and the boaUwain's wife, all of whom died. These facts 
I think sufficient to prove, that the appearance of the tongi^a 
cannot be relied on as a distinguishing symptom of Bukm fevart 
We observe the state of the tongue to jud|fe that of the stomach 
and bowels. Where these last are diseased the former cannot be 
natural ; but if the exciting'cause be powerful and auddenly ap« 
plied, I shouki expect the tongue to be dean when the disease 
makes its first appearance, and until the svslem had ben for 
a short time under the diseased action. 1 nis disteropmr is cer- 
tainly inflammatory, and an inflammatory diathesis cannot exist 
in the constitution without affecting every part of it, and the 
tongue will become rough, white, or black, which wUl gmtljf 
depend on the ingesta and the habits of that individual $ but Ak 
cause must exist before the eflfect, and the patient mw finnplain 
before die struggle which precedes the overthrow of the halaaoa 
of the different powers of the eonstitntion be tanniuited| and 
the increased actkm hove taken piaoei the tongne will tba| oer* 



tsi7. MtKaokMY dh m J^ m. IM 

tiMy appMT natonJ. A flreal many odMr cniti wfaidb ¥•• 
gukle die appearaaoe of wk oigan miglit be adduced $ bat 
when it is fiurh proted that one or more cases of this ftiter faaife 
existed when die too^e was fou], rough, white, or biacky then 
a clean natural state of it can be no necessary part of the disease^ 
and can distinguish it from np other, m if one can eidst 
without this appearance, a thousand may. With respect to its 
terminating in one paroxysm, on referring to the cases of Mr 
Baron, Ayisbury, and others, I find they had intervals cfpam 
and easiness. Mow, 1 understand by paroxysm, merely eaacei^ 
baticn^ sihd I cannot conceive an exacerbation or parozyam^ 
which could admit of intervals of pain or ease, or which could 
last for seven, eight, or nine days. 

What I have to say respecting the treatment^ shall be coik 
tained in very few words. Venesection atways relieved the 
racking pains, brought on a flow of perspiration, thereby ren- 
dering the skin cool and soft, often prevented the coming on of 
irritability of stomach, and thus cut iff the disem^ at once. But 
to be of the least use^ it must be carried so far as to produce syn» 
cope ) and farther ^ if that efl^ct ib produced by the extraction 
of a small quantity of blood. This, in my opinion, is the only 
means cS cure to be relied on \ but it is necessary to state, thot 
it will not always cure, for several have died delirious widi all 
the ^mpipins of increased action and general irritation, thougli 
they hiwl lost, on the first attack, from sixty to an hundred 
ounces of blood. Calomel, and other preparations of mercury, 
are generaHy esteemed specifics, but as ail allow that the disease 
-will be determined, with respect to its consequences, in, at most^ 
three days, it will scarcely be found possible to impregnate the 
sptcm, except, perhaps, by means of fumigation, in that time ; 
I diink it, therefore, very wrong to tcaze the patient by useless 
rubbing in, or to increase bis uneasiness by forcing cafomel on 
him, especially after irritability of stomach has commenced. I 
have even seen many die of this disease after the system had 
been a£Pected and the gums very sore. Calomel combined with 
jalap, is certainly the most apprc^riate purgative at the com- 
mencement of the disease $ but when the fever appears in its 
most a^avated form, and calomel is given to affect the system, 
it is eitl^r rejected from the stomach, or passes by stooi, without 
undergoing Uie least change in its passage, and, consequently, 
cannot be expected to supersede the diseased action. Mr Neil 
has made an observation, which I think well worthy of bsing re* 
corded : it is, that calomel and other preparations of meranrg^ 
are oj great use^ and only of use^ where the tongue is foul^ and 
vkere there are other indications of diseased secretions Jrom tha 



840 Mf Wa^imY4hnhMet»r. i^y 

pfimaTj pBtSHfges s wd that ikey arecf fiQ use v^tfe the tongue 
is natural clean^ and no bad taste present^ — ^viz* They ar« of 
use where the disease is of «o miid a type as not giieatly to affect 
or destroy the patient before these diseased secretions have tioie 
^o make their appearance. The cold-bath has been ei^ten^iyely 
used, it indeed rendered the patient copl and ea^y for a short 
time, but I always found the symptoms retiirn with tenfold 
yiolence after it, when reaction had taken plaoe; reaaoning 
a priori^ I should not expect much benefit from it The heat 
and dryness of ihe skin are only effects of the disease^ not it9 
cause i therefore, it is absurd to endeavour to remove the <;au8e 
by attending only to its effects, and if the cause be removed: the 
effects will also disappear. Besides, the cold thus applied to th^ 
surface causes a contraction of dl the external ye^s, veins, 
and arteries ; this contraction throws the biqod in gveatier quan^ 
(ities on the internal organs, oppresses and overloads them, in- 
creases their diseased actions and secretion^ apd at last pro- 
duces their most violent efforts to overcome tliis opprosed 
state, whidi is the reaiction I have already p>eptioned. I, there- 
fore, am decidedly against the use pf the cpld-batf^* Perhapfs 
sponging the body with cold water might be of use, but I would 
never prescribe vinegar and water, for all acids contract and 
corrugate the skin, close its pores, apd Jiinder that tran^iration 
which must precede convalescence. I have now given you the 
sketch .which J promised, as far 9s / observed the nature and 
course oj this Jever in the Anteiope an4 Childerst and I beg that 
as soon as powble yoii will write to me, and let me know in 
what we agree and disagree on this subject. If you think this 
letter worth inserting in any of the medical journals, you are at 
liberty to do so, or as you please with it. When in the Chil- 
ders, I had a most severe attack of this fever, a|id was given over 
by the physicians at Barbadoes hospital for fiyie days, but I re^ 
covered. 



1817. 



Mr Birnie on YeUowPever. 



841 



It 
ll 



Names. 



Rev. Mr Baron. 
Mr W.K, Smith. 
Robt. Aykbury. 
Mr Geo. Morris. 
By all, (Mar ) 
Clapcote. 
Edward CMar.) 
Dowieyi (Man) 
Lieut iThurgood. 
Mr T. Aynsworth 
Cap.Dtirrie(R.M.] 
Crow, (a black.) 
HilL . 

Mr H. Harvey. 
Mr S. M. Laws. 
Mr Banniiter. 
Mr G. Carter. 
Mr £di AreiGOtt* 
Fairthoni. 
Morgan, (MQ 



Mar. 






Apr. 



Oct. 






,2 
Is 



SI 
24 
S4 
31 
27 



Not. 1 



Apr. 



foul, 
clean. . 
furred, 
very foul 
foul. 
6<Hery foul. 
foal 
isjveryfoul 

wbite. 
16 not said- 
clean, 
foul, 
clean* 
furred, 
foul. 
SC\ not said. 

dean. 
s| not said. 
fouL 
white. 



80 
16 



30 
87 
101 
56 
5S 
ftS 
77 
42 
81 
48 
48 
40 
89 
none! 



gal's 



P^t E 



805 
75 

185 
165 
190 
ISO 
10 
130 

diedlat Antigua 

to Hospiul 

4 



8 
18 

4 sent 
senttoHoi. 



sent 
100 
800 
165 
275 

40 
1 85 
195 

90 
430 

85 



not. 

not. 

not. 

not. 
to Hosp. 

not. 
April 9> 

not. 
Hospital. 

not. 

greatly. 

affected. 

a little. 

do. 

not. 

a little. 

a little. 

not. 

not. 






had. 
had. 

had. 
not. 



all 



died?Bth Mar 
died 4th April 

died 7th 

recovered. 

Ap. 9>:died there. 

had. Idted 1 4th Apr. 

where he recoverad. 
not. Idled Slat Apr. 



It. Idle 

Ifie 
Dt.die 



lied, 
not.died 25th Oct, 
not. recovered, 
not. klied S7th Oct. 
not. recovered, 
not. recovered, 
not. died 3d Nov. 
had. Uied 4th Nov. 
had. died 7di Nov. 
not. klied 4th Dec 
had. 'died a 8th Apr 



H. JJf. S» Mtelope,St Christopher's, January ^th, 1817, 



VIIL 



Qbservatums upon Diseased Spine f mth a Case. 
UN, Surgeon, Bristol. 



s 



ByJ. B. EffF- 



oifB time haTing elapsed since the Edinburgh Medical and 
Surgical Journal has contained any remarks upon diseased 
of the spine ; I shall take the liberty of recalling the attention 
6f its readers to this most important complaint With the 
exception of the review of Mr Copeland's work on the Symp- 
toms and Treatment of this disorder, I find no observations have 
app^ed on the same subject, since Mr Earless ^ Reply to the 
Review of Mr Baynton's Essay on the cure of Crooked Spine^" 
inserted in the llth volume, page SS. 

• . In this article, Mr Earle has entered into a very foU esami* 
nation of Mr Baynton's Essay, and. has noticed every case whidi 
Mr Baynton has brought forward in proof of the effica<7 of his 



9M J. B. Eftlin'9 OisenHiitdHi miim Diseaud Spine. July 

plan» orcttriog die disease by rest aIon«, in the horizoiilal po0- 
ture. 

In the first case (which, however, is one of diseased bipjoint) 
Mr Earle sbowsi that the cure might as reascmably be attribated 
to the use of setons, as to rest In the 2d, setont were had re^ 
course to daring the whole treatment The Sd he oonaiders^ faj 
a reasonable inference, as not a legitimate ease of diseased spnie \ 
and the 4th, he is also disposed to think, is not a rery cfeurly 
marked instance of this disease. * 

The 5th ca^e being a very interesting one, and an undeoiable 
example of the complaint in question, Mr Earle criddses mi* 
nntely, and very decidedly expresses his opinion, that the cur»* 
tive dflTorts of nature were called into action by the ase ot issues^ 
and that the plan of perfect rest, pursued by Mr B^mton, though 
the moat rational that could then be adopted, was only amdiiary 
to the advantages that had in the first place bc«n obtabied by 
the issues. 

The subject of the 6th case died before Mr Baynton*s plaa 
was put into execution. 

Cases 7th and 8th, Mr Earle observes, *• are both instaaoes 
of common lateral curvature, which never takes place ftom dis- 
eases of the bodies of the vertebrae, in which neither Mr Pott, 
nor any sHrgeon conversant with the principles of his profi»sion, 
would have ever dreamed of applying issues.** 

' Mr Earle professes himself sceptical respecting the nature of 
the disease in the 9th case, which, he says, does not at all coi^ 
respond with his ideas of destruction of the bodies of the verte- 
brae. A similar doubt he expresses with regard to the lOth, that 
of Master W. Castle, in whom he attributes the symptoms to 
that debility of constitution which is incident to the period of 
dentition, and which is removed « by keeping the duM off hie 
legs, and giving such medidnea as are calculated to strengthen 
the constitution generally.** 

H^ thinks the 11th case no instance of diseased spine, attri« 
bttting the pain in the back, and other symptoms, to the period 
of life of the yoong lady, who was the subject of ikneau 

Case l£th is one in which Mr Earle considers that iasneshad 
been of serviee, and that their good cActs had b^gim to mmm^ 
fint themselves, at the period when the palient was snbfected 
to Mr Ba^nton*s mode of tieatmaqt, which he speaks of as 
higUy jttdieiotts as an avniUaiy. 

In the ISth and hut case, issues were also employed beface 
the patient fell under Mr Baynton's notice^ to vdiidi Mr Eaile 
afttiibuled the eassationof the iDorhUeeti«» and the< 

la 



meat of a healthy one : this, thei^Mre^ he will sot adnit to bo 
an inttanoe of the disease cured by rest alone* 

Such is the nature of Mr Earle's remarks upon the cases 
which Mr Baynton has published as evidence of his success in 
curing disorders of the qpine, in a mode different from that 
heretofore followed by medical practitioners. When cases are 
ffiven to the public to illustrate any particular point of mediod 
uieory or practice, it is natural to select those which can admit 
of the least possible doubt, and which are involved in the least 
degree of ambiguity. It is curious to observe^ that there is not 
a single instance among those published by Mr Baynton, to 
which Mr Earle does not object as unsatisfactory, and by no 
means a decided example of the efficacy of the new practice. 
On the contrary, the greater part of the identical cases which 
Mr Baynton insists upon as proofr of diseased q>ine being cor* 
ed wiikota the employment of issues, Mr Earle conriders as ex- 
amples, in which these discharges have had the greatest dbaro 
in promoting tlie recovery of the patients. 

Upon an attentive examination of the cases related in Mr 
Baynton's book, and of Mr Earle's remarks upcm them, I can- 
not but think the latter gentleman has beai rather fiutidious in 
rejecting every case that Mr Baynton has adduced. The 4th 
ait^years lo me to be a welUmarked instance of diseased spine $ 
it has certainly the most conspicuous features of this maladyt 
and was cured by the patientTs being confined to the horizontal 
posture for eleven months^ without recourse having been had 
to drains. One difficulty with regard to it exists, which, Mr 
Earle remarks, is an ailment against its being a fair illustra- 
tion, namely, that at the expiration of the eleven months, the 
patient <^ rose in as straight and perfect a state as possible/' af- 
ter having had five of the vertebrse in a protruded state, in con« 
sequence of their being diseased. When the qpine has been 
distorted by the approximation of soma of the vertebrae from 
the softening and giving way of one or more of the intervening 
bones, the ravages committed by the disease are often repaired 
by the deposition of new bone, and the consequent consolidation 
of the diseased and distorted parts I but a return of the vertebras 
to their natural situation, mer euoh an event, is neither very 
eoasmon, nor veijr explicable i the distortion gaieraUy remainsg 
though die diseased action has ceased. 

In the 7th and 8th cases, though the hileral curvature, as Mr 
Earie observes, aright not be from disease of the bones, the 
tandcmesa disooveraUe by pressure upon some of the vertebm^ 
alMywed that they were in an inflamed state,.and, in these casesi 
cures were effected, I presume^ by rest alone. Mr Baynton 



344 J. B. Eitlin'8 Obserotiihns 9^n Diseased Spine. Mj 

iBysy that 8etdn» were fecommeiided by medieal men who had 
been consalted beTore him, but does not mention whether thqr 
were used or not ; the natural inference, however, from the man- 
ner in which the cases ere staiedi is, that they were not had re* 
coarse to. 

' The 9th case appears to me not iiaUe to the objecticms which 
Mr Earle makes, and is, in my estimation, a satisfactory ex« 
ample o(' the success of Mr Baynton*s plan ; and in that of Mas- 
ter Castle, I am not inclined to be so sceptical as Mr Earle^is^ 
and cannot agree with him in his suspicion that Mr Bayntoa 
had mistaken an increase in the natural curve of the dorsal ver- 
tebrae, resulting from debility, fer a symptom of disease. It is 
not a probable supposition that a person so conversant as Mr 
Baynton must be, with disorders of the spine^ couM be led into 
such an error, though the idea is certainly somewhat counte- 
nanced by Mr Baynton*s mentioning, as one of the more obvi- 
ous si^s of this disease, ** a projection or standing out of one 
or more of the spinal processes, beyond the straight Une of the 
spinal column," as if he had forgotten the natural camateres of 
a healthy spine* 

In the greater part, however, of Mr Earie*s critique, I can- 
not but coincide, and I think there are very few professional 
men who have paid attention to diseases of the spine, who, up- 
on perusing Mr Baynton's work, wHI not at once see that he 
has completclv failed in proving the superiority of his practice 
to that which has received the sanction of the most enlightened 
surgeons in Europe. 

Whatever may be the qrinion of professional men with, re- 

Krd to the justice or severity of Mr Earle'a ronarka upon Mr 
ynton's essay, none will deny that they wete entitled to a re- 
ply. Mr Earle is a gentleman of deserved reputation ; he was 
educated in a school where a most successful method of curiz^ 
disewied spine waa firat empbyed, and where an ample field haa 
been open to him of studying this complaint in all it varieties; 
he has come forward in a manly manner, as the avowed wp- 
porter of a practice which it is the aim of Mr Baynton's essay 
to bring into disrepute, and mast, as well as his bredmai in tfate 
profession, be surprised that no notice has. been taken*of his r^ 
marks by the author of that essay, though they were, published 
so long as two years ago. Those who are acquainted with Mr 
Baynton's professional talents and information, can hardly sup- 
pose him incapable of defending hia essay fnxn the okgectiona 
which have been made to it ; Iwt the medical wodd at kxgf^ 
who have read th^essay) and whoiiava aba aeen lli 



]Slr« J. B. Estlm's Gb$ervatian$ upon Disea$fd Spittf 346 

upon it by a gentleman xfhose opinions mttst carry weight wUh r 
them, in«^ be dispoiied to form a iebs favourable inference. 

li is impoiisible to read Mr Pott's observations upon disorders , 
of thi$ $p^ne» without being forcibly struck with the accuracy of 
his remarks* and with the decided success which followed the 
plan of treatment he pursued. The labours of succeeding sur* . 
geoni had %o firmly esubiished the truth of his principles, and 
the success of his practice, that bleeding in pneumopia, or diu*-' 
retics in dropsy, were not iixe4 upon a firmer basis than the 
use of issues in diseases of tlie vertebrse. Bold indeed was the 
atleoipC to shake the foundation of this practice, and fortunate- 
ly it has little to fear (to use Mr Eaile's wordii}from ^^ the feeble 
and imper&a evidence'' of Mr Baynton's cases. 

There is, perhaps, in the whole science of surgery, no plan 
of treating diseases more rational, and more supported by ana- 
k^f than the excitement of counter- irritation in inflammation 
ofUieqpinal column. Few surgeons can be Lznorant of the 
beneficial effects of caustic^ in inflammatory aneaious of the 
bones or ligaments of the knee, ankle, hip and wrist-joints; 
daily foay examples be seen, ^in which their use has saved dls* 
eased limbs from amputation i and, were there no instance upon 
record in which they had been employed in inflammation of the 
bones or ligaments composing the spine* the advantages of using, 
them in thib disease, which bears so near a resent blance to the 
former,, might be calculated upon with a great degree oi certainty. 

But not in theory alpne is this mode of treatment ralionalj^ 
there are few of the formidable diseases which fall under the 
surgeon's notice, that could furnisli a larger catalogue of cures 
than those of diseased spine which have yielded to the applica- 
tion oi caustics, or similar counter-irritations, in the vicinity of 
the affected part. Instead ot thirteen cases, ail of them object- 
ed to, and most of them certainly ot^cctionable, a mass of evi* 
deoce composed of as many hundict'dj* would be necessary to 
shake the confidence of surgeons in ^this valuable remedy. Not 
less exceptionable than hih cases, is Mr Bay n ton's reasoning in 
favour of his proposed method of cure, ^fottiing can be more 
iiypotbetical, or, as Mr Earle calls it, «* visionary," than Mr 
Baynton's account of the diseased action which takes place in 
scrofula. Mr Earle, in his paper, to which I would refer the 
readers of this article, ably refutes it in a few words. 

Mr Baynton seems to torget, that, when the spine is diseased, 
tnflawmatory action is going forward } and when be says it is 
difficult to account for the accomplishment of cures by the use 
of caostics afone, he appears to overlook the well known effects 
#f an artificial external inflammation, in fire^uently checking the . 

VOL. xiii.no. 51. z 



S46 J. B: E8llm*8 Observatians upon Diseased Spine. July 

progress of a similar internal action. He speaks, too, not only 
of (^ficient action in the secreting vessels, but also in the aisor^ 
beniSf as being die cause of the disease : now, where ulceraticm 
of a part has taken plaee, and loss of substance followed, I have 
been ^accustomed to think that the absorbents have been too 
aciive^ and not too indolent in their functions. 

I should, however, regret to be thought to under^estimate 
Mr Baynton*s professional talents ; hb reputation stands so h^^ 
in the annals of surgexy, that whatever comes from bis pen is 
entitled to a respecSul consideration ; but the greater weight 
the authority of an individual carries with it, the more incum- 
bent is it upon those surgeons who are zealous for the advance- 
ment of their profession, to oppose, by all the rational arm* 
ments thc^ can adduce, any practice he may recommend, mi 
seems to them founded upon insufficient groundst 

When any improvement is first introouced into the practice 
of medicine or surgery, its discoverer is generally so sanguine as 
to dismiss aH former modes of treatment, and to depoid only 
upon the new one. If the discovei^ be really valuable, it wiU, 
in a short time, find its proper level, and will probably be con- 
sidered a useful auxiliary to long-established practice. This, I 
believe, will be precisely the case with Mr Baynton^s proposal of 
curing diseases of the spine by rest alone. Few, I ima^e^ will 
ever trust to it so implicitly as to omit other means, particularly 
the employment of issues ; but I have no doubt, it will be the 
moans of inducing sui^ieons to enjoin rest in these complaints, 
more strictly than they have been accustomed to do, and will 
thus accelerate the cure of thdr patients. At all times, however, 
a degree of caution will be necessary in recommending to pa* 
ticnts who have been in the habit of taking some exercise, a 
state of undcviating rest ; in infants, it is impracticable. Though 
Mr Baynton considers resting in the horizontal posture as so 
effectual )n ^* impraoing the circidatiim^ favouring the deposition 
of bone, and protnoting abscrpHmi^^ eases will frequently occur, 
in which the very reverse of these happy consequences may be 
more reasonably anticipated. Infinite is the variety in the hu« 
man constitution, and a plan of treatment which may be very 
efficacious in a disease in one person, will require considerable 
variation when put in practice in another. 

It is notorious that a ereat number.of persons with diseased 
spine have recovered under the use of issues, without having 
recourse to the recumbent posture more frequently than during 
the usual hours of rest. Others have been restored to health 
' while assisted by machines in addition to issues, proving that^ 
in many cases, a state of undeviatisg rest is by no means necea* 



su^ to recpveiyt though, had it been employed]^ it ipight have 
proyed apcessorv to it. I suspect that the use of machinery has 
been often condemned in top indiscriminate a manner. That 
]hischief may sometimes have been done by suffering it to su- 
piersede the use of issues, is not improbable ; the sakne, I have 
no hesitation iii saViiiga will frequently be the case, if perfect 
rest be alone tilisted to. t bannot doubt, that, in some attacks 
of vertebral disease, an instrument which will diminish the' 
weight the spinal column has to bear, by removing; it to the pel- 
vis, will, in conjunction with issues, be sufficient io effect a cure ; 
indeed, it is not a matter oi^ opinion, daily experience proved the 
fact 'f and there are practitioners who pursue no other ' plan of 
treatment in remedying this di^ase,' and who meet with great 
success. It' 18 probable, that, in many of these cases, the gene- 
ral health of {he^patieiit is improve by' his being able to take 
somi§ exercise, and that "walking about has been more efl^tual 
hi *^ inipraoing the circulaiioti/' than lying on hfs back wo'ald 
have been. On the other hand, it must bp admitted, that per- 
fect cur^ will sometimes be' effected by rest klorie in the hori« 
zontal posture. Besides tome of Mr Baynton's cases in sup- 

B' trt of this practice, a very good 6ne' has been piiblished by 
r Armstrong, in tiie ninth volume of this Journal.' Yet, au 
the evidence we have of the efficacy of this treatinent, will go 
but little way in justifying Mr Baynton*s belief,' that << difains 
are not generally, if they are ever, necessary for the curing of 
such diseases." It must be remembered, that occasionally cases 
^iil be Inet with, which will baffle every attempt of the surgeon 
to cuire theib,' whatever plan he may pursue. We mus;t'not 
expect unvaried success i and it is no argument agsdnst the ge- 
neral use of issues, that every person does not recover in whonv 
they have been' employed. 

There is an objection which Mr Baynton makes with r^rd 
to the employtnent 6f issues, which I cannot avoid <eplying to. 
He speaks of the ** suffering '' ex^rienced by patients who ai:e 
treajted by i^ii^, apd considers the escape from them procured 
by his' mode of treatment, as an'impoirtant circumstance ifi re- 
comn^endation of his plan. *« The lying," he says, page 'SB, 
^^tipbn'open ulc«rS of cousiderabld Extent, filled' with peas, 
beans, or other hard bodies, will be prevented h^ tl)e adoption 
of this pliui of treatment^** which he calls *^ more sfmple, moVe 
reasonable, aind nmch more asreeaJNeJ*' This appeal to the pre- 
judices of the ignorant, mav ht opposed by objecting to th^ <* s^ 
Jering^ which, in some cases, his own method' must inevitaMy 
inflict; for in the fourth case, that of a young lady, (paffe84) 
it is said^ <^ five of the vertebrae were found in a diseased pro* 



S48 J. B. EsUin^s Observations tfpon D'isiisei Spine, 'Jvif 

truded state, and so exquisitely tender , as to retideT preisifre al- 

iDost insupportable i^ and vet this ^oung lady was coftdemned^ 

to lie with her whole weight upon this exquisitely tender part^* 

Fender<*d still more exposed to the pains of pressure by its hein^ 

more prominent than any other part of the back I To arrive at 

very ** agreeable'' methods of curing diseases, is, I fear, never 

likdy to be the lot of medical practitioners : we must be satisfied 

with being able to alleviate the psings of disease upon less'ad- 

vantageous terms ; and if the surgeon, in the discharge of his 

arduous duties, had to inflict no more severe suffering than (he 

fbrmatioQ of an issue or seton in cases of diseased spii^e, his art; 

wotdd be freed lirom any great degree of terror to his patients 

or pain to himself. Common principle and common humanity 

will always influence a conscientious practitioner to select that 

mode of treating a complaint, which, ctUer is paribus^ will be 

least disti easing to his patient ; but the man of enlarged views, 

who takes a genuine interest in the improvement of his profes« 

sion, will be more solicitous about the useful than the agreeable^ 

in his practice. The fact is,— that the discharge so important 

in disease of the spine, may be procured by means which will 

occasion but trifling inconvenience to the patient. << The 

making and dressing of sctons" may, as Mr mvnton says, be 

painful and troublesome ; particularly, if they be such as he 

inserted in Mr Thornton's back (Case 5d,} ^^ eight or nine inches 

in length!** but caustic issues, which are now most approved of» 

may be managed even with peas or beans in them, so as to give 

but very little uneasiness. Nor can I even admit that the slight 

degree of movement which is necessarv to have the issues dres- 

sea, can be productive of the danger Mr Baynton apprehends : 

on the contrary, I conceive, that it is as likely to prove beneS* 

cial as injurious : — it is not unusual to have recourse to gently 

moving the extremities of a fractured bone, for the purpose of 

accelerating the deposition of ossific matter, when that process 

is going forward languidly. 

To conclude the remarks which Mr Baynton's Essay has 
given rise to,--^I conceive, that, in the greatest number of 
cases, the observance of undeviating rest in the horizontal pos- 
ti^re, will be found a valuable addition to tlie present mode of 
treating diseases of the spine, and for this Mr Baynton is en- 
titled to the thanks of the profession \ but, I consider his ob- 
ject, of exploding the use of issues in this disorder, as an at- 
tempt at a dangerous innovation, and one that demands the 
most decided opposition of his professional brethren. 

Diseases of the spine, when so far advanced a^ to Mcasiou 
projections of the vertebras, and palsy of the lower extrefldties, 

10 



1817. X B. Esttia's CbteroaHoHS upon IXseased ^ine. S49 

fire instantfy detected by the surgeon ; but ho«r. desiraUe 
would it be to discover the approach of the disorder at its first 
advances ! Permanent deforixiity, and many of the sufferings 
attendant on this formidable complaint, might then be frequent* 
ly averted. The profession is indebted for some verv judicious 
remarks on this subject to Mr Copeland. His " Observations 
on the Symptoms and.Treatment of diseased Spine, more par- 
ticularly relating to. ihe incipient stages/' are well worthy at- 
tention. This author has, I believe, been the first to direct the 
attention of practitioners to the commencement of the com- 
j^aint 

^ Many of the constitutional symptoms attendant upon the in- 
cipient state of diseased spine, such as loss of strength and ap* 
petite,' .uneasiness in the back, listlessness, &c. are so oftea 
found in other disorders, as to be very equivocal. When» in 
coiyunction with them, it is found, that slight pressure upon 
thp spinous process. of. one or more of the vertebrae occasions 
considerable uneasiness, while the others of the column may be 
pressed upon without betraying any unusual tendernessi we are 
warranted in considering that inflammation exists in the liga* 
ments or bones of the part, which, if neglected, will probably 
terminate in carles of the bodies of the vertebras, and produce 
.the usual distressing^ consequences of the more advanced stages 
of this disorder. There will always be considerable difficmty 
in ascertaininjz, before any distortion has taken place, to what 
degree the inflammation, or even caries, may have proceeded | 
for caries will sometimes occur in the bodies of the vertebraSf 
without any displacement of the bones. Mr Copeland men- 
tions a preparation he has, in which the intervertebral substance 
of some of the dorsal vertebrae has been entirely removed, and 
the bones anchylosed, without any alteration having taken 
place in the situation of the spinous processes. 

As much obscurity will often exist in the early symptoms of 
thb disorder, great vigilance and attention will be necessary 
on the part of the practitioner to detect them, and arrest them 
by decisive measures. Issues, and continued rest in the hori- 
zontal posture^ if had recourse to early, will, I believe, in most 
cases, succeed in checking the progress of this formidable com- 
plaint, and in preventing its ever reaching an alarming height. 

I will conclude these observations by detailing a case which 
fell under my care, where the good effects of Uiis plan were 
strikinglv exemplified* 

In February 1811, Miss — — , a^ed 26, after a ride on horse- 
back of about twenty miles, felt, tor the first time, a weakness 
in the back, and general sense of languor i to zemow whicb» 



d50 J. % EMn^'Observafiohs upon Diseased SfUie. Jaly 

she was advised to lie down upon her babk during a part oF 
every day ; she followed this advice^ and, in a few weeks, fell 
no more of the indisposition. In the following winter, she used 

Seat exertion, by taking frequent and lonj; walks, for nearly 
ar months, and again ielt a local weakness in the back; there 
was also, she recollects, some degree of tenderness in the verto- 
brse when pressed. These symptoms were also relieved by ob« 
casioual recumbency and repose from much exercise, but, du- 
ring the summer (1812), the uneasiness returned so constantly, 
that she was obliged to lie down tlie greatest part of the day. 
She always felt easv while lying down. In September, by the 
advice of a medical gentleman, she put on a machine, which 
was constructed to remove the weight from the spine, and 
throw it upon the pelvis. During the next twelve months, she 
either lay down, or sat with the assistance of this machine: she 
used to sit up for one hour, and lie down two or three; theti 
dt up for an hour, and so on. At the expiration of the^ 
twelve months, she was, upon the whole, worse: the sensatioh 
in the back, which she has uniformly described as more a feeliiig 
^ of weakness than of actual pain, had increased: talking, lauding, 
or crying, even while tying down, always produced a heat m the 
biick, ami she constantly felt a sensation as if bits of horse hair 
were pricking the back. At this period, September 1814, Mr 
Cline was consulted by letter: he said, that he considered the 
' symptoms those of inflammation going on in the back, and i^ 
^ commended rest in a horizontal posture. Another eminent sur- 

Son, residing at a distance, was also consulted by letter, who 
ought the case was one of diteased spine, and recommended, 
as Mr Cline had done, undeviating rest in a horizontal pos* 

' ture. This plan was scrupulously persevered in, frofn Scptedi* 
ber 1814 to ApHl 1815. The patient by, for the first two 
months, upon a hair-mattress, but, fearing it might be too 
yielding, she had it removed as far as the small of the back, 

' and a board covered with blankets upon a level with die upper 
part of the mattress, was substituted. 

On the Hth of April 1815, I saw her for the first time since 
her indisposition. Mv notes say, that she fbels exactly in the 

' same state in which she has been for some months. Whfen 
perfectly at rest, and not speaking, she experiences no inconve- 
nience. ' Moving the arms, and talking, ofibct ber most Yawn- 
in^r, sneezing, hughing, cryii^, and coughing, occasion the sto- 
sauon of weakness and heat between the shoulders, or, as she 
expresses it, <• under the lungs.*^ She describes the general 
feding as «< a want of compactnen in the vertd^ne.** If she 
holds up a book for a short time only, her back becomes beat* 
ed, and she has slight pains, «< like lines as small as horse hairs, 



1817. X B. Esdin'B Ohmvatiaus t^pon Diseased ^ine. SSI 

and abont an inch in length/' To comnrahicate an idea oF W 
feelings, she also describes them to be <* as if all the ligattients 
of the body were suspended by a wooden peg between the 
ahoulders.'' An* obstinately constipated state of the bowelrtei- 
ists* Daring the day her conch: is wheeled into an airy draw<^ 
ing-room ; and her clothes are contrived so as to be put on and 
taEen off without her removing her back from the mattress. 
When she feels the uneasiness in the back most, she is able to 
refer it to a particular and small spot between the shoulders. 

Upbn examining the u>ine attentively, no distortion or cur- 
vature was perceptible. Pressure with the fingers upon Ae cer* 
vical vertebne occasioned no uneasiness, but, when it was ap- 
plied to the third or fourth dorsal, she started suddenly away, 
and said her breathing was impeded by it. The sensation thus 
produced, she said, could not properly be called pain. The 
same tenderness existed in several of the succeeding bones, but 
the principal seat of it was between the third and seventh or 
eishth. There was not the least tenderness in the lumbar ver- 



Afier this examination, I could entertain no doubt that se* 
veral of the dorsal vertebrae were ailected by disease; and, when 
I considered how long the patient 'had been indisposed, and 
how slight a dq;ree of pressure occasioned the sudden starting 
and uneasiness she complained of, I was led to fear that the pro* 
gress of the inflammation had heen considerable, though no cur* 
vature or paralysis had yet appeared. The custom she had so 
long adopted of lying down whenever the back was uneasy, and 
of thus relieving pressure, was probably the cause of the com- 
plaint's not hating manifested any appearance of distortion or 
palsy. 

As the plan of undeviating rest had been persevered in for 
seven months, without producing any considerable amendment 
(though she thinks she felt a little benefit from it,) I did not hes!« 
tate to propose the immediate cstabli^ment of issues on each 
side of the affected part of the spine, and could not help feeling 
regret, with my views of this disorder, that so much time had 
been suffered to elapse without their having been had recourse 
to. I had, however, the pleasure of finding that the result did 
not disappoint my most sanguine anticipations. 

I applied the rotassa fusa to a circular space, of about an 
inch and a quarter in diameter, on each side of the tender ver- 
tebrae. She lay upon her ftice for about twenty minutes while 
the eschars were forming. The surrounding skin became con- 
siderably inflttned. On the evening of the day upon which the 
caustics were applied, Ae said her back felt leis uneasy tjian it 



S52 J. B. Efllm*a Olnmmtiami9(MOkimtiapi*i. Mf 



bad been ibr sooie time befere» though die had used laore < 
tioD than she had done for a consideraUe preceding period* 

As the lady who is the subject of this case Hred at a great 
distance from Bristol, I was obliged to leave her the day after 
the application of the caustics ; &t she was fortmiate enoof^ 
to remain under the occasional observation of a gentleman who 
is eminent for his professional abiiitiesv to whose jsKlicioiis 6o» 
operation I feel much indebted, as instmmental to the happy 
termination of a case, where feelings of private friendship added 
to the interest which, in a professicmal point of view, I neitorally 
tookiliit* 

When the eschars formed by the caustic had slou^ied away^ 
the <ypenings were kept dtschirging by the insertion of a'large 
Wbidsor bean into each ; and, on th« lAth of May, a month 
after the caustics had been applied, I reeeived the foOowing ao-> 
count: — 

** She has not felt lately the heat and irritation she used to 
have in the back, excepting one day when she coughed a great 
deal and sneezed. She turns upon her side more easily than 
ahe did. Talking does not produce so much local heat as it 
did." 

June 1 !.-«•*< The vertebrie are as tender as they were at firsts 
but the catching of the breath when they are pressed by no 
means so great. The issues discharge freely." 

I cannot give a better i<iea of the immediate good effects of 
the i^ues, than bv transcribing ber own words from an account 
of her case which she ha4 .since favoured me wiUi. Shaking 
of her state previous to the period of my seeing her, she says, — 
. «< From September 1814 40 April 1815, I simply lay down, 
and certainly felt benefit^ but still the inflammation in the part 
continued on the smallest exertion ; even the weight of my 
hands crossed upon my chest was a burthen ; and the least 
movement of hand or foot seemed to bear on the weak part on- 
ly. Coughing or sneering 1 dreaded, as the jerk seemed to 
strain the part. In April you applied the caustics; from that 
time I felt nobbing of the pricking : the effect seemed instanta- 
. neons.'* 

The symptoms gradually abated. The caustic Was applied to 
a fresh part, and the former openings suffered to dose* In all, 
five issues were made. The tear of producing any recurrence 
of the symptoms by a premature remission ol' the plan that bad 

E roved so beneficial, was the cause of its being persevered in 
mger, perhaps, than was absolutely neeessmry* In February 
1816, as no uneasiness was fek upon pressing or knodung the 
vertebras, and the catching of the Imath having cnsed for some 



.1917. J. B. JSfObin ObtervBiiaut i(po» Dkeased Spine, 353 

tttathft bdbiet on the appKootioB of pressure, she began to be 
raised during the day a little from the horizontal posture^ by 
meads of a conlrivanee in the crib for the purpose. There was 
a h'mgie at the part where the bottom of the back came, which 
enabled the upper part of the trunk to be raist^d towards the 
aktiog posture. Soon after this, her progress- received a little 
^ecK^ owi^g to a catarrhal attack, attended with cough ; and 
frequaHly, during her confinement, she bad to contend with the 
depressing influenee of mental anxieties. It is not, then, to be 
wondered at that she did not venture to sit upright before the 
December following. On the first day of the present vear she 
sioodf and in a fortnight after was able to wait In tne latter 
ci^def last March I saw her again, and examined the back. 
There was no more sensation upon pressing the vertebrae thai^ 
fhe soreness of the skin produced by the issues, which were then 
inflamedi fully accounted for. Her umeiidmeat has continued. 
- The issues hatre been sufferedto heal* She goes up and down 
stairs, walks out, and is able to indulge in the recreations of 
phying, singing* and drawing. Her back is free frdm uneasi- 
ness, and her general health unimpaired. It may not be amiss 
to. observe, that the ** steering** occasioned by the issues was 
loo trifling to be named. 



IX. 

Aecmini of ike faial Accident vohich happened in the LeadhilU 
Cbmpani/s Adines^ the Ist March 18 1 7. By Mr Jaaiks Braid, 
Surgeon, Leadhiils. Eead before the Wernerian Society 7th 
June* 

^\}g 1st March last, I was sent for, about 7 o'clock A* M.« to 
^^ try if any U^ing could be done for a number of men, who 
were found in the Leadhiils Company's mines, who appeared 
to be suffocated. 

On th^'^Otb December 1816, a young man, who kept a fire* 
engine, nearly 600 ieet below the surface, was found dead, and 
the air where be was, not to be at all agreeable:— the usual 
modiea of resuscitation were tried, but without any good tffects. 

On S4th of February 18X7, there were several men very se- 
verely affected from the bad state of the air, but, by givi g 
them gentle laxativesp and keeping them quicty they got pretty 
well again in the course of a few days. 



954 UrBrtid^s Aectmnftf a Jaial Accident ai'LeaJIti^ Jtiy 

On the Ist of March, none of the men had got to bank, when 
I arrivedy except a few who had been down aoiy a very short 
time, and returned upon 6nduig the air so bad. By and bjie, 
a number of those who bad been down for a short tiaoe, at 2S 
fathoms, were brought up, and most of them quite Airioat. 
Some were disposed to fight, — others, supposing every osie 
they saw disposed to lay hands on them, xoade rabrts, under 
the most extreme terror, to escape,— others, quite listless, ap- 
peared to take no notice of what was going on around them. 
Some were singing, and some praying. Many were as if in- 
toxicated with ardent ^irits : — ^those who had seen them in that 
state assured me their actions were rery mudi the same. 

Many of them vomited, and others had the inclination,' but 
could not do so. Some evacuated the contents of the rectum^ 
and others had the desire, without efibet The puke was dif- 
ferent: — in some, remarkably quick and feeble,-— in others^ 
slow, feeUe, and irregular. Most complained of insufferable 
' headache, which was somewhat relieved after vomiting. To 
those who had a desire to vomit without efiect, I gave an eme- 
tic of sulphate of zinc, and to those troubled with tenesmus, a 
laxative glyster:-«4x)th were followed by an alteration of symp* 
toms. 

In the course of two or three hours from the time th^ were 
brought to bank, the pulse was greativ accelerated, ana haid. 
I prescribed a brisk purgative, after the operation of whidi 
thev found themselves greatly relieved^ and, by enjoining a 
coolinff regimen, most of them got pretty well, in the course of 
a few days, without any other medicines. Upon inquiring at 
the men how it affected them, they said> tney first felt a 
difliculty of breathing, and had frequent involuntary deep 
inspirations,— -then a violent pain and besting in the head, 
witn ringing of the ears, — the inferior extremities became weak, 
and veiy painful immediately above the knees, and they could, 
with difficulty, support the body,— the heart fMdpitated vioI»t» 
Ijr^gT^t anxiety, and in some followed by vomiting. They 
now became giddy, and lost all recollection, and were, as has 
been remark^], affected as if they had taken a large dose of ar- 
dent spirits. 

There were four men, however, at 95 fiohoms, who were ir* 
recoverably lost throurii their own imprudence of going to w<»k 
at irregular hours. Tliough six o'dock A. M. was the proper 
hour, two had gone before four, and other two a little amr, -in 
order that they might get out so much sooner. Such practices • 
are not sanctioned by the masters. When they came to the 
bad air, they had thought to force their way dirough it, ex- 



181 7* Mr Braid's Account of a fatal Accident at LeadAWi 355 

pecting it to be better below ; but it had soon produced its de1c«' 
terious efFects upon tbem, so as to make them unable, either to 
go further, or to retrace their steps ; and then, linahle to sup- 

Eort themselves, they had fallen, and remained amongst the 
ad air till assistance came too late* Animation must have 
been gone two or three hours before they were brought to 
bank, for they had been down not less than four hours. Had 
they not gone till the regular shift, when the air was found to 
besQibad, they would not have proceeded so far ; and if one 
or two had fallen, the others would have found some means to 
have rescued them, before they had been irrecoverably gone. 
It is presumed, the adcidemt happened from a quantity of smoke 
escaping from the chimney of the engine under ground. Into 
the way-gates, about die 25 fathoms, and so contaminating the 
air in the workings, from the quantity of sulphurous acid gas 
which the smoke contained, such as to render it unfit to sup* 
port animal life, or rather, hi^ly deleterious. The men de» 
scribed the air to be the same as where sulphur is burning 
slowly, and consequentlv, sulphurous add gas forming. 

At the 'time the acciclent happened, the atmosphere was fo0^ 
gy, and there was a want of a proper current of air in the work- 
ings, and, in consequence of the stagnation, the air in that part 
of the way-gates, where the smoke was escaping, became so con- 
taminated, by sulphurous add gas, as to render it highly dele- 
terious to animal life. A trap*door bdng opened, in order 
to save those who were still alive, about me SB fathoms, 
(that is, thote who went at the time for a regular shifl, the 
'lour who had gone in before were dead when these men went 
to them,) and to enable others to give them assistance, with 
safety to themselves, the bad air immediately rushed down to 
the lov/er workings, and began to exert its deleterious efiects 
. upon those at 80 fathoms, wno were effecting their escape by 
another shafl. * All who were any length of time in this situation 
' were violendy affected in the manner already mentioned, and 
three (two of whom went down tqsave others) perished at the 
80 fathoms, from the air all below the 40 fathoms becoming so 
bad, as to render it imprudent, or rather impossible, for any 
person to go down to their assistance ; and by thb time^ they 
were unable to assist themselves. Those in this situation were 
drawn up by an engine, and the last who got on the rope, from 
the others, either, by tliis time, not being able to secure him 
properly, or not having time to do so, from him ffiving the sig- 
nal too soon, fell from the rope, after he was withm 20 'fathoms 
of bank, and was thrown into thelanding^box of the water en« 
gine» which threw the water from the landing-box (which is si- 



S56 Mr Braid'9 Account tf a foialAcadentaiLeailiills. July 

tuated at the 50 fathoms) to the bottom of the shafts ao that it 
had 4(Xfathom$ to fall Water was also thrown from the top, with 
buckets, before the engine water was diverted by this poor fel- 
low tumbling into the landing box. The water, by fidling down 
the shaft, caused a circulation of air, and likewise, by absorbing 
the sulphurous acid gas, improved the air so much, that one 
who had lain at the side of tne shaft, in an insensible state, for 
more than an hour, was restored. Other two, who were only 
at a very little distance from him, but were by so much further 
from the shafts and consequently where the air could nol be so 
much improved by the waterfall, were brought up immediately 
after him ^ but, though the usual moiles of resuscitation were 
tried, neither of them could be restored. One of these last had 
had a ver^ florid countenance. I took away a considerable 
quantity of blood from the jugular vein. 

Those of a plethoric habit were much sooner, and more vio- 
lently affected, than tliose of a spare habit, and, from what I 
saw, I make no doubt but one of a spare habit might remain in 
some dqjree active, whilst one of a very plethoric habit would 
Jbe irrecoverably lost. When it becomes necessary for men to 
go into such situations, would it not be proper to take away 
a quantity of blood from those of a plethoric habit? I shall cer* 
tainly be disposed to try it, if ever the aii* shall again become 
bad. 

The cafldles burnt, though faintly, where the men perished, 
which was generally considered as an extraordinary thiim j and 
the only hypothesis which t can conceive proper to be advanced 
on the subject, is, that, in a mixture of sulphurous acid gas 
and atmospheric air, the acrid nature of the sulphurous acid 
gas prevents respiration, or rather produces peculiarly deleteri* 
ous effin^ts, which, continued a certain length of time, will de* 
stroy animal life; whilst it has no further e&ct on combustion, 
than merely mechanically preventing the more bee supply of 
oxygen it would have from pure atmospheric air, and, cons^ 
quently, causing it to burn more faintly. 

Leadhills^ Sd May 1817.* 



1817. Mr Wag^ Cases tfCatarrha Hepatieus. 3Si 



X. 

Cases of Catarrhus Hepaticus. By John Hat, Esq. Sargeon, 
2d Battalion Hon. £. L C. Artillery, Madras. 

JOHN Plant Matross, 2d Battalion Artilleir, statis 2S, a re- 
cruit, admitted into hospital July 6« 1 8 16. Has suffered from 
frequent short distressing cough for several days, without ex- 
pectoration $ pain of chest and right hypochondre, the latter 
much aggravated by pressure; bowels generally confined j tongue 
loaded ; pulse full and frequent, heat uicreased. 

Mittantur pleno rivo sanguis unciae quatuordecem. 
Applicetur emplastrum vcsicatorium supra jecur. 
Capiat mox bolum e submuriatis bydrargyrl granis vj. 
Extracti convolvuli jalapas resinosi granis duodecem. 
Antimonii tartritis grani tertia parte. 
Utatur regimine disetas imo. 
7th. — Feels oetter ; bolus purged him freely ; blood drawn 
in fiiil quantity ; blister rose well. 

Sumat acidi nitrosi diluti guttas octoginta, ex aquas libris 
duabus, portionibus parvulis de die; necnon hora de- 
cubitus, et per mediam noctem submuriatis hydrargyri 
grana tria. 
8tb. — Cough a^n more troublesome, and sputum of doubt- 
ful appearance, bowels open from pills. 

iJL Mistune physeteris macrocephali sevi uncias octo. 
Tinctures digitalis purpureas guttas triginta. Fiat mis* 
tura cujus capiat $emiunciain frequentissime urgente 
tussi. 
Bis indies, sumat massas hydrargyri grana quinque^ et 
eras mane bolum mercurialem purgantem. 
9th.— Considerably better. Cough easier. Expectoration 
(when put to the test with caustic alkaline lixivium) decidedly 
purulent i is now under action of purgative. 

Repetantur mistura pectoralis et pilulas hydrargyri ut heri. 
10th.«-'Bolus gave three dark motions ; is much easier ; has 
now no pain at ude or chest ; cough still troublesome. 

Addatur mjsturas pectoralis tinctura^ sciUas maritimas drach- 
ma. 
Continuentur pilulas, necnon eras prima luce bolus purgans. 
11th.— Bdus alrei^ operates ; cough continues in slighter 
degrees, but sputum equally purulent ; pulse calm. 

Repetalur mistura pectoralis cum tinctures digitalis guttis 
quadraginta. Continuentur pilulas hydrargyri. 



rS5fr Mr.Hay'8 Caui tfCaiarrhu Hep^tUcm. Jaiy 

12th.«-BoIa8 acted freely \ boweb still open ; qpatoniy as well 
as cough, diminisbed. 

Repetantur mistura cum iincturis digitalis et scillie^ nec- 
non pilulffi bydrargyri. 
, 13th.-- SUll improving $ belly twice open« 
Repetantur medicamina ut heri. 
14th. — Much better; sputum now daily loses its purulent 
quality; belly freely open. 

Cootinuentur medicainina ut supra, et eras mane bolus 
purzans. 
15th. — Cough much easier ; sputum still somewhat puru- 
fcnt ; beHy r^ular. * 

Repetantur mistura pectoralis et pilulse hydrargyn. 
16th. — CSontinues miich better; belly still well opened. 
Addantur misturse'tincturse digitalis guttce quin^uaginta. 
Contimientur piluhe bydrargyri. 
I7tb.-— Now coughs rarely, and sputum inconsiderable ; 
mouth slightly affected. 

Q>ntinuentur medicamina ut heri. 
18th.'— 'StiU coughs, chiefly in the morning; sputum ag^^in 
more purulent'; bowekopen* 

Repetentur mistura et pilulse, et bora sonmi capiat pulvens 
niei palmati semidrachmam. 
19th««»Np sputum in last 24 hours ; powder gave only one 
motion. 

Repetatur mistura cum tinctura digitalis et scillas. Con- 
tinuehtur pilulfie hydrargjrri. ' '^ 

20th.— -Better ; cough has ceased. 

Continiientur meiSicamina ut heri. 
21 st.-^No return bf cough. 

Repetatur mistura cum tincturse digitalis gutti^ qua- 
dniginta, et tinctures scillae drachnpa. C^ntiauentur pimlae 
hydrargyri. 
22d. — Much as before \ no cough. 

Repetantur tincturm ut heri. 
23d.^— Same as yesterday. 
Repetantur pilute et mistura pectoralis cum tinclnrs? digi- 
talis guttis viginti qiiinque. ' ' ^ 
24th. — No complaint. 

Repetantur medicamina ut heri. 
25tb. — No Cough nor sputum. Boweb regular. Mouth 
blightly aflfected by mercurv. 

Intermittantur pilulaehydrargyri. 
Repetatur mistura cum tinctures dugitalis guttis duodecem. 
26th.— Well 



1817. Mr Hay's Cases of Cufmrkus HqwiHcus. S59 

Repete medicamenta ut heri. 
. 87tb.— Continues weQ. 
Discharged. 

Caiarrhus Hepaticus. 
Jaices Gatnor Matrosb» 2d Battalion Artillery, aetatis 20, 
arecniitt admitted into hospital July 18th 1816,. 

Gnnplaining of having had severe pain at riffht side, extend- 
ing np the chest, for some days, attended with teasing coush, 
with expectoration of purulent matter : pulse rather full i sLn 
oool ; tongue loaded ; belly confined. 

Sumat mox bolum ex hydrargyri subrouriatis grants quatuor^ 

Extract! convolvuli jalapas resinosi granis duodecem, 

Antimonii tartritis grani quadrante. 

I9th.— Pain, still continues^ bolus taken* not yet operated ; 

beQy confined ; has pain on pressure at liver ; pulse full and 

frequent 

Injice illico per anum dysma purgans. 
Applicetur vesicatorium supra situm jeooris, 
-Mittantur sanguinis e braraio pleno rivo unciae quatuor- 
decem, et mane vespereque ciq[>iat submuriatis hydrargyri 
grana tria. 
20th.— Blister rose; blood dark and sizy ; pun rather easier i 
cough troublesome; belly freely opened. 
Repetantur pilulae ut heri. 
21 St.— Cough still continues troublesome, and respiration 
becomes more affected; eyes suffused; tongue foul, without 
thirst ; gums affected by mercury ; all pain removed ; pulse J 02, 
]% Ma^esias sulphatis drachmas sex, 
Foliorum cassiae sennse drachmas tres. 
Fraxini omi succi concreti drachmas duas. Infunde 
in aquce ferventis unciis decem per horss quadran* 
tem et cola. Capiat dimidium statim, et alteram 
partem vespere. . 
Infricetur unguenti hydrargyri semiuncia de die. Inter- 
mittantur pilulsc. 
22d.— Had. 8 dark bilious stools from two portions of infusion, 
and seems to-day much better ; had his rest broken by cough, 
but is in all respects easier, excepting after severe fits of cough- 
ing, when his respiration becomes affected. Used in the even- 
ing saline effervescing draughts, with antimonial wine, which 
produced a soft moisture on the sur&ce. Skin to-day soft, cool, 
and moist; pulse 100; tongue cleaner, and spits much firom 
mercuiy. 

Habeat haustus efiervescentes diaj^boreticos frequenter* 
Repetatur i^guentum hydmrgyn, ^t pro potu^ 



360 Mr Hay's Cases ofCaiarrhus Ttep^Hcus. J^y 

Habeat decoctttm plantaginis ispogbalcutn radice glfcjr* 
rhizae glabr® et nitrate {lotasse, neetion bom deoibitas 
detur iterum bolus purgans. 
S P. M. — Since noon, had increase of heat, fulness and qaidc- 
Bess of pulse, and more cough, with puralent spatum, tinged 
with blood ; pain at chest and side doHng paroxysms of cotigb. 
Fiat venae sectio ad tmcias sex statkn, et detur mox bohia 
mane pra^s^criptn?. Addantur dccocto ispqgbul tindtore 
digitalis pui^pureac gutxse quadraginta. 
?Sd. — Had mocfa cough in the night, but more rest ; blaod 
drawn dark and sizy ; pulse 92 and softer; has less heat| been 
several times to stool in the day, and thrice at night ; sweated 
freely ; urine (by account) high coloured, and r^er scanty ^ 
medicines been neglected. 

Applicentur hirudines decern hypochondrio d^tro. 
Repetatur decocti ispoghul libra, enm nitratis potassa^ 
drachma, et tincturas digitaUs guttis triginta nocte maiie-^ 
que (sexaginta dedie)* 
Vespere capiat sabmuriotis hydntrgjrri grana deoem, anti-.. 
monii tanritis grant tertiam partem, e€ per noetem re« 
petatur mistura salina diaphoretica. Conttiiaetur an* 
guentum hydrargjTi. 
S4th.— Became uneasy in the afternoon } cough very trouble* 
some, and respiration more afibcted ; belty once moved in tlie 
day, and once loosely at night y leeches bled very freely ; skin •' 
cool s pulse moderate, but complains of weakness and thirst 
this morning ; says he has been distressed with pain at bMitered 
part from coughing ; had no sleep till lowfirds morning, aiid 
has no hectic symptoms ; vomited once in the evening from me-^ 
dicine^ pulse now 104 ; skin moists mouth more sore. '- 

Adhibeaturemplastrum unguenti hydrRr<;yri parti v6Bicata& 
Kepetantur bolus purgnns, decoctom ispeghnl cum 
tinctura digitalis nocte maneque, et mistUra salina din- 
phoretica Continuentur perlricationes. 
25th. — Became easier about mid^day; passed the evening 
and the early part of the night weU, but slept none uBtil day. 
break ; cough much easier ; has sense of fulness of abdomen ; bo* 
lus gave only two motions j urine frequent, but scanty ; ne 
Datisea; pulse 102, soft ; skin moist ; sputum more mtiooos. 
]^ Foliarum cassias sennae drachmas tres. 

Supertartritis potassa^ drachmas sex. Infandi» in aqa« 
ferventis unciis duodecem per gemihoram, dt cokk 
" Capiat uncias tres secundis horis. 
Repetantur perfricatioqes, decoctum cum tinctarii, et nilnile 
potassa^ bis ut stipra. - Accipiiit peranum, enema Axnes* 
ticu&if et liora somim detur bolus esL hjdnrgyn mbmo^ 



1S17* MrHi^E'ACbier^Cbtei^ SSI 

nA gnais degoirif ntiiDoiiii tertritii gnmi lertia 
parte. 
. 26tli.«-^MiiGh better; mouth more afiected, and spits mote; 
jested however < badly } ooogb leas firequettt; sptttmn more 
easy and much diminished; skin oool; pube 108, and very 
calm ; urine still hi^ colooied ; belly bar times moved id ^e 
'day siod tbrioe at night 

Peafrioentur nngoenti bydrargyri draehnue tres. 
Continuetur decoctom ispoghul, cum dncturas digitalis gattb 
triginta qamqne (bis de die) et nitratis potasse scrupulia 
doobiia. 
Recipe acidi nitfoii dilati gattas octoginta es aqoss libria 
doabnst prntionibos parvulis de die, et ntator coUaterio 
astringente* 
S7di^-^really better, eoaoh mndi removed, and greatly 
easier, expectoration veiy sli^t, and without appearance A 
pus ; pulse 92, and soft ; belfy ftedy open ; has no nneasinesa 
at side or biseast wbatever^ but rests bully atmght. 

Perfiricenturunguentihydrargjqi drachmas dnsar Continuen- 

tur alia ut heri. 

98th.*— Continues tojnmvove; pulse US, and calm ; bad five 

lig^ coloured motions with shew of slime, and at liaies sHght 

straining cough, again this morning more troublesome ; in o£er 

xespects: much as yesterday. 

Capiat nunc dei ricini drachmas quinque^ ex aqu& menthae 
piperitae. Continaentttr alia ut supra. 
Sdth. — Been easy ; had four motions from oil ; straining near- 
Iv removed ; had no cough whatever in the night, but is agun 
this morning troubled with it 

Perfricetur unguenti bydrargyri drachma. 
Continuentur alia, et eras nutne repetatur banstus okosus. 
90th«— Ibd slight return of cough in the evening ;^ofl Ukem. 

Bepetantnr medicamina ut supra. 
Slst — Had again severe cough in the evening ; feds tender* 
ness when pressed at margin of right &lse ribs; bdly twice open 
yesterday. 

Applicetur enqplastrum msicatorium supra sternum et costaa 
notbas. Continuentur alia ut hen, et eras mane haustua 



AnffM 1st— Blister rose well ; .oil taken ; cough less trouble* 

me. Continuentur medicamina. 

Sd«««»Coaiplains chiefly of weakness; oil gave three motione. 

Repetantur remedia ut supra. 
3d^«^Much better; cough lesa troublesome. 

Continuentur remedfau 
4th .—Improves ; beUy open. 
viOn xiu. «o. 51. A a 



S6S Mr Ha7*t Coses qfCatarrkus HtpaHm. Jdf 

Perf rioetur uoguenti hydnurgyri aemidracbma de die. Rcpe* 
tantur alia. 
5th.-i- Daily better ; cough easy ; ipuCQin ceased ; belly free. 
Ci^eat mox olet ricini semunciam ex aqua menUiepiperitas. 
nepetantur alia. 
6tb.-— Oil gave seven motions ; cough inconsiderable, and 
still no appearance of pus ; improves in appearance and strength. 
G>ntinuentur decoctiim, mistnra acida et unguentum ny- 
drargyri. ' 

7tbd— Cough nearly gone ; belly open. 

Repetatur deooctum cum tinctura digitalis guttis viginti 
quinque, bis de die. Continuentur ^ia. 
8th— *Complaim of sense of weaknws at right 'side; coughs 
rarely ; belly freely open. ^ 

Applieetur emplastrum ex emplastri ly ttse parte una, em* 
plastri lythargyri partibus quatuor, supra latns dextnuDb 
Continuentur alia. 
9th.— Still better ; belly twice open $ coughs but little. 

Repetautur medicamina. 
ISth.— Complains only of weakness s belly free. 
Repetantur remedia, et eras mane capiat olei ricini semunci- 
am, tinctune cassias sennas drachmas duos, ex aquae men- 
thspiperitae uncia* 
11th.— Same ; oil taken. 
Repetatur decoctum plantaginis ispoghul cum tincturse dt« 
gitalis guttis quadraginta semel tantum de die. Continuen* 
tur alia. 
12lh.«^ily draught gave three stools; regains strength. 

Continuentur remedia. 
13th.— Doing well. Repete remedia. 
14th, 15th, 16th.— Same. Repetantur remedia. 
1 7th.«T*Improving. 

Capiat pulveris rhaci palmati grana viginti quinque, potaasqe 
sulphatis grana duodecem, ex aqua. 
18th. — Powder gave six stools i cough entirely removed. 
Repetantur remedia. 
19th.«^Same. Continuentur medicamina. 
20thd— >No cough $ belly freely open. 

Recipe acidi nitrosi dilutt guttas octoginta, tinctune digita- 
lis ^ttas viginti, aquas libras duas. Fiat mistura cujus 
capiat undas quatuor temis horis, etsecundis diebua per- 
fricetur unguenti hdydrargyri scanidrachma. Intefmit- 
tantur alia. 
Continued daily to improve in health, strengthi and apfietite^ 
and was discharged on 29th August. ' > 

Si Thomat Mounts 12M September 1816. 



I81T. S^sf 



PART. IL 

CRITICAL ANALYSIS. 



Jn Essay on the Utility of Blood-letting in Fever^ lUustrated 
by numerous Cases. Second Edition. JFith a Supplement, 
containing Cases and Dissections which occurred in Private 
Practice. By Thomas Mnxs, M. D. &c. &c. Dublin, 1^16« 
8vo. pp« 927. 

WE reviewed tbb work when it first appeared, at great 
length. (&^ Jbumal, Vol IX. p. 451.) The present 
edition is increased bv a Supplement of 107 pages, containing 
24 cases of fever, whida was added in consequence of a suggee* 
tion, that a mode of treatment, successfully adopted with (he 
lower classes, would not be suited to those in a b^ter oonditioa 
ofU& 

The form and s^Ie of the appendix correspond in every respect 
with the original work ; and we rwret that our author did not 
take the opportunity of a second edition of his essay being call- 
, ed for, to render it more methodical and connected. The casea 
in the appendix are printed without attention to classification $ 
and to each is subjoined a short commentary, which arises 
out of the consideration of the history. This mijg^ht be very 
well adapted as a clinical remark to those who witnessed the 
case, but it renders the perusal of the work very laborious $ at 
the same time, it must be allowed, that it gives a very strong* 
eonviction of the fidelity and truth of the narration. 

We shall only extract Dr Mills's general conclusions : 

<< From the whole of what has been said the following infereooes 
riHiy be diawo. 
^^ 1st, Fever is an inHammatory aflectioo. 
^^ 9A, Fever is of one kind, of which there are sumy varieftiesi 



M« DrmkMtkeVtiliifrf Jdy 



^< My The Taifate depend ontheorgaii or pert pertiailBily i 
ed. 

<< 4th, Tlie following adfnatageB are to be derifed feon Uood. 
letting. Tis. 

'* A diminntion of the mortality of fever. 

<< The preserradon of the strength by the more speedy and effectual 
removal of disease, 

** The prereotion of morbid actions and dborganization in the ta- 
rioas Tiscera, in which fever may be seated. 

*^ 5th, The advantages, to be derived from blood-letting, do#ot 
depend on the quantity taken away. 

^^ The removal of pain, heat or uneasiness in the organ or organs 
diseased, is the effect to be produced. 

<' if this can be accomplished by the ab e tracU oo of a faw ounces of 
blood, any further depletion, at that time, will be injurious." p. 327. 

So far as our experience of blood-letting in contintted fever 
goes, we are nnich inclined to corroborate the practical conclu- 
•iona drawn by Dr Mills. We have not, indeed, seen it un* 
equivocidly shorten the period of the disease ; but tbe poor sel- 
dom applv for assistance until the eighth or ninth day of the 
disease, when it probably no longer admits of being cut short- 
On the other hand» we found, that the good effects of venesec* 
tion were not limited to its employment in the early stage of the 
disease, but were produced even when it was considerably ad- 
vanced, and the state of the patient aeetned to requh^ that ulode 
of depletion. Of its power in' removing pain and uneasineas in 
the head, cbe^ti or abdomen, we were perfectly satisfied ; and 
IB no insianoes did it produce any subsequent debility. On the 
eontrary, the patienta bled went through the disease mor^ 
Wittily, and recovcfred more speedily. *We had no instance of 
s relapse, and no imperfect recovery. As employed by o^ur* 
selves, we experienced no unpleasant occurrence from general 
Needing in fever, but vifere convinced of its advantages. 

In regard to the nature of the fever in which we had recourse 
k> it^ lest it ahoold be thought that it had a peculiar cfaarac 
ter, it is necessary to state, that it was the common con- 
tiniied fever which prevails in Edinburgh, more or less, al- 
most every winter i and, in fkct, the very individual disease 
fromi which Dr Cuiien and Dr Brown drew their description 
of typhnsi the very disease in which even the former, from 
ezag^rated notions of impending debility, suggissted so many 
^cautions, with respect totheemploymentof purging, and in which 
teoesection came to be totally proscribed, in consequenee of 
the doctrines of the latter. We shall, therefore, controoe to 
call the disease Typhus, the appellation by which it has always 
been known, And 6nly oautiott ourreadert, thsit we nse it strict- 



m7J JB/ood'leiting m Aver. : 9M* 

W as a proper nanie, and that we wiiih altb^faer todiniiiite it 
from the idea of debility so long associated with it ' The change * 
of opinion respecting the treatment 6f typhus in this place, frcmi 
which the doctrine of debility spread over the world, is curions « 
and instructive. Dr Hamilton, in his excellent work on pur^ 
cative medicines, with that candoar which characterizes an - 
honourable mind, gives us some information concerning the - 
treatment of typhus when he began to practise. 

** I was appointed physician to the Royal Infirmary upwards of ^ 
thirty years ago. At this time, the core of typhus was thought to ' 
consist chiefly in (he remoTal of atony and spasm of the extreme ves* 
aels of the surface of the body. For this purpose, together with 
other medicinesy weak antimonials were gtvea freely. An emetic and • 
a purgative medicine were commoiily exhibited on the first approach 
of the attack, but the state of the stomach and bowels was little fe« r 
Ipirded io the after periods of fever. An alvine evacuation was occa*' 
sioaally procured by a mild glyster^ while piirgitive0 were given with ) 
extreme diffidence, lest, by their operation, they should rivet the spasm^ 
of the ixUreme vessels, and increase debility, one of the supposed di* 
vect Qauses of death in fever. These apprehensions may still bias the . 
practice of many, as they certainly did bias mine Tor a long time.**--- \ 
p. 49, 30. '^ 

After the period Dr I^amilton alludes to, the doctrines ot 
Brown acquired an ascendancy in the minds of the students, 
and even the most &ith&l. disciples of CiiQen relinquished their, 
weak antimonials, and trusted for the cure of typhus almost 
aolely to the exhibition of stimuli. Opium, wine, and brandyj. 
were administered indiscriminately, and although it was iouiuti 
that they had not the desired efibct of precluding the acces- 
sion 6f debility, it Ivas contended that they had been exhibit-, 
ed with top sparing a band^ and that they were unable to coiin^ 
teract the debilitating effects of some injudicious treatment, or of 
insufficient diet These prejudices prevailed almost generally, 
till within these few years ; and many of those who are other-* 
wise justly considered as. among our best practitioners, canr^ 
not even now divert themselves of the fear of the debility whose 
dcstroctive power they dread in the last stage of the disease. , 

Gradually, however, the excessive and indiscriminate use oC 
stimuli was generally abandoned in this country, and relinquish- 
ed to the Italians and Germans, who had just received and 
adopted the principles of the Brunonian school with the wildest 
enthusiasm. We nave the authority of Hufeland for saying, 
that venesection was almost struck out of the list of remedies. 
All diseases were converted in the heads of physicians into as« 
tbeniscj and even in univeruties, it was maintained in theseSf that 



there wns no true inflftinmatory disease, and diat blood-Iecdng 
was useless. In Britain, the antiphlogistic treatment was intro- 
daced step hj step ; but it was for many years confined to the 
external apphcation of cold, in ,the forms of a cool atmoqphere. 
and oold adfusiont and in this way the typhus mitior was treated 
wtdi tolerable success. This treatment was, however, found 
totally inadequate to counteract the violent excitement in the 

J fellow fever, which desolated the transatlantic world, and blood- 
ettinff was tried first with cautious timidity, and afterwards with 
confidence of success^ both by American and British practition- 
ers. 

About the same time, Dr Hamilton* in the Royal Infirmary 
of this place, was laying the basis for the general introduction 
of the next great improvement in the practice of fever i and it is 
truly gratifymg to trace, in his admirable work, the steps by 
which he arrived at a firm conviction of the utili^ of a prac* 
tice at direct variance with his previous opinions, and the pre- 
inslent doctrines of this school. 

The typhus gravior had been introduced into Edinbnrffh 
by a diseased fleet, which arrived in 1781, and prevailed mr 
several years afterwards. 

^< Having been often disappointed in promoting the curs of this 
fever by means of mild antimonials, which were then so much in use, 
I was induced, by the same views which directed the employment of 
these, to use the cah onHmonn tntratOf Ph» EdituedUw mnno 1774i» 
I gave fonr or six grahis of this preparation for a dose, which was re- 
peated three or four times, at an Interval of two hours, unless sweat* 
log, vomiting, or purging, were previously excited. 

<^ I resorted to thb practice towards the termiaadon of the lever, 
and in the treatment of those patients only of whose recovery I was 
exceedingly doubtful. I entertained hopes that a favourable crisis 
night be procart-d by the efficacy of the antimonial medicioe ; and^ 
in the mean time, I thonght I supported the strength of my patients 
by the moderate use of wine. 

'^ This antimonial remedy was not ineflectnal ; but I remarked, 
that it was beneficial only when it moved the belly. In this case, the 
feces were black and fetid, and generally copious. On the dUdMi^ 
of these, the low delirium, tremor, floccitatio, and subsoltus tan*' 
dioum wfiich had prevailed, were abated; the tongue, which had 
been dry and furred, became mobter and cleaner; and a feeble creep- 
ing pulse acquired a firmer beat. 

^^ On reflecting afterwards on these circumstances, it appeared to 
me to be probable, that, as the purgative eficct of the calx antimooit 
nitrata had been t\ie useful one, any purgative medicine might be sub* 
stituted for it, and that, by this substitution, the unnecessary debili- 
tation of an exhausted patient| by swcatiug and vomiting, would be 
avoided. 

** More extended experience confirmed these conjectures ; and I 



181T. SlcoUatkigmfmr. . ^m 

vw gmdiiallgr €i«6oiinged.toig;tfe:pttrgative mOiAvm duiiilg Hk^ 
course of tjphus, from the commencemeot to the termioatioii of tho 
disease. 

^^ I Iiave directed a strict attention to this practice for a long time^. 
and I am now thoroughly persuaded^ that the fall and r^ular eya- 
cuation of the bowels reliefes the oppression of the stomach^ cleans 
<he loaded and parched tongue, and mitigates thirst, restlessness, and 
Tieat of surface ; and that thus the later and more formidable impres*' 
elon on' the nerrous system is prerented, recovery more certainly and 
gpeedily promoted, and the danger of relapsing into the fever macb 
duoMitslied* 

<^ This practice, by means of purgative medicines, does not super* 
sede other remedies employed to fulfil other indications, particttfair« 
\y the free access to pure and fresh air. I am even, ready to allow^ 
that although I exclude emetics and glysters from my general pracf 
tice in typlius fever, yet particular circumstances may arise to malMS 
both the one and the other necessary. 

' *< i cannot, however, avoid remarking, that, for many yean past, 
I have found these other remedies, aad wine in particular, to be lesa 
necessary than I formerly thonghiu This may be owing in part ta 
typhus fev^r lieing less malignant than it was some time ago, and ia 
|uirt to the purgative medicines, which i employed with fieedom, f6> 
moving and obviating symptoms of debility. If this be a just view 
of the case, the plain inference is, that while purgative medicines pre^ 
serf e a regular state of the body, they do not aggravate tho del)ilitat» 
iog efiects of fever." 

The good effects of purgatives were sp unequivocal in the 
cases reported by Dr HamDton, tbat practitioners no longer 
feared to administer thenii when indicated in typhus, and ue 
bugbear debility quickly lost half its terrors. 
• rhe success which our naval and military surgeons met with 
in treating fever in the tropics by venesection, natural^ led 
them to employ it in the ardent fever of the south of Europoy 
and there also the practice of depletion soon became general, 
almost universal. Still, however, the practice was generaUy 
supposed to be onlv adapted to the fevers of hot climates, and 
the disease was held to differ essentially in its nature from the 
continued fever of Great Britain. But, before this time, we. 
find that blood-letting had been very extensively and judiciously 
used in the treatment of what was called a remittent fever, 
which was observed frequently to recur among the tro<^ in; 
this climate. For the history of this lever we are indebted to 
Dr Thomas Sutton, * late pbysician to the foroes ; and we re* 



* A Practical Aecount of a Remittent Fever» frequently occurring among 
the troops in t^is climate; By Thoma« Sutton, M. D- of the Royal Oalle^ Si 
Physicians, London. Canter bury, 1806. pp.42, 



DrMttMllrlNrt%< M^ 



fPttdHTttie mamai^tttthk luitiag pabMhed in ftjpra*' 
viddd town, and the condoised and unpretencBng gtyle ot his 
hkfory(f f^ionld bave prevented his obsenrations nrom having 
prbdoofid the effect thejr ought to have done. Although he has 
gtven the name of remittent fever to the disease of which he 
^eitts^ It evidently was propagated by contagioUf and the remis* 
9ona da not seem to have been very different from what are 
fftan bbperved jn the biginnipg of the common typhus of this 
WMitv^ while* in every other respect, they seem to oorrespood 
perfectly s and, indeed, we are disposed to think that the md 
efims of' bioodJctting bad some share in preventing htm firom 
eo n s id ei in g it «s a typhus fever, from the general q^iikion, that 
fffdms womd be made worse by venesection* Be this as it may, 
m lis recoil the efiSects of the different modes of treating the 
flistese^ and ftrst, that which proved successful 

, << Though leversl synptoiBS of typhus may ^pear to occnr. ia this 
di sd ase;. fpr instsace, a eontidsiable debility and proatralion of 
straagl^} theconfufed slate of theaotellect, with afiectkm of the 
hesd ; the pnlse appsariag, at tunes, quick, feeble, and iolennitdug, 
Ika yet, upoa a further view of the sabject, them are maay circom« 
stances, which difier from the Inst ■wnttoaed disease, in tius fever. 
Tbs pain in the head is more* vioieat and intolemble ; a coaghaod 
affeoCion of the chest may, in most cases, by a miaute iovestigatioa, 
be discovered ; the tongne, though not in all, is early, io most of the 
casesi^much coated, and its sides and extremities eiihibit a considerable 
inflammatory redness ; the delirium is of a Tiolent kind ; the heat of 
the skin, In the paroxysms, is often intense, the iiains in the back and 
Ihnbs very great, and the disease mostly comes on with considerable 
rigors. 

^* With this train of symptoms, venesection has been found the 
most effectual means of mitigating the sufferings of the patient, and 
the most prompt and decisive remedy for arresting the progress of 
the disease, 

-. <^ The quantity of blood to be taken away, should seldom be less 
than twelve ounces, nor should often exceed twenty«four, except in 
▼ery urgent cases i nor should the cure be trusted to one or two ve. 
nesections, but the lancet should be employed once or twice a day, 
according to the urgency of the case, until a considerable ameliora* 
tioo of symptoms takes place. 

'^ The signs of amendment iv ill be a mitigation of the paibs in the 
Bead, body and limbs, and a relief of the pectoral symptoms, while 
the tongae arquires a natural appearance ; but if it remains coated 
aod red as described, though the symptoms seem to have given way, 
it often happens, timt they return with considerable violence. . For 
these appearances of the tongue indicate, that the inflammatory ten* 
deocy ia the habit remains as yet in a considerable degree. It will ' 
he often prudent^ therefore, in such cases^ to draw awajr blood in a 



iloAeffctoqtiiifil^y'lhteghiio iMu symptim wem lo demaaf lt^.«* 
pp. 18— 30; 

<^( Wko tbe tongue in fever cases liecomes brown, it is by some 
deemed an act of temerity to drair blood, as this appearance is sap- 
posed to indicate a fever of tbe typhus kind, or an approach to it. 
Tbe following cas^i of the disease will proTC^ that ^is appearance 
should not always dissuade from blood-letting. On the fifth day of 
the ferer, after /our veneseetionsj three to the extent of iwehe ounccM 
each, and one \6fifieen ounces^ the patient was in the following state: 
bis tongue mther brown ; nausea and TOmiting ; skin very hot ; de« 
lirinm: breathing short; pnlse 190; expressed himself flree ^flrba 
pain. In this state^ blood was drawn to Mriy ounces* On the foU 
lowing day, the report was, blood bnffy ; pulse soft ; tongue most 
.and not BO brown ; skin cool ; romiting abated. The patioit, in five 
days after this period, was in a state of conralesccnce.<-*In ano^ier 
case, poke coatracled; tongue ratbac brown; ^oU^iiua. The pa- 
tient was bled to fourteen ounces. On the next day, the blood was 
tough ; the delirium abated ; the patient finally recovered. — In ano- 
tiier case, on the fifth day of the dieoase, the iongue appeared bfowm 
and dry ; the pulse 190, very full ; great pain in the bead ; breallu 
ing short ; slight cough ; the patient felt faint and very debilitaled 
opon riring ; blood was directed to be dvawn to ifdriy ounces. la 
tbe course of a few hours, the report was, blood very buffy ; polae 
softer, but still fall ; breathing easief « This patient was afterwards 
lapeatedly bled, and recovered.*'— p. 94, 95. 

We bav^ now tp state the e^Escts of an opposite treatment. 

*^ When the disease is treated as typhus, and recourse is early had 
to wine, opium, bark, camphire, and other stimulants, the' following 
appearances generally occur :— -In a short time, stupor and tblirTum 
come on ; the tongue becomes brown and dry ; is protruded wift,' 
difficulty, and remains out of the month of tiie patient' with a seem* 
ing unconsciousness of the circumstance, or is withdrawn with a sort 
of trembUng involuntary effort. In a few days, the teeth are cover- 
ed with a blaekeordes, and the tongue with a black fbr, or pellicle ;' 
tbe eyes become muddy and watery; the countenance vacant ; the 
remissions of fever less perceptible ; the delirium, or stupor uoabat.' 
ed, or Incieased ; the pulse is now quick, but in such as recover sdw 
dom exceeds 190 ;. the skii^y in- these cases, is hot, a^d for . the must 
part dry and harsh, though, in some, partial, and in others profusa^ 
sweats break out without reliefl . Uoiter such circumstances, patients^ 
seldom (H>m plain of pain, or uneasy sensations'; though durrag the, 
night exacerbations there is great restlessness, and nigh deltriom.l 
With this treatment, symptoms of amendment seldom appear bcfbfe 
Ae end bfthit'seeond week, and are often slower in thtBirupproach.' 
They are' geaeraIFy introduced by some refreshii^ sleep*; when this 
skin becomes soft and moiat, the tongue pato of its dark"appcaraiice» 
and ia for toiaa days covered mlihm ropy secfelloByOeappears ct^is^ 
ed and sodAsn;. tlieflnpoi'> delirittfla,,«oid fever giadoafiy secede, and 



»)0 JkiahmOeUm^^ S^ 

icmt appetiAe for food bogins Co appear. After a tlaophcii^ fe#. 
some dajS) the nataral sensations are, in a degree, restored, thongJs 
the progress to a- perfect recotery is slow, and the health of many is 
ne^er entirely re-established. But when the disease ends fatally un- 
der this treatment, except when death happens,^ as before mentioned^ 
in an early stage of the ferer, the affectioas of the brain increase to 
a total insensibility ; the pnlse becomes very quick, small, and flat- 
tering ; the discharges of urine and feces are inrolantary ; the eyes 
sunk and dim ; profuse colliquatiTe sweats come on ; petechias are, 
sometimes, observed ; d^lutition becomes difficult, or impracticable, 
which, with a distressing hiccough, closes the scene. Sometimes, 
opon conralcsccnce, under this treatment, a troublesome cough comes 
on, and is accompanied, in some cases, by a purulent expectoration* 
In this mode of treating the disease, the cough seems to be often 
much suppressed, until couTalesccnce takes place.*' p* 10^12. 

Tbe oomparatiTe snccesa of the diflerent modes of treatmenl 
are tims sumned up : 

^< In one Instance of the occurrence of this disease, when trsated 
u Typhus, out of thirty*sef en patients receiTed into the hospitai 
eleven died. 

^* In another, where the same treatment was pursued upon a mo« 
delated plan (that is to say, without pressing the use of the bark, 
opium, wine, te* in the early stage of the disease), out of ninety*two 
patients eighteen died. 

*< In another, in which the case was treated as Synochus, wliere 
■lodeiate bleeding and eracuants were employed In the beginning of 
the disease, and the usual remedies for typhus were afterwards resort* 
ed to, the mortality was upon the average of three in twenty. 

'* By the treatment in which venesection has been relied on as a 
principal remedy, the greatest average of deaths, in any of the in« 
stances in which tliat plan of cure has been adopted, docs not exceed 
one in twenty. 

^< In the above cited examples of the comparative fatality of this 
fever, tbe disease In each appeared to be in an aggravated form, and, 
so far as could be perceived, the cases were equal in violence. Ua^ 
der each method of cmre,. therefore, at many times wliea this fever 
occurs, the mortality may be much less considerable.^ p. 16, 17. 

These obserratioiiu and ve da.not apologize SarAe leogA 
of the qnotation, are the result of Dr Sutton's pmctice in the 
military hospital at Deal during 1799, 1800, ana 1801, but be 
had previously employed it in Holland in 1794, and at Hilsea 
barracks in 1706 and 1797. We have gladly taken this oppor^ 
tunity of doing justice to Dr Sutton, as being, so far as wa- 
know, tbe first who dared to deviate from the routine prac^ce 
vfhich had resulted from an erroneous hypothesis. i 

At the same time that Dr Sutton gave a practical demon- 
etratipn of the utility of l^ood-letting in the oure of ^er^ 



fevcn, evm io* these diaialcsi Dr CIstleriHiek, in hift vahiflble 
work CD fisver, recommended the same practioe on theoretical 
groundfliy and he was more fortanate in making a considerable 
impression on the profestton ; but) as his doctrines were not ac- 
companied with the practical sopport they would have received 
from Dr Sutton's experience, had it been generally known, they 
were strongly combated by oar best systematic writers^ andf 
till lately, acted upon very partially and timidly. Mr Stevenson, * 
surgeon of the ;:.d Lancashire militia, used large and repeated 
bleedings in the treatment oFthe sick landed at Plymouth from 
Corunna in the beginning of i h09, and Dr Burnet f treated with 
equal boldness the prisoners brought to England about the same 
tame. In 1812, 181S, and 1814, Dr Dickson, | who had for- 
merly contributed so much to the extension of the depleting 
treatment in the Antilles, experienced rimilar snecess from the 
employment of purgatives and blood-letting in the severe fever 
which prevailed in the Russian fleet then on our coast. 

The experience thus derived, however, although abundantly 
extensive, was considered to be attended with sucli peculiarities 
as not to warrant the employment of the same active measures 
in the common continued fever of this countiy. Previous to 
the publication of Dr Mills's first edition, Mr Mnir § had made 
known the good effects he derived from it in a fever which pre* 
▼ailed in the suburbs of Paisley in the first months of J 8 1 1 ; but 
he seems to have used it only when the crisis was imperfect^ 
and the convalescence slow. Dr Mills did not publish till ISIS^ 
but he employed the practice extensively in the summer and 
autumn of 1810. Since that time the practice seems to have 
gained ground in Dublin. The cases in the supplement 
to the second edition of his work were treated in private by 
different practitioners, and we find, from the very candid and 
judicious report of the fever hoqsital for the year 1815, drawn 
up by Dr Richard Grattan, that other physicians of that exten* 
five establishment have^ to a certain degree, adopted the prac* 
ticectf bleeding. . ^ 



* AecMmt of the diteaie of the nek landed at Plfiiioiitli {from Coniaiia» 
Vf Richard Hooper, Esq. Ecfinburgh Medical and Sui|;ical Journal, Vol V. 
p. 408, 1809* 

'^ Olwenrationa on tlis fever wliich appeared ia tlie snay from Spain, m 
dieir return to this country in January 1S09, by James M'&rigor, M.D* Ib" 
tpector of Hospiult. Edinburgh Medical and Surgical Journal, Vci. VI. p. se. 

± Edtikborgh Medical and Surgical Journal, Vol. XII. p. 158. 

f E^burgh Msdkal and Surgical Jounial, Vol. VIII. p. 184« 



^ WStIb idi^iia4lM pmoHtit of He lut fmf iM fttm ivMdk 
fNvmitoddnringtlieiMfthfMinNiths^weM nailEi^lqr'ttiiaoMaeA 
«ctHHi of thfr brm. And fre^mitly. attended wiftli Tiolont delirian. 
In ftiMdi cve§j the.tece was iMnd and Insiied^ tlw cfes wero led, 
tkeneezNted great inlatomiice of Ught^ and oonsidqrable dtrobbtng. 
of tks temporal and carotid arteries. When the ajm^ptona had beea 
Biglectcd, the dbease proved extieniely fatal, and generally aeeaud 
to terminate by effusion in the ▼entriclea of the brain. In cases of 
fatal termination, this event was indicated by stupor, dilatibn of the 
pupils, low muttering, and other appearances of coma. When 
such were the symptoms, wine, bark, and opinm, remedies once 
8D celebrated in the treatment of fever, were altogether inadmis* 
siMe, at least in the commenceiaent of the disease, and even to^ 
wavds Us conrcinsion required to be administered with the greatest 
cantion. 

*^ The pkm which experienea proved to be most snceessful, Gon« 
sistad in moderating: the violent action of the brain, by msans of the 
various antiphlogistic remedies; but more particularly by topical 
Uood.ietting, When the excitement was considerable, the head was 
uniformly directed to be shaved* and repeatedly washed with cold 
vinegar and water. Leeches were applied to the temples, and if 
they failed to afford relief, the temporal artery was opened, and 
blood teken to the extent of from four to six ounces. By these 
means the local excitement was diminished, the symptoms became less 
Ttelent, and the patient gradually recovered ; whereas, had he been 
sUoiulated by spirituous or heating medicines, bis danger would have 
been incluased, in the exaet proportion of the means that were nsed|* 
with a view to Insure his reeovory. 

^^ Theory has at all tmes exerted a most pernicious influence over 
medieine, and profefibly a greater number of individf els have faUea 
» sacrifice to die %kny prejudices of which it is productive^ thpus 
have at any time recovered, in consequence of the advantages that it: 
affords. Indeed, of this I am persuaded, when I consider the pnc«, 
tice of the present day, and compare it with that which prevailed : at 
ilo distent period. Many of the cases for which it was necessary to* 
prbscribe blood-letting, In order to moderate the increased action of 
the vascniar system, were cases of petechial or spotted fever. Even 
In our own memory, the appearance of pctechiss was considered' «' 
symptom of the most alarming kind, and one which itidicated tho jt- 
most debility. Wine and bark were therefore given in the greatest 
poss&bie Tuautify, under the oon#tiBti«s, that they waseebssilftteiy 
mteessary to support the pateit^s strength, and obv>iate tba sActs 
of putresccncy. \ 

^ F<?rtunateiy« however, the treatment of fever b now better 
understoodi and a more rational, and infinitely more successful mode 
of pnctice is' adopted. Wine and bark are no longer considered 
essential to its t^ure^.aod ia their placa remedies of quite an oppo^te 



1^17* . 3hot^4ftl^m,Ff!9er, $f» 

utme ate adoifaiMered with tte most dedded ^faaliige. Bfti^ 
what bas most of all contributed to diminish the mortality of fetet 
18 the introduction of blood, letdog, which was, until of hite^ with 
sp little reason, so maoh dreaded, and so uaiYerpailj eensnied; 
though, at the same time, it is to be acknowledged, that theie is no 
remedy which is more frequently abose^r or which, in fe^er espeeiak 
ly, is capable of prododng more destructiTo consequences when ia« 
judicionsly employed. 

<< Of this, I had an opportunity of observing, a striking inslnnee^ 
in the case of a man, who had been blooded U> the jexteat of eight 
ounces, without appearing at the time to suffer any inconTeaienosb 
In the course of two days, hawerer, he. complained of a pain in hUi 
arm ; the puncture of the lancet had becooie inflamed ; it soon as* 
sumed a gangrenous appearance, and notwithstanding every eibft 
to arrest its progress, the mortification continued to spread, nntii It 
included the entire arm from. the shoi^der down tp the fingera, and 
even a great portion of the side, when the patient, wpm out by his 
sufferings, at length expired. 

*' It appears to me, that the aathor of the blood-letting syvtea 
has pushed his practice to an unnecessary extent, and recommends 
it too generally, which may perhaps be accounted for on the prinei* 
pie, that most persons who have suggested aoy scientific improve- 
moot, an naturally inclined to attach to it more importance than it 
wall J deserves, the interest that they take in its success, rendering 
them anxious to eaiol it to the utmost Hence, also, it sometimes 
happens, that their anxiety .defaata the viery object that they have 
in view, for, by promising too much, thoy dtsafipoint tim expe^ 
tations of those who adopt their system, which, therefOie, tboi^ 
useful to a certain extent, soon falls into disrepute^ aind is nfeglectsd 
altogether. 

** It b probable, that such has already been tie case even with 
this particular remedy, for the practice of blood.letting in fever haa 
no claim whatever to the merit of originality. It is a fhct, that 
this remedy was employed nearly two centuries ago, precisely in 
the same way, and in cases exactly simifau* to those in which it is used 
at the present day. In Riverius's practice of medicine, there is an 
account of the treatment of a fever termed *< Febris Continua ei Mom 
Ugnmi^* in which the patient was blooded repeatedly \n the ma^* 
ner recommended by the author of the essay, and eventually re* 
-covered. 

^^ Blood-letting, in fever, is, thesefore, a remedy which, havbg been 
once perhaps generally practised, was afterwards peglecied, probably 
id consequence of its being abused, and is again revived, fiat al* 
though it must ever be abused, in the hands of injudicious persons, 
yet surely this circumstance should not be considered an objec- 
tfouvtotit, nor should it on that account be less employed by prae» 
litioners ii^ cases where it is clearly .ipd)cated« Fm this woahl be 



§74 Dr Ifilb M tkeOHHly o/Bhod^kitingt ^. 'JUfy 

lBdeed| io mn into the oppoeitd extreme, tnd Terify tiie idage of^ 
Mliag into Scylto) by eDdearonring to a? oid the dangers of Cki-- 

*' Practitboen formerly erred mnch with respect to blood-letting 
in tlie treatment of fever ; for they either obstinately refased to bleed, 
•r, If the symptoms were so urgent as to admit of no other remedy, 
they generally blooded to excess. But as the injorions effidcts from 
«xoessiTe blood-letting were for the most part obrious, while pa* 
tients who had not been blooded occasionally recorered, the deple. 
ting system came into dbrepnte, and the stimulating practice was 
adopted. 

** It Is fortunate for the present time, that we now clearly per- 
ceite the advantage of pursuing a middle course ; for I am convlnoe< 
that then is not in medicine a maxim of greater practical utility than 
this^ when symptoms require blood-letting, bleed, but bleed moderate* 
fy. And in thls» I think, consists the entire merit of the system al. 
laded to, that it has directed our attention to an active and a useful 
xemedyf which our piedecessors were prevented from employing, b j 
the Infiaence of ilUfounded apprehensions resulting from erroneous 
opinions, with respect to its mode of action, and the nature of the 
dfocta that it produces.** p. 59—39. 

We may take any other opportunity of making some farther 
czlracta from the verv valuable annual reports of the Managing 
Committee of the nouae of Recovery and Fever Hospital in 
Cork Street, DoUin % but we cannot take this opportunity of 
leoommcndiiig them to genetal notice, as worthy of imitation 
by public hoflpitala in general, whose reports conmionly convey 
sio wudkal intormation whatever. 



n. 

Uiber die Kriigspesi alter und neuer Zeii mi besmderer Rudk^ 
$kht auf die Epidemie des Jahrs 1813 m TeutscUand. Von 
D. Chaxst. Wilu. Hvpbland, KonigL Preoaa. Staatarath^ 
lidbarzt, und Proiiessor der Medecin auf der Universita't zu 
Berlin. Berlin, 1814. pp. 136. 

VAer den Ansteckenden Typhus^ nehst Einigpg Wmhen sir iZr- 

eckranhmg oder giwdkhen U/gtmg der Kri^jpest, und meh^ 



1817. Hufekmd, HOdenbrand, and Richter, On Fmr, ^. s45 

renr anderer Menschenseueken. Von JoH. Val. Edlbr Voir 
HiLDSNBRAND, KaiserL Konigl Rath, tic. 8cc. Wien, 1810. 
pp. 310. 

Medizfnisci^ GeichichU der Belagtrung und Einndhme der Fes-^ 
itmg TorgaUf und Bescfireilmng der Epideme^ wekhe daselbU 
in den Jahren 1813 und 1814 herrsckte* Von Dr Geom 
August Richter, KbnigKch-Preos&ischem Oberstaabsarzt 
Berlin, 1814. pp. 158. 

Tt is singular and instructive, that a similac revolution, to 
* what we have noticed in the preceding article, but greater 
in degree, should have been taking place in Germany nearly 
at the same time ; for although we undoubtedly preceded our 
Continental brethren in relinquishing the iniproper exhibition 
of stimuli* their change of opinion seems to have been entirely 
owing to their own observation, and their dreadfully extensive 
experience^ acquired in the febrile diseases which have afflicted 
Germany, since its first invasion by the French. 

The history of this change of opinion, and of the various epi« 
demies during which it took place, has been detailed with great 
spirit and candour by the veteran Hufeland, in the ess^ v^ff 
before us, 

^* The antiphlogistic method, and especially blood-letting, now (ia 
1814) begins to be as prevalent as the tonic and stimniant plan 
was ten years ago ; and it cannot be denied, that it has often been 
very serviceable in the present epidemic of typhous fever. Much as 
the rational physician must rejuice in this change, and much as he 
must feel indebted to those who gave the first impulse to it, there is 
but too much reason to fear, that the mass of medical men who do 
not think for themselves, but servilely follow t(eir leaders, will soon 
commit the same abuses with blood-letting that they not long ago 
committed with opium. It is also very natural, that the scientific 
physician should itok himself,*— Is it possible, that the true nature of 
typhus has been so long mistaken ? Is it actually, and has it always 
been, an inflammatory affection of the brain ? And if this be the case^ 
how did it happen, that, ten years ago, it was successfully treated 
with wine and opium, and now is treated with equal, success with ve- 
nesection and nitre ?— -iiow can it be, that the same disease shoald 
be succeflsfully treated by means so diametrically opposite ?" 

It is these questions which Hufeland proposes to answer, and 
he finds their solution in a cycle, through which he imagines 
medical opinion has always revolved, but with a constantly ac* 



«M fhMktii,Wimbafa,ndnut$m . . v#l^ 



•ekratu^irelod^l aiid» Id prate Ihity lie dketchet! 
lustonr ot his subject 

*< A life is now sufficient to witness the revolution of a thoii» 
smd jean in former ages, and it is enough to have practiaed 
medicine for thirty years, to have survived the history of oar 
art for whole centuries in past times. I appeal to the teaci^ 
nony of my contemporaries, and I myself can come. fbaw)uid 
aa a wttnesa." He still recoUeets perfectly the trealoient of 
fever by his father and grandfather, both physicians of Hofr 
nuum's Hippocratic school, who treated all acute fevers in the 
bqpnning according to the antiphlogistic method, and always 
let blood in the beginning, in plethoric patients, or whope the 
bead or breast sufiered, and only had Tecourse to the pnideot 
use of stimuli, when the antiphlogistic plan did not succeed, or 
signs of debility, or as it was then called malignity, appeared* 
As this plan was successful, Hufeland adopted it, but, being 
educated by Stoll* and Uichter, he combined with it the doc- 
trine of gastricism; but he says he recollects well the great 
abuse of blood-letting by barbers and ignorant practitioners, 
when, in the beginning of his practical career, he was oonsolt- 
cd in cases of pleurisy and frensy, which had been obvioQshr 
•made worse, or even fatal, by untimely or too freouent bfeea« 
ing, and was thus convinced of the truth of theaoctrineshe 
leoeived from his teachers, that there are kinds of tiiese local fe- 
brile aftctions in which venesection is not useful, but hnrtful. 
He has lived to see the gastric and the BruDooiau periods 
pass away, and new he can almost imagine, firaa the tfa(iiM|fal- 
ins manner in which venesection is again employed, aoooraing 
to the name of diseases, without regard to the mdivi4iiBlt the 
state of the pulse, or circumstances, that he is carrkd back to 
the earliest period of his professional career. 

In further corroboration of these opinions, he sketches with 
a masterly hand, the history of opinions in regard to fever in 
general, nervous fever, and the fever attendant upon armies and 
war. In a treatiM which he published in 1799 on nervous fever, 
Hufeland stated^ as the result of his experience, that it admit- 
.ted of complications with inBammatory fever, even with, true 
active local inflammation, which required blood-Iettingt both local 
and general, even to permit afterwards the more luieral use of 
stimoii. But the stream of the Brunonian doctrine then carried 
idi before it Every thing was debili^, nothing but debili^ ;«*- 
and .even widi the strongest indicatioiis .feir y^esectijiyi^ it was 
omUied from fear of didMUi^ i insi^ of which, , thj& Miqilest 
fever was aggmvated by thflt irratiomd. use of opium into ner- 
vous and even putrid fever. At last, the voice of natore and 



coimnon wtont fxicctiwM iti I'dcomtiiMhHii^ tm mUMw^Mt 
method. Sliq;litz treated in this wsj 8'eamtini^ and (iikleflh 
brand tjphus, and afterwards Mai*cas contribute especiafiy tb 
the intmaction of venesection into the treatment of typhus. 

Fever has, in all ages, been the attendant upon war. In the 
earliest records of history, we hear of whole armies being sud- 
denly cat off by disease ; the leas accurate descripticsis of the 
classics may be passed over to sketch the pestitential fevers 
which have ooettrred during the last centuries. 

in 1516, we find that, mer a severe war whieh Maximilian 
II. wi^ed against the Turks in Hungary, a most dreadful epi- 
demic arose, which not only afflicled his army, but hud all Ger- 
many waste. It was a putrid petechial fever, with colliquative 
aweatSy and was called the Febris Ungarica. Even Cullen, who 
has classed the Morbus or Febris Hungarlca amcmg the remit- 
tent fevers, admits that the epidemic which began in the army in 
Hungary, and was spread by the soldiers returning from thenoe 
all over Germany, was a continued fever, and nearly the same 
with that which is well known to arise in military hospitals.^— 
(CulMs Nosology^ note to Typhus gramor* ) 

In 168S, a similar pestilential disease followed another war in 
Hungary, and has been described by Fr. HoflSnann* It was 
attended with the greatest langour, violent headadi, vatifo, 
^ickly succeeded by delirium, sopor and petecbim, as chief 
symptomst The alexipharmaca, th^i in use, agnavated the 
disease, and gave it a iatal tendency, and H^mann fimnd 
greatest advantage ftx>m refrigerant adds, and his bezoar powder, 
consisting of i^sorbents, nitre, and a little camphor, also 
vinegar, elder rob, and spiritus nitri diluted with water. He 
bled plethoric individuals at the commencement, and as apre« 
servative, with the greatest advantage. 

The French war in 1740 and 1750 againgetierated a pesti- 
lence, with which the masterly description of Single haft made qs 
well acquainted. BkxKl* letting was observed to be hurtful in 
this epidemic. 

The seven years war excited it once more. Baldinger treai* 
ed it successftilly without venesection, at first with emetics an4 
purgatives, then with acids, spiritus mindereri, whidi he praised 
highly, camphor and blisters, and lastly with cinchona and ser* 
pentaria. Frederic the Great, whose piercing eye nothing 
escaped, and who was so much interested in the eflects of the 
disease, has described it thus, 

^< Even the dcsofaition caused by the war, in soyen great battles, 
did not at all eqnal tlmt produced hy the coatagious disea^ in the 

VOL. xm; NO. 61. b b' 



«8 ITnfthnrtt Badrnktmi^md Bicktart . Mj 

hoi|iiteI« It mm a kindofaidMtfafer^-wlucii wm acefUBMiMBd 
with all tli6 characters of the pkgue. The patieots in the fint day of 
the diaeaie, became delirious, and got boils in the neck and under the 
arm* pits. It was of no consequence whether the physicians bled or 
not* Death carried off all who were attacked with the disease, and 
the poison was so Tiolcnt, its pro^^ress so quick, and its efiects so 
sodden, that it proved fafal in three dajs. All kinds of remedies 
were tried in Tain. At last Tomiting was had reconrse to, and that 
Sttcceoded. Three grains of an emetic were disaoWed in a meaattie of 
water, and giTcn to the patient to driak antil it began to operate: 
This proved a speeifio against the disease, and after it waa iiad le- 
course to, scarcely three of the hundred of those affected, died." 

Fro^m the oommenoement of the French revolntiony the 
beginning of a state of war among the European nations of 
twenty years duration, several epidemies have followed each 
other. In the first ten years they prevailed more in the south 
of Germany and in Italvt which was then the seat of the war. 
But it was once earned, by the transport of prisoners, to 
Magdeburg, though only for a short time, and confined to the 
places of ^xony and Bradenburg, throu^ which they passed. 
Its phenomena were nearly alike ; its character nervous and 
asthenic, and its treatment corresponding. It is best described by 
Larrey, as it occurred in the Austro- Prussian campaign of l^OS. 
He calls it, in Pinel*s new French nomencla