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THE

v •

LONDON

CAL REPOSITORY

MONTHLY JOURNAL

AND

REVIEW.

GEORGE MAN BURROWS, M.D. E.L.S*

FELL. OF THE PHYS.-MEDi SOC. OF THE UNIVERSITY OF ERLANGEN*
CORRESPONDING MEMBER OF LATHENEE DE MED. DE PARIS

AND OF THE MINERALOGICAL SOCIETY OF JENA* ETC.

AND

ANTHONY TODD THOMSON* F.L.S.

MEM. OF THE ROY. COLL. OF SURG. AND THE MED.-CHIRURG. SOC. LOND«
FELL. OF THE ROY. MED., THE PHYS. AND SPEC. SOC. OF EDIN.

AND THE SOCIETE DE MEDECINE DE MARSEILLE*

Qiiserere Verura. Horace.

VOL. VIII.

FROM JULY TO DECEMBER, 1817.

BLbntson :

PRINTED FOR THE PROPRIETORS,

By JOSEPH MALLETT, Wdrdour Street, Soho:

And Sold by

Longman, Hurst, Rees, Orme, and Brown, Paternoster Row;
Anderson and Co. Edinburgh; Cumming, Dublin ;
and Edwards and Savage, Cork.

1817.

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CONTENTS

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VOLUME VIII.

PART I.

ORIGINAL COMMUNICATIONS.

PAGE

1. Retrospect of the Progress of Medical Science

from January to July, 1817* - - 1

2. Synoptical View of the State of the Atmosphere, &c. in

London, between the Ipth of November 1816, and the
20th of May 1817 - - - - 66

3. Nosological Table of the aggregate of the Cases recorded

in the Monthly Registers of the Repository of the Dis¬
eases of London, between the 20th of November 1816,
and the 19th of May 1817 - - - 67

4. *— 5. Quarterly Review of the Diseases of the Boys in

Christ’s Hospital, by Henry Field, Apothecary 80, 302

6. A Sketch of the Human (Economy, by a Member of the

Royal College of Physicians in London - 83, 97

7. Some Observations relative to the new Method of extract¬

ing the Cataract as proposed by Dr. Loben stein Lobel,
by Edward Chapman, Surgeon, Bath - - 88

jS,

CONTENTS*

page

10.

11.

JL /Srf •

13.

14.

15.

16.

17-

18.

19-

go.

A Case of Ruptured Uterus, where Part of the Foetus
was extracted through the Parietes of the Abdomen,
by J. H. Brock, M.D. Mansfield, Nottinghamshire ;
Member of the Royal College of Surgeons, London :
communicated through Dr. George Pearson - 110

A Case of Demonomania, by Edward Oakley, Hospital
Assistant, Hilsea, and Member of the Royal College of
Surgeons, London - - - - 113

An Essay on Diseases resembling the Venerea! Disease,
by Whitlock Nicholl, M.D. Ludlow, Shropshire,

117, 187, 27 3, 361

Observations on the Function, and some particular States
of the Organ of Hearing, with a Description of a
Newly-invented Instrument for Puncturing the Mem-
brana Tympani, by Jacob Vale As bury. Member of
the Royal College of Surgeons, and Licentiate of the
Society of Apothecaries, London - - 199

Explanations of Opinions and Practice respecting the

Yellow Fever of the West Indies, by Morgan Thomas,
Woolwich, Kent, Surgeon of the Royal Artillery 20 5

A Case of Catalepsis Verminosa cured by Oleum Terebin-
thinae rectificatum, by F. Weaver, Walsall, Surgeon 209
A Case of Imperforated Hymen, by R. H. Hooper,
Downton, Wilts, Surgeon- Apothecary - - 211

A Case of extraordinary Accumulation and Retention of
Urine, by J. G. De Merveilleux, Jun., Stamford,
Lincolnshire, Member of the Royal College of Sur¬
geons, London - - - - 212

Letter from Mr. Richard Rawlins, Surgeon, &e. Oxford,
to one of the Editors, on his Invention of the Reflected
Forceps ----- id.

An Explanation of Dr. Davis’s Craniotomy Eorceps ( with
a Plate ) - - - - - 214

Observations on Serous Effusion, by Edward Chapman,
Bath, Surgeon - - - - - 283

On the Cure of Bronchocele by Pressure, by James Hol¬
brook, Monmouth, Member of the Royal College of
Surgeons, London T 28S

Further Observations and Experiments on the Motion of
the Blood, by Charles Hastings, Edinburgh - 291

CONTENTS.

PAGE

J21. A Case of Aneurism from a Puncture of an Artery in the
Operation of Bleeding, by John Dunn, Pickering,
Yorkshire, Member of the Royal College of Surgeons,
London - *■ ^90

gg. A Case of Puerperal Convulsions subsequent to Partu¬
rition, by Wiliam Gaitskell, Rotherhithe, Member
of the Royal College of Surgeons and of the Society
of Apothecaries, London - 303

23. On the Craniotomy Forceps of Dr. Davis, in Reply to

Mr. Rawlins of Oxford, by David D. Davis, M.D.
Physician to the Queen’s Lying-in Hospital, to the
Lying-in Charity, &c. &c. - 373

24. Cases of Hernia Cerebri, with Remarks, by Richard

Moyle, Jun., Penzance, Member of the Royal College
of Surgeons, London _ - - 384

2.5. On the Effects of the Nitro-Muriatic Acid Bath in several
Surgical Diseases, by G. J. Guthrie, Deputy Inspector
of Military Hospitals, Lecturer on Surgery, &c. &c. 449

26. Observations on some Points of Difference which obtain

betwreen the Endemial Fevers of Marshy Soils and the
Yellow Fever or Inflammatory Endemic incidental in
the West Indies to New-Comers from Temperate
Climates, by Nodes Dickinson, Member of the Royal
College of Surgeons, London, Surgeon to the Forces,
and Member of the Medico-Chirurgical Society 4®2

27. Observations on the Plague, communicated by Henry

Robertson, M.D. ‘Coll. Med. et Academ. Ion. S. in a
Letter to Dr. M'Mullar, Physician to the Forces, &c. 473

28. Observations on Gout, by William Coombs, Bath, Mem¬

ber of the Royal College of Surgeons, London 479

AUTHENTICATED CASES, OBSERVATIONS , AND DISSECTIONS.

29. A Case of Cough with Watery Expectoration - 304

30. A Case of Cephalalgia - 393

31. A Case of Podagra - - - 399

32. A Case of Rleuritis, attended with Abscesses within the

Pericardium 3 6.

33. A Case of Ascites terminating in Paralysis and Apoplexy id.

34. A Case of Thoracic Inflammation - » 484

CONTENTS.

PART II.

ANALYTICAL REVIEW.

1. Majendie’s Elements of Physiology, Vol. II.

2. Parkinson’s Hospital Pupil

3. Marshall’s Remarks on Arsenic

4. Spurziieim’s Observations on Insanity

5. Dewar’s Account of an Epidemic Small Pox

6. Blaine on the Diseases of Dogs - -

7* Bancroft’s Essay on the Yellow Fever

8. Medico- Chirurgical Transactions, Vol. A lii. Part 1.

9. Mayo’s Remarks on Insanity

PAGE

131

143
149
217, 305
240
331
401
417,519
485

10. Forster’s Observations on the Casual and Periodical Influ¬

ence of particular States of the Atmosphere on Human
Health and Diseases, particularly Insanity - 497

11. Forster’s Observations on the Phenomena of Insanity 498

12. Report of the present State and Management of the Hos¬

pitals for Insane Persons at Paris - - 499

13. Marcet on Calculous Disorders - - - 501

PART III.

SELECTIONS,

1. Ainslie on Balsam of Peru in Phagedenic and Sphacelous

Ulcers ----- 341, 524

2. Extraordinary Case of Miss Mc Evoy , a Blind Young Woman

who read by the Points of her Fingers * 424

PART IV.

FOREIGN MEDICAL SCIENCE AND LITERATURE.

ANATOMY, PHYSIOLOGY, PRACTICE OF MEDICINE, AND SURGERY.

Granville on the Present State and Progress of Medical Science

in France - - - - 164, 24 6, 346

Carradori on the Respiration of Tortoises - - 170

Brugnatelli on the Efficacy of Hydro-chlorine for Preventing

and Curing Hydrophobia - - - 1 71

Jasinsky s Case of Chronic Trismus * - 348

CONTENTS.

vii

PATHOLOGY.

Breschet on a Polypous Tumour in the Stomach
Hebreard on a Scirrhous Tumour of the Brain
Weber on an Uncommon Petrifaction of the Heart
Esquird on Epilepsy « - . ;

PAGE

25o

351

428

430

MATERIA MEDICA AND CHEMISTRY.

Pelletier and Majendie s Analysis of Ipecacuanha
Cadet on a Bark resembling that of Cinchona -
Sertuerner’s Analysis of Opium - ■*

252
350
433, 528

PART V.

MEDICAL AND PHYSICAL INTELLIGENCE.

Royal Society, Proceedings of = « - 175, 260

Linnaean Society, Proceedings of - - * 175

Eighth Report of the Associated Apothecaries and Surgeon-

Apothecaries of England and Wales - - 2 60

Proceedings of Associated Apothecaries, &c. - 262

Report of the Society for the Benefit of Widows of Officers of

the Medical Department of the Army - - 9d

Resolution of the Worcestershire Medical and Surgical Society id.
Report of the Society for the Relief of Widows and Orphans of

Medical Men in London - « - 438

Case of Her Royal Highness the late Princess Charlotte of
Wales -

List of Certificated Apothecaries for 1817 -

Medical Information -

Surgical Information - *

Chemical Information -

Pharmaceutical Information

Botanical Information -

Physiological Information * -

Pathological Information - -

Medical Statistics - - - -

CQrrection of Errata in Mr. Good's Nosology

53 4

177, 264, 439
178, 352
178, 440
353, 442
442

- 353

439
354
» 91

CONTENTS.

Vlil

PAGE

Miscellaneous Intelligence - 91, 179; 356

Literary Intelligence - - 96, 184, 272, 356, 44 3, 540

Prize Questions of Learned Societies - - 176, 177

Notices of Lectures - 96, 265, 270, 360, 44 3, 539

Meteorological Table kept at Richmond Q2, ISO, 266, 356 , 444, 540
Meteorological Table of London 1 03, 181, 26 7, 357,

Weekly Rill of Mortality for London ( 44 5, 541

Registers of Diseases in London 94, 182, 268, 858, 446, 542

Observations on Prevailing Diseases in London

Quarterly Prices of Substances used in Pharmacy 270, 544

Quarterly Prices of Phials - * - 271, 545

Monthly Catalogue of New Books
Notices to Correspondents

}

96, 184, 272, 860, 448, 546

f 95, 183, 2 69,
t 359, 447, 543

PLATE,

Dr. Davis’s Craniotomy Forceps - - * 214

CORRIGENDA.

Page 70 line 7 for Davies read Davis.

— _ 30 for tenacity read tenuity.

83 Sc 97 — 1 for The History read A Sketch.

. 181 — 7 for 229 read 29».

462 — 9 from bottom for Endemics read Endemic*

46(5 — 2 - for human read known.

467 — 12 — — for every read very.

THE

LONDON MEDICAL

DEPOSIT

No. 43.

JULY 1, 1817.

Vol. VIII.

RETROSPECT

OF THE

PROGRESS OF MEDICAL SCIENCE,

FROM JANUARY TO JULY., 1817.

Si Ye deest quicquam, sive abundat.

Cic. de Div . i. 29.

O history can be regarded as either extremely interesting
or very instructive, unless the historian occasionally assume the
robe of the censor, and pass judgment upon the character of the
transactions which he narrates. Impressed with the correctness
°'l l^is observation, we have, hitherto, in our Retrospects, which
nay be regarded as approximating to something like the His-
lC,ry Q1 Medical Science for the periods they embrace, not
routined ourselves to naked details of facts; but have endea¬
voured to examine critically, yet impartially, the value of the
v -Tei ent opinions and suggestions that have progressively ap¬
peared ; to dispel the clouds of error, and to shed the beams of
tcutn over the path which' we have attempted to trace.

In prosecuting this plan, it might be expected that, before
taking up the more particular objects oi our task, we should
oiler some opinion regarding the transactions of various public
bodies, connected with the improvement of the profession, and
particularly those of the Apothecaries Society, as far as they
have been brought before the public *> With regard to the

* v 1(le A Statement ofCirciLrnsianc.es connected with the Apothecaries
Act, and its Administration. By G. M. Burrows, M.B F I, S
London. ] 817-

vol. VIII, — no. iX

2 Retrospect of the Frogrcss of Medical Science .

latter, however, we refrain from giving any opinion at present,
because we look forward to the consideration of the subject
in a general meeting of that branch of the profession which is
particularly interested, and we have no doubt of the pro¬
priety of the judgment that will then be pronounced. The
community, however, is deeply concerned ; and if its con¬
fidence in those whom it was led to regard as the guardians
of its welfare, in what appertains to the preservation of
health and the cure of diseases, be shaken, it must look to
other sources for those benefits which have been already in part
sacrificed, and are likely to be altogether lost in the eager cu¬
pidity for gain of those by whom they were, fondly, expected to-
be cherished.

Of the observations on the Surgeons’ Bill, and the mo¬
tives which we conceive have influenced much of the oppo¬
sition it has experienced, we have already given our opinion*.
The Bill itself is certainly more liberal in its principles than that
which was brought into Parliament some years ago f, and pro¬
perly rejected ; and as there is reason for believing that those
to whom its administration will be confided are actuated by an

ardent zeal for improvement of their profession, we might be
led to expect many salutary effects to result, both as regard
surgery immediately, and ultimately the welfare of the public,
% securing to that branch of practice, if not a greater com¬
bination of talent, at least a richer store of information than it
has ever yet been able to boast. But circumstances are not
wanting to rein in our expectations on this point. One of the most
important memorials against this Bill, is that from the Univer¬
sity of Glasgow j ; and as far as concerns the just claims of that
Learned Body, and its right to grant licenses to practise surgery,
the arguments are too forcible to be neglected. One remark of

* Vide Repository, vol. vii. p. 498. T Ibid. vol. v. p. 26l.

J Vide Medico- Chirurgical Journal and Review, voh iii. p. 5lf} - —
As our limits prevent ns tram transcribing the whole of this memo¬
rial, we will endeavour, for the satisfaction of our readers, to ex-

Iietrospect of the Progress of Medical Science • 3

f lic memorialists we think worthy of repetition ; and the more
so, because a very mistaken disposition for fencing, as it is
termed, the respectability of professions, by augmenting the
-fees of admission to practise them, has lately too generally pre¬
vailed. “ Every thinking man,’’ they observe, “ must be sen¬
sible, that the greatest favour which learning can receive, or
government can bestow, is to keep the expense of education
.moderate.”

We might close these prefatory remarks by noticing the
publication of a second edition of Mr. Parkinson s Hospital
Pupil, a work well calculated to improve medical education

tract its substance in as small a compass as possible. It states, in the
first place, that the foundation charter of the Glasgow University,
which was granted in 1450, by the Pope, at the request of James
the Second of .Scotland, has been since frequently recognized and
confirmed, and by recent transactions between the Government and
the University, “ has become a law of the .land.” That that charter
conveyed to the University the right of granting brevia or licences ,
authorizing those who hold them u to exercise their respective
faculty or art throughout Great Britain and Ireland andalthough
the granting degrees in medicine at Glasgow was not pracused until
1/20, owing to no professorships of medicine having been establish¬
ed there before 1 7 1 G ; yet, since that time, <c the conferring medi¬
cal degrees has been regular and frequent. , That a professorship of
surgery in the University was a year and * half ago established and
endowed by the crown, and thence the University conceives that it
is, consistent with its oath de Jideli , obliged to grant diplomas in sur¬
gery. That proscription cannot be pleaded against the University,
b( -'cause, by having continually exercised their privilege of granting
brevia in any one faculty, they have “ secured their right to exercise
it in all.”

The memorial next proceeds to shew, that the establishments of
the University in the medical department are nearly complete; that
their professional chairs have been filled by such men as Cullen,
Slack, Robison, and Irvine; and the studies connected with medical
science have been recently much advanced by the establishment of
an Infirmary, by Dr. William Hunter’s richly stored Museum be¬
queathed to the University ; and by the addition of a chemical la¬
boratory and an anatomical theatre : improvements which had prov¬
ed expensive to the University, but had increased the number of
medical pupils resorting to it, from thirty or forty annually to be¬
tween three and four hundred. But if the right of granting diplo¬
mas in surgery be taken away, all the other advantages will be
insufficient to secure the resort of students to Glasgow, and thence
the University must suffer.

Re trospect of the Progress of Medical Science .

but as we intend, at an early opportunity, to present our readers
with an analysis of the work, we shall at present defer bringing
forward our opinions on the subject of which it treats.

ANATOMY

PHYSIOLOGY, AND PATHOLOGY.

In the short periods of time which our Retrospects embrace,
we cannot be expected to be always able to record improve¬
ments in every branch of medical science* or even to have to
notice the publication of many new works. No treatise ex¬
clusively on Anatomy has appeared during the last six
months ; but the controversy between Dr. John Gordon and
Dr. Spurzheim, regarding the claims of Professors Gall and
Spurzheim to discovery in the anatomy of the brain, has
excited considerable interest. We believe the following are
the circumstances connected with that discussion : About the
end of June last year Dr. Spurzheim having repaired to Edin¬
burgh, took an early opportunity of giving a public demonstra¬
tion of the brain, at which manv eminent anatomists were
present; and among others Dr. John Gordon, who is supposed
to have written the criticism on Dr. Spurzheira’s Physiognomi¬
cal System in the Edinburgh Review, in which, besides hold¬
ing up to derision the physiological and physiognomical doc¬
trines of that work, he depreciates the anatomical views
of Gall and Spurzheim. To afford to Dr. Gordon an op¬
portunity of defending his opinions, Dr. Spurzheim consented
to give a second public demonstration at Edinburgh, and to
enter into a disputation with his adversary; but as too much
warmth of temper was displayed at that exhibition to permit
the question to be properly settled, Dr. Gordon, early in this
year, published “ Observations on the Structure of the Brain*,’’
in vfiiich an attempt is made to estimate the claims of Drs. Gall
and Spurzheim to the title of discoverers ; and wras answered
by Dr. Spurzheim in a pamphlet, containing an “ Examination
of the Objections made in Britain against the Doctrines1’ of him¬
self and his coadjutor Dr. Galbf*.

Dr. Gordon in his introduction states it as his opinion, that
the general ignorance of medical men, as far as regards the
minute anatomy of the brain being “ favourable to the progress

* Observations on the Structure of the Brain , &c. By John
Gordon, M.D. F.R.S.E. Svo. pp. 215. Edinburgh. 1817-

f Examinations of the Objections made in Britain against the Doc¬
trines of Gall and Spurzheim . By J. G. Spurzheim, M.D. Svo. pp,
87. Edinburgh. 1817.

Retrospect of the Progress of Medical Science.

<A any hypothesis respectingthe structure of this part of the hu¬
man frame,” may be ascribed to this cause: 44 the support, with
which the alleged discoveries of Drs. Gall and Spurzheim are
said in several places to have been honoured.” He disbelieves
them ; and adds, speaking of their authors, 44 that the descrip¬
tions which they have derived from the writings of other anato¬
mists, and which they have sometimes modified, but never im¬
proved in the transference, make up the whole portion of truth
which this new system comprehends.” (p. 5.) As this is a seri¬
ous charge; let us examine briefly the manner in which it is
supported, and in which the accusations are rebutted by Dr.
♦Spurzheim. It is requisite, however, first to notice, that, as con¬
taining the most complete summary of the doctrines which he
examines, Dr. Gordon has printed, in the Appendix to his
volume, a literal translation of the article Cerveau , in the 4th
volume of the Pictionnaire des Sciences Medicales, which was
written by the German professors themselves, and bears their

_ _ _ j.

signatures.

Dr. Spurzheim does not notice in his reply any of the gene¬
ral charges of plagiarism in Dr. Gordon’s Introduction, but
descants on an observation of his opponent, that although a
minute knowledge of the brain may be important in a physio¬
logical point of view, yet, 44 it is fortunately not of essential
consequence in the practice of medicine.” We do not, how¬
ever, think he lias satisfactorily proved the reverse of this po¬
sition ; more particularly as he assumes, as the foundation of his
arguments, that 44 the brain alone explains the various instincts
of animals, the innateness of genius, and all the modified mani¬
festations of the human mind,” each of which he asserts has its
appropriate part in the brain ; positions which, to speak in the
.east objectionable manner regarding them, are certainly not
generally admitted. ’ ‘ '

Dr. Gordon commences his investigation by examining the
statement of the professors, 44 that the while substance of the
brain is fibrous in its structure.” He admits the fibrous struc¬
ture of this substance, but denies that it can be rendered dis¬
tinct to the naked eye, even by scraping , a method of demon¬
strating it, which, although claimed by Drs. Gall and Spurz¬
heim as their own, was employed by Vieussens : but he pre¬
fers Reil's method of hardening the brain in alcohol and other
media. He charges the Professors with affirming, that the fact
of the fibrous structure of this part of the brain 44 was known
to few anatomists and gives extracts from Malphigi, Vieus¬
sens, Haller, Mayer, Reil, and Portal, to prove their acquaint¬
ance with the fact; while he taxes Dr. Spurzheim with having
denied, at his second demonstration, 44 that he had ever affirmed
that the white substance of itself, unmixed with the grey, pos-

i> JiETROspjscT of the Progress of Medical Science :

sesses (( any such structure/’ He condemns the Professors for
styling the cineritious substance inorganized, adding the evi¬
dence of Iieil and Soemmerring in proof of its fibrous structure ;
and he regards their hypothesis, “ that the use or function
of the grey substance , every where, is to form the white, f
as 64 absurd,” and unsupported by u the shadow of a
proof/’ In answer to these accusations Dr. Spurzheim denies
that he and Dr, Gall ever thought of maintaining that the
fibrous structure of the brain was unknown before their times,
and refers to quotations in their work of authors who knew the
fact ; but he does not notice the charge regarding their hy¬
pothesis of the formation of the white substance.

Dr. Gordon next examines the opinions of his opponents
respecting the fibres of the brain; and regards their assertion,
46 that the diverging fibres of the cerebellum take their origin
from the grey matter lodged in the interior of the medulla
oblongata/1 as a mere assumption. He thinks it is impossible
4,4 to trace any fibres, either from the corpus restiforme, or from
any other part of the medulla oblongata, into the corpus
dentatum,” as described by Gall and Spurzheim ; denying
that the corpus dentatum is a mass of grey substance : but
affirming that it is a nucleus of white nervous matter, suiv
rounded 44 with a thin capsule of brown /’ that no nervous
bundles enter or leave it ; and that there is no correspondence
in size between its projections and the laminae of the cere¬
bellum ; while at the same time he maintain-, 44 that there is
no such system of diverging fibres in the cerebellum as Drs.
Gall and Spurzheim have described and that their system of
converging fibres is equally visionary. He adds, that when
Dr. Spurzheim, at his second demonstration at Edinburgh,
was urged to demonstrate these parts, he excused himself, 44 on
the ground that the cerebellum had already been too much
destroyed by the previous stages of dissection but they have
not been demonstrated by them to any anatomist in this
country, and were not endeavoured to be displayed to the
Committee of the French Institute. In reply, Dr. Spurzheim
maintains that he displayed all these parts at his second public
demonstration, and that they were seen by every one present
hut Dr. Gordon; and fairly offers to shew the set of fibres
which bring the cerebellum into communication with the
medulla oblongata to any one who shall procure a fresh brain* :
but his statement is weakened by some personal reflections on

* It is but justice to observe that one of the Editors of this
Journal, along with Dr. Pearson, and twelve other Gentlemen, had
these, parts most clearly pointed out to them by Dr. Spurzheim, in
London.

Retrospect of tke Progress of Medical Science. 7

his opponent’s faculty of vision, which he has imprudently"
allowed himself to employ : indeed we have to regret, for the
sake of truth, that the vein of personal attack which runs
through the whole of this pamphlet, is very likely to injure
the cause it is meant to defend, in the opinion of the majority
of its readers.

Having finished the examination of the cerebellum, Dr.
Gordon proceeds to that of the Brain proper. In treating of the
diverging fibres, he refuses to his opponents not only the merit
of discovering the decussation of the filaments of the pyramidal
eminences, as that was known and described by Mistichelli,
Francis Petit, Santorini, and others, from whose works be
quotes largely; but even he will notallow them the merit, which
the French Commissioners admitted, of having recalled the
attention of physiologists to that fact. He denies that there is
any proof of the fasciculi from the pyramidal bodies receiving
reinforcements “in their progress through the annular protu¬
berance and that I)rs. Gall and Spurzheim ever traced these
fasciculi accurately through that protuberance: and he ascribes
the revival of the investigation of the librous structure of the
brain in modern times altogether to lieil*. He, also, accuses
his opponents of having taken no notice of the numerous
“ delicate filaments of white substance, which shoot out front
the anterior radiations of the crura into the inner bulbous part
of the corpora striata, and are there entirely lost;” because
such a distribution is 44 quite irreconcilable with their system
of continued reinforcement.” He states, that, at his public
demonstration, Dr. Spurzheim was not able to shew the fibrous
structure of the white bands of the corpus striatum, although
nothing is more easy, if the brain be prepared according to
Reifs method; and, when requested to trace them into the
grey substance, that he asserted he had 44 nowhere professed in
his writings, that he could trace the fibres, either of the diverging
or converging system, farther than the bottom of the convolu¬
tions,” an assertion at complete variance with the passages
quoted by Dr. Gordon from his physiognomical work. The
inaccuracy of their account of the second set of diverging fibres is
also pointed out; and the impropriety of regarding as gangleons,
the corpus olivare and the optic thalami, are commented on.
There is a great deficiency in Dr. Spurzheim’s reply to these
charges ; many of them are scarcely noticed ; and a considerable
portion of the section is taken up with the account of a dissec-

f Iteil published an essay suggesting his first ideas on this sub¬
ject in Gren's Journal for 1795 ; and the final results of his investi¬
gations in the Archives of Physiology for 1809 and 1812.

& Retrospect of the Progress of Medical Science ,

tion of a hydrocephalic brain, in the Edinburgh Infirmary’*
which was so conducted that neither the pupils, amongst whom
Dr. Spurzheim had placed himself, nor the Doctor, could
see what was going forward ; and the blame of 64 preventing
this case from receiving its proper publicity f is of course
ascribed to Dr. Gordon. He is more successful in refuting the
charge of plagiarism, and shews pretty clearly that lieil rather
owes his views of the subject to Gall, than that the professors-
have defrauded him. He lias also succeeded in refuting the
charge, that he had denied 44 that the white substance, apart
from thegrey,” exhibits a fibrous structure; and asks, “is not the
whole order of our converging fibres white r" and also the
carpus callosum, the fibrous structure of which he had demon-
strated.

With respect to the converging fibres. Dr. Gordon proceeds
to shew that the statement of the professors, which assumes that ?
in conjunction with the diverging fibres, these make up the
convolutions of the brain, is a mere chimera, and utterly
incapable of demonstration ; and that their hypothesis of the
convolutions being each composed of two laminae of fibres,
joined together in the middle by a mucous nmrikma. , is as
unsubstantiated : the experiments attempted in order to de¬
monstrate it being inadequate, while the separation is equally
easily effected at any part of the convolutions as at the median
line, where the professors assert the layers are united by a
■mucous jieurilema , or very fine cellular tissue. The fallacy of
this hypothesis being proved, that which ascribes to the fluid
in hydrocephalus the separation of these laminse, must appear
equally futile, and Dr. Gordon advances sufficient arguments
to prove its insufficiency. The separation of the laminae, he
observes, could not be effected without lacerating the substance,
every where intervening between the ventricles, 44 and the
bottom of the convolutions,^ which is never remarked to be
the case in hydrocephalus, and 44 could not occur without
rupture of vessels and fatal haemorrhage :,J for were the con¬
volutions merely split by the distending powers, they would be
found in every state of separation ; but long after they become
shallow , they are found solid : and he further contends, that the
assertion that 44 there is no loss of substance in a hydrocephalic
brain in any stage of the disorder, is a position not only without
proof, but demonstrably incorrect.'’ In answer to these various
objections, Dr. Spurzheim maintains that each convolution can be
easily separated in the middle line, and unfolded into two layers;
but he deserts the position that the laminae are united by a neuri-
lema ; stating that this had never been positively asserted, and
that the answer to a query of the French Commissioners, on this
point was— line adherence de contiguite entretenuepeid-etrcpar

Retrospect of the Progress of Medical Scieiice. 9

chi tissu ceilulaire.” It certainly is of little consequence whether
the laminae are thus agglutinated, if they can be unfolded. He
still defends the opinions of Gall and himself, regarding the
the state of the brain in hydrocephalus, and thus explains the
changes which take place: “ The principal changes take place
in the corpus callosum, its appendices, and the convolutions of
both hemispheres. The corpus callosum is entire, and lifted up
towards the top of the head, the falx is elongated, the convo¬
ke dons sometimes quite distended like a thin membrane of
cerebral substance, from within white and horizontal fibres,
and covered on the external surface with cineritious substance.
The distension, however, is not mechanical, but also vita! and
susceptible of modifications, on account of the continual de¬
composition, and new composition which take place in the
organization in general.” The accuracy of this explanation has
still to be confirmed by future dissections, and accurate exami¬
nations of hydrocephalic brains. The remainder of Dr. Gor¬
don’s book is occupied with remarks on Dr. Spurzheim’s plates,
which we do not think of sufficient importance to notice : indeed,
we would not have commented at all on this controversy, if it
had involved merely a question of difference of opinion between
the disputants ; but it is of the first importance to elicit truth
on every subject connected with the animal eeconomy, and we
know of no method by which it can be so effectually accom¬
plished as by raising doubts, and exciting discussion.

Mr. Charles Bell has thrown out some hints on the structure
of the cranium, to shew that its form and joinings prove design,
although they have been attributed to accidental circumstances*.
He compares the sphenoidal bone to the tie beam of the center¬
ing of an arch ; intended to counteract what is termed a
horizontal thrust, and to prevent the lower part of the parietal
bones from being thrust outwards; a security which is chiefly
affected by the tranverse position of the sphenoid, “and the
strong embrace of its aim upon the edge of the parietal bones.”
He conceives there is a strict analogy also betw een “ the man¬
ner in which the parietal bone sits down upon the temporal
bone,” and the graining, “ which is the foundation of a wall
in masonry the temporal bones resembling the abutments
of the arch of the parietal bones. The skull, therefore, being
built as it were on the principles of an arch, we see the reason
“ why a man falling upon his head,'” or struck on the vertex,
<£ doe3 not suffer at the part struck, but has a fissure in the
temporal angle of the parietal hone.” The sutures he regards
as joinings by dovetail, or tenon and mortoise; and there is

* Vide Surgical Observations, by Charles Bell, vol. i. p. 478.
—no. 4T

VOL. VIII.

10 .Retrospect of the Progress of Medical Science.

evident design in these indentations being on the outer table
only of the skull ; for as the inner table is more brittle, it “ is
unnt for this form of union."’ These illustrations are taken
from the work of the mason and carpenter ; but, (we think it
is an observation of the illustrious Boyle,) 64 much philoso¬
phy is to be acquired in the work-shop of the artisan.”

The importance of morbid anatomy in

eases, and thence, establishing

elucidating* dis*

more successful methods of

treating them, becomes every day more obvious, and few
practitioners now neglect the opportunity of examinations post
mortem. Many very valuable cases of morbid dissection are
recorded in the volume of the Repository which we just closed* * * §.
One of these, detailed by Dr. Granville , proves that there was
at least some foundation for the statement of several of the
older anatomists relative to the existence of a particular duct,
for conveying the secreted bile from the liver immediately into
the body of the vesicula fellis*E Another by Mr. Parkinson
demonstrates in a striking manner the incorrectness of Dr,
Spurzheinfs opinion, regarding the integrity of the brain, how¬
ever much it may be distended, in hydrocephalus, whilst the
intellectual faculties remain uninjured f Some practical sug¬
gestions on the treatment of this disease have arisen from
the dissection of a case of hernia of the dura mater, detailed by
Mr. Earle jj. The hernial sac, which was ten times punctured,
and a considerable quantity of fluid drawn off from it, was
found on dissection to communicate with the ventricles, from
which the fluid had been evidently supplied. That the
difficulty of lying in a completely horizontal position, on
either side, is not always an attendant of hydrothorax, is
Illustrated by the appearance found on the dissection of
a case of dyspnoea, recorded by Bit Letlsom§: a pint of
limpid fluid was found in the left sac of the pleura, and
two ounces in the pericardium. In the dissect ion of a fatal
case of abscess of the lungs, which had burst externally, and
rendered carious the ribs, Dr. Johnson found masses of calca¬
reous matter in the abscess, which 44 appeared like broken pieces
of arborescent coral,” and 44 lay partly loose, partly ramified
through the other substance.” The roots of the pulmonary
artery and veins were partially ossified. The liver, which was

* Vide Repository, vol. vii. p. (J2, 101, lip, 120, 27S, 287, 380,
375, 42 6, 46*9, 526. ?

t Ibid. p. 158. :J: Ibid. p. 208.

j| Mcdico-Chirurgical Transactions , vol. viii.

§ Vide Trans, of ike Med. Society of London , vol. i. part u.
art. p. ■ t

Retrospect of the Progress of Medical Science . XI

very large and much diseased, appeared to have been the pri¬
mary seat of disease*. The following remarkable appearances
in a case of dropsy were observed in a dissection of the case by
Bezard. The peritoneum was found to be three lines in thickness,
cartilaginous, and resembling at first sight a rind of bacon.
The omentum, mesentery, liver and gall bladder, spleen, pan¬
creas, kidneys and urinary bladder, had, as it were, disappeared,
and in their stead a scirrhus mass found towards the right side,
resembling the liver in shape, and containing pusf. Besides
the instance of complete reversion in the principal organs and
viscera, which occurred at one of the dissecting pavilions of
the Hospice de Perfect ionnement , as described by Dr. Granville,,
in his second letter on the present state and progress of Medical
Science in France J, we have to notice an instance of preter¬
natural position of the heart, related by Dr. Amelung||. During
the life of the patient the movements of the heart were felt on
the right side; and on opening the chest, after death, neither
heart nor lungs were found in the left side; but, instead of them,
about ten pounds of watery fluid, and a small portion of some¬
thing like lungs, shrivelled and resembling a dry sponge, the size
of the egg of a goose, enclosed in a sac of the pleura above the
mediastinum. The pleura lining the left cavity of the thorax
was thick, like leather, and of a yellow olive colour. The heart
was found in the right cavity, with the apex towards the right
hypochondrium. 64 The aorta arose from the anterior portion,
but the vena cava had emptied itself into the posterior part. The
luims on this side were tuberculated ; and some of the tubercles
in a suppurating state. The patient was a tall robust man,
thirty-one years of age, and had served five years as a
soldier.”

With full conviction of the utility of Physiology, we feel
much gratification in tracing, not only the rapid progress
which is making in that branch of Medical Science, hut the
prevailing disposition of the inquirers to throw aside those fan¬
ciful hypotheses and illusions, which have so long tended to im¬
pede the pursuit of truth ; and to be guided only by experiment
and observation. It is not easy to explain trie reason, why
Physiology has found so few votaries, comparatively speaking,
in this country ; while it has found so many, and so much has
been effected on the other side of the channel. The most
important, and, in fact, the only work generally on this sub-

* vide Med. Chirurg. Journ. vol. iii. p. 255.

+ Continental Medical Repertory , No. 1. p. 13$,
t Repository, vol. vii. p. l6'3.

(| Continental Med. Rep. No. 1. p. 13?.

Retrospect of the Progress of Medical Science.

ject, within the last six months, is the second volume of Af.
Majendie's work, 44 Precis Elementaire de Physiologic It
contains the history of the nutritive and generative f unctions ;
and is fraught with original and well-conceived experiments,
admirably qualified to stimulate inquiry in others ; but as we
mean to lay an early analysis of the. volume before our readers,
it is unnecessary here to dilate on its merits.

Of a different character, but certainly not devoid of in¬
terest, are Dr. Park's Physiological Essays. The continuation
of them, which has appeared since the period of our last Re¬
trospect^ treats of a the laws of muscular motion*.” In pur¬
suing his subject, Dr. Park observes, that it is not essential tor
arriving at correct conclusions regarding the general laws of
motion, 44 that we should ascertain the agent by which muscu¬
lar contraction is effected, or that of the change it produces
these laws, like those of matter, being best deduced from the
phenomena. On these principles he lays down the following as
laws of muscular motion : 44 1. That exertion is productive of
certain changes in the organs of motion, which are accompanied
by corresponding changes in the powers of action. 2. That the
powers of action have certain limits prescribed to them, which
sooner or later require the renovation derived from rest.” The
continuance of every exertion is followed by fatigue, and this
our author contends, 44 arises from a change of condition in the
moving fibre, effected by the repeated application of the nerv¬
ous influence and that the mind becomes conscious of this
change, when it arrives at a certain degree, owing to a portion
of nerve being blended with, and entering into the composition
of the musciflar structure. But he denies 44 that the sense of
fatigue arises from the expenditure or exhaustion of that power
or energy imparted by the nerve to the moving fibre ; and not
from the changes produced by its repeated application. He
maintains that the state of the moving organ, on the approach
of fatigue, is that of over-contraction, not that of relaxation ;
and hence nothing is more common than cramps or spasms in
the calves of the legs, and the soles of the feet,” as fatigue ap¬
proaches ; and when it is carried to excess, there is an actual state
of the muscle almost approaching to inflammation, and a rigid
contraction, equally in the flexor and extensor muscles. These
phenomena are objects of observation and experience in the
voluntary organs ; but their operation. Dr. Park argues, 44 can
be shewn to extend also to those which are involuntary;” the
motions of both being merely 44 different modifications of the
same faculty and in boll), derived, as Dr. Whytt contended,

*r-

Vide Journal of Science and the Arts, vol. ii. p.

Retrospect o f ike Progress of Medical Science. 13

immediately from tlie nerves. Notwithstanding the high au¬
thorities of Haller and Bichat, who, while they admitted that
nerves are the chief instruments of voluntary motions, vet de¬
nied that they have any thing to do with that which is involun¬
tary, our author brings forward many and very plausible rea¬
sons in favour of the theory he supports. Having established
“ the unity of the motive power under both its modifications, and
the subjection of both to the same general laws,” he next ex¬
amines “ the connection that prevails between the vital proper¬
ties and the state of the circulation. ^ As our limits prevent us
from following his arguments closely, we shall merely observe,
on the facts, that those parts of the muscular system most con¬
spicuous for mobility are most abundantly supplied with red
blood ; and that every change in the state of circulation pro¬
duces a correspondent change in the degree of mobility ; , or.
whatever increases circulation, and determines red blood to the
muscles, is productive of a temporary augmentation of mobility :
while, on the contrary, whatever diminishes these, is followed
by a diminution of moving power. He endeavours to establish
the position, that, increase of mobility uniformly attends in¬
crease of circulation. “ both in healthy and morbid states ; the
motive power, as well as the sentient faculty, bearing always,
within certain limits, relation to the quantity of arterial blood
circulating in the minute or capillary vessels of the muscular
system ”

In our last Retrospect * we noticed the very ingenious experi¬
ments of Dr. Johnson, confirming the position of Dr. Parry,
that 44 in ordinary states of the system, there is neither dilata¬
tion nor contraction in the arteries corresponding with the
systole and diastole of the ventricle.” Without doing more
than merely referring to the controversy between Dr. Johnson
and Mr. Hastings on this subject*}", in which the objections of
the latter were by no means successfully maintained ; we have to
notice that Dr. Parry’s opinion has received a strongconfirmation,
and has been much elucidated by a fact observed by Professor
Do] linger, who was led to conclude, that 44 by the wave of
blood driven into the arteries by the heart, the impulse is com¬
municated to the parietes arteriarum in such a manner, that it
may be felt without the artery suffering any dilatation j.” As

* Vide Repository, vol. vii. p. 13.

t Vide Repository, vol. vii. p. 196 and 364

X Continental Medical Repertory, No. 1. p. 128. — 1 The following
is the fact from which the Professor drew his conclusions: 44 Hap¬
pening to visit so me water-works a few years ago, he found that on

Retrospect of the Progress of Medical Science v

connected with the circulation, we may notice here the con
fan alien of Dr. Gordon’s observation , that arterial blood becomes-
InniV, in a case in which the blood was drawn directly from the
temporal artery, by Mr. Dunn of Pickering, and which we have
recorded*'. Having a considerable affinity also with it,, is the in¬
teresting paper of Dr. J. Davy, which will be found amongst our
Selections on the heat evolved during the coagulation of the
blood, in which he supports from a variety of experiments the
opinion first advanced by Mr. Hunter, “ that during the coagu¬
lation of blood, there is no sensible evolution of heat.”

No investigations in physiology are of more importance
than those connected with vision. Dr. Brewster and Dr, Gor¬
don | have ascertained that the refractive powers of the aqueous
and the vitreous humours of the human eye, are greater than
that of water, that of the vitreous humour being the highest.
These physiologists have also proved, that the crystalline lens ex-

fsldng hold of some pretty thick leaden pipes, in which the water
was' forced up by pumps, he could plainly perceive an impulse, as
often as a wave was driven into them, very much resembling that
which is felt in the arteries. As the pipes were well secured and
fastened, as no trembling could be perceived in them, and as what
was felt was the absolute impression of undulation, he could not
derive the sensation he felt in Ms hand from the impulse of the
piston of the pump ; and thus recollected the pulse, and particularly
as- in vivisections he had always found it immoveable, he was now
anxious to know whether a pulse might be discovered in living
animals in an artery when laid bare : he thus laid bare the carotida
of a dog, in the presence of several of his pupils, and a pulse was
plainly felt in it, though no motion wras visible in it. If we now
cxmskler, continues he, how seldom actual contractions have been
observed in the arteries, we shall hardly be able to persuade our¬
selves of the vital motions of the parietes arteriarum being the
cause of the pulse ; and thus many first rate physiologists found
themselves compelled to suppose only a mechanical dilatation of the
arteries. But nobody, to ray knowledge, having ever observed
that either, I feel myself now convinced, that the arteries do not
suffer any alternate contraction or dilatation at all whilst producing
that effect called the pulse.”

We would not accuse the Professor of plagiarism ; but the.
following expressions in his reasonings on his experiments, “ only

the last series of elastic balls is moved, on an impulse being applied
to the first, whilst all the intervening ones remain in a state of
inactivity,” incline us to think he had obtained some information of
Dr. Parry’s opinions.

* Vide Repository , vol. vii. p. 4 >66.

i ibid. p. 320, and Journal a f Science and. the Arts , vol. ii. p. 216.
1 Journal of Science and the Arts , vol. iii. p. 134.

Retrospect of the Progress of Medical Science.

liibits a polarizing structure equal to that of quartz, or the same*
as the middle of the crystalline in fishes, and the tint polarized
by it being a faint blue of the first order. The cornea lias an
opposite polarizing structure, being nearly the same as that of
calcareous spar ; or as the outer and inner coats of the crys-
? talline lens in fishes.

No physiological question has elicited so many hypothetical
explanations as that regarding the nature of conception and
generation ; and perhaps on none has so little that is satisfac¬
tory been published. Some observations which Sir Everard
Home lias had an opportunity of making, have led him to
hazard a new opinion on the subject. He conceives that im¬
pregnation may take place without the existence of the cata¬
menia ; and that, whenever any great excitement of the female
system occurs, an ovum may pass from the ovarium into the
uterus ; and that, when it is there brought into contact with
the male semen, impregnation takes place*. We confess this
statement is not very satisfactory to us ; but, as a mutilated
account only of his paper is before the public, we will reserve
our comments upon it until the whole be published. But
if the early part of the process uf utero-gestation- be obscure,
much light lias been thrown upon its more advanced periods.
One curious physiological fact connected with the expulsion of
the foetus, and its spontaneous evolution, we formerly slightly
noticedv ; hut we afe' now enabled to refer to what we trust

will be regarded as a fair exposition of the subject, in our ana¬
lysis of l)rs. Douglas and Kelly’s Essays J,

The most important use of physiological inquiries is uiu
doubtcdly the elucidation of Pathology : and it is in this point
of view only in winch they can be ever regarded as practically
useful. In commencing our remarks on this part of our subject,
we cannot avoid noticing the great light that has been of late

* Sir Everarri was led to these conclusions from the following;
circumstance : — “ A female servant having left her master’s house’
for a tew hours, on the 7th 6f January, and returned in high spirits^
was in a few days seized with an epileptic fit and fever, and died on
tne loth. On opening the body, an impregnated ovum was found
in the uterus, so extremely small that it would have escaped obser¬
vation, had not Mr. Bauer, by his skill in the use of his powerful
microscope, detected and delineated it. It had come from the ova-
r um of the left side, which was of a larger size than the other.—

p. iHTt! Annul;-- oj Phil: vci ix. j>.

^ ule Pnd. Mace. vol. Ixix
4(A

T Vide Repository,

lOid

\Oi. Vll.

VO!
• ) <p <,

V L i

~ o

1 6 Retrospect of the Progn. ts of Medical Science:

years thrown upon the treatment of Insanity, by the examine
don of the state of the brain which professional men now almost
generally endeavour to obtain in fatal cases of that disease, or
where states of mental faculties approaching to it have existed
In this point of view, we consider Mr. Hastings’ account of an
anomalous structure of the brain* highly interesting. How far,-
however, the anomalous structure, which was not the effect of dis¬
ease, and consisted of the deficiency of the posterior cornua of the
ventricles, and consequently of the hippo-campus minor, can be
regarded as the cause of the defect of intellect of the patient,
who was an idiot, it would be rash to decide : but it is singular
that, in another head of a man of equally weak intellect, ex¬
amined by Mr. Hastings, the posterior cornua were also wholly
deficient..

The dependance of spasmodic and convulsive affections on
some peculiar morbid change in the state of the brain, or some
part of the nervous system, has been generally admitted : but
the nature of this change has not hitherto been satisfactorily
explained. Some new light has been attempted to be thrown
on the subject by Dr. MouSson of Chester. He conceives that
44 when such a column of blood presses upon the brain or spinal
marrow, as not entirely to overcome the nervous energy, then
convulsions occur.” On the same principle he imagines that
any irritation applied to a part beset with nerves, will u occa¬
sion such a part to exert all its nervous influence to overcome
or free itself from such an irritation ; of course an increased
quantity of blood will be solicited to support these actions ;
which actions, too long continued, destroying the usual con¬
tractile power of the vessel or vessels, will occasion such a debi¬
lity in them, as to allow of a turgescence of blood here and
there, unequally pressing upon the nerves, thereby occasioning
spasmodic or convulsive movements If this view of the
pathology of convulsive action be correct, it is easy to conceive
that the greatest benefit must result from the abstraction of
blood ; and some cases detailed by Dr. Moulson have practi¬
cally evinced, in this respect, the accuracy of his theory. In a
certain degree it is confirmed by the dissection of a fatal
ease of tetanus by M. Patissier, a French surgeon, who found
that ££ the membranes lining the cavity of the spine,” and the'
internal surface of the heart, u presented a highly inflammatory
aspect J. 11

We have been enabled to lay before our readers a very

* Vide Repository, vol. vii. p. 74.,

t Vide Medico-Ckintrgical Jmm^avd Review, vol. hi. p. 56$,
| Vide Repository, vdL vii. pk. 251.

itETjiosPECT of the Progress of Medical Science.

■ and masterly exposition of u the Primary Elements of
disordered Circulation of the Blood,” by Dr. Whitlock Nichol],
which we particularly recommend to the attention of our junior
l eaders*. Intimately connected, also, with the pathology of the
circulating system, are some very interesting experiments qn the
ti ansfusion of blood, made by Dr. Leacock*!*, tending to shew the
advantage of this process “ in extreme cases of haemorrhage.”
Dr. Leacock, reasoning, very justly, that the only stimulus by
which the heart and circulating system can be roused when nature
is exhausted by excessive haemorrhage, is the supply of that pa¬
bulum which lias been lost, found his ideas confirmed by expe¬
riments upon animals of the same species. He drained, for
example, the blood from a dog, until the animal fainted and
appeared at the point of death, and then immediately transfused
1:uo vessels the arterial blood of another dog; the consequence
was the restoration of the receiving dog, who, from lying half dead,

* uised his head ; the pulse, before imperceptible, began to be
plainly felt ; the eye that was dull and glossy regained its
former splendour; the respiration became easy and natural ;

6 wand the dog, having completely recovered, when let loose, ran
about with ease and apparently very little indisposed.” Prom
Dr. Leacock’s experiments, it appears that the blood to be
transfused should, perhaps, be that of an animal of the same
specaes, or nearly so ; but it is also evident, from experiments,
in which blood from a sheep was transfused into a dog, that
penefi t may be produced when the blood of a herbivorous animal
is transfused into one altogether carnivorous. That this prac-
l ice may prove useful in excessive haemorrhages, when blood
. an be obtained from an healthy individual, is probable ;
but we are not prepared to accord with the opinion that it will
l'iove useful in diseases connected with deficiency of blood.

^r*. ^las investigated the u mode by which constitutional
disease is produced by the inoculation of morbid poisons^.” He
( onceives that when a morbid poison is applied to an abraded
sui face, it is not directly absorbed, but induces a new secretory
action in the very contiguous arteries, by which a morbid fluid
similar to that with which the person was inoculated is generated;
ana then, but not before, the poison is absorbed and carried into

* Vide Repository, vol. vii. p. 441.

D)e Inaugural Thesis, containing these experiments, was
published last year at Edinburgh. For a plate of Dr. Leacock’s
apparatus, see Medico- Chirurgical Journal , April 1817.

+ An Essay on the Mode hi/ which Constitutional Disease is pro¬
duced Jrom the Inoculation of Morbid Poisons , by Charles Salt, 8vo.

pp. 88.

VOL. VIII, — No. 43. D

18 Retrospect of the Progress of Medical Science .

the system. He founds his opinion on the facts that local in¬
flammation always precedes and accompanies the constitutional
disease produced ; and he believes that, as inoculation of a
morbid poison does not always produce this effect, nor is always
followed by constitutional disease, the deposited poison, when
absorbed without exciting local inflammation and a new secre¬
tory process, “ is harmless.” Hence “ excision or destruction
of the contiguous organized structure,”' prior to this process,
will prevent the constitutional effects ; but these may always
be expected to follow, when the local effect is produced and
goes through its regular stages. The length of time required
for giving the necessary impulse to the secreting vessels ; as,
for example, in hydrophobia ; and the difference displayed in
different individuals in this respect, is justly regarded as form¬
ing no objection to his theory. The immediate absorption of
animal poisons, however, such as that of the rattlesnake, &c.
he admits is an exception to the general law.

Connected with the absorbent and exhalent systems, is the
following very curious circumstance noticed by Mr. Rigby
of Norwich^. A precipitation, if it may be so termed,
of sulphuret of mercury occurred all over the skin, giving it at
first a dirty, dusky-blue colour, and afterwards a completely
black hue, in a patient who had been employing first frictions
with sulphur ointment ; and soon afterwards, while the fcetor
of the skin evinced the continued sulphurous impregnation,
began the mercurial friction. The phenomenon has no ana¬
logy with the effect sometimes produced by the long-continued
use of nitrate of silver, and admits of a more easy explanation.

It has generally been supposed, that the valve-like obstruc¬
tion, which the prostate gland occasionally offers to the flow of
the urine, is owing to the enlargement of the third lobe : some
dissections, however, by Mr. Shaw, have satisfactorily demon¬
strated that the part projecting into the bladder and forming
the valve, is not the third lobe, “ but a more anterior part of
the gland.” He has, also, ascertained “ that whenever there
is this valvular projection from the prostate, the muscles of the
ureters are enlarged,” and will be found inserted at the root of
the tumourjx

A singular consequence of the existence of worms in the intes¬
tines is recorded in a paper of the late Dr. Lettsom. The patient
bad all the symptoms of enlargement of the mesenteric glands: but
after the application of leeches to the abdomen, with soothing
fomentations, and the internal use of the pilula hydrargyri, a
circumscribed inflamed tumour appeared below the navel, and

* Vide Retrospect , vol. vii . p. 266. t Ibid, voLvii. p. 24 3,

Retrospect of the Progress of Medical Science.

suppurated. When it was opened, a puff of air escaped ; but
was not followed by faeces : and a few weeks afterwards, on re-
movingthe poultice, a lumbricus, alive, and nine inches in length,
was observed in the abscess, and carefully drawn out. Some
bubbles of air, foeculent matter, and the seeds of apples arid
pears which had been eaten, occasionally protruded : but the
patient, a female, perfectly recovered*.

The effects of ascending great heights have been often de¬
tailed by travellers, but of the histories of this nature on record,
fev/ have been so satisfactory as the account of the effects on
himself and his party, given by Col. Beaufoy, of a visit to the
summit of Mount Blancff. At a height, little above one half
of that of the mountain, the appetite for food failed, there was
a strong aversion from the taste of spirituous liquors, and the
whole party felt extremely drowsy ; on still ascending, the thirst
became insupportable ; and, although the party were continually
drinking water, which they carried, yet the urine was not increased
in quantity, and the little that passed was very high coloured.
“ The air itself,1’ to use Col. Beaufoy’s strong language, cc was
thirsty ; its extreme dryness,11 he adds, “had robbed my body of
its moisture.11 When at the base of the small pyramidal moun¬
tain, which, correctly speaking, is Mount Blanc, the head be¬
came affected with a dull heavy pain, and an acute sensation of
pain, also, “ very different from that of weariness,11 was felt in
the limbs immediately above the knees ; the desire for sleep be¬
came irresistible as the party advanced, and the greater part
were affected with severe vomitings. Colonel Beaufoy himself
was affected with violent palpitations, whilst on the summit J ;
and his respiration was performed with difficulty ; on descend¬
ing, he experienced, after taking some repose, a tormenting
pain in Ills face, which became one continued blister, and he
was unable to open his eyes||, until they had been bathed in
warm water for half an hour. Such are the results of the prin¬
cipal investigations on the subjects forming this division of our
Retrospect , which have occurred within the last six months.
If they are few, some of them are not unimportant ; and, if
properly applied, cannot fail to aid in advancing science.

Before concluding, we cannot avoid noticing the singularity
of three new systems of Nosology having been offered to the pro-

* Trans, of the Medical Society of London , vol. i. part ii. art. 7*

+ Annals of Philosophy, vol. ix. p. 97.

t According to Saussure, the summit of Mount Blanc is 15,700
English feet in height.

|j This inconvenience was not experienced by the guides, owing
to their w earing masks of black crape.

n 2

Retrospect of the Progress of Medical Science.

fesskra within a few months of each other. Two of them are
professedly mere outlines, and should be regarded as such :
but the third is a more complete work, and consequently may be
fairly brought to the bar of criticism. In the first* * * §, its author.
Dr. Parkinson, has attempted the division of diseases into two
classes, which he denominates Hyperbiosis and Catobiosis : in
the former, the natural functions are exercised above the
limits of health ; in the latter, depressed below these limits.
Each of these classes he has divided into three orders, founded
upon anatomical construction ; while he makes the genera
dependant upon, and limited to, identity of diseases ; the species
on situation ; and the varieties to introduction of poisons. Views
so novel necessarily required an appropriate language, and this
Dr. Parkinson has invented ; but, as has been justly remarked
by a cotemporary journal*!*, in which the work has been criti¬
cally noticed, the task he has undertaken is not only arduous*
and difficult, it 44 is impossible- — to reduce nosology to a pro¬
gressive, methodical, and logical system, fixed upon solid and
just principles, governed by acknowledged and inflexible laws,
and divested of fanciful and delusive hypothesis.1’ Of the se¬
cond];, Dr. Nicholl’s Tenlamcn, which was given to the public
through our pages, and on the character of which our readers
must have already decided for themselves, we will not further
express an opinion, than that it is highly creditable to its
author. Our sentiments regarding the value of the third §
are already before the profession. Whatever may be the indi¬
vidual merits of these systems, their appearance is indicative of a
desire for the improvement of medical literature, which cannot
be contemplated without feelings of satisfaction.

CHEMISTRY.

As usual, we have abundant materials for this division of
our Report ; but our notices will be brief, except as respects
those improvements which are more immediately connected with
medicine.

In no branch of science does the perfection of apparatus
tend so materially to facilitate research as in chemistry. Hence
every suggestion on this point is of importance. In our last
Retrospect we noticed the improvement of Newman’s blow-

* Synopsis Nosologur, or Outline of a New System of' Nosology, fyc.
by T. Parkinson, M.l). 8vo. London, 1 810.

t Edin. Med. and Stag. Journ . vol. iii. p. 98.

1 Tentamen Nosologicum, by Whitlock Nicholl, M.D. — vide
Repository, vol. vii. p. 177-

§ A Physiological System of Nosology ; with a corrected and sim¬
plified Nomenclature ; by J. Mason Good, F.R.S. 8vo. London, 1817*

Retrospect of the Progress of Medical Science,

pipe, and the application of that instrument for obtaining a very
intense heat from the ignition of mixed gases. The explosion
of Dr. Clarice’s apparatus excited the attention of the ingenious,
and many improvements intended to prevent explosion have been
since suggested. The first which is worthy of notice, besides that
which we formerly described*, as the invention of Mr. Newman,
but which was properly that of Professor Gumming who
adapted to the instrument the pneumatic cylinder, is the pro¬
posal of Dr. Clarke to use oil in this cylinder instead of water,
which he considered was calculated “ to prevent the possibility
of reviving the metals of the earths, in all instances, where it
was forced out of the jet and came in contact with the fused
body while, on the other hand, oil aids the reduction.

Mr. F. Spilsbury of Worcester proposes to improve Pro¬
fessor Cumming’s instrument, by placing a pipe of zigzag form
instead of that which commonly communicates between the two
cylinders, in order to prevent the minor explosions from forcing
the oil back into the condensing cylinder.

Mr. Gray of Kelso, finding that the mixed gases contained
in a metallic tube, with a diaphragm of double wire gauze in the
centre, could be exploded at each end successively, as led tp
conclude that every danger in the blow-pipe may he prevented
bv adjusting wire gauze to the reservoir, or even to the pipef.
On this principle, Mr. Gray is not aware, that the greatest im¬
provement on the instrument has been already devised by Dr.
Clarke. It is the substitution of a fagot of capillary tubes,
instead of a simple tube, for the passage of the mixed gases to
the jet. Instead of the fagot of brass capillary tubes, which
can scarcely be made small enough, Mr. Beale suggests the
employment of cane, or any very porous wood ; or a fagot of
small steel wires, the spaces between the wires acting as so many
capillary tubes} .

We cannot help noticing in this place, the unsuccessful re¬
sults obtained from the repetition of Dr. Clarke’s experiments,
as far as these regard the decomposition of the earths, at the la¬
boratory of the Royal Institution. The earths and their sails
were fused, and pure auhvdrates constantly obtained, “ which,
appeared as hard stony masses, but never exposing a true me¬
tallic surface with a clean file, or effervescing with water or dilute
acids f1 even with the aid of charcoal and other fluxes in the

* Vide Repository, vol. vii. p. 22.
f Annals of Philosophy, vol. ix. p. 47.9-

J Ibid, p. 481. Mr. A- T. Thomson’s professional and other
engagements have prevented him from completing his blow-pipe.
Vide Repository, vol. vii. p. 22.

22 Re trospect of the Progress of Medical Science .

experiments made in the laboratory of the Institution, no re-
Auction of the earths has been effected. The natural conclu¬
sion from these failures is, “ that some impurities in the earths
or the supports used, have caused appearances on which the idea
of decomposition has been founded*.*’

As advancing the art of analysis, we may mention that M.
Poebereiner has lately proposed the employment of the oxide
of copper in the analysis of vegetable and animal substances,
even in those cases in which chlorate of potass may be usedf .

Mr. Peschier of Geneva has ascertained, that benzoic acid,
and the alkaline benzoates, are very good and useful tests of
the presence and quantity of iron contained in any solution, as
they precipitate that metal readily and entirely^.

The facility of producing a 'low temperature by quickening
the evaporation of fluids in vacuo, with substances calcu¬
lated to absorb the exhaled moisture, has been very much
increased by the discovery of Professor Leslie, that this quality
resides in a high degree in porphyritic trap, when grossly
pounded and moderately roasted. He found that in this state
it will <c absorb the fiftieth part of its weight of moisture before
its absorbing power is diminished one half, and the twenty-
fifth part of its weight before this power is reduced to one-fourth.
When completely saturated with humidity, it may hold near a
fifth part of its whole weight.” He found from actual experi¬
ment, by putting a quantity of this powder into a saucer seven
inches wide, placing about an inch and a half over it a shallow
cup of porous earthen ware three inches in diameter, filled with
water, and covering the whole with a low receiver, that when
the air wTas exhausted from the receiver until the gauge stood
at of an inch, the water in a few minutes was converted
into ice. Garden mould, when roasted, produces nearly the
same effect, and “ is capable of freezing more than the sixth
part cf its weight of water.” Professor Leslie proposes to in¬
stitute a series of experiments on this subject with different
compound earths |[.

* Journal of Science and the Arts , vol. ii. p. 462.

t Sckweigger’s Journal , vol. xvii. p. S69. The Editors of the
Annales de Chimie et de Physique , (vol. iv. p. 107-j refer to the Ann.
de Chim . vol. xcv. p. 154, 184, 187, and vol. xevi. p. 53, to shew
that the proposition is not new : but they regard it as an admirable
agent.

J Annals of Philos, vol. lx. p. 1 62. Dr. Thomson mentions that
Berzelius had proposed benzoic acid as a re-agent for iron, in 1806' ;
and a set of experiments with benzoate of ammonia w ere made by
Mr. Hessinger in 1810, which confirmed his suggestion. For a trans¬
lation of Hessinger's paper, see Phil. Mag. vol. xl. p. 258.

|| Annals of Philosophy, vol. ix. p. 412,

j Retrospect of the Progress of Medical Science. 23

On tlie very interesting subject of light and heat , some very
valuable observations have been made; and several facts at v a nu¬
ance with the generally received opinions established.

The first which we have to mention was ascertained by
Colonel Beaufoy, in a visit to the summit of Mount Blanc *2
He found that ihe effect of a burning glass on paper, and on &
piece of wood, at that height was greater than in the lower
regions. The thermometer in the shade at the time was 3S®.

M. Fourier has satisfactorily proved, that the intensity <#f
the rays of radiant heat is not the same, but that it depends
on the angle comprehended between the ray and the surface
from which it passes, and is proportional to the sine of that
angle.

Mr. Benedict Prevost has thrown out some new ideas re¬
garding the cause of colour in bodies. He conceives as erro¬
neous the ordinary opinion, that when light falls upon an
opaque body, which appears coloured to our eye, red for
example, the colour is owing to all the rays which compose the
white rays being absorbed by the body, except the red, which
are reflected ; and, from a number of ingenious observations
and experiments f, he concludes, that the ravs of light passing
from an opaque body, and by their impression on our eyes
enabling us to assume that it is coloured, are not reflected, but
radiated ; and, with certain modifications or exceptions, the
same is true of transparent bodies. When light, he observes,
falls upon any body, part of the rays are reflected unaltered ;
but the remainder penetrate more or less into the interior of the
body, where certain of the rays are retained, owing to their affi¬
nity for its substance, while the others radiated diverging from
every point of its surface and constitute its colour — red for cop¬
per, yellow for gold, &c. If the rays which constitute the
peculiar colour of any body were really reflected from its sur¬
face, the very oblique rays of this colour would be much
more numerous than the perpendicular or little inclined rays,
and images seen obliquely in mirrors would appear more
coloured than those seen perpendicularly ; which is not the
fact.

When a piece of gold is illuminated by white light, a part
penetrates, is decomposed, and all the rays retained, except the
yellow, which are radiated; but when the yellow rays are isolated

* This visit was made in August, 1787; but the account of it
was published only in February last, in the Annals of Philosophy ,
vol. ix. p. 87.

t Vide Annates de Chimieet Physique, tome iv. p. 192.

2$ Retrospect of the Progress of Medical Science .

and fall upon gold, they do not penetrate the surface, but are
reflected in the strict meaning of the term : thus the image of a
piece of gold, seen in a mirror of gold, has a much deeper tint
than the object itself.

A plate of polished gold illuminated by the light of day,
radiates, as has been already stated, the yellow rays, and reflects
the white ; but when the whole are received upon a second
plate of the same metal, equally polished, the yellow light will
be reflected by it: a part qf the white will be decomposed, and
furnish, by radiating, new yellow' light, which, joined to the
first, will augment its intensity, so that the image of the first
plate given by the second will appear much deeper and so
on, by multiplying the reflections, we at length obtain a
very deep orange-red tint, which is probably the real colour
of gold ; for the natural colour of the metal is rendered paler
by the white rays with which it mixed. It is on this account
that a well-polished deep copper vessel exhibits a richer tone
of colour in the inside than on the out— that a coloured velvet
appears of a deeper colour than a silk of the same colour : and
JVL Prey os t is of opinion that the shining of the eyes of cats and
of other animals depends partly on the same cause*.

Sir H. Davy has instituted an investigation on flame
of the most interesting character. In endeavouring to as¬
certain the effects of diminished atmospherical pressure upon
flame, he found, that by ratifying explosive mixtures m
the receiver of the air pump, the point at which they lose
the power of inflaming by the electric spark differs in va¬
rious gases ; the difference depending 44 on the heat required
for the combustion of individual portions of the gas, and
that given out by their combustion.” Chlorine and hy¬
drogen burn at a lower temperature than oxygen and hydro-

& Some particulars connected with this curious physiological
fact, arc thus described by M. Prevost. When a cat looks at a per¬
son seated near a table, on which a lighted candle is placed, so that
the eyes of the animal, being in the shade, are illuminated by the
1 ght reflected from the surrounding objects, its eyes appear to .the
person like little fire brands ; but they cease to produce this effect
if the person’s hand be placed between the flame and the objects,
which, from their situation, reflect their light upon the eyes of the
cat. They shine again as soon as the hand is withdrawn. Should the-
observer be dressed in black, and have a white towel on his knee,
the eyes of the cat will shine more brilliantly if the tow'el be folded up.
The dilatation of the pupil of the cat’s eyes, when in an obscure
place, exposes a larger portion than is usually uncovered of the
bottom of the eye.

Ih'.TnosPF.c.T of the Progress of Medical Science. 25

gen, and produce nearly as much heat, but can bear to be more
rarified before losing their combustibility ; ce because, as the heat
produced by inflammation diminishes with the rarety of the
mixture, the quantity requisite for the inflammation of conti¬
guous portions of oxygen and hydrogen is sooner lost than
when chlorine and hydrogen are used. A mixture of the two
last gases, when so rarified as not to explode by the electric
spark, will inflame when considerably heated. Sir H. Davy
lias also proved, contrary to the results of M. Grotthius’s
experiments, that rarefaction by heat increases the combus¬
tibility of all gaseous mixtures. That the compression pro¬
duced by flame is not the cause of continuous explosion, was
proved bv a mixture of hydro-phosphoric gas and oxygen,
condensed into one-fourth of its original bulk, not inflaming,
although a heat of 210° inflames such a mixture. By diluting
explosive mixtures with other gases, the aptitude for inflam¬
mation of the mixtures was found to be according to the inverse
ratio of the densities and capacities for heat of the elastic media.
Those gases which require least heat for their combustion,
bear the highest degree of dilution before their combustion is
prevented.

Connected in some degree with these investigations are
several ingenious experiments and observations on the flame of
a candle by Mr. Porrett*. The only fact in the paper which
we think necessary to be noticed by us is, that flame is not
an opaque body.

The effect of temperature in altering the density of bodies,
has been long wrell understood ; but the point at wdiich water
acquires its greatest density, nevertheless still admits of a
question. Mr. George Oswald Sym, by experimenting with a
very ingenious instrument, has added his testimony in favour
of the accuracy of the more general opinion, which places it at
or near 40°.

A portion of an interesting investigation into the Chemical
Phenomena of Heat , by Mr. J. B. Emmett, of Trinity College,
Cambridge, has been published in the Annals of Philosophv,

* Annals of Philosophy, vol. ix. p. 340. The following experi¬
ment he regards as decisive of this point. Three feet from a sheet
of White paper on a wall, place a lighted spirit lamp, and close by
its flame a piece of thin and clear glass ; and, having placed a
lighted candle nine feet' behind the lamp, look at the sheet of paper.
Two faint shadows will be seen on it, representing the flame of the
lamp and the piece of glass ; but that of the glass will be the
deepest ; hence the natural conclusion, that flame is less opaque than
glass, from its intercepting less light.

VOL. VIII. — xo. 43.

Retrospect of the Progress of Medical Science.

to which, as the paper does not admit of analysis, we must
refer our readers*.

Galvanism. — From a series of experiments on the effects of
temperature on the galvanic action, M. Dessaignes has been
led to form the following conclusions -f\ 1. That metals, the

temperature of which is equal throughout, lose their electro¬
motive property when that is very much raised or lowered. 2.
In heating a homogenous body unequally, it acquires the power
of exciting a prepared frog, in the same manner as two hetero¬
genous bodies. 8. The electro-motive property of a metallic
combination, for example zinc and silver, may be destroyed by
beating the zinc only to a certain point, or by cooling the silver.
4- When the voltaic pile is exposed to a cold of 18°, or to a
heat of 100°, all its effects cease, provided the temperature is
uniform throughout its extent.

Metals and Earths. — We have very little to notice re¬
garding these substances.

Platinum.— -Mr. I. T. Cooper has ascertained several new'
facts regarding this metal. He obtained a hydrate of the metal,
and calculating the equivalent of an atom of platinum to be ,
22464, this hydrate must contain two atoms of the metal and
one of water. It is unaltered by heat, until at the point of
ignition, when it becomes incandescent and its particles approxi¬
mate considerably ; and in this state it may be hammered into
a solid bai; J. Sir H. Davy has succeeded in forming a fulmi¬
nating compound with platinum, by converting sulpkuret of
'platinum into sulphate of platinum by nitrous acid ; then adding-
ammonia in slight excess to the aqueous solution of this
sulphate, boiling the precipitate formed in caustic potash, and
after it is washed, drying it at 212°. It consists of platinum,
73 5 ; oxygen, 8-73 ; and ammonia with water, 17 *50; in one
hundred parts. It explodes when heated to 400°§.

Copper. — -Dr. Meissner has detected this metal in the ashes
of a great number of plants j|.

Annals of Phil., vol. ix. p. 387

Some high authorities have
placed it at 3b9; while others -conceive it to be at the freezing point .

4 Vide Journal Je Physique , 1816; and A /males de Chimie el de
Physique , t. Hi. p. 41 8.

$ Journal of Science, 8j'cv vol. Hi. p. lip. § Ibid. p. 131.

j] Schweigger, vol. xvii. p. 340 and 436. He detects it by boil¬
ing the ashes after they have been well washed, in hydro-chloric
acid ; then nearly saturating the solution with ammonia, so as to
leave a very small excess of acid, and placing in it a plate of po¬
lished iron or zinc. In a few days the copper appears on the iron
or zinc, if the ashes contained- any of it.

Retrospect of the Progress of Medical Science. 27

Potassium. — The obtaining this metal with facility, is an ob¬
ject of some importance in a philosophical point of view. It can
be effected by adding to one end* of the curved gun-barrel
usually employed, a tube of glass descending into an open
vessel of mercury; which, by the pressure of the atmosphere,
tends to maintain a pressure within equal to that of the atmos¬
phere. An ounce of it was procured with this apparatus
from four ounces of potash, by a French gentleman, at the
laboratory of the Royal Institution*.

Thorina . — This name has been given to a new earth dis¬
covered by Berzelius in the gadolinite of Kararvet ; and again
found by him in analysing the deuto-fluate of cerium, and the
double fluate of cerium and vttria of Finbo. It has a great
analogy with Zirconia , but differs from it in crystallizing easily
with sulphuric acid ; in its precipitate from a muriatic solution,
lieing bulky, semi-transparent, and gelatinous ; instead of
■heavy, white, and opaque. In the citrates of it yielding a pre¬
cipitate when the liquid is boiled ; in being thrown down, from
its solution in sulphuric acid by oxalate of ammonia; and in
the sulphates and muriates in solution not being precipitated
by sulphate of potash j*.

Acids. — It is impossible to fix any limit to the increase of
the acids, at least of such as have a ternary basis ; every new
combination of the elements, carbon, hydrogen, and oxygen,
giving rise to newr substances which possess acid properties, and
display different affinities from the already known acids. In
pursuing his investigations on flame, Sir II. Davy observed the
formation of a new acid body during the combustion of aether.
Mr. Faraday has continued the inquiry ; and, according to him,
oxygen, hydrogen, and charcoal may be considered as the ele¬
ments of this acid, the charcoal appearing to be in very great
proportion. u The peculiar character of this acid is the pun¬
gent irritating effect it produces on the eyes and nostrils; re¬
sembling that occasioned by the oxalic acidT."

Boric Acid.— One part of this acid in a crystallized state,
and four parts of acidulous tartrate of potash, form a com¬
pound which dissolves readily in three quarters of its weight of
cold water, and in one-half that quantity of boiling water.
The mineral acids decompose it very imperfectly ; but it is not
at all affected by tartaric acid. M. Vogel, who has examined
this compound, affirms, that no union takes place between the

* Philosophical Magazine, vol. xlix. p. 72.

+ Annals of Philosophy, vol. ix. p. 4 52.

7 Vide Journal of Science and the Arts, vol. iii. p. 77°

E 2

28 Retrospect of the Progress of Medical Science,

boric and the tartaric acids ; for if equal parts of these two
acids be mixed together and moistened with a little cold water,
almost the whole of the tartaric acid is dissolved, while the
boric remains untouched : and if boiling water be employed,
the boric acid entirely separates on cooling. He regards it as a
chemical combination of 0* * * §80 of tartar, and 0’20 of boric
acid*.

Succinic Acid.— Some years since Gehlen announced that
he had discovered the presence of this acid in a decoction of
amber. Bouillon la Grange, conceiving it would he interesting
to verify this statement, instituted a series of experiments on
the subject, which enabled him to conclude, that amber con¬
tains a free acid which dissolves with it in alcohol, but which
cannot be separated from it by water ; although it is possible
that it might be obtained, by passing steam through melted,
amber, softened by a fat oil at the boiling point*f\

Acetic Acid. — Doebereiner, by decomposing in a glass tube
the acetate of copper mixed with the oxide of that metal, ob¬
tained results winch enable him to regard the following as the
components of this acid J :

Oxygen . . 64*641 f ir t a ,

Carlton . 3*43 l or 1 Hyaro-carbon . 1.

Hydrogen . *94 j { Carboy acid . ,3.

100*00

M. Baup proposes § to procure this acid in its concentrated
state, by distilling sixteen parts of crystallized acetate of lead ,
one part of oxide of manganese ; arid nine parts of concen¬
trated sulphuric acid. He also suggests, that a mixture of one
part of this acid, and eleven parts of distilled water, may he
employed as a substitute for distilled vinegar ; but M/ M.
Henry and Bajet assert, that this mixture has neither the taste
nor the odour of distilled vinegar.

Malic Acid. — M. M. Bouillon la Grange and Vogel, have
originated the opinion, that this acid is a combination of acetic
acid, and a peculiar extractive matter [j. They prove, that in
distilling the greater part of the acid vegetable juices, the fluid
which is obtained when saturated with barytes and heated with

* Vide Journal dc Pharmacie , vol. iii. p. J.

f Journal de Pharmacie , vol. iii. p. 97.

t ' Schmezgger , vol. xvii. p. 369 ; and Annales de Chimie et de
Physique, t. iv. p. 107.

§ Journal de Pharmacie, t. iii. p. 563.

|| Ann. de Ckim, et de Phy. t. iv. p. 403.

RETROSPECT of the Progress of Medical Science.

phosphoric acid, yields acetic acid. This is the case with the
malic acid also, and they ascribe the precipitation it produces
with acetate or nitrate of lead to an extractive matter, united
with the acetic acid.

Gallic Acid.— In a substance resembling nut-galls, brought
from China, Mr. Brando found :

T annin and gallic acid . 75

Resin . 2

Woody flbre . 23

100

The tannin, which was of a brownish-yellow colour, was
completely soluble in water and in alcohol of R820 ; it has an
astringent taste, and precipitated per-oxide of iron black from
acids. He did not succeed in separating it from the gallic acid.

Mr. Brande found, as Scheele had formerly done, that un¬
decomposed gallic acid is obtained by distilling nut-galls.

Meconic Acid.— This is a peculiar acid, which Ser turner has
detected in opium, and named meconic, from jifjxov, a poppy*.
We are unacquainted with his process for obtaining it.

Jiheumic acid. — Some doubts regarding the mixture of this
acid have been suggested by Mr. Donovan f . This gentleman
discovered malic and sorbic acids in the stalks of rhubarb, and
admitting, on the authority of Mr. Henderson, who discovered
the new acid, citric acid also is present, he conceives the satura¬
tion of the acid juice with lime would yield malate, sorbate, and
citrate of lime, which are insoluble salts; “and when this
powder was acted on by sulphuric acid, the result was a mix¬
ture of sorbic, malic, and citric acids.” Other acids, as acetic,
nitric, and oxalic, are also evolved by the processes proposed by
Mr. Henderson; and, with regard to the combination of the
new acid with ammonia, in which state Mr. Henderson thinks
it exists in the plant, Mr. Donovan observes, “ that extractive
matter and lime were presented to each other, and by the mu¬
tual action of these substances ammonia is always produced/’

Prussic acid.— Mr. E. Davy};, conceives he has ascertained
file existence of this acid in bread made from new flour. When
strong sulphuric acid was added to infusions of this bread
evaporated to dryness, the odour of prussic acid was evolved
on the gentle application of heat. Mr. A. T. Thomson thinks
he has detected it in the recent juice of the Euphorbii.

* Vide Annals of Phil . vol. ix. p. 486.
t Ibid. vol. ix. p. 103.

f Philosophical Magazine, vcL xlix. p. 161 and 3 73.

30 Retrospect of the Progress of Medical Science.

Formic acid . — Berzelius* has ascertained the composition of
this acid to be,

Hydrogen

. . . . 2-84

Carbon .

Oxygen ...

10000

Neutral salts. — Every new acid necessarily produces
new neutral salts : that which we have already noticed, as hav¬
ing been procured from ether, forms neutral compounds with
the alkalies ; and when these are decomposed by the common
acids, the peculiar acid flies off.

Carbonate of Magnesia. — The effect of this substance in
improving bread made of the new flour of last year, a great
part of which had been made from grain which germinated
either before being cut down, or whilst in the sheaf, has been
recently pointed out by Mr. Edmund Davy. This chemist has
since investigated the subjectj, and ascertained that the car¬
bonate acts chemically on the bread in the act of baking ; one
portion of it uniting with the acetic acid, which is then abun¬
dantly formed, if much new flour be employed, and the other
remaining in its original state. The magnesia seems also to
give to the new flour a greater capacity for water ; but although
the bulk and weight of the loaf is increased, yet the bread is
more porous, and specifically lighter.

Borax and the Neutral Borates. — We have already men¬
tioned Vogel's remarks on the action of boracic acid in cream of
tartar. He has examined also the nature of the action of
borax, the neutral borates upon the acidulous tartrates of pot¬
ash and of soda§. When six parts of acidulous tartrate of

* Annals of Phil. vol. ix. p. 107. The author observes in the
sequel of his paper, the comparison of the composition of the fol¬
lowing acids is curious enough : —

Oxalic acid . 3 -f- 2 -f- |

Formic acid . 3 -f- 2 2

Succinic acid . 3 4 -f~ 4

Acetic acid . . 3 -f- 4 -f 6

Gallic acid . 3 -f- 6 -f- t>

Benzoic acid . 3 ~f~ 15 -f 12

J Vide Phil. Magazine, vol. xlix. p. 1 61-173. The quantity of
the subcarbonate of magnesia, which produces the best bread, is
about thirty grains for every pound of flour employed.

§ The Memoir from which we quote was read to the Royal
Academy of Sciences at Munich, on the 10th of January, 1817.—
Vide Journ , dc Pharmacies vol. iii. p. 1.

l?EfrtosPECT of the Progress of Medical Science , 31

potash and two of borax are boiled in sixteen parts of water for
five minutes* the whole is dissolved, a little tartrate of lime
only, which cream of tartar always contains, remaining in the
bottom of the vessel. The salt obtained by evaporating this
solution to dryness is deliquescent; it dissolves in its own
weight of water at 54°. 5'. Fah. and in half its weight of boil¬
ing water : but this last is of the consistence of syrup. The
solution is imperfectly decomposed by the sulphuric, nitric, and
muriatic acids ; but no cream of tartar is regenerated : hence
I\J. Vogel regards this salt as a chemical combination of the tar¬
trate and the borate of soda. The neutral borates act on the
acidulous tartrate in the same manner as borax.

Acetate of Potash. — M. Baup has proposed the preparation
of this salt by saturating a solution of the subcarbonate of pot¬
ash in distilled water with the concent rated acetic acid. This pro¬
cess is not new. It furnishes a very white, w ell neutralized salt*.

JStiier. — M. Deslauriers has deduced the following results
from a variety of experiments made by him on the preparation
of sulphuric etherf. 1°. That two parts of alcohol at 38° are
necessary for exhausting one part of acid at C6°, which is then
diluted with one fourth of water ; 2°. that the acid thus ex¬
hausted is no longer fit for producing ether, and that it, besides,
retains a fourth part of ether in intimate union ; 3°. that the time
of discontinuing to add the alcohol, is when the products mark
only 45° ; 4°. and that the operation should be st opped as soon as
a little water appears in the products, forming two layers in the
receiver ; for, beyond this point, the ether which is obtained is
not free from sweet oil, a circumstance which ought to be
avoided ; 5°. that this oil is never produced by the immediate

decomposition of the alcohol, but always after this has been
reduced by the action of the acid on the elements of the ether;
6°. thence the residue of the retort is composed of 12 parts of
acid, 3 of ether, and 3 of water, when the process has been
continued to, and stopped at., the proper periods.

Oils. — M. Colin, in prosecuting some experiments on the
fabrication of hard soaps ascertained that the simultaneous
action of the air and aqueous vapour carries off the smell of
oils, and whitens them. It also divides them into two parts ;
one of which very readily saponifies, whilst the other is scarcely
capable of that process ; but for this purpose it is requisite that

* Journal dc Pharmacie, vol. iii. p. 5(35.

t Journ. de Pharmacie , Sic. Nov. 18i6. p, 481.

% Ajinales de Chime, Sic. tome iii. p. 22.

32 Retrospect of the Progress of Medical Science.

the oils be previously treated with sulphuric acid, or be exposed
to a very low temperature. He also found that the fluid part
of oils may be obtained in a pure state by a careful saponifl-
cation.

Soap. — M. Colin has confirmed the opinion that water is

absolutely necessary in the formation of soaps ; for even lime

will not combine with oils without that intermedium

Mineral Waters. — - The improved state of chemical
analysis has rendered it necessary to re-examine many of these
waters. Thus M. Gimbernat has ascertained that the gas
contained in those of Baden is not carbonic acid, as has been
generally believed, but. azote.

Various analyses have been made of the Cheltenham waters ;
but, owing to the number of new wells opened in the establish¬
ment of Mr. Thompson, a new inquiry was* * Wanted : and, from
the character of the chemists, Mr. Brande and Mr. Parke, who
have published the following analyses, wre do not hesitate to
regard them as the most correct that have yet appeared' j*.

“ No. 1. The strong chalybeate saline water ; the specific
gravity of which is ~ 1*0002. One wine pint contains 74

grains of dry salts, consisting of

Muriateof soda.... . . . 41*3 grains

Sulphate of soda . 22*7

Sulphate of magnesia . 6*0

Sulphate of lime . 2*5

Carbonate of soda and iron... 1 .5

74*0

The pint yields about 2*5 cubic inches of carbonic acid gas.

No. 2. The strong sulphur cited saline water. Its specific
gravity, after the evaporation of the gases, === 1008*5. One
pint affords 64 grains of dry salts, containing

Muriate of soda . . . 35*0 grains

Sulphate of soda . 23*5

Sulphate of magnesia... . . 5*0

Sulphate of lime. . . . 1*2

Oxide of iron . . . *3

640

& Annales de Chimie, 8$c. tome in. p. 23.

*t The paper from which these analyses have been copied, con¬
tains an excellent account of Mr. Thompson’s laboratory and manu¬
factory, Vide Journal of Science and the Arts, vol, in. p. 54.

Retrospect of the Progress of Medical Science . 33

Gaseous contents :

Sulphuretted hydrogen . 2*5 cubic inches

Carbonic acid . 1*5

4*0

This water has the foetid odour of sulphuretted hydrogen. It
renders tincture of galls slightly black.

<c No. 3. The weak sulphuretted saline water. Specific
gravity, after the loss of its gaseous contents, =d 1006. A pint
affords 36 grains of dry salts, consisting of

Muriate of soda . . . 15*0 grains

Sulphate of soda . 14*0

Sulphate of magnesia . . 5*0

Sulphate of lime . . . 1.5

Oxide of iron . — . ’5

36*0

Gaseous contents :

Sulphuretted hydrogen... ... 2*5 cubic inches

Carbonic acid ......... . 1*5

4*0

cc No. 4. The pure saline water; specific gravity = 1010.
One pint affords 80*5 grains of dry salt, composed of

Muriate of soda . 50*0 grains

Sulphate of soda . 15*0

Sulphate of magnesia. . . . . 1 TO

Sulphate of lime. . 4*5

80*0

“ No. 5. Sulphuretted and chalybeated magnesian spring , or
bitter saline water ; specific gravity, after the loss of the gaseous

matters, = 1008.

Sulphate of magnesia.... . 36*5 grains

Muriate of magnesia . . 9*0

Sulphate of soda. . 9*5

Sulphate of lime . 3*5

Oxide of iron . 0*5

Loss . TO

60*0

Gaseous contents :
Sulphuretted hydrogen
Carbonic acid .

1 *5 cubic inches
40

34 Retrospect of the Progress of Medical Science .

u No. 6. Saline chalybeate , drawn from the well near the
laboratory. Specific gravity, after the loss of the carbonic acid,
= 1004. One pint affords 34 grains of dry salt, containing

Muriate of soda.
Sulphate of soda

Oxide of iron _

Loss . . .

22 0
100
15
0-5

The carbonic acid is about 10 cubic inches.'”

The effects produced by the baths of Mont d’Or, which are
much resorted to, have been investigated bv M. Bertrand,
He found that there are — 1. a constant temperature of 43ocentig.
2. a considerable portion of carbonic acid in solution, both in
the atmosphere and in the water ; and, 3. an atmosphere ge¬
nerally hot, always humid, even when quite transparent ; and
at times stagnant. In general, patients can remain from fifteen
to eighteen minutes in the bath without inconvenience; but
Sometimes, they cannot remain longer than seven or eight
minutes without danger. On entering them, also, they feel a
burning heat, and sense of suffocation ; the pulse becomes much
quickened, and the face becomes turgid and covered with sweat.
At these times, on entering even the hall of the baths, respira¬
tion is impeded and much uneasiness experienced. M. Ber¬
trand attributes these effects to the electrical condition of the
baths ; but the Reporters of the French Institute, to whom his
paper was submitted, ascribe them, with greater probability, to
the carbonic acul being more copiously extricated at one time
than another ; and this opinion is probable, as the effects
are felt only, when the head is plunged in the vapour, or the
stratum of air it occupies*.

At Oldesloe, between Hamburgh and Lubeck, tvro mineral
springs have lately been brought into noiieef. The first is a
saline, sulphureous spring, and, according to Dr. PfafFs analysis,
contains, in three pounds of water, the following solid ingre¬
dients : °

Muriate of soda

310-0 grains
8-5

Muriate of magnesia . .

Muriate of lime .

Carbonate of lime .

Sulphate of lime .

Carbonic acid oxyd of iron . . .

* rlnnales de Chirnic. cl dc Physique, tome iv. p. 207.
t Continental Medical Repertory , No. 1. p. 123.

Retrospect of the Progress of Medical ScicJicc.

o n

Besides which, the gaseous contents in 100 cubic inches, are.

Carbonic acid gas . 11*6 cubic inches

Sulphuretted hydrogen gas.. P4
I he temperature is 9° Reaum.

The second is a simple saline spring. Three pounds of the
water were found to contain,

Muriate of soda . 70*5 grains

Muriate of lime . 6

M uriate of magnesia . 3

Carbonate of lime . 4

Carbonate of magnesia . 3

Gypsum . 1

Oxyd of iron... . . a trifle.

VEGETABLE CHEMISTRY.

from the progress of this branch of chemical science, much
may be anticipated, although little has been done within the
period our Report embraces.

Rice. — M. Henri Braconnet lias completed an analysis of
n hs grain*. The following is the result of his experiments on
me variety cultivated in Carolina, and that in Piedmont.

Carolina Rice.

Piedmont Rice.

Starch .

85.07

83-80

Parenchyma .

4 SO

4-80

V egeto-ani mal matter .

3-60

Incry stall izable sugar. . .

0-29

0-05

Gummy matter, having
some affinity to starch

} 0-7J

0-10

Oil . . .........

0* 13

0-25

Phosphate of lime .

0-40

0 40

100-00

The presence of muriate of potash, phosphate of potash,
acetic acid, a vegetable salt with a basis of lime, another with a
basis of potash, and sulphur, were also indicated ; but in un-
appreeiable quantities.

This result does not strictly agree with that of V ogel, con¬
tained in an essay read in March last to the Royal Academy of
Munich, on the Cereaha ; in which the following are the princi¬
pal results of his experiments :

1°. I he flour of common wheat, triticum hybernum , is com¬
posed of Fecula . 6-S

Gluten . . 2 -4

Saccharine gum . . 5

Vegetable albumen . 1A0

. . \ _ _ ' '"■*

Annales dc Chimie ct de Physique } vol. iv. p. 470.

F 2

36 Retrospect of the Progress oj Medical Science 3

That of triticum spelta , contain s,

Fecula . ^4

Gluten, (undried)* * * § . 22

Saccharine gum . 8 50

V egetab! e albumen . . . *50

2°. Oat flour contains,

Fecula . . — . — . . 59

Albumen . . i *30

Gum . 3 50

Sugar and bitter principle . 8'25

Fat oil . . . . — . 2

Fibrous matter . . . - . . . . —

3 . Rice flour yields,

Fecula...... . . . 96

Sugar . . . . . . — 1

‘ Fat oil...... . 1*50

Albumen . . . 020

Ergot.—- We have already transferred to our pages Van-
quelin’s analysis of this morbid production of the rye, to which
we must refer*)*. M. Yirey conceives, with great probability,
that it is to the acrid and the putrescent animal matter contained
in the ergot, that wre must refer the poisonous properties
of til s production.

Datisca Cannabina. — BraconnetJ has ascertained, that this
plant yields a peculiar vegetable principle, which resembles
inulin in some respects, but possesses peculiar properties suffi¬
cient to distinguish it from that substance. It is obtained by-
evaporating, in a moderate temperature, a decoction of the da¬
tisca, and allowing it to remain at rest, until a granular crystalline
precipitate is formed, which is the principle in question. It is
of a yellow colour, and communicates its colour permanently
to silk and wool §. It is soluble in boiling water and boiling
alcohol ; but is not, like inulin, precipitated by water of barytes.
It dissolves in a weak solution of potass or of barytes, from
which it is precipitated unchanged by an acid. Concentrated
sulphuric acid, aided by heat, dissolves it unaltered ; but it is
precipitated by the addition of water, which is not the case with

* In drying the albumen, 9’5 0 of the product should be
deducted.

t Repository , vol. vii. p. 339-

J Annates de Chyme, t. iii. p. 277-

§ Braconnot observes, “ that, if the wood be prepared with
alum, the colour is very lively and intense ; and rejects the action
both of the air and the light.”

liETROSPECT of the Progress of Medical Science. SI

dissolution of inulin in that acid, lode forms with it a yellow
compound soluble i^ cold water. Its concentrated solution in
lime water is not precipitated by nut-galls; but that of inulin
is thrown down in a glutinous elastic form.

Narcissus, Pseudo-Narcissus. — M. Caventou* has ascer¬
tained, that 100 parts of the flowers of this species of Narcissus
contain: '

Odorous fatty matter.... . . 6

Yellow colouring matter . 44

Gum . . . . 24

Vegetable fibre . . . 26

100

Potatoe.— -Gwing to the very extensive employment of the
potatoe as an article of food, its nutritive qualities have been
over-rated. According to a recent analysis of Cadet de Vaux,
100 lbs contain: *

Amy laceou s fecula . . 1 6 lbs.

Parynchyma . . 9

W ater of vegetati on . . 75

lOOf

Tannin.— M. Cadet, in an Essay on Astringent Vege¬
tables has given the following comparative table of the quan¬
tity of tannate of gelatine precipitated from decoctions of the
plants enumerated §. The quantity of each operated upon?
was fifty grammes, and the desiccation and division were
brought as nearly as possible to the same point in all.

Grammes. Deeigr.

Gall-nuts . . . 43 0

Tormentil root . . 2 5 0

Cornus sanguinea, of Canada..... . 22 0

Bark of the alder... . 18 0

• — - — — — apricot..... . . . 16 0

* Journal de Pharmacies vol. iii. p. 545.

+ Ibid., vol. iii. p. 34. £ Ibid, vol. iii. p. 104.

§ As it was, in many instances, difficult to collect the precipi¬
tates, M. Cadet employed the following method : When the solu¬
tions, after the addition of the gelatine, did not clear, an excess of
the gelatine was poured in ; and, after agitation, a concentrated so¬
lution f caustic soda was gradually added ; which, dissolving the
precipitates, rendered the solution transparent. On saturating the
soda with weak sulphuric acid, the precipitate re-appeared, coagu¬
lated, and was easily collected on the filter. It exhibited all the
properties of tannate of gelatine.

3S Retrospect of the Progress of Medical Science .

Bark of the pomegranate . . . .

- — . oak... . . . . .

— — — cherry-tree..... . .

- - — — — cornus mascula .

- - — — maple (de Sir W ager) . . .

— - — *— — - weeping willow .

*— ■ - — — - coriaria myrl folia .

— — - — — Virginian sumac .

— — — — holm oak . .

— — — - - common service . . .

- - — — — - American ch esn u t . . .

— — — — — horse chesnut. . . .

— - — aesculus pavia . . .

- - - Canadian sumac . . . .

These results, although intended by M. Cadet for the
manufacturer, should not be overlooked by the medical
practitioner.

Resin. — Mr. Daniel has published * an analysis of a resin,
which is new in this country, but is employed in India as a
varnish, without any preparation, and hence may become a
valuable acquisition, if brought home in quantity. It was in a
concrete state when he got it ; slightly translucent, of a very
path green colour, and having a lustre between that of resin
and wax. It was tasteless, inodorous, and pulverulent ; but,
when burnt, deposited much carbonaceous matter, and emitted a
pleasant aromatic smell. The mean of three analyses, one by
ether, and the other two by alcohol, gave the Following re*
suits

Extractive matter soluble in water . 0.4

Resin soluble in alcohol and ether... . 62 6

Resin insoluble in alcohol and ether . . 370

1000

finchona.—lSi. Laubert has continued his chemical analy¬
sis of the Peruvian bark. As we intend to present our readers
with a translation of his additional essay, we shall here only
mention the general results. He concludes that the green
matter extracted from the loxa bark by ether is probably an
essential oil ; but it is not yet. well understood. From the yel*
low bark, Calisaya, he has procured a kind of yellow balsam,
which furnishes a crystallizable resinous matter ; and he has
also obtained from the alcoholic tincture of the same bark a
colouring matter, which he regards as a species of extractive or
rather of tannin f.

* Journal of Science and the Arts, vok iii. 115.
t Journ . de Phann. p. \<)3.

Retrospect of the Progress of Medical Science. 39

Opium.— T> r. Gilbert of Leipzig informed ik* d„t nr
Sarturner bad discovered t],,. ■ s- V , ea us » that M.

characteristic con stKnf “ pn"-C,P,e lhat C0'^tituteS the
he extracted !“ I sa ™ "A*** which

of v, orphan f. it ap pears t m‘ ^ glTCn the nMle
Sion of opium made wbh w -7 1P°T,1,S lnto atr infu-

annnonia esS ^ '7* acetic acid-
coloured with extractive matte- from ‘mediately precipitated,

be dear , bv agitato,, it with a %££& ^wC’ITZ
We in alcohol *«,"* S0>-

tessr, ■ Ist&hfe Lf cr-vstallr? a~-

resinous black ^aves a solid

?^r£2wHS£ i§

able, but more soluble than mornhiunf' 'Mr$nate 7 cr>’stalliz-

Zfipsvh, Sr ^-’JESSi
-S-— ^ t&TF&zsst"* - *•

barturner has ascertained that the salt whl^Ji n
garded as the narcotic principle is a

ANIMAL CHEMISTRY.

from'SerSult'ofsotua ex^!^merIte*detaiSl^)ynlVI*c^a^^r0^a^,

that muscular fibre is no! convert! into fat Vv f ‘ 5'LuSMC«>
turned action of water ; but that, when a portion of l°T COn*
posed to this agent, the muscular fibre strictlv s nLV ^ ^
consequence of the putrefactive process wlichu,mfkg’ -*
dissolved in the wat'er, and leave’s th^t wSlioh Ts "Sb
Tins opinion is also supported by M. Chevruel. "

* Repository, vol. vii. p. 347.
t Annals of Philosophy, vol. ix. p. 485.
fi Repository, vol. vii i. p. 29.

Annates de Chunk cl dc Plu/simir

hjA'iuc, tome iv. p. 7 1,

40 Retrospect of the Progress of Medical Science.

Carbon — In the translation of Dciebereiner s observations

» will u m*

tSSS^XSSi -4— - “•

lion with azote. . g yo] of vapour 0f carbon.

1. Animal charcoal . j \ vol. of azote.

| 6 vol. of vapour of carbon..

2. Azoture of carbon • •• j 2 vol. of azote.

| 6 vol. of vapour of carbon.

3. Cyanogen . . *• { 3 vol. of azote.

Intestinal gases— V auquelin having examined the ^ found
in the abdomen of an elephant who lately died at the M useum
nf Natural History in Paris, found it to contain, bes . v._ «

45 centigrammesf.

GlaMar calculus- In the maxillary g^» of|« ■
elenhant several white calculi were found ; some crystallized 1
fe^ ar tetrahedrons, others of an oblong form, and having a
Sin of oS aTa nucleus, and some without any regular form,

but, like the others, breaking with a of'these' concre"

quelin, who examined the chemical properties of these c ^
Sons, found them to be composed chiefly ofcaibonateo

some phosphate of lime, and an animal mat, eH. .

Calculus found in the vagina-fi «, our a^s of a pku-
Ins found in' the vagina of a girl, it is evident that calcul
form in different p°arts of the body, closely resembling one
species of urinary calculus. That to which we refer consisted
f phosphate Of Immonia, phosphate of magnesia phosp ■hrteof
lime, and a considerable portion of animal matter, but no u ..

CCin0dosingafo;Sa3nof ’ ^Lmbjec " we may notice the pub¬
lication of th°e Elementary Treatise of M. Thenard||, which, ah
though not published exactly within the period our present B ^
nort embraces, is yet scarcely known in this country. For an
admirable criticism on the merits ol this work, we refer o r
readers to the Journal of Science and the Aits, (vol. .

p. 255.)

* Vide Repository , vol. vii. p. 165.
f Journal de Pharvn. vol. id. p. ~05.

t Ibid, p. 208.

§ Repository, vol. vii. p- 111. . Vmf'urue ’

II Traiie dc Chime, E^idairc, Thconque, et ‘‘gf*’..
L. J. Tiienard, &c. &c. 4 tomes, 1’ans, 18 IS, IS 14, tv m -

Retrospect of the Progress of Medical Science . 41

NATURAL HISTORY.

One ox the most interesting works on Natural History which
oas appeared for many years, has been lately published by M.

* uvier, intitled, Memoir es pour servir a V Histoire etV Analo-

mie [ des Mqllusques* P , The volume contains twenty-two me¬
moirs. He first details the history and anatomy of the
<- ephalopodes, , ( sepia of Linnaeus). The peculiar black sub¬
stance, or ink, with which this class is furnished by Nature,
as an instrument, of defence, is shewn by Cuvier to be dif-
terently situated in the different species of the genus. In the
common cuttle fish, le poulpe common (Sep. octopodia L.) it is
contained in a sac, incased in the liver, a circumstance which
misled Monro to regard it as the bile of this animal ; but in S.
officinal is, in which it is blacker, the sac containing it, which is
situated in the abaomen, before the testice and the ovarium, is
much larger than in the octopodia, and discharges its contents
into the rectum by a large excretory duct, opening near the
rectum ; and in the S. loligo , the sac is suspended before the
h\ei, out not incased in it. 3 he anatomy of the eye. which
is the most remarkable part of the organization of the cuttle
fiSii, is minutely described by M. Cuvier. It has no anterior
chamber, nor transparent cornea, the crystalline being in im¬
mediate contact with the conjunctiva. It has three coats; 1.
an external or sclerotic, which is somewhat cartilaginous, and
terminates before at the edge of the crystalline, forming an im¬
moveable pupil ; 2. a second, which may be regarded as a re¬
tina, opake and white, formed by the coalescing of nervous
filaments, which traverse the former, and terminate by a plaited
circle in minute rays of the greatest beauty, forming a kind of
ciliary process; and, 3. a very delicate deep violet brown mem¬
brane, which may be regarded rather as a coat of varnish, an¬
alogous to that covering the choroid in man, than as a real
membrane ; but there is no true choroid in the cuttle fish. At
t ne back of the globe of the eye is a sac containing some glan¬
dular bodies, and the optic ganglion, which is, in point of
size, equal to that of the brain of the animal, to which it is at¬
tached by a short thick fillet, which protrudes through a hole at
the bottom of the orbit.

M. Cuvier regards the Cephalopodes as beings completely in¬
sulated in the scale of animals.

The second memoir is on the Clio borealis ; the third on the

* Memoires, & c. par M. le Chevalier Cuvier, Conseiller d’Etat
Ordinaire, Secretaire Perpetual de f Academie des Sciences del’In-

stitut Royal, &c. 4-to. pp. 498. avec 35 planches en taille-douce.
Paris, 181?.

VOL. Mil. — NO. 43. a

42 Iie trqcpect of the Progress of Medical Science,

Hyde ; and the fourth treats of the Tritonia hambergii, the
description and anatomy of which is characterised by the most
minute accuracy. The most remarkable circumstance m its
organization is the simplicity of the nervous system, ad the
nerves passing from the brain in the form of rays to the various
parts of the body, without the intervention of ganglions, plexi,

or spinal marrow. .

The fifth memoir is on the genus Doris > to which M. Cm ]ei
has added several new species, and cleared the whole from the
confusion in which it was left by Lip ureas and succeeding
naturalists. The dissection of five of the species, viz. D.lacera ,
solea , scahra , tuber culata , and verrucosa, ^ are detailed; but we
must refer our readers to the work itself for tne details. \Lik
sixth memoir treats of the Scyllcea, JEohdes, and Glaucus , thr^
beautiful genera of the Molluscse; with some additions to the
memoir on the ‘Tritonia : the subject of the seventh is the genus
TJiethys , and its anatomy ; and the eighth contains some re¬
marks on the Phy Hided and Pleuro-branchus , two new genet a o.t
Molluscs of the order gasteropodes. The ninth memoir, besides
detailing the anatomy of the genus Apfysia, contains several new
facts regarding some of its species. 1. his genus of Mollusc a.
gives out a violet coloured liquor, which bwammerdam asserted
to proceed from a small sac connected with the organs of gene¬
ration ; an opinion which M. Cuvier has found to be a mistake.^
According to his observations, it is transuded from the poie> oi
the skm ; and, when collected and dried, has a beautiful deer*
tint, resembling the colour of the scabiosa a t ropvrpu rea ; but no
acrid quality, such as it is believed to possess by the vulgar.

The tenth essay treats of the Aceres , or gasteropodes, with¬
out apparent feelers i and the eleventh, ci scans, the Limctx and
Helix of Linnaeus. W e would w illingly, did pur limits pel am,
make some extracts from this Essay, winch contains man) in¬
teresting remarks. We can only, however, notice a few pai -
ticulars regarding the interior organs, of sense of the limaees,
« The ear does not exist in this family, no appearance of the
oman, either interiorly or exteriorly, being perceptible. I he
sense of smell appearsto be very delicate, as may be perceived
by the promptitude with which the animals leave the shell when
placed close to plants they are fond or, and the odour of winch
only can attract them ; but it is difficult to determine the seat oi
this sense. Perhaps,” says M. Cuvier, 41 it resides to a certain
extent in the entire skin, winch has much of the texture of a
pituitary membrane.'* He conceives the sense of taste must be
feeble, as the tongue is nearly cartilaginous. But the most
singular faculty of these moiluscse, is the powei they possess o\
re-producing the feelers and the head almost entire after ampu¬
tation ; a fact first observed by Spallanzani. The eleventh me-

RETROSPECT of the Progress of Medical Science. 43

Rioir is on the Testacella haliotoidea , and a new genus of Mol-
hiscae, named Parmacella. The twelfth treats of the Anehi-
dium pcrcnii. The thirteenth of the Helix stagnates, and cornea
of Linnaeus : and in the fourteenth, M. Cuvier closes his ex¬
amination of the gasteropodes furnished with lungs, with the
anatomical history of the lanthine and Phasiandk of Lamarck.
In the fifteenth memoir he examines the Helix vivipcra , (Lin.)
which presents many very striking singularities. M. Cuvier
refutes the opinion of Spallanzani, that this animal is a true
hermaphrodite, and capable of fecundating itself; and points
out the characters of the two sexes. The uterus of the female
n spring is full of the young in their shells, and at the same
time globules of a glary matter, which, when examined by a
magnifier, appear to contain in their centre a very small ani¬
mal, with the first rudiments only of the shell. As these gio-
b ales coagulate like albumen when spirit of wine is added to them,
Cuvier concludes that this animal is ovo-vivi parous liketheviper.
The sixteenth memoir gives the anatomy of the Buccinum unda¬
tum, (Lin.) ; and the seventeenth that of the Pectinibrancheatea,
which have not turbinated shells: and in which no separation
of sex can be perceived. In these our author has never dis¬
covered any other generative organs than an ovarium more or
less developed; but he has remarked some glandular parts en¬
tering into the composition of this organ, which he thinks may
be regarded as serving for the secretion of the fecundating
sperm. The eighteenth memoir describes the organization of
the J hate a, (Brown), an dSalpa, (Forskaohl). The nineteenth,
that of the Ascidine : the twentieth treats of the Lingula anatina ,
(Lam.), a singular species of bivalve ; and the twenty-first of
the genus Lepas, (Lin.), the members of which differ from all
the other molluscs?, in being furnished with numerous, horny,
articulated members, susceptible of motion, with a mouth fur¬
nished with lips and jaws, and a nervous system formed of
a series of ganglions. The volume is concluded with a critical
Dissertation on the different species of cray fish, known to the
ancients, and the names which they gave them.

J J O

A new genus of vermes; distinguished by the name of
Amphiro , has been described by Dr. Leach, from the manu¬
scripts of the late Colonel Montague. It contains five British

the sea, have ions;

species. 1 hey are all inhabitants of
tentaculse, organs of respiration, and organs approximating to
feet.

Polypes. — The circumstance of the production of perfect
polypes from cuttings of a polype, naturally attracted the atten¬
tion of philosophers, who were led to consider the fact similar
to the slipping of a plant, and thence regarded the polype as

NG 2

44 Re trospect of the Progress of Medical Science,

the uniting link in the chain of beings, between the vegetable
and the animal kingdoms. This idea, however, has lately been
regarded askable to two objections : first, that, as in the animal
frame a complete organization runs through the whole being,
and is intimately connected with the will or mind of the animal,
when a part is cut off, its animal functions are destroyed, be¬
cause it no longer possesses this completed organization ; and,
secondly, with regard to vegetables, 44 it is only when they are
cut agreeably to certain rules, that we can depend on an increase
of plants.” On these grounds Mr. John By water has suggested
the idea* that a polype is a portion 44 of mucilaginous matter,”
in which a great number of smaller animalcules reside ; and that
these have the power 44 of shaping the mucilaginous masses,
derived from decaying vegetables and their own secretions, into
such forms as to be able to move them by their aggregate force
for all the purposes of pleasure and existence.” The dark
spots with which a polype appears studded, when highly mag¬
nified, he regards as 44 small groups, or single animalcules.”
This suggestion is certainly highly ingenious; but it is liable to
several objections. In the first place, various parts of the polype,
its feelers for example, appear intended to be altogether sub¬
servient to the other parts of the animal, as constituting a
whole ; but we can scarcely conceive such a universal consent
to be obtained throughout a community of animalcules, as will
secure the actions of all the parts in so perfect a manner as if
the whole were moved by the same will. In the second place,
when a polype is cut in pieces, the perfect animals pro¬
duced from these would require, on Mr. Bywater’s principle,
a quick generation of animalcules to make up the new parts ;
but it is not easy to suppose that the generative powers of the
animalcules would be left to be called into action merely by ac¬
cidental circumstances: and, lastly, Mr. By water is not correct
in his assertion that all vegetables require to be cut according
to certain rules, to secure an increase of plants.

Cicada mannaf evens. — Several specimens of this curious
locust, from New South Wales, were lately presented to the
Bath Literary and Philosophical Society, with some of the
inanna they deposit on the Eucalyptus-)*. The late Colonel
Patterson first observed this insect in the pupa state in Novem¬
ber 1800. After leaving its covering, it rapidly enlarges, and
in a few hours gains strength enough to fly to the height of
sixty or seventy feet. The notes of the male and female, when

* Philosophical Magazine, vol. xlix. p. 283.

+ Ibid. vol. xlix. p. 29fi. The specimens were presented by
Mrs. Grose, the widow of the late Colonel Patterson.

Retrospect of the Progress of Medical Science.

sounded together, exactly resemble the noise of grinding knives
or razors ; and hence the insect is popularly called the razor-
grinder. The eggs of this Cicada are deposited in the ground
in January ; the larva is perfect in September, when it is formed
into the pupa, in which state it remains until November. The
saccharine matter may be collected either in a liquid or a con¬
crete state. It possesses, in some degree, the quality of manna ;
but has not been chemically examined.

Coccus lacca. — M. Latreille, conceiving that the facts relating
to this insect, detailed by Kerr and Roxburgh, are in many re¬
spects incorrect, has endeavoured to correct their mistakes*. He
places it amongst the cocci, or cochineal insects, because the
female fixes herself permanently to the vegetable whence she
extracts her nutriment, and dies on the same spot, her carcase
covering the germ of her posterity. This species he denomi¬
nates Coccus fens or lacca. The female never acquires wings,
and has a small proboscis, which proceeds from the anterior part
of the chest, between the two fore claws. The male has no pro¬
boscis, but is provided with two wings, which lie horizontally
upon the body. The antennae of both sexes are composed of
eleven joints, and terminated by two long diverging hairs. From
the female of the Coccus lacca , a resinous matter exudes, chiefly
from the sides of her body ; and by accumulating, forms a crust
over the insects, who are generally crowded together, side by
side. When separated from the branch, this crust, which is
the lac, is cellular, the cells being lined with a white matter,
which appears to he the exuviae of the ova of the insects. The
lac is known in commerce under five different names, each indi¬
cating some particular modification of the substance: thus —
1. Stick-lac is the crust adhering to the young branches in its
natural state. — 2. Seed-lac is obtained by separating the crust from
the branches, reducing it to a gross powder; and extracting its co¬
louring principle, after which, a hard, resinous, yellowish powder
remains, somewhat resembling seeds of mustard. — 3. Shell-lac is
prepared by melting the seed-lac in a cotton bag over a charcoal
fire, and then forcing it through, while it is fluid and receiving it
upon the trunk of a Banana, so as to form it into thin plates ; the
resin, being the most fusible part of the lac, passes in a state of
great purity. — 4. Lac-lake is a preparation made with the resin-
lac, which, besides the colouring matter, contains about one third
of its weight of resin, one sixth of alum, and some earthy matter.
— 5. Lac-dye is an Indian preparation also, which contains scarce¬
ly so much resin as the lac-lake, and rather more colouring

* Annates de Chimie et de Physique .

4-6 Retrospect of the Progress of Medical Science.

matter, with the same foreign ingredients. It is softened by
hot water, but not dissolved by it.

Ornitkorinchus paradoxus. — A fact mentioned in a letter
from Sir John Jamieson to Mr. Macleay, read lately pt thy
Linnean Society, shews that the mechanism ot tne fang ot
venomous serpents is not peculiar to that class of reptiles y the
spur of the Qrmthorincus paradoxus being a hollow organ of the
same kind, and intended, like the serpent's fang, for ejecting the
venom secreted beneath it into any wound which it may indict.^
The game-keeper of Sir John, having slightly wounded one ot
these animals, one of its spurs run into his hand. In a short
time the arm swelled. Ins jaw became fixed, and lie exhibited
every symptom of a person bitten by a venomous serpent, f he
symptoms gradually yielded to the external application of oil,
and the internal administration of ammonia*.

Among the works which have recently appeared on Natural
History, we may mention a Catalogue of British Birds, by Dr.
Leach, of the British Museum, the most correct that has yet
been published; another Catalogue of 203 Species, by Mr.
Iddward Forster, j uryf’ ; and Lam ark’s work, Hi s to ire A a t u-
retie des Animaux sans Vertebres , which, although pubiisned last
\ ear in Paris, is yet scarcely known in this country.

BOTANY;

There is much satisfaction in perceiving the ardour with
which philological inquiries are pursued ; and although there
is much of hypothesis blended with the explanations of the
vegetable functions that have hitherto been made public, yet
the doubts which these raise, and the investigations to which
they lead, are likely ultimately to illumine with the beams of
truth this interesting branch of natural knowledge. The
opinion of Mr. Knight, that gravity is the cause of the down¬
ward growth of the roots of plants, which we noticed on a
former occasion, and the attack made upon it by Mr. Keith, has
been spiritedly defended by its author in a paper read before
the Linnean Society ; but we shall defer giving any account of
this defence until it be published.

The cause of the ascent of the sap in trees, is a point in
Phvtology that yet remains undetermined. Mr. Knight en¬
deavoured to explain it by the action of what is termed the
silver grain of the wood; and some experiments, which he has
recently made on the expansion of the wood of trees in different

* Repository, vol. vii. p. 435.

t Catalogus Avium in Insults Britanuicis habit aniiutn, cur it el
studio Edwardi Fprstcri,jim .

Retrospect o f the Progress of Medical Science, 47

directions, have confirmed him in this opinion. The principal
circumstance observed in these experiments was, that, in sawing
a horizontal section of a tree, from the bark to the pith, it ex¬
pands so much as to prevent the action of the saw ; but if the
saw be made to work in a direction to cut across the silver grain,
instead of merely separating them, it will continue to act freely,
as no expansion takes place. Admitting the accuracy of these
experiments, and the expansion of the silver grain, we cannot
admit the application of the fact as accounting for the ascent of
the sap. In all experiments of this kind, the important truth,
that plants are living beings seems to be overlooked. If the
silver grain retains its action when a tree is sawed into planks,
it would, were the hypothesis of its action being the cause of
the ascent of the sap admissible, operate also when a tree withers.,
and still carry up the sap to its extreme branches ; which we
know is not the fact.

The effects of vegetation on the atmosphere has long at¬
tracted the attention of phvtologists. Among others, M.
Saussure made many experiments on the subject, and was led
to conclude, that the leaves and green parts of plants decom¬
pose the carbonic acid contained in the atmosphere, assimilating
the carbon into their proper substance, and emitting the greater
part of the oxygen in the form of gas. The accuracy of this
observation of Saussure has been lately called in question by
M. Ruhland*, who has endeavoured to prove, that plants do
not decompose carbonic acid ; and are incapable of producing
such an effect ; for as the oxygen is instantaneously extricated
on exposure to the sun, “ the decomposition,” he remark?,
44 of the carbonic acid would be effected with a rapidity which
could scarcely be equalled in a furnace heated to the highest
degree.11 The emission, therefore, of more oxygen when a
plant is exposed to sun-shine, in an atmosphere containing a
small proportion, for example, of carbonic acid, than ^ when
it is exposed in an atmosphere containing none, is merely owing
to the carbonic acid being favourable to the vegetation of the
plant. He also affirms, that acids in general have the property
of enabling plants, exposed to the sun, to give out a greater
quantity of oxygen ; and, to prove this opinion, he made &
number of experiments, by exposing plants, (the leaves of
sambucus nigra,) in vessels of water, containing acids in the
proportion of one to 6000 of water, inverted over mercury, to
the s uti, for the space of five hours. The following table
shews the results he obtained :

* Journal <!e Physique, 1SU) ; and Annalcs dc Cltimir ei dc Pkys „
tome iii. p. tl 1.

4S JRetrospect of the Progress of Medical Science.

Nature of the Fluid .

Inches of Air
disengaged.

Purity of A ir \
disengaged, j

Spring water . . .

4*7

0*47 j

Water, boiled during two hours . .

034

Water and sulphuric acid..... . .

7*0

0*31

_ - muriatic acid . . . . .

20 6

0 73

_ . . i, of muriatic acid .

17*0

0*70

Water boiled with nitric acid .

9*0

0*66

Water and muriatic acid in the shade .

0*0

and nitric acid . . . .

1 7.3

0*65

nnrl acpfic acid . . ...

24*5

0*7 6

saturated with carbonic acid at 12p...

7*2

0*45

saturated with carbonic acid mixed ^

22*0

0*76

with t distilled water . . . j

mixed with § distilled water . . .

24-0

0*78

, ... wnr! ammonia.... . . . . .

0*0

Lime water.... . . .

0*0

W ater and carbonate of potass ........... .....

0*0

<^fd ammoniac. t . . .

6*5

0*51

- acetate of nota.s'h . . . .

5*5

0*30

_ _ _ _ . nitre . . . . . . , . , .

11*0

0*55

. . eld or lire of sodium. . . .

4*7

0*36

_ * fra vtar . . . . . , T T T t - * .. .. - , ........

l6*Q

0*56

, , not ash . . . . . . .

0*0

1 . nl mnol . « , e * . .

1*2

0*21

......... chlorine. . . . .

4*7

0*46

I , i _ of chlorine . . .......

2-5

0*39

| * - 30 0 0 u

The Editor of the Annales de Chimie justly observes, on
the results in the above table, that M. Ruhland has not ascer¬
tained how much is to be attributed to the action of the sun on
the fluid itself, or whaf it would be on the fluid containing any
other substance, such hs silk or cotton, so as to determine what
is justly due to the action of the plants.

" The phosphorescent property of some plants have been
noticed by various botanists ; but the most remarkable account
of this kind which we have read, is contained in a letter from
A, T. Mornay, Esq. to Dr. Wollaston*. The plant, which
displayed the phosphorescence we are about to mention, grows
in Brasil, between Monte Santo and the river Bendegd, and is
orobably a species of Euphorbium. It is called in the country,
ijipo de Cunanam ; is a leafless climbing plant, and emits a
very acrid white juice. “ When I made a cut at the bush with
my hanger,” says Mr. Mornay, 46 in the dusk of the evening,
the wounds inflicted, presented a beautiful luminous line, which
was not transient, but lasted for several seconds, or a quarter oi

* Philosophical Magazine, vol. xlviii. p. 422.

He trospect of the Progress of Medical Science.

a minute.” When the plant was bent so as to break the
cuticle, the same appearance was observed at each crack ; and
the milky juice, as it dropped, appeared like drops of fire, or
dropping- inflamed tallow.

Ergot. — This is an elongated excrescence, which fills the
dace of the seed in the glume or husk of rye. l)e Candolle
elieved, that it was a small fungus belonging to the genus
selerotium, and arranged it under the specific name clavus. M.
Teissier first combatted this opinion by observing, that he had
seen 44 seeds, one-half of which was sound rye, and the other
half ergot;** 1 and M. Virey has asserted, that it is actually a
morbid modification of the rye itself, an opinion at least highly
probable.

On the subject of systematic and descriptive botany, the
most interesting event we have to record, is the publication of
a very learned and elegant history of the genus Cassia , from the
pen of Dr. L. T’h. Fred. Coi laden, of Geneva*, both as re¬
gards the natural history and the medicinal properties of the
different species. We can only notice a very few of his remarks
respecting that species which yields the senna of our Materia
Ivied ica.

There are two varieties of senna known in Egypt, the
Cassia senna obovata , and the Cassia senna lu?ieeolata ; and at
Boulac, the great entrepot of senna, not only are these varieties
mixed together, but the leaves of the Cynanehum olcafolium ,
which is there known by the name of argel or arguel, is also
added. The proportions, according to Dr. Calloden, are 500
parts of the lance-leaved senna ; 200 parts of obovate senna ;
and 200 parts of argel. Although the leaves of the argel re¬
semble those of the senna, yet they can be distinguished by
attention to the following- circumstances : 1. The leaf of arg;ei

is an inch,* or fourteen lines long; while the ieafets of the
senna scarcely ever exceed nine lines. 2. The leaf of argel
has a straight side ; and below, the lateral nerves are not seen ;
the senna leafet has the lateral nerves conspicuous on the under
disk. 3. The leaf of argel is regular at its base ; the two sides
terminated at the same part of the petiole; the senna leafet is
oblique, one of the sides being larger, and produced lower upon
the petiole than the other. The druggists in Europe occasion¬
ally mixed the senna with the Ieafets of Colatea arbor escetis ;
but this is of little consequence, as these are purgative in nearly
as great a degree as the senna Ieafets.

* Histoire Naturelle ct Medicals des Casses, 8$c. &fc. par L. Th.

1 red. Colladon, de Geneve, M.D. 4to. Planches, pp. 140. Mont¬
pelier, 1816.

VOL. viii. — no. 43.

bO Re TJWSPEC7' of the Progress oj: Medical .Science.

We shall close this part of our Report, by simply ad¬
verting to the following investigations. An examination
of the Coniferous ‘plants of Koempfer, by R. A. Salisbury
Rsq. F.L.S.* * ; a review of the genus Amaryllis , by J. Bei-
lenden Kerr, Esq.f ; and of the genus Crtmim, _ by the
same botanist J ; and some extracts from a periodical miscellany ,
published in Spanish at Santa Fe de Bogota , intitledj je,i
Semanario del Nuevo Hey no de Granada pf1 1810.

MATERIA MEDIC A AND PHARMACY.

Unless the medicines, which are prescribed for the cure of
diseases, be good and genuine of their kind, and unless the
pbarmacopolist who prepares them be correct and guided hy
chemical principles, it will be vain to expect advantages from
their employment, or to rely upon the skill of the physician.
In this point of view, the importance of improvements in
Materia Medica and Pharmacy, is perfectly obvious, and
ought to be acknowledged. Little, however, has yet been ac¬
complished, although some chemical physiologists of high cha¬
racter have undertaken the investigation of detached parts of
the subject. Thus M. M. Pelletier and Majendie have ex¬
amined ipecacuanha, and, from the results of their experiments,
have been led to draw the following conclusions :

1. That that root, as generally employed, contains a peculiar
substance which they have denominated emetine , and on which
the medicinal properties of the root depends. 2. That this
substance is emetic ; that it exerts a specific action upon the
lungs and the mucous membrane of the intestinal canal, and
that it is also narcotic. 3. That emetine may be_ employed in
every instance in which the use of ipecacuanha is indicated, and
with much more success, as the dose is determinate and its
properties constant; and with the advantage also of being
devoid both of odour and taste ||.

Preparation of Cinchona. —Mr. C. Johnson, one of the sur¬
geons of the Lancaster Dispensary, has discovered, that the best
method of preparing the infusion of cinchona bark, is, by using
Count Rumford’s coffee apparatus' f ; on the strainer of which.

* Journal of Science and the Arts , vol. ii. p. S Op. 4 Ibid. p. 842.

* Ibid. vol. iii. p. 102. § Ibid. vol. iii. p. 124.

|1 Annates de Chimie, Ac. tome iv. p. 184. A translation of M.
Robiquet’s Report to the Institute on this Essay, shall appear in our
next Number.

«f[ The apparatus employed by Mr. Johnson, was made by
Edmund Lloyd and Co., 178, Strand.. Count Rumford's description
of his apparatus, is to be seen in the Repertory of Arts for April
and May, 1815.

- Retrospect of the Progress of Medical Science. 51

the bark pounded and sifted through a wire sieve is placed, and
boiling water poured upon it in successive portions. “When
about a quart of water has been thus passed through an ounce
of cinchona, it forms a beautiful clear solution of all that water
can extract, and strongly exhibiting the sensible properties of
cinchona.1’ The stratum of bark should be of such a thick¬
ness, that the water may not pass either too slowly or too rapidly
through it. Mr. Johnson states, that he has found tc a strainer
of two inches, three inches, and four inches diameter, most suit¬
able for a half-ounce, one ounce, and two ounces of cinchona*.

Colchicum Autumnak. — Sir E. Home has ascertained, that
the sediment which an infusion of the colchicum lets fall, acts
violently as a purgative ; and therefore as the separation does
not lessen the specific effect of the medicine in gout, he pro¬
poses to separate it, as the means of rendering the action of
the remedy milder.

Nux Vomica. — This has been generally regarded as a medicine
too dangerous for internal use ; and writers on the Materia
Medina, even Murray, having few authorities to guide them,
and these not of the first rank, have given verv erroneous ae-
counts of its effects on the animal ceconomy. It has lately been
introduced in France as a remedy for partial paralysis, and a
number of cases illustrative of its efficacy, have been published
by Dr. Fouquier of the Hospital de la Char it if. It has been
given in the form of powder and of an alcoholic extract,
in gradually increased doses, until from thirty to fifty grains
have been taken in a day. Its sensible effects are strong
contractions in the muscles, which occur in general about half
an hour or an hour after the dose has been taken ; but it the
dose be moderate, these transitory tetanic appearances happen
in the paralytic parts only, the healthy limbs remaining un¬
affected ; and occasionally, the only sensible effect of the medi¬
cine, is an unpleasant feeling of oppression, accompanied with
a sense of heat, and increased sensibility in the affected parts.
The appetite is improved by this remedy, while the bowels
become rather confined. In some instances, and when the dose
has not been well regulated, it has even excited a kind of deli¬
rium ; and sometimes a general tetanic appearance, during
which, the patient loses his speech and his power of swallowing,
breathes oppressed! y, has palpitation of the heart, passes his
urine with great difficulty, and suffers the most distressing
anxiety. These symptoms, however, subside in a short time ;
and he feels himself in possession of a greater power over the

* Annals of Philosophy , vol. ix. p. 452.

t Bulletin dc la T acidic de Medecine de Paris, 181 f, p. 272-3b2.

52 Retrospect of the Pfogress of Medical Science,

paralytic parts, which increases by degrees until he altogether
recovers their use. The remedy is certainly one of great power,
and worthy of being tried. In a chemical analysis of mix
vomica, Mr. A. T. Thomson detected the presence of prussic
acid. What influence would this exert in the production of its
efficacy P

Manna. — This substance, which much more generally enters
into formulae on the Continent than on this side of the Channel,
has lately been examined by M. Bouillcn-ia-Grange* * * §. His
experiments have led him to conclude, that it is composed of
two substances ; one of which is soluble in cold alcohol, and
h$s some analogy to sugar ; and the other, insoluble in cold
alcohol, and yielding a very large quantity of mucous acid,
when treated with nitric acid. If manna be dissolved in bon¬
ing alcohol, the solution deposits, on cooling, a light spongy,
very white, crystallized mass, equal to about three-fourths of
the manna employed. This is what M. Thenard has denomi¬
nated mannite. Bouillon-la-Grange regards it as a pure manna.

Butter of Antimony.— The process for preparing this sub¬
stance is tedious and uncertain. M. Hobiquet has proposed
the following method of procuring it very beautiful by direct
combination Take one pint of nitric acid, four parts of mu¬
riatic acid, and one part of antimony (the pure metal) ; dissolve
the antimony cautiously, and evaporate the solution in a close
vessel to dryness ; when the chlorine is dry, change the receiver,
and continue the action of the heat until the cblorure or butter
of antimony be obtained.

lime

Mi agnesia.-

This substance is frequently combined with
from which it may be freed by means either of the neu¬
tral carbonate of potash, as proposed by Bucholz, or of the
subcarbonate of ammonia, as recommended by Doebereiner.
For the method of employing, either of these, we must refer
our readers to our translation of the Report on Buchohds paper
We may conclude these few notices by observing that
practitioners have lately become much disposed to throw aside
altogether the employment of mercury in syphilis ; and this
affectation is not confined to our side of the Channel. M. Briem,
a physician of Lyons, has lately published a translation of
the work of Joseph Parta, which appeared in I?88§, recom-

* Journal de Pharmacie et de Physique, vol. iii. p. 8.

t An nales de Chinlie et de Physique f vol. iv. p. lb't>.

t Repository, vol. vii. p. 337 •

§ De la Vert u de l' Opium dans les Maladies Vsneriennes . par
Joseph Parta ir adult en Francais par M, Brian, Medccin a Lyon,
181 6’.

Retrospect of the Progress of Medical Science . 53

mending the use of opium as a direct anti-syphilitic ; and lias
assigned as his motive the proofs which he himself has had of
its extraordinary efficacy. The practice, however, after being
put to the test of a three months experience in the Hopital des
Eenenens in Paris, has furnished the conclusion, that, although
opium alone cannot be regarded as a specific in syphilis, yet, it
is an admirable adjuvant; disposing the subject to receive the
mercurial action, and repairing the injuries sustained by the
system by a long continued course of mercury. The same may
be said of nitro-muriatic acid, the advantages of both the exter¬
nal and internal administration of which are now very firmly es¬
tablished. Besides the remarks and summary of the practice of
Dr. Scott*, a number of cases of the beneficial effects of this acid
in syphilis, which had resisted the action of mercury, and in
which the constitution had suffered from its exhibition, have been
published by Mr. C. Bell*f*. We confess that,inour own practice,
although we have found it of great benefit in ulcerations of the
extremities of long standing, with a reduced state of habit, yet
we have not observed any advantages to arise from it in cases
of diseased biliary secretion, as observed by Dr. Scott.

THEORY AND PRACTICE OF MEDICINE.

Although Fever is one of the most common forms of disease
in every quarter of the world, and the attention of the phy¬
sician has necessarily been directed to it from the earliest periods
of the history of the healing art, yet the opinions regarding its
causes, and in many respects its treatment, are by no means
settled. In Great Britain, and wherever British practitioners
have been employed, the subject has been closely investigated;
and, from observing the almost constant signs of inflammation
having existed in some important organ in those cases which
have proved fatal, the dangerous doctrines which led to the
opinion that debility is the symptom chiefly to be combated in
fever, have been fairly driven from the ground they unfortu¬
nately too long maintained. It is pleasing to observe, that the
same improved mode of reasoning upon the phenomena of
febrile affections is beginning to extend on the Continent, and
a more efficient practice to be adopted.];.

* Repository, vol. vii. p. 41 7*
f Surgical Observations, vol. i. p. 338.

£ In proof of the accuracy of this remark, vide Examen de let
Doctrine Medicate Generalement adopte, et des Systemes Modemes de
Nosohgie; par J. V. Broussais : our analysis of this work. Repository ,
vol. vii. p. 469 : Dictionnaire des Sciences Medicates, article Fievres
en particulicr : and Recueil General de Mcdccmc, tome Iviii. p. 221.
ike. &c.

54 Retrospect of the Progress- of Medical Science,

But it is more especially that modern medicine may in the
treatment of fevers exult. We shall notice such improvements
as have recently occurred The management of Intermittent s
is so well understood, that any new proposals regarding them
rather tend to excite surprise. The successful revival, how¬
ever, of an old method of arresting the paroxysms, and, con¬
sequently, of removing the disease, will be seen in our trans¬
lation of Professor Chladni’s report of the effect of ligatures to
the extremities, in his own case*. W e leave to the opinions ol
our readers M. Hufeland’s explanation of the fact. The ques¬
tion of the contagious nature of that description of fever, which
has been termed 44 yellow , or Bulam , or ardent fever f is still
unsettled. A very able and interesting report, drawn up by
Mr. Mortimer of thenavyf , which, we are informed, 44 conveys
the sentiments of nearly the whole of the medical naval corps,’
presents many strong facts against the idea of its contagious
nature, and refers it altogether to the influence of local causes,
such as the effluvia or miasmata, arising from putrifying animal
and vegetable matter. This decomposition of vegetable matter
he conceives may arise even on ship-board ; and he ascribes the
rise and great mortality of this fever, as it occurred in the Re¬
galia transport, in 1815, to her being supplied, when on the
coast of Africa, with green wood, which he conceives, when
acted upon by the bilge water and dirty ballast, generated the
fomes of the disease. This opinion is very ably supported by
Dr. Dickson who, besides, lays much stress upon the dispo¬
sition of the body of the individual, exposed to the local cause's,
to receive the disease : and from the youthful, sanguine tem¬
perament of the newly arrived European in tropical climates,
the system 44 goaded by the stimulus of unnatural heat,” free
living, and exposure or exertion, becomes infinitely more sus¬
ceptible of fevers, than those assimilated to the climate. Hence
Dr. Dickson reckons the tendency to yellow fever to be in the
compound ratio of the disposition, and the force of the exciting
cause. He considers, that 44 whatever may be the peculiar
coincidence of circumstances, or modification of cause, most
fertile in the generation of yellow fever, an uniformly high
temperature is the sine qua nonR But although it be generally
admitted, that a high temperature favours the spontaneous pro¬
duction of yellow fever, yet, M. Moreau de Jonnes|| has ascer¬
tained that this is not a circumstance essential to its production.

* Repository , vol. vii. p. 253 .

t Medico-Ckirurg. Journ. and Rev. vol. iii. p. 9,, 93, 182.
f Edin. Med. and Sttrg. Journ , vol. xlix. p. 35,

|| Journal de Medicine, vol. xxxviii. p. 108.

R k tro spec t of the Progress of M edical Science, 55

Dr. Dickson, anticipating such an objection, observes, that it is
incumbent on those who rest their opinions of the contagious
nature of the disease, on tiie fact that this fever does not occur
in countries where the heat is more intense, anil also in places
lying in the same latitude with the Caribbean Archipelago, to
sh ew 44 why a temperature above a certain height ought to be
more favourable to its production ; and, secondly, that the cli¬
mate of two places must be alike, because they lie at the same
distance from the equator.” He brings forward various au¬
thorities to account for these discrepancies, and concludes by
remarking, that he is fully convinced that yellow fever arises
only in 44 hot, low, moist, close places, whenever new men are
exposed to miasmata, intemperance, or fatigue,” and, conse¬
quently, that it is not 64 an imported or contagious disease;
but a strictly local and indigenous evil- — quod sol atque imbres
dederant, quod terra crearat sua sponte.” Notwithstanding
the extent of the facts and the reasonings which have been
brought before the public on this important subject, we must
confess that our mind is still unsettled on the point.

With respect to the susceptibility of the system to a repe¬
tition of the fever, we have to remark, that Mr. Mortimer, in
the Report alluded to, conceives it can be taken a second time ;
but the weight of the instances he brings forward* is weakened
by the quickness with which these supposed second attacks fol¬
lowed the first ; and they have with some reason been regarded
rather as 44 relapses,” than second attacks. Dr. Dickson's evi¬
dence is, nevertheless, in favour of Mr. Mortimer's opinion ;
for although indemnity to a considerable extent, may be pur¬
chased by a previous attack, 44 yet,” he remarks, 44 such pro¬
tection is but relative, and though a sufficient security against
ordinary causes, is not proof against such as are of great in¬
tensity.' ” In a report on this fever by Mr. Comrie, we find the
folio wing passage, corroborative of the opinion that the body is
susceptible to a second attack : 44 On our passage to Bermuda*
the captain and almost all the officers (of His Majesty's sloop
Dasher), and most of the midshipmen, were again severely at¬
tacked with this diseasef.”

Whatever maybe the opinions regarding the contagious ©run-
contagious nature of this fever, and the susceptibility to a second
attack, practitioners, we believe, are pretty generally agreed
as to the general principles on which the treatment should be
conducted. The practice of phlebotomy in cases of continued
fever, which is daily gaining new advocates, has been adopted

* Vid e Medico-Chirurg. Journ.and Review, voL iii. p, 100.
t Edin. Med. arid Surg. Journ. voL 1. p. 179*

56 Retrospect of the Progress of Medical Science.

in yellow fever; and the success of the plan fully warranted its
adoption. In the instances which we have particularly noticed,
Mr. Mortimer* found bleeding, ad deliquium, the most appro¬
priate, and indeed the only remedy required at the commence¬
ment of the attack ; but, when the symptoms are indicative of
a relapse at this period, he conceives the habit should be pre¬
pared by immersing the body in warm water, with a view of
exciting the languid circulation, and giving the surface its
natural warmth. The bowels should be kept lax by calomel
exhibited as a purgative, in which view alone he thinks it use¬
ful, and by enemas. To allay the vomiting he recommends effer¬
vescing draughts, with carbonate of ammonia and magnesia.
Dr. Dickson, also, relies upon the early employment of the
lancet, in conjunction with purging and the cold affusion, if
indicated : but he prudently fences his recommendation of
blood-letting by remarking, that its utility is 44 entirely depen¬
dant, not only on time and quantity, but on the varying state of
the animal system and, consequently, this remedy 44 is in con¬
tinual danger of being rated too high or too low.” The extra¬
ordinary extent, also, to which the bleedings were occasionally
carried, must in our opinion have contributed to bring the
remedy into some disrepute ; for, unless the indications, which
could authorize such enormous abstractions of blood as u seventy
ounces” at one bleeding, or 250 ounces or more in three dayst,
were judiciously examined, much mischief might be the result.
The free use of the lancet, however, is fully authorized by
morbid anatomy. Among other testimonies Mr. Mortimer,
states, that he has found the meninges of the brain highly vas¬
cular, the surface covered with patches of lymph, 44 and the
adhesions remarkably firm the stomach also, in some cases,
exhibited evident marks of high inflammatory action.

Although we are fully satisfied that too much alarm has
been excited on the subject of contagion, and that many unne¬
cessary restraints are often imposed by the quarantine laws, we
are by no means prepared to go the length which has been
done by Dr. Maclean];, and declare that no fever can be com¬
municated by contagion, and that lazarettos and the quarantine
laws should be utterly abolished;

* M cdicO” Chirurgical Journ. and Review , vol. iii. p. 18 6.
t Vide a Paper On the Ardent Fever of the West Indies . By
Mr. Peter Corarie. Edin. Med. and Surg. Journ. vol. 1. p. 165

f Vide Suggestions for the Prevention and Mitigation of Epidemic
mid Pestilential Diseases, comprehending the Abolition of Quarantines
and Lazarettos, Spc. by Charles Maclean, M,D. 8vo. pp. 108. Loud.
1817-

R ET no BP EC t of the Progress of Medical Science. 57

However painful the duty, we feel ourselves called upon to
notice the numerous and accumulating failures of cow-pox
in preventing small-pox, whether in the natural way, or
by inoculation. Our communications on this subject have
been numerous ; and some of the cases do not appear to
have been modified by the previous disease. It is not easy to
account for these distressing occurrences ; but were we to h&-
2ard a conjecture, we would venture to suggest that it is possi¬
ble the virus may have become so modified by being confined
altogether to the human subject, that its powers of producing
the necessary affection of the constitution, which only can be
regarded as the test of security, may be so nearly worn out, as
to be no longer a certain preventive. Hence the necessity of
frequently renewing the efficacy of vaccination by procuring
the virus directly from its original source. This opinion,
however, can be regarded in the light of a conjecture only, cal¬
culated to excite inquiry ; for the real causes of the fact which
it is meant to explain cannot be too minutely investigated.

The methods of treating erysipelatous inflammation by in¬
cisions in the affected part, suggested by Mr. Copeland Hut¬
chison* * * §, in that species of the disease denominated phlegmonodes ,
we still regard as a great improvement in those attacks of the
disease which are strictly symptomatic of great local irritation*f*.
Dupuytren’s practice of applying blisters in similar affections
certainly merits, also, attention j.

The prevalence of pertussis has given several opportunities
for determining the effects of belladonna in this distressing
complaint; and one of the Editors § has had ample proofs of
its powerful influence in subduing the spasmodic character of
the cough, and shortening the period of the disease. He has
generally prescribed, at the same time, confinement to one or
two rooms, complete abstinence from animal food, occasional
laxatives, and a combination of subcarbonate of soda and ipeca¬
cuanha, to allay any disposition to fever, and correct the tenden¬
cy to acidity of stomach, which the continued use of the asces-
eent diet recommended induces. The disease in the worst cases,
thus treated, has not been protracted beyond five or six weeks;
and the hoop has usually terminated in a much shorter period.
The convalescence is greatly shortened by the administration

* Some Practical Observations in Surgery, fyc. By A. Copland

Hutchinson, Svo. pp. 167, London, 181 7.

t Repository, vol. vii .p. 21 9. J Ibid, vol. vii. p. 249.

§ Mr. A. T. Thomson, who proposes to give the result of his
practice, in a considerable number of cases to the public,, through
the medium of the Repository.

VOL. VIII, - NO. 43. T

58 Retrospect of the Progress of Medical Science .

of a mixture with decoction of cinchona and soda, and free ex¬
posure to the air. ,

In the method of treating rheumatism by percussion and

pressure, Dr. Johnson has shewn* that Dr. Balfour has been
anticipated by the Oriental practitioners, and, also, by Dr. Lint
of Haslar Hospital, who adopted their method about thirty
years ago. Instead of the hand, however, the Orientals use two
instruments; one, a wooden cylinder, with a pretty ban ,
stuffed leather ball on one end ; the other, a stick, on which a
number of smooth wooden balls are strung, like beads on a
wire. The affected part is beaten with the first, then rubbed
well* with the second, for a quarter of an hour every day, and
afterwards bound up lightly in a calico bandage. Dr. Lind
found it, on trial, beneficial in many cases of the chionic form
of the disease. Dr. Balfour, however, has addressed the Edi¬
tors of the Medico-Chirurgical Journal, defending his claim

to discovery in this practice^ . n . '

Several cases of the deleterious effects of the Eau medianale

in gout have been recorded by Dr. Bartley of Bristol*.

Some interesting cases of the efficacious effect of large dose^
of calomel, in combination with opium, in dysentery, have been
published by Mr. Power, a naval surgeon §. The remedy was
.riven in doses of a scruple, and repeated two or three times
a day, until ptyalism came on, after which the violence of the
symptoms invariably abated. It ought, however, to be kept
in view, that this practice was pursued in a tropical climate.
On the importance of an early and free use of the lancet m this
disease, we have lately had occasion to express our sentiments || ;
and we must repeat, that to Dr. Somers" is justly due the merit
of having pointed out to modern practitioners the extent to

which it may be carried. .

We have been rather surprised at an observation of Dr.
Woodforde, that practitioners are become sceptical with regard
to the utility of blood-letting in apoplexy*. We believe on tew
points are they in general so well agreed ; and wre scarcely know
a practitioner who would be deterred by appearances of debility
from bleeding freely in any case where cerebral congestion was
evident. This effect of plethora has been well illustrated in one

* Med.-Chirurg. Journ. and Review, vol. jii. p. 109*
t Ibid. No. for April. J Repository, vol. vii. p. 2 75.

§ Medico Chirurgical Journal and Review, vol. iii. p. 179*

|| Repository, vol. vii. p. 41 6.

a Medical Suggestions for the Treatment of Dysentery, §c. By
C. S. Somers, Mr!). 8vo/pp. 78, London, 1816.

b Trans, of the Medical Society of London , vol. i. Part ii.Art, ii.

Retrospect of the Progress of Medical Science.

of Dr. Leacock’s experiments. By transfusing arterial blood
from a dog into a cat, until plethora was induced, all the symp¬
toms of direct debility supervened. The contractile power of
the heart diminished ; the eyes became suffused, slightly pro-
truded, glistening, and excessively red : salivation next ensued,^
with vomiting, coma, and every symptom of compression of
the brain. The animal died in six hours. Dissection displayed
symptoms of congestion, both in the brain and abdominal
viscera; “a quantity of bloody bile was found in the gall¬
bladder; and in most of the cavities some bloody serum was
effused*.

We have already noticed Dr. Fouquiers method of treat¬
ing paralysis with nux vomica. We may here mention, that
although this physician conceives that almost every case of
hemiplegia depends upon an effusion of blood in the brain,
yet he does not regard this as an obstacle to the cure, or
sufficient to exclude the use of the nux vomica as a remedy ;
but, at the same time, lie justly remarks that the degree
of circumspection necessary in employing general stimulants
in hemiplegia, when it is the sequel of apoplexy, or where
the mental faculties are much impaired, or relapses demon¬
strate the disposition to another attack, ought never to be
forgotten. He regards the excitement produced by the nux
vomica favourable to the re-absorption of the effused blood ,
and “ if,” he adds, “ as experience has proved, feeling and
motion can be restored to the paralysed members, notwith¬
standing the permanent compression of the medulla spinalis,
why should not the same remedy hasten the cure of paialysis,
when it depends on a similar causef ” Whatever may be
thought of Dr. Fouquier s reasoning, the facts he has detailed
are extremely valuable.

Although pathologists have noticed tremors and agitations
of the body, as an accompaniment of paralysis, and have em¬
ployed the term shaking palsy to designate some of these, yet,
the meaning attached to the expression has been vague, and
palsy, chiefly characterized by these shakings, has never, until
the subject was lately taken up by Mr. Parkinson, been re¬
garded as a distinct disease. The Essays which this author
has just published on the subject, is equally remarkable as a

* For a case analogous to this, in the human body, aiising from
natural causes, vide Repository, vol. vi. p. 11 6.

t Bulletin de la Faculle de Medecine de Paris, #c. No. iv. 1817-
p. 359-

+ An Essay on the Shaking Palsy. By James Parkinson, Mem¬
ber of the Roy. Coll, of Surgeons. 8vo. pp. 66. Lend. 1817.

i 2

li e r r osPECT of the Progress oj Medical Science,

specimen of bis characteristic modesty, and the acuteness of
Ills observations. He defines the disease in the following words :
“ Involuntarjr tremulous motion, with lessened muscular power*
in parts not in action, and even when supported ; with a pro¬
pensity to bend the trunk forwards, and to pass from a walking
to a running pace; the senses and intellects being uninjured.^
The tremors commence in the upper extremities, and gradually
pass to the lower, until the entire body is so much affected that
the patient is unable to make any progressive movement, even
with the assistance of crutches. The tremors, however, occur,
although the affected part be supported and unemployed, and
are even checked by the adoption of voluntary motion but
are never accompanied “ by a lessened sense of feeling while
m palsy, consequent to compression of the brain, the diminu¬
tion of voluntary motion is sudden, and generally accompanied
by impaired sensation. The distinction also between the dis¬
ease our author describes under the term Shaking Palsy, and
those passive tremblings to which the name has frequently been
applied, and which are chiefly consequent to indulging in
spirituous liquors and narcotics, is well defined.

Mr. Parkinson proceeds with some hesitation, inasmuch as
he is unaided by previous inquiries and anatomical investigation,
to trace the causes of shaking palsy. The proximate cause he
conceives to be, “ a diseased state of the medulla spinalis , in
that part which is contained in the canal formed by the superior
cervical vertebra, and extending, as the disease proceeds, to
the medulla oblongata .” Although this opinion must be received
•with caution until opportunity enables it to be confirmed by the
test of anatomy ; yet, the progress and nature of the symptoms
render it probable. It is only difficult to conceive, that the
diseased state should be so local as to exist in the superior part
of the medulla without extending to the encephalon, the in¬
tegrity of which is implied from the absence of any injury to
the senses and the intellect. The remote cause is not less ob¬
jectionable than the proximate ; but Mr. Parkinson assumes
that it “ may be the result of injuries to the medulla itself, or
of the theca helping to form the canal in which it is inclosed
and, reasoning from the circumstances connected with several
analogical cases which he details, and the observations of Sir
Everard Horae on the effects of injury to the medulla spinalis ,
lie is led to conclude that these injuries cannot be produced by
compression, laceration, or complete division, of the medulla;
but may be 44 occasioned by simple inflammation, or rheumatic
or scrophulous affection.” ” With regard to the means of cure,
every thing whjch can be expected to accomplish any beneficial
effect must be attempted in the first stage of the disease, or
while the agitation does not extend beyond the arms. The

Rs teg&pe c t of the Progress of Medical Science . 6 1

means suggested are bleeding from the upper part of the neck,
followed by vesicatories or issues, calculated to begin and keep
up a purulent discharge. No internal remedies are recom¬
mended, unless opportunity occur to make trial of mercury:
but tonics, and nutritious stimulating diet are justly reprobated.
The slow progress, however, of the disease, and the late period
of life at which it occurs, does not allow much to be expected
in a remedial point of view.

We have already brought before our readers Dr. Morrisorfs
judicious practice in / etanus*. Asto iheopinionof Dr. Dicksonf,
that every case of the disease is preceded by a torpid state of the
bowels, we may observe that although costiveness frequently
ushers in idiopathic tetanus, yet it is seldom a forerunner of the
traumatic form of the disease. In the interesting case of the
disease drawn up by Mr. North J, the bowels were constipated,
and the opium ordered was judiciously' combined with purga¬
tives. The benefit which may be reasonably expected from
blood-letting in tetanus, is well illustrated by Dr. Macarthur’s
casesjj ; and besides the illustration of the rationale of this prac¬
tice, derived from his dissections, the practice gains further
suppor.1 from that of M. Patissierg.

It is stated that Brugnatelli has succeeded in curing Hydro-
phopia by means of oxygenated muriatic acid internally and ex¬
ternally employed®; and our correspondent Dr. Granville adds
four well authenticated cases of perfect cure; and two, in which
the developement of the disease had been impeded, are re¬
corded b. in Calabria, Dr. Scuderi imagines he has effected '
several cures by means of sulphuric acidc. It is unnecessary to
make a comment on such statements ; the profession will readily
appreciate their value.

We may here mention the appearance of a work by M-
v dlermay, on Hysterical and Hypoehondrical affection sd. As we
have not seen the original, we can merely notice here the
opinion of M. Dubuisson, who has reviewed the work in the
Journal de Medecine: “ It is,” says he, <c the best and most
complete work that has hitherto appeared on these diseases.”

In fatal cases of affections of the heart, polypus concretions

Repository, vol. vii. p. 30 6.

f Ibid. p. 404. J Ibid. p. 450. || Ibid. p. 404. § Idid p. toi.

- Philosophical Magazine, vol. xlix. p. 312.

- * Repository, vol. vii. p. 252. c Ibid.

° Traite des Maladies Nerveuses on Vapeurs, ei particulierement
3 Hysteria et de I’Hypochondrie. Par M. Louyer-Villermay, M,D.
&c. % vol. <8 vc, Paris, 1816*.

62 Retrospect of the Progress of Medical Science.

have been found in the cavities of that viscus, and in the aorta ;
but it is extremely difficult to determine whether these leallv
existed previous to the death of the patient. In a case of En¬
largement of the Heart , recorded by Mr. Stewart*, dissection
demonstrated, that the right auricle, and both ventricles, con¬
tained each a large polypus, attached by pedicels, and having
so much vascularity and perfect organization, as to leave little
doubt that they had existed for a considerable time previous to

death. ... c

As if by common consent, medical writers in most parts ox

Europe appear at length to have become sensible of the neg¬
lect with which forages the disorders affecting the human intel¬
lectual faculties have been treated ; and hence an infinite num¬
ber of essays on insanity generally, or on particular forms . of
it, have emanated from the press. Within the period to which
our Retrospect extends, several have been published inspecting
the physical and moral condition of the insane, and others are

announced as being in progress.

Mr. Maurice Roubaud-Luce's Recherchesf bring into a
compressed view the observations of antient and modern prac¬
titioners on the subject of that species of insanity which noso-
locdsts have defined Melancholia ; but the author adds nothing
towhat was before known regarding this peculiar affection.

Dr Haslam, who is already so well known by his “ Observa¬
tions on Madness,” has offered, in a little Tract*, some very ju¬
dicious hints relative to the moral management of insane persons;
which, if regarded as they merit, would doubtless contribute to
the immediate comfort and security, and consequently, although
remotely, to the recovery of such patients. But, excepting some
remarks on keepers, there is little novelty in Dr. HaslanTs ConT
siderations. We cannot but lament, that, on a subject where
so much could have been said, and that by an author whose
opportunities have been so great and instructive, he has, m
this instance, been so succinct as to lea\e the leadei m con¬
siderable doubt of the reality of his intentions.

The recent inquiry by a Committee of the House of Com¬
mons into the state of mad-houses, &c. has exhibited, m a
forcible point of view, the necessity of legislative interference
and regulation ; and hence a Bill was arranged and introduced
into Parliament, professing the correction of existing abuses,

* Edin. Med. and Eurg. Journ. vol.l. p. 184.
t Reclier dies Medico- PJdlosoph iques sur la MclancoUc , par
Maurice Roubaud-Luce, 12m o. a Paris, 1817-

7 Considerations on the Moral ■Management of Insane Persons,
bv John Haslam, M.D. 8vo. London, 1817.'’

J 1

Retrospect of the Progress of Medical Science.

and the amelioration of the condition of the insane in this King¬
dom. But the projected measure, when submitted to examina¬
tion, appeared rather to defeat than promote the humane
intentions of the framers; and, by some very extraordinary
provisions, to shift the reprobated system of coercion from the
patients to their attendants. The errors of the whole of the
proposed regulations were also highly injurious to the interests
of all those whom they most affected to regard. Dr. Burrows
has, in a pamphlet*, exposed these errors, and successfully
combated the principles upon which the Bill is founded ; and
has offered many hints to the consideration of the Legislature
upon this delicate and important subject. The effect has been
decisive ; for the Bill, although not formally disposed of, yet is
deemed lost for the present, the second session of its being en¬
tertained.

In those acquainted with the speculations of Drs. Gall and
Spurzheim, it will not excite surprize to find that either of them
should offer their opinions on the subject of insanity. Accord¬
ingly, Dr. Spurzheim, has published a volume of Observations*}'.
The lateness of the publication precludes the possibility of our
perusing it with that deliberation necessary, in fairness to the
author or ourselves, to form a decisive opinion of the merits of the
work. It is evident, however, from the frequent references
of the writer to his Physiognomical System, that this must be
considered as an emanation or offspring of that work ; without
which, in fact, his doctrines and inferences cannot well be com¬
prehended. For the present, as it will speedily come under
our review, we shall do little more than give Dr. Spurzheinfs
division of the contents. After a preface and introduction,
the subject is divided into two parts: — 1. Derangements of
the External Functions of the Mind; 2. Derangements of
the Internal Functions of the Mind. — Under the first head
lie treats of disorders of voluntary motion, and diseases of
the five senses: under the second, of diseases of the brain,
insanity, its definition, symptoms, division, causes, forms
and lits of insanity, prognosis, and the treatment of in¬
sanity. The work is embellished with four plates ; one of which

* Cursory Remarks on a Bill now in the House of Peers, for Pegu-
fating of Mad- Houses, its probable Influence upon the Physical and
Moral Condition of the Insane, and upon the Interests of those concerned
in their Care and Management ; with Observations on the Defects of the
Present System, by George Man Burrows, M.D F.L.S., &c. 8vo.
London, 1817*

t Observations on. the Deranged Manifestations of the Min’d, or
Insanity, by J. G. Spurzheim, M.D. royal 8 vo. London, 1817-

64 Re rR'GS&ECT of the Progress of Medical Science,

represents the heads pf six idiots, whose brains, with respect try
size, were defective in different degrees; another, with the con-
o-uration of two skulls of idiots, and the skull of three heads,
distended by water in the interior of the brain ; the third plate
is the plan of an hospital for curable insane patients; and the
fourth, the plan of a house for convalescents.

Within these few days, Dr. Thomas Mayo has also pub--
lisbed Remarks on Insanity* * * §; but this work we have not yet seem
On a paper of Mr. Hey of Leeds, containing some facts
which he is inclined to think 46 illustrate the effects of the
venereal disease on the foetus in utero,11 we have already deli¬
vered our opinion *j*. The employment of the nitro-muriatic
acid bath in cases of this disease, in which the system appears
to have suffered under the continued use of mercury, becomes
more general ; we have inserted in our pages the manner of
using the bath, as described by Dr. Scott himself

In closing this portion of our Retrospect it is scarcely re¬
quisite to observe, that the catalogue of medical literature has
not been very amply swelled within the period it comprehends.
We may, however, enumerate the following works on the prac¬
tice of medicine, in addition to those which we have already
more particularly noticed. A cursory Inquiry into some of the
principal Causes of Mortality among Children. By J. B. Davis,
M.D. Reflections upon Oil of Turpentine ; and upon the present
State of the Medical Profession in Ireland. By a Country Prac¬
titioner. Medical and Miscellaneous Observations relative to the
West Indies. By John Williamson, M.D. Practical Rules for
the Management and Medical Treatment of Negro Slaves in the
Sugar Colonies. By a Professional Planter. The second part
of Mr. Thomas1 Commentaries on Scirrhus and Cancers. A
Treatise on the Watery Gripes of Infants. By Dr. Zugen-
buhler §. Memoirs on Chronic Diseases , &c. By Dr. Berlioz jj :
and a Medical Account of the Antilles. By A. Moreau Jonnes ®.
As more or less connected also with this part of our subject,
we may add Canine Pathology ; or , a full Description of the

* Remarks on Insanity , tending to illustrate the Physical Symptoms

and Medical Treatment of that Disease, and founded in the Practice
of John Mayo, M.D. by Thomas Mayo, B.M. &c.

+ Repository, vol. vii. p. 405. Ibid. p. 417°

§ Uher den Viefarbigen D arch fall j linger Kinder .

j| Memoirs sur les Maladies Chroniques, les evacuations sanguines
et /’ acupuncture ; par L. V. T. Berlioz, M.D. a la Cote Saint Andre.
8vo. Paris, 1 « 1(3=

a Tableau du climat des Antilles, &c. Vide Journal de Mede-
cine, om. xxxviii. p. 85.

Retrospect of the Progress of Medical Science. 6.5

Diseases of Dogs, &c. By Belabor a Blaine ; with a Treatise
n> 1 1. JJupuy on the Tuberculous Affection of some of the lower
animals* ; and we do not consider, that we lessen, in any re-
spect, the dignity of the profession, by remarking, that much
iig.it may occasionally be thrown upon human pathology, by
investigations into that of brutes, properly conducted by inge¬
nious ana properly instructed inquirers.

SURGERY AXD MIDWIFERY.

to infuse much interest or novelty into the descriptions of a tra¬
veler, who has to pass over ground that lias been trodden and
described by hundreds before him ; and in a similar degree an
annual oration on the same subject scarcely admits even of variety.
It is but doing justice, however, to say, that Mr. Norris has dis¬
played, 111 this performance, considerable skill in the arrange-
ment of his subject, and purity of taste in the style he has
aaopted ; and has produced an elegant specimen of his talents
for rhetorical composition.

In estimating the qualifications of a surgeon, too much va¬
lue has, perhaps, been placed upon skill in operating, and too
little on that general knowledge of pathology which is requi¬
site mi successfully conducting the subsequent treatment of a
It is gratifying to see this subject properly treated by
such men as Boyer and Delpechf , and not less so by Mr. Bell,
in his Surgical Observation s+. In his third number he brings
forward several cases to demonstrate the tendency which « ihiu-
L .e- to the frame, w nether the effect of wounds or of surgical
operations, have to produce disorders of the lungs, by exciting*
a general high state of irritation. In these instances, which
\u0 often prove fatal, dissection exhibits marks of recent in¬
flammation in the lungs, “ coagulable lymph exuded, puru-
imicy on the surface of the lungs or in the bronchi, and con¬
gestion or abscess in their substance.” Mr. Bell seems to con¬
cede that this state may be induced independent of any phthi¬
sical predisposition in the habit of the patient; an opinion with

, * our Analysis of Delpedhfs work. Precis Elmentaire

des a! a dies Repirtees Chiricrgicates, 3 vols. 8vo. Paris, IS Id: 2iV
posit ory, vol. vii. p, 120.

+ &urg- Obscrv. tkc. Py C. Bell. 8vo. Lend. 2 SI 7, p. 241—25$.
VOL. VIII.— NO. 43. , k

Retrospect of the Progress of 'Medical Science.

which we cannot entirely accord ; but we fully subscribe to the
propriety of his caution, that the 44 knowledge of this con¬
nexion betwixt wounds and the state of respiration, will make
us careful to defer ail operations when any tendency to disease
occurs;’ For the cure of this affection, the most active anti¬
phlogistic treatment is requisite; while, at the same time, a.,
local irritative applications should be suspended.

So much has been lately said and written on the subject of
ligatures applied on arteries, that it really has become a mattm
o? the first importance, to consider soberly m wsiat the oio
method is defective, and what the advantages really are wmeii
the new methods hold out. On this subject seveial seayum
observations have been made by Mr. C. BeilM i n his opinion
a ligature should be round, strong, and Graven sunicienty m m
to indent the coats of the vessel, and interrupt tne bio oa m n-
course : for if it be so small as to cut the inner coat ot the ves ¬
sel, the outer coat only is left to restrain the bleeding ; ana u
too laro-e, it cannot be drawn sufficiently tight to stop the cur¬
rent of the blood : and a ligature should, m every part of its
circle, be in contact with the coat of the vessel p for n other
matters be included it is apt to lose its hold. I he ciot that
plu^s the artery, and is formed behind the ligature, is longei
or shorter, according to the distanced the last branch from tne
part tied : but besides this clot, yoagulable lymph is thrown
oht from the irritated artery, and is of the. greatest consequence
in effecting the union of the coats of the vessel, winch, from
the loss of function, degenerate into a common texture.. Ft
advises the taking away the ligatures on the smaller aiteiies o
a stump, at the first dressing, and to twist the ligature on the
laro-e vessel, so as to reduce it to the state of a small round
cord. This twisting is sufficient to bring away the ligature,
which Mr. Bell contends should never he pulled. He is ap¬
prehensive the case is not made out, with regard to cutting tie
ligatures off close bv the knot, and healing the flap over them ;
because the necessity for a change in this part of the operation,
of amputation is not very obvious, and the roreign body is
likely, in the majority of cases, to prove a hurtful mutant, dm
this important question we would particularly direct the atten¬
tion of our readers to the experiments -and observations +- of out
valuable friend and correspondent Mr. Cross, whose opinions,
in many respects, accord with those we nave ust detailed. f \ t
confess we have, as yet, formed no settled opinion on the subject.

As connected with the subject of tying arteries, we may an¬
nounce here one of the boldest operations that h<ts evei ^ Ov-tu
undertaken in surgery, the tying the aorta in tne living subject.
This operation was performed by Mr. Astley Cooper, on a

* Surg, Obscrv. vol. 1. p. 25Q.‘ t Repository, vol. vii. p. 353,

Retrospect of the Progress of Medical Science .

futient at Guy s Hospital, on the 25th of this present month
( j one). i he man had an aneurism of the common iliac on
Uie le] 1 S1.(e\ wbich uc believe was in that state that life was
momentarily m danger. Mr. Cooper immediately cut through
pie panet os of the abdomen, put aside the intestines, and free¬
ing a poi lion of the aorta, close to the bifurcation, succeeded
gctting a hgature round it. The patient lived thirty-six
hours ; and on opening the body, no appearance of inflamma-
t- on, except on a small portion of the omentum, which adhered
wriLtC uie incision had been made, were discovered.

Amputation is often requisite to save the life of an indivi¬
dual when mortification occurs in a limb, which it occasionally
coes even limn Slight injuries. The operation however, should
not be hastily undertaken; and the young surgeon would do
well to ascertain, as Mr. Bell has remarked in his Observations*
that satisfactory answers be obtained to the following queries,
betore determining the point : “ 1. Does the mortification pro¬
ceed from toe violence done to the part, or does it come of the
constitution ? 2. Has the mortification extended so widely and

destroyed so much of the substance, that, in the event of reco-
bmb will be useless ? 3. Has a large joint been

ept Has t.ie mortification gone so far, that, even in

tne event of its stopping, the suppurating surface will be too
tensive for the powers of the constitution ? 5. Are tlie treat

vessels undermined, and is there danger of fatal hamiorrhage ?”

-lose questions are not new ; but the necessity of attending
to them cannot be too often urged. When the operation how”
e ,-er is determined on, it should be well done ; and in few parts
«n surgery have, so many improvements been introduced. 4
n'letieh soldier, who was wounded at the battle of Waterloo,
rid whose limb was amputated by Mr. Guthrie at (he hip-
.pint was lately presented to the SocU-te de Mtdkinc of Pans,
V A' Carrey, as another proof of the success of this opera¬
tion-;. Avery praise is undoubtedly due to M. Larrey, for
is exertions in removing the prejudices against the hip ope-
11 ‘"f exampre; and we ere not unwilling to grant him

y0 ‘?'’our :!e Cialm.s» of having first practically 'demonstrated
its safety and propriety.

Previously to performing another important operation also,
-Mhotomy, it iso. much importance to determine, whether the
stone be free in the bladder, or sacculated. In the workt we
. a\e had occasion already to quote, the following rules for this
purpose are laid down. When the stone does not change its

Surgical Observations , vol. i. r*. 303.

.1 Kulktin de la Faeuttt de Medecine de Paris, 1817, p. 31 £>.
+ ^urgtcal Observations, vol. i. p. 447-fiO.

K 2

68 Retrospect of the Progress oj Medical Scierce*

place, nor stop the flow of the urine ; “ when in sount i ig, it is
felt always at the same point; when that point retreat the
bladder be full, and approaches if it be empty ; when the sound
cannot be got. round the stone, but only to touch it. we must
doubt whether the stone be free in the bladder.” If the stone
be sacculated in the coats of the bladder, at or near the kinam,
Mr. Bell recommends the high operation ; 44 and in performing
it, to lower the handle of the sound until the part of it in tne
bladder and in the sac, be felt through the inner coats of the
cell”. This is then to be cut open with a sharp bistoury ; tne
wound enlarged with a probe pointed bistoury, and tne stone
.seized. To insure the success of the operation, a catheter should
be kept in the bladder. If the stone be fully ascertained to be
sacculated in the neck of the bladder, by the usual first incision
carried directly upon the face of the calculus, 44 it might be ex¬
tracted without cutting into the bladder at all ; aim h me
sacculation be behind the muscles of tne ureters, it is

to cut upon the gripe.” _ _

Some remarks on the morbid growth of the cornea, wmra
gives it a conical form, with a new method of treating it, 'm e
been published by Sir Wm. Adams*. This state occurs without
inflammation, is progressive, and the thickness producing tue
conical form, is .chiefly in the centre. The cornea, when exa¬
mined in front, sparkles with a brilliancy like crystal; a cir¬
cumstance, which Dr. Leveiile attributes to the cornea reflect¬
ing, instead of transmitting, an opinion which Sir William’s
operations have proved to be well founded, ihe vision, n no*,
utterly destroyed, is so indistinct, as to oblige the patient teyio
nearly as dependant as if totally blind. From a case which
occurred, in which cataracts were combined with conical corner,
and in which, after the removal of the cataracts, the patient
could see more distinctly without convex glass than is usual
after the operation, and with a convex glass small print could
be read without difficulty, Sir \\ illiam was induced to try the
removal of a healthy cornea, 44 as a remedy for blindness pro¬
duced by conical cornea and the result was perfectly satisfac¬
tory. When the crystalline is healthy, or in a state capable ot
beino- broken down/he properly recommends it to be removed
by that method as preferable to extraction.

Dr. Lobenstein Lobel has proposed to extract the diseased
lens in cataract through the conjunctiva instead of the corneay.
He conceives, much benefit is likely to result from this, 44 when,
the capsule, half or a whole line thick, is morbidly indurated,
or when the lens is very large and cannot be broken down, by

* Phil. Mag., xlix. p. 110.

t Edin. Med . <$• Surg. Journ. 1. p. 59.

Retrospect of the Progress of Medical Science.

lie, setting aside any chance of prolapsus of the iris ; and by
the re- muon of the divided parts being more expeditious than
on making tnc incision through the cornea. We may remark as
an objection to this proposal, that wounds in the conjunctiva
are followed by more inflammation than those in the cornea.

On the subject of fungus hamatodes , or soft cancer, some
very valuable cases and remarks have appeared* *. Mr. Bell is
of opinion, that the only remedy, is recourse to the knife the
moment the disease is ascertained ; and if it have 64 got entan¬
gled in the vessels and muscles of a limb,’’ nothing offers hope
but amputation; but even this will not avail, if the muscles
“ exhibit a pale blanched and fishy appearance.” Another set
of tumours, nearly as dangerous if neglected as the soft cancer,
we mean those which rise from the gums, have also engaged the
attention of this excellent surgeon. A tumour of this descrip¬
tion first appears as “ a small hard prominence of the gum,
shooting out betwixt two teeth/'’ If those be not decayed, we
may conclude, that the cause is deep, and not to be removed by
pulling the teeth ; but if they be bad, there is a rea
hope of arresting the progress of the disease, by re

:<&sonable

■emoving

hope or arresting tne progress or toe disease, by
tnem. If the tumour originate “in the membrane of the
hang, or in the socket,” then the “ whole system of parts, the
whole of what is connected in constitution, must be removed.”
These opinions are illustrated by several very interesting cases -K

When hernia occurs in early infancy, it is generally of that
description which has been denominated congenital; in which
the protruded bowels are found in contact with the testicle; but
instances have occurred to prove, that real hernia may occur at
a very early period ; in testimonyof which, the dissection of a
case has been published by Mr. Howship, in which the hernia
had no connection “ with the tunica vaginalis testis t.”

We notice as a valuable addition to works on hernia, the
dissertation of Dr. Hesselbach, which has been lately translated
into Latin by Dr. Ruiand j .

Connected with this subject, is the operation on the artificial
anus at the groin, suggested by M. Dupuytren, and described
m our last Retrospect . We had much satisfaction in being able
to lay the plates illustrative of this operation, before our read-

* Surgical Observations, vol. i. p. $65.

*f Ibid. p. 413-28. ij; Med.-Chir. Jour n. Sec. vol. iii. p. 1 70,
jj F. C. Hesselbach, JII.I). in Theatro Anatomica Wirceburgensi
Prosecloris, Soc. Med. Erlang. Membri, Disquisitiones Anatomica
Pathological de Orta el progressu Hemiarum inguinalium et crura Hum,
accedit Descriptio instrument, hcemorrhagiis sub herniotomia ortis et
secure detegendis , et sistendis apt, iconibus illustrata. Latinitate
donavit Th. Aug. Ruland, M.D. &c. 4to. p. SO. Wirceburgi, 1810.

JRetrq&pect of the Progress of Medical Science,

ers ; and shall seize the first moment of putting them in pos¬
session of M. Dupuytren's description of its various steps, as
soon as it is given to the public.

No material changes have taken place in the practice of Mid¬
wifery within the period of our present Retrospect , if we except
the invention of an improvement in the -craniotomy forceps, by
Dr. Davies, Physician to the Queen's Lying-in Hospital ; the
advantages of which the following description will render evi¬
dent. The instrument is intended to complete the delivery
speedily and safely in those unfortunate cases where it is pre¬
viously necessary to diminish the bulk of the child's head. No
other instrument has been proposed to answer this intention
either in ancient or in modern times, that is not liable to very
strong objections. The order of laborious labours requiring the
use of instruments of this class, has been therefore regarded as.
embracing the least cultivated department of instrumental mid¬
wifery.

The instrument, now proposed, consist s.of two handles and
two blades, with a locking part common to each, to be adjusted
precisely in the same manner as those of the ordinary mid¬
wifery forceps. The handles, as far as the Jock inclusive, are
in no respect different from those of the common forceps. The
blades, however, are not divergent from each other, but are
produced in a parallel direction, remaining very near each
other, until they meet at their expanded extremities within
about an inch and a half of their terminations. At this part,
the opposite blades are made to embrace each other so firmly,
as to have the power of detaining within their grasp substances
of the utmost tenacity. Both blades are gently curved, to
adapt them to the axis of the pelvis and to the shape of the
child's head. Each blade is to be introduced singly. The
external blade is to be insinuated on the outside of the head,
which, in most cases, cannot be very difficult, after a proper
quantity of brain has been removed. The internal blade is to
be . introduced into the inside of the head, through the perfora¬
tion which has been already made on it by the operation of cra¬
niotomy. The corresponding parts of the instrument are then
to be brought together by a careful adjustment at the lock.
This adjustment will have the effect of causing to be embraced
between the blades, a portion of the child’s skull on the inside,
and of the integuments covering that part of the skull on the out¬
side, corresponding to the dimensions of their grasping extre¬
mities. The internal surface of the external blade, it will
3>ow be readily inferred, is concave, to adapt it to the convexity
oi the child's head on the outside. On the contrary, the inter¬
nal surface, by which is meant the grasping surface of the inter¬
nal blade, is convex , that it may come in contact more readily,

RETROSPECT of the Progress of Medical Science.

and at many points with the concave surface of the child’s skuli
interiorly. But as we operate in cases of this kind in circum¬
stances often of great confinement or distortion, much force of
traction must in many instances be employed, and therefore
without great tenacity of purchase, any instrument would be
liable to slip. This accident has been provided against in the
following manner. The expanded extremity of the internal
surface of the external blade is hollowed out into a receptacle
like that of a spoon. Attached to, and rising from the bottom
of this receptacle, are a number of sharp teeth, the points of
which are under the level of the brim ; and are therefore
secure from the reach of any part of the mother during the in¬
troduction of the external blade. Corresponding with these
teeth of the external blade, imperforations are drilled into the
convex or grasping surface of the internal blade. Upon the
•handles -of the instrument being forcibly brought together, the
adjustment at the locking part ‘having been properly attended
to, it is manifest that the imperforated convex surface of the
internal blade must have the effect of pressing the embraced
part of the skull and integuments ‘of the child’s head upon the
sharp teeth of the opposite part of the instrument ; or, in other
words, that the teeth of the external blade will be made to pene¬
trate the integuments and skull at every point of surface
exposed to their action.

In cases of great distortion, it will sometimes happen, that
portions of the frontal, temporal, and parietal bones, may be
removed in fragments of greater or less magnitude ; while the
occipital part of the head shall remain fixed above the brim of
the pelvis, hitching over the pubis, and beyond the safe reach
of the instrument which has been described. It has, therefore,
been found expedient, to apply the same principle of purchase
to cases of this class i 11 another form of the instrument. The
difficulty of applying the first form of the instrument to this
description of cases, arises from the direction of its curve in
relation to its handles, it being impossible to introduce the ex¬
ternal blade immediately behind the symphysis pubis, so as to
embrace the occipital portion of the child’s head resting there,
without producing dangerous pressure with the handle upon
the perineum and os coceygis.

The instrument of the second form is therefore so con¬
structed, as to obviate this difficulty. The blade part is pre¬
cisely the same with that part of the first ; (here is to be un¬
derstood the whole of the curved part of the first instrument;)
but at the termination of the curve, where each handle and
blade may be supposed to meet, (allotting to the handle a
much larger portion of either half of the instrument than is
covered with wood,) the handles of the second instrument are

72 Retrospect of (he Progress of Medical Science .

made to bend considerably backwards in the direction of the
convex surface of the external blade ; so as to enable the prac¬
titioner to introduce both blades of his instrument perfectly
and safely, and embrace the occipital part of the child’s head,
which is supposed to be wedged in a state of arrest, immedi¬
ately behind and above the pubis, without the necessity of
disturbing the perineum and the parts adjacent witli the handle
of either part of the forceps. This form of the instrument may
be called the doubled curved craniotomy forceps. In a very
large majority of unfortunate cases requiring the operation of
craniotomy, trie delivery will be satisfactorily completed by
the abundant power over the form of the head and the resist¬
ance made to its descent by the first firm grasp and steady pull
of the instrument which has been first described.

The external part of each instrument, measured singly, is
considerably longer than its corresponding or antagonizing
internal part. In the instrument with the single curve, this is
more remarkably the case than in the other, arising from the
circumstance of Its describing necessarily a segment of a larger
circle than its antagonist.

It is intended here, however, to request attention more par¬
ticularly to the extremity of the grasping part of each half of
the instrument. The termination of the external part of each
form of the instrument is lengthened out about one half or
three quarters of an inch beyond the brim anteriorly of its
receptacle in the blade, and therefore so much beyond the ex¬
treme point of the convexity of the internal part of the in¬
strument.

Persons, who are familiar with cases of distortion, will
be able to attest the correctness of the remark, that what is
called obliteration of the orifice of the uterus, would never
take place in many instances for want of the ordinary pressure
upon it from above ; there being no room above the pelvis to
put it upon the full stretch of distension. In a proportion
therefore of such melancholy cases, a part of the unobliterated
lip or orifice of the uterus will be found hanging down loose
and pendulous into the vagina.^ Now the extremity of the ex¬
ternal part of the instrument is lengthened out, as described,
beyond its internal antagonist, for the purpose of carrying
before it, and by that means of removing beyond the purchase
of its own grasp, any unobliterated part of the os uteri which
mav present itself during the operation*.

* Dr. Davies was presented with the gold medal of the Society
of Aits, for this invention. It may be useful to mention that the
person who made Dr. Davies’s instrument, is M. T. Bat - cham/ SO,
Worship-street, Fiiisbury-square.

Retrospect of the Progress of Medical Science. 73

MEDICAL JURISPRUDENCE.

This is a branch of medical science of great importance, and
to which we have been most anxious to call the attention of our
readers ; but, from the great length to which this Retrospect
has already extended, we must withhold the particular obser¬
vations we had prepared on the subject, till we draw up our
analysis of Mr. Marshall's Remarks on Arsenic which have
just issued from the press, but came too late into our hands to
form a part of our present Report. Under this head, therefore,
we shall merely notice a very few facts, the general knowledge
of which may prove useful.

Some interesting experiments have been made by M. Man-
gili on the venom of the viper, which prove that it does not
.become mortal under ordinary circumstances. From his ex¬
periments he concludes — 1. that ammonia is the chief remedy
against the bite of the viper ; 2. that the vital powers alone may
in some cases be sufficient to overcome the effects of the poison ;
and, 3. that musk and opium are insufficient remedies, and
ought never to be preferred to ammonia.

Brugnatelli has employed Iodine as a test for discovering the
presence of oxide of arsenic and of corrosive sublimate. He adds
as much iodine to recently boiled starch as will give it a blue
colour, and then dilutes it with pure or distilled water, so as
to form a beautiful azure tincture. If a few drops of an aque¬
ous solution of oxide of arsenic be added to this azure solution
of starch* the blue tincture will instantly acquire a reddish hue
( roussatre ), and afterwards be altogether dissipated $ but the
addition of a few drops of sulphuric acid will again restore the
blue colour. The blue colour is destroyed in the same manner
by corrosive sublimate ; but cannot be restored by any acid-fy

Cases of the poisonous effects of the oxalic acid are frequently
occurring. It has been suggested that it is from the magnitude of
the quantity taken that is deleterious. Would not citric, tartaric,
malic, and other vegetable acids, be equally noxious in large
quantities j? is a question which has been asked, and is certainly
one of considerable moment : but from the form of their crys¬
tals, and other circumstances, even admitting that they are
poisonous, these acids are less liable to be productive of such
extensive mischief as the oxalic acid. The inquiry, however,
ought not to be neglected.

* Remarks on Arsenic , considered as a Poison, and a Medicine ;
tyc. fyc. By John Marshall, Member of the Royal College of Sur¬
geons, See. 8 vo. pp. iff 3, London, 1817.

f Giorn. di Fisica, ix. p. 4ff5.

t Edinburgh Medical and Surgical Journal , vol. 1. p. 25 0.

Vol. vni. — no. 43. l

74 Retrospect of the Progress of Medical Science.

Such is the Hetrospect of Medical Science, for the last six
months, which our opportunities enable us to present, to our
readers. We have been more anxious to collect facts than to
offer critical opinions ; yet we would venture to hope that the
sketch we have drawn, imperfect as it is, will serve as a test
by which some estimate may be formed of the value of what
has been effected ; as an aid to practitioners in winnowing the
seeds of truth from the chaff of hypothesis and conjecture ; —
and as a.touch-stone, to detect the base coin of empiricism from
the sterling gold of true philosophy.

Synoptical View of the State of the Atmosphere,

in London, between the 19th of November, 1816,

and the 20th of May, 1817.

From the 20th of November to the 19tii of Decem¬
ber. — Barometer, highest SO7 ; lowest 287 : — thermometer,
highest 48° ; lowest 27° prevailing winds, S. WSW; — quan¬
tity of rain, two inches 10-100ths. In the week from the 3rd
to the 1 0th of December there was an uncommon mortality,
without any particular discernible cause.

From the 20th of December to the 19tix of January.
•—Barometer, highest 305 ; lowest 289 — thermometer, highest
45° ; lowest 28° :• — prevailing winds, SW SE : the quantity of
rain was very great ; but, owing to the breaking of the guage,
could not be given.

From the 20th of January to the 19th of February.
— Barometer, highest 3Q5 ; lowest 28* thermometer, highest
52° ; lowest 32° : ■ — prevailing winds, W S W quantity of
rain, two inches 69-1 00th s. A singularly mild temperature
during the whole month. The aurora borealis was, in different
parts of England, on the nights of February the 8th and 9th,
very vivid and singularly beautiful.

From the 20th of February to the 19th of March.
—Barometer, highest 303 ; lowest 29 : — thermometer, highest
57° ; lowest 32°: — prevailing winds, W. SW: —quantity of
rain, one inch 26-lQ0ths.

From the 20th of March to the 19th of April.—
Barometer, highest 306 ; lowest 298 : — thermometer, highest
58° ; lowest 30° : — prevailing winds, SW and NE :* — quantity
of rain, one inch 12-100tlis

From the 20th of ArRiu to the 19th of May. — Baro¬
meter, highest 30s ; lowest 29 : — thermometer, highest 66 ;
lowest 34°: — prevailing winds, NE and SW —quantity of
rain, 24- 1 OOths of an inch.

Retrospect of the Progress of Medical Science. 75

A Nosological Table of the aggregate of the C ases recorded
in the Monthly Registers of the Repository, of the Diseases
of London, between the 20 th of November 1816, and the
19 th of May 1817.

CLASS I. PYREXLE.

OltDO 1. Febres.

Nov.

Dec.

A a

Jan.

Feb.

Mar.

April.

Mav.

Total.

Fata 1.

Interm itterites . . .

15,

Catarrhaies .

54]

367

Synocha .

27!

100

Typhus viitior .

Synochus . .

124

Pnprnpvp . . . . .

Remittentes infantiles . .

125

ORBO 2. Phlegmasia.

JPhlogosis .

V li 1 n errn ^ isi 'i rfnIp?iR. . .

A hrpstei is . .

125

Furunculus . . ..

Pm no aaail, ««,

Paronychia . j

PnrKnnn \ h is . . . . .

Ophthalmia . * .

193

| ( ' vnauche tonsillaris .

c;o

Vi ■

207

; - paroiidea .

j Bronchitis acuta . .

- chronica . ...........

Pneumonia . .

208

- ■peripneumonia .

.12

- pie ur His .

118

Phthisis puhnonalis .

4 C

221

PnrvliHs .. _ _ ..........

1 A>ri rrl i f I Q . . . .

Peritonitis . . . . . .

3-1

fin ’•,'t ritis . . . .

j 8

Enteritis .

I 35

Hepatitis .

Splenitis acuta . .

I •,

« ♦ ♦ i«

Nephritis..*.., . .

6j 21

r.if'hiacis: . . . .

! 9

J 11

Hysfcritis . ..........

Rheumatismus acidus . .

4-8

■ 57

280

- chrcrdcus .

j 66

332

» 40

Ynhah'lp'io . * .

3 S

J 208

Pleurodyne .

i] 50

{Lumbaao .

1 &

•*>

i go

76 Retrospect of the Progress of Medical Science,

0111)02. Phlegmasia,

Continued. _

Hysteralgia . 1

Ischias . . . 3

Hepatalgia . 5

N euralgia. . . 2

Nephralgia..’.. . 1

Tic Douloureux... . . . .

Odontalgia . . 6

Otalgia . . . 3

Podagra . . . . .j 11

OliDO 3. Exanthemata. ‘ \

Variola . .

Impetigo jigurata,. . .

sparsa . .

erijsipelatod.es .
scahida........ .

Porrigo larval is .

scutulata,
favosa....
decal vans.

Ecthyma.... . .....

Scabies . . .

Varicella . .

Vaccinia . .

Herpes zoster — ...
— — - — circinatus ...

— - - labial is . .

- prceputialis.

Eczema .

Aphtha lactentium.. .

- - an gin os a —

Miliaria...., . ...

Rubeola — . .

Scarlatina simplex,.

— - angindsa.

- maligna.

Urticaria fehrilis...

- - - evanida..

confertus.

Roseola.

Purpura simplex . .

Erythema feeve . .

- nodosum,...,

pal palatum.

Erysipelas.

Pemphigus . . . . .

P ompholy x benignus . .

ORJDO 4. Hamoerixagia.

Epistaxis. . . .

IRemoptoe.. . . .

Hiemorrhois..... .

Menorrhagia . . — .

If!

24
3 f

Dec.

Jan.

| Jan.

| Feb.

•

-S.S

Mar.

April.

May.

Total.

Fatal.

•«•••*

]

25.

113

202

J 2

t> t. * • «

r e S 0 P •

9 9 • • •

e o • • • •

/•a

158

505

553

' 1

■o

t J

16*

...... 1

5 2

106

133

162

Retrospect of the Progress of Medical Science. 77

ORDOi. H/EMORRIIAGIjE,
Continued.

Nov.

Dec.

Si 5

1 Jan.

1 Feb.

Feb.

Mar.

•

• *—-<

« b

— ; .

“

< S

Total.

Fatal.

Abortus .

! 97

I laematemesi s _ , . . , .

2 U

Hematuria .

OR DO 5. pROiFLUVIA.

Catarrhus .

1 CO

i or

ii/i

699

Coryza .

1 0 O

1 44

125

114

Leucorrhoea .

1 d.

107

Dvsenteria .

1 H

1 £

1 O

i /i

CLASS II. NEUROSES.

ORDO I. Com at a.

Apoplexia .

Paralysis.. .

jL l)

1 D

4. .v

nennpleirica .

var-tptefj-ica .

tremor .

ORDO 2. Adynamizg.

«* o » a -» a

Angina pectoris .

Syncope .

.» a o • rt «

» » 0 0 0 *

Asphyxia .

Asthenia .

9 £

32
65

33
26

o t» • » • •

Dyspepsia .

287

, Anorexia .

i 9

462

• Cardialgia .

or?

Gastrodynia .

128

Entrodynia .

204

Hypochondriasis. .

i i

1 A

u>4

7 ,f

22
7 7

158

Chlorosis .

T 1

i i

Icterus..... .

A 1

1 1

Vertigo .

1 o

ORDO 3. Stasmi.

168

Spasmi .

Tetanus.. . .

1 1

/ *

Convulsio .

Chorea.... . .

Epilepsia.. .

Palpitatio .

Asthma .

O Q

/? f*

O' 7

■

Dyspnoea .

O'!

n t-

Tl,

420

Pertussis .

Zit

O*?

143

Pyrosis .

z /

o u

26,

166

Ileus .

11 '

Colica .

| - pictonum .

ZrZ

146

| Cholera .

7 Q

i n

Diarrhoea . ‘... .

1 O

i y

Diabetes .

o J

i z

420

Hysteria.... .

ii:

: l*rIctura . . .

1 <* . — * —

106

7$ Retrospect of the Progress of Medical Science

-fl

. o c.

5 d d

,A \s

: s-< s-
2 ct o

•

• l H . r-

2 L< •-

& f

\p '

4->

’

c8 _

0111)0 4. VesanLe. i

H Q -

( cti cc

0> j 3
&

j krS «-
H f£, *

2 .

Amentia.....* . »••••••••••** . {

1 -

Mania . . . . . j

Melancholia . * . — . .

| CLASS III. CACHEXIES.

ORDO j. Ma&cores.

. 4

«3

ORDO 2. IntuMescenti.e.

Flatuosje.

aquobx.

130

Hydrocepnaius ................

19]

'Hvctrotnoi ra. . . . *• . *

SOLII>*E.

Physconia. . * . • . .

••••**

ORDO 3. IMPJSTIGIWES.

119

233

.Syphilis . * .

Scorbutus . . .

•Strophulus iniei unu . . * '

' - - £() (( 1 if t CcO • • • ® *

Lichen sinipl ex . . . * *

».

3 1

Prurigo mu is . . **"

i* :

• _ — — senilis. • • . . .

*->

]

3 ^

2 1

Lepra... . .

1 15

^ f

1 ^Ol Itl'tr'if* li . . .

2 .

• A

> 1
•> 21

)

2 L

1 1

)

3 1

2 .

Pity nasi s ..... . . . .

. • • » ♦ •

. 1

1 .. ..

• • • • • t

Ichthyosis. . • •••• .

• * • ♦ • *

• • • • • •

. « • s •

5 ’

1 .

1 2‘

i — — cdpiUtii . • . . .

5 CLASS IV. LOCALES.

!' ORDO I. Dys.ethesiaa.

t.1 align . . .

• • • • • •

• . • • •

2 ..*•

•

n . . .

• •)••• •

• • * * •

-1

1 ....

•

Retrospect of the Progress of Medical Science .

CLASS IV. LOCALES.

ORpO 1. DYSiETHESIA.
Continued.

£ «■
0 C.

6 rf

<u b

•

r-. lc

~>fa

Xi a

• »—

9 £

GO v-

5h XT
- CL ^

, 3
*

■*-1

Dvsecoea.. . .

. i

* 11

Paracusis . . .

) c

5 c

i . . .

ORDO 2. Dysorexiae.
Bulimia . . .

- 3

Anorexia .

O r

ORDO 3. Dyscinesiae.
Dysphasia .

wtJ

Contractura .

ORDO 4. Apocenoses.
Profusio . . . . .

Enuresis .

Gonorrhoea . .

oj.

CIO

zrA

ORDO 5. Episches.es.
Obstipatio . . .

1 0

14*1

i5) AO

Ischuria . . .

frO

TfV

1 y

/Co

.zUsi

160

Dysuria .

1 0

1 I

Amenorrhtea .

I ft

ORDO 6. Tumores.
Anemisma . T .

-Cv

Soirrhus . . . . .

c~<

Cancer .

Polypus .

Hydrarthyrus . .

Exostosis........,.,,,,, , . .

Bronchoeele . .

194

609

419

ORDO 7. Ectopias.
Hernia.. . . . . ..

humorrhalis . .

Prolapsus...... . . ,.f ..

......

ORDO 8. Dialyses.
Fungu, . . . .

Fistula .

HETEROCLITES.
Dystochia .

Vermes . . .

0 /?

rr r\

Morbi Infantile 3 .

lot

/CO

104

111

G A

100

# " .......

— ■ — Biliosi . . .

Ill

y 0

a a

1 J-C

l /

/ y

Totals . ..|«5

>533 *

*385 2

'578 <

>453 $

*164$

*201 1

4314 l

>68

... .. , .. . ’I

, «r 7 „ . - °f ^ascsi?i all the Genera of Diseases recorded in th-s

Monthly Registers , between the 19 th of November 1816, and May the 2Gth 1817.

From 19th of November to the 20th of December 1816, ......... 2533 . fff

- December 1816 — - — January 1817, . ” 2385 . *

. January — - February

* - February - - March

- — March - - — April

- — April - - May

2578 ...
2453
2164
2201

. . 86

5 $

* * • « *> * * c « t ‘S

f* £

"ffi'fc* S'S

J 4,314

&08

4 i s PART L

ORIGINAL COMMUNICATIONS,

A General View of ike Diseases usually occurring in Boys during
the. Period between Infancy and Puberty in Christ s Hospita< .
exhibited in a Synoptical Table , and accompanied wiih p/ actical^
Observations. By Henry Field, Member of the Society <>■
Apothecaries, London, and Apothecary to Christ s Hospital?

(Continued from Vol. VII. p. 282. J

j i

TABLE OF DISEASES.

1817.

Mar.

1817.

Apr.

1817

May.

i rnnomiKo frmeillnvi a . . . .

f L y llclllvU.L vOiioixitii in ••••••••■

2 Scarlatina anginosa . . . . . . . .

1 .

A T irnhuG . . .

x. , ,, Mpcpnfprioa . . . ....*««• •••

(' Tiil.no mOConfpi'ir*fl . . .

ry Wfiocie C«3fnrrnnli« . . .

9 Nausea, Gastrodynia vel Diarrhoea; :. ; : , . ..... . . .

i i X> 7-* miYYiofi cm lie o rmtn t: . . . .......

1 2 Odontalgia Catarrlialis ... . . . .

1 Q OW-vofinifae r nf-arrvh nil <5 . .

\_/ KJ O tlpA wUO W

1 K Oo-s’nfio Iipiii rrrvn . ......

i n Cir.c4-i.ifio ov.nifllemahna ? .

IQ Pmirum . ..«•••••«

!■■•

Totals . . .

! 1.4

t ■

The early part of the spring season was mild. The latter
end of April, and the whole of May have been colder than
usual. The weather was uncommonly dry until the middle of
May, when much rain fell, to the great benefit of vegetation,
which, prior to it, was exceedingly retarded.

Several instances of scarlatina anginosa have occurred, all
c*>f which were of a mild description. The case of typhus fever
commenced with early symptoms of an alarming nature, and
discovered almost from the first attack very great danger.
The Boy, G. W.j vats about twelve years of age, had been rc-

Field* Quarterly Report of the Diseases in Christ's Hospital 31

moved from Hertford only a day or two, and sunk under the
disease about the fourteenth day.

aoed fourteen years and a half, was received into the
Infirmary in the last week of January. This disease soon
ecame strongly characterized as an affection of the mesenteric
glands, accompanied with a considerable degree of fever, and
an abdomen unusually hard and tumid. Notwithstanding
every means employed for his relief, these symptoms continued
to increase, while his body became proportionally emaciated,
and his strength greatly diminished. About the latter end of
March he became universally dropsical, in the form of ascites
and anasarca ; both of which, however, gave way to the
remedies employed, and in a week or two almost entirely disap¬
peared ; nature then began to rally, and there were flattering
appeal ances of convalescence. In this state he was removed to
the residence of his father, near Canterbury ; where, as I am
informed, he was considered for some days to be going on
very favourably : but about a week after his arrival there, he
>vas suddenly attacked with some kind of fit, and very soon
expired. J

The case of tabes mesenterica, mentioned in the report for
March, was that of C. S. aged fourteen years. His symptoms
were very similar to those of the former patient, excepting that
no appearances of dropsy occurred. He was removed by his
fi leaps into the country about the middle of IVXay ; but no
amelioration oi the disease followed, and he gradually sunk
under it,

A case came under treatment during the month of May,
the symptoms of which were so unusual, as to render its ela§!
siflcation doubtful ; it has, therefore, been included in the table
for that month with a note of interrogation. The patient was
H. C. about twelve years of age: having been lately removed
from Hertford, bis former state of health does not appear ; but
there is reason to believe that he has always been of an inactive
disposition, and his faculties dull and weak. He was brought
to i£e Infirmary on the 6th of May: his early symptoms were
drowsiness, sickness of stomach, and much debility ; he com¬
plained but little of pain : it was soon discovered that his
mouth was sore, which, in the space of two or three days, in¬
creased so much, as to give the whole internal surface of that
and the fauces the appearance of being studded with sloughy
uxcers, and deglutition was much impeded. Though he was at
one time almost constantly asleep, yet, when roused from it, his
answers were perfectly sensible. His bowels, though somewhat
confined, yet were easily acted upon by mild laxatives. During
the progress of the disease the drowsiness abated : but he was
then at intervals delirious ; his pulse was quickened, thoimh
VOL. viii. —no. 43. M

M Original Communications.

seldom greatly accelerated. About this time he complained ot
pain in the epigastric region, which, however, was much re¬
lieved by the application of leeches to the pained part, and a
subsequent blister. On the fifth or sixth day of the disease, an
almost incessant and very distressing cough came on; his
vomitings were then very frequent ; and his general appearance
was such, that there was great reason to believe he must soon
sink under it. But the contrary was. the. event : an early
amendment then took place, the ulcers in his mouth put on a
healthy aspect, every unpleasant symptom subsided, and on the
26th of May he was so far recovered as to be removed
Streatham for the benefit of country air, where, I under¬
stand, he continues at this time (June the 11th) progressively
improving in health. In addition to the remedies a ready
mentioned, the warm-bath was employed. Castor oil as a
purgative, and various saline sedatives, were given, also setnc;
and ammonia under circumstances of lowness and depression.
Blisters were applied behind the ears, and boraeic gargles to>
the mouth and fauces ; but the medicine which appeared to
render most service, was tincture of opium, (given in an oily
emulsion as a vehicle,) of which he took daily, for several days
together, from twenty to twenty-five drops in divided doses
It was begun at the period above mentioned when the cough
and vomiting were excessive, and its beneficial effects in allaying

those irritations were very striking.

To speak with certainty as to the nature of the disease m
question would be impossible ; but there appears great proba¬
bility that it was what Dr. Cullen terms an ery thematic ; inflam¬
mation of the stomach. The symptoms detailed by that
author bear a very strong resemblance to the case before us.
Drowsiness or delirium are not mentioned by him in connection
with this species of gastritis ; but the well-known sympathy
between that organ and the brain may sufficiently account for
'their occurrence, especially since there seems to have beeh no
original affection of the latter, though the early symptoms of
the disease were calculated to excite at first some suspicion ot

hydrocephalus. . . .

Burserius, in his u Institutiones Medicmm Fracticae, treats

largely on gastritis, though his account ot it applies moie to
the true or phlegmonic species of that disease than to the erysi¬
pelatous gastritis. He enumerates both delirium and convulsion
as symptoms of the higher degrees of it.

Sauvages gives a brief description of this disease under -the
name of gastritis exanthematica. He appears to consider it as
not well ascertained ; for lie expresses a wish, that such peisons
who may have an opportunity of seeing it, would give it then
particular attention, and would note, the symptoms, in order, as
he says, to improve our knowledge on the subject.

History of the Human {EconoJny. US

II. •

Thr History of the Human (Economy. By a Member of the
Iioyal College of Physicians in London.

The works of Nature consist of animate matter, and of in¬
animate matter. Animate matter is matter endowed with that
something which we call life ; and under it are comprised, the
vegetable and the animal kingdoms. Life, when united to
matter, is not always manifest ; in the seed of a vegetable or
in the egg of an animal, it exerts no energy, but that whereby
it prevents the component elementary parts of such seed or
egg from yielding to the laws of chemical affinity. A seed or
an egg, when placed under those circumstances, which their
several natures require, will, if endowed with life, furnish a
vegetable or an animal similar to those from which such seed
and egg were derived ; but if the seed or egg have lost or have
been deprived of its life, no process can make it furnish a
vegetable or an animal ; for its component parts being freed
from restraint, will yield to the laws of chemical affinity, and
will form new' combinations. A vegetable or an animal fur¬
nished by a seed or egg, is an organized body endowed as its
primitive germ with life, performing various functions, and
being capable of assimilating other matter to itself. The ani¬
mal and the vegetable thus produced, will retain its life for a
greater or a less period of time ; after w hich, it will lose its life,
and its constituent parts will then yield to the laws of chemical
affinity, and becoming disunited ana decomposed, they will form
new combinations. A vegetable or an animal may be deprived
hi life at any period of its existence. A vegetable and an animal
are each then organized matter endowed with life. The orgaized
body of the anirnal thus endowred with life, is inhabited by
something equally invisible as life, which something receives
various degrees and kinds of feeling from various impressions
made upon the body, and which possesses and exercises various
powers ; this is the sentient principle, the mind. The mind
varies in the degree and in the extent of its powers, not only
in different animals, but in animals of the same tribe, and also
in the same animal under different circumstances and conditions
of the animal. An animal then is an organized body, endowed
with life and inhabited by mind. The mind of living man
possesses powers so vastly superior to those possessed by the
mind of any other animal, that it entitles him to a distinct and
separate place in the works of creation. The body of man
consists of a structure calculated to give it lightness, combined
with firmness and solidity, and to admit of various motions and
changes of position. Such is the structure furnished by the

S4 , Original Communications . -

bones and cartilages with their joints and ligaments. Attached
to this structure are fibrous masses of various extent and thick¬
ness, called -muscles ; by the contractions of whose fibres, the
different motions of the body are produced.

There are distributed throughout the body two systems ;
one of these is the nervous system, which consists of the cranial
and the spinal brains, and of an infinite assemblage of white
cords connected with these, which cords are called nerves. The
other system consists of the heart, arteries, veins, exhalents,
secreting structures, absorbents, and the several fluids contained^
in these several vessels, and it may be termed the system of
supply and waste. Through the nervous system, the mind
takes cognizance of impressions which are made upon the body ;
through the nervous system certain impulses are communicated
to different parts of the body, regulating and influencing their
functions and actions. The system of supply and waste re¬
ceives fresh matter for the use of the body ; prepares and dis¬
tributes such matter, and removes and rejects matter from the
body. One of the offices of the nervous system is the trans¬
mission of a power which has received various titles, and which
we may call the nervous power. This power, when conveyed
to muscles, produces contraction of their fibres; it is a power
distinct from life, for life may exist in a part to which the ner¬
vous power is not conveyed. The mind has been spoken of as
inhabiting a living organized body ; but it is not merely an in¬
habitant ; it is closely and intimately connected with the living
body; the functions of the body influencing those of the mind,
and the functions of the mind influencing those of the body.
The properties of the mind are various and numerous. When
through the nervous system it takes cognizance of an impres¬
sion made upon the body, such impression is said to excite sen¬
sation ; sensation is the cognizance which the mind takes oi
impressions. The various actions of the mind within itself are
called its faculties ; the various states and affections of the mind
arising; from its various sensations, and from the exertion of its
several faculties, are called its passions.

Although the organization of the living body of man is, in
its essential and more apparent characters, alike in each indivi¬
dual of the same sex, yet we And that the body is somehow or
other differently constituted and differently endowed in dif¬
ferent men, so that what is to one man a healthy state and a
healthy action of the body and of its parts, would in another
man constitute disease. This peculiar state of each individual
is called hi habit, his temperament, his constitution. The
mind has also its temperaments, for it varies in the degree and
in the extent of its powers in almost every individual. The
character of the mind, as relating to its faculties, we term its

History of the Human (Economy. $5

genius; as relating to its passions, we call it disposition ; and as
relating to sensations, we give it the name Perception. In what
the difference of the constitution, or temperament of the living
body of man consists, we cannot strictly determine. Whether
the degree of life with which it is endowed may vary in different
individuals, is a question which we may ask, but not answer*
If there be a varied degree of endowment of life, such varied
degree being connected with varieties of organization, too mi¬
nute for human investigation, these acting upon, and being
acted upon by the mind, may constitute the varied shades of
temperament of body, and may give a character to the genius,
to the disposition, and to the perception. The sensations de¬
pend upon the part of the body impressed, and upon the thm»*
impressing. Thus certain impressions made upon the mem¬
brane of the nose produce the sensation called smelling; other
impressions upon the optic nerve produce the sensation called
seeing ; other impressions upon the internal ear produce the
sensation called hearing ; and other impressions upon the tongue
iind palate produce the sensation called tasting ; and other im¬
pressions made upon all these several parts, as well as upon all
other parts possessing nerves, will produce that universal sen¬
sation which is called feeling. When an impression upon any
part of the body has produced a corresponding sensation in tile
nind, if that impression cease, the sensation excited by it com¬
monly ceases also, the mind passing from one sensation to
another, according to the succession of impressions which are
made upon the body. When an impression has excited sen¬
sation; when that impression has ceased, and when the sensa¬
tion excited by it has ceased also ; and when other succeeding
impressions have severally excited corresponding sensations ;
yet, although that first impression be not repeated, the sensa¬
tion excited by that first impression may be present at various
times, and at various periods, after it was first and originally
excited. When a sensation, which has formerly been pro¬
duced,, presents itself again to the mind, without a repetition
of the impression which produced it, such sensation is seldom
as powerful or as perfect as that sensation originally was. The
mind has a faculty of recurring to or recalling a past sensation,
and when such past sensation again presents itself, it is fre¬
quently accompanied or followed by those sensations, or by
those passions by which such past sensation, when originally
excited, was preceded, accompanied, or followed. So if a sen-
ration have formerly been excited by an impression, which im¬
pression, as well as the corresponding sensation, have long
f‘mce ceased, if that impression be repeated, and excite scnsa^.
tion, this second sensation being similar to that former sen¬
sation, may cause the mind to refer to such former sensation \

S(i Original Communications .

and if such former sensation re-appear to the mind, there may
arise with it those sensations also, and those passions, by which
that former sensation, when excited originally, was preceded*
accompanied, or followed. In these cases the mind perhaps only
glances, as it were, over the former original sensation, while it
passes on and rests upon the sensations and the passions which
are suggested by it.

Sensations consist of various degrees of what, is called feel¬
ing, and of those peculiar modifications of feeling which are
known by the names seeing, hearing, tasting, smelling. The
faculties of the mind are judgment, thought, reflexion, memory*
recollection, fancy, invention, and the like. The passions are
joy, love, pride, rage, grief, fear, hatred, shame, envy, ana the
like. The mind has not the power of attending closely to dif¬
ferent subjects at the same time. It cannot order and direct
accurately two different and distinct actions of the body, and
attend closely to each at the same time. It cannot attend
closely and accurately to two distinct and different sensations at
the same time. It cannot exercise powerfully two distinct
faculties at the same time. It cannot be occupied with two dis¬
tinct passions at the same moment. If the mind be closely
engaged in directing actions of the body, it pays but little at¬
tention to sensations, and its passions and its faculties are more
or less quiescent. If it be occupied by a sensation, other sen¬
sations are slightly attended to, or are disregarded, and all other
actions of the mind are more or less suspended. If the mind
be engrossed by the exercise of a faculty, the sensations are neg¬
lected, and its other actions are more or less suspended. If one
preponderating passion occupy the mind, those sensations only, ,
will probably be attended to which are connected with that
passion, other passions will not be present, nor will the facul¬
ties be exerted. Tims we see that the mind does not always
take cognizance of impressions which are nevertheless capable
of exciting sensations. If the mind does not take cognizance
of an impression, the corresponding sensation will neither be
presented to the mind nor suggested to it at a future period.
In the. absence of present impressions the mind recurs to past
sensations, and it attends more or less closely to these in pro¬
portion as its faculties are more or less quiescent; thus in sleep,
past sensations appear very strong and vivid, so as to be mis¬
taken for present sensations. Sensations depend much upon
the temperament of the mind, on its genius, its disposition,
and its perception. Sensations affect the mind with pleasure,
or they are unpleasant, or they are regarded with indifference ;
the effect of them depends much upon the passions which they
give rise to, upon the passions which similar sensations have
at other times given rise to, upon other effects of similar

History of the Human (Economy. 87

former sensations, and of other suggested sensations, and also
upon the state of the faculties. Judgment is a review of past
and of present sensations and passions, by which review the
mind determines upon the probable consequences of such sensa¬
tions and passions, and upon the passions which the suggestion
of such sensations may at a future time give rise to. Thought
is the steady contemplation of past or of present sensations and
passions, and the anticipation of future sensations and passions.
Reflection is the contemplation of past or of present sensations,
and also of the passions which have been connected with them,
as well as of the manner in which the faculties have been exer¬
cised upon such sensations and passions, whereby the mind de¬
termines upon the propriety of such sensations," passions, and
such exercise of faculties, or upon the advantage that has at¬
tended or followed these, or may attend or follow a similar
repetition of these.; from which determination the mind forms
plans either for a repetition of similar sensations, passions, and
exercise of faculties, or for avoiding these, or for in any way
altering a part or the whole of them. Memory is the re-ap-
pearance to the mind of those individual sensations and passions
which have formerly been excited. Recollection is the power
of summoning the re-appearance of past sensations or passions.
Taney is an exercise of the mind, whereby it creates to itself
sensations without the intervention of impressions, the materials
for such creation being chiefly more or less furnished by the
recollection, or it is the mistaking past sensations for present
ones. Invention is that faculty whereby the mind discovers
new modes of exciting sensations and passions, either by new
exertions of its own powers, or by directing new associations of
matter external to its own body, or by directing the application
of the laws of nature to matter, in a manner different from that
in which they have before been applied.

From this very imperfect definition of the faculties it will
appear, that they are much connected with, and that they de¬
pend much upon each other. The faculties are strengthened
by frequent exercise. The passions are the results of sensa¬
tions, and of the reciprocal influence of the sensations upon the
faculties, and of the faculties upon the sensations ; the same
sensation will, under different circumstances, excite different
passions, according as the mind is more or less occupied by
certain passions, or as one or other faculty is more or less power¬
ful ly exerted, or according to the sensations w hich are suggested
by such sensation.

( To be continued.)

Original Communications .

III.

Some Observations relative to ike new Method of extracting the Cataract
as proposed by Dr. Lobenstcin Label. By Edward Chapman,,
Surgeon, Bath*.

About six months prior to the date of this communication, on
Considering the many objections which may, with propriety, be
urged against the operation of extracting the cataract through an
aperture caused by a circular incision of the transparent cornea ; an
idea suggested itself to me, whether or not there existed a possibi¬
lity of removing the opaque lens, by means of an incision through
the schlerotic and choroid coats, at a few lines distant from the junc¬
tion of these tunics, with the cornea itself.

In order to ascertain the practicability of such an operation, and
no opportunity immediately occurring to me of making the experi¬
ment on the eye of the subject, previous to its removal from the
orbit, I obtained the eyes of various quadrupeds, and on such, made
frequent trials in the presence of several medical friends.

From these experiments, the facility with which the' crystalline
humour will admit of removal from such a situation was established;
and I anticipated the pleasure of communicating to the profession
the particulars of an operation, possessing on the one hand all the
advantages, and obviating on the other those several disadvantages,
of the present method of extraction.

1st. The important objection arising out of the probability of
the subsequent partial or total opacity of the transparent cornea as
a consequence of inflammation. — 2ndly. The serious injury which
not un frequently is occasioned to the iris, in the passage of the
opaque chrystalline lens through its aperture or pupil into the an¬
terior chamber. — Sdly . I had conceived that an eminent advantage
would result from the probability that the divided parts would more
speedily unite in consequence of the certainty with which the edges,
of the incision would remain in contact subsequently to the opera¬
tion. — And, 4thly, That a possibility of thus removing the opaque
lens by extraction would be afforded, although union should have
previously taken place between the fibres of the iris while in a
state of dilatation and the capsule of the lens, the pupil having in
such cases commonly sustained a partial obliteration or diminution
of diameter.

Notwithstanding however the very flattering view which I had
taken of this subject, as the effect of the extremely favourable nature
of the inferences deducible from my experiments, I determined
to give the subject further consideration ; reflecting, that as the ex¬
periments had hitherto been confined to the eyes of oxen, sheep,
there might possibly exist some trifling difference in the relative
.situation of the parts, with respect to the human eye.

The determination which I then formed, 1 have since experienced
no reason for regretting ; for, in opportunities which have very fro

* We believe this paper has appeared in a contemporary Journal ; but. w§ could
not, according to cur rule of impartiality, give it an earlier insertion. — Lm cur.

Chapman on a new Method of extracting the Cataract. 89

quently, within a short period, been afforded me of repeating similar
experiments on the human eye, previously to its removal frpm the
orbit, the results very materially differed; inasmuch, as that the degree
of difficulty which was experienced in effecting the removal of the
lens was very considerably increased ; indeed it occasioned to me
such disappointment that I became somewhat discouraged from pro¬
ceeding any further in the investigation.

In performing the operation on the subject, (the eye yet remain¬
ing in the orbit,) I made an incision through the schlerotic and cho¬
roid coats, at a few lines distant from and parallel to the edge of
the cornea, to the extent of about one half or two thirds of an
inch ; with the extremity of the instrument having lacerated the
capsule of the chry stall ine lens, the knife was withdrawn ; but, al¬
though a very considerable degree of pressure was made upon the
globe of the eye, such pressure was not, as might have been ex¬
pected, followed by the escape of the lens itself. I found, that in
consequence of the toughness and inelasticity of the choroid and
schlerotic coats, it. was necessary, before such an effect could be pro¬
duced, that the length of the incision should be increased. I therefore
enlarged in a very inconsiderable degree the extent of the incision,
and with the application of a very gentle pressure the lens escaped;
not however alone, but unfortunately accompanied by a portion of
the vitreous humour.

I have several times since repeated this experiment, and from, the
sum of the results which they have afforded, have found sufficient
reason for the conclusion, that although ah opening be made In this
situation less in extent than is sufficient to admit of a partial protrusion
ot the vitreous humour, yet it is impossible without making use of
a degree of pressure which .would be incompatible with the. sub¬
sequent maintenance of vision in the organ, to effect the removal of
the opaque lens.

I can assign no other cause of such difficulty being exp©*
rienced in effecting its passage through an opening less extensive
than the unyielding and inelastic property of the tunics, in conjunc¬
tion with tlie acknowledged difficulty which the lens, .being of a
convex form, must necessarily experience in its passage through a
merely lineal aperture or section by incision.

To obviate the objection occasioned by this latter circumstance,

1 have since tried the effect of varying it, by accommodating
tiie form of the aperture to the lens. Such a variation in the form,
of the incision, I have not found attended with any advantage, in
consequence of the smallness of the distance betwixt the edge of
the iris, and the capsule of the vitreous humour.

From these circumstances, which appear to be incapable of
remedy, 1 had resolved not to trouble you v/ith any communication
on the subject, or even with a relation of my experiments ; and
from such a resolution should not have deviated, had I not to my
utter astonishment, on reading a recent number of the Edinburgh
Medical and Surgical Journal, seen a proposal to the same effect
communicated by Dr. Von Ernbden, wherein it appears that the
supposed discovery was made by Dr. Ldbcnstem Lobe), from an
accidental occurrence.— In conclusion 1 have to observe, that my
VOL. Vlil, — no. 43. N

90-

Medical and Physical Intelligence*

object is not that of endeavouring to deprive this individual of any
merit he may himself attach to the proposal, but merely to offer
my opinion, that the operation in question will never be deserving
of a preference to the one in common use.

MEDICAL AND PHYSICAL INTELLIGENCE .

I. - SOCIETIES.

Report of the Society for the Benefit of Widows of Officers
of the Medical Department of the Army, laid before the Second
Anniversary Meeting, held at the Thatched House Tavern, on the
9th of May, 181?." Dr. William Somerville, in the Chair. — It was
stated in the report of last year, that the money then accumulated
had enabled the Trustees to purchase to the amount of £ 1 67 1 : 10:9
in the three per cent, stock. In addition to this sum, there was as
much due as would purchase £800 in the same fund, at the value it
bore at that period, making a capital of £2471 : 10 : 9 in the three
per cents. This capital was rendered much more productive by
the salutary measure adopted of exonerating the fund of the
Society from all expences of administration, by the voluntary sub¬
scription of five shillings annually for that purpose.— A comparative
view of the following statement of affairs of the Society at this
period will shew, that the establishment has risen to its present
state of maturity in a shorter time than its most sanguine supporters
ventured to predict. There are 74 married members of the first
class : 40 married members of the second class ; 220 unmarried
members of the first class : 110 unmarried members of the second
class: total, 444 members, whose subscriptions amount to £1071
per annum; this sum, added to the interest on £5638:4:3.
three per cents., makes the income of the Society upwards of £ 1200
a year.- — Dr. T. Gordon, Dr. C. Griffith, and Dr. H. G. Emery, were
elected members of the committee for 1810-17, in the room of
Dr. B. Moseley, Dr. Pym, and Mr. Guthrie, who go out by rota-
tation, agreably to the 31st' article of the regulations. The Rev,
George Clark, Chaplain to the Royal Military Asylum, was unani¬
mously appointed Chaplain to the Society ; and John Dawson, Esq.
Solicitor.— The Committee have deemed it due to their absent bre¬
thren, to communicate to them this short account of the prosperity
of an institution which afforded no less gratification to nearly eighty
of its well-wishers, assembled on that occasion, than it must do to
those who have been prevented by duty or distance from attending.

Worcestershire Medical and Surgical Society. _ At a

general meeting of the Members of this Society, it was resolved,.
That the present system of removing paupers on account of appli¬
cation in cases of illness to the overseer of the parish in which they
happen to reside, to that parish to which they belong, often deprives
the poor family of the means of gaining a living, and frequently
induces them not to apply for a suspended order ; while, if a me¬
dical man is called in, under such circumstances, to attend* them he
has no legal means of obtaining any remuneration for his attendant "

Resolved, That, petitions be presented to both Houses of Parli

e.
lia-

Me diced and Physical Intelligence. 91

ninni, praying, that some regulation may be introduced in the Bill
•now pending relative to the Poor Laws, for medical attendance
upon the casual poor. C. Hebb, Secretary.

ii. — miscellaneous.

To the Editors the London Medical Repository.
Gentlemen, In noticing my Physiological Nosology, p. 4<Q6 of
your last Number, you point out an omission of Species under the
genus Alphosis. The remark does credit to the accuracy of your
reading : but you were unfortunate in having been supplied with an
imperfect copy of the work. The fact is, that the text was first
printed with such an oversight, which 1 detected on the day of its
publication ; and immediately ordered the leaf to be erased and its
place supplied by a cancel : nor was I aware, till I saw your account,
that a single copy of the work was in general circulation without
this cancel, a copy of which is herewith inclosed for your use,* and
which, possibly, you may think it right to transcribe into your next
Number, il you should find room. The more so, as I have taken the
opportunity it has afforded me, of correcting, at the same time, an
accidental error respecting the genus Ulcus, which you will find
in p. 4[)7 of your Repository, has escaped your own attention.

I will be obliged to you also to add, that if there should be any
other person in possession of a copy of the Nosology without the cor¬
rected leaf, he may have it gratuitously on application to my Book¬
seller, Mr. Cox, of St. Thomas's Street, Borough.

1 remain, Gentlemen, your obedient servant,
Caroline Place, June 1 6, 1817. J. M. Good.

GENUS V. ALPHOSIS. — Cuticle dead white; pupils rosy;
corporeal powers weak.

1. jETHIopica. Hair white, and woolly ; irids white; sight

strongest in the shade. Found among negroes.
iEthiops. Plouquet.

Alhor cutis. Plenck .

Weissehaut. G.

Albino.

2. EUftop.-EA. Hair flaxen and silky; irids rosy. Found

among Europeans, and other white nations.

Trail in Nichol-son’s Joam. of Nat. Phil. See
also Blumenbach, Med. Bibl. ii. 537. Lc Cat , Trade
de la Couleur de la Peau Humaine. Phil. Trans.
passim.

“ Gen. V. Alphosis. The character of the genus and species is drawn up from
the description of Saussures, Maupertuis, Razz;, and Blumenbach. The whiteness
is probably produced by a want of the secretion of the pigment that among negroes
renders the rete mucosum black ; and which does not usually take place till several
weeks, sometimes months, after birth ; the negro-child being fair when first born. The
Spaniards and Portuguese denominate those who are taus affected Albinos ; the
French, Blafards ; the Dutch, Kacklackcn.

“ As the present page is a cancel, and has consequently been worked off after
the rest of the volume, the author takes the opportunity of requesting his reader
to correct .the numerals of the specific names under the genus Phyma, p. 154>
2, 3, 4, to 1, 2, 3: and to give to the names of the species and varieties
under Ulcus, p. 247, a neuter instead of a masculine termination, as vitiosum , cal*

N 2

• ' 92

losum , See.: the author having at first employed a masculine noun instead of ulcus:
and it having escaped his attention to make the necessary emendation on a change of
the generic term. He has also to entreat the reader’s correction of a few other errors
that will occasionally occur to him, chiefly, typographical, and mostly in the accentua¬
tion, and the use of a large or small capital in the commencement of certain specific
names: it being uniformly intended to employ a large capital whenever a new species
is distinguished by the name of an old genus, or a substantive of a similar kind in the
nominative case ; and never otherwise.

A METEOROLOGICAL TABLE,

From the 21 st of May to ike 20th of June 1817,

KEPT AT RICHMOND, YORKSHIRE.

230 Milos NW from London.

Baron

Max.

aeter. i
Min.

The

Max

rm. |
VI in.

Rain

Gage.

Winds.

Weather.

NNE,.

1 Sun. 3 Cy... 4 Rain.

NW.

i Cloudy*. 2 Rain.

Vblei

i Sun. 4 Moan.,.

8.SW.

1 3 S... 2 Cy.. 4 Mil,..

NW..NE.. '

1 Sun.. 3 Mist.. 4 11....

NNE.

1 Rain.. 3 Cy.. 4 Mist..

■27

NbE..

1 Sun...

55i

N..

1 Mist... 3 Rain,... -

53,

NbE...

13 4 Cloudy... 2 Sim.

N„

1 Sun. & Sh, 3 Sum.

NW..NE..

1 Sun.. 4 Cloud..

4329

NE..SW..

1 3 Sun... 2 4 Cy..

28 29

SW..

13 Cy.. 2 Sum. 4 Rain.'

2628

SW..

1 S. & Sh. 2 S.. 4 R.

SW...

1 Sum. 3 Showers. |

SW...

1 Sun...

SW..

1 Sun..

SW..

1 Sun.. 3 Rain..

42,29

SW..

1 Sun..

40 29

SW.SSE

1 Sun.. 2 Cloud..

NW..VbIe.

1 S.. Sh. & Th.. 2 S..

6029

W..SW..

1 Sun... 3 Cloud.. 4 R.

30 29

SE.SW..

1 Cloud... 2 Sum.

8428

SE.

1 Cloud.. 2 Rain....

63 29

SW..NW..

1 Sh. 2 Sun.

9129

w.„

1 Sun..

8429

s..

1 Sum.

66 29

SSE..

jl Sun...

38 29

NW..NE..SE..

1 Sun....

53 29

SE.

1 S.... 3 Th.... Lt.v. R.

62 29

NW.ENE..

!l Sun.... 3 Th.. 4 M.. [

The quantity of rain during the month of May was 2 inches 19-100ths.

Observations on Diseases at Richmond.

The disorders that have been under treatment in this last period,
were Asthenia, Cynanche Tonsillaris, Diarrhoea, Dysmenorrhoea, Dyspep¬
sia, Dysuria, Epistaxis, Febris Catarrhalis, Febris Puerperalis, Febris
Typhodes, Gastrodynia, Hsematuria, Icterus, Mania, Menorrhagia, Obsii-
patio, Ophthalmia, Phthisis Pulraonalis, Pneumonia, and Kheumatismus.

METEOROLOGICAL TABLE FOR LONDON,

From the 20th of MAY to the 1 9th of JUNE, 1817,

By Messrs. HARRIS & Co.

Mathematical Instrument Makers , 50, High Holborn.

i€)

Therm.

Barom.!

Rain jDe Luc’s
Guagej Dry.

Hygrom.

Damp.

Winds, j

Atmo. Variation.

45 49 42

295

2 2

Rain;

■

31'47 51 40

294

226

.29

2 5

Rain!

Clo.

43 47 40

295

.20

3 2

SW ' '

Fine! Rain! Clo.

42 52 43

295

296

.12

4 4

SSW

Clo.

Fine 1

49 51 42

295

3 3

Fine

Rain Fine

44 47 41

29*

292

.18

4 4

Rain

Fine

45 51 47

29-

294

.23

4 4

Clo.

51 59 46

296

295

.10

4 ‘ 4.

Fine

Rain'

Clo.

51? 60 47

296

297

.13

5 5

NNW

Clo.

Rain'

Clo.

48 54 45

295

297

.09

5 4

Rain

Fine

48 53 41

29"

299

.24

3 2

NNE

N •

Clo.

46 59 44

299

29s

.17

1 2

Fine

52 56 44

29*

29s

2 2

Fine

Clo.

Rain

51 59 48

29s

29'

.12

3 2

Fine

Clo.

54 61 52

29 7

29s

1 3

ssw

Fine

— __

Rain

56 61 49

295

299

.10

4 4

Rain

Clo.

Fine

si RQ SO

QA4

4 3

SSW

TT 5 v p

0~r \J & o/w

56 63 59

299

O Q

<->

P vv

;sw

ssw

jl MIC

Fine

Clo.

66 70 54

299

297

O o

Q O

Fine

Clo.

59 68 53

29&

3 2

Rain

Clo.

Fine

57 69 55

30 1

301

.15

0 1

Fine

—

Clo.

56 68 56

30 1

2 4

Rain

Clo.

59 65 52

29s

.17

5 4

Fine

55 61 53

297

3 5

Ram

Clo.

55 59 54

296

293

.10

5 5

Rain

Clo.

57 59 54

294

299

.14

4 3

SSW

WSW

Fine

Rain Clo.

59 61 47 301

309

.07

0 1

Fine

- -

55 61 49 30*

302

0 0

SSE

Fog

Fine

— —

57 69 59j30

29s

1 3

Fine

63 77 63,29s

297

3 2

!mne

ENE

Fine

f *

66 77 67j297

298

.02

1 1

'SE

Fine

Rain

Fine

The quantity of Rain fallen in the month of May is 2 inches 78-100this.
Bill of Mortality from May 20, to June 17, IS J 7-

< CHRISTENED

^ED.

JURIED.

{

OF WHOM >
HAVE DIED/'

Males .

May 27.

J O*

June 10.

June 17-

272

277

186

Females.

251

241

156

412

523!

518

Total „
1135.

Males .

174

175

1 33

females.

162

161

127

277

336

m |

Total,

1203.

f Under 2

Years.

. 83

Betw. 2

and 5

. 19

and 10

. 10

and 20

. 12

and 30

. 18

and 40

. 23

and 50

. 30

and 60

and 70

..... 28

and 80

and 90

. 9

90 and 100

. 2

MALL POX.... .

T-Otaf

32.

A REGISTER OF DISEASES
Between MAY 20tk, and JUNE 1 gth, 1817.

DISEASES.

Ahorfcio .

Abscassio .

Acne ............... ...........

Aipeoorrhoea . .

Anasarca. . .

Aneurisma. . . . .

Angina Pectoris . .

Anorexia.... . . . .

Aphtha lacientium .........

■ - - — angbiosa..... ......

Apopiexia. . .

Ascites............ ............

Asthenia...... . . .

Asthma.... . . . .

Atrophia . . .

Bronchitis acuta . .

- — — - chronica _ .....

J3 r onchocele . . . .

Calculus............ .... _

Cancer . . . .

C arbunculus .................

C ardialgia

Carditis...... . . . .

Catarrhus ...................

Cephalalgia. ...............

Cephalaea.

Chlorosis . .

Chorea...... ..... ........

Cholera.. . . . . .

Colica. . .

- - Pictonum.. .

Convulsio . . .

Cystitis.... . . .

Cynanche Tonsillaris .

— - maligna ... .

— — - Parotidea ...

Diarrhoea .

Dysenteria — ..
Dyspepsia.......

Dyspnoea........

Dysuria .

Ecthyma .

Eczema . .

Eneuresis . .

Enteritis .

Entrodynia . .. ..

Epilepsia .

Epistaxis .

Erysipelas .

Erythema lave.

Total.

diseases..

""T “■* 'gZ1'-

Erythema nodosum.. .......

Ery thismus Merc . . . .

Febris intermittent .

10,

- co ta rrhal is ..........

lit

— — ■ Synocha . .

]

- - Typhus mitior......

! i

• — — Typhus gravior . . .

* - Synochus . .....

remit. Infant .

Fistula.... . . .

Fungus... . . .

Furuneulus . . .

Gastritis..... .

Gastrodynia . . .

Gonorrhoea..... .

Haematuria. . .

Htemoptoe . . .

Haemorrhois . .

€>Q

-id

Hemiplegia... . . .

Hepatalgia... . .

Hepatitis....... .

Hernia.. . . . .

Herpes Zoster . .

— 1 — — circinatus . .

la. hi nli <?

{

Hydrarthyrus. . .............

Hydrocele.... . . .

-»•

Hydrocephalus. . . . .

Hydrops ovarie... . .

Hvdrothorax. . . .

Hypochondriasis.. .

Hysteralgia . . . . .

Hysteria .

****

Hysteritis...... . . .

Icterus . . . . ......

Impetigo Jigurata... .......

- - — erysipelatodes . . .

.cm hi /hi .

Ischias.. ............. .........

Ischuria . .

Lepra . .

Leucorrhoea .

Lichen simplex . .

Lumbago... . . . .

/ o

Alania..... .

Melancholia..... . .

•Menorrhagia . .

Miliaria................. .

M c rbi Infant lies * . .

DISEASES.

Total.

i \

Morbi Biliosit .

i Nephralgia . .

Nephritis.... .

Neuralgia. .

Obstipatio .

Odontalgia . . .

Opththahnia.. . .

Otalgia .

Palpitatio . .

Paracusis .

Paralysis .

Paraplegia . . .

Paronychia .

Pericarditis .

Peritonitis .

Pernio .

Pertussis .

Phiogosis .

Phrenitis .

! Phthisis Pulmonalis .

Physconia . .

]

Plethora .

1 Pleuritis . . .

Pleurodvne .

Pneumonia....'...-, .

Podagra.... . . .

Polypus'. . ./

Porrigo larva Us .

decalvans .

! - ■ imuifta.

1 Prolapsus. . .

Prurigo mitis . . .

- senilis .

Psoriasis guttata .

01 fata .

- . .. .... ... .

DISEASES.

Psoriasis inveterata .... .,...

Pyrosis .

Rachitis..... . . .

Rheumatismus acutus .

— - - chronicus...

Roseola..... . . .

Rubeola .

Scabies . .

Scarlatina simplex .

— - — - anginas a .

Scorbutus.
Scrofula. . . ,
Spasmi... .
Strictura...
Strophulus

maligna.

Sycosis menti

Syncope .

Syphilis .

Tabes Mesenterica

Tic Doloreux .

Trismus . . .

Tympanites. .

Vaccinia .

Varicella. .

Variola . . . .

Vermes . .

intertinctus. ..
confertus....

Vertigo .

Urticaria febrilis..

- — e&hnida..

- - - conferta.

Total of Cases . ,.2050;

7
2

71
16

8
2
1

• 1
2
36
. 8
1
1
1

72
18
53
40
38

Total of Deaths . : . I93

accurately

from dentition o:
Mcrbi Biliosi, surf

Observations on Prevailing Diseases.

At the latter part of the period which the Register embraces the tem¬
perature of the atmosphere was ' extraordinarily high. The affections of the
re^puato:/ organs have been accordingly much less frequent and severe.
I he Exanthemata have, from the same cause, increased: although this
does not appear in- any remarkable degree from the returns in the Register
we xnow tnis to oe the fact, variola , above all, continues and spreads
a devastating contagion. However painful, yet it is a duty we owe to the
paouo and the profession, to apprize them, that the number of all ranks
suffering under Small Pox, who have previously undergone Vaccination by
tue most skilful practitioners, is at present alarmingly great. This subject
u 38n°us> an,d 8° deeply involves the dearest interests of humanity as
well as those of the medical character, that we shall not fail in directing
our utmost attention to it. . s

in.— NOTICE OF LECTURES,

Dr. Merriman and Dr. Ley will recommence their Lectures
on Midwifery and the Diseases of Women and Children at the'
Middlesex Hospital on Monday, July 7th, at half past Ten o’clock.

IV.— LITERARY NOTICES.

Deputy Inspector Hennen’s Work is ready for the press. J e
have seen both the MS. and the drawings for the plates, and do not
hesitate in pronouncing it a work 'which will stand pre-eminently
high in surgical literature. ^

In the Press, the Principles of Diagnosis. By Marshall Krai,
M.D. &c. This work is founded entirely on the External Appear¬
ances of Morbid Affections.— It embraces, 1. A view ot the coun¬
tenance and attitude of patients, inasmuch as They are plainly
characteristic of diseases : 2. The symptoms of diseases, considered
in their modifications and in relation to particular affections : S. A
diagnostic arrangement of diseases : 4. And, lastly, their diagnosis.

Dr. Scudamore has in the press, and nearly ready for . publica¬
tion, the second edition, corrected and enlarged of, A Treatise on tne
Nature and Cure of Gout and Rheumatism, including General Con¬
siderations on Morbid States of the Digestive Organs ; some
Remarks on Regimen ; and practical Observations on Gravel.

MONTHLY CATALOGUE OF BOOKS.

An Essay on the Nature of Light, Heat, and Electricity. By
C. C. Bompass, Barrister at Law. 8vo.

The Hunterian Oration, delivered before the Royal College ot
Surgeons, 161 7. By William Norris, Master of the ^College, and
Surgeon to the Charter House and Magdalen Hospital.

Remarks on Insanity, tending to illustrate the Physical
Symptoms and Medical Treatment ot that Disease, founded on the
practice of John Mayo, M.D. Fellow of the Royal College of Phy ¬
sicians. By Thomas Mavo, B.M. Fellow of Oriel College, Oxford,
and Inceptor Candidate of the College of Physicians. Svo.

Remarks on Arsenic considered as a Poison and a Medicine,
&c. By John Marshall. Svo.

NOTICES TO CORRESPONDENTS.

Communications are come to hand from Mr. Moyle, jun.
Mr. Gaitskell, Mr. Kerri son, Mr. Weaver, Mr. De Mcr-
veilleux, jun. and Mr. Morgan Thomas.

The Paper signed W. requires a signature.

Air. Hastings' Experiments and Reasoning , in refutation of
Dr. James Johnsons opinions regarding the Circulation of the
Rlood , shall have a place as soon as we have further discharged the
obligation which the priority of other Communications imposes.

In order that we might pay due attention to our numerous Cor -
respondents , we. have added half a sheet to the ordinary number oj
the present Number of the Repository. >

THE

LONDON MEDICAL

REPOSITORY.

No. 44. AUGUST 1, 1817. Vol. VIII.

PART I.

ORIGINAL COMMUNICATIONS.

The History of the Human (Economy. By a Member of the
Royal College of Physicians in London.

( Continued from p. 87. J

The nervous system consists of the cranial and spinal brains,
cf the nerves, and of the ganglia. The cranial brain occupies
the cavity of the skull, and is divided into cerebrum, cerebellum,
and medulla oblongata ; the spinal brain is continued on from
the medulla oblongata, and it fills the cavity called the verte¬
bral canal. The nerves are white cords, composed of medullary
filaments, which are enveloped and enfolded by a membranous
structure called neurilema. The nerves are connected by a
continuity of structure with the cranial or spinal brain, or with
both these. The nerves are distributed throughout the body
in two sets, whereof one goes to the right side, the other to the
left. Ner ves are in a very few instances single and unconnected;
they almost universally form numerous unions with each other;
in tracing several brandies of nerves we find them terminating
m an union of all these branches, which union is called plexus;
from this plexus may be traced fresh branches which com¬
municate with other plexuses, and themselves form a second
plexus, from which other branches proceed in like manner ; so
that the nerves of each set form a kind of net-work throughout
reach side of the body. This frequent union of distant nerves
and the formation of plexuses, occur particularly among those
nerves which belong to the systenl of supply and waste, and to
the parts appended to that system, and less so among those
nerves which supply the muscles ; nor are these last nerves
connected with the nerves of the system of supply and waste,
as closely or as frequently as these last nerves are with each other.
vol. vm. — no. 44. o

98 Original Communications .

In different parts of the body nerves are traced into small
masses of medullary matter, which are called ganglia, from
"which ganglia or small detached brains, fresh filaments of nerves
may be traced ; sometimes a ganglion unites two points of a
nerve, sometimes it is the centre of several filaments. T. hese
ganglia are, with a very few exceptions, found among those
nerves which belong to the system of supply and waste. All
nerves communicate with the cranial brain, either by their
own branches, or through other nerves, or through ganglia, or
through the spinal brain. The nervous system is every where
supplied with arteries and veins. Nerves send branches to every
part of the bodv, excepting the substance of the teeth, nails, hair,
marrow, cellular substance, and epidermis. There are other
parts in which the anatomist cannot discover nerves, as tendons,
ligaments, cartilages, bones; upon which parts, when in a healthy
state, impressions do not excite sensation ; but when in certain
diseased states, impressions upon them may excite sensation.

The nervous system is that through and by which the
mind holds communication with the rest of the body, and
with the material world. In order that an impression upon
a nerve excite sensation, such nerve must have its communica¬
tion with the cranial brain or spinal brain entire and uninter¬
rupted. If a ligature be placed around a nerve, or it such
nerve be divided, those impressions only which are made upon
that nerve between the ligature or division and the cranial or
spinal brain will excite sensation ; all impressions made upon
the nerve beyond such ligature or division will fail to excite
sensation. The sensation excited by impressions depends much,
perhaps, upon the temperament of the nerves impressed upon ;
it depends much upon and is much influenced by the quantity
of blood which is contained in those arteries and veins w hich
are intermingled with the nervous system generally or locally.
The sensation depends much also upon the thing impressing,
and upon the particular nerve impressed. T his has been ex¬
emplified when speaking of the mind. A nerve may have lost
the power of communicating its peculiar sensation, yet it may
still convey the general sensation, feeling. The nerves which
belong to the system of supply and waste do not transmit to the
mind impressions, which they are exposed to under the ordi¬
nary and natural performance of the functions of that system.
The digestion of food, its passage along the intestinal canal, the
passage of chyle, of lymph, of blood, of various secretions
through their proper passages, these do not so impress the
nerves of the several parts concerned as to cause sensation to be
excited; impressions upon parts may influence and produce
actions in these parts without exciting sensation. But if the
parts in which these several functions are performed are in an

History of the Human (Economy i 99

iittnatural or disordered state, sensation may be excited even
when the parts are merely discharging their natural functions,,
l '<nnatural impressions upon these parts, or natural impres¬
sions carried beyond natural limits, will excite sensation ; but
in some cases the degree of sensation excited by impressions
upon parts of the system of supply and waste appears not in
proportion to the impression : thus wounds of the lung or of the
liver often excite but trifling sensation. .Generally speaking,
impressions are not made directly upon the nerves, but a sub¬
stance destitute of nerves is interposed between the thing im¬
pressing and the nerve impressed. The kind and the degree
of sensation depends upon the interposed medium. When an
impression has existed for some time, the degree of sensation
excited by it generally diminishes gradually, until the sensation
perhaps ceases altogether ; but if the impression be removed for
a time, and be then re-applied, the sensation will be re-excited.
This cessation of the sensation must depend either upon the
mind ceasing to take cognizance of it, or from some change in
the nerve impressed upon ; but the mind may continue to take
cognizance of other sensations, although the sensation by this
particular nerve has ceased ; there must then be in this case
some change in the nerve, which prevents the impression pro¬
ducing sensation ; in common language, we express this change
by saying that the nerve is fatigued, that its sensibility is ex¬
hausted ; this is merely stating the fact ; in other words, we do
not know upon what change in the nerve it depends, or how
the property of re-conveying sensation is restored by rest.
When sensation is excited, the mind generally traces the sensa¬
tion to the part impressed upon, and refers it to that part ; but
it frequently not only does this, but it traces also the impression
to its source; thus, with regard to objects of sight, rays of light
strike the retina, the)'' excite sensation, the mind traces the rays
to the object whence they proceed, and refers back the sensation
to the situation of that object. In the same manner does the
mind trace undulations of air to their source. So, when we
hold a pencil or a probe between the fingers, and trace out the
form of a body or the irregularities of its surface, the mind
traces the impressions to their source, and refers them to the
end of the pencil or probe. If a nerve be impressed upon at
any point between the cranial or the spinal brain, and the ulti¬
mate subdivision of such nerve, the sensation is generally re¬
ferred to all such subdivisions, and sometimes also to the part
impressed, sometimes not. Thus an impression upon the blad¬
der may excite sensation, which shall be referred to the external
end of the urethra ; a blow on the ulnar nerve at the elbow
mav excite sensation which is referred both to the elbow and to
the ultimate subdivisions of the ulnar nerve in some of the

o 2

100

Original Communications'

fingers. An impression on the hip-joint may excite jfexjsatioBy
which may be referred to the knee only, or to both hip and knee.
An impression upon the ultimate branches of a nerve may ex¬
cite sensation which shall be referred to the other extremity of
such nerve: thus an impression upon the ends of the phrenic
nerve in the upper surface of the liver, may excite sensation
which shall be referred to the other extremities of that nerve at
the shoulder. Impressions are then communicated in some way
or other through nerves; but the sensation excited, is referred
either to the part directly impressed upon, or to either of the
extreme points of such nerve, while no sensation is referred to
the intermediate part of the nerve between the part impressed
and the extreme points.

If the communication between certain parts and the cranial
or spinal brain be interrupted, by tying or dividing the nerve or
nerves of such parts, we find that certain functions of those
parts cease ; we therefore naturally infer, that something wat
conveyed by the nerve, when in its entire state by which those
functions were regulated ; this something, whatever it be, we
call the nervous power ; and since whatever interrupts the com¬
munication of the nerves with the cranial brain, interrupts the
communication of this power, we infer that the cranial brain is
the fountain head of the nervous power. The nervous power
when directed to muscles, produces contraction of their fibres.
This power is generally directed to muscles by the mind. When
it has been so directed for a certain length of time, the mind
ceases more or less to have the power of producing contraction
of the muscle or muscles : this must arise either from a fault in
the mind, or from a deficiency of nervous power, or from fault
in the particular nerve or nerves, or from fault in the particular
muscle or muscles ; but the mind may continue to order the
contraction of other muscles which have not been so long in
action. There is not then a fault in the mind, nor is there a de¬
ficiency of nervous power generally ; there must then, in this
case, be either a local deficiency, or a fault in the nerve or in the
muscle. But the nerve in the present case may convey oth«r
powers, as the electric power, and the muscle may still contract
independently of the mind ; yet as the cranial brain is consi¬
dered as the fountain head of the nervous power, we know not
how to suppose that there can be a local deficiency of that
power. The power which muscles possess of contracting, in¬
dependently of the cranial brain, has had various names ; it has
been called vis insit a, irritability ; how far it may be the same
power as life, we cannot exactly determine. We see then, that
a nerve, whether it be considered as the medium through which
impressions are conveyed to the mind, or as that through which
tile nervous power is conveyed by the mind, when it has been

History of the Human (Economy. 101

long incessantly employed, ceases more or less to perform its
office, and that it requires to be unemployed for a time, in order
that it again become a proper and natural medium.

If the living body of man be placed in an atmosphere
colder than the body, or if other bodies colder than the human
body be applied to it, the temperature of such atmosphere or
of such bodies will be raised so as to be equal to that of the
human body, and the human body shall still keep up its own
natural temperature; so that the human body must possess
the power of generating heat. If the human body be placed
in an atmosphere hotter than the body, the body will stiil pre¬
serve the same natural standard of heat which it possessed when
in a colder atmosphere. This standard is about that degree of
temperature which is indicated by 97° of Farenheit’s thermo¬
meter ; the human body then, in a natural state, has not a
capacity for a greater degree of heat than that which is indi¬
cated by about 97°. If the communication between a part of
the body and the cranial or spinal brain be interrupted by
tvingor dividing the nerve or nerves of such part, the tempera¬
ture of such part will be diminished, and such part will, more
or less, readily partake of the temperature of surrounding
bodies. The integrity of the nervous system is necessary then
for the production of heat, and for regulating the capacity for
heat.

The system of supply and waste is that system, which, as its
titles imply, receives supplies for the maintenance of the body,
and which carries off what is superfluous or no longer useful.
It consists of the heart, the arteries, the veins, the absorbents,
the exhalants, and the secreting structures. It is a system of
vessels which contain and convey various fluids. All the vessels
which have been mentioned, are connected together; for the
absorbents terminate in veins ; veins terminate at the heart ;
to the heart are attached also the arteries, the subdivisions of
which are continued on by capillaries into veins, or termi¬
nate m exhalants. or in secreting structures, which have their
several outlets, and from which secreting structures there arise
veins which are also continued on to the heart. The heart
then is the common centre of this system. To this system is
attached a long canal, consisting of the oesophagus, stomach,
asd intestines ; upon, and throughout which, the system of
vessels is every where spread out and ramified ; the canal is for
the reception of fresh nutriment for the body, and as it is
only subservient to this system, it may be considered as forming
a part of it. To this system also are attached various struc¬
tures or viscera, which are to be considered as expansions or
prolongations, or convolutions of parts of this system, the mass
©f the viscera being principally composed of ramifications of it.

10S Original Communications .

The food being masticated, and being mixed with the juice of
the salivary glands, is forced down the oesophagus into the sto¬
mach, where it is mixed with the gastric juice ; passing thence
into the duodenum, it receives the bile and the pancreatic juice*
and the mass thus compounded, passes along the intestinal
canal, the mouths of absorbents separating and taking up what¬
ever is useful and nutritious for the body 5 the useless remain¬
der being gradually pushed along the canal by the peristaltic
motion of the bowels, and being afterwards expelled from the
canal partly by this motion, but principally by the action of
powerful muscles. The nutritious part of the aliment passes
along those absorbents which are called iacteals ; the remaining
absorbents take up and convey whatever is superfluous or what¬
ever ceases to be useful in the body. All the absorbents termi¬
nate in the large veins near the heart, so that the fresh matter
which is just entering the system, and the old matter which has
become superfluous, are alike poured into the mass of circu¬
lating blood, and are carried into the heart ; the heart, by its
contraction, propels the blood along the arteries from the
various terminations of which it passes, either by exhalants in
the form of fluid or vapour, or by veins directly to the heart
again, or through secreting structures, where part of it under¬
goes a separation and an alteration according to the nature of
the secreting structure ; and, being thus separated and altered,
passes on by various ducts or outlets ; the other part of it from
which the secretion has been abstracted, passes on by other
veins and again reaches the heart. The blood which returns
to the heart flows on to the lungs, where it undergoes a change
from exposure to air, and, being changed, returns again to the
heart, and thence is propelled as at first. So that the blood is
in perpetual motion, and is undergoing perpetual changes ; its
quantity and its quality depending upon the fresh matter poured
into it, and upon the matter poured from it.

The nervous system and branches of the system of supply
and waste, are distributed throughout the body. The system
of vessels is everywhere supplied with nerves ; the nervous
system is everywhere supplied with vessels, the parts appended
to the system of vessels are supplied throughout with nerves, so
that the two systems are blended together. The circulation of
a due quantity of blood through the vessels of a part is neces¬
sary, in order that the functions of the nervous System as re¬
lating to that part, be properly performed. For without that
due circulation of blood, the impressions made upon such part
will not excite due sensations, and the evolution of heat in
that part will be more or less suspended. An injury done to a
nerve in a part may increase the quantity of blood that
circulates through the vessels of such part, and the greater the

History of the Human (Economy , l(kcS

quantity of blood that circulates through a part, the greater is
the quantity of heat which such part will give off' to other
bodies. There is then a great connexion between the quantity
of blood that circulates through a part, and the heat which such
part gives off, and the degree of sensation which impressions
upon such part produce. The nervous system and the system
of supply and waste are then closely and intimately united, and
they mutually influence each other.

The muscles are masses of fibres, which fibres everywhere de¬
ceive branches from the nervous system and from the system of sup¬
ply and wraste. These fibres are met with in three states; the one
a state of contraction, another being a state of relaxation, and the
third si ie being an intermediate state between these two: this last
state s : lat in which we see a muscle which has another muscle
opposed to it, or an antagonist muscle, as it is termed : thus the
muscles on each side of the neck are in this state : they oppose
each other ; for if those on one side lose their power, while those
on the other side are in a healthy state, the head will be drawn
Jo that former side; but when both are in a natural state they
counteract each other, and thus keep the head upright. In
some persons we see a constant alternation of action between
these antagonist muscles, which causes the head to shake from
side to side. The nerves which supply the muscles generally,
are more connected with the \ cranial or spinal brain, and less
connected with each other, than the nerves of the system of
supply and waste.

The contraction of the muscular fibres of the system of
supply and waste, and of the parts appended to that system, is
more or less independent of the cranial brain. That system
has a nervous system in some measure peculiar to itself; one
with which the mind is less immediately connected, and which
is competent to the exercise of functions without the direct
agency of the mind or of the cranial brain. The contraction
of muscular fibres arises from the direction of the nervous
power to those fibres, or of some other power, as the electric
power, or from some power resident in those fibres, by virtue
of which they contract without the agency of the nervous
power. It would be foreign to the present purpose to inquire
minutely into the laws and the phoenomena of muscular
motion : it is sufficient to notice further, that the mind can
order the contraction of most muscles, by directing the nervous
power to them ; that those muscles which have been most fre¬
quently and most powerfully contracted, have generally a
larger quantity of blood circulating among their fibres ; and
that it can indirectly influence those muscular fibres over which
it has not a direct controul. We have seen the intimate con¬
nexion that subsists between the nervous system and the system

|04 Original Communications.

of supply and waste ; we have observed, that a close connexion
subsists between the mind and the nervous system ; it follows
then that there must be a mutual relation between the mind and
the system of supply and waste. The various states ana affec¬
tions of the mind influence the quantity of supply admitted
into the system, the mode of its distribution, and the quantity
of expenditure. The quantity of supply depends upon the
state of the appetite for food, upon the more or less perfect
mastication, upon the quantity of saliva which mixes with the
food, upon the state of the gastric juice, of the bile, and of the
pancreatic juice, upon the secretions of the mucous membrane
of the canal, upon the action of the lacteal s, upon the action of
the canal, upon the quantity of superfluous matter retained in
the canal. Now the mind more or less influences all these.
Under certain states of mind, the appetite is increased ; under
others, it is diminished ; and if appetite depend upon a due
and healthy secretion of the gastric juice, it follows that the
mind influences the secretion of this juice; that there is some
influence conveyed to the stomach through the medium of the
nervous system, which directs the secretion of the gastric juice,
appears from the secretion of the juice being destroyed, and
consequently digestion being destroyed, by the division of the
stomachic nerves. The appetite may be good, yet the mind,
being engaged in some other way, may not attend to it. The
quantity of saliva is diminished or increased by states of the
mind, and by certain sensations immediate or suggested ; and
the quantity of it which mixes with the food depends also upon
the more or less perfect mastication of the food, which of
course is under the influence of the mind. The mind indi¬
rectly influences the secretion of bile and its influx into the
bowel, by influencing the circulating system, by influencing the
action of the stomach and intestines, by influencing the reten¬
tion or the expulsion of superfluous matter from the intestines.
The same may be said respecting the pancreatic juice and other
secretions. The peristaltic motion of the canal is very much
influenced by and through the mind, is affected by the influx
of bile, and by the state of the mucous membrane of the canal.
Some passions increase the peristaltic motion, otheis letaid it ,
while others invert it. Certain impressions upon remote parts
affect also this motion. Suggested sensations, which frequently
are accompanied or follower! by those actions of the body and
inind by which those sensations, when originally produced, were
preceded, accompanied or followed, will also increase or invert

the peristaltic action. . .

Thus if we see or hear of certain substances or certain im¬
pressions which have formerly exeited vomiting in ourselves,
wc shall probably have nausea or vomiting again excited.

105

History of the Human (Economy.

lllows on the head affect the mind and the distribution of the
nervous power; they also excite vomiting. Affections of the
Uterus influence the mind ; they also excite vomiting. Affec¬
tions ol the kidney produce vomiting; the mind has a great
influence over the secreting power of the kidney. The reten¬
tion or expulsion of superfluous matter from the canal, is more
01 less under the influence of the mind ; inasmuch as the mind
influences the peristaltic motion, and directs also those other
efforts by which such matter is also expelled. The mode in
which the supply is distributed, is more or less influenced by
tne mind. The action of the heart as to force and frequency
is influenced by the mind ; and this, either from the direct in¬
fluence of the mind upon the heart, or its indirect influence
from its controul over the respiration.

The quantity of blood in arteries is influenced by the mind
also, inasmuch as the mind influences the secretions and the
action of exhalants ; and it does this either by its influence
upon the action of the heart, or by its direct influence on cer¬
tain secretions and upon the exhalants ; and ns it influences
these, it influences, as we have said, the expenditure from the
system of supply and waste. The mind may influence parti¬
cular vessels ; thus shame enlarges the vessels of the cheeks,
producing the blush ; while other passions cause them to con¬
tract ; genitalium vasa implet libido. The mind then has a
great and varied influence over the system of supply and waste,
it is also in its turn influenced by and through this system.
The quantity of food taken into the stomach, the quality of
such lood, the manner in which it is digested and passed on,
the action of the heart, the quantity of blood contained in
vessels, whether generally or locally, the greater or less action,
and the more or less perfect action of secreting structures, and
of the exhalants, all these very much influence the mind and its
various actions. In some instances, the influence of the mind
over the system of vessels is directly reciprocal ; in others, not.
Si turgeant genitalium vasa nascitur libido ; this is an influence
directly reciprocal, for genitalium vasa implet libido ; but al¬
though shame enlarges the vessels of the cheeks, a preternatural
distension of the vessels with blood does not give rise to a
sense of shame in the mind.

From the foregoing imperfect sketch, it appears that
all the parts, all the powers, all the functions of living man
are closely and intimately connected and blended ; that nothino*
is distinct and independent ; that the sensations, the passion?,
and the faculties are dependent upon and influence each other;
that they are severally and collectively connected with, and
influence, and are influenced by, the different systems of the
various states and actions of these systems ; and

VOL. viii. — no. 44. p

iOG Original Communications.

that all these several states and actions mutually influence and
affect each other .

There is a certain state of the several parts of living man,
a certain harmony between them and between their seveia
functions, in which state every part is in a natural and proper
condition, and every function is duly and naturally penoime
with a due relation to every other part, and to every other
function : such a state is called Health. Every deviation iohi
such a state is Disease. In order to particularise every possible
diseased state, we must enumerate every possible vane ty an
degree of deviation from that state which we have described as
the state of health : this would be a laborious tasK, and vou
require complicated investigation. For the present puipose, 1^
will be sufficient to take the mere outlines of the varieties 01
disease, with a view to the general treatment of these; premising
that the titles of diseased states are assumed generally from,
some more prominent feature of such state, and from one pan
or one function appearing to be principally concerned. ^ ^

If disease be present, we must recollect the various parts or
living man, the various functions of these several parts, the
dependence of these and the influence of them on each other,
and what it is that constitutes the health of the individual ;
taking into account the temperament, sex, age, and situation.
We must examine into the manner in which the functions o
the nervous system are performed, and into those also or the
system of supply and waste. We must see whether the
rhony between these two systems is perfect and natural, it
the nervous system appear principally in fault, we must inquire
whether the fault be as relating to the communication oi sen¬
sation, or in the conveyance of nervous power, or in the quan¬
tity of nervous power, or in the temperature of the body.
the fault in the parts of the cranial brain, of the spinal hi am,
of the nerves generally or locally ? Should the fault appear to
be principally in the system of supply and waste, is it in the
action of the heart, or in the quantity or quality of the blood :
is it in the state of the arteries, of the veins, of secreting struc¬
tures, of exhalents, of absorbents, and on these generally or
locally ? Is it in the quantity or quality of food taken, in toe
digestion of that food, in the canal through which such food
passes ? Is it in the respiration, in the organs of respiration,
or in the air respired? Is it .some fault in muscular fi hies, in
their proper power ? What is the state of the mind, its genius,
its disposition, and its perception ? is the mutual influence of
these over the body, and of the body over these, perfect and

natural ? c . - .

In setting about the treatment of diseased states oi uving

man, we must still bear in mind the dependence of all the

107

History of the Human (Economy.

functions upon each other. We must remember that we can
influence the nervous system through the mind, and through
the system of supply and waste, or by acting directly upon it ;
that we can influence the system of supply and waste, by acting
directly upon it, or through the nervous system, and also indi¬
rectly through the mind; that we can influence the mind either
through the nervous system, or through the system of supply
and waste. If impressions do not excite sensations sufficiently
strong, we must see whether there be any injury or unnatural
state of the nervous system generally, or of particular nerves.
We shall remember that the degree of sensation depends much
upon the quantity of blood which is intermingled with the
nervous system, whether generally or locally ; we can therefore
increase this quantity ; the sensation depends in part upon the
temperature of the part impressed ; we can therefore increase
• he temperature, should that appear to be deficient ; we can
increase the force of the impression ; we may endeavour to fix
the attention of the mind more particularly to the particular
sensations; we may alter the interposed medium between the
thing impressing and the part impressed ; we may act, perhaps,
directly upon the nervous system generally or locally. If the
faintness of sensation appear to arise from that state of the
nervous system generally or locally, which is in common lan¬
guage called an exhausted state, we shall remove all impressions
for a time, and allow the system, whether generally or locally,
to be at rest. If sensations require to be lessened, we can lessen
the quantity of blood that mixes with the nervous system gene¬
rally or locally ; we can diminish and abstract heat ; we can
diminish the force of the impression, or alter or remove it ; we
can endeavour to call off the attention from such sensations ;
we may alter the interposed medium between the thing impres-
sing and the nerve or nerves impressed upon ; we may act per¬
haps directly upon the nervous system, either generally or
locally. Ii the nervous power be improperly conveyed, does
this arise from fault in the nervous system generally or locally^
or from fault in the mind ; is there excess or deficiency of this
power, and that generally or locally ? If the cranial brain
appear to be in iault, so as not to furnish the due quantity of
tins power, we must see that the parts of this brain are in a
healthy and natural state, that they are furnished with a due
proportion of blood in the vessels intermixed with these parts i
if the fault appear to be in the spinal brain, the same observ¬
ance will be necessary ; if in nerves, the same inquiry is neces¬
sary. We have it in our power to increase or to diminish the
quantity of blood that intermingles with the nervous system
generally or locally ; we are possessed of some known means
which appear to act directly upon the nervous system, and to

108

Original Communications.

increase the quantity of nervous power, generally or loca.lv -
we must endeavour to call the attention of the mind to the
proper and due distribution of this power: we may contuve
means of expending the power, if it appear in excess ; 01 o

saving it, if it appear deficient. . ,

If the system of supply and waste appear to be m fain., w e
must remember the natural and healthy equilibrium between
all the parts of this system ; and we must endeavour to lestoie
this equilibrium : if the supply be too great m proportion to
the expenditure, we must diminish the former, or increase t.u,
latter • if too small, we must increase the former and diminish
the latter. If the heart act too powerfully, or too frequently,
we can reduce this action, either by means which act upon the
heart itself, or which act through the nervous system, or through
the mind perhaps, or by lessening the quantity of blood if it
be in excess, or by increasing it. if it be deficient. If the quan¬
tity of blood be too great generally, we can dimmish the supply ;
we can alter the quality of supply ; we can increase the expen¬
diture by increasing the action of secreting structures and ot
exhalants. If the quantity of blood be too great locally, we
can lessen this, either by lessening the general mass of blood,
or by abstracting heat from the part, or by acting upon the
nerves of the part, or by lessening the blood contained in the
local vessels, by withdrawing that blood, by increasing the se¬
cretions of the part, by diminishing the capacity of the blood

vessels, or by avoiding such actions of the mind as have a en-
dency to enlarge these particular vessels. I he reverse of ad
these means can be employed, if the quantity o. blood be too
small, generally or locally. If any secretion appear too pro¬
fuse, we may lessen it, either by lessening the mass of blood
generally, or by increasing other secretions, or by lessening the
quantity of blood sent to that particular secreting structure or
bv acting upon the nerves which are contained m sue.) secreting
structure, or by diminishing the capacity of its blood-vessels, or
of its outlets, or by avoiding such actions of the mind as have a
tendency to increase such secretion, or by increasing ttie quan¬
tity of blood that passes from such secreting structure oy its
exhalants and veins, or by other means ; which possess an in¬
fluence over the secretion. The reverse of all these means may
be used if the secretion be too scanty. If the temperature ot
the body be too great, generally or locally, we may abstract
heat by the application of colder bodies ; we may dimmish the
quantity of blood, generally or locally, by any of the means
above mentioned ; we may employ means that act upon the
nervous system generally or locally. If absorbents be inactive
generally or locally, we must endeavour to increase their action ;
we must remove all impediments to their action ; or we must,

History of the Human (Economy. 109

in some way or other, diminish or remove that which they
refuse to carry off. If absorbents be too active, we must en¬
deavour to restrain their action, and we must oppose impedi¬
ments to such action. Recollecting the various functions upon
which digestion of food depends, we shall see that all these
functions be duly performed, and we shall be guided in our
treatment by the rules already laid down, remembering the
influence of the mind directly and indirectly upon these func¬
tions. We shall take care that the action of the bowels be
regular and natural, by regulating those actions upon which
this action depends, by using other means which can increase
or diminish this action, and by keeping up or avoiding those
actions of the mind which have an influence over this action,
if the fault appear to he in the respiration, is it from disease of
the air-passages, of the muscles concerned in this office, from
too much blood flowing to the lungs, from too little blood flow¬
ing to the lungs, from an impediment to the return of blood
from the lungs, from the dilatation of the lungs being impeded
by a diseased state of such lungs, by disease of the parietes of
the thorax, by pressure upon the lungs either in the thorax or
in the abdomen, or is it from affections of the mind, or from the
air respired ? The result of this inquiry will point out the
means to be pursued. If the disease be iri muscles, from a
want of their proper power, we may let such muscles rest ; we
may increase the quantity of blood that mixes with their fibres ;
we may exercise such muscles duly, and divert the nervous
powder to them or some other power, as the electric power. Op¬
posite means wil 1 be used, if muscles appear to possess too much
power ; in which case we may also increase the power of the
antagonists of such muscles, if any exist. If the fault appear
to be principally iu the mind, is it in the genius, in the dispo¬
sition, or in the perception, or in the direction of the nervous
power P We must remember how all the functions of the mind
are influenced by functions of the body, when these last func¬
tions are properly or improperly performed ; how we can in¬
fluence the functions of the mind through the nervous system,
and through the system of supply and waste ; and how the
various functions of the mind influence each other. If the
mind be too much occupied by the exercise of one faculty, we
may call its attention from this, by calling other faculties into
action, by exciting vivid sensations, and by calling its attention
to these ; by exciting passions, or by withdrawing the attention
of the mind to varied kinds of bodily action. If the mind be
too much occupied by one passion, we may avoid ail sensations
that can lead to such passion, whether immediate or suggested ;
we can consider what states of body favour such passion ; we
can alter such states ; we can raise new sensations and new

110 Original Communications .

passions ; we can direct it to the exercise of faculties, or to the
ordering varied kinds of bodily action. W e can make the mind
more or less attentive to any present sensation, by increasing
©r diminishing such sensation, by withdrawing its attention to
other sensations, or by employing it in the exercise of faculties,
of passions, or in directing bodily actions. We can make the
mind attend more closely to bodily actions, by withdrawing it
from the exercise of its faculties, from its passions, and from
sensations.

A- Case of Ruptured Uterus , and a Part of the Foetus extracted
through the Parities of the Abdomen, By J. H. Brock, M.D.
of Mansfield, Nottinghamshire ; Member of the Royal College
of Surgeons, London. Communicated through Dr. George
Pearson.

Wilmot, a healthy Negresse, about 35 years of age, was
taken with symptoms of labour with her eleventh child, on
Thursday, August the 5th, 1813, which continued gradually
to increase till Friday morning following ; when the midwife,
on examination per vaginam, found the membranes at the os
externum distended with the waters, which shortly afterwards
burst, when she said she felt and saw the head of the child,
much covered with hair (to use her own expression), very low
down, or, as I understood her, at the os externum. Shortly
afterwards, the patient had a good deal of acute pain, and be¬
came very anxious, restless, and impatient, and insisted upon
walking about the room, which she was allowed to do for a few
minutes, during which time she had a very violent pain, foL
lowed by cold sweats, nausea, and violent liquid purging.
After waiting some time, as the pains of labour did not. return,
the midwife examined her again, when to her surprise she could
neither feel the head of the child, nor any presenting part ; and
as the patient had no return of pains like those of labour, she
was allowed to remain without any further assistance till Sun¬
day the 8th following, when I was called upon to visit her.

" On examination per vaginam, which I could very imper¬
fectly perforin, the parts being so very sensible that the patient
could not bear me to touch them, I could feel no presenting
part. The uterus was so high up in the abdomen, that I could
with difficulty touch the os uteri with the point of my finger.

However, the os uteri I found dilated to the size of a dollar
piece; it felt thick, rather flabby, and had a very irregular orifice,
similar to what I have felt in some cases of scirrhous uterus^,

Brock on a Case of Ruptured Uterus .

I could also feel something fl Occident, like the thin edge of the
placenta within the orifice of the uterus ; but from the heat,
urjness, and extreme sensibility of the vagina, 1 did not think
it prudent to use any more force by the introduction of my
hand, to make a more particular examination, having some
doubts of the midwife’s accuracy. The pulse was very small
and quick. The abdomen was much distended and very sore;
so much so, as scarcely to bear the pressure of the" sheet.
Tongue whitish ; bowels very open ; skin hot and dry ; sto¬
mach easy ; no discharge per vagin aim Being at a loss what
to make of the case, and having been frequently deceived by
the information I have been able to obtain from black midwives,

I was inclined to think, that on this occasion the woman had
Been deceived. I therefore ordered a warm purgative mixture
to be given, and after the operation of it, an antimonial opiate
to be administered at bed-time.

August Oth. The tension of the abdomen remains the same.
Pulse 100; the skin hot and dry. The medicine has operated
well. She is very restless and has had very little sleep ; was
ordered to take antimonials with the saline julep.

10th, 1 1th, and 12th. The symptoms continuing the same,
she was desired to continue her medicines.

13th. The fulness, tension, and soreness of the abdomen
having much subsided, on pressure I could distinctly feel what
I conceived to be the limbs of a child. It was not till then
that I could make out the case ; when I was satisfied the uterus
had been ruptured, and that the foetus had escaped into the
abdomen. I requested Mr. Moses Bravo and Mr. Garcia to
visit the patient with me, and they entertained the same opinion
as myself. From the length of time after the accident, and the
great heat and soreness of the vagina, 1 did not think it pru¬
dent to attempt to pass my hand into it, for the purpose of as¬
certaining whether the uterus was empty or not ; but proposed
an operation for the extraction of the foetus through the parietes
or the abdomen, which however was not consented to.

14th. Whilst the patient was on the close-stool, the pla¬
centa slipped away from her without any pain, in a highly
putrid state. I now attempted to introduce my hand into°the
vagina, but the patient could not allow me to use the least force.

15th. She complains of a cutting pain about the navel, and a
soreness of the whole abdomen ; so much so, as to scarcely bear
it to be touched.

16th. . The head of the child can be distinctly felt through
the umbilical ring.

17th, 18th, and 1 9th. All the symptoms continued the same.

20th. The tenderness of the vagina having much abated,
I passed two fingers into it, and got hold of the toes of one foot.

H2 Original Communications .

B gentle pulling I brought down the lower extremities with

the pelvis in a very putrid state.

21st. One rib and much purulent matter were discharged

from the vagina ; the patient complains of much pam in the
abdomen.

22nd. Several ribs were discharged.

From the 23rd to the 31st inclusive, there were continued
discharges of matter and pieces of bone per vaginam.

September 1st. The navel felt very thin, and had evidently
matter confined under it. A great deal of matter was discharged
in the evening from the vagina ; the nurse says, at least, a quart,
2nd. The navel burst this evening, and discharged a small

quantity of matter ; the orifice is very small.

3rd. Mr. Moses Bravo and Mr. Garcia visited with me
this morning. On introducing a probe at the aperture at the
navel we felt very distinctly the denuded bones ol the iieao ;
and by the advice and with the assistance of those gentlemen,

I laid open the abdomen in the direction of the linea alba, com¬
mencing three inches above the umbilical ring, and continued
it as manv below; when, with some difficulty, we exiracteddhe
head and upper extremities of the child. rlhe cavity we
sponged out well, and brought the lips of the wound together
with two sutures and adhesive straps, and dressed it superhciady.
An opiate was given at night, and saline julep dining the day.

4th. She has had a good night; skm much cooler and rather
moist ; pulse 100 ; no thirst : she has a wish for some food ;
and from this time began to recover in a natural way ; so that
in about six weeks from the operation, she was peifectly let¬
tered to health. .

June 28th, 1814. X this day saw the patient, who is grown

very fat, and has been in good health since her illness, but has

never since had any menstrual evacuations.

From the history of the above case, it evidently appears that
the uterus was ruptured at the time the patient was attacked
with cold sweats and purging, and that the upper par t of the
foetus had escaped into the abdomen, leaving the lower extre¬
mities with the placenta in the uterus ; by which means the
communication betwixt the vagina and the cavity in which the
head and other parts were confined, was kept open. Had me¬
dical assistance been at hand, the case I conceive could have
easily been remedied by immediate delivery ; but as it was, her
real situation was not known till the seventh day after the
accident : and at the time I first saw the patient, from the ex¬
treme soreness and distension of the abdomen, I could not as¬
certain her real situation ; nor do I think any good could have
been done had I known it ; for the heat, contraction, and ex¬
treme tenderness of the vagina was such, that the attempt

113

Oakley on a Case of Demonomania.

would have rather increased the irritation already produced,
and most probably would not have succeeded; as in all likelihood
the upper part ot the body of the foetus., by the adhesive inflam¬
mation, had already formed a nidus for itself in the omentum;
which, on opening the abdomen, was found to be the case. It is
somewhat extraordinary, that the patient never had any bloody
discharges per vaginam after the first day of labour (the 5thj,’.
nor any thing like a leucorrheal discharge during the whole of
her illness.

III.

A Case of Demonomania. By Edward Oakley, Hospital
Assistant, Hilsea ; and Member of the Iloyal College of
Surgeons in London.

November 14th, 1816, Benedict Bloste, aged 34, a native
<n a small village near Ghent, in the Netherlands, about five
feet two inches in stature, and by trade originally a miller, was
admitted into the military hospital at Hilsea, with mania.

By what I could glean from the mingled jargon of Flemish
and English spoken by those who had conveyed him hither,
Bloste had exhibited unusual symptoms of despondency during
a voyage from Demerara ; and about a fortnight before their
arrival in this country, he had been suddenly attacked with a
violent paroxysm of madness, which rendered confinement
necessary, as he declared that the evil spirit with which he was
possessed would not suffer him to die until he had killed a man.
These paroxysms were repeated at uncertain intervals ; but the
same idea continued constantly : he ever seemed on the watch
to. accomplish his avowed design, although so sensible of the
criminality of indulging this propensity, that he requested to
be more firmly secured.

1 he evening after his arrival lie had a very furious parox.*
ysm, and a second about midnight ; which evinced the necessity
oi coercion. After musing on the follies of his youth, his me¬
lancholy appeared to glide into despondency— an agitation of
the whole body supervened, and gradually increased to a con¬
vulsive motion — -he felt continually incited by some powerful
impulse to injure those around him, although retaining sufficient
reason to warn them away. In some of the fits the globus hys¬
tericus seemed to rise, and for a few minutes consciousness
deserted him, and he appeared in danger of suffocation. The
system then gradually re-established itself; the respiration,
though still hurried, became free ; the convulsive motion sub¬
sided into a tremor ; and the face resumed" its settled gloom.
VOL. VIII. — NO. 44. £

114

Original Communications.

In the intervals of these paroxysms he was tractable, and
answered directly to any question proposed ; but his eye wan¬
dered unremittingly ; his hands seemed impatient of lestramt »
everv moment produced a change of position ; and tne fiequent
shrub- of the shoulders peculiar to Frenchmen was accompanied
with "some expression implying disgust. His appetite was vo¬
racious, and his tongue slightly white; otherwise he had eveiy
appearance of the most robust health ; except that at times he
was troubled with epistaxis, to which he had been subject in
his youth. His neck is unnaturally short ; but the head presents
no peculiar conformation,- except that the frontal bone was sin¬
gularly developed, and prominent at about two inches above
the middle of the upper edge of each orbit.

The following is the account he gave me of himself.—-! n
the year 1807, during the time that Bonaparte was First Con¬
sul, he was included in the conscription, and after some time
sent out to Martinique, where he became a prisoner to the
English, and in the end was enrolled for seven years’ service.
During the chief part of this time he lived as a servant ; two
years with one master, and three with another ; and was twice
attacked with the fever of that climate. It was during his
second illness, about four years ago, that the fear of sharing the
fate of the many swept off around him induced him to take an
oath to be more guarded in his conduct if he recovered. I ms
oath he describes himself as having subsequently broken.
Melancholy from that moment began to prey on him ; and the
lapse of time served but to fix the impression ; until about a
twelvemonth ago, when he became convinced that an evil spirit
had full possession of him, and that he had nothing more to
hope. He further states, that this demonomania has been
gradually creeping on him since the last access of fever in the
West Indies, where he owned that he lived freely.

A continual knawing sensation at the stomach was new
superadded, to which gradually succeeded the hysteric affection ;
which at the present period is repeated once, twice, or thrice in
the twenty-four hours ; but most constantly about midnight,
when nothing interrupts his sombre reflections. Fie declared
himself unable to pray ; because every attempt to address his
Creator had no other effect than to suggest oaths and impre¬
cations, which he believed to depend on the instigation of the
demon that possesses him ; and even if lie falls off to sleep,
horrid dreams and convulsive motions of the muscles allow him

but short intervals of repose. _

By way of treatment, I prescribed an emetic every other

day ; and impressed him with fear during the paroxysms, by
threats of using corporeal punishment ; but at the same time

115

Oakley on a Case of Demonomania.

gained liis affection, by allowing him occasionally some harm¬
less deviation from his otherwise spare diet. I allowed him no
time during the day for meditation ; but kept him incessantly
employed ill a variety of ways ; and at night exhibited a large
dose of opium, which threw him into a kind of slumber or
stupefaction incompatible with the exertion of intellect, until
the morning renewed his occupations. Indeed, to unremitted
and varied exercise I trusted more for relief than to all the other
means combined.

Although lie had not the power of abridging the paroxysm
when it lias commenced, yet, by avoiding the melancholy mus¬
ing, which may be considered the first link that, by habitual
association, introduces the convulsive motion which terminates
in the globus hystericus — yet, I repeat, by abstracting his at¬
tention from the past, he had it in his own power to diminish
the frequency of the hysteric symptoms, or totally to avoid
them. I also forbad him, under penalty of bread and water,
to shrug his shoulders (as wTell as those expressions which
implied disgust of life) ; for many examples in common life
concur to prove that the muscular expression of passion (by
which I include not only anger, but melancholy, despair, Sic.),
if carried to excess, gradually produces its corresponding mental
effect.

iSth. The means employed kept him in awe, and the fits
■were weak ; but restlessness, and the conviction that he had an
evil spirit, continued.

22nd. He seemed to be more reasonable ; his countenance
had a happier physiognomy, and no distinct paroxysm had oc¬
curred since yesterday. The globus hystericus now left him,
and did not, return.

25th. Omitted the emetics, continued the opiate, and yield¬
ed to his solicitation for an increase of diet.

30th. Last night he exhibited symptoms of discontent
without being able to assign a cause; and, this morning, con¬
versed very irrationally. The idea is returned, that he must
kill somebody. An inconsiderable epistaxis occurred early this
morning.

In his youth, he was considered as imbecile, with a very de¬
fective memory. At the present moment however, although
the acts of yesterday are remembered obscurely, yet the most
minute circumstances that occurred in early life, particularly
between the ages of ten and twelve, are restored with a vivacity
which he describes in energetic language ; indeed in numerous
instances, he manifests a singular shrewdness ; and, although it
is an humiliating reflection, nevertheless instances demonstrate
too often how short the distance is between genius and insanity,

q 2

116’

Original Communications .

There was now' evidently a morbid activity of the irervou#
system, as well as a tendency to produce too much blood. His
feyes had somewhat of their former wildness, and his whole body
■was in restless motion.

It was judged prudent to put on the straight waistcoat im¬
mediately ; one active emetic was instantly given ; his diet re¬
duced to bread and water, and he was kept continually walking.

December 3rd. He again became much more rational.
All restraint was removed ; and he was made to attend to the
wants of the whole ward. In the French translation oi
Hufelandks L'Ari dc prolonger la Vie Humaine , the case of a
French officer, who, on account of some private misfortunes,
had resolved to starve himself to death, (and actually fasted
during forty-five days,) is terminated by the following obser¬
vation : “It is interesting to remark, that while he fasted, he
was exempt from delirium; but as sOon as nourishment had
restored his strength, his brain became deranged anew, and ail
his absurd ideas reappeared. ’ But it was evident in jlloste s
case, that the functions of the whole brain were not affected, as
was proved by bis warning others to avoid him, even when he
was under the influence of the paroxysm.

4th. Flis eye had again lost that wild quick motion, which
for some time after his admission was so characteristic of mania.
The good effect of the emetics during their continuance, the
return of the disease on an increase of diet and omission of

emetics, evince, that the quality of the food has a very decided
influence over the reason and judgment; which, in fact, are
merely relative terms that refer to a common standard, and
somewhat strengthen the opinion of Locke, that mind is matter.
Yet nothing amiss in the functions of the stomach is to be ob¬
served; nay, the lacteals seem to act with too much energy, or
a superabundant chyle forms more blood than the system can
dispose of, as is marked by the occasional epistaxis.

10th. He is now as cheerful as any of Iris companions, and
joins in the laugh at his former belief of an evil spirit. He feels
convinced that it is in his own power to prevent a relapse, and
therefore seizes every opportunity to make him sell useful ; and
not a gesture that marks impatience is ever observed by Ins
fellow patients. Fie still takes the opiate at night.

16th. No change can be observed in his conduct or con¬

versation.

The bread and water which formed the chief articles of his
diet latterly, may perhaps seem an unnecessary hardship ; but
whoever had seen the serenity of* countenance and calmness of
action which he rapidly acquired under the influence of the
two great precepts of Pythagorus, frugality and exercise, would

An Essay on Diseases resembling the Venereal Disease. 11?

have thought him another being from the maniac, with the
ferocious look and restless gesture. Indeed I have found from
close observation on myself, that when I fed highly and lived
indolently, the least thing served to ruffle my temper ; whereas
frugality and exercise introduced a third virtue, which kept
me cool under supposed danger or actual misfortune.

Others may think that blood should have been abstracted ;
but venesection seems, under favourable circumstances, to pro¬
duce the same effect on the system, as the developement of a
new organ (of which Natural History presents innumerable
examples in the spring), or a new arterial trunk to be supplied,
or an equivalent, as issues, which seem to have led the Italians
into the error, that some diseases of the orders hsemorrhagiae
and profluvia were instituted by Nature to throw off something
injurious to the body ; or in other words, they confounded the
cause with the effect.

IV,

AN ESSAY ON DISEASES

RESEMBLING

THE VENEREAL DISEASE.

BY A PHYSICIAN.

INTRODUCTION.

It happens, unfortunately for science and for the world,
that medical men set out with certain fixed views and theories
of disease, whereby their judgment becomes so blinded and so
warped, that subsequent practice and experience are unable to
remove the first impressions which have been received. The
young practitioner comes from the lecture-room stored with
theories ; he has heard every disease described in nosological
order ; and he expects to find all maladies observing a regular,
defined course and appearance : and although a little expe¬
rience is sufficient to shew him that disease appears under
many varied forms, which no nosology, however comprehensive,
can embrace or describe, yet, having no names for disease but
those taught in the schools and books, and being anxious to
give to every malady or diseased appearance a name, in order,
to ward off the imputation of want of knowledge in his art, lie
has recourse to his nosology, and borrowing thence a name, he

US Original Communications .

applies it indiscriminately to diseases, which, if minutely exa¬
mined, would be found to‘ differ in their nature and character,
although their prominent features may be similar. It is thus
that all indolent diseases are called scrophulous, and all
maladies that are incurable, cancerous : it is thus that symp¬
toms which resist other remedies and yield to mercury, as well
as all diseases occurring on the organs of generation, and all
constitutional diseases which can be traced to any affection of
these organs, are hastily and indiscriminately considered as
venereal. I need not dwell on the importance of being accurate
in our diagnosis, when the disease under consideration has any
symptoms resembling those of lues venerea. It may happen
that syphilis may be mistaken for some other complaint ; ana
when that is the case, the venereal virus may be allowed to take
such deep root in the habit, that the discovery of the real na¬
ture of the complaint, if ever made, comes too late, when the
constitution is worn out and unable to bear the means necessary
for its relief. But it much oftener happens that a complaint
which is not venereal, is considered and treated as such ; the
patient is sentenced to a course of mercury, which may not
only be inefficacious, but may be productive of the worst effects,.
But this is not the only mischief that results from mistaking
complaints for venereal symptoms : the character of the patient
may suffer undeservedly from unfounded suspicions ; or irre¬
gularities in his conduct, which might have remained concealed,
are brought to light and published, and the peace of a family
may be disturbed or destroyed for ever.

PART I.

In treating of diseases which resemble venereal diseases, I
shall consider the primary and secondary symptoms of lues
venerea separately, pointing out their usual appearances and
characters, enumerating afterwards the complaints which may¬
be mistaken for such venereal symptoms, and offering remarks
on the mode of distinguishing between these complaints and
venereal affections.

It must be remembered that my descriptions of the venereal
disease are intended as portraits of the disease as it appears in
England : I have no certain means of ascertaining how far
climate and manners may affect its appearance and character.
That the disease is in some unknown manner modified in some
countries, so as to be curable by means which in this island
have been found unavailing, appears from the reports of dif¬
ferent writers. It is said that in Portugal little or no mercury
is employed in the cure of venereal symptoms, whether primary
or secondary ; and that in some parts of Germany, and of

An Essay on Diseases resembling the Venereal Disease. 119

Bussia, the opposers of the use of that mineral are numerous.
In other situations the disease may appear under an aggravated
or altered form. It has been argued that the sibbens (or sivvens)
of Scotland, the disease which broke out about thirty years ago
in the Bay of St. Paid in Canada, and that known in Norway
by the name radesyge, and some parts of Sweden by the term
saltfuss , are all varied forms of the venereal disease. But I
shall not enter into the discussion.

Mr. Hunter had remarked* that undescribed diseases re¬
sembling the venereal were very numerous; and Mr. Aber-
nethyf* has roused the observation of medical men by his
remarks on diseases resembling syphilis.

It has been found that primary symptoms, followed by se¬
condary symptoms, may present themselves, all imitatingclosely
the venereal disease in its primary and secondary stages, and
yet not be venereal. Symptoms resembling the secondary
appearances of the venereal disease occur, also, without any
preceding primary symptom, and turn out not to be venereal.
In many of these cases the character of the party has been
above all suspicion: in others the symptoms got well without
any remedy ; in others, common alteratives, such as decoction
of the woods, subdued the complaint.

In almost every case of doubt, mercury is considered as a
test; if a disease does not yield to, or is exasperated by that
mineral, it is almost universally considered as not being venereal.
This, however, may not be considered by all as a certain rule or
proof ; the rule is grounded upon the assumption of two axioms,
namely, that mercury will cure every case of syphilis, and that
no case of syphilis will get well without mercury.

As general rules, these may be allowed ; but it must be re¬
collected, that all general rules have exceptions, and the prac¬
titioner must keep his mind unfettered by theory, always open
to facts, not conceding any established modes of thinking or of
practising upon light grounds, and never refusing to allow of
any well-authenticated facts, however strongly they may mili¬
tate against the notions which he has formed. Diseases which
resemble the venereal disease have been called by the name
cachexia syphiloidea, or pseudo-syphilis. These terms being
used to designate such diseases, and being applied to every case
where the symptoms resemble strongly those in lues venerea,
but prove not to be venereal, and yet are not referable to any
head in our nosologies; it is more than probable, that diseases
differing in their nature, but agreeingin imitating syphilis, have
been comprehended under the general name cachexia syphi-

* Treatise on the Venereal Disease. t Surgical Observations .

Original Communications.

loidea. The subject has not been very long agitated, and the
present state of our knowledge on this head is limited, imper¬
fect, and confused. I shall not attempt to describe any regular
set of symptoms under a name which is used to embrace every

anomalous appearance. .

The venereal disease is progressive, not disappearing with¬
out means of art ; the powers of the constitution being unable
to subdue it. The symptoms of lues venerea, generally speak¬
ing, occur in regular succession ; the primary symptoms being
followed by the first class of secondary symptoms, and these
leading to those of the second class. The symptoms, where the
disease has been left to itself, are pretty strongly marked ; and
may, in most cases, be recognized by an experienced eye ; but
where the patient has been tampering with his complaint, and
has been using mercury in inefficient or excessive quantities, the
appearance of the symptoms becomes altered, and the case
obscure. Mercury, improperly administered, aggravates the
disease, and frequently brings on symptoms as severe as the
original venereal complaint. It were better to do nothing, than
to give mercury in insufficient quantity. In every obscure
case, (and many will be constantly presenting themselves,) the
history of the case, and the treatment that has beeu adopted,
and especially the primary symptom or symptoms, must be
closely and minutely inquired into ; and the length of time that
lias occurred since the disease was contracted, and between the
appearance of the several symptoms, must be ascertained ; tne
character and credibility of the party must be taken into the
account ; it must be recollected what the diseases and what the
symptoms are which resemble venereal symptoms ; and from an
attentive consideration and review of all these circumstances
the practitioner must form his diagnosis.

Of Sores in the Organs of Generation.

Although syphilis was unknown in Europe prior to the siege
pf Naples in 1494, yet diseases of the generative organs occur¬
red, and were described long before, tj leers on these parts aie
described by the old Greek, Homan, and Arabian wnteis.
Celsus, in his chapter, 44 Be obscanarum partium vitiisf par¬
ticularly mentions several kinds of ulcers on the penis. Gu-
lielmus de Saiiceto, of Piacenza, who wrote in the year 1270,
speaks, ii Be pustules albis vel rubris , et de niiho ct scissuris ' qua
Jiunt in vivgci vel circa preputium propter eoituni cum fei 'M d
muliere aut cum mereirice , aid ab aha causa.' Lanfranc, of
Milan, in 1290, speaks of a sore on the penis arising “ Ex com-
missione cum. fad a muliere qua cum agro talem habentc morbum de
novo coicratf Hernard Gordon, professor at Montpelliei, m
1300, speaks of several diseases of the penis arising from inter-

An Essay on Diseases resembling the Venereal Disease. 121

course with a woman, 44 Cvjiis matrix est immunda plena sanie
aut virulenta.” In 1400, Valescus de Taranta, also professor at
Montpellier, says, 44 Pustula virgdfunt si quis cocat cum faemind
habente ulcus in mat rice” Peter de Argeleta, or Arsellata, of
Bologna, has a chapter, 44 De pustulis qua: adveniunt virgte
propter conversationem cum feeda muliere , qure alba sunt vel
rubra::' These authorities are all collected by Astruc*. Pub¬
lic stews, subject to severe regulations, were common many
years before the appearance of syphilis; and a heavy penalty
was exacted from a stewholder, if any person was infected by
the women in this stew. In a statute, 44 Di disciplina Lupa-
naris publici Avenoniensis (Avignon) ,” made in 1347 by the
Queen of the Two Sicilies, who was also Countess of Provence,
occurs this passage, 44 Jubet Regina Sabbato quolibet a Bayliva
una cum chirurgo a consulibus proposito , mulieres meritorias sin -
gulags lustrari ; quoicunque in lupanari prostant. Et si qua
scortatione agritudinem ullam contraxerit a ceteris seponi ut seor-
sun habited, ne sui copiam facer e possit ; ut viorbi pracaveantur
qui a juvenibus possent concipi. ’ Stews were allowed in Eng¬
land, subject to certain laws. A statute of 1163 forbids any
stew-holder to keep any woman having the perilous infirmity of
burning. In another statute of 1430, any stew-holder keeping
a woman having 44 nefandam injirmitatemf was liable to a
•penalty of one hundred shillings. This 44 nefanda infrmitas ”
was called brenninfj. which means ardor urines, .

The preceding extracts are here copied, to shew, that in all
ages, diseases of t lie genitals have been known ; and we are not
to suppose, because in our latter days the curse of syphilis is
entailed upon us, that we are to escape the diseases to which
our forefathers were liable.

The variety of sores occurring on the organs of generation
is so great, that I shall not pretend to describe them all. I
shall first mention the characteristic appearances of chancre,
and thus all other primary ulcers will be negatively described.
If we can say exactly what is chancre, we may distinguish
other sores from it by their wanting those characters which
mark the primary sore of syphilis.

Chancre appears in men on the glans penis, on the fraenum,
in the angle between the fraenum and the glans, at the orifice
of the urethra, on the prepuce, on the body of the penis, and
sometimes on the pubes and the scrotum. In "women, on the
labia, the nymphae, the clitoris, and in the vestibulum.

A chancre comes on with itching of the part, and some¬
times in men with a frequency of making water. A small
vesicle, pimple, or pustule appears ; this bursts, discharging a

vol. vm. — ko. 44.

* Lib. i.

122 Original Communications,

thin purulent fluid. The small sore, which is very painful, and
is attended with general uneasiness, is circumscribed; rather
circular, excavated, without granulations, with a thickened base,
and with prominent hard, horny, edges, terminating abruptly.
The sore is covered with an ash-coloured slough, and increases
progressively. When the skin on the body of the penis is the
seat of chancre, the ulcer is more superficial, more diffused, of
a darker hue, and less indurated ; and not unfrequently covered
with a scab. There are not many chancres present in the same
case, often only one, seldom more than two or three. Although
the genitals are the parts usually affected with the primary
sore of syphilis, yet if the virus be applied to any secietmg
surface, or to any part deprived of cuticle, a sore may be pro¬
duced. Mr. Pearson saw a case in which a sore had formed on
the thigh, which spread and destroyed the end of the femur
before the nature of the disease was known. This sore arose
from the virus being applied to a part where the cuticle had
been rubbed off. Thus accoucheurs having the skin of the
fingers abraded, have contracted the disease which lias conta¬
minated the glands in the axilla. These glands have also been

affected from primary sores on the nipple.

From the preceding account it appears, that the primary
syphilitic sore is strongly marked; and yet we have the autho¬
rity of persons thoroughly conversant with venereal disease tor
saying, that there is no appearance exclusively peculiar to
chancre. The great leading characteristic of chancre, is cal¬
losity ; this borne in mind, will be of the greatest import¬
ance m enabling us to decide upon the natuie ol pnmaiy anc
of secondary symptoms ; still we must recollect, that a sore
wanting the character ol hard edges, and not being syphilitic,
may, nevertheless, by stimulating applications, 01 by irritation
from any cause, have hardness and thickening of the edges
induced, and these sometimes subsiding and again returning.
If quietude, then, and soothing applications reduce the bald¬
ness and thickening, or if these symptoms disappear sponta¬
neously, or in either case, if they often go away and return
again, such sore is not to be considered as syphilitic. Chancre
occurs at various periods alter exposure to the contagion , it
has appeared in twenty-four hours, and as late as seven weeks,
or two months; but from two to three days to as many weeks,
will generally include the time of its appearing.

Sores and excoriations of the glans or prepuce, with phy-
mosis and other troublesome symptoms, may be produced by
the natural secretion of the prepuce, and behind the coioiia^
gland is, being rendered more stimulating ; as by the use of
mercury, want of cleanliness. Sores may thus aii^e on the
scrotum, in the angle between the scrotum and thighs ; and

An Essay on Diseases resembling the Venereal Disease. 123

between the labia and thighs in women. Excoriations may
also arise on the glans, or the internal prepuce in gonorrhoea
from erosion of the cuticle. They may arise from coition with
a woman who has discharges from the vagina, from Onanism,
from the use of prophylactic washes and applications. In all
these cases the sore is superficial, often irregularly extended ;
there is rarely loss of substance, the sore will generally heal
readily, and we shall be enabled to distinguish it from chancre
by the history of the case, and by the want of those appear¬
ances which belong to chancre.

Herpes praeputialis is an eruptive disease first mentioned
by the late Mr. Royston*, and is well described by Hr. Bate¬
man, whose words I shall copy. It commences with heat and
itching ; “ one or two red patches then appear, about the size
of a silver penny, upon which are clustered five or six minute
transparent vesicles ; which, from their extreme tenuity, appear
of the same red hue as the base on which they stand. In the
course of twenty-four or thirty hours, the vesicles enlarge and
become of a milky line, having lost their transparency, and on
the third day they are coherent, and assume an almost pustular
appearance. If the eruption is seated within that part of the
prepuce, which is in many individuals extended over the glans,
so that the vesicles are kept constantly covered and moist, (like
those that occur in the throat,) they commonly break about the
fourth or fifth day, and form a small ulceration upon each patch.
This discharges a little turbid serum, and has a white base,
■with a slight elevation at the edges ; and by an inaccurate or
inexperienced observer, it may be readily mistaken for chancre ;
more especially if any escharotic has been applied to it, which
produces much irritation, as well as a deep-seated hardness be¬
neath the sore, such as is felt in true chancre. If no irritant
be applied, the slight ulceration continues till the ninth or tenth
day, nearly unchanged, and then begins to heal ; which process
is completed by the twelfth, and the scabs fall off on the thir¬
teenth or fourteenth day. When the patches occur, however,
on the exterior portion of the prepuce, or where that part does
not cover the glans, the duration of the eruption is shortened,
and ulceration does not actually take place. The contents of
the vesicles begin to dry about the sixth day, and soon form a
small, hard, acuminated scab ; under which, if it be not rubbed
off, the part is entirely healed by the ninth or tenth day ; after
which, the little indented scab is loosened and falls out.*” This
affection “is liable to recur in the same individual, and often
at intervals of six or eight vTeeks'J*.r’ It is said to depend upon,

* Med. andPhys. Jonrn., vol. xxiii. p. 441 ; and Med. Repository,
vol. i. p. 206‘. t Practical Synopsis of Cutaneous Diseases.

124 Original Communications .

and to be connected with, irritable urethra and stricture. It
attention be paid to the foregoing description, as well as to the
symptoms and appearance of chancre, and to the history ol
the case, there will be little hazard of mistaking herpes ot the
prepuce for a syphilitic affection. At all events, if a few days
are suffered to elapse, all doubts and difficulties will vanish.

In sibbens and in yaws, and in the Norwegian disease
* radesyge, the penis may partake of an eruption, terminating in
ulceration, which at the same time attacks other parts of the
body; the penis not being affected primarily, but through the
medium of the constitution. I shall have occasion hereafter to
notice some of the characters of these diseases.

Women are liable, during pregnancy, to be affected with
troublesome sores of the genitals. Hippocrates mentions aph¬
thae occurring in pregnancy. These aphthous sores sometimes
spread, destroying the nymphse or the labium, attended with
distressing pruritus. Women labouring under lluor albus, or
other discharges, are also subject to sores on the genitals ; as
they are also at the cessation of the catamenia. Haemorrhoids,
when very troublesome, may produce ulcers about the anus
and the labia. Procidentia uteri may induce ulceration of the
vagina. Want of cleanliness assists in the production of all
these sores. Whatever causes erosion in these parts, will pro¬
duce a small denuded surface, secreting a purulent fluid. Such
erosion may be produced by violent friction, which women
resort to when they labour under pruritus, or prurigo pudendi,
which is a most tormenting complaint, consisting ot severe
itching of the parts, with fulness and redness, attended some¬
times with papulse or aphthae. This affection is connected
with haemorrhoids, ascariues in the rectum and leucorrhcea. It
is possible that some of these cases may be mistaken for cases
of chancre ; but the knowledge that such cases exist, attention
to the history and circumstances of the case, the character of
the woman, and, if married, that of her husband, together with
attention to what has been said when speaking of chancre, and
the absence of other symptoms, all these together will enable
the practitioner to form a correct opinion as to the nature of
the case.

But a sore may in the first instance be syphilitic, and its
nature and character may be afterwards entirely changed. In
some cases the chancre is followed or attended by violent active
inflammation, which, unless soon subdued, may run into mor¬
tification, terminating in sloughing. This particularly happens
where phymosis is present in the first instance, and where,
superadded to an irritable habit, there is want of cleanliness.
The prepuce is sometimes eroded, having a hole made through
it, part of the glans appearing through the opening, giving to

An Essay on Diseases resembling the Venereal Disease. 123

the penis the appearance of a double glans. The penis in
these cases is sometimes extremely enlarged, and the whole of
the glans and prepuce are in a rotten state. If suppuration
takes place, the tension of the penis from the unyielding nature
°i structure, is very great. The integuments are red; but
no fluctuation is discovered, from the tense state of the part. If
an opening is not made to evacuate the matter, ulceration of a
troublesome kind may ensue.

In some cases, in very irritable habits, upon which mercury
acts as a poison, especially where the patient is confined in a
close mercurial ward, the exhibition of that remedy shall cause
the ulcer to spread, preceded by discolouration and~ hard tume¬
faction of the whole body of the penis ; and when the ulceration
arrives at the corpora cavernosa, its progress is most rapid and
alarming. It eats its way as high as, or within, the ossa pubis,
destroying the patient, or mutilating him dreadfully. The
nutation, pain, and constitutional disorder in such a case, are
very great. This is a picture of an extreme case : there are
many shades of a milder form, as to progress and danger.

In mortification and phagedsena of the penis, it is not very
material whether we consider the first symptom to have been
chancte 01 not ; at least during the existence of the mortification
or phagedsenic ulceration. In any view of the case, mercury
is improper, and will only assist the spreading of the mischief.
It, however, we know that the first symptom was a syphilitic
sore, it may be necessary to have recourse to mercury, when a
stop has been put to the subsequent spreading ulceration ; and
it is possible that the repetition of that mineral may again put
the ulcer in motion and induce its malignant character. Our
rule then must be this: — If the venereal sore shall have com¬
municated its virus to the absorbents of the penis, beyond the
point to which the subsequent sloughing* or phagedsenic ulcera¬
tion reaches ; or if the inguinal glands have been contaminated ;
or if, after the separation of the slough, a hard, painful sore
is left, disinclined to heal — in all these cases mercury must be
cautiously introduced, carefully avoiding every possible cir¬
cumstance which can call forth the injurious effects of that
remedy.

During and subsequent to a mercurial course, the penis is
liable to be attacked with ulcers of the glans and prepuce, of a
very troublesome nature. If the original sore has healed with¬
out leaving any hardness, and the patient has not been exposed
to fresh contagion, we are not to consider any fresh ulcerations
of this part as syphilitic, however troublesome they may prove.

Projecting sores, studding the end of the prepuce, and con¬
nected with a discharge from the internal prepuce, are frequent¬
ly met with. The sores have a granulated divided surface,

126 Original Communications.

somewhat resembling a venereal wart, bat more flattened.
These sores come out sometimes in succession. In ail the cases
of this kind that I have seen, mercury has been employed. I
cannot, therefore, say whether, if left to themselves, they would
be followed by secondary symptoms or not. Mr. Abernethy*
considers them as not being venereal, and not requiring mer¬
cury. Dr. Adams-h styles them “ red, soft warts.’’

I said that I should not endeavour to describe every possible
sore which may present itself on the genital organs ; they will
be best distinguished from the primary syphilitic sore, by re¬
collecting the characters of chancre. The sores which occur
on these parts, and are communicated by impure connexion,
but which are not syphilitic, are, by Mr. Carmichael J, referred
(independently of excoriation connected with gonorrhoea pre-

putic) to the following species :

Superficial ulcers, without induration, but with elevated
ed £Tes ; similar ulcers, without induration, or elevated eugcs ,
phagedenic ulcer ; and the sloughing ulcer.

Cancer has been mentioned as a disease which may be mis¬
taken for venereal ulceration of the penis. But cancer never
'perhaps appears primarily as a sore, but is pi seeded by long-
continued induration, or by warty excrescence. The descrip¬
tion of the cancerous wart will be given under the head Marts.
The sores most likely to be confounded with cancer, are, the
sloughing and the phagedaenic sores (whether preceded by-
chancre or not), and the sores which sometimes occui after a
course of mercury. The knowledge of the first cause and ap¬
pearance of the sore, the progressive erosion ana destruction of
the penis, the history of the case, its duration — -all these will
enable the practitioner to distinguish between these cases and
cancer of the penis ; in which latter affection the diseased part:
forms an addition to the bulk of the penis, remaining still at¬
tached to it. .

In all cases where we have suspicions that the sore is chancre,

but where, at the same time, it is extremely doubtful, it may
be better to wait until some new appearance or some new
symptom arise to put the case beyond doubt, supposing it
really to be syphilitic, and to wait until that new symptom be
urgent. Commonly, unless the patient should be particularly
i ratable, and very much affected by mercury, if the sore have
many of the characters of chancre, although we may not be
certain that it is chancre, it will be more prudent to introduce

* Surgical Observations. t Observations on Morbid Poisons.
X Essay on Venereal Diseases , §c.

An Essay on Diseases resembling the Venereal Disease. 172

mercury cautiously. If tlie sore heal speedily under mercury,
there can, generally speaking, be no objection to the introduc¬
tion ot that quantity of mercury which is necessary to guard
against secondary symptoms, should the case really be sy¬
philitic. This will not only save the patient a great deal of
time and suffering, supposing his affection to be syphilitic,
inasmuch as a secondary attack will be spared, but it will also
throw considerable light on any future symptoms that may
.arise, should symptoms resembling the secondary symptoms of
syphilis occur after the patient has gone through a proper mer¬
curial course for his primary symptom.

Of Discha rges from the U rethra f in Mien) which resemble

Gonorrhoea.

Men are subject to discharges of a purulent fluid from the
urethra from various causes, independent of the discharoe
termed gonorrhoea.

A discharge of a purulent fluid, attended with more or less
uneasiness in making water, may arise from connexion with a
woman who has discharges from the vagina which are not ve¬
nereal. In irritable habits, coition with a woman who has the
catamenia will bring on discharge and heat. In all these cases,
the history of the case, the character of the parties, the know¬
ledge that the woman has discharges, together with the compa¬
rative mildness of the symptoms, will enable the medical attend¬
ant to pronounce accurately on the nature of the discharge.
Such discharge may also be produced by blows on the perineum,
hard riding, intemperate living, Onanism, excessive venery,
stricture, extraneous substance in the urethra, calculus in the
urethra, stone or any other irritation in the bladder. Inflam¬
mation of the kidney, or of the bladder, terminating in sup¬
puration, will cause pus to be voided by the urethra. Metas¬
tasis of the gout has caused a discharge from the same passage.

In all cases w here discharge is brought on by any of the
causes just enumerated, a little attention and inquiry will lead
the practitioner to an accurate diagnosis. The time that has
elapsed since the last suspicious connexion, must be taken into
account : it may be so long as to preclude the possibility, or
any thing like the probability, of the discharge being gonor-
i uoea. It is difficult to limit the time m which gonorrhoea
appears after impure connexion : it has occurred in a few hours;
almost always in a few days ; seldom beyond three or four
weeks. The patient will recollect having had any severe blow
on the perineum ; his own conscience will accuse him, if Onan¬
ism be the cause of the discharge ; besides, it is not likely that
those who indulge in this solitary vice will be affected with any-

128 Original Communications .

tiling that results from connexion with the other sex ; since the
adoption of so unnatural a mode of getting rid of a passion ,
proves that they have little opportunity or inclination to indulge
in that way which nature points out: and where the vicious
custom of Onanism has been so long persevered in as to induce
a thin glairy discharge from the urethra, there will generally be
present symptoms of great constitutional debility, pallor, ema¬
ciation, loss of appetite, and very often hectic symptoms*.

When stricture is, as it very often is, the cause of the dis¬
charge, if the stricture be recent, the patient will complain of
frequent desire to make water, and of uneasiness below the
fraenum or just within the urethra. If he be very irritable, or
have had connexion with a woman who has discharges from the
vagina (such discharge not being that of gonorrhoea), lie will
have great irritation about the orifice of the urethra, together
with great heat of urine; and in this state the case may be, and
very commonly is, mistaken for gonorrhoea. But the violence
of the symptoms wall generally soon subside, if the patient avoid
exercise and stimulants. The bladder will gradually accom¬
modate itself to a stricture in an early stage ; but after the lapse
of some months, or years, the obstruction to the flow of urine
shall become so great, that the bladder, in its endeavour to
overcome this obstruction, must act very violently. Here again
there will be discharge and difficulty of making water. The
pain is a forcing pain about the neck of the bladder and in
the situation of the stricture. The discharge is in some cases
completely purulent, with some of the glairy secretion of the
prostate gland, or there is a mixture of white films floating in
the urine, or a deposit of matter like hair-powder, or of a sub¬
stance which has been compared to vermicelli. The urine has
often a very peculiar, unpleasant odour. Uneasy creeping sen¬
sations in the urethra, rigors, great sympathy between the
Stomach and the urethra, and a twisted or forked stream of
urine, also characterise strictures of long standing. The intro¬
duction of a bougie will of course at once ascertain the nature
of the complaint.

The presence of an extraneous bodv in the urethra must be
known to the patient. When a small calculus gets into the
urethra, the passage of the urine will he obstructed. Here the
previous symptoms, the knowledge that the patient has been in
the habit of voiding small calculi, attention to present symptoms,
and especially the introduction of a catheter or bougie, will at
once point out the cause of the symptoms. A difficulty of

An Essay on Diseases resembling the Venereal Disease. 129

making water, frequent attempts to pass it* great pain attending
such attempts, and a discharge of a mucous or purulent fluia,
may arise from irritation or inflammation of the internal coat of
the bladder, by whatever cause produced. Here the pain will
be more in the region of the bladder and in the perineum ; and
the violence of the symptoms, together with the sympathetic
affection of the stomach which often accompanies them, will
leave little or no room for mistaking such a case for gonorrhoea;
more especially if we carefully investigate the first attack of the
complaint. Where a calculus in the bladder is the cause of
difficulty of making water, and of discharge, there will be un¬
easiness and troublesome itching at the orifice of the urethra—
perhaps a dull pain in the bladder ; the urine is in some cases
voided better when the patient is in a recumbent posture, than
tvhen he stands up : there is a mucous deposit in the urine,
and perhaps a tinge of blood. A frequency of making water,
succeeded by a discharge of pus, may be the consequence of
inflammation of the kidney : but here the symptoms attendant
on nephritis will point out the case ; such as pain in the region
of the kidney, numbness of the thigh, retraction of the testicle,
and sickness. Calculous concretions in the kidney may pro¬
duce the same effects ; and the same symptoms will be present^
with the addition of a discharge of red crystals in the urine,
and frequently of blood, with pain in the loins, increased on
motion : and in both these cases there will be an absence of
ardor u rinse, and of inflammation of the meatus urinarius.

It is hardly allowable to mention strangury, produced by
cantharides whether externally applied or internally adminis¬
tered, among the cases which may be mistaken for an incipient
gonorrhoea.

True gonorrhoea must be distinguished from that discharge
from the internal prepuce which may be produced by any thing
causing irritation there or behind the corona glandis, as warts^
the use of mercury, want of cleanliness, &c *

Of Discharges from the Vagina , which may be mistaken for

Gonorrhoea.

From the difference of structure, women do not suffer as
much pain and inconvenience in gonorrhoea, as men. Women
are also sO very subject to mucous and purulent discharges, that
when they really labour under gonorrhoea, the appearance of
the discharge often excites no alarm or suspicion.

In order to caution the practitioner against too hastily taking
bp the idea, that discharges from the vagina are the result of
impure coition, I will enumerate the most common causes oi
vaginal discharge. These are, great general debility, local de-

vox.. viii. — no. 44. s

130

Original Communications.

bility, want of cleanliness, local disease ; as polypus, or oilier
tumours or excrescences of the uterus, scirrhous uterus, ulcer
of the uterus, partial inversion of the uterus, procidentia uteri
aut vesicae, impregnated uterus, hydatids of the uterus, warts
in the vestibulum. Disease in the neighbourhood ; as piles,
collection of faeces in the rectum, calculus, or other diseases of
the bladder, fulness and thickening of the cellular membrane
surrounding the urethra, the presence of pessaries, in short,
whatever causes an increased determination of blood to these
parts. A discharge from the vagina, commonly called fluor
albus, occurs also at a middle period of life, when a change
takes place in the uterine system, on the cessation of the
catamenia.

When a woman complains of having a discharge from the
vagina, we must not rest satisfied with the knowledge, that she
has a discharge ; but we must ascertain the appearance of the
fluid. It may be mucous, purulent, watery, or tinged with
blood. We must bear in mind all the possible causes of these
several discharges, recollecting the symptoms attendant upon
them. If the character of the woman and of her husband are
not above suspicion, then proceed to the investigation. The
knowledge that the woman has had repeated or recent miscar¬
riage, of her being with child, or of her having some of the
diseases above-mentioned, the presence of hysterical symptoms,
pain in the back and loins, the peculiar sensation termed bear¬
ing-down, all these will assist us in our diagnosis. But where
all these are insufficient, we must examine per vaginam ; by
such examination, we shall find out whether there be any en¬
largement of the uterus from impregnation or from disease, any
displacement or other disease of the uterus, or any extraneous
substance in the vagina ; if we find any of these, the cause of
the discharge will be explained ; if not, we shall have the ad¬
vantage of having materially abridged the catalogue of com¬
plaints, from which discharge of the vagina may arise. A dis¬
charge of a purulent fluid, may also be the consequence of
ulceration of the vagina, and of collections of matter in the
sides of the vagina. But these causes can only clearly be ascer¬
tained by examination.

Of Fhymosis .

The existence of phymosis is by no means a proof that the
part has been exposed to venereal contagion. It may be
natural. In one case I removed about two inches of prepuce
where the glans penis had been from birth entirely concealed ;
and where there was scarcely any thing like an orifice, the urine
finding its way through a puckering of the skin at the upper

Majendie’s Elements of Physiology.

131

part. The patient, a lad, came under my care for gonorrhoea.
Phymosis may be the consequence of want of cleanliness ; it
may be produced by fingering the part much ; by Onanism ;
by inflammation produced by any cause, as by riding; by con¬
nexion with a woman who has discharges from the vagina, other
than gonorrhoea, &c. GEdema of the integuments will, of
course, prevent the retraction of the prepuce.

(To be continued. )

PAR T II.

ANALYTICAL REVIEW.

Precis Elementaire de Physiologic. Par F. Majendie. Tom.

a Paris, 1817.

This volume is very recently published, and, through
the author’s kindness, we are able to offer to our readers an
early account of its contents— The History of the Nutritive
and Generative Functions The former are first treated of
under the following divisions: — digestion; absorption and
course of the chyle; course of the lymph; venous circulation ;
respiration ; arterial circulation.

There exists an evident relation between the structure of
the digestive canal of each animal, and the substance suited to
nourish it. In herbivorous animals the digestive apparatus is
extensive and complicated ; in carnivorous, short and simple.
Man maintains a medium in the disposition and structure of his
digestive organs, being destined to receive support equally from
vegetable and animal substances : he cannot, however, be called
omnivorous, as animals eat and digest many substances which,
taken into the human stomach, afford no nourishment.

The surface of the membrane lining the whole of the ali¬
mentary canal is lubricated by a viscid transparent fluid, a part
of which is continually evaporating, so that there exists always
a certain quantity of vapour in every part of the canal. This
fluid is often found in greatest abundance where there are no
mucous follicles or glands, a circumstance which seems to prove
that these are not the only organs which secrete it. In the
stomach this fluid is mixed with the saliva and other secretions
of the mouth and pharynx, which are swallowed at short inter-

s 2

132 Analytical Review.

vals ; and this mixture of different fluids is what physiologists
have called the gastric juice. It would seem, from this account,
that, when the stomach has been some time without receiving
food, an accumulation of mucous, follicular, and salivary fluid
would take place ; but observation has often shewn the contrary.
In animals, after several days of starvation, M. Majendie has
found only a little viscid mucus at the left extremity of the
stomach. A physician, who possessed a voluntary power of
vomiting, could only raise two or three ounces of this fluid from
the stomach in a morning ; but, by previously taking a mouth¬
ful of any aliment, he could, in a short time, procure half-a-pint
of it. The internal membrane of the small intestines is covered
with a fluid little different from what is found in the stomach ;
and M. Majendie has ascertained, by experiment, with what
great rapidity this fluid can be secreted. A portion of the
mucous membrane of this intestine being exposed in a living
dog, and the layer of mucus adhering to it wiped off with a
sponge, not a minute elapses before it appears in as great a
quantity as before ; and this observation may be repeated with
a like result, until the contact of air, and a foreign body, excite
inflammation.

<e No one, I believe/’ says M. Majendie, “ has observed, in a
living man, the manner in which the bile and pancreatic fluid are
discharged into the duodenum. In some animals, such as dogs,
these fluids flow at intervals, a drop of bile oozing from the oriflce
of the biliary duct about twice in a minute, and diffusing itself uni¬
formly over the surface of the intestine : thus a certain quantity of
bile is always found in the small intestine.

u The fluid formed by the pancreas flows into the duodenum
much in the same manner, but more slowly, a quarter of an hour
sometimes elapsing before a drop of it issues from the oriflce of the
pancreatic duct. I have, however, in some cases, seen the pan¬
creatic fluid flow with considerable rapidity.” — p. lo.

M. Majendie thinks that it is impossible the soft palate
should be elevated so as to apply itself to the posterior nostrils;
but there appears to us plenty of evidence that this does take
place, whatever conclusions may be drawn from anatomical
dissection of the parts. In expiration we easily send all the
air through the mouth, which could not happen if the posterior
nostrils were not completely closed.

Deglutition may be divided into three stages. In the first,
the substance to be swallowed passes from the mouth into the
pharynx, chiefly by the action of voluntary muscles. In the
second, it reaches the commencement of the oesophagus, by the
simultaneous and rapid action of muscles not under thecontroul
ol the wifi. Its passage through the oesophagus, in the third
stage, is slow and gradual, two or three minutes sometimes

Majendiefo Elements of Physiology. 138

passing, before the substance reaches the stomach. In the
two upper thirds of the oesophagus, the relaxation of the cir¬
cular fibres succeeds immediately to the contraction by which
the food is propelled towards the stomach. A peculiar pheno¬
menon lias been noticed by M. Majendie in the lower third of
the oesophagus ; the circular fibres remain in a state of con^
traction for several moments after the aliment has reached the
stomach, and an alternate change of relaxation and contraction
occurs for a considerable time afterwards.

“ It is this alternate motion of the lowest third of the oesopha¬
gus which prevents the aliment from returning again into its cavity.
The more the stomach is distended, the greater is the intensity and
duration of the contraction, and the shorter the period of relaxa¬
tion. The contraction generally coincides with the moment of
inspiration, when the stomach is most strongly compressed. The
relaxation happens most commonly at the instant of expiration/’ — ,

The food remains nearly one hour in the stomach without
undergoing any considerable change. The chyme is princi¬
pally formed in the pyloric half of the stomach, the aliment in
the left or splenic portion still retaining its properties until it
changes its situation. The chyme, as it forms, is gradually
propelled into the duodenum, two or three ounces being the
greatest quantity which M. Majendie has found accumulated
in the pyloric portion of the stomach. The time required for
the digestion of food must evidently vary according to the quan¬
tity, the quality, the preparation it has undergone before reach¬
ing the stomach, and the peculiar disposition of the individual ;
but in four or five hours after an ordinary meal, the transform¬
ation of all that has been taken into chyme will generally be
effected. The interruption to the process of digestion which
has been found to follow the division of the eighth pair of nerves
in the neck, is attributed by M. Majendie to the injury which
the function of respiration sustains by such an operation.

“ I am inclined,” says he, f<r to this opinion, because, if you
divide the eighth pair of nerves in the chest, as I have often done,
below7 the branches which are sent to the lungs, the food in the
stomach is converted into chyme, and chyle is afterwards plentifully
formed from it.” — p. 95.

The phenomena which attend the progress of the food
through the small and large intestines, as they appear in a
living animal, and the changes which the food undergoes, are
admirably detailed. The digestion of fluids, which preceding
physiologists have almost overlooked, furnishes the subject of
many interesting pages. The circumstance of liquids being
digested, ought, our author observes, to have taught us to
reject the systems of trituration > maceration , &c. which have

134 Analytical Review.

been set up to explain digestion. Fluids, when taken into the
stomach, occupy chiefly the left and middle portions of it;
they remain a less time in this organ than aliments ; but the
manner in which they pass out of it into the duodenum is little
understood. Water becomes mixed with the secretions and
other contents of the stomach, without forming any chyme.
Alcohol is absorbed in the same way ; but the albumen which
it meets with is coagulated, and afterwards undergoes digestion
as a solid substance. Fluids therefore may be divided into two
classes ; those which are in part or wholly converted into chyme,
and those which form no chyme. Oil, M. Majendie thinks, is
completely converted into chyme, the reason why it remains
longer in the stomach than any other liquid. Milk coagulates
in the stomach, and is acted upon as a solid aliment. The
power of swallowing atmospheric air, which has been thought
a rare occurrence, has been met with by M. Majendie in eight
or ten medical students out of a hundred. In certain diseases,
patients swallow air involuntarily, without being aware of it>
A physician of the author s acquaintance, whose digestion was
habitually laborious, used to render it less so by swallowing a
few mouthfuls of air.

The chyle offers slight variations, according to the sub¬
stances from which it has been formed; but M. Majendie has
never observed it tinged with colouring matters, as saffron or
indigo, that had been mixed with the aliments. Of the three
substances into which the chyle separates on standing, the co-
agulum or solid part is in small quantity, where food containing
little ff brine, as sugar, has been taken * and the opaque white
oily coat which swims upon the surface is scarcely perceptible
when an animal has lived upon aliments deprived of fatty
matter. The absorption of chyle by the lacteals continues a
long time after death.

*e After having emptied, by compression, one or more of the
chyiiferous vessels of an animal recently dead, it gradually becomes
filled again with the same kind of fluid ; and this observation may
be witnessed several times in succession. 1 have sometimes noticed
it two hours after the death of the animal.” — p. lf)3.

Capillary attraction, a peculiar sensibility of the orifices of
the chyiiferous vessels, &c. which have been given as explana¬
tions of the absorption of lymph, are regarded by M. Majendie
as so many modes of expressing our ignorance of the nature of
this phenomenon. He has assured himself, by experiments on
animals, that liquids which do not undergo digestion, as water
and spirit, are not mixed with the chyle, nor absorbed with it ;
but that they take a different course to reach the circulating
system. If a little alcohol and water be given to a dog, whilst
he is digesting food, and chyle be procured half an hour after-

Majendie’s Elements o f Physiology. 135

wards, by opening the thoracic duct, this liquid will be found
not to contain any alcohol ; but the blood of the same animal
will exhale a powerful odour of alcohol, and will yield an evi¬
dent quantity of it by distillation. If the experiment be made
with camphor, or any other odoriferous substance, the same
result will be obtained.

M. Majendie applies the term lymph to the fluid which is
found in the lymphatics and the thoracic duct, and describes it
as being salt to the taste, having a smell strongly resembling
semen, sometimes of a yellow colour, at others reddish, like
madder, soon taking a solid form when separated from the
body. The quantity of lymph in a single animal is inconsider¬
able. From a large dog he has not procured more than an
ounce and a half. The author insists upon these details, in
order to obtain accuracy in experiments, and to distinguish
lymph from the fluids of serous and cellular surfaces, which are
different in appearance and in chemical composition.

The uncertain foundation on which the present doctrines of
absorption rest, is ably examined. John Hunter employed but
five animals for making the experiments which have been con¬
stantly quoted with so much confidence*. M. Majendie has
repeated these experiments without success, never having found
the lacteals filled with milk, which had been injected into a con¬
fined portion of the intestine. Indeed, he doubts whether the
lacteals have the power of absorbing any other fluid than chyle ;
and he seems to be firmly convinced that they are not the only
agents of intestinal absorption: — I. decoction of rhubarb is
detected in the urine half an hour after it has been taken into
the stomach ; but no traces of it are to be found in the lymph
procured from the thoracic duct ; 2. prussiate of potass is ap¬
parent in the urine a quarter of an hour after a solution of it
has been taken into the stomach; but the lymph procured at
the same time from the thoracic duct, gives no sign of the
prussiate being present on the application of chemical tests :
3. alcohol, as we have just noticed, is found in the blood soon
after it has been drank ; but not in the chyle of the thoracic
duct : 4. when the thoracic duct of a dog is tied, a decoction
of 71 ux vomica , injected into the stomach or rectum, kills as
quickly as if the duct were left pervious.

“ In a dog, which had taken food plentifully seven hours before,
to make the chyliferous vessels very apparent, M. Delille and myself
made the following experiment. Through an incision in the abdo¬
minal parietes, we drew out a considerable portion of the small
intestine, to which we applied two ligatures. The lymphatics aris-

* See Dr. Hunter’s Medical Commentaries , 4to. p. 38.

136

Analytical Review .

ing from this portion were white and very evident, being distended
with chyle. To each of these lymphatics we then applied two-
ligatures, and divided the vessel between them. We took all pos¬
sible means of ascertaining that the exposed portion of the intestine
had no further communication with the rest of the body by lympha¬
tic vessels. Five arteries and five veins were distributed to this
portion of intestine; four of these arteries and as many veins were
tied and cut through in the same manner as the lymphatics ; after¬
wards the two extremities of this portion of intestine were cut
through and separated entirely from the rest of the gut. We had
thus a considerable portion of the small intestine which communi¬
cated with the rest of the body only by a single artery and vein of
the mesentery. These two vessels were insulated for four fingers'
breath, and we even took away the cellular coat, lest any lympha¬
tics should remain concealed in it. We then injected into the cavity
of this portion of intestine about two ounces of a decoction of imsc
vomica, and prevented the injected liquor from escaping by putting
©n a ligature. The intestine was enveloped in fine linen, and re¬
placed in the abdomen. The effects of the poison were evident in
six minutes, and every thing went on the same as if the portion of
intestine had been in its natural state." — p. 185.

It is rather from analogy with the chyliferous vessels of the
intestines than from positive facts, that we have admitted lym¬
phatic absorption from mucous, serous, or synovial surfaces; or
in cellular substance, the skin and the tissue of organs. John
Hunter, after having injected coloured fluids into the peritoneal
cavity, saw the lymphatics filled with it ; but others, who have
undertaken similar experiments, have seen in the lymphatics
tione of the coloured liquids, although these had been very
quickly absorbed. M. Majendie says, that in an hundred andf
fifty instances, he and Dupuytren have submitted coloured
fluids to absorption from serous surfaces, without having once
been able to observe them in the lymphatic vessels. Wine and
solutions of opium are quickly absorbed when introduced into
serous cavities, and produce intoxication and drowsiness ; and
tying the thoracic duct does not at all diminish the rapidity
with which these effects become manifest. Moreover, the
arachnoid and the membranes of the aqueous and vitreous
humour, the structure of which is analagous to that of serous
membranes, and in 'which no lymphatic vessel has hitherto been
perceived, are endued with the power of absorption. M.
Majendie therefore thinks, that the absorbing power of the
lymphatics, is far from being demonstrated. He thinks, that
the lymph is a part of the blood which returns to the heart by
the lymphatics instead of taking its course by the veins; an
opinion which he deduces : 1. From the Strong analogy between
the lymph and the blond. 2. From the communication which
anatomists have found to exist between the termination of arte-

Majendies Elements of Physiology, 137

tics and the commencement of lymphatics. 3. From the
facility with which colouring or saline substances are introduced
into the latter. It is not, however, for the sake of giving us
this idea, which is neither new nor ingenious, that the author
has dwelt so long on absorption by the lymphatics; but tocorrect
erroneous opinions, and convince us how little is known upon
the subject.

In considering the course of venous blood, the author elu¬
cidates by many new arguments and experiments the question
of absorption by the minute extremities of veins. These, as
anatomists have shewn beyond a doubt, communicate with the
arteries and lymphatic vessels ; it may be inferred* that they
have orifices which open upon the surfaces of membranes, cellu¬
lar tissue, and even in the parenchyma of organs. If gases or
fluids of any kind be put in contact with any part of the body,
(the skin excepted,) they are taken up by the minute orifices of
veins, and pass quickly to the lungs with the venous blood ; all
solid substances which are susceptible of being dissolved by the
blood or the secreted fluids they meet with, are received in the
same way, and transferred to the heart and lungs. To give an
idea of this property, of the minute extremities of veins to ab¬
sorb liquids and solids in contact with living surfaces, M. Ma-
jendie introduces a solution of camphor into any serous or
mucous cavity of the body, or buries a small portion of solid
camphor in the tissue of any organ, and the air emitted from
the lungs soon obtains a powerful smell of camphor. Cam¬
phorated injections thrown up the rectum produce the same
effect in five or six minutes in the human subject. Almost
every odoriferous substance which does not combine with the
blood, exerts the same influence in imparting its peculiar odour
to the air in the lungs. The venous absorption, M. Majendie
has ascertained, varies in different tissues ; it is much more
rapid in serous than in mucous membranes, much quicker in
tissues abounding with vessels than in those which have little
vascularity.

“ The villous surfaces, formed partly by the venous orifices
( radicules ), are the organs for absorbing all the liquids in the small
intestine, except the chyle. It is easy to convince yourself of this,
by introducing into this intestine substances of a powerful smell
and taste, capable of being absorbed. From the commencement of
their absorption until their completion of it, the properties of these
substances mav be recognized in the blood of the branches of the
vena portae, but are not to be distinguished in the lymph until a long
time after the absorption has commenced. We shall shew hereafter,
that they arrive at the thoracic duct, not by the way of absorption
from the chyliferous vessels ; but by the communications of arteries
with lymphatics.

“ A grain of bile thrust into the crural vein, generally kills the

VOL. viii. — no. 44, x

138 Analytical Review.

animal in a few minutes. The same thing happens from the intro¬
duction of a certain quantity of air into this vein. These sub¬
stances, introduced in a similar manner into one of the branches of
the vena portae, will be followed by no evident inconvenience.
On what depends such a difference in the result of these experi¬
ments ?

u It may be, that the course of the veins proceeding from the
digestive organs through the liver, was necessary in order to mix
intimately with the blood the substances absorbed in the intestinal
canal. Whether this effect be produced or not, it is no longer
doubtful that medicines absorbed in the stomach and intestines
must pass immediately through the liver, and that they must exert
upon this organ an influence which appears to me to be highly de¬
serving the attention of the physician/- — p. 232.

The skin, we have just stated, makes the only exception to
the general law, that the veins, in all parts of the body, absorb
the substances in contact with them. This is owing to epider¬
mis; and when this is removed, as by the application of a
blister, absorption takes place in the skin, the same as from an
ulcer or any other Jiving surface. Friction, however, will ac¬
complish what does not happen by simple contact ; and mercury,
alcohol, opium, &c. having passed through the pores of the
epidermis by the use of friction, are readily absorbed into the
system.

In justice to M. Majendie, 'who has advocated a doctrine
so very contrary to general opinion, we quote at length the
experiments which have appeared to him the most decisive ;
but much as we respect his character, and admire bis zeal, we
cannot, until his experiments shall have been verified by others,
place more confidence in them than in those of John Hunteiy
against whom wre should be glad to find him employing, on
some occasions, more argument and less severity of language.

cc Having previously given opium to a dog to mitigate the pain
of a tedious experiment, M. Delille and myself separated one thigh
of the animal from the body, witli the exception of the crural artery
and vein, which were left untouched so as to preserve, by means of
these alone, a communication between the limb and the body.
These two vessels were dissected with the greatest care, and insu¬
lated to some extent ; their cellular coat even was removed for fear
that lymphatic vessels might be concealed in it.. Two grains of the
most powerful poison (the upas tree) were then injected into the
foot, and its effects were as quick and intense as if the limb had not
been at all separated from the body, the animal being influenced
by the poison in four, and dead before ten minutes.

“ It may be contended that, notwithstanding all our precautions,
the coats of the crural artery and vein still contained lymphatics,
and that these vessels were sufficient for conveying the poison. To
remove this difficulty, I repeated the above experiment on another
dog, with this difference, and I introduced into the crural artery a

139

Majen die's Elements of Physiology.

small cylinder of a quill, to which I fixed the vessel by two ligatures ;
the artery was afterwards cut through circularly between the two
ligatures ; the crural vein was treated in the same manner. Thus
there was no longer any communication between the thigli and
the rest of the body, except by the arterial and venous blood,
which were passing in contrary directions from one to the other :
yet the poison, introduced into the foot, shewed its effects as usual
in about four minutes.

“ This experiment leaves no doubt of the poison having passed
from the foot to the trunk through the crural vein. To render this
phenomenon still more evident, you must compress this vien
between the fingers, at the moment when the effects of the poison
begin to shew themselves : shortly these effects cease ; they appear
again if the vein is left free, and again cease when it is compressed
anew. Thus you may regulate the effects of the poison at plea¬
sured — p. 2 38, 2 39,

M. Majendie further urges, in favour of the absorbing
powers of veins, that in many parts of the body, the eye, the
brain, the placenta, &c. where no lymphatic vessels are met
with, absorption goes on with as much activity as in other parts
where they are abundant ; that in animals without vertebrae,
where no lymphatics can be observed, absorption is very mani¬
fest ; that the thoracic duct is much too small to give passage to
the great quantity of matter which is sometimes absorbed, par¬
ticularly fluids, ten or twelve pints of which are sometimes
taken and voided from the bladder in a few hours. Facts,
arguments, experiments, therefore concur, in the opinion of
M. Majendie, to support the doctrine of absorption by veins,
and the whole of our knowledge may be reduced to the follow¬
ing general remarks: — 1. it is certain that the lacteals absorb
the chyle ; 2. it is doubtful whether they absorb any other
fluids ; 3. it is proved that the veins absorb ; 4. it is not de¬
monstrated that the lymphatics are possessed of any such pro-
perty.

Upon the mechanism of the respiratory organs, there is,
perhaps, little room for novelty. Contrary to what lias been
taught by anatomists since the time of Haller, M. Majendie
believes the first rib to be very moveable, and that each rib
is less moveable to the seventh of the true ribs. The scaleni
and the muscles of the neck attached to the sternum are con¬
sequently muscles of respiration : in the list of the respiratory
muscles, the author also places another, to which the use of
expanding the chest has not been attributed, the diaphragm,
which, in consequence of its attachment to the sternum and the
six inferior ribs, must, by its contraction, elevate the thorax
more or less, in proportion to the resistance it meets with from
the contents of the abdomen.

The author identifies the function of respiration with the

t 2

140 Analytical Review.

change of venous into arterial blood. The latter has a tem¬
perature of more than two degrees of Fahrenheit above the
former, with less specific gravity and capacity for heat, a smaller
proportion of serum, a stronger odour, and a greater disposition
to coagulate. The vapour exhaled from the lungs is not all
furnished by the venous blood of the pulmonary artery, but is
formed in a considerable degree at the expense of arterial blood,
distributed to the mucous membrane of the bronchi. In living
animals the pulmonary exhalation can be increased at pleasure.
Water of the temperature of the body may be injected into the
veins of a dog, in such a considerable quantity as to produce a
degree of plethora and distension of vessels that scarcely allows
the animal to move ; in a few instants respiration becomes
greatly accelerated, and an abundance of fluid may be observed,
flowing from all points of the throat, the evident source of whicn
is the increased transpiration from the lungs. Alcohol, aether,
solutions of camphor, &c. injected into the peritoneal cavity, or
elsewhere, are thrown off from the surface of the lungs in the
same manner as the aqueous part of the blood. Even gases of
different kinds, injected into the veins, have been found to pass
off by expiration. The divison of the eighth pair of nerves in
the neck, which has been a favourite experiment with physiolo¬
gists, influences the larynx as well as the lungs. When it kills
immediately, it is owing, M. Majendie believes, to the dilating
muscles of the glottis, which are supplied by the recurrent
nerve, being paralized, whilst the constricting muscles, which
receive their nerves from the superior laryngeal, continue in
action, and close more or less completely^ the glottis.

The heart is regarded as the chief, if not the sole, agent, by
which the blood is propelled from the arteries into the veins,
and the action of the capillary system of vessels on the move¬
ment of the blood towards the heart is to be considered as no
more than a gratuitous supposition. Respecting the dilatation
and contraction of arteries, JVX. Majendie believes that they are
passive in both these cases, their dilatation and contraction
being simply an effect of elasticity of their walls called into
action by the blood which the heart is continually propelling
into their cavities. From a writer, who confines himself for
the most part to matters of demonstration, we did not expect
the opinion, that arteries are dilated at every contraction of the
ventricles of the heart, which is contrary to actual observation
on living animals. An account of the different secretions fol¬
lows that of the circulation of the blood. From the rapidity
with which certain substances, taken into the stomach, are
voided with the urine, Sir E. Home and others have sus¬
pected, that the circulation was not the only means of commu¬
nication between the stomach and the bladder. Upon this §ub«

141

Majendie’s Elements of Physiology.

jt'ct, M. Majendie has offered a fair illustration. Prussiate. of
potass, whether injected into the veins or absorbed from the in¬
testinal canal, or from a serous surfa6e, is, in a short time, easily-
detected in the urine. If the quantity of the prussiate em¬
ployed be considerable, it is also detected in the blood ; if in
small quantity, it cannot be recognized by any of the tests in
present use. The same thing happens in mixing the prussiate
with blood in a vessel. But the smallest quantity of this salt
can be made evident in the urine, and therefore it is not extra¬
ordinary that experimentalists should not always have found in
the blood, the substance which could be distinctly ascertained
toHbe present in the urine. M. Majendie thinks, that all liquids,
except the chyle, are absorbed by the veins of the intestines,
pass through the vena portss of the liver, and thence, from the
minutest branches of the venae cavse hepaticse, to the heart :
that this is a much shorter route, for those fluids which are soon
found in the kidneys, than the one more generally admitted,
(the lymphatic vessels, mesentric glands, and thoracic duct,) is
a point which many anatomists would probably contend with
him.

Upon nutrition, our author avoids discussing the numerous
hypotheses that have been offered, confining himself to such
facts as give us some notion of this process, and to the history
of experiments on animals with sugar, gum, &c. which have
been sufficiently noticed in preceding numbers of our Journal.
He has occupied very few pages with the subject of animal
heat. The most evicfent, if not the principal source of animal
heat, appears to be respiration ; the blood acquiring an increase
of temperature of more than two degrees (Fahrenheit), in its
.conversion from venous into arterial, which it afterwards parts
with to every part of the body, to which blood is distributed.

M. Majendie has next taken a concise view of Generation.
Much of the information which he has given us upon this diffi¬
cult subject, is of the negative kind ; shewing us what is not,
rather than what is, ascertained. As in fishes, reptiles, and
birds, the semen comes in contact with the ova to produce fecun¬
dation, we may conclude, that Nature does not employ a very
different method in mamiferous animals. We may therefore
consider it probable, that the semen arrives sooner or later at
the ovary. Some have supposed, that the semen is absorbed
from the surface of the vagina, and carried to the ovary by the
circulation. Were this idea well founded, a female might be
impregnated, our author observes, by the injection of semen
into the veins, an experiment which still remains to be tried by
the physiologist. The period at which the ovum or vesicle
passes from the ovarium through the fallopian tube, varies in
different species. In rabbits, this appears to happen on the

Analytical Review*

third or fourth day ; in dogs, on the fifth or eighth. In women,
it probably happens still later, perhaps not before the twelfth.

M. Majendie has made many new researches upon the phy¬
siology of the foetus, particularly upon the connection which
the foetal circulation has with the mother. Into the vessels of
the uterus of a living animal, he has injected odoriferous and
even poisonous solutions, without ever finding reason tor sus¬
pecting any direct communication between the uterus and
placenta.

“ Towards the middle of gestation, we perceive in the bitch a
great number of small arteries ; which, proceeding from the sub¬
stance of the uterus, dip into the placenta, where they divide them¬
selves into many branches. At this period it is impossible to sepa¬
rate these two organs without tearing these arteries and producing
considerable haemorrhage ; but at the end of gestation, on pulling
the uterus ever so gently, these small vessels become separated from
the placenta without any discharge of blood taking place.

“ When a certain quantity of camphor is injected into the
veins of a hitch, its odour is strongly imparted to the blood. ^ Atcer
having made an injection into the viens of a pregnant animal, I
have extracted one foetus from the uterus, and perceived, at the
end of three or four minutes, no odour of camphor in its blood ;
but the blood of a second foetus, extracted after a quarter of an
hour, had a strong odour of camphor. It was the same writh the
remaining fetuses in the uterus ot this animal.

« Thus notwithstanding there is no direct anastomosis between
the vessels of the uterus and the placenta, it is impossible to doubt
that the blood of the mother, or some of its elements, pass readily
to the fetus ; probably it is deposited by the uterine vessels on the
surface, or in the substance of the placenta, and absoibed by tne
origins' of the umbilical vein.” — p. 444.

It is much more difficult to ascertain, whether the blood of
the foetus returns to the mother. M. Majendie has thrown
most active poisons into the vessels of the umbilical cord, di¬
recting them towards the placenta, without ever having seen
the mother experience any effects from them ; and when the
mother dies of haemorrhage, he finds the vessels of the fetus
remaining full of blood. To ascertain whether venous absorp¬
tion exists in the foetus in utero, this author has injected the
most poisonous substances into the pleura, peritoneum, and
cellular tissue ; but without obtaining any satisfactory result,
“ for the nervous system of the foetus which has not respired,
does not,'” he says, <c appear sensible to the action of poisons.”

The favourable opinion which we ventured to express upon
the first part of M. Majendies physiology, we might repeat in
still stronger terms, in concluding our analysis ot the volume
before us. In this, as in every other branch of science, a1 can¬
did and judicious writer finds much to be undone as well as

143

Parkinson’s Hospital Pupil.

done ; and no inconsiderable part of M. Majendie’s time has
been necessarily occupied in correcting errors, denouncing
theories, and bringing us back to a conviction of our own io-n£
ranee, by pointing out the obscurity that reigns over all the
phenomena of life to which we cannot apply the Jaws of physics,
chemistry, or mechanics. Many will feel dissatisfied, that the
author should not have found more which he thought worthy
of being communicated, and that he ^hould have been able to
reduce the whole stock of our valuable knowledge in physiology
into so small a compass. For perspicuity, conciseness, an cl
originality, the work must stand conspicuous; and no compen¬
dium -of physiology has, within our observation, made its ap¬
pearance, that seemed better calculated to convey sound infor¬
mation, to stimulate active inquiry, and to point out the best
means of improving the noblest and most useful of sciences.

II.

The Hospital Pupil , or Observations addressed to the Parents of
3 oaths intended for the Profession of Jit edicine or Surgery , on
their previous Education, Pecuniary Resources, and on the Order
of their Professional Studies ; with Hints to the Young Pupil
on the Prosecution of Hospital Studies, on entering into Prac¬
tice, and on Yledical Jurisprudence. By James Parkinson
Member of the Royal College of Surgeons. Second Edition!
12mo. pp. 208. London, 1817. Sherwood and Co.

J he copious title page is sufficiently expressive ; but to
judge of tlie ments of this little work, it should be carefully
perused and considered. It is not always that we notice new
editions of books ; for they rarely contain any additional mat-
tei worthy of attention, "in the present instance, however, we
are induced to swerve from our usual course : firstly, because
the foi mei edition was antecedent to the commencement of
our labours : secondly, because the work is of great utility,
and cannot be too widely known : and, thirdly, because, at a
period when our efforts have been so pointedly directed to-
waids eveiy means calculated to promote anci improve the
course of medical education, Mr. Parkinson’s Hospital Pupil
opportunely appears in aid of our observations and precepts.

The a uth oi s sentiments so entirely coincide with our
own, and his advice is so evidently the result of experience
that we cannot adopt a better mode of conveying those senti¬
ments which we shall never omit a fair occasion for repeating
than by extracting such passages as best illustrate the subjects

upon which he treats, and about which we ourselves are so

solicitous.

144

Analytical Review.

Advice upon the ordinary affairs of life is never more ef^
fectually imparted than in a familiar manner : it comes home
to the head and the heart ; and leaves impressions not likely
soon to be eradicated, where sense and feeling exist,. Such a
form our author, therefore, has chosen ; and, in three letters,
makes such very judicious comments, and directs such a
system of education, that, if perused by parents before they
devote their children to the profession of medicine, or it
regarded only with ordinary attention by those youths who
have selected it as their future pursuit in life, it cannot fail to
have the most important influence on the decisions of the one,
and the success and happiness of the other. Association with
medical men of whatever class, soon affords numerous and
striking examples of the physical defects of many of them-—-
defects which no moral instruction could ever have corrected ;
and which exhibit the misguided judgemnt of those by whom
they were destined to a profession, requiring superior qualities
and talents. The origin of this species of delusion is thus
correctly traced by our author :

When you reflect on the vast importance of the science of
medicine to mankind, and on the mischiefs which may ensue from
the errors of an ignorant practitioner, you cannot be disposed to
place your son in the profession, unless you are confident he is
equal to the arduous duty. You will, I trust, not think of placing
him in a situation so loaded with most serious responsibility, unless
you are satisfied, that his mental abilities are such as give a fair
prospect of his obtaining those acquirements, by which he may be
enabled to practice the art of healing, to the greatest extent of
advantage, which the state of medical and chirurgical science will,
admit.

“ Consider, that if he does not manifest abilities, at least equal
to Other young people, the probability is, that his future attainments
may be exceedingly insignificant. Should you, in that case, from
overweening fondness and partiality, or from want of consideration,
choose for him a profession, the object of which is the restoration
of health to mankind, know that, by his inability duly to execute
its functions, he must become the cruel scourge of those who may
-unhappily place in him their confidence, and intrust him with the
preservation of their dearest interests.” — p. 6.

« We will suppose for a moment that a regard for the welfare
of others is not sufficient to prevent a parent from thus disposing of
a son, possessing but ordinary, or less than ordinary abilities. Let
him then reflect on the miserable course of life he has destined his
son to pursue. He strives, perhaps, with unremitting ardour, to
benefit those who call on him for aid; but, from frequency of
failure, he at last takes alarm, revises what is past, and judges it
by the knowledge which daily experience brings him. His mind
is perpetually stung by self-accusation; he perceives that, in spite
of "his utmost exertions, those calamities increase which it is his

145

Parkinson^ Hospital Pupil.

duty, and his most anxious wish, to diminish ; and, with pain he
discovers, that his endeavours are too frequently, not only unsuc¬
cessful, but even injurious. Can it be a matter of surprise then
that he often finds himself agitated with most distressful doubts as
to the mode of conduct to be adopted, when a valuable life is at
Stake ; and that he loads himself with reproaches for having, per¬
haps, augmented through ignorance, those calamities which a man
of more information might have entirely removed. Such must fre¬
quently be his tormenting reflections; but, as he dwells on the
melancholy theme, he most probably will discover, that the parent,
who, to gratify a silly pride, placed before him the unequal task"
in justice, merits the largest portion of reproach/’ — p. 9.

IIow often do we see the truth of the following remarks
exemplified ?

“ Among the errors committed in the choice of an establishment
for a youth, none is, perhaps, fraught with more mischief to the
object whose benefit is thereby proposed, than when a youth of but
small pecuniary resources and but ordinary intellect is disposed of
as an apprentice to an apothecary, under the notion of obtaining
for him a comfortable and genteel situation through life by a trifling
premium. J a

“ Miserable indeed is often the consequence of this miscalcula¬
tion. '1 lie young man having eompleated his apprenticeship, finds
it necessary to enter upon almost a new course of studies ; to pursue
which, with a hope of success, demands pecuniary aid greater than
he can obtain. In consequence he is obliged to give this under¬
taking up entirely, or attempt it under circumstances so narrow and
stinted, as to find at the termination of his attempt, that he has
been obliged to leave so much unlearnt as renders liis entering upon
his professional career presumptuous and unwarrantable.

“ But should extraordinary perseverance overcome these diffi¬
culties, and he be enabled to place himself in a situation promising
of success, his calls for pecuniary help are by no means concluded.
It too often happens that from too youthful an appearance, or some
other unfortunately opposing circumstances, not only months, but
years, are lost before any competent return commences for his
laborious and intense exertions, in acquiring the ability of fulfilling
the important trust which is involved in the duties of his profession.

ee Besides these there is another circumstance which claims the
parents consideration — there is hardly any situation in which the
necessity of keeping up, what is termed a genteel appearance, is
more demanded. If whilst thus waiting for a fair reward of his
labours, the least appearance of shift and poverty is discoverable,
from that moment, it will be only from the influence of some for¬
tunate occurrence that he can be saved from a distressing failure.
When he will painfully lament that the misguiding pride of a parent
had placed his hopes on a slight and unstable foundation/' — p. 29.

These observations apply more directly to young men in¬
tended for general practice; but mutatis mutandis they are equally

VOL. VIII. — no. 44. u

116

Analytical Review.

applicable to those educating to practise as physicians. With
another remark also of our excellent author, we perfectly
a«ree. A youth, possessing ample pecuniary resources, and a
proper degree of application, often loses all the expected advan¬
tages, from the want of a mentor to advise and guide him in
the course of studies which he ought to pursue ; hence, after
years of desultory attention, having completed his education,
he still feels conscious of insufficiency ; and, from ignorance of
the real cause, accuses himself of incapacity for the duty which
he has undertaken : hence disgust and diffidence in practice ;
and hence disappointment is an inevitable consequence.

As Mr. Parkinson's observations are principally intended
for those destined to practise the three branches of the pro¬
fession, he, very naturally, and, in our opinion, very truly ex¬
poses the errors of the system of education usually hitherto
adopted. The binding of youths to the drudgery of an apo¬
thecary's shop for a term of seven years, is certainly a mechanic
usage, and has, too often, injurious effects upon their characters
and future pursuits. In fact, the effects of such a protracted
bondage are indelible. The business of the counter supersedes
all other considerations ; or habits of idleness are contracted ;
and whatever classical attainments may have been acquired, are
forgotten. Young men thus initiated, rarely become proficients
or ornaments to the profession.

Having exposed the faults of the inceptive system of educa¬
tion, the author next, with much modesty, proceeds to detail
that course which he would recommend.

After prescribing a very judicious course of studies, Mr.
Parkinson thus concludes his first letter :

« put the grand point on which I must draw your attention is,
that a young man who has served an apprenticeship to an apothecary
and surgeon, will require that which his friends will be seldom
disposed to allow him — three seasons of lectures • and, at least,
half as long attendance on an hospital, before he can be duly
qualified. This must, of necessity, bring him to the age of four-
and-twenty, when his attainments, in all probability, would not
exceed those of a youth at nineteen, whose education had been
arranged in the mode I described.

“ But although 1 have thus endeavoured to shew you, that the
necessary professional acquirements may be thus attained with more
facility and certainty, than by confining a youth behind a counter
during the term of " an apprenticeship, I by no means intend to
imply that his attendance there is unnecessary. On the contrary,
I should recommend earnestly a twelvemonth’s attendance at least
in the shop of an apothecary, and even a close attention to the
details of the counter.

<s lu guch a situation he will have the opportunity of exercising

147

Parkinson's Hospital Pupil.

and confirming the knowledge he has gained. He will become
more acquainted with the different articles of the materia medica, and
with the results of their different combinations ; and he will almost
hourly meet with and experience the confirmation of some precept,
or the exemplification of some rule of professional practice.

“ Thus, with no more expence, four or five years advance in
knowledge would be obtained ; the advantage of which, through
life, must be immeasurable/’ — p. 73.

The second letter is supposed to be addressed to the youth,
for whose sake he gave to the parent such excellent advice ;
but whose son, notwithstanding, had, according to the ordinary
course, served a long apprenticeship, which being now expired,
lie is in London to walk the hospitals for a year.

Our author here enters fully into the new situation in which
a youth is thrown ; displays with friendly zeal the temptations
to which he will be exposed, and the facility with which the
best intentions are warped, by the association and example of
idle and dissipated companions ; and the inevitable mischiefs
resulting from the procrastination of those duties and studies
to which he ought immediately, and without ceasing, to devote
himself.

After expatiating on the great importance of anatomy,
justly appreciating it as the key-stone of medical knowledge,
whereby the student becomes acquainted with “ the form and
situation of the various organic parts of the system, ” and
pointing out the value of physiology, Mr. Parkinson observes,
that —

“ before you attend to medical, surgical, and clinical lectures,
assure yourself that the easiest part of medicine and surgery, is to
remove curable diseases ; if their natures are but known : and, that
the most difficult task is, to obtain that knowledge which nosology
teaches, by which one disease is distinguished from another. A
moment’s consideration can hardly be wanting, it may be supposed,
to discover this ; and yet I am assured, that it is very common to
see young men, comparatively inattentive, wffiilst the definition and
pathognomonic symptoms of disease are being taught ; and seeming
to reserve themselves for the exercise of all their attention on the
Methodus Medendi. But whoever practices with this species of
knowledge only, has no right to expect satisfactory success. The
practice of medicine, as taught by a lecture, is a collection of infer¬
ences, drawn from previous propositions ; and cannot be fully
understood, unless the mind has possessed itself of those propositions,
and of the mode of reasoning, by which the inferences have been
deduced. Previous to attempting to possess yourself of a mode of
treating diseases, acquire, therefore, a knowledge of those diae;7ios~
tic symptoms, which characterise each disease, and which mark the
difference between those of similar appearances. Learn the nature
of those morbid changes, which form the proximate causes of disease |

v 2

148.

Analytical Review. ■

and inform yourself respecting the various circumstances, which,
become the remote or occasional causes.

cc If, without this previous knowledge, you form to yourself a
system of medical practice, this practice, though founded on the pre¬
cepts delivered from a professor’s chair, will, justly speaking, be only
a system of quackery. You will only acquire a set of rules, applicable
to a certain set of cases, of ordinary occurrence ; whereas the man of
science derives, from his well-conducted studies, certain established
principles, which serve for the foundation of rational and salutary,
general practice ; and which will also assist him, when employing
analogy and comparison, to discover the nature ot such cases as are
marked by uncommon appearances. You will, doubtless, perceive,^
that every thing which I have now said, respecting the necessity ot
obtaining a just knowledge of the nature of disease, in the practice
of medicine, must be equally applicable, in the practice of sur¬
gery.” — p. 107-

He next adverts to the danger of being seduced by the
eclat attending operative surgery; the utility ol clinical in¬
struction ; of chemistry and natural philosophy ; and of other
sciences essential to an accomplished practitioner. What a
store of knowledge would be accumulated, it medical students
would keep in remembrance and adopt our author’s hints !

“ Permit me, here, to suggest one hint or two. Never read
but with your pen in your hand, and your common-place book
beside you, in which you will enter such passages as strike your
mind by their novelty and importance. Besides this, you will do
well to strive, to make your extracts from the more interesting and
valuable books, in the form of a regular analysis : thus you willy
not only secure the individual passages which excite your notice,
but, by placing them in the order of arrangement in which you find
them, you will have them stored in your memory in that order
which will best serve for their future recollection ; and, at the same
time, furnish your mind with a correct impression of the work, as a
whole.

“ Let, at least, one of the books you select for reading he in one
of the dead languages, so that the knowledge you have obtained of
the Greek or Latin may be augmented rather than be suffered to
be lost. The same advice applies, with equal force, to any other
language you may have acquired ; and, indeed, when I consider
the numerous scientific works which are written in the French and.
German tongue, I am obliged to urge you, to endeavour to number
the knowledge of these languages among your accomplishments.”
»~p. 12 b.

The third letter commences with the supposition, that his
studies being completed, the next object of his young friends’
attention, is the professional line he shall pursue.

This part, also, contains some very important remarks,
peculiarly adapted for the consideration of young medical men
just commencing their career in the world ; for they are the off-

Marshall’s Remarks on Arsenic.

149>

spring of actual experience, and the truth of them is within the
scope of every one's observation. Indeed our author here points
out with great force, tire difficulties to which all young practi¬
tioners are commonly exposed when first settling in business.
He concludes with some notice of that most abstruse and perhaps
most neglected in these kingdoms of all departments of science,
medical jurisprudence ; offering such hints as must be useful
in a very high degree to those who cannot be supposed to be
sufficiently informed and cautious, and which may be read by all
with equal pleasure and instruction.

The good sense and parental feeling that pervades the whole
of this little work, is truly characteristic of the author ; who is
as well known in the superior paths of science, as by the many
but humbler, though practical lucubrations, which his prolific
pen has produced.

We know of no greater service that we can render to those
parents and guardians who destine their children or wards for
the medical profession ; or to a student, either on the com¬
mencement or the conclusion of his studies, than the recom¬
mendation of Mr. Parkinson’s Hospital Pupil.

f. - - - - .

hi.

Remarks on Arsenic , considered as a Poison and a Medicine ; to
which are added. Five Cases of Recovery from the Poisonous
Effects of Arsenic : together with the Tests so successfully em¬
ployed, for detecting the White Metallic Oxide ; in which those
satisfactory Methods peculiar to Mr. Hume were principally
adopted , confirmed , and compared with others formerly in Use.
By John Marshall, Member of the Hoy. Coll, of Surgeons
in London, &c. Svo. pp. 1(58. London, 1817. Callow.

The importance of forensic medicine is sufficient to direct
our immediate attention to any work connected with it ; and
although the style of the title page ot the volume before us could
not lead us to anticipate extreme gratification from its perusal,
yet we expected to be recompensed with some additional in¬
formation on the subject ; and from the experiments that the
author had made, which we concluded must necessarily be nu¬
merous, we anticipated at least novelty of remark, both as to
the effects of arsenic on the living frame, and the tests best
adapted for detecting its presence in the dead animal stomach.
Of the extent to which our hopes have been realized, the fol¬
lowing analysis will, we trust, enable our readers to form a cor¬
rect judgment.

Our author was the practitioner who attended the family of
Mr. Turner, of Chancery Lane, which was attempted to be

1 50 Analytical Review.

poisoned, two years ago, by a servant of the name of Eliza Fen*
ning, whose life was for this crime justly forfeited to the injured
laws of her country. As the public opinion was very much
divided respecting the guilt of this misguided female, Mr.
Marshall, immediately after her execution, published a brief
account of the cases ; which, we are informed in the preface to
the present volume, was so well received by the profession, as
to induce the author to publish the edition now under review,
omitting the details of the conduct of the criminal, and retaining
those u occurrences only which are more immediately connected
with medical reasoning, and the history of the cases.1’ The
contents of the volume are divided into twelve articles, each of
which we shall examine in the order of its arrangement.

The first article contains a detailed description of the symp¬
toms and medical treatment of the five cases of poisoning, as
they occurred in the family of Mr. Turner. The following
were the general symptoms as experienced by all the patients :
burning pain in the stomach, which was felt more or less through
the whole course of the oesophagus; vomiting; the matter
ejected in two of the cases being of a peculiar green and yellow
colour ; great thirst ; tension of the abdomen, accompanied,
in some of the patients, with contractions and knotting of the
muscles ; griping pains and purging ; the respiration in one
case was extremely hurried, and accompanied with palpitation
of the heart: the pulse in all was quick, ranging from 120 to
126; but in two cf the patients, when they were first visited,
it was too small and weak to be felt at the wrist. Headache
was a prevailing symptom ; with flushings, and some degree oi
swelling of the face, and intolerance of light. Two of the
sufferers were attacked with vertigo and epilepsy: and in Mr.
Gadsden, the apprentice of Mr. Turner, the epileptic fits came
on regularly every evening for a fortnight; then left him alto¬
gether for a week ; but recurred, and have continued “ up to
the present time.” The same patient also experienced a pecu?
liar trembling of the right arm and leg; and Mr. R. Turner
complained, for nearly six weeks, of a sense of numbness, prick¬
ing, and great weight of both the upper aud lower extremities ;
which, however, immediately subsided in the arms on raising
them 64 in an upright position.” Such were the symptoms.
A summary of them, which ought properly to have followed
tliis article, is given in the eighth article : but the arrangement
of our author is altogether without method. The summary,
in addition to the symptoms we have enumerated, states that
in three of the patients, “ for many weeks afterwards, in at¬
tempting to reach an object by extending either arm,” the fore¬
arm suddenly contracted, u causing them frequently to miss
their aim.” Mr. Turner, senior, felt also for some time u daily

Marshall's Remarks on Arsenic,

151

attacks of a burning sensation in one or both feet f1 and all
the patients “ lost the entire cuticle of their tongues a short
time after they had been poisoned.11 The sensation of itching
mentioned by Orfila, and noticed also by l)r. Itoget, was not
present in any of our author's patients, although the cuticle
peeled off “ in furfuraceous scales.11 One of the most remark¬
able symptoms, the green colour of the fasces, is but slightly
noticed in this summary, although it is dilated upon in the
third article, where it is introduced, pell-mell, amongst the natural
and artificial causes of recovery.

The treatment, the detail of which is given in the first article,
and repeated in the seventh, in despite of all method, before the
summary of the symptoms, was as follows. The stomach of each
patient was cleared by means of copious draughts of warm water,
sweetened with sugar, and a occasionally mixed with milk /’
castor oil was then freely administered, and the purging after¬
wards kept up by a solution of sulphate of magnesia with manna
in mint water.

“ A dose of this purgative mixture/’ says our author, <c was
alternated, every four hours, with a supersaturated saline draught,
in actu effervescentice , allowing the alkali to predominate four grains
to each dose, with the intention of neutralizing any probable remains
of the white oxide, by forming an arsenite of potash, and relieving
the disposition to vomit.” — p. 1 03.

We w ould remark upon this passage, that nothing could be
more injudicious than the allowing the alkali to predominate;
for if any particles of the arsenious acid remained in the stomach,
they would be rendered more soluble by the alkali, and the
sphere of their action increased ; and, with regard to the idea
of neutralizing the white oxide, our author ought to have in¬
formed himself that arsenite of potash is not less powerful as a
poison than the arsenious acid. Among the fluids, also, that
were freely allowed, we observe soda water, which is liable tq
the same objection as the excess of carbonate of potash in the
saline draughts.

The patients were permitted to drink freely of milk and
mutton broth, carefully avoiding to overcharge the stomach, in
drder to prevent the recurrence of vomiting; while beer, wine,
and other fermented liquors, with animal food, were judiciously
interdicted. The camphor mixture was given to allay the
nervous symptoms; and it was. found to be so serviceable, that
we are told the patients <c frequently took it with a degree of
eagerness/1 Our author strongly reprobates the use of emetics,
and properly directs the stomach to be evacuated by distending
it with warm fluids, “ in which magnesia, sugar, honey, treacle,
milk* or any mucilaginous fluids, have been mixed or dissolved,
at discretion :11 while the action of these diluents in exciting

132 ' Analytical Review,

vomiting is directed to be aided “ by tickling the fauces, either
i?itli a feather or the finger.” This mode of evacuating the
stomach is, however, supposed to be necessary only if sponta¬
neous vomiting does not occur : but, in our opinion, the vo¬
miting ought, at all events, to be urged by the irritation of the
fauces; for, if the assistance of the practitioner be demanded
early enough, vomiting is the only method of getting rid of
the arsenic ; arid, unless inflammation be already excited, no
harm can result from urging, much beyond what would spon¬
taneously occur, the inverted action of that viscus. Instead of
the magnesia which our author recommends, we would be dis¬
posed to employ lime water, the arsenite of lime being more in¬
soluble and inert than arsenite of magnesia, and more readily
formed in the stomach, owing to the lime being in a state of
solution.

The second article of the volume contains “ Reflections on
the Natural and Artificial Causes which necessarily contributed
to the Recovery of Patients, with Practical Observations ; and
some Remarks on the Treatment of* Epilepsy.” The recovery
of the patients, whose cases are detailed by Mr. Marshall, are
here ascribed chiefly to the 44 speedy and spontaneous operation
of the arsenic, both as a powerful emetic and purgative
although in the seventh article we are informed, that the suc¬
cessful- issue of the cases was, 44 in a great measure, to be as¬
cribed to the prompt and judicious exhibition of the diluents,
so as fully to evacuate the stomach, employed by the late
Mr. Ogilvy ;” which we think very probable ; for we doubt
whether the spontaneous vomiting and purging would, in
any instance, be sufficient to evacuate the whole of the poi¬
son. Were such the case, arsenic might justly be regarded
as its own antidote. With more probability, some part of
the successful issue is ascribed to the nature of the vehicle,
the yeast dumplings, in which the arsenic was administered ^
for the first action of vomiting must necessarily have dislodged
from the stomach many grains of the poison that never came in
contact with its villous coat, but remained involved in portions of
the undigested dough ; which, in this instance, was fortunately
very heavy and ill-baked. Mr. Marshall states his preference
of the use of purgatives to that of the lancet, even when the
inflammation of the stomach has positively supervened, owing to
their debilitating effects being less than that of bleeding; but, as
the latter remedy was not tried in the instances under review,
it is not improbable, that the convalescence of all the patients
might have been much shortened, had bleeding been resorted
to after the stomach and bowels were freely evacuated ; and
more particularly that of Mr. Turner’s apprentice, Mr. Gads¬
den, who, although he ate a very small portion only of the

153

/ , . . „

Marshall V Remark# on ArseniCo

- - v

dumplings, suffered more severely than any of the others. He
had previously dined on a beef-steak pie, and his greater suffer¬
ings are ascribed to the charged state of the stomach, preventing
_ the vomiting from occurring for an hour after the poison had
been swallowed, and the minuteness of the quantity not allowing
it to exert fully its emetic and purgative action. This young
man, however, vomited 46 almost without intermission” during
the whole time occupied in passing in a coach from Vauxbajl
to Chancery Lane ; and as he was afterwards treated with dilu¬
ents and purgatives in the same manner as the other patients,
we may reasonably suppose the violence of the symytoms, as
they occurred in him, must be attributed to some other cause.
Something may have depended on peculiarity of habit, and
something on the nature of his dinner, particularly if the pie
was fat ; for in the experiments of Eourcroy and of Renault,
animals to whom the white oxide of arsenic mixed with butter
or fat, was administered, died much sooner than those to whom
it was given in combination with any other substance.

We cannot avoid here again remarking the singular con¬
fusion of Mr. Marshall’s arrangement ; the greater part of
this article, notwithstanding its title, being taken up with the
detail of symptoms, instead of that of the causes of recovery.
The remarks on the treatment of epilepsy, merely shew, that
the author’s experience has not led him, to place any confidence
in the use of the lancet; and that l)r. Plenderleath has informed
him he has found the oil of turpentine, “in doses of thirty
drops, ter quotidie , rubbed down with mucilage and mint water,”
succeed in many instances in speedily reducing the fit from
twice a day to once a day, and in effectually curing the disease
in two or three days. We have not, lately, had any communi¬
cations on the effects of this remedy in thediands of other prac¬
titioners ; but, from our own experience, we doubt its efficacy
in idiopathic epilepsy ; and imagine, as Mr. Marshall himself
suggests, that “ possibly some of the patients mentioned by
Dr. Plenderleath have laboured under taenia” or other visceral
irritation arising from worms.

The third article is intitied “Arsenic considered as amedicine;
together with the relation of some extraordinary and novel effects
produced by its administration in the medicinal form of Dr.
Fowler’s solution.” In this section our author mentions the
case of the son of a nobleman who 44 has been severely afflicted
with epileptic fits,” in consequence of the too long continued use
of Fowler’s arsenical solution, which was prescribed for an inter¬
mittent disease: and notices two other cases, on the authority of
Dr. Johnson of Weymouth, in which paralysis of both sets of
the extremities supervened on giving the arsenical solution m
the usual dose for ten days only. A detail of some trials of
vol, viii. — no. 44 x

154* Analytical Review.

the arsenical solution in ague, by Mr. Gregg, Surgeon to the
Second Royal Surry Regiment of Militia, is also brought for-*
ward to shew the deleterious effects of this remedy ; but our
readers will not be surprised that it excited nausea, pain or the
head and stomach, dimness of sight, and anasarcous swellings,
when we inform them that the dose was carried to the extent of
sixteen drops three times aday. Such are the slender materials on
which our author ventures to suggest,that the real advantages to
be expected from the employment of arsenic as a iemeciy,aie pro¬
bably “ scarcely sufficient to compensate for its injurious effects.’'
Now it is unnecessary to point out to the profession, that the ad¬
vantages or disadvantages to be expected from any remedy, de¬
pend much on the circumstances under which it is exhibited; but
we would inform our author that the statement of the cases he
has brought forward is so loose, that no correct inferences can
be drawn from them ; and although they may have the effect
of prejudicing a general reader against the use of a valuable
remedy, yet they are not likely to influence, in any degree, the
mind, or the practice of [an intelligent and properly educated
practitioner. The effects of the remedy in the three first cases
evidently depended on idiosyncracy ; and in the account of
Mr. Gregg's experiments, we are neither told of the peculiar
circumstances under which the remedy proved not only ineffica¬
cious, but prejudicial/ nor are we informed whether the symp¬
toms it is said to have occasioned were of a transitory nature,
disappearing after the use of the arsenic was discontinued, or
were permanent. We might indeed suspect the latiei to ha\ e
been the case, from the following specimen of our author's
pathological reasoning.

« It does not at present appear that two of these diseases” (epi¬
lepsy, paralysis, cedematous swellings, and dimness of sight) excited
by arsenic, are likely to assail the same subject, except cedematous
swellings and dimness of sight, which, in all probability, are depend¬
ing upon a general anasarcous affection operating upon the system,
which, though sufficiently evident upon the extremities, may also
be accompanied with hydrocephalus interims, and, by pressure upon
the optic nerves, cause the dimness of sight, a symptom usually
attending that diseased action ol the ventricles tne main, but ak*
quently amounting to total darkness.” — p. 6l.

To prevent the deleterious effects of arsenic, when employed
as a remedy, Mr. Marshall proposes

to administer it in the usual doses for seven or eight days ; tnen to
allow an interval of four or five ere it is resumed ; and during the
cessation of the arsenical solution, if, for example’s sake, the disease
under cure be an intermittent, after a purgative, let bark, or the
sulphas ferri, with infusum quassice, be substituted : by such a method
the risk of incurring mischief might possibly be obviated. - p. 62.

Mar shaiFs Remarks on Arsenic.

155

And we may add, the chance, also, of curing the disease
reduced almost to a shadow. But it is unnecessary for us to
combat the authors groundless alarms, the fourth article of the
• volume being a complete answer to the third, and ending with
the following sentence, a due consideration of which by our
author might have saved him the trouble of composing at least
one section of his work.

“ That essential benefit,” he remarks, “ is derivable from arsenic
in a variety of diseases incidental to the human frame, is beyond all
doubt ; and while its application is restrained within bounds, I am
satisfied no adverse symptoms will arise, or hazard the patient to
the severe attacks it is capable of exhibiting.”

Bergmans opinion regarding the solubility of white oxide
of arsenic, which has been copied by the majority of chemical
writers without examination, is adopted also by our author; who
states that one part is soluble in fifteen parts of boiling water,
■and in eighty of cold water. Klaproth’s experiments, however,
have shewn the inaccuracy of this opinion; one part of the
white oxide requiring four hundred parts of water at 59° Fah.
for its solution ; although one hundred parts of water, which
has been boiled on white oxide of arsenic and cooled down to
59°, retain three grains of the oxide in solution*. This fact is
of importance, as it displays the necessity of employing boiling
water in examining the vomited matters and the contents of
the stomach, in cases of poisoning by arsenic.

As coinciding with his own practice in administering the arse¬
nical solution, our author quotes the practice of Dr. Brown, “ an
able and experienced practitioner,'1' who, we are informed, in pres¬
cribing the solution, has uniformly “commenced with three drops,
and restricted the dose to five, twice a day ;” that is, to of a grain
of the oxide for a dose: and yet, two pages further on, we are in¬
formed that one of the Doctor’s patients took of a grain twice a
day for seven months, with impunity. The following is said to
be an exact copy of the recipe ; although, for the credit of the
Doctor’s latinity, we should hope this is not strictly the case.

& Extracti humuli, 3ss.

Pul vis opii, gr. ii.

Olei caryoph. gr. iij.

Arsenici oxidi sublimati, gr. i.

Pu'lvis zingiberis, q. s. — Miace ut fiant pilulse x
quarum sumatur xma bis quotidie.

The fifth article is intended to recommend magnesia u as a
remedy to counteract the deleterious effects of arsenic.” The
common carbonate of magnesia is said to he one of the best

* Repository , vol. ii. p. 250 ; and Stkiveigger’ s Journal , vol, vi. 232.

v Q ,

A .v

156

Analytical Review.

remedies u to restrain, if possible, tbe action of arsenic;” and,
by forming an arsenite of magnesia, “ tna.y probably be found
fully adequate to check the baneful tendency of its effects upon
the human frame, as has been variously exemplified.” Now
we confess we are perfectly at a loss to comprehend the author's
meaning ; the words if possible and probably leaving the recom¬
mendation so indefinite, that the author does not commit him¬
self; while, at the same time, the expression variously exemplified
would lead one to suppose, that the good effects of magnesia as an
antidote of arsenic had been really demonstrated. We are, how¬
ever, ignorant of any such circumstance; and the opinion of Mf.
Hume, who, our author informs us, “ prefers it to any other oi
the earths, or even to the fixed alkalies,” has no influence with
us, as he does not shew us that that opinion has been formed
on sufficient and tenable grounds. Even the recommendation,
or rather suggestion, of Dr. Thomas Percival, quoted by Mr.
Marshall, however highly we respect the memory of Dr. Per¬
cival, goes for nought on this occasion ; for we do not admit that
calcined magnesia decomposes the white oxide of arsenic, with
Which it on the contrary combines, and forms a soluble arsenite
of magnesia, which, our author has asserted, acts feebly “on the
human frame;” but without advancing a single proof in sup¬
port of his assertion. The opinion in favour of lime water is given
on the authority of Orfila, who, unlike our author and Mr. Hume,
did not advance it, until he had proved by experiment that the
arsenite of lime, formed by pouring lime water into a solution
of white oxide of arsenic, is insoluble, and, when swallowed,
is not poisonous. Indeed, tlvjs opinion might, a priori, have
been ventured ; for it may be regarded almost as a general law,
that substances of equal powers, as poisons, exert their influence
with more effect, the more readily they are dissolved in the sto¬
mach. We cannot avoid remarking here, that no part of the
Volume shews the careless manner in which the author has
received the statements he has advanced, more conspicuously,
than a note in the page now open before us, which states that
the insolubility of arsenite of lime, as mentioned by Orfila,

ic is contrary to Mr. Hume’s experiments; for he has proved that
lime will form a soluble salt, and may be employed in place of any
alkali to detect arsenic.” — p. 79-

This is more inexcusable, as be bad only to pour some
lime water into a solution of arsenic, to obtain the insoluble
arsenite of lime, which is thrown down in the form of a white
fiocculent precipitate It is true, indeed, that no precipitate
falls when a small quantity only of lime water is employed, the
sub-arsenite of lime being soluble ; but by continuing to add it,
the mixture soon becomes milky, and the insoluble neutral
arsenite is formed.

15T

Marshall’? Remarks of Arsenic.

With the view of determining the comparative solubility
of the arsenites of lime and of magnesia, we prepared these
salts, by boiling together for half an hour four grains of
quick-lime and two grains of white oxide of arsenic in one
ounce of water ; and, in another vessel, the same proportions
of magnesia, white oxide of arsenic, and water ; and filtered
the solutions. The fluid in which the lime and arsenic were
boiled, when tested with ammoniaco nitrate of silver and am¬
moniac/) sulphate of copper, displayed no appearance which
could indicate the presence of arsenic, the precipitates thrown
down being the same as those produced in lime water by these
tests ; while in the fluid in which the magnesia and arsenic
were boiled, an instantaneous and copious bright yellow pre¬
cipitate was formed by the nitrate, and a bright green by the
sulphate. Reasoning on these results, and drawing an analo¬
gical deduction from the effects of the arsenites of the alkalies,
we were led to infer that arsenite of magnesia, being very
soluble, is nearly as poisonous as arsenic itself; while the
little solubility or complete insolubility of arsenite of lime
might render it much less active, if not altogether inert.
But as the determination of this point was an object of some
practical utility, we made the following experiments, with the
view of Ailing up Mr. Marshall’s deficiencies, and satisfying our
own minds.

Experiment 1. A scruple of white oxide of arsenic and
a drachm of prepared chalk were rubbed together with a small
quantity of mucilage and about an ounce of water, and intro¬
duced into the stomach of a strong male cat. He did not seem
to suffer any inconvenience ; and, apparently, would have sur¬
vived, had not the same quantity of the white oxide, suspended
in a little mucilage without any chalk, been introduced into his
stomach about an hour and a half afterwards, which quickly
displayed its effects and destroyed the animal.

Experiment 2. Three grains of white oxide of arsenic and
and six of sub-carbonate of magnesia, rubbed together, with a
little mucilage and about three drachms of water, were injected
through a gum elastic tube into the stomach of a rabbit. The
animal appeared almost instantaneously convulsed, and died in
one minute afterwards. On opening the stomach, it appeared
slightly inflamed only at and near the cardiac portion: the
immediate cause of the suddenness of the death not being ren¬
dered evident by the dissection.

Experiment 3. The precipitate obtained by pouring lime
water into a solution of three grains of arsenic, was col¬
lected ; and, with about three drachms of the supernatant fluid
injected into the stomach of a rabbit. The animal did not
suffer the least inconvenience ; nor was any alteration produced

15$

Analytical Review.

on injecting into the stomach of the same rabbit, an Lou?
afterwards, a mixture of three grains of the white oxide, and
nine grains of chalk, well rubbed together in three drachms of
water with a little mucilage.

Experiment 4. A similar mixture of arsenic and magnesia,
as employed in the second experiment, was, an hour after the in¬
jection of the chalk and arsenic, thrown into the stomach of the
rabbit used in the third experiment. Little effect was apparent
for some time; but in less than three quarters of an hour, it
became violently convulsed, uttered several piercing cries, and
died. On opening the stomach, it presented marks of high in¬
flammation as far as the pyloric portion, where the redness
suddenly terminated.

From these experiments we conceive we may justly infer,
that instead of magnesia proving an antidote in cases of poison¬
ing by arsenic, the arsemte of magnesia is, itself 9 a virulent
poison ; while chalk and lime water destroy the deleterious
effects of an over-dose of a solution of the white oxide, if
taken in time ; and are likely even to suspend or lessen the
action of the poison swallowed in a solid form, if aided by
plentiful dilution. "We are fully aware, that the effects of poi¬
sons on the stomachs of the lower animals, do not always cor¬
respond with those produced on that of man ; but even were
this admitted to effect the present case, these experiments at
least fully demonstrate the activity of arsemte of magnesia
on the stomach of the same kind of animal to be much greater
than that of arsemte of lime. But to return to our author :

The sixth article treats of 44 a variety of analytical ex¬
periments upon arsenic,” particularly with Mr. Hume’s test,
in the first sentence of this article we are informed, that the
arsenic 44 was collected in so palpable a form in the yeast
dumplings,” that it became wholly unnecessary to analize the
fluid ejected from the stomachs of these patients, (Mr. Turner’s
family). Now we must strongly protest against this method of
.supplying medical evidence. Whatever was the state ol the
dumplings and the 44 scrapings of the dish in which they were
kneaded,” the matters vomited by the patients ought to have
been carefully tested, in order to substantiate the fact, that the
symptoms were actually the effects of the presence of arsenic
in the stomach. We do not mean to raise the slightest doubt
of the propriety of Eliza Fenning’s sentence; on the contrary,
we believe that she justly paid the forfeit of her crime ; but we
would have medical men to reflect on the serious nature of their
employment, in collecting the materials of evidence that must
effect the life of an individual; and to consider, that by confidence
in their skill and accuracy, the judge is directed in making
his charge, and the jury influenced in forming their decision.

Marshall's Remarks on Arsenic.

159

As the evidence of the presence of arsenic in the dumplings
Was unequivocally made out, we shall therefore offer a few ob¬
servations on the mode only of conducting some of the expe¬
riments.

With regard to the silvery white appearance of the upper
surface of the polished halfpenny, on which a portion of one of
the dumplings was reduced to a cinder, which our author re¬
gards as a “ satisfactory and positive proof,1’ we would remark,
that the suet and carbonaceous matter of the dumplings when
thus treated, would whiten copper; and that it is as proper, as
Dr. Bostock has advised*, to rub the copper after being used
with fine sand, and then with soft chalk ; when, if the silvery,
whiteness remain, the presence of arsenic as the cause may be
correctly inferred. The same remark, howerer, does not apply
to our author’s experiment with the oxide alone heated between
two polished plates of copper.

In an eulogy on Mr. Hume, our author thus expresses
himself. <k Whereas the ammoniaco nitrate of silver, and the
ammoniaco sulphate of copper, the discoveries of Mr. Hume,'’ &c.
On this passage we must observe, that at least the first of these
tests cannot strictly be said to be the discovery of Mr. Hume. To
this chemist is certainly due the discovery of nitrate of silver as
a test of arsenic in solution with potash ; but the use of the
ammoniaco-nitrate was undoubtedly first suggested by Dr.
Marcet. The test of the ammoniaco-sulphate of copper is simply
a modification of Scheele’s test of sulphate of copper added to
a mixed solution of white oxide of arsenic and potash. Al¬
though we have been induced from our experiments to prefer
this test to the ammoniaco-nitrate of silver in examining vo¬
mited matters, or the actual contents of the stomach, for which
we shall afterwards state our reasons, yet, it must be remarked,
that it fails when the solution is too concentrated ; a fact, not
noticed by Mr. Marshall. These experiments, and heating the
white oxide so as to obtain the alliaceous odour, were all that
were tried ; and they were amply sufficient, as more than half a
tea-spoonful of the arsenic was obtained from the earthen pan
in which the dumplings had been kneaded. The forme he for
preparing the ammoniaco-nitrate of silver and the ammoniaco-
sulphate of copper , are added to this section of the volume ; and
we extract them for the benefit of some of our readers.

“ Ammoniaco A itrate of Silver.

(C Dissolve a few grains, say ten, of the nitrate of silver, com**
monly called lunar caustic, in about nine or ten times its weight of
distilled water ; to this add, by a drop at a time, some liquid am-

* Edinburgh Medical and Surgical Journal, vol, v. p. 173.

Analytical Review ,

mam, till a precipitate is formed. Continue cautiously to add the
ammonia, now and then shaking the bottle, till the precipitate shall
be nearly taken up, and the solution again become transparent, or
nearly so, as the ammonia need not be in great excess, if in any.”— -

P- 99* ' ' ' ' '

(C Ammoniaco Sulphate of Copper.

iC Let a little liquid ammonia be dropt into a saturated solution
of sulphate of copper, or common blue vitriol, until a precipitate
be formed ; then continue to add the ammonia by degrees, when
presently the precipitate will be perfectly dissolved, and the solution
will become of a rich elegant deep blue cnlour, and perfectly trans¬
parent/’ — p. 101.

Our author gives several other tests, chiefly on the authority
of Mr. Hume ; but we confess we afe unreasonable enough to
think, that an exposition of all that have been proposed, with a
practical examination of the relative value of each, should have
been attempted. In addition to those mentioned by Orfila, who
is more complete than any other writer on this subject, we may
notice, that we have tried Brugnatellfs azure tincture* but it has
altogether failed in our hands ; and the method of using lunar
caustic, proposed by Dr. Parish, appears to us to involve too
much ambiguity to obtain general confidence. There is no occa¬
sion, however, for increasing the catalogue of tests for detecting
the presence of the white oxide of arsenic, when it has not been
taken into the stomach ; but, when this has been the case, the
most delicate tests often afford us no assistance, or, at best, offer
but dubious results. With the view of ascertaining which of
the more approved tests, now in use, is to be preferred, we
made the following experiments :

Experiment 1. A bull-dog puppy, six weeks old, was killed
by injecting into its stomach, through a flexible tube intro¬
duced by the mouth, a mucilaginous mixture, containing about
two scruples of white oxide of arsenic, in two different doses.
The animal vomited soon after receiving the first dose ; but the
second was retained. The matter ejected by vomiting having
been washed in hot water and filtered, the fluid, when tested,
exhibited the following results :• — with am moniaco-sul ph ate of
copper, a copious green precipitate was thrown down: — with am-
moniaco-nitrate of silver, the precipitate was of a dubious charac¬
ter, being at first a very pale yellow colour, which was rapidly
obseured by a dirty white that could not be altered by the
means recommended by Dr. MarcetJ, for removing the muriate
of silver, formed from the muriates frequently present in the

* Giorn. di Fisica, ix. p. 465 ; and Repository , vol. viii. p. 73.

t For an account of this method, see the section Intelligence of
the present Number. % Mcdico-Gkirtirg. Trans, vol. iii. p. 346.

Marshall^ Remarks on Arsenic.

161

stomach. With lime water, a copious white insoluble precipi¬
tate was produced. The stomach and its contents being washed
in the same manner as the vomited matter, the filtered fluid be¬
came green on the addition of ammoniaco-sulphate of copper ;
but no precipitate fell until after some hours had elapsed, and
even then it was scarcely perceptible ; the ammoniaco-nitrate
threw down merely a dirty white precipitate, which changed to
a purplish black on standing exposed to the light : lime water
occasioned a very scanty -white precipitate.

Experiment 2. A strong male cat was killed by two
drachms of white oxide ol arsenic, exhibited in two separate
doses, in the same manner as in the last experiment. He vo¬
mited twice before death. The Altered fluid, from the washings
of the stomach, yielded a slight green dubious precipitate on
the addition of the ammoniaco-sulphate ; and, with the amrao-
niaco-nitrate, a dirty white, or chiefly muriate of silver ; lime
water produced no effect.

These experiments demonstate, in some degree, the extreme
difficulty of detecting arsenic in the contents ,of the stomach
after death; and the necessity of carefully testing the vomited
matters. They also prove the ambiguity of the results pro¬
duced by ammoniaco-nitrate of silver employed as a test, when
muriates and animal juices are present. The ammoniaco-sul¬
phate of copper is certainly the most delicate test of the three
which we have tried ; but we should scarcely he led to draw
decisive conclusions in a case of poisoning, even when the green
precipitate appears, unless we obtained the arsenic in a metal¬
lic form, by mixing the precipitate dried, with equal parts of
carbonate of potash and charcoal, and a drop of oil, and subli¬
ming the paste in a small test tube, by the heat of a spirit lamp.
Whatever be the methods adopted, the results should be com¬
pared with those obtained from solutions really known to contain
arsenic.

We have already examined the seventh and eighth articles.
The ninth details some trivial “ experiments with arsenic upon
human bile,'1 which lead to no useful inferences; while the
tenth and eleventh are intended to prove the safety and utility
of using the white oxide of arsenic, combined with unctuous
substances, in the form of an ointment, as an escharotic to open
cancers .; and the danger of applying it in solution, or in the
form of a lotion, to abraded surfaces. For the sake of those
who may wish to try our author’s ointment, we subjoin an
exact copy of his formula.

Vk Unguenti cetacei, § j,

Arsenici oxidi albi,

Sulphuris loti, ana B j.

jVIisce flat unguentum, pars affecta pro re nata applieandum,

VOL. VIII. — NO. 44. Y

Analytical Review.

162

The twelfth and last article contains a summary of the me¬
thod to be pursued in examining a suspected case of poisoning
by arsenic, 66 whether antecedent or posterior to dissolution.”
It is drawn up in the most careless manner, and clearly demon¬
strates that the author has made no experiments on animals to
verify the utility of the methods he is desirous of recommending;
for had he done so, he would have found, on examining the
matter vomited, that the Cf fine yellow cloud,” far from being
produced as it is in a simple solution of arsenic, is often so
much obscured by muriate of silver, as to be scarcely recogniz¬
able, even when arsenic is really present. No notice is taken
of Dr. Marcefs method of removing this obstacle ; and, indeed,
our author does not appear to have been aware of its existence.
In the event of not finding arsenic in the contents of the sto¬
mach, when examined post mortem , we are directed to boil a
divided portion of it in rain or distilled water, and to submit
the fluid, when filtered, to chemical examination. To this
method we would suggest, as an objection, that the corrugation
of the portion of the stomach by the boiling may envelope, so
completely, in its substance the particles of the white oxide as' to
prevent the water from acting on them ; an obstacle which is al¬
together removed by cutting the stomach into shreds and boiling
it, as directed by Hose*, in conjunction with caustic potash, or,
as we would suggest, in much diluted liquor potassae ; by which
means the stomach is partly dissolved, and the arsenic, if any
be present, combined and saturated with the alkali. The re¬
mainder of Hose's plan consists in boiling the filtered fluid,
adding at intervals a little nitric acid, until it becomes of a
bright yellow colour ; then filtering again and saturating the
acid with carbonate of lime. A small portion of the arsemte
thus formed being precipitated by boiling water, to -expel any
remains of carbonic acid, and then washed and dried, is readily
decomposed by heating it to redness, in conjunction with half its
weight of borax, in a coated tube, and the arsenic is sublimed
in its metallic state. The olive green appearance of the alvine
contents, and the swollen state of the abdomen, which our au¬
thor conceives 64 imply a strong presumptive inference or sus¬
picion” that the death of the individual has been caused by the
administration of arsenic, are likely to be produced by so many
other causes, that, even when the suspicions are otherwise cor¬
roborated, these indications can scarcely be regarded as of any
importance. The directions to inspect the mouth, tongue, and
oesophagus, as far as the cardia, when no proofs of the presence

* Vide Journal fur de Chemie und Physik herausgegebm von
Gelilen, bol. ii. s. 665 .

Marshall’* Remarks on Arsenic. 163

of the poison are found in the stomach, are judicious and im¬
portant.

The appendix contains an interesting experimental inves¬
tigation of the effects of the two principal tests recommended
by our author on decoctions of onions. He found that the
amtnoniaco nitrate of silver strikes a yelloiv colour, which gra¬
dually degenerates to a dark red , when it is added to a filtered
decoction of onions ; but no precipitate is produced ; the mix¬
ture, on the contrary, remains perfectly transparent ; the am-
moniaco sulphate of copper in a similar manner produces a
grass green colour, in the same vegetable decoction, but also
without any precipitate. These characteristics are sufficiently
distinctive in pointing out the difference of action of a decoc¬
tion of onions and a solution of white oxide of arsenic on these
tests. Our author was induced to make the experiments that
afforded these results, in consequence of reading the contra¬
dictory medical evidence given on a trial for murder, at the
Lent Assizes for 1817, held at Launceston, in Cornwall : and
he afterwards repeated the experiments precisely u after the
mauner described in the medical evidence adduced at the trial;”
but the results which he obtained had no similitude whatever to
those that would have followed, from treating a solution of
arsenic in the same manner. For these inquiries the thanks of
the profession are certainly due to Mr. Marshall. — 0, si sic
omnia !

Our readers will have already collected our opinion of the
contents of this volume. Were we disposed to give specimens
which display the most flagrant neglect of the common rules
of grammar and of composition, we should find ample matter
in almost every page ; but we do not wish to draw out
farther the frailties of the work. We cannot however avoid
remarking, as we have done on some former occasions, that
although elegance of style be riot an essential quality in medical
writing, yet, the literary productions of the members of a pro¬
fession, which is dignified with the title of learned , cannot be
excused any direct outrages against grammatical construction*
We sincerely lament the necessity of these animadversions;
but to suffer such a work to pass uncensured would be
productive of two serious evils. In the first place, it would
afford an example of the most dangerous tendency to the
student ; and in the second place, would deservedly reflect
discredit on the profession itself ; which can maintain the high
reputation it has acquired in this country, as long only as its
members appear capable of forwarding its utility, and uphold¬
ing its respectability and dignity by their erudition and science,

SELEC TIONS postponed for want of room ,

164

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

anatomy, physiology, practice of medicine, and

SURGERY.

X.— .We are muck pleased in being able to lay before our readers
a' renewal of Dr. Granville’s communications, “ On the present
State and Progress of Medicine in France From the period
at which the correspondence recommences, some circumstances
necessarily fall under his observation which have ahead\ been
noticed in the Repository.

LETTER IV.

« My short absence of two months from Paris has neces¬
sarily interrupted my correspondence. In my conversations
with yourself*, and some of the leading medical characters,
during my late visit in London, I have indeed followed up the
progressive narrative, which it is the object ot these letteis to
give you, respecting all that is doing in this country connected
with the study and practice of medical science. Put the kind
of promise I "have made to your readers of acquainting them
with any important facts that may occur to me while I remain in
Paris, with regard to the French practice of medicine, induces
me again to take up my communications at the precise point
where I left them.

« a collection of well-authenticated cases, corroborating
what has hitherto been advanced respecting the medical pro¬
perties of the mix vomica , must be a desirable circumstance for
the profession in general on your side of the water, I shall
begin this letter by informing*you that Professor Dumeril has
had occasion to administer the remedy in question to a woman
aged about 40, affected by a complete paralysis of the abdo¬
minal extremities ; and in whom all sort of motion of the dis¬
eased parts had been found impracticable. The effects he has
obtained from this medicine have heed most satisfactory ; and
the patient is now able to get out of her bed1 without any assist¬
ance, and likewise to stand a short while on her legs without

* These letters are addressed to one of the Editors.

Cranville on the present State of Medical Science in Prance. 1 (x>

tottering. He is, at this moment, giving her five grains of the
alcoholic extract; which seem to excite so much internal action,
particularly by promoting a considerable sensation of heat in
‘the spine, that the patient has requested the dose might not be
increased further. It is well to observe that she had been try¬
ing every sort of medicines before with no effect. .At the same
time I must not conceal that a similar experiment, tried on the
relative of an eminent chemist, my intimate friend, even for a
long period, has completely failed in procuring him even the
slightest relief.

" “ The history of the woman in whose stomach a polypous
tumour was found after death, as I mentioned to you, is this
. — She entered the Hotel Dieu last February, to be treated for
a chronic diarrhoea, which had greatly reduced her, and' which
had lasted several years. Proper treatment was had recourse
* to ; but with no advantageous result. The ejections became
-daily more numerous ; the patient fell into a state of marasmus
and complete adynamy ; when at last she died, aged 64. ^ On
examining the body after death, a general inflammation of the
intestines was observable, and ulcerations were found spread"
here and there on their surface. On laying open the stomach
in the direction of its anterior and abdominal border, from the
eardia to the pylorus, a tumour of an extraordinary nature pre¬
sented itself to view. Tiiis tumour, implanted on the posterior
border of the stomach, a short distance from the eardia, was
cylindrical and six inches in length. Its diameter was various
in different parts ; above an inch at its origin, and three quarters’1
where it assumed a tapering form towards the pylorus, into
which opening it penetrated, and seemed completely to fill it,
by which it had suffered a considerable and protracted con¬
striction, from the action of the sphincter of that orifice, so as
1 to leave a deep impression on the tumour at about two inches
distance from its loose extremity. The tumour was wholly
covered by a mucous membrane, being a prolongation of that
which lines the stomach. The colour of this membrane was of
a livid and even black tinge in some places, while it appeared of
a grey-red in others. No difficulty was experienced m detach¬
ing it from the body of the tumour. The latter was evidently
organised on its surface, where the most beautiful ramifications
of large and small vessels were perceived. On dissection, how¬
ever, the tumour was found to consist of a dense, red, fleshy
substance, becoming livid, and even white at its base. It was
ascertained that the woman had never had any particular com¬
plaint which could be ascribed to the presence of so considerable
a foreign body in the stomach. Nor could any fact be brought
to light by which any conjecture might be formed respecting
the origin of this extraordinary vegetation.

1 66 Foreign Medical Science and Literature.

i( Who has not heard of die malaria of some parts of Italy
and other marshy countries? The conjectures respecting the
mode of action of the miasmata on the human body in sucli
cases, have been as desultory as they have been numerous.
Nor have the means proposed to avoid its bad effects, had
a better success. Monsieur Delile now comes forward, and
from numerous personal inquiries arid actual observation, pre¬
tends to have ascertained, that what constitutes the malaria ,
is the constant and regular series of emanations from decom¬
posing animal and vegetable substances, on which the powerful
sun of the preceding summer had been acting. That these in¬
visible atoms spread and mix in the air, with which they are
drawn into the lungs, and penetrate into the cavities of the
nose; and that the best method of preventing this, would be
to sift the air to be breathed, which might be done by wearing

a fine silk gauze to cover the nostrils and the mouth. The

• ^ ' c

miasmata are heavier than the air, and are therefore always to be
found in the lower strata. A very high place of residence in
countries infested by malaria , would of course be a perfect
security from its influence. The author had an opportunity
of making some experiments near Rome and at the Pontine
Marshes ; he there found that an elevation of 300 yards was a
complete security from infection. Watery vapours are, accord¬
ing to him, the true vehicle of the miasmata ; hence the bad
effects of dews, fogs, &c. ; and the very curious circumstance
that the middle of towns is often more salubrious than the
suburbs. The pituitous membranes and the adjacent parts,
are considered by M. Delile as the organs on which the mias¬
mata first accumulate, till they have acquired sufficient power
to infect the whole system.

“ \ ou must recollect the experiment by which Dr. Majendie
endeavoured to shew, that the stomach in vomiting, is nearly
passive, and that the diaphragm and abdominal muscles are the
only agents in that phenomenon. In some of those experi¬
ments he even pushed the demonstration so far, as to substitute
a bladder in place of the stomach, which had been removed in
a dog; when, by exciting the action of the above-mentioned
muscles, vomiting was produced, or the ejection of the coloured
liquid contained in the bladder. Dr. Portal now comes for¬
ward with other experiments on his side, to prove that Dr.
Majendie’s general assertion was too hasty — that vomiting begins
by a particular action of the stomach, as commonly supposed
by physiologists in general, and is further continued by the
action of the abdominal muscles and diaphragm ; but, that in
many cases, the latter are by no means necessary ; as lie state?
having ascertained, that vomiting may be produced in the sto¬
mach, where the abdominal parietes have been removed ; a fact.

Granville on the present State of Medical Science in France. 167

which he had occasion to observe in an experiment made for that
purpose.

44 A very interesting paper, detailing some physiological
•experiments relative to the injection of medicated fluids into the
trachea and lungs, written by a German Doctor, whose name I
do not recollect, having fallen into the hands of Dr. Majendie,
he determined to repeat them at one of the lectures which he
has been giving to a small number of pupils, on a few physiolo¬
gical subjects illustrated by experiment. I was present on this
occasion ; and as the results are both interesting, and somewhat
different from those said to have been obtained by the author, I
shall briefly relate them to you.

. “ The first proposition of the author is this, that if a sharp-
pointed body be introduced into the trachea, it will cause a
much greater symptom of irritation when turned upwards, so
as to stimulate the larynx, than when it is plunged in any of
the bronchia.

44 Experiment 1. A dog of middle size, strong, and lively,
was submitted to the operation of tracheotomy ; the anterior
.halt of one of the rings was cut out, and a long probe intro¬
duced first downwards into the left lung. A spasmodic action
of the trachea took place, and great efforts for coughing suc¬
ceeded each contact of the instrument. On turning the latter
upwards, and on reaching the larynx, strong movements of
deglutition were excited, terminating in fits of coughing as
numerous as in the first period of the experiment. The same
phenomena occurred when the probe was plunged into the right
lung. An ounce of common water being now injected %y
means of a syringe through the opening into the trachea, seve¬
ral convulsive efforts were excited : and the animal being set at
liberty, coughed violently, by which a portion only of the in¬
jected fluid was thrown out through the wound. The dog did
not, in other respects, shew any particular symptom of un¬
easiness, and walked off very nimbly to another part of the
room.

44 Experiment 2. A larger dog was now submitted to the
same operation ; but here no ring of the trachea was removed
as the opening was made through the crico-thyroidean cartilage.
rI he introduction of the probe, directed first downwards and
next upwards, produced exactly the same phenomena described
in the first experiment. An ounce and a half of solution of
tartaric emetic was next injected. Two minutes elapsed, when
signs of nausea were clearly exhibited by the animal. In six
minutes the efforts for vomiting became very strong ; and the
contents of the stomach were ejected.

“ Experiment 3. A third dog, when stimulated upwards
and downwards by the probe passed into the trachea, presented

.68

Foreign Medical Science and Literature ,

the same symptoms as well as strong movements of degluti¬
tion, which are manifested by a curious vermicular action begin¬
ning at the pharynx and proceeding downwards, swelling as
it passes the different portions of the oesophagus, and raising
the trachea placed immediately over them in the recumbent
position of the animal. One ounce and a half of an aqueous
solution of extract of mix vomica being afterwards injected,
the dog gave three or four strong jumps, fell in twenty seconds
on its "side, as if struck by lightning ; and, after many strong
convulsive fits, expired.

“ Experiment 4. A small quantity of diluted muriatic
acid was injected into the lungs of the dog (Experiment 1).
He fell on his back instantly, with expressions of extreme and
acute pain, accompanied by shrill and piercing screams of dis¬
tress. " In about a minute he arose on his legs, but again fell
backwards ; and, after a long and peculiar agitation of the fore
legs, died.

~ On opening the dog killed by the injected solution’ of mix
vomica, the trachea was found frothy: the iu-ngs hepatized $
and tire cavities of the heart full of blood. The author pre¬
tends, that these and other such experiments, which I have
neither leisure nor inclination to relate, have led him to believe,
that fluid medicines might be administered through the trachea
in many thoracic diseases with success ; but in opposition to
tills, I venture to say, and you will agree with me, that so much
needless cruelty on dogs, as has been shewn of late by se¬
veral young experimentalists, will never advance one step our
knowledge of physiological phenomena. For after all, though
it is true, that by all such experiments we learn, that when act¬
ing with a given cause on a given part of the animal system, we
produce a given effect, which we see and can describe — still be¬
yond that we cannot go; and though we may thus learn the-
why— we shall never know the hoiv that given effect and not
any other, has been produced— in which only, I take, to consist;
the essence of physiology.

44 A medical gentleman, but little known by name, has
recently proposed to substitute for the emplass. meloes canthar,
a cerate, which he forms by mixing a certain quantity of caustic
ammonia with purified butter of cacao. This spap is applied
spread on linen, and produces its effects after a few hours.
On this I have to observe, that no soap can be made with
ii fat substance and ammonia, according to the late researches
on this subject. The author wishes to substitute his cerate
for canthar ides, because the latter have been found to
affect the urinary organs ; but he ought to have known, that
ebullition in water deprives those insects of all power ol
acting on the kidneys, without altering their epispastfc

Granville on the present State of Medical Science in France. 169

properties. Another of his reasons is much more solid. # He
hopes, by his cerate, to banish from practice the two or
three species of blistering cerate used in Paris; in each of
\Vhich, arsenic enters as a component part, to the great detri¬
ment of the patient ; as I was assured by M. Larrey at a
meeting of the Phylomathic Society. While on the subject
of epispastics, I think I shall render a service to the medical
profession in mentioning to them, that Sir H. Davy, in a con¬
versation I had with him a short time since, suggested the use
of concentrated acetic acid applied to the part. The skin^ is
raised in blisters after a very short period ; a great quantity
of fluid is brought to the part, and all the effects of the com¬
mon emplas. canth. are produced in a neater and equally efficient
manner. Sir H. Davy had occasion to use it for a sore throat
by which he was affected last spring, and derived immediate
and complete benefit from the application of the acid to the
neck ; since then I have myself employed it with the greatest
success. This opens my views on the treatment of croup; as
the absorption of the acid in question applied to the neck,
might free the larynx of the concrete mucus, by the solution
of the latter animal substance, known to take place in acids,
particularly the acetic.

66 You have given, I see, a review of M. Broussais’ book
in one of your late numbers. The astonishment it has created
amongst the pupils having subsided in part, some of them, who
are at the eve of becoming independent by being raised to
the Doctoral dignity, have dared to raise their voices against
the Professor’s theory. Among these I must notice the thesis
defended, but, alas! ill-defended, by M. Jacquet, within these
few weeks. This gentlemen, after giving a clear and summary
view of Broussais’ doctrine respecting his monomalady, taken from
, his work, proves that it is by no means new, nay, that several
authors, from 1660 to 1815, have entertained and expressed the
, same sentiments on the subject ; some of whom indeed seem,
from the ample quotations he gives, to have been entirely
copied by our modern writers. But by far the most important,
and the greatest part of this paper is directed to shew by the
report of a number of well-described cases of numerous affec¬
tions, that, though considered by Broussais to iorm a patt of
liis system, they can by no means be said to coincide with his
principles ; and where a system of therapeutics, totally opposite
to that he recommends, had alone succeeded in cutting the
disease short, and in curing the patient.

“ The importance of having a soluble supertartrate of
potash for medical purposes, lias long engaged the attention of
! several chemists and physicians in Paris. You have acquainted
your readers with the memoirs of Vogel and Thevenin on this
VOL. viii. — no. 44. z

170

Foreign Medical Science and Literature.

subject. M. Meirac, a young gentleman, studying pharma¬
ceutic chemistry under tile best masters, has likewise made
several interesting experiments on this subject ; and their result
was communicated to the Phylomatlnc Society a short time
back. The action of the boric acid on the salt in question
suffices to render it soluble. The proportions oi the foimei
have been variously stated ; but M. Meirac has ascertained, by
direct Experiments, that one-eighth of boric acid is the neces¬
sary proportion to render the supertartrate of potash very
soluble. He also partakes the opinion of other chemists,
that during the operation, there is a real combination between
the boric and part of the tartaric acid of the supertartrate aoo\ e
mentioned. His experiments tenu evidently to shen, that, pn
the soluble cream of tartar, the boric acid does hot combine
with the potash ; but that by the combination of the tartaric
acid with the boric, a specific salt is formed, having for its es¬
sential character its great solubility in water. In fact, many or
the chemical properties of the latter salt are quite different from
those of either the boric acid or the cream of tartar ; though
the latter, by being rendered soluble by the action or the bone

acid, does not lose its purgative property.

« X have nothing particular to communicate from either
Germany or Italy at present, A. b>. GliAiN V ILLL,

Pans, June 1817.

XX. — Every fact connected with the function of respiration
is of importance. Professor Carradori has observed a very
singular peculiarity connected with that of tortoises*.

i<‘ It is well known T the Professor remarks, 44 that although
these animals respire by lungs, like many other cold-blooded
animals, yet they can bear the privation of air better than any
others, being capable of living a long time in a vacuum and in

imrespirable air. _

44 When insects are covered with oil, they are soon suffo¬
cated, and do not again revive ; as is die ease when they are
plunged into water and again taken out of it-f*. Frogs, which
Jive a long time in a vacuum and in imrespirable air, die in less
than an hour in oil Leeches alone live for many hours under
oil, as Morand first observed ; whence it appears they can resist
the complete privation of air, as none is contained in oil.

44 A very fat land tortoise was put into very pure olive oil,
which stood six inches above the body of the animal, and was
left in it for six hours. During this time some bubbles of

An nates de Chimie cl dc Flips. t. v. p. 94. — extracted from the
Giornale de Fisica, ix. 318.

t Carradori on the return to life of flies in a state of asphyxia.—
Op. Sidii. Milan. J Ann. de Chim. de Pavie, t. 1?.

171

Brugnatelli on the Cure o f Hydrophobia.

air Were disengaged. On being taken out, as it was thought
to be dead, and placed in the air, on the ground in a garden.; it
revived. After two days, it was again put into the oil, and
•lived for twenty-four hours. On withdrawing it when it ap¬
peared dead, and placing it on the ground in the garden, it
vomited a considerable quantity of oil ; but it did not again
fairly recover, and died in a day*

44 In another experiment, made with a smaller tortoise, the
animal lived after being kept thirty-three hours under oil ; but,
when kept for thirty-six hours, it died. It is surprising that
an animal which respires by lungs can live so long under an
absolute privation of air.”

III. — M. B rugnatelli's supposed discovery of a remedy for
hydrophobia, has been noticed in the Repository * and some
other journals in this country ; but no account of the circum¬
stances connected with this imagined discovery, is as yet before
the public. We have not seen the journal of Brugnatelli
which contains his essay on this subject ; but we hasten to lay
befote our readers a translation of an abstract of it, with re¬
marks by 'M. Gaultier de Claubryf. The paper is intitled
u Observations on the Efficacy of Hydro-chlorine (chlore aequeux)
for Preventing and Curing Hydrophobia , by Professor Brug¬
natelli C

44 M. Brugnatelli (says the author of the remarks), reflect¬
ing on the promptitude with which chlorine (oxy muriatic acid)
decomposes animal substances and destroys noxious effluvia,
conceived the idea of employing it as a remedy in cases of
disease produced by the introduction of animal poisons into the
system ; against the effects of which, no efficacious treatment
is yet known. The virus of rabies particularly attracted his
attention ; but he evidently forgot, that the actual cautery and
caustics are effectual means of preventing rabies, and even of
arresting its early symptoms. PXowever that may be, the
following is an abstract of the observations he has published
on this subject in his interesting journal. ~

44 On the 7th of July 1816, five children were bitten by a
dog who was supposed to be effected with hydrophobia. The
physician on the spot declared that he had had instant recourse to
the most appropriate external and internal remedies, but without
stating what they were. The children were afterwards carried
to the hospital of Milan, where, by the advice of M. Brugna¬
telli, the wounds were washed with concentrated hydro-chlorine,
and covered with pledgets soaked in the same fluid, which was

Vol. vii. p. 252. and Retrospect , vol. viii. p. 6l.
Journal General dc Medecine, iyc. tome lix. p. 303.

Foreign Medical Science and Literature.

also administered internally, combined with crumbs of breads
of a strength adapted to the age of each child. This was the
second day after the accident, and the first symptoms of hydro¬
phobia were already apparent.

44 On the same day, the 7th of July, two other children
were bitten by the same dog. One of them, in whom the parts
were scarified, washed with soap and water, and treated with
mercurial frictions, was attacked with hydrophobia on the fiist
of August, and died ; whilst the other child, wrho, after shew¬
ing symptoms of hydrophobia, was treated with hydro-chlorine
both externally and internally, recovered in a few days. When
M. Brugnatelli published this case, sixty days had elapsed from
the time when these six children were bitten, and they con¬
tinued free from any symptom of hydrophobia.

“ On the 12th of August, a little girl who was bitten by a
large dog, was immediately treated locally with the hydro-chloric
lotion, and pledgets dipped in it 'were kept applied over the
wounds. She was in perfect health on the 29th of the month ;
but on account of the great number of the bites, some of which
were very deep, she took, once a week, six pills composed of

bread soaked in hydro-chlorine.

44 Another child, seven years of age, wras bitten in two
places in the right arm by another dog, and taken to the hospi¬
tal of Milan on the 18th of August. The wounds were washed
with hydro-chlorine, and a general bath, mercurial frictions,,
some gentle purgatives, and the internal use of the extract of
belladonna, were prescribed. The last mentioned medicine,
however, was soon left off on account of its hurtful effects ; and
on the 29th of September, the child left the hospital cured. .

44 A father and two sons, who were bitten by a cat, which
was supposed to be hydrophobic, and treated both externally
and internally with hydro-chlorine, were perfectly cured with¬
out having employed any other remedy.

44 M. Brugnatelli, desirous of not prescribing fluid reme¬
dies for hydrophobic patients, prefers using bread pills embued
with hydro-chlorine. Children, about eight years ot age may
take two scruples of hydro-chlorine for a dose, and repeat it
four or five times a day. The dose may be gradually in¬
creased according to the age of the patient, and the disagree¬
able odour evaded by enveloping the pills in moistened oread.

44 On these cases of M,. Brugnatelli, M. Gauitier-de-Clau-
bry remarks, that no positive inference can be drawn from the
last fact brought forward to substantiate the efficacy of this
remedy, since it is not certain that the cat which bit the father
and his two children was really hydrophobic, as it was killed
almost immediately after the accident. The five children of the
Same village, who were bitten on the 7 th of July by the same dog

173

Brugnatelli on the Cure of Hydrophobia.

that escaped pursuit, were, it is true, treated with hydro-chm-
l'ine, and have not been attacked by hydrophobia; but it may
be demanded, whether this dog was really rabid P The case
•would certainly have been more convincing, if the five children
had been bitten by different dogs. As it is, it can only be
classed with those, which, from being too uncertain, or equivo¬
cal, are useless, as far as regards the progress of Science and the
cause of Humanity.

« We are informed, indeed, that the dog already mentioned,
on the same day, bit two other children in a neighbouring
village. The author says, one of them became hydrophobic
on the 24th day, and died before his remedy could be employed,
although deep scarifications, washings with soap and water, and
mercurial frictions, were employed ; whilst the other, m whom
signs of hydrophobia had already appeared, was cured by the
use, both externally and internally, of hydro-chlorine. Under
the supposition that the dog was rabid, the' treatment to which
the first of these children was submitted, appears to us not to
have been sufficient for destroying the hydrophobic virus; con¬
sequently the death of the child, if it died in a rabid state,
cannot be a matter of astonishment. But, as the author states,
only from report, which he had no opportunity of verifying,
that the symptoms of hydrophobia were already manifest in the
second child, we still doubt whether this was the case, and even
whether the child was really infected with the virus of rabies.
In effect, the first of these two children was bitten in the face,
and some of the wounds penetrated into the mouth ; . whereas
the second had two wounds only on the fore-arm. Besides, this
child was a boy, and being bit through the cloth of his coat, is
it not easy to conceive that the saliva might be cleaned from
the teeth in passing through the cloth, and the wounds not ino¬
culated with it ? If this supposition be correct, the hydro-
chlorine could not prevent the developement of a disease, the
virus of which had never existed in the individual.

44 The last alledged fact of the infant bitten by a dog can
have no weight in the discussion, as it is not circumstantially
detailed, and we have no proof that the clog was rabid. Upon
the whole, therefore, the cases of M. Brugnatelli do not appear
to us to be sufficient to establish the efficacy of the remedy he
has proposed, either for correcting the symptoms of rabies, or
curing them after they have appeared. _L<et us now examine
his theory.

44 The extraordinary efficacy of chlorine,’ he remarks,
44 m destroying, as rapidly as fire does, a great number of animal
poisons, both fixed and elastic, in the state of vapour and of gas,
when it is properly employed, either in the liquid or gaseous
form, leads us to regard it as a very powerful antidote of animal
poisons. Contemplating these effects, I conceived the greatest

Foreign Medical Science and Literature .

hopes of accomplishing* by its means, the complete decoifrpO
sition of the virus of rabies. As many cases have afforded
ample proof that this virus often remains inert in the wound,
and is not absorbed into the circulation till after a considerable
time has elapsed, there was reason for thinking that the appli¬
cation of this chemical agent, even some time after the bite was
indicted, might still produce the desired effect ; and as hydro¬
chlorine is neither irritating, nor poisonous, nor corrosive, it may
be readily employed by physicians, and taken by the patients*.”

46 We do not pretend to deny the general property which
chlorine possesses of destroying the deleterious effluvia which
arise from animal matter under certain circumstances : but
what hopes can we have of combatting successfully the danger
to which individuals bitten by rabid animals are exposed, by
treating them with hydro-chlorine only, and7 neglecting those
curative means, the efficacy of which is beyond doubt ? The
deficiency of any irritating, poisonous, or corrosive property in
chlorine is the very circumstance which prevents us from trust-*
ing to it for decomposing the virus of rabies, whether still
remaining in the wound, or already taken into the system, and
displaying its effects by the symptoms ; whilst the truth can¬
not be too often repeated, that the most essential point in the
treatment of wounds produced by the cause under consideration,
is the destruction of the wounded part, and decomposing the
virus at the surface of the bite; both of which are completely
effected by the local action of the actual cautery and caustics";
an important practice, which cannot have been known, or pro¬
perly felt, by the Italian physicians, who have had their atten¬
tions engaged with the anti-rabid properties attributed to
hydro-chlorine.

44 The result of these critical reflections,” observes M. Gaul¬
tier de Claubry, 44 is, that the facts brought forward by M.
Brugnatelli are not demonstrative of the opinion he has hazard¬
ed ; that, consequently, without a culpable imprudence, the new
chemical means which he has proposed cannot be employed to
the neglecting of the more certainly efficacious method of treat¬
ment by scarifications ; and that, as experience has unfortu¬
nately demonstrated the impotency of both Nature and Art,
when hydrophobia has once decidedly shewn itself, vague asser¬
tions and badly attested facts, in proof of the possibility of still
curing it, ought to have no influence on the mind of the
practitioner.”

“ * The author rests too much on the assertion of Fourcroy and
Guyton de Morveau, wrho necessarily supposed chlorine to possess
these negative qualities : but, in a science of observation, opinions
ought to be disregarded, and facts only confided in. — G. de C.”

175

PART V.

MEDICAL AND PHYSICAL
INTELLIGENCE.

I. — -SOCIETIES.

Royal Society. — On Thursday, May 22nd, a paper by Mr.
Sewell, assistant at the Veterinary College, was read, describing a
new mode of curing a chronic lameness in the feet of a horse. A
charger having got a chronic lameness in the fore foot, was given by
the owner to the Veterinaw College for experiment. It occurred to
Mr. Sewell that, by cutting the nerves that enter the foot, the sensi¬
bility might be destroyed, and the lameness removed. He accord¬
ingly cut out about two inches of the nerves that entered the pas¬
tern, sewed up the place, and healed it. The consequence was the
removal of the lameness, and the restoration of the horse to the
owner perfectly sound, — On Thursday, June 5, a paper by Dr.
Leach was read, on the genus ocythose of Rafanesque ; supposed
to be that of the animal often found in the paper nautilus. Dr.
Leach considers the observations made by the gentlemen of the
late Congo expedition as deciding the question, whether this is
the animal belonging to the nautilus. Various paper nautili were
caught containing these animals in them. When put into water,
the animal moved about like a common polypus, left the shell,
attached itself to the sides of the vessel, and shewed no inclination
to return to it again. These, and similar observations, induce Dr.
Leach to conclude, that the true inhabitant of the paper nautilus
shell is still unknown, and that the animal in question does not
belong to it, although it occasionally takes up its residence in it.
At the same meeting, a paper by Sir E. Home, Bart, was read,
explaining the differences between the sepia and shell vermes.
When the young of the shell vermes are in the egg, the blood is
aerated through its coats ; and on that account, the shell is not
formed till after they are hatched. To secure the egg from injury,
it is put into an annular bag. The author gives a description ol
the auriculata, and shows that the animal found in it is a sepia,
and not the original animal of the shell, from the way in which
the young are produced.

Linn/Ean Society. — On Saturday,, May 24th, the Society
met for the election of office-bearers for the ensuing year. Hie
following members were chosen: President, Sir James Edward
Smith ; Treasurer, Edward Forster, Esq. ; Secretary, Alexander
Macleay, Esq.; Under Secretary, Mr. Richard Taylor; Council,
Sir James Edward Smith; Samuel, Lord Bishop of Carlisle ; Edward
Foster, Esq. ; George Bellas Greenough, Esq. ; Aylmer Bourkc
Lambert, Esq.; William Horton Lloyd, Esq.; Alexander Macleay,
Esq. ; William George Maton, M.D.; Joseph Sabine, Esq.; Lord
Stanley ; Michael Bland, Esq. ; George, Earl of Mountnorris ; Sir
Christopher Pegge ; William Pilkington, Esq. ; Charles Stokes,

J76

Medical and Physical Intelligence .

Esq.— June 3rd a description of the lycoperdon solidum, by Dr.
Macbride, of Charleston, Carolina, was read. The substance so
called is an immense tuber, sometimes 40lb. in weight, found in the
southern parts of the United States. It may be used as food.
Soon after it is dug up, it becomes very hard. It exhibits no regu¬
lar structure, and seems to have the property of uniting with the
roots of those trees near which it grows. It vegetates under the
earth, and is usually found in the fields that have been cleared of
wood only about three years.-— -June 17th, a paper by Mr. Seaton
Was read, on the red and white varieties of the lychnis diciva ,
Some botanists are of opinion that these two plants constitute two
distinct species, while others think that they are only varieties. To
decide the point, Mr. Seaton placed them near each other. The
produce was a hybride plant with pink flowers, which was capable
of producing seeds like any other plant. Hence he conceives it to
follow, that they are only varieties.

Associated Apothecaries and Surgeon- Apothecaries of England

and, Wales.

Committee Boom, July 18, 1817.
A General Meeting of the Subscribers to the Asso¬
ciation of Apothecaries and Surgeon-Apothecaries of
England and Wales will be held at the Crown and Anchor
Tavern, Strand, on Wednesday the 20th of August next, at
Two o'Clock precisely ; to receive a Retort of the Committee,
and on other affairs of considerable importance to the Interests
of the Association. By order of the Committee,

W. T. WARD, Secretary ,
N.B. None but Subscribers can be admitted.

— K3& jEss**—— —

The following is a copy of the circular letter to the Subscribers :

Sir, I am instructed to communicate , that the principal motives
which induce the General Committee to call a Meeting of ike As¬
sociation, are: 1. To receive the Report of the Proceedings of the
Committee since the last Report, of April the 241 h, 1816; and to
take into consideration what course is the most proper to pursue under
existing circumstances : 2. To receive the resignation of the Chairman ,
Dr. Burrows ; of whose great exertions and eminent services the
Committee is fully sensible; hut which lie has signified his inability
of longer continuing : 3. To hear the state of the Fund , and decide
upon its appropriation 4. To re-organize the Committee , winch, from
deaths, resignations , S;c. is rendered ineffective.

The Committee begs leave to add, that it has fully advertized this
Meeting ; but particularly requests that the Gentlemen who acted as
Provincial Chairmen, or Secretaries, will apprize the Subscribers in
their respective districts of it. I am, Sir, eye. W. T. HARD, See .

Holies Street, Cavendish Square, July 22nd, 1817.

II. - PRIZE QUESTIONS.

THEjFtoyal Medical Society of Edinburgh has proposed the fol¬
lowing question, as the subject of a prize essay for the year 1818 :

<e What changes are produced on atmospherical air by the action
of the skin of the living human body ?”

Medical and Physical Intelligence . 177

The members only are invited to be candidates. The dissertations
maj; be written in English, French, or Latin, and must be transmitted
to the secretary on or before the first of December 181 7. To each
.dissertation shall be prefixed a motto, which shall also be written on

the outside of a sealed packet, containing the name and address of
the author.

, The Royal Academy of Sciences and Literature of Brussels,
ms proposed the following questions, among others, for competition
during the year 1818. — Is it possible, from satisfactory experiments,
or reasons deduced from the doctrine of determinate proportions to
establish with certainty that the radical of muriatic acid is a com¬
pound body ; or, is it more probable that the radicle is a simple
budy ? . M hich of the two methods (experiment or the doctrine of
determinate proportion) is best calculated to simplify the theory of
Chemical facts ? — The prize is to be a gold medal of the weight of
twenty-five ducats. The essays to be written in Latin, French,
Dutch, or German, and delivered before the 1st of February, 1818/

The Royal Society of Sciences of Copenhagen proposes the
following question, as the subject of a prize which is to consist of a
gold medal of the value of thirty-six ducats : — “ Ought the arti¬
ficial perforation 01 the membrane of the tympanum to be per¬
mitted ?” r

J hf following prize questions have been also proposed by the

Societe dc Medecine-Pratique dc Montpellier for the year 1818. _ Is our

knowledge of the nature* the character, and the treatment of
epilepsy influenced by the information we have acquired upon the
functions of the nervous system, and those of the brain in par¬
ticular ? W hat are the results of the information we have acquired*
and in what manner can it be applied in promoting the cure of this
disease ?

III. - MEDICAL.

Tesi of Arsenic. Dr. Paris has proposed the following method
of employing the nitrate of silver as a test of the presence of arsenic.
Instead of conducting the trial in glasses, drop the suspected
liquor upon writing paper, making a broad line with it. Along
this line, if a stick of lunar caustic be slowly drawn, a streak is pro¬
duced of a colour resembling that called Indian, yellow ; and this is
the case whether arsenic or a phosphoric salt be present; but the
one from arsenic is rough and curdy, as if effected by a crayon ;
the other, quite smooth and even in its appearance, such as would
be produced by a Water colour. A more important, and still more
unequivocal, mark of distinction soon succeeds : in less than two
minutes the phosphoric yellow fades into a sad green, becoming
gradually darker, until it becomes black: the arsenical yellow, on
the other hand, remains permanent for some time, when it becomes
brown. These experiments should not be made in the sunshine, as
the transition of colour is then too rapid. — Annals of Phil. vol. x. p. 6‘0.

Mr. A. 1. Thomson, one of the Editors, in repeating these ex¬
periments, found that, if the above directions be strictly adhered to,
the test is ambiguous ; but if modified in the following manner^

vol. vm. — no. 44*

A A

Medical and Physical Intelligence.

it is one of the best for detecting the presence of arsenic hitherto
suggested. When the lunar caustic instantly produces a very
bright yellow, we may suspect it is occasioned by a phosphoric
salt ; and this is rendered certain, if, notwithstanding it be brushed
over with liquid ammonia, the colour becomes in a few minutes a
sad-green, and, as it dries, a dark claret brown. If the suspected
solution contain arsenic, combined with potash, as in b owler s solu¬
tion, or that of the London Pharmacopoeia, the streak will be curdy, as
Dr. Paris describes ; but of a very pale yellow colour. If it con¬
tain no alkali, it will be indistinct, and of a greenish-yellow tint ;
and if any muriate be present, it will be nearly white. rhcpie-
seiiCe of arsenic, however, is unequivocally determined in all, if, on
Brushing them over with liquid ammonia, a bright queen s yellow
Be instantly produced. This remains permanent ror . nearly an
hour ; and, in changing, the first and second acquire a light or yel¬
lowish mahogany brown colour, aim the third a very dark browng
but after some hours, the whole becomes nearly black.

Antidote of Prussic Acid.— M. Virey, from observing _ the effects
of sulphate of iron in restoring a cow, who was nearly killed by the
essential oil of bitter almonds, proposes the solution of sulphate oi

iron as the antidote of prussic acid.

Tic Dolcmreux.- — A Correspondent informs us, that he has seen a
tincture of the leaves of Atropa Belladonna, made in the same
manner as the tincture of henbane of the London Pharmacopoeia,
advantageously employed as an external application in two cases of
tic doloureux.

Cure of Epilepsy.' —A young man, who had been epileptic for
eight years, and who had tried various remedies, was at length cured
by taking the superacetate of lead, in doses of three grains, night
and morning for five days. The use of it was begun three days
before the moon was at the full, and then repeated for five lunar
periods. After each dose a table spoonful of olive oil was swallowed.
M. Eberle, who details the case, observes that this remedy is more
likely to succeed in cases in which the accessions are regular and
the patient strong.™ Gazette de Sant 4 .

IV. - SURGICAL.

Aneurism. — Signor Palleta, in operating upon a popliteal aneu¬
rism, according to the method of Scarpa, having removed the liga¬
ture on the fourth day, the wound healed by the first intention,
and the cure wTas perfected on the fourteenth day after the ope*
ration . — G horn, cli Fisica , 2r l Pis. 1817.

V.- — CHEMICAL.

Artificial Congelation of Water. — Professor Leslie in a letter to
Dr. Thomson, has announced that parched oatmeal has a stronger
power of absorbing humidity than even decayed trap, and hence
may be advantageously used for freezing water in vacuo. He states
that with a body of dried oatmeal a foot in diameter, and rather
more than an inch deep, he froze a pound and a quarter of water
contained in a hemispherical porous cup, although the temperament
of the room was above 50°. The Professor adds, - that when the

179

Medical and Physical Intelligence.

experiment was reserved, and the surface of the water about double
that of the meal, this substance acquired, after the air linger the
receiver had been rarified, a heat exceeding 50° of Faht., so as to
feel indeed sensibly hot on applying the hand.” — Annals of Phil ,
vol. x. p. 61.

Explosion in a Laboratory. — On the 12 th of February last,
whilst a pupil of one of the first druggists in Munich was triturating
in a mortar, a mixture of three ounces of oxymuriate of potash,
sulphur, sugar, and cinnabar, for forming matches, the mixture
exploded, and wounded the lad so severely that he died in two
hours after the accident : and at the same time his master received
several dangerous wounds. The explosion was so great that it was
felt in almost every quarter of the town : the windows were broken ;
and a piece of the shattered mortar, that was driven through them,
wounded a gentleman passing in the street.

Volatility of Mercury. — Dr. Hermbstaed has ascertained that the
minimum of the temperature at which mercury is volatilized is 80°.
Farenheit: hence it is easy to explain why workmen employed in
the silvering of looking glasses are sometimes salivated.- — Giornaie
di Fisica, fyc. 2d Bisnestre, 181 T-

Colouring Matter of the Flood. — Berzelius has lately examined
the opinion deduced by Mr. Braude from his experiments upon
blood, and confirmed by those of Man quel-in, that the colouring
matter of the blood is perfectly free from iron. He lias been led to
an opposite conclusion, from having found that the ashes produced
by incinerating this colouring matter are one half oxide of iron ; and
conceives he is authorised in regarding his former opinion on this
subject confirmed — (vide Animal Chemistry.) Fie asserts, therefore,
that, as the colouring matter of the blood is distinguished from co¬
lourless animal substances by the quantity of oxide of iron which it
yields when calcined, there is some reason for thinking that iron
contributes to give blood its deep colour. — Annales de Chim.L v. p. 42.

VI. - MISCELLANEOUS.

Lactometer. — -An instrument for the purpose of ascertaining the
relative quantity of cream produced from milk, has lately been con¬
structed by Mr. Jones, mathematical instrument maker. Charing
Cross. It consists of several glass tubes, resembling test tubes,
mounted on a stand, each about eleven inches long and three quar¬
ters of an incli in diameter, closed at one end, and open and a little
flanched at the other. At ten inches from the bottom of each tube,
a mark is made upon the glass, having an o (zero) placed against it ;
and, from this point, the tube is divided into tenths of inches, arid,
graduated downwards for three inches, so that each division is
of the tube. By filling these tubes with the new milk of different
cows, the percentage of cream will be evident upon inspection, —
Journal of Science and the Arts.

Upon a recent ballot for the place of Foreign Associate of the
French Royal Academy of Sciences, in the room of M. Klaproth,
deceased, M. Scarpa was elected ; 27 votes having combined in his
favour, and 21 only for Sir Humphry Davy,

A A 2

A METEOROLOGICAL TABLE,

/ .

From the 21 st of June to the 20 th of July 1817,

KEPT AT RICHMOND, YORKSHIRE.

230 Miles NW from London.

Baron

Max.

leter. ^
Min. I

Thei
VI ax i

an. j Rain
Vlin. Gage.

Winds.

Weather.

21 S

■

ME.

[ Mist... 2 Sun...

22 5

ME..

L Mist... 2 Sun....

23 5

■

MNE..

t Mist...2Sun....3Cloud..

24 5

NNW.

1 Showers. 3 Sun..

NW.NNE.

1 S.... 2 R. 3 S.. 4 Cd..

NE..

1 3 Sun... 2 Cd.. 4 Mil-

NE..E.

1 Sun.. 3Cloud....4Rain..

44]

SW. .

1 Cloud.. 2 Sun..

SW..SSE.

V Sun.. 3 Cloud.. 4 Rain.

SW..E.

1 3 S..2Th..Lt.&R.4M...

SW..ESE..

1 Sun... 2 Cd.. 3 Rain. ..

SW...

1 Sun.. 3 Sh. 4 Star...

wsw..

1 Sun.. 4 Cloud..

NW..NE..

1 4Rain..2Sun..3Cloud..

N..SW..

1 4 C..2Th...Lt..R....3S..

WSW.

1 3 Sun.. 2 4 Rain..

SW..

1 Sun..

129

wsw..

1 Cloud.. 2 Sun..

^29

w..

1 Cloud.. 3 Sun...

5229

SW.E.

1 Sun.. 2 Showers.

57 29

N.NE.

1 3 4 Cd... 2 S. and Sh,

6129

NE.SW.

1 Cd... 2 Sun. and Sh.

4529

SW.S.

1 Sun... 2 Rain..

23,29

SW..NE.

1 S... 3 R.. 4 Cd...

3229

• NE..N..

1 Showers. 3 Sun..

>29

4929

NW..N.

1 Sun.. 2 Showers.

47 29

' 67

W..

1 Cloud.. 2 Sun..

1 29

6129

» N.NE.

1 Cloud. 2 Showers.

) 29

6229

) 68

NW.NE.W.

1 3 S... 2 Cd.. 4 Mil...

3 29

5429

4 c

i 68

0 1

V WSW..

1 Sun... 2 Cd... 4 Rain

The quantity of rain during the month of June was 2 inches and 04-100ths.

Observations on Diseases at Richmond.

The diseases under treatment the last period, were Cephalalgia, Cholera
Morbus, Convulsions, Diarrhoea, Dyspepsia, Febris Catarrhalis, Febris
Simplex, Gastrodynia, Hysteria, Icterus, Obstipatio, Ophthalmia, Hheuma-
tismus. Rubeola, and Urticaria.

The last year was very unpropitious to vegetable productions, and there
was also in this district a great mortality amongst dogs and cats, yet it was
particularly favourable to human life. The number of burials, according
to the parish register of Richmond, was about three-eighths less than the
average of eleven preceding years, and the baptisms were one-sixth more
than the average for the same time.

METEOROLOGICAL TABLE FOR LONDON,

From the *20 fk of JUNE to the 19 th of JULY, 1817,

By Messrs. HARRIS & Co.

Mathematical Instrument Malcers, 50, High Ilolborn.

Therm.

Barom.

Rain jDe Luc’s
Guage^ Dry. |

Hvgrom.

'Damp.

Winds.

Atmo.

<20

29*

29‘

0 5

Fine ]

29s

229

2‘SE

Fine

29°

* 2

Fine

299

29°

3 0

WSW

wsw

Fine

25|63

0 0

wsw

Fine

29 9

0 0

Fine

rV v

< O

29c

296

Fine

28 61

296

2 2

Fine

29(63

295

29 7

3 2

wsw

Fine

30i 64

2 9°

29?

2 0

Clo.

€)

295

29 1

Rain

297

299

.09

Clo.

297

296

.10

Fine

29c

295

.11

Rain

29 5

29'

.10

Clo.

29 7

29'

.07

Rain

29'

29s

.03

Fine

29s

29*

.04

Fine

29s

297

✓

sw ■

Fine

29 7

Fine

297

296

Clo.

297

Fine

29*

29«

Fine

298

29'

Clo.

297

.06

ssw

Rain

J 6

51 29c

295

Clo.

5429°

296

.05

Fine

294

298

Fine

56 29°

299

Fine

Shoy

Rain

Fine

Rain

Clo.

Rain

Clo.

Rain

Fine

Clo.

Rain

Clo.

Fine

Clo.

Ilain

Fine

Clo.

Fine

Clo:

Clo.

The quantity of rain that fell in the month of June cannot be easily ascertained, as the guage had:
leaked the latter part of that month, but it is supposed to be about 1 inch and 60-lOOths.

Bill of Mortality from June 1 7^ to July 15, 183 7’-

ClIRISTENED.

BURIED.

{

OF WHOM \
HAVE DIED/’"

June 21.

July 1.

July 8.

July 15.

Males .

137

188

347

Females .

... 161

123

168

303

349

260

556

650 |J

Males .

153

166

210

Females .

146

171

214

266

299

337

424 V

Under 2 Years.

. 89

107

113

Betw. 2 and 5

. . 22

5 and 10

. 16

10 and 20

...... 10

13.

20 and 30

. 16

50 and 10

. 24

10 and 50

. 21

50 and 60

. . 19

60 and 70

. 16

70 and 80

; 32

80 and 90

. . 14

90 and 100

. 2

105 .

ALL

25 /

1615.

Total,

1326.

A REGISTER OF DISEASES
Between JUNE 20 th, and JULY IQih, 181?'.

DISEASES.

Abortio . .

Abscessio . .

Acne . .

Ameuorrhqea .

Amentia .

Anasarca. . .

Anorexia .

Aphtha lactentium .

Apoplexia .

Ascites..... .

Asthenia .

Asthma.... . . .

Atrophia .

Bronchitis acuta ....

- - - chronica.

Bronchocele .

Calculus .

Caligo . .

Cancer .

Carbunculus .

Cardialgia . .

CardiOs .

Catalepsia... . . .

Catarrhus . .

Cephalalgia .

Cephaleea .

Chlorosis .

Chorea .

Cholera .

Colica . . .

■ - - Pictonum .

Contractura .

Convulsio . .

Cystitis .

Cy nanche Ton sill a ris .

- maligna... .

- - Trachealis.

■ - - Parotidea. .

Diarrhoea...
Dysecoea...
Dy senteria.
Dyspepsia..
Dyspnoea. . .
Dysphagia .
Dystocia....
Dysuria....
Ecthyma...

Eczema _

Eneuresis ..
Enteritis....

e& i ci

I ■«->

O j &

Eh i fn.

12
27
3
gl
3
38
* 9

37
31

8
15

38
21

4
1

4
3

5
2
8

diseases.

Entrodynia . .

Epilepsia. . . .

Epistaxis . . . .

Erysipelas .

Erythema leave. -

— - - — . nodosum.

Exostosis . . —

F ebris intermit tent .

— catarrhalis . .

- - Synocha . . .

Typhus miliar...
Typhus gravior
Synochus... ......

Puerpera . ....

remit . Infant....

Fistula......

Fungus... . . .

Furunculus .

Gastritis.... . ....

Gastrodynia .

Gonorrhoea . .

Haenicitemesis . .

Hsematuria.,. .

Heemoptoe . .

Hsemorrhois . .

Hemiplegia. . .

Hepatalgia .

Hepatitis . .

Hernia. . .

Herpes Zoster .

- circinatus...

— - labial is......

— - prceputialis.

Hydrarthyrus .

Hydrocele.... . .

Hydrocephalus.. .

Hvdrothorax .

H ypochoudriasi s .

Hysteralgia .

Hysteria . . .

Hysteritis . .

Icterus .

Ileus . . .

Impetigo figu rata .

- - sparsa. .

— . — . — erysipelatod.es ..
— — scabida .

Ischias...
Ischuria.
Lepra. . . .

» f

£"4

■24

-T r»

1 4
1

1 5

L-b

•

DISEASES.

+->

DISEASES.

4->

4-»

Leucorrhoea .

Prolnnsns .

* Lichen simplex .

Prnri/ro mi/is .

Lithiasis .

]

- Qpn 7/ 7 ?

Mania .

Psoriasis omttnta

Melancholia . .

iN I enorrliasri a .

] 9

't o #

j Morbi I nfantiles * .

Morbi Biliosif .

Pyrosis .

X ephralgia . . .

Ttar.hitis ..... .

Nephritis .

li liPiimatiQmiifl rtriiin <?

Cfi/ U/t 60 Ci'O • * •

Odontalgia . * .

Tlubpoln . . .

Opththalmia .

Sarcocpic .

Otalgia .

Scabies . . .

Palpitatio .

Sim root bun xhm.rJp.r .

Paracusis .

Paralysis . . . .

Paraplegia .

Snirrhiis .

Faronvchia . .

Scorbutus . . ...

Peripneumonia .

Srrofnla .

Peritonitis . ..i .

Snasnni .

Pertussis . . .

S olenitis

Phlegmasia ddens .

Strictura . . .

Phlogosis .

Strophulus intertinctus. ..

Phrenitis .

iSvnmnp .

Phthisis Pulmonalis .

•> i

Syphilis .

Pityriasis .

Tabes TvFpspnfprica .

Plethora . . .

‘9

Tic TJoIotpiiy

ri'

Pleuritis .

faccinia . . .

PI euro dvne .

Varicella .

Pneumonia . .

Variola .

Podagra .

Vermes .

Polypus . . .

Vertigo .

Pomphol yx benignus .

' 1

TTrticn ri a lhl> ri 1 / ?

Porrigo larval is . .

— - rJrrt/I nn n ?

— - scutulata .

T otal of Cases

2110

- favosa . .

Total of Deaths .

4 Morbi Infantile 3 is meaivt to comprise those

Disorders principally arisimr from dentition or

indigestion, and which may he too trivial to enter under any distinct heads ; Morbi Biliosi, such

Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing' Diseases.

Generally the diseases of last month partake of that nature usual to
the season; hence there is nothing' but Variola particularly demanding’
notice.

Small Pox however still forces itself upon our observation. It has
we believe been more prevalent than for many years past, and has assumed
a more than usually virulent character ; many of the cases having been
of the confluent kind. This may in some degree account for so many, who
had previously undergone vaccination, being infected by small pox, as we
remarked in our last report; and we are concerned to find, from the
increasing testimonies of medical practitioners, that these instances have
been mucli and widely extended. So little modified has the disease hi
some cases appeared to have been by the influence of the vaccine inoculation,
that death has ensue-d : an effect which, as far as our information goes,
was never before produced by small pox, after the patient had been
sulyect to the action of the vaccine virus.

Literary notices.

Dr. Bancroft has In the press and nearly ready for publication?
A Sequel to his Essay on Yellow Fever.

In the press and speedily will be published, the History of Vac¬
cination, by James Moore, Surgeon.

Professor Orfila, author of the celebrated Treatise on Animal*
Mineral, and Vegetable Poisons, has in the press an Elementary
Work on Chemistry.

Mr. Alibert has in the press a very splendid work, intitled
Nosologie Naturelle , ou les Maladies du Corps Humain , distribuees pai
Families. The work will consist of two quarto volumes, with
coloured plates. We have had some of the plates presented to us*
and can bear testimony of their accuracy and beauty.

MONTHLY CATALOGUE OF BOOKS.

An Essay on Capacity and Genius. Bvo.

Practical Observations on the Cure of the Gonorrhoea Virulenta
In Men. By Thomas Whately. The Second Edition, with addi¬
tional Notes and Corrections. Svo.

An Essay on the Nature of Heat, Light, and Electricity. By
C. C. Bompass.

NOTICES TO CORRESPONDENTS.

Communications are received from Dr. IT. Robertson, Dr®
John Astbury, Mr. Spilsbury, Mr. Coombs, Mr. Chapman, 4’^

The subject of Mr. Rawlins" ( of Oxford ) Letter shall certainly
receive attention in the next Number .

A short Sketch of the Pathology of Dropsy, and several
Authenticated Cases, are come to hand .

Communications intended for insertion in the Subsequent Number
should be sent before the 12 th of the month ; and should be addressed
(free of expense) to Mr. Shury, Printer , 7? Berwick Street, Soho; bp
' whom" Books for the Review Department, Articles of Intelligence, fyc.
fyc. mill also be received.

This Publication, by application to the Clerks of the General
Post Office, London ; or, if previously ordered, of the Post Masters,
British or Foreign, will be sent to any of the British Colonies or
Foreign Countries, upon the same terms as other Periodical Works.

THE

ONDON MEDICAL

POSITORY.

No. 45. SEPTEMBER 1, 1S17. Vol. VIII.

PART I.

ORIGINAL COMMUNICATIONS.

AN ESSAY ON DISEASES

RESEMBLINO

THE VENEREAL DISEASE*

BY A PHYSICIAN.

( Continued from p, J31.J

PART II.

Of Affections that may he mistaken for Venereal Enlargement

of the Inguinal Glands,

Medical writers, and the generality of practitioners* divide
buboes in the groin, resulting from* or connected with, venereal
contagion, into three kinds : the venereal, the primary, and the
sympathetic. The first of these succeeding to chancre ; the
second, shewing itself without any preceding sore or discharge ;
and the last being connected with gonorrhoea. I should not
attack this arrangement of buboes, if it were not set up as; a
rule and guide for practice ; but the distinction has been in¬
sisted upon on these grounds, that a bubo succeeding to chancre
is the only one of the three requiring mercury. Nay, more ;
that in the others, mercury is by no means to be employed.
The man of experience, however, who is unprejudiced and
open to conviction, knows that, as far at least as regards disease.
Nature is not to be fettered by fixed rules* In the generality
of cases I will admit, that buboes which have not been pre¬
ceded by chancre, may have yielded to other remedies than mer¬
cury. But to maintain, that in no case is syphilis conveyed into

VOL. VIII — no. 45, B B

2${f Original Communications

the constitution through the medium of a bubo, except where
that is preceded by chancre, as many have done, is boldly to
set up a theory in opposition to experience. Besides, it is very-
difficult in many cases to ascertain whether a chancre has been
present or not. Many men, who have an interest in deceiving
you, will do so ; in women, it is still more difficult, from the
difference of structure, to learn whether a small sore has pre¬
ceded the appearance of a bubo in the groin.

In spite then of all your endeavours to get at the truth, you
will not learn it ; you may be led to think that there has been
no chancre, and if you happen to have adopted the doctrine of
those who tell you that no bubo, without preceding chancre, can
be syphilitic, you will, considering the case before you as a
primary bubo and consequently as one which cannot miect the
constitution, leave the case to Nature, or employ unavailing re¬
medies, still persisting in your refusal to call in the aid of mer¬
cury. The best rule is to act in every case according to the
circumstances of that particular case. I know that I have fre¬
quently failed in my attempts to heal sores m tne groins, the
consequences of buboes, where no chancre preceded, (at least
as far as it was possible to ascertain that point, and in one case
■where there had been no connection for a year,) although I
tried every method that I could think of, and upon using mer¬
cury, the sores have rapidly and permanently healed. Much
mischief arises from laying down general unalterable nues 01
practice, as well as from the incorrect supposition, that if mer¬
cury heals a sore, such wound must be syphilitic. I proceed
however after this long digression, which I could not well avoid,
to the consideration of those appearances in the groin widen
may be mistaken for venereal enlargement of the inguinal
glands.

The glands in the groin are, in common with other gland?,
liable to be enlarged from various causes. Where gonorrhoea
really exists, if by injections the discharge be suddenly checked,
the inguinal glands shall become tender and swollen, and this
tenderness and swelling shall subside on the return or the re¬
production of the discharge. The mind of a man who has
had an illicit connection, is alive to every sensation in these
parts ; he is constantly feeling for an enlargement, and should,
the woman w7ith whom he has had intercourse, happen to labour
under some of the discharges which I have before mentioned,
he may have some irritation in the urethra ; this, with a slight
degree of tenderness, and perhaps of swelling produced in the
groin by pressure and examination with the fingers, will con¬
vince him that he has been infected, although his fears have in
reality no foundation. Mercury rubbed in for the cure of
chancre may cause enlargement of tne inguinal glands ; but as

An Essay on Diseases resembling the Venereal Disease . 18?

here the chancre is in itself a sufficient reason for employing
mercury, it is of no great importance to distinguish between
such a swelling and a common bubo4-. Bubo in the groin may
succeed to some of the sores on the genitals which have been
described when treating of ulcers on those parts ; here we must
look to the nature and character of such sore, and if we find
that the sore was not chancre, it is fair to presume that the
bubo is not syphilitic.

A swelling of the glands of the groin may arise from the
use of bougies, from stricture, or other disease of the urethra,
from irritation after connection produced by intercourse with a
woman who has vaginal discharge (other than that of gonor¬
rhoea), from disease of the testis, from disease of the penis, from
ulceration of the integuments, from piles '^, from common in¬
flammation produced by blows, strains or other causes, from
sores situated on the inside or top of the foot or on the fore part
of the leg or thigh in the course of the vena saphena, or on the
buttocks or inner part of the ilium ; from white swelling of the
knee, or from disease of the hip-joint, from oedema of the lower
extremity, from true elephantiasis, and from the modern ele¬
phantiasis or Barbadoes swelled leg. In women, the glands
may also be enlarged from diseases of the organs of generation,
of the vagina and of the uterus, whether discharges, ulcera¬
tions, or some other affection (excluding of course from our
present consideration, syphilitic affections). These glands may
also be the seat of critical abscesses, or they may become en¬
larged from scrofula. The only kind of venereal affection for
which an enlargement of the inguinal glands proceeding from
any of the causes just enumerated, can well be mistaken, is
primary Bubo, or bubo unaccompanied with chancre or gonor¬
rhoea +. In looking over the list of cases in which the glands of
the groin may become enlarged, we shall find that there are
but few of them likely to be mistaken for bubo from venereal
taint, if we use but common observation. We must remember
the possible causes of swelling of the glands of the groin, and
this will lead us to investigate the case, and to ascertain whether
any of those causes exist, before we pronounce on the nature
of the enlargement. A primary bubo, although more tre-

* It is necessary however to recollect, that swelling of the
inguinal glands may be caused by mercurial friction, lest we should
be induced to exhibit more mercury when enough has been already
used. : t Cruikshanks.

J Where a discharge happens to attend some of these cases of
enlargement of the glands, the case may be considered as that of
bubo and gonorrhoea. For distinguishing the discharge from gonor¬
rhoea, I must refer to what I have said when treating of discharge,

B B 2

Original Communications.

quently occurring than many will allow, is still much more rare
than bubo preceded by chancre or by gonorrhoea, or by both.
Where there is no apparent cause of the enlargement of these
oiands, and where we suspept the swelling to be venereal, we
shall be assisted in our diagnosis by recollecting, that, in bubo
from syphilis, the swelling usually proceeds uniformly and
quickly from its first appearance through the inflammatory stage
to suppuration, if left to itself; that the swelling is mostly con¬
fined to one gland on the side affected ; that there is only one
abscess which is general throughout the gland, and that the ten¬
derness is very acute and the integuments are highly inflamed.
In scrofulous enlargement of the glands of the groin, the progress
both of enlargement and of suppuration is more slow, particularly
the latter; the suppuration is unequal, the matter formed is
seldom true pus, but thick and curdled ; the extent of the ab¬
scess being often considerably greater than that in bubo from
syphilis, the skin covering it of a pale red, mottled with white,
the pain more obtuse and dull. Swelling of the glands in the
groin may take place without any evident cause ; it may be
accompanied with fever and other constitutional symptoms,
several glands may be attacked, the swelling hard, slow in its
increase, generally enlarging to a small extent, and being
attended with but little pain.

When a bubo in the groin has burst and lias assumed the
appearance of an ulcer, it is more difficult to determine upon
its nature. The ulcer produced by bubo from syphilis is
painful, not shewing any disposition to heal, but, on the con¬
trary, inclined to spread. The character of the sore may
depend much upon the habit of the patient. But although we
are satisfied that a bubo which has ulcerated^ may originally
have been syphilitic, we must always bear in mind that the sore
may remain, and its nature be entirely changed. The bubo has
been suppurated, and has burst or been opened ; mercury may
have been employed with advantage. But there is a point, which
being passed, the mercury becomes as prejudicial as it before
was serviceable : by pushing the exhibition of it to an improper
length, the venereal sore may be converted into a . mercurial
sore ; the ulcer, instead of the whitish appearance which charac¬
terizes the healing of a sore under mercury, shall put on a fiery
red hue; and, if mercury still be persisted in, or if the habit
be saturated and enfeebled, more especially if the patient
breathe the confined miasma of a mercurial ward, such a sore
shall spread from ilium to ilium, destroying all before it. The
edges of this sore are jagged and irregular, as if they had been
eaten away by caterpillars, the cavity extending beyond the
edges which overhang the ulcer. Such a case is far more
dreadful and dangerous than the worst case of syphilitic ulcer a-

An Essay on Diseases resembling the Venereal Disease. 189

rion. One part of the mercurial sore may heal, whilst in
another part great havoc is made.

Sometimes, after the venereal virus has been destroyed, the
sore shall assume an indolent, or what is termed a scrofulous
character ; in which case it is pale, indolent, and gives but
1 ft tie pain.

An enlargement of the inguinal glands resulting from any
of the causes I have named, is not the onty affection that may
be mistaken for venereal bubo. In the true elephantiasis, im¬
properly called lepra arabum, there is a firm indolent swelling
at the upper and anterior part of the thigh, without discolour¬
ation, pain, or disposition to suppuration, easily moveable,
usually much larger than the venereal bubo, and lower in its
situation*. These characters will distinguish such an affection
from enlargement of the inguinal glands caused by syphilis.
Psoas or lumbar abscess pointing at the upper part of the
thigh ; hernia, both inguinal and femoral ; aneurism; a testicle
which has not descended into the scrotum; encysted hydrocele
of the spermatic chord ; scirrhous ovary : all of these may by a
hasty observer be mistaken for an enlarged gland, and conse¬
quently for venereal bubo.

Psoas abscess may be distinguished by the symptoms atten-?
dant on that disease, by dull heavy pain in the loins under the
kidney, by the shiverings attendant upon the formation of
matter, by the febrile or hectic symptoms, by pressing on the
tumour and desiring the patient to cough, by making him lie
down and then try to get up, by desiring him to rotate the
thigh, which action will give him pain, while no pain is felt if
another person rotate it for him, and by the tumour being
flaccid when the patient lies down. Hernia is marked by its
sudden appearance ; its want of discolouration ; by the con¬
comitant sickness and obstruction of the bowels, and by febrile
or other symptoms. In Aneurism the situation of the tumour,
its gradual formation in most cases, the pulsation which is
more or less distinct, the receding of the tumour which
sometimes succeeds to pressure, the numbness and pallor of
the limb, all these symptoms will distinguish aneurism from
enlargement of a gland. The peculiar sensation produced by
pressure on the testicle, and the want of it in the scrotum,
sufficiently mark that cause of tumour in the groin. In encysted
hydrocele of the spermatic chord, the tumour feels like a dis¬
tended bladder, and appears transparent if examined by a
strong light; and its situation may sometimes be made to change,
from the fluid receding on pressure. A scirrhous ovary of a large

* Adams on Morbid Poisons.

Original Communications,

O J

jgize \n a thin person may sometimes be ascertained by examina¬
tion through the parietes of the abdomen. In all tne cases just
enumerated, we shall not only be able to form our diagnosis
from the symptoms attendant upon each disease, but also from
the want of the appearances belonging to syphilitic bubo.

Of Warts on the Organs of Generation .

Warty excrescences are very frequent consequences of im¬
pure coition : they are met with on the gians penis, on the
frsenum, and the prepuce, both external and internal ; ^ anu in
women, on all parts of the external organs, in tne vestibulunq.
and on the groins or the perineum. 'I know of no affections hxely
to be mistaken for these warts, unless it be chancre which nas
healed into a tubercle, and a cancerous wart. The first ot
these can only be mistaken for an incipient wart ; butane great
hardness which accompanies the tubercle will, with the histoiy ot
its origin, prevent mistake. It is important to make the cm-
tinetion, since the patient is not safe if hardness remain aitei
the healing of a chancre. The risk of mistaking a cancerous
’wart is much greater. I think that I cannot do bettei thari
copy the remarks of Mr. Pearson on this subject : 46 The basis
of a venereal wart is smaller than its surface, the roots nave
rather a superficial attachment, and if the intermediate parts
can be seen, they commonly retain their natural appearance.
Cancerous excrescences have a broad base, often more extensive
than their superficies ; they seem to germinate deeply from
within, or rather to be a continuation of the substance of t .e
part ; and in their progressive state the contiguous surface has
a morbid appearance. When a venereal wart is removed oy the
knife, and a very small portion of the substance of the pait
below the surface has been taken away along with it, the. ap¬
pearance' of the wound is similar to that of a wound made in a
healthy part ; but where the wart is cancerous, the alteration
of structure descends much deeper. The increased bulk of
the penis, when the complaint proceeds from a venereal taint,
is evidently owing to the number and magnitude of the excres¬
cences ; and as soon as these superfluous productions are re¬
moved, the part is restored to its natural condition ; but the
cancer is accompanied with an alteration of the internal stiuc-
ture, and addition of substance to the part itself ; so that no
partial extirpation of the morbid appearances is followed by
the least benefit to the patient*.”

* Pearson on Cancer.

An Essay on Diseases resembling the Venereal Disease. 191

0/ Affections of the [ Testis which may be mistaken for Venereal

Affections of that Gland.

There are two diseases of the testicle resulting from venereal
infection ; the one a primary, the other a secondary affection,
T he first is connected with gonorrhoea, and is termed hernia
humoralis, or, more correctly, phlegmone testis ; the second
occurs together with the cutaneous affection, and is called
venereal sarcocele.

Enlargement of the testes may also arise from cynanche
parotidsea, from the irritation of stone in the bladder, from the
use of bougies, from stricture, gout, fever, diseased prostate,
onanism, affections of the kidney, from inflammation produced
by any cause, by blows, cold, the operation of lithotomy,
hardened faeces, from scirrhus, scrofula, hydatids, from effusion
of blood, and from a varicose state of the vessels. Hydrocele
and hernia may be mistaken for disease of the testicle.

Attention to all the circumstances of the case will, in many
or most of the cases of enlargement of the testes, as well as in
the cases resembling enlargement of that gland, enable the
practitioner at once to decide upon the nature of the case, as
far at least as regards the suspicion of its being venereal. I
will, however, notice some of the most striking characters of
tke different affections.

It may seem hardly necessary to mention the symptoms
attendant upon phlegmone testis, as that complaint will be
sufficiently marked by its connection with gonorrhoea. It comes
on when the discharge has been suddenly checked by injections
or other means, by cold, intemperance, violent exercise, or the
like . It sometimes occurs at the decline of a mild form of
gonorrhoea. Both the testes are seldom affected at once, al¬
though they may be alternately. The affection is preceded
by throbbing and pain in the testes ; the disease extends down¬
wards, not upwards ; the pain is most acute at first ; there is a
burning pain in the chord ; pain in the loins and in the lower
bowels ; general uneasiness of the abdomen and thighs, with
fever and other inflammatory symptoms. This affection gene¬
rally subsides on the return or re- production of the discharge.

The venereal sarcocele is a secondary symptom, not com¬
monly met with. Both the testes may be affected. The swell¬
ing, which is considerable, is sometimes hard, generally soft,
puffy, and uniform ; the igure of the testicle not much altered;
the chord not much affected, though it may be thickened;
the testicle bears handling ; there is little pain, and that little
is of a dull kind ; the disease has seldom any tendency to
suppuration ; but should that take place, the discharge will be
purulent. The scrotum is often affected with tubercles or

£92 Original Communications .

small ulcers, and there is most probably present a cutaneous

affection. . , . T

As to swelling of the testes in cynanche parotidasa, 1 may

remark, in the first place, that this is a disorder occurring
chiefly at an early period of life ; the enlargement of the testes
is for the most part connected with the diminution or the
swelling of the parotid gland; the enlargement is generally
.slight, elastic, sometimes large, hard, and painful. 11ns
affection resembles more phlegmoue testis than venereal sar-
cocele, for which last it can hardly be mistaken; and tie
absence of gonorrhoea, with the presence of the swollen parotid
gland, will distinguish it from the former of those venerea
enlargements.

Enlargement of the testis, arising from irritation m the
urinary passage, is more commonly the effect of stricture than
of any other cause. Where the case is not clearly marked,
let it ‘be recollected, that this and the other affections above
mentioned may be the causes of such swelling, and we sna e
led to make that examination which will lead to the discovery

of the cause.

Inflammation of the testis, produced by common causes,
will be distinguished by the knowledge that those causes nave
led to it ; it will be distinguished from phlegmoue testis by its
not being preceded by gonorrhoea; and from venereal sarcocele
by recollecting what has been said of that affection, as well as
by the want of accompanying secondary venereal symptoms.

Attention to the history, progress, and appearance of a
disease of the testicle really scirrhous, will generally enable ns
to distinguish it readily from either of those affections which I
have described as resulting from venereal infection. It is
hardly possible to conceive that scirrhus of the testis should be
mistaken for phlegmone testis. Scirrhus attacking the testis is
slow in its progress; the swelling is hard, and heavy in piopor-
tion to its bulk ; it is often irregular, generally so at an ad¬
vanced stage ; the skin of the scrotum ^uruess the disease have
extended to it) is of a natural colour ; the pain lancinating and
severe; the chord becomes unequal, hard, and tendci ; the
constitution is much affected at a late period ; the disease in
its progress ulcerates, discharging a thin bloody sanies, and the
sore assumes that character which is known by the name

cancer. ,

A violent inflammation of the testis may produce aber¬
ration of structure in the gland, and the testis may lemam
enlarged, unequal, and tender, long after the decline of the
inflammation; the epididymis may continue hard and large
for many months. The testes may suppurate imperfectly,
the chord may become enlarged, and pain may be felt in the

yin Essay on Diseases resembling the Venereal Disease. 19T?

back ; but the health of the patient is not affected, and the
symptoms are mild to the termination of the complaint*.

In scrofulous enlargement of the testis, the symptoms are
generally mild ; the progress of the complaint slow ; the pain
generally slight ; the constitution not much affected ; the
scrotum often discoloured ; the swelling more or less soft ;
examination and pressure are borne with comparative ease ;
the symptoms continue long stationary ; there are present,
perhaps, other symptoms of scrofula in the habit, or on other
parts of the body ; and there is a want of the symptoms
attendant upon the enlargements produced by venereal infec¬
tion. The attack of scrofula may, however, seize the testicle
suddenly, enlarge its bulk considerably, producing great pain,
discolouration, and constitutional disorder, and irritating phi eg-
mone testis ; from which it will, however, be distinguished
by the absence of gonorrhoea.

Hydrocele is a pyramidal tumour (the apex of which is
\]pwards), beginning at the lower part of the scrotum, and
proceeding upwards. The tumour resists pressure ; but it is
comparatively soft at an early stage, at which time it is trans¬
parent. The testicle, instead of constituting the tumour, forms
a part of the parietes of the swelling at the lower and back part.
There is an absence of pain and of constitutional disorder.
Although, at an advanced stage, this disease may be confounded
with pulpy testicle, or some other disease of the testicle, yet, if
attention be paid to what has been said, it will be impossible
to confound hydrocele with pblegmone testis, and scarcely pos¬
sible to mistake it for venereal sarcocele, though it resembles
this more closelv than scirrhous testicle does.

Hsematocele may be confounded with hydrocele ; but it is
unnecessary to offer any rules for distinguishing it from a ve¬
nereal affection of the testis. The same may be said of varico¬
cele. Nor will the practitioner require any rules to be offered
him to enable him to distinguish scrotal hernia from either

phlegmone testis or venereal sarcocele.

Of Ulcerations in the Fauces which may be mistaken for Syphilitic

Ulcers .

I may first premise, that, to a careless and uninformed ob¬
server, particularly to a patient whose fears magnify every sus¬
picious appearance, and who looks into his throat in a looking
glass, the natural inequalities and openings of the tonsils may
be mistaken for ulceration. When ulceration of the tonsils-

* Pearson on Cancer.

VOL. VI J I .

no. 45.

c c

194

Original Communications

arises from syphilis, it is, generally speaking, a secondary symp¬
tom— almost always so — out we every now and then meet with
it in a case where there is every reason to suppose that the ulcer¬
ation of these glands is the first indication of the disease ; in
which case it occurs at a later period after infection than when
primary symptoms have preceded it. The venereal sore
throat occurs at different periods after the first contamination ;
sooner when the chancre or bubo have discharged but little and
have been soon healed, than when they have remained long open
and have discharged much; sooner too where mercury has
been given improperly, than where the disease has been left to
itself ; and generally sooner when no affection of the inguinal
glands has taken place from the primary sore. Exposure to
cold, and certain peculiarities of constitution, may hasten the
appearance of the disease in the throat. The tonsils are more
usually affected than the uvula, or the velum palati, though
the affection may spread to these from the tonsils. The ulcer
of the tonsils is an excavation, as if a piece were scooped out ;
the sore has an uneven, jagged, foul appearance; with an ery¬
sipelatous redness, on a hard, elevated, defined border ; the
uicer is commonly covered with a whitish or brown slough ; it
is progressive* and, like the rest of the syphilitic symptoms, it
is not curable by the powers of the constitution. There is
usually not much pain, nor much enlargement, attendant on
tills form of the disease ; in other respects the sensations do not
materially differ from those produced by ulceration of the
throat proceeding from other cau'ses.

Persons who have had primary symptoms, and who have
either pushed the use of mercury very far, or have very irritable
habits, easily acted upon by that remedy, and are still under
the influence of it, are very often alarmed at the appearance of
ulceration of the throat, which, not only they, but their medical
attendants also, may consider as syphilitic, when, in fact, it is
the effects of mercury ; and being produced by that mineral, it
is also kept up and exasperated by the continued use of it*
This kind of ulceration is often very like the venereal sore-
throat, from which it is very important to distinguish it.

In ulceration of the tonsils produced by mercury, there is a
fulness and enlargement of the tonsils, and the ulceration is gene¬
rally more extensive and less defined. The sore is white, and
aphthous spots may be present. This w hite appearance may
extend over the fauces, and it marks the character of the attack.
There are present, perhaps, also, ulceration of the inside of the
cheeks and tongue, fulness and ulceration of the gums, foetid
breath, with stiffness of the jaws, and general fulness of the
salivary glands. If the ulceration of the tonsils occur whilst
the patient is much under the influence of mercury, we shall

An Essay on Diseases resembling the Venereal Diseases . 295

not only be enabled to decide upon the nature of the ulceration
irom concomitant circumstances and appearances, but we may
fairly argue that it is very improbable that syphilis should make
* progress under a course of mercury, the effects of which are so
apparent. If the ulceration comes on some little time after mer¬
cury has been discontinued, we may be more apt to be misled :
we must then examine closely into all the circumstances of the
case ; and from the history, progress, and appearance of the case,
form our opinions of the nature of the sore. Mr. Bell says, that
in true venereal ulcer of the throat, after the first irritation is
over, the application of caustic produces a clean healing and
improved appearance of the sore ; whilst, in sores in the throat
produced by mercury, caustic not only gives great pain at first,
out the sores retain the same appearance, however frequently
the caustic is applied.

Ulceration of the tonsils may be the consequence of common
inflammation, or cynanche tonsillaris. But this may be dis¬
tinguished by the synochal pyrexia, and by the local inflamma¬
tion and redness, and by the suppuration and abscess which
precede the ulceration. We shall be assisted also by noticing
that the surface of the sore is more florid and clean, more limited
and less inclined to spread, than the syphilitic ulcer. The
ulceration in cynanche tonsillaris begins in the substance of the
gland ; the venereal ulceration proceeds from the surface to the
centre. The pain is more acute in cynanche tonsillaris,

Cynanche maligna may be mistaken in some of its stages
for venereal sore-throat ; from which, however, it may easily be
distinguished. Phe disease makes its attack in different ways.
Pyrexial symptoms are first noticed ; and there are also present
great muscular debility, or pains in the back and limbs, with
general languor, which symptoms mark the tendency that the
febrile symptoms have to assume a typhoid type. Attendant
on the ulceration of the throat, several white specks or aphthae
are seen scattered over the velum pendulum palati and the pos^
terior fauces. The ulcer frequently is pale, jagged, and un¬
equal, spreading rapidly, sometimes assuming the appearance
of a gangrenous sore — -sometimes it is deep, with livid edges
and ash-coloured slough. Not only the throat and neighbour¬
ing soft parts are affected, but in a little time the inside of the
cheeks may become excoriated and ulcerated, the inflammation
highly florid, and the parts bleeding upon being touched.
Whatever the character of the febrile symptoms may have
been, you will now have (supposing the disease to be left to
itself, or to resist the remedies made use of) typhus fever, with
weak pulse, dark brown furred tongue, offensive breath, and
the wmole catalogue of symptoms attendant on an advanced
case of that form of fever. The skin is perhaps covered with a

196

Original Communications.

scarlet eruption. This is an extreme case ; hut in milder
forms, however close the resemblance ot the ulcer may be to
that produced by syphilis, a few days will clear up all doubts.
Attention to what has been said of the two different affections,
will, together with the history of the case, guard the practitioner
against mistakes ; he must remember, that, where he still doubts,
he is to treat the case as cynanche maligna, until the accession
of new symptoms and new appearances place the case bey one

all doubt. . . , £•

In scarlatina anginosa the connection of tne mceration o

the throat, with the efflorescence on the skin, sufficiently mams
the disease. . . i i i

When the tonsils are attacked by scrofula, the gland be¬
comes enlarged, and there is often an appearance of jiunatiou,
with an ash-coloured border and slough ; when in reality there
is no ulceration, the deception being produced by the throwing
out of coagulable lymph, which may be washed or wiped on.
Here there is a want of the appearances attendant on venereal
sore-throat— -a pale, indolent state of parts, connected too, per¬
haps, with other scrofulous symptoms. ^

Cancerous ulceration of the throat is happily not yeiy com¬
mon. Such ulcers are situated mostly at the root, of the tongue.
The history of the case, its progress, the fungated appearance
of the sore, the lancinating pain, the presence of hard, strong
enlargements of the glands of the neck, and behind the ang e
of the jaw; all these are circumstances sufficiently strong to
distinguish this sore from venereal ulceration.

Aphthae covering the soft parts of the throat may occur as
a solitary disease or epidemic ; without any marked symptoms
preceding or accompanying them, excepting, perhaps, oebnity.
They may remain long stationary, or a small slough may se¬
parate, and the ulper left may spread, perforating the velum
oalati. As it is possible that a case of this kind may be mis¬
taken for a syphilitic affection, I have selected a case which
proved very obstinate, but where the indolent character of the
affection was strongly marked . In this case there was not,
however, the slightest suspicion in the minds of the patient, or
of his attendants, that there was any venereal taint ; indeed
the character of the patient was above suspicion.

Case.

Thomas M- - n, Esq., a very respectable middle aged

man of verv regular habits, came under my care in May ISO 9,
bavin o- an ulceration of the velum palati. He had applied
blisters externally, and had taken bark for a fortnight previous
to my seeing him. There was a pale ulcci of the size o a
finger-nail, situated at the commencement of the soft palate

An Essay on Diseases resembling the Venereal Disease.

which it had perforated, allowing the blunt end of a probe to
pass through the perforation. He suffered scarcely any pain ;
but considerable uneasiness whenever he swallowed liquids, from
a part of the fluid getting into the posterior nostril, through
the hole in the soft palate. He w^.s directed to increase the
quantity of bark, and to use gargles. The progress of ulcera¬
tion was very slow ; and, for a time, seemed to be arrested. In
a short rime a fissure appeared, extending longitudinally to the
extremity of the velum palati. Muriate of antimony, nitrate
of silver, and the mineral acids, were successively added to the
gargles, and guaiacum to the bark draughts ; still no ground
was gained. In the beginning of duly the ulcer shewed a ten¬
dency to spread. I omitted all applications, except a garble of
myrrh and honey, and gave him arsenic in the form of Hr.
Fowler’s solution. In a few days the sore put on a more fa¬
vourable appearance ; there had been two or three fresh specks
of ulceration when he began this plan ; these now healed, and
the original ulcer gave him no inconvenience. He continued
taking the arsenic till the 27th of July, when he was attacked
with gout in each foot. The ulcer being now healed, the arse¬
nic was omitted. For several succeeding months, specks of
ulceration continued to appear ; first, a small white spot was
seen ; this gradually enlarged to the size or a silver penny, when
a whitish slough came away, leaving a pale ulcer. Ihese sub¬
sequent ulcers were on the palatum ciurum. Barx and guaia-
cum, with volatile alkali, were given for several months with
little variation. The healing of one set of sores was followed
by the appearance of another set. At last, on the 5th of April
1810, one twenty-fourth part of a grain of the bydrargyrus
muriatus was added to his bark draught and given three times
a day ; the dose was gradually increased to one-twelfth of a
grain. This plan was continued until the 30tn of the same
month. In this short space of time, all the ulcers vveie healed ,
and as the gums were slightly affected, the mercury was discon¬
tinued. A considerable degree ot hoarseness continued for
some time, from what cause I know not ; but this gradually
went off. This gentleman has continued ever since quite well.

I trust that I shall be excused for inserting this long case, as
I think it may serve to describe an affection which might possi¬
bly have been confounded with a venereal affection. It will also
serve to illustrate what I have before observed, namely, that
although mercury may cure an ulcer, it is no proof that the
ulcer was venereal. I have seen ulceration, produced by com¬
mon inflammation, very obstinate ; and it has yielded at last to*
small doses of calomel.

The disease, known in Scotland by the name of Sibbens c
Si wens, attacks the throat, destroying the tonsils, uvula, and

Original Communications.

soft parts. This disease usually makes its primary attack on
the lips and mouth, it being supposed to be contracted by
smoaking a pipe, or by drinking out of a vessel which an in¬
fected person has used. The ulcer of sibbens is a clean pha- ’
gedaenic sore, unattended with the callous base and edge wnich
mark the primary syphilitic sore?. Ulceration of the tonsils
produced by this disease, will be distinguished from venereal
sore-throat in the few situations where it is probable that the
two diseases may be confounded by the history of the case, by
the knowledge that tbe ulceration of the throat was the first
symptom, or th^t it was preceded by soreness of the lips, or of
the inside of the cheeks, and by recollecting the characters of
syphiliiic ulceration of the throat.

No stress can be i<iid on what I say of a disease which I
know nothing o i but from books. My knowledge of yaws is
derived from the same source. This disease, which seems to be
nearly allied to the preceding disease, sometimes attacks the
throat with ulcerations, closely resembling syphilitic ulceration.
In this quarter of the globe \ve are not likely to meet with the
disease; but should a case present itself, we shall be led to $
suspicion of the nature of the case, by the history of its com¬
mencement and progress, by the knowledge that the patient
has recently been in countries where the yaws prevail, and by
the character of the attendant eruption.

In the disease known in Norway by the name Jladesygc , the
throat is often the first seat of the disease, which may erode all
the soft parts. But the want of a primary affection of the
genitals ; the spontaneous healing of the ulcer in some cases ;
and its connection with ulceration of the cheeks pr lips ; the
apparent health of the constitution ; together with the know¬
ledge of those situations in which the disease is prevalent ;
these appear to be the chief rules for distinguishing this dis¬
ease from syphilis*(*.

Besides the cases of ulceration of the fauces above men¬
tioned, as liable to be confounded with syphilis, there are others
with the nature of which we are less acquainted. Some of
thesg cases originated perhaps from sores on the genital organs
and inguinal abscesses, which sores and buboes were not syphi¬
litic ; in others again, there may have been no preceding affec¬
tion of- the genitals. Such are cases termed pseudo-syphilitic.
We shall not, perfiaps, have any light thrown upon the case by
any description of the primary affections, (where any have oc¬
curred,) which the patient can give ; and we shall be left to

* Adams on Morbid Poisons.

^he symptoms and character of this complaint from
Dr. sjdckcr.^J^dinburgk Medical and Surgical Journal , vol. v.

Asbury’tf Observations on (lie Organ* of Hearing. 199

form our opinion of the case by the information we can-
collect by the progress of the disease while under our care.
If we are not assisted by the knowledge of previous symp¬
toms, or by present appearances, or by the mode of accession
and progress of the complaint, still the knowledge that mercury
has not proved of service in the treatment of symptoms which
preceded the ulceration of the throat, and any anomalous ap^
pearance that the throat may exhibit, or any want of regularity
in the progress of the disease ; all these* with the knowledge
that it is possible that an ulcer may not be syphilitic, however
closely it may resemble it, will at least lead us to be slow in
deciding upon the nature of the case. Recollecting that a
syphilitic ulcer is progressive, not yielding to the powers of the
constitution, we must wait until the progress of the ulceration
makes it necessary that we should try the effects of mercury ;
if the sore assume a better appearance under mercury, we must
persevere in the use of it ; and if the disease is got rid of, it is
of little consequence to the practitioner at least, whether it be
considered as syphilitic or not. I may just observe, that if we
perceive the sore partially heals before we employ mercury,
the case must not be considered as syphilitic.

( To be continued.)

II.

Observations on the Function and some particular States of the
Organ of Hearing ; with a Description of a Newly -invented
Instrument for Puncturing the Membrana Tympani. By
Jacob Vale Aseu,ry, Member of the Royal College of
Surgeons, and Licentiate of the Society of Apothecaries,
in London.

The ear is- an organ so ingeniously adapted to the purposes
for which it is designed, and contributes so largely to our most
exquisite and refined enjoyments, that it presents, to such as
are disposed to examine its minute mechanism, a most intersting
subject of investigation. Thm distressing consequences which
result from a diminution or loss of' its faculty, place those so
circumstanced out of the reach of much mental intercourse, and

ee Wisdom at one entrance quite shut out*/'

renders the unhappy object perhaps more solitary than he who
has sustained the loss of sight. Therefore, when the functions
of the ear are impaired, whatever means can be suggested, in

Milton.

200 - ‘ Original Communications ,

order to remove tills morbid state, and to restore its lost energy,
are of the utmost importance both on a physical and moral
consideration.

When we reflect on the oeconomy of this organ, and the
multifarious parts of which it is composed, the diseases affect¬
ing it do not appear so numerous as might, a 'priori, have been
expected ; yet, the obscure situation of the most essential
parts, and the difficulty attending the removal of any morbid
affection of them, render it a subject worthy of the deepest
attention.

The effects of obstruction of the eustachian tubes, and the
most simple and easy mode of removing it, will be the principal
subject of which I mean to treat. These canals, which lead from
the fauces to the tympanum, must remain pervious ; so that
the membrana tympani may the better receive the pulses of
sound; which, p'ivins; mobility to the air within, are thence
transmitted to the membrana fenestra ovalis ; and tnence to the
portio mollis. If the air in the cavitas tympani be confined,
the action of this membrane must be so limited, that the
sonorous rays will produce no effect on it ; neither under these
circumstances can there be any motion given to the confined
air; consequently deafness must ensue. This is daily mani¬
fested in those who are much exposed to cold ; which, producing
an increased secretion from the mucous membrane of the fauces,
the eustachian tubes become obstructed ; and when this secre¬
tion is restored to a healthy condition, the patient's hearing re¬
turns. In those complaints, however, such as scarlatina, cynanche
tonsillaris, fyc. where inflammation sometimes extends to the
organs of hearing, the tubes become permanently obstructed by
the secretion of coagulable lymph ; and finally by adhesions,
which obliterate the passages. In this case it is necessary to
make an opening into the cavitas tympani, to answer the pur¬
pose of the eustachian tube, and this can only he done with
propriety through the membrana tympani.

This operation has been successfully performed ; hut it
.should he observed, that the success attending it is limited ;
and, that in a short time after the operation, the patient has,
in consequence of the opening closing, experienced the same
degree of deafness. This has unjustly brought the operation
into disrepute, and merely because due attention has not been
paid to all the circumstances of the case.

The want of success, I conceive, may result from two causes ;
either from the opening not being made sufficiently large to
remain pervious, or from the inflammation produced by the
injury which the parts have sustained in the operation. That
t hese causes may depend on the kind of instrument which is em¬
ployed, I am much disposed to believe ; and for the following

A suury 5 Observations on the Organ oj' Hearing* $01

reasons : If the extremity of the instrument be small, as is the*
case with the trocar used for this purpose, the opening which
it makes must be small also ; and hence there is the greater
probability that it will again close; if> to enlarge the Opening,
the instrument be urged forward, then there is every chance of
its wounding the opposite side of the cavitas tympani, and oc-
casionmg inflammation , which, by extending to the membrana,
tympani, may produce a thickening of it, and closure of the
aperture. There are cases recorded, and others with which I
am personally acquainted, that justify me in this opinion. If
tne eustachian tubes are obstructed, without organic defect of
tne internal structure of the parts, or constitutional affection*
ot the individual, and yet the operation fails, in what other way
can the failure ot it be explained ? Either the opening must
be too small, or such an injury be done to the parts as to&excite
inflammation ; and which ever of these happen, the operation
proves an additional evil to the disease. I have punctured the
membrana tympani with a triangular probe*. It gives tempo-
*ai/ be le* » but, in the course of a week, the hearing is often as

e ectiye as before the operation. This of course can be ac¬
counted tor only by the closing of the aperture.

f t{lese considerations, I had an instrument made by

Mr. Blackwell, of Bedford Court, C’ovent Garden; the cutting
part of which, is an equilateral triangle, one eighth of an inch
m each direction, and resting on the plain surface of a bisected
bulo, which has, proceeding from it, an iron wire, a line in
diameter, terminating in a small octagonal handle. The point of
tnis instrument can only enter the tympanum to the eighth of
an inches it is then arrested in its further progress "by the
bum. The base of the triangle is sufficiently large to make an
opening in the membrana tympani, that will admit the softened
extremity of a small bougie, which may occasion ally be introduced
to keep open the aperture, when this precaution is necessary.

I he diameter of the tympanum is about double the length of
the point of the instrument ; therefore no injury can possibly
ensue to the opposite side ; and as the membrana tympani itself
is supplied only with very few vessels, the occurrence of inflam¬
mation from the perforation with this instrument must be
extremely rare. The appearance of blood on the instrument
after the operation, will show whether it has penetrated too far.

The triangle is fixed in the radius of the bisected bulb, for

. Afr. Bi ookes, the celebrated anatomist, to whom I am much
indebted for my anatomical knowledge, inculcates the puncturing
with tins probe, provided a more convenient instrument is not at
hand. He expressly states, that no harm can arise from simply
puncturing the membrana tympani.

VOL. VIII. — NO. 45.

D D

’ Original Communications.

the purpose of Avoiding the manubrium mallei and chords'
tympani. The former of which is attached to the upper part?
of the mem bran a tympani ; the latter crosses it transversely,
and. may generally be seen in the form of a white cord at the*
bottom of the meatus. Therefore if the instrument be intro¬
duced with the cutting angle in the lowest direction, it will
enter that part of the membrane which is beneath both of them
where there is nothing to injure; and the flat surface above the
angle will come against the chorda tympani. rX here are two
white spots in the handle corresponding to that part of the in¬
strument which in operating must be kept uppermost. . So little
is the chorda tympani concerned in the function of hearing, that
a wound or division of it is regarded by some as. of no. conse¬
quence; but it appears to me probable, that injuring it may
diminish the sensibility of the parts exterior to the labyrinth.

I am by no means inclined to argue this point ; but it is evi¬
dent that no good can arise from disturbing this nerve ; there¬
fore I altogether avoid it.

It h as been suggested, that the instrument would answer
better, if curved, so as to correspond to the obliquity of the
ineatus auditorius externus. But, although the passage takes
a course at first upward and forward, then making rather a.
sudden turn downward and backward, yet it proceeds atiCi-
wards horizontally to the membrana tympani. 1 fie obliquity
therefore may be removed by taxing the pinna of the. ear .be¬
tween the thumb and finger of the left hand, and drawing it a
little backward and upward ; then the instrument being in tna-
right hand, observing that the two white spots in tne hand fe
are directed upwards, it may be introduced witn great eaye.
ft is right to bear in mind also, that the membrana tympani is
Hot placed horizontally at the bottom of the meatus ; but that
it takes an oblique direction, so much so, that it forms a very1
acute angle at the lower, and an equally obtuse angle at the
upper side of theboney externa? meatus; to which it is at fhst
nearly parallels If, therefore, the instrument be curven, so a >
to correspond to the obliquity of the passage, with its convexity
upward, while the concavity is applied to the convexity of the
lower side of the meatus, the cutting angle will not only enter
the lowest part of the membrane', but it wall also wound the
bottom of the cavitas tympani. in this position indeed the
opening of the tympanum will be quite uncertain, lor the
instrument may enter at the acute angle formed by the union
of the membrana tympani with the lower side of the meatus

Externus.

A short time since I had a case of deafness resulting from
an attack of scarlet fever in 1802, which had been at ten emu
with violent inflammation of the tonsils and. adjacent parts*

Asburyls Observations on the Organ of Hearing . 203

The patient could not hear unless she was spoken to in a loud
tone of voice. As the constitution was perfectly good, I im¬
mediately punctured the membrana tympani. I was instantly
.appmed of success, by the patient declaring with a strong
emotion of joy, that she cotdd “ hear the clock tick f’ that her
“ ears cracked afterwards, succeeded a confused noise, and
sounds were distinguished that she had not heard since the
scarlet fever. Her hearing soon became exceedingly painful.
In a short time, by putting a small piece of wool into each
meatus, the sensibility of the organ diminished, and it adapted
itself to the new impressions of sound ; and the patient finally
declared, “ 1 can hear almost as well as I could at fifteen.’*’
The same success attended a similar operation, where one of the
eustachian tubes was obstructed.

Another young lady had laboured under a defect of hear¬
ing for five years. It had declined gradually till she was in¬
capable of hearing a conversation in any tone of voice. There
was a defective secretion of cerumen. From examination of
the state of the eustachian tubes, I found that by closing the
mouth and nose, and then attempting to expire, she could not
distinguish the least noise in the ears 4 consequently I con¬
cluded, that they were obstructed, although, from the gradual
approach of the deafness, without any previous affection of
the fauces, I had some doubts. But as no harm could arise, I
punctured the membrana tympani ; and I regret to add, that
the operation did not succeed. This failure induced me more
accurately to examine the state of the eustachian tubes ; and
•on the patient clearly understanding, which she did not before,
what I meant by a sensation of swelling in the ears when forci¬
bly expiring, she was sensible upon further trial, of such an
effect. This, therefore, proved a'case in which the operation
could not be expected to succeed, because the air within the
■cavitas tympani was free. This patient had decidedly a scro¬
fulous habit. I immediately adopted a suitable mode of treat¬
ment, from which she derived considerable advantage. She took
a calomel pill and saline purgative every seventh day ; and in
the interval, mineral tonics. I ordered the ears to be fumigated
three times a day, with strong camphorated spirit*'; and
stimulated night and morning by a liniment composed of cera-

* This was proposed to me by my ingenious friend Mr. Edward
Turner Bennett, who also suggested Mudge’s inhaler as a fit appa¬
ratus to be used in this case. 1 procured one, and set it upon an
iron stand four inches high ; then filling it half full of hot water, I
added two tea spoonfuls of strong camphorated spirit, and placed a
spirit-lamp underneath. The vapour rose through the flexible tube^
the extremity of which was then applied to the external meatus.

n n 2

20 1 ■ Original Communications.

turn resin ae, oleum olivae, and a small portion of tinctura iytta?,
and spiritus ammonias compositus applied with a camel's hair
pencil. By these means I hoped to restore the secretion of
wax. In this regimen she persevered as long as I thought
requisite ; and she now enjoys conversation in the society of
Jier friends, By occasionally varying the internal and external
remedies, she is still sensible of improvement.

There are numerous cases on record which directly prove,
that the membrana tympani is not essentially necessary to the
faculty of distinguishing sound ; therefore we may conclude,
that it can be punctured without detriment. Mr. Astley
Cooper has noticed an instance, in which the membrana tym-r
pani of one ear was totally destroyed by disease, and that of
the other nearly so ; the deafness appeared inconsiderable ;
and the hearing in the ear, in winch no trace of the membrane
could be found, was distinct. In similar cases, the ear is some¬
times acutely sensible of musical tones, and accurately judges
of time. Some persons are capable of driving smoak from tire
mouth through the meatus externus* ; and in them there is
great accuracy of hearing. In this instance, the opening in
the membrana tympani must be formed artificially, and most
likely by the efforts of the individual ; as the most exact re¬
searches, I believe, have discovered no such communication,
existing in the natural structure of the parts. But a natural
foramen is particularly described by Professor Rivinus, of
Teipzic, whose name it long bore. This foramen, however, is
not admitted by modern anatomists to exist. I have repeatedly
found this opening in cats and some other animals ; but I never
could trace the smallest appearance of it in man.

If we inquire into the use of the ossicula in the cavitas
tympani, they also are by no means necessary for distinguishing
sound ; since in cases where there has been inflammation and
suppuration of the cavity destroying the membrana tympani,
so that the bones have escaped, the sense of hearing has still
remained. But in these cases, the membrana fenestras ovalis
must remain entire, otherwise the aqueous contents of the laby¬
rinth would escape ; whereby all power of hearing is completely
destroyed. If, when the parts external to the labyrinth are
lost, sounds can be distinguished, it follows that the ossicula
have no share in transmitting the sonorous vibrations, the con¬
trary of which has been generally believed, and that the air in
the cavitas tympani gives the impulse of sound to the fluid of
the labyrinth. Otherwise how is it that an obstruction of the
eustachian canals diminishes, in so great a degree, the faculty

* This phenomenon, I am informed, is very general among the
North American Indians,

Thomas on the Yellow Fever of the West Indies. 205

cf the organ ? The air thus confined cannot prevent sound
passing through the medium ot bone. The ossicula themselves,
therefore, are to be considered as secondary agents, designed to
enable the impulse of sound, thus transmitted, to act with more
correctness and accuracy on the membranes to which they are
connected. The membrana tympani, being furnished with a
contractile and relaxing power, its use, is, I think, analagous with
the iris, to the sight, by regulating the intensity of the violent
impulses of sound, and increasing the power of the weak. When
our attention is directed to a low tone, the membrane is rendered
tfense ; but the opposite state takes place when loud tones are
transmitted to the organ. Considering, therefore, the use of
i lie parts severally, which are external to the labyrinth, and the
degree of deafness from the want of each separately or conjointly,
it will be found that, where the eustachian tubes are obstructed,
the power of hearing will be more diminished than where a part
of the membrana tympani is destroyed. And sometimes, it will
be equal, if not greater, than that which is occasioned by the
Joss of the whole membrane and ossicula. In every case of this
kind, therefore, it will be adviseable to open the tympanum^
which may be done in the manner I have directed.

Hence it appears that, provided the rays of sound are coiv
veyed to the membrana fenestras ovalis, the functions of the
organ will be performed with sufficient accuracy, and that this
membrane is one of the most essential to hearing ; that the
Junctions of the ossicula and membrana tympani are merely
accessary, and are principally employed in regulating the trans¬
mission of sonorous rays to the necessary parts of the organ,
and in protecting those which are more delicate.

III.

Explanation of Opinions and Practice respecting the Yellow Fever
of the West Indies, By Morgan Thomas, Woolwich,
Kent, Surgeon of the lloyal Artillery,

I observed, only a few days ago, to my no small surprise,
in a paper, by Dr. Pym, in the London Medical Repository,
(vol. vi. p. 186,) that my name is brought forward as a kind of
evidence to that gentleman's theory of a fever which he terms
“ Bulam contrary to my decided opinion and practice, de¬
duced from very extensive observation on West India fevers for
the last three years and a half. It must appear indeed strange,
alter this length of residence, serving with the most considerable
part of the troops composing the army in the West Indies, and
which constantly received fresh supplies from England, that I
should never have witnessed the fever of the country in its worst

SOS

Original CommunicalionSo

®rad most concentrated form, which is evidently implied by Dr,
jy-m, when he asserts that “ I did not see a case of Bui am.'’ The
truth is, I never considered that gentleman’s 66 Bii-Iam” a distinct
disease ; and I believe I am sanctioned in this opinion by almost
all the medical officers who have had extensive opportunities
of viewing West India fevers— men who I believe to be as in-
fetligent medical officers as any in the British army.

Dr. Fym has indeed made a very hasty and erroneous
inference from the casual conversation I had with him, which
was for a few minutes only in the public street, and was the
only one I ever had with him upon the subject.

‘The only part of my conversation with Dr. Fym which
could possibly have induced him to draw such inferences, wa%
as nearly as I can recollect, ‘4 that as a distinct disease, and as
he has described the- Bu lam fever, I knew nothing about it,’*
which was the real purport and intent of what I said, or what
I meant to have said. This was mentioned of course in the
manner of desultory conversation : but if Dr. Fym had given
roe any intimation of his object for addressing me upon the
subject, or that I had had any idea that I should be brought
before the public, I would have been more explicit at the time,
and have been saved the trouble of this explanation, in order
to place my opinions and practice in a true point of view, and
prevent my name appearing in support of a doctrine which I
do not entertain.

If Dr. Fym, I say, had informed me of his intention, I
should have told him that, what he terms “ BuiamT I consider
no other than a. more aggravated or concentrated degree of the
bilious remittent of the country, by no means contagious, and a
disease which a person may have more than once, as fatal ex¬
perience has demonstrated. I understand that Dr. Fym does not
admit that the fever can attack the same individual twice, unless
it can be proved that the person has had the black vomit ; no
other symptom being admitted by him, or the few favourers of
his doctrine, as characterising the Balam, whenever second
attacks are mentioned to have occurred. Upon this principle
be may rest a long time, confident of having established that
the disease attacks but once ; for it is well known that the
black vomit is a symptom preceding death, from which few, if
any, have ever recovered. Besides, it may be remarked, that
the yellow fever occurs in its most genuine concentrated form
without this symptom appearing, or perhaps only in very
few instances. In Gibraltar, whence Dr. Fym has taken his
history of the disease, during all those noted seasons of sickness
and mortality, viz. 1804, 1810, 1813, and 1814, the black
vomit, I understand from good authority, was a comparatively
rare symptom ; for where o m patient who bad this symptom.

Thomas on the Yellow Fever of the West Indies .

even of those who died, there were an hundred and upwards
whose eases terminated fatally without its appearance.

In fafct, the great puzzle in the hospitals at Gibraltar was
to distinguish what should be called bilious remittent, and
w hat Bulam : every variety, from the mild to the concentrated
form of the disease, being in the wards, at the same time: and
this difficulty will always exist amongst them, so long as they'
labour to form a distinction when none in reality exists. Dr,
Fym’s history is, however, evidently taken from the extreme
bad cases, or the most concentrated degree of the fever.

With respect to the West Indies being remarkably healthy,
and my not consequently seeing much severe disease, I certain¬
ly expressed to Dr. Pytn that it was healthy, compared to the
notions I had entertained of the diseases of the climate previous
to my leaving England ; for I wTent out under the impression
that I should have met the yellow fever in its worst form all
the year round. I believe every medical staff officer serving m
the same garrison with me in the West Indies at the time, will-
admit that they never witnessed more severe forms of the con¬
centrated fever of the country, than were under my own imme¬
diate charge ; indeed, the artillery was at one period so sickly,
that Dr. Jackson, Inspector of Hospitals, remarked that I had
in my hospital as strongly marked cases of the genuine yellow
fever as he had ever witnessed. I might have told Dr. Pym,
if he required fuller information from me, that, by the practice
of depletion at an early period, the yellowness of the skin, black
vomit, and other symptoms characterising the more advanced
stage, might in the majority of cases be prevented.

The fever which presented itself to me during my residence
in Barbadoes in the years 1813, 1814, 1815, and the early part
of 1816, afforded me ample opportunities of viewing the disease
throughout its course, from the mild remittent type to the most
severe and concentrated form to which the term yellow fever is
usually applied ; and in no instance was there the least tendency
to contagion or infection. The most common symptoms on the
first attack were languor, lassitude, preceded by tremors and
chilliness, severe head-aches, pain in the loins and back, a sense
of uneasiness in the region of the stomach, in most cases
strong vascular action, tongue whitish and moist, little thirst ;
at the more advanced stage, violent shooting pains about the
fore part of the head and temples, darting through the orbits;
the stomach irritable, accompanied with much nausea and pain¬
ful retchings; vomiting, the matter discharged of a green colour;
tongue dry, with excessive thirst ; bowels obstinately costive;
spasms of the extremities, particularly the calves of the legs;
redness of the eyes, flushed countenance, violent throbbing of
the carotid arteries ; the skin intensely hot, oppression about

208

Original Communications.

the precordia ; sighing, yawnings, great anxiety and restless¬
ness ; the patient desirous of being left quiet to sleep ; but the
constant vomiting harasses and wears him down to such a
state of extreme debility^ as to be even unable to articulate his
wants ; distressing hiccough ; haemorrhage from the nose ; and
the patient generally expires in convulsions, delirium^ or a
comatose state. Much variation of these symptoms is however
to be met with in different subjects.

In the treatment of this disease, a great deal depends upon'
the early and liberal use of the lancet, copious alvine evacua¬
tions, warm bathing, blisters, mercurial frictions, &c By this
plan I found the happiest effects in cutting short its violence,
or rendering it more mild and tractable. I have not observed
that state of debility to follow, which has been imputed to large
bleedings. Experience taught me to have recourse to this
powerful remedy in most instances on the first attack. I fre¬
quently saw the strength more impaired by continuance of
re-action at this period, than by a copious bleeding. At a more
advanced period this remedy cannot be used with safety.

During my residence in the West Indies, I felt of course
much interest in preserving the artillery stationed there in as
good health as possible. This I attempted to do, by adopting
a measure suggested to me by Dr. Jackson, of visiting the men
in barracks daily at their breakfast hour, and closely inspecting
every soldier present, off duty, in order to detect any indispo¬
sition among them. This wots accomplished with the assistance
of the non-commissioned officers in charge of messes, who were
strictly enjoined to report immediately to the surgeon any un¬
usual deviation from the healthy state, even the slightest ail¬
ments ; for I often found that such deviations were connected
insiduously with the fever of that climate. The most favour¬
able results, no doubt, arose from these precautionary measures.
A dose of calomel, with sulphate of magnesia, given at this
time, generally removed any disposition to disease lurking in
the system.

If the desired result w’as not fully accomplished by this
simple method, tire patient was ordered into the hospital.

In pursuing the above mode of treatment, I rarely wit¬
nessed much visceral disorganisation ; the patient, from fre¬
quent attacks, inevitably suffered some derangement of bodily
health ; but a change of climate to a northern latitude, shortly
restored him. If this plan was not fully put in force, dread¬
ful destruction of important organs wras the consequence, and

patient became a valetudinary for life.

1 feel it a duty I owe to myself and to my profession, to
give this brief exposition, with the view of removing those
erroneous notions which must be formed of my opinions res*

209

Weaver on a Case of Catalepsis Verminosa,

pecting this disease ; and, frotn the manner my name is intro¬
duced by Dr. Pym; and having so done, I disclaim any wish
or tendency to enter into a controversy, which has, perhaps,
b een rather intemperately cond ucted.

A Case of Catalepsis Verminosa , cured by Oleum Terebinthinoe
rectificatus . By F. Weaver, of Walsall, Surgeon.

On the first of June last 1 visited Mrs. C. She was of a
delicate habit, and had frequently been subject to hysterical affec¬
tions, from which being generally slight, she usually recovered
without much medical assistance. A similar result was anticipated
in the present instance; but the attack continued, without remis¬
sion, longer than usual, and assumed adifferent character. Much
alarm was therefore excited in the anxious minds of her relatives.
On my arrival I found her on the couch, apparently in a state
of insensibility. “ Corporis totius recepta forma, constans,
flexilis, cum insensibilitate,” Catalepsis Linnaf. The tempe¬
rature of the body was considerably below the natural standard;
but the diminution of animal heat could not be accurately as¬
certained, having no thermometer at hand. There was an
entire suspension of all voluntary actions ; the eyes were closed,
the pupils much dilated, and insensible to light ; trismus
maxilaris , and the jaw was so firmly clenched as to preclude even
the possibility of separation ; respiration scarcely percepti¬
ble ; a strong full pulse, indicative of increased excitement of
the vascular system ; but “ sine rubore faciei'’ — “ sine stertore
rel sonora respirationeP Recourse was had to various external
stimuli ; and phlebotomy was suggested as essentially requisite ;
but this was opposed. I was, however, about applying the band¬
age or fillet for venesection, when the pulvis nicotianse excited
sneezing, and caused a separation of the maxilla inferior, which
enabled me to give three grains of tartarized antimony. She
articulated, and expressed disapprobation at my preparing to
open a vein, and immediately relapsed.

A blister was applied, and mustard cataplasms ; but
without waiting the effects of these doubtful auxiliaries, I
immediately abstracted thirty ounces of blood, conceiving there
was a determination to the head, with compression, from some
cause hitherto not ascertained. Before a third of the quantity
was obtained, she revived, opened her eyes, moved the extre-

VOL. VIII. — NO. 4J. E K

210 Original Communications e

mities, and was' raised up in bed ; the vital fluid still flowing
with a rapid current. She expressed much satisfaction and gra¬
titude for the benefit received. The pulse maintained it& _
strength and velocity till within two or three ounces of the quan¬
tity taken ; it then became soft and feeble. A solution of
magnesia sulphas was given every hour till it operated.
It operated well : after which a volatile cordial draught was
given. The cataplasms were removed, having excited much
local irritation. The emetic acted soon after the bleeding.

June 2nd. She had a tolerable night, and continued
mending ; ordered the solution to be repeated every four
hours, with a suitable regimen. The blister had done its
duty.

June 3d. She was going on tolerably well, although rather
languid ; and had slept. The solution was omitted. In the-
evening I found her not so well ; and apprehensive of a relapse,
was about to request the attendance of Dr. Darwin of Litch¬
field ; but during the night she became considerably better.

June 4th. No improvement ; rather worse than yesterday.
44 Sopor constans cum insensibilitate, respirationeque tacita” — a
small, slow pulse. The remote cause of this tumult in the
system was evidently not removed. Dr. Darwin visited the
patient;' and, from having recently had a similar case, he was
of opinion that the disease was catalepsis verminosa, and that a
tape-worm was the exciting cause. He ordered oleum tere-
binthinse §ij. statim sumendum. In a few hours a portion of a
taenia, about eighteen inches in length, was expelled, besides
many fragments ; but, expecting some might be left behind,
this specific was repeated, and more were evacuated. An opiate
was administered at bed-time.

June 5th. She was considerably better— a draught was?
prescribed of decoct, aloes Jij bis die.

June 6th. She continues her medicines, and is in good
spirits ; but much debilitated. The bowels being too lax, the
aloetic draught was continued once a day. By the aid of
gentle tonics, she was soon convalescent.

It is remarkable that my patient had never before expe¬
rienced any inconvenience from the taenia. She had been
subject to hysteric affections ; but generally during uterine
gestation only. From the appearance of the 'worm, I should
imagine it was not of mature growth, its breadth being not
more than one-sixth of an inch, and it w as almost diaphanous.

It is astonishing that vermicular irritation should produce
suspension of all voluntary and involuntary powers, and of'
sensation.; and should induce so strong a vascular action, and
determination to the head, as to threaten the extinction of life.

211

Hooper on a Case of Imperforate Hymen.

How necessary it is to distinguish between cause and effect—
between idiopathic and symptomatic affections — primary and
.secondary cauies — this case fully illustrates.

ff Felix qui potuit rerum cognoscere causas.”

A Case of Imperforated Hymen . By B. H. Hoofer, of
Downton^ Wilts, Surgeon- Apothecary.

In July 1816, 1 was desired by Mrs. H. to see her daughter,
of whom she gave the following account: She was seventeen
years of age, but had not yet menstruated ; for the last twelve
months she had been complaining of violent pains in different
parts of the body ; for which, she was placed under the care of
a medical gentleman, who administered medicines, but without
relief. She grew gradually worse, and the pains were now be¬
come intolerably acute. After a violent fit of pain, a swelling
was perceived, and it was supposed that a rupture had taken
place, for which she before wore a truss. The pain was very-
excruciating, and attended with so much sickness and fever, as
to make it appear impossible that she could long survive, unless
some relief could be given*

From this account I was led to suppose, that it was a case
of strangulated hernia ; but, on examining the tumour, I was
immediately convinced, both by its situation, which was a little
below and to the right of the umbilicus, and its size, that this
was not the case. On an examination per vaginam, I found
the. orifice of the vagina dilated, and occupied by a membrane
which was slightly protruded ; and the labia were more promi¬
nent than natural. On pressing this membrane with the point
of my finger, a fluctuation was felt, very similar to that which
occurs when there is a large collection of the liquor amnii be¬
tween the membrane and the head of a foetus.. I had no longer
any doubt but that this was a case of imperforated hymen,
and therefore made an opening with a lancet through its whole
length, when about a quart of thick uncoagulated menstruous
-blood was discharged, to the immediate relief of my patient.

I should not have thought it necessary to publish this case,
had not considerable doubt been entertained as to the nature of
it, and from the mistake of supposing it a rupture, for which a
truss w'as actually applied ; an error that might be attended with
unpleasant consequences both to the patient and the medical
attendant. The general health of this young lady appeared
for twelve months previously, not to have been affected very

e e 2

312 Original Communications .

materially ; indeed she was rather full and plethoric. When¬
ever the pain was violent, nothing appeared to give so much
ease as pressure on the abdomen. The appearance ol the en¬
largement and the attending pains might have deceived a young*
practitioner, and have led to a suspicion of pregnancy and
uterine action. The recollection therefore of the possibility
of similar cases to the above, may prove extremely useful, and
on that account, this case may be deemed worthy ol a place in
the Repository .

VI.

Case of extraordinary Accumulation and Retention of Urine f
By J. G. De Merveilleux, Jun;^ Stamford, Lincolnshire,
Member of the Royal College of Surgeons in London.

Bridget Hill, aged forty-five years, a poor woman belong¬
ing to the parish of King’s Cliffe, Northamptonshire, seven
miles from Stamford, ten days after her delivery was attacked
with retention of urine, which bad continued five days, when
I was called to see her on the 2Sth of January, 1816. She
had frequent vomiting and hiccup, and a weak tremulous pulse
beating 100 strokes in a minute. The abdomen appeared as
large as in an extreme case of ascites. There was a little
urine evacuated a short time before I saw her.

I immediately introduced the catheter, while, as the urine
was flowing, an assistant applied steady pressure on the parietes
of the abdomen. Sixteen pints , as measured by Mr. Wood
of King’s Cliffe and myself, of dark-coloured and offensive
urine were evacuated. Fearful, lest the sudden evacuation of so
large a body of fluid might be productive of evil consequences
in the reduced state of my patient, I applied a bandage
round the abdomen to keep up a gentle pressure; a little
aperient medicine was ordered, as there had been no evacuation
during the retention ; and the tinctura ferri muriatis was given
three times a day. The catheter was continued for six days,
and on the seventh, the patient was able to void her urine with¬
out any assistance. She has since remained in perfect health.

VII.

Letter from Mr. Richard Rawlins, Surgeon , Oxford , to

One of the Editors , on his Invention of the Reflected Forceps ,

Sir, I find, in the London Medical Repository, vol. viii.
p. 70, Dr. Davis announced as the original inventor of the

Rawlins on the Invention cf the Refected Forceps . 213

reflected forceps for delivering the heads of children in their
birth, after the use of lire perforator in craniotomy ; and, as a
reward, he acknowledges having received a gold medal from the
Society for the Encouragement of the Arts and Sciences. Now,
Sir, I beg to assure you I made this discovery many years
since ; and, as far back as the year 1793, published an account
of it in a Dissertation on the Obstetric Forceps , addressed to Dr.
Wall of Oxford. I have had the pleasure of shewing you the
instrument, likewise the handsome mention made of me in a
Latin Treatise by Dr. Mulder*, upon the various improvements
made upon this instrument since its first discovery, as also of
leaving for your inspection the Dissertation above referred to.
I therefore trust you will take an early opportunity of inform¬
ing the public who was the real jirst inventor of the refected
forceps. I intend making my claim known at the office for the
Society for the Encouragement of the Arts and Sciences.

I am, Sir, very respectfully, vour’s,

July 29, 1817. Richard Rawjuns.

*** We have seen the instrument to which Mr. Rawlins
refers in his letter, and likewise his Dissertation. When we
published, in our Retrospect of last J uly, the account of Dr.
Davis’ forceps, we were not aware of the existence of Mr. Raw¬
lins’s ; or we would have noticed the invention of that venerable
accoucheur.

It has always been our intention to give an accurate en¬
graving of Dr. Davis’ Instrument ; and this letter of Mr.
Rawlins has induced us no longer to delay it, in order that the
respective merits of each forceps may be before the public.
For an explanation of that which the latter gentleman claims as
an original invention, we refer to his Dissertation, (plate II).

So far as that both blades of the forceps fare parallel,
with a locking part common to each, and that they are
introduced one within and one without the cranium, so as to
embrace a portion of the cranium of the foetus, the design of
both forceps is nearly analogous. But the inner blade of Mr.
Rawlins’ forceps, it will be seen, is much shorter than the outer ;
and although the insides of the points be corrugated, to give a
firmer hold of the parts, yet, in this and some other particulars,
the forceps of Dr. Davis appears to have decided advantages over
that of Mr. Rawlins.

As to the question of originality of invention, we must leave

* Historia Literaria et Critica Forcipum et Vectium Obstetriciorum .
Auctore Johanno Mulder, Lugduni Batavorum, 1794.

214

Original Communications .

that where we found it ; remarking only, that we have seen the
several forceps exhibited by Dr. Davis to the Society of Arts,
be. shewing his progressive improvements of the instrument ;
and we have too high an opinion both of his talents and cha-‘
racter, to think that he has occasion to resort to plagiarism, or
that he would wish to usurp any merit to which another has
a just claim. — Editors.

VIII.

An Explanation of Dr. Davis’s Craniotomy Forceps „

(With a Plate.)

Fig. 1. — Ihe single curved Craniotomy Forceps.

a.- — The external blade and handle.

b c.-—A strait line drawn between the extreme points at the ends
respectively of the external blade and its handle, and subtending
the curve of the instrument. This line measures thirteen inches
and gives the greatest length of the forceps,

d e. — A line drawn at right angles at d, from the subtending
line b c, to the outside of tne external blade, measuring ] | inch,
shewing the extreme curve of the instrument at this part. N.B.

> /'he hne d e> as represented in the above engraving, measures twq
inches ,* but this deception arises from the instrument being’ seen a
little in perspective for the convenience of shewing its grasping
surfaces.

f The dotted lines from the angle at f are intended to direct
tlm readers attention to the grasping part of the external blade.
This pait oi the external blade is hollowed out like a spoon j from
the bottom of which, project seventeen sharp and angular* teeth.
1 he points of the teeth are under the level of the brim, so as to
enable the operator to introduce this blade at pleasure without the
risk of injuring the mother.

P h.—A stiait line drawn between the extreme points of the
internal blade and its handle. This line measures 12| inches.

i k. — A line drawn at right angles at i from the lineg h, to shew
tlie curve at this part of the instrument. The dimensions of curves
are usually expressed, by stating those of fhe circles of wdiich they
are segments ; but as in this instance the curve is considerably
greatei at the blade than at the shank part of the instrument, and
scarcely the same at any two points, such precision could not have
been conveniently attained. The line i e> including the thickness
ot the instrument, at ky measures one inch. The thickness of the
instrument at this part, is ~ of an inch. At two inches nearer
tile handle, it is full J of an inch. . '

I’CRCBf'rt

tlg.i

1' liA>’ lOTOMV

l).\vi ,s\i

Wf%|v4

nr * u+n Mal»4*MMr*Ktwy Vt4.mjM4

Explanation of Dr. Davis* Craniotomy Forceps. 21&

l >n. — A line drawn at right angles at l from the line g h, to shew
the greatest degree of curve of the internal blade. This line
measures an inch and

ft. — The dotted lines from the angle at n, are intended to direct
attention to the perforations in the convex surface pf the grasping
part of the internal blade. These perforations are also seventeen in
number, and are so arranged as to receive very accurately the corres¬
ponding teeth of the opposite blade. The convexity of the internal
blade corresponds with great precision to the concavity of its oppo¬
site. Hence it must have the effect upon the instrument, being
firmly adjusted at the lock, of pressing the intermediate skull and
seal]) of the foetus into the concavity, and upon the teeth of the ex¬
ternal blade. Thus armed with seventeen transfixing points, which
are forced to penetrate into the scalp and cranium of the foetal head,
it is evident that the craniotomy forceps cannot readily slip.

o. — A brass nut, projecting at right angles from the metallic sur¬
face of the handle of the internal blade, intended to enter into a cor¬
responding perforation in the opposite handle. The use of this con¬
trivance, for which Dr. Davis is indebted to the maker, Mr. Bots-
chan, is to admit of greater play at the joint ; and at the same time
to insure the accurate adjustment of the grasping surfaces. This nut
is about | of an inch long, and about fr of an inch in diameter.

p. — The joint of the instrument • being the same with the joint
of' the common, midwifery forceps.

Fin. 2. — The Craniotomy Forceps of the second form, or the
DOUBLE CURVED CRANIOTOMY FoUCEES.

In cases of great confinement of the pelvis, it will sometimes
happen, that the frontal and parietal bones may be removed in frag¬
ments of greater or less magnitude, without however bringing down
tiie remainder of the head so as to make it engage in the brim of the
pelvis, the occipital part of it remaining unmoved, and hitching over
the pubes. By the removal of the anterior part of the skull and,
scalp, all purchase accessible to the single curved forceps, is lost *
inasmuch as that instrument could not be reversed in the application
of its curve, without causing with its shanks, much and dangerous
pressure upon the perinceum. For the relief of such melancholy
cases, Dr. Davis has adapted another form of his instrument, of
which we have given a nearly perpendicular view sketch in Fig. 2.

The whole of the anterior part of the fcetal skull being removed
by the single curved forceps, the external blade (i. e. the blade with
the teeth in its concavity) is to be introduced immediately behind
the pubis over the occipital part of the foetal head, with its convex
surface to the pubis. The internal or grasping surface will conse¬
quently be applied to the outside of the child’s head. The internal
or antagonizing part of the instrument must be introduced, so that
the convex or grasping surface shall embrace the corresponding part
of the child’s skull on the inside. In consequence of the double
curve here adopted, the purchase sought for will be easily obtained
without the necessity of laying any material stress upon the peri**

21$ Original Communications .

neeum of os eoecygis ; the shanks of both blades of the instrument
being diverted at the curve from the axis of the brim of the pelvis
to that of the lower part of the vagina.

a b. — This dotted line gives the length of the external blade of
the double curved forceps, and measures thirteen inches.

c d. — This dotted line gives the distance of the shank of the ex¬
ternal blade at the curve ; c the thickness of the shank, inclusive
from the strait line a h. It measures one inch and a half.

ef. — This dotted line gives the distance of the shank of the in¬
ternal blade at the curve e, from the strait line k i. the thickness of
the shank inclusive, and measures two inches.

g. — The perforation in the handle of the external blade to receive
the brass nut, as described in Fig . 1. of the opposite handle. N.B.
This contrivance is intended to be common to both forms of the
instrument.

Fig. 3. — This figure is given to convey an idea of the dimensions
of the grasping surface of the external blade.

a b . — The dotted line a b , being one inch and ^ in length, mea¬
sures the greatest breadth of this surface across its concavity ; the
line being understood to subtend its concavity.

c ds — The line thus marked, expresses the production of the in¬
strument beyond its concavity in the direction of its length, and
measures a quarter of an inch.

The object of this contrivance is to remove any pendulous part of
the os uteri out of the reach of the grasp of the instrument.

ed. — This line is a measure of the length of the concavity and
subtends it. Th« length of the subtending line is 3f inches.

The teeth projecting from the deepest part of the concavity, are
a quarter of an inch long. Those in the shallower parts of the
spoon, are progressively shorter as they approach the brim ; it being
necessary for all, for the reason which has been already stated to be
under the actual level of the brim.

Fig. 4. — This figure is given to represent the convex surface of

the internal blade.

a b. — A strait line, which measures 1 inch, and gives the greatest
breadth of this blade.

c (]' _ -A curved line drawn from the commencement of the con¬

vexity, where the shank begins to expand into blade, to its termi-
natioi/at the top of the blade. This line is supposed to be a curve,
following a curve of the grasping part of the instrument, and mea¬
sures 3 f inches.

The perforations on the convex surface, which are very well re¬
presented in the engraving, are intended to receive the teeth of the
opposite blade. The vacant spaces between the perforations are
made rough, after the manner of a rasp, in order to prevent the
slipping of this blade along the polished interior of the fetal skull.

SpurzlieimV Observations on Insanity.

217

PART II.

ANALYTICAL REVIEW.

Observations on the Deranged Manifestations of the Mind , or
Insanity. By J. G. Spurzheim, M.D. Licentiate of the
College of Physicians in London, Physician to the Austrian
Embassy, Author of the “ Physiognomical System of Drs.
Gall and Spurzheim,” &c. with Four Copper Plates, Lon--
don. Royal 8vo. pp. 312. Baldwin, Cradock, and
Joy, 1817.

Much as the lovers of speculative philosophy have been
amused with the craniological and physiognomical systems of
Drs. Gall and Spurzheim, they wTho value all theories only as
they conduce to some useful and practical end, and these per¬
haps form by far the majority in the British isles, have asked,
and hitherto perhaps asked in vain, to what good do such specu¬
lations lead ?

We by no means range with those who thus argue, and who
value nothing but what produces visible or tangible results.
Science can never stand still ; it may and will retrograde when
the thirst after knowledge shall cease. But until humanity is
content with its lot on earth, inquiry will be active, new theories
will arise, and philosophy extend her empire.

In the science of physiology, no part has been more
stationary than that which pertains to the brain. Although
from the industry of numerous anatomists, we are made ac¬
quainted with the form and various parts of this organ, yet from,
the time of Willis, a period of near two centuries, little has
been added to what he demonstrated ; and notwithstanding ail
the learning and ingenuity that has been displayed, we are still
really ignorant of its precise functions in the animal (eco¬
nomy ; and what are the relations of the human intellectual
sentient faculties, to the several parts of which the ceiebrai
mass is manifestly composed.

System after system has arisen, and each has had its par¬
tisans and supporters ; but when the touch-stone ol reason has
been applied, everyone has successively departed, u like the
baseless fabric of a vision,1 and still left us in darkness and in
doubt.

vol, vin.!—' no. 45.

It F

218 Analytical Review v

Enthusiasm is commonly the concomitant of genius ; v/e
should therefore never, a priori, condemn doctrines merely be¬
cause they exceed the limits which our own reasoning or imagina¬
tion prescribes ; but, ere we decide, we ought patiently to exa¬
mine them, or wait the test of experience, to assay their value.
To us, the systems of Drs. Gall and Spurzheim, making due
allowance for enthusiasm, have appeared too speculative and
fanciful ; yet, amidst many extravagancies, very important
considerations are mingled, which demand serious deliberation
and thorough investigation, before they are rejected.

Divesting the doctrine of the author before us of all ex¬
trinsic matter, and viewing it as a new system of physiology
of the brain, we have ever conceived it deserving of attention ;
nay even of our thanks. Strictly according with the motto
prefixed to his work, that 44 Nothing tends more to the corrup¬
tion of science than to suffer it to stagnate,” it is a more than
ordinary merit to attempt breaking those fetters in which the
judgment has so long been enthralled : and since every phy¬
siological system of the cerebral functions has been abandoned
almost as soon as it had birth, to suggest another which could be
supported by at least plausible arguments, is a fair claim to the
palm of praise. We think none can deny Dr. S. this merit*
His dissection of the brain itself, which * we have witnessed
and closely examined, is, notwithstanding the attacks with
which he has been assailed, a most admirable specimen of adroit¬
ness, and superior accuracy of anatomical demonstration. Im¬
partiality demands that we should do him this justice. But,
although we concede this much, yet let it not be conceived
that we go so far with him as to admit all the inferences he
deduces from the form and disposition of the cerebral parts.
In truth, we neither intend to admit nor to deny them ; con¬
scious that nothing but observation upon a much more extended
view of man in health and in disease, and for a long series of
years, can prove their truth or fallacy.

From an anatomical investigation of the organs which com¬
pose the brain, and the contemplation of the beautiful arrange¬
ment it exhibits, we are naturally led to meditation ; and, m
reflecting upon the uses for which this wonderful structure was
intended, to feel the littleness of man, and confess the presence
of that Omniscience who made nothing in vain. Still human
investigation and ingenuity have clearly established the con¬
nection of the brain with the operations of the mind ; and hence
numerous hypotheses have been formed upon the relation of
different faculties of the mind with certain cerebral organs.

For a particular account of the doctrines of Drs. Gall and
Spurzheim, and their appropriation of each particular part of
the brain to a corresponding faculty or manifestation of the

219

Spurzheim's Observations on Insanity ,

mind, we must refer to our review* of their Physiognomical
System for an explanation.

The transition from the consideration of the physiological
or healthy, to the pathological or disordered state of these
manifestations, was at once easy and natural ; and knowing
that our author professed not only novel views, but also an
intimate knowledge of the human intellectual powers, we anti¬
cipated the publication of his “ Observations'7 with much im¬
patience ; concluding, that if he were better acquainted with
the instruments of the mind, he must consequently be better
informed respecting their morbid manifestations; and hence
a new system of the therapeutics consonant with those
views, and lhs great experience. How far our author has
realized those expectations, the analysis of his work will best
testify.

Ere we, however, enter deeply into the subject, we must, on
the very threshold, embrace the occasion to oppugn a position
which Dr. Spurzheim, in common with most foreign writers
on insanity, has advanced ; which is, that in Great Britain
“ this affliction may be considered as almost endemical.77 We
are confident that there are no more grounds for supposing in¬
sanity endemic in this country, than ceteris paribus in most other
countries of Europe. This national reproach, we believe, may be
ascribed to our own countryman, Dr. Cheyne; who, in his popu¬
lar Treatise, intitled ■“ The English Malady,77 gave rise to the
supposition that “the spleen,77 a species of hypochondriasis, was
an affection peculiar to England ; and the French nosologists,
have accordingly classed it under vesanix by its English name.

If we search into the history of man, we shall universally
find, that the frequency of insanity is in a direct ratio with the
degree of his civilization ; and that any great event affecting
suddenly the religious, civil, or political relations of a nation, and
hence the condition of its population, will always augment the
number of the insane. Such, according to the French medical
writers, was the effect of the revolution in France, and the de¬
vastating wars that ensued. Such effects also resulted through¬
out Germany, wherever the war most particularly pressed ; such
also, according to Dr. Hallaran, resulted from the late rebellion
in Ireland. Habits, and the mode of living, differ in all
countries; and we are far from denying, that those of the
English more readily induce those corporeal diseases which
predispose to derangement of the intellects. But to say that it
is endemic, is an assertion for which no authority can be ad¬
duced. Were it in place, we would descant more largely oi}
this subject.

* Repository, vol. iv. p, 53, 208.
f f 2

220 Analytical Review .

Dr. Spurzheim proceeds with some preliminary and just
remarks on the neglect of the study of disorders of the
mind ; and assigns as the cause of our present ignorance, the.
difficulty attending the examination of the subject. In fact,
the study of insanity has been too generally considered out of
the proper sphere of medical practitioners ; hence the treatment
of it has been universally deemed an exclusive branch of the
healing art. But this cannot entirely account for so limited
a state of knowledge. In our opinion* it is almost impossible
for a physician, occupied with other pursuits, ever to acquire
any great proficiency in the treatment of insanity. It demands
certain constitutional, as well as acquired talents that are rarely
united ; and it, besides, requires a devotion, that none who have
other professional views and engagements can possibly give it.
Another cause mentioned by our author, none can doubt ;
for 44 it is indeed to be lamented, that, from public institutions
and from private establishments, where opportunity of inquiry
into this disease occurs, no more medical communications are
made.1’ It is indisputable, that no one physician to any public
insane establishment of Great Britain has benefited the world
by the experience such establishments have so amply afforded.
It is true, Dr. Haslam published his 44 Observations on Mad¬
ness,” while apothecary to Bethlem ; and although those ob¬
servations convey important information, and strongly mark
the talents and peculiar fitness of the writer for the task,
yet it must be confessed, that the perusal of his work excites
deep regret, that so favourable an opportunity has not been
productive of a more satisfactory result. There are, neverthe¬
less, a few tracts by other practical writers, which evince a
considerable degree of knowledge of the subject; while too
many exhibit nothing but theory ; and others betray very
adroit specimens only, that the promotion of science is not
always the object of an author.

There is another cause too for our ignorance respecting insa¬
nity, at which Dr. Spurzheim glances, and which is certainly
true; but it is a cause which, to remove, appears to us almost
insurmountable. Medical pupils, although instructed in every
disorder to which the human body is subject, and, in many medi¬
cal schools, are even obliged to attend lectures on the diseases of
animals, and on the veterinary art, yet, have no opportunity of
studying the disorders affecting the mental faculties. We have
beard it urged that lectures on insanity should be instituted,
and that public insane establishments ought to be opened, like
other hospitals, for the instruction of pupils in all that appertains
to the treatment of the insane. Dr. Battie informs us, that,
when St. Luke’s was first built, it was intended that it should
afford the opportunity for students to acquire this knowledge.

221

Spurzheim’s Observations on Insanity

Wh v it was not so appropriated, does not appear. But it is
not improbable that further reflection would show the many
objections that must exist to the throwing open insane establish¬
ments, wherein the recovery of patients was an object desired,
to inconsiderate young men. Let this thought be for a
moment entertained, and the propriety or utility of such a
scheme must instantly vanish. If such establishments can
ever be made accessory, in a general way, to the obtaining of a
knowledge of insanity, it could be only to those whose age and
character would be a surety for a prudent exercise of the privi¬
lege. Yet, as medical men at that discreet age are generally
fixed in their pursuits, there would be very few indeed to avail
themselves of it. Hence the advantage of such a plan for
medical instruction would be very insignificant.

Nothing, we believe, will contribute so much to success in
the treatment of insanity, in any of its forms, as for physicians
to discard all metaphysical and abstract speculations concern¬
ing it ; and to adhere to those principles of pathology which
ought to be our guide when viewing all the oilier diseases of
the human body ; and if that view be aided by an intimate
knowledge of the moral faculties of man — a knowledge which is
acquired by association with the world only ; then shall we
arrive at a more correct diagnosis of insanity.

There are,” says Dr. Spurzheim, in his Introduction, ff gene¬
ral considerations of patholog'y which are overlooked in the treat¬
ment of the deranged manifestation of the mind. As, however,
the diseased state of animal life, in many respects, is to be treated
in the same way as that of automatic life, and as medical practi¬
tioners never ought to lose sight of these considerations, I shall
mention them succinctly.

“ In medicine the first notion to be acquired is that of the dif¬
ference between symptoms and disease. If the functions of the
body or its parts be disturbed, not the disturbance of any functions,
hut the cause of this disturbance, is the disease. Hence by far the
greater number of the pretended diseases are mere symptoms.

" In every patient, a peculiar attention is to be paid to his bodily
constitution. Its influence on the susceptibility of diseases, and on
their curability, may be observed in whole nations, and in different
individuals of the same nation. Civilized people suffer many com¬
plaints which are quite unknown to savages ; and these overcome
injuries and diseases, the tenth part of which would kill delicate
citizens. The greatest practitioners consider it as a maxim, that
weak and cachetic persons are easily and often affected, and that
their functions suffer the greatest disorders by insignificant causes,
which have not the least influence on strong and robust individuals.
Moreover, not only general, but also local weakness is to be consi¬
dered. There are few persons who have not one part of the body
weaker than the rest. In many families the weakness of various
parts is even hereditary. On this account, the same disease oiten

<OQ&

Analytical Review .

produces different symptoms in different individuals, and affects in
one patient the head, in another the thorax,, in a third the abdomen,

& c. so that sometimes physicians are mistaken, and declare the ditV^
ferent symptoms to be different diseases.” — p. 7.

These observations introduce us to many of the author’s
practical views. In pursuing the discourse, he conceives that
it is necessary to distinguish the healing power of Nature and
that of Art. Nature will, no doubt, do much in insanity, as
well as in many disorders of the human constitution ; and her
means are various : but the powers of Nature are not always
adequate to the cure. It behoves us, therefore, in cases where¬
in a doubt on this point may arise, to be exceedingly cautious,
since not only the preservation to the patient of his rank among
intellectual beings, but the happiness of bis family may depend
on our judgment. The whole of the Introduction, indeed,
contains many judicious reflections.

The page of Contents will best dispk}^ the authors divD
sion of his subject.

Preface — Introduction.

“ Part i. Derangement of the External Functions of
the Mind. — Chapter 1. Disorders of Voluntary Motion. Convul¬
sions; Epilepsy; Catalepsy; Palsy. — - Chapter 2. Diseases of tk&
Five Senses.

“ Part ii. Derangements of the Internal Functions of
the Mind. — Chapter 1. Diseases of the Brain. Cephalalgia, Ver¬
tigo, and Lethargic Affections; Apoplexy; Phrenitis; Hydroce¬
phalus aeutus. — Chapter 2. Insanity. — 1 . Definition. — 2. Symp¬
toms. — 3. Division. — - 4. Causes ; the Proximate Cause of In¬
sanity is Corporeal ; it resides in the Brain ; on the Nature of the
Causes of Insanity ; Idiopathic connate Idiotism ; Idiopathic occa¬
sional Idiotism ; Fatuity; Idiopathic Mechanical Causes of Insanity ;
Is the Shape of the Head a Cause of Insanity? Idiopathic Dynamic
Causes of Insanity ; Sympathic Causes of Insanity ; Insanity is;
frequent in England. ■ — 5, Forms of Insanity; Fits of Insanity. —
6. Prognosis. — * 7. Treatment of Insanity ; Moral Treatment ;
Architectural Requisites of a Hospital for Curable Insane ; Depart¬
ment for Convalescents ; Reception of Patients ; Cleanliness, Air,
and Light ; Temperature ; Diet ; Coercion ; Treatment of the
Feelings; Treatment of the Intellectual Faculties; Occupations of
the Insane ; Inspection and Visitation ; Medical Treatment ; Ex¬
planation of the plates.”

Under Mental Functions Dr. Spurzheim arranges “ voluntary
motion, the five senses, feelings, and intellectual faculties
and these are divided into external and internal functions ;
the one being the result of automatic, the other of animal life ;
the former the result of organization, the latter of the mind.
In treating, therefore, of derangement of the external functions,
it is to be understood, that voluntary motion and the functions

Spurzh elm's Observations on Insanity. 223

of the five senses are meant. But of their disorders a brief out¬
line only is given ; because they are already so much examined

other writers ; although he thinks our knowledge of them
susceptible of great improvement.

In Dr. S.’s opinion, there are no peculiar diseases of the
muscles ; but when they are affected, which they may be, by
different diseases, as inflammation, syphilis, fevers, &c. that the
derangement of their functions arises only from their peculiar
structure and function ; for chorea, tetanus, trismus, epilepsy,
&c. are merely symptomatic, or, as Dr. Spurzhcim has it,
sympathic .

In explaining the phenomena of palsy, Dr. S. has recourse
to the position he laid down in his Physiognomical System ;
viz. that there are two sorts ol nerves — those of motion, and
those of feeling.

In palsy, as in any other disorder, the first examination to be
made concerns the parts which are affected, and the functions which
are disturbed. Then the cause of the disturbance is to be disco¬
vered. In palsy, the disorder may reside in the brain, in the ner¬
vous cord of the spine, in the abdominal viscera, or in the paralytic
parts themselves. Hemiplegia originates from various iniuries of
the brain." — p. 26.

For an amplification of the pathology of palsy, we must
refer to the opinions which are peculiar to Drs. Gall and Spur-
zheim. It is not our object here to discuss those opinions ; and
since they are not new, there is the less reason to dilate upon
them. His conclusions upon this subject however ought not
to be omitted.

Palsy of the whole body or of one side, is less common
than that of the upper or lower extremities, or of single parts. I
doubt whether palsy of the lower extremities alone, or of one single
part, has so often its cause in the brain as it is said. Formerly such
an idea could have been adopted and supported by the erroneous
opinion that all nerves originate in the brain. But as the contrary is
anatomically proved, I think that, in many cases, the cause may also
reside either in the nervous cord of the spine, or in the abdominal
viscera, or in the affected limbs themselves.

“ The morbid affections of the nervous cord of the spine are far
more frequent than it is commonly believed. It is too seldom exa¬
mined after death. The dissection of the vertebral canal is too diffi¬
cult, and discourages the anatomists. If there be no external mor¬
bid. appearance of the vertebrae, physicians do not think of dissecting
this important part.” — p. 28.

In illustration of his arguments, the author adduces the
anatomical researches of Dr. Saunders of Edinburgh, and the
observations of Dr. Parry and Mr. Pott ; the former of whom
has investigated, with great attention, the morbid appearances
in the spinal cord, and has pointed out the congestions of the

224 Analytical Retime-

blood vessels there situated, after convulsions. The author
observes, that

“ the spinal cord is composed of a nervous mass, has the same mem--,
branes as the brain ; hence it may be affected by the same diseases
as the brain, such as inflammation, suppuration, induration, tumours,
congestion, or ossification of the blood vessels, collection of any fluid,,
by irritation, weakness, or exhaustion of the nervous mass. . The
spinal cord may also be injured or compressed by the deviation oi
the vertebrae.” — p. 30.

As causes of palsy, he refers to disorders of the digestive
organs, to an idiopathic affection of the muscles themselves,
from compression of the nerves in their course, or fiom ossified
arteries, preventing the blood from going to the parts, and to
ossified veins opposing its reflux : refrigeration is likewise a
cause of partial palsy.

« According to all these different causes the plan of cure must
be modified.— If a local disorganization of the brain, or a collection
of anv fluid in the brain, be the cause, the disease is incurable.— --if
It originate from a depression of the skull by violence, the opeiation
of trepanning must be performed, and the broken poi lions lemov ecL
« — If it be a symptom of a general disease, as of gout, fever, inani¬
tion, the plan must be adapted to the general disease.— If it lesult
from repercussion of cutaneous eruptions, or from drying up habi¬
tual drains, then issues, blisters, setons, artificial eruptions of trie
skin, and remedies acting on the skin, are to be administered.* It
it have been produced by lead, the remedies against the conca picto-
num in general are also indicated against this symptom. p.

When the cause is in the spine, Dr. Spurzheim thinks, with
Pott, that palsy of the lower extremities is not the result oi
weakness and softness of the spinal vertebrae. He is adv erse to
a long continuance in the horizontal position, and decides,
« that Pott’s or the Arabian method of treating palsy of the
lower limbs, even where there is no curvature, lias cured a
greater number of patients than the horizontal position uiUiout
issues.” If weakness of the abdominal viscera occasion palsy,
the cure must be attempted by restoring (i the digestive powder
Tby means adapted to the individual irritability of the patient.

The author next proceeds to u Diseases oj the Five Senses .
After some preliminary remarks, he observes,

<c as to the causes of the deranged functions of the five senses, the
same general considerations obtain. The individual nerves may De
affected for themselves ; they may, for instance, be inflamed or af¬
fected by a greater vascular action, or diminished m size, disor¬
ganized, or morbidly affected by general diseases, like every organic
part ; or their functions may be deranged on account of a diseased
brain, or on account of disorders of the abdominal viscera. tonus
in the intestines, for instance, may affect all the senses ; they may
produce pain in thy limbs, tickling in the nose, cough, grinding o

225

SpurzheimV Observations on Insanity.

the teeth, disagreeable smell, blindness, deafness, and other symp¬
toms. Derangements of the five senses are often precursory symp¬
toms of apoplexy.

“ Thus, the disorders of the five senses are to be considered
according to the general principles of pathology.” — p. 37.

and, finally, he refers the details to general pathology.

Dr. Spurzheim then enters upon what may be considered
the immediate and more interesting part of his work ; viz. “ De¬
rangements of the Internal Functions of the Mind”

Agreeably to his reasoning, the external functions of the
mind are disturbed and cured according to the general princi¬
ples of pathology ; are sympathetically affected in different
diseases ; often suffer idiopathically, ana sometimes the organ¬
ization presents a morbid appearance, whilst at others none can
be detected : so, likewise, the same obtain in respect to the
internal functions of the mind.

“ It is known that the internal operations of the mind are often
deranged in general diseases, such as in fevers, inflammations, gout.
Sec. ; and every one admits that delirium, stupor, vertigo, lethargic
affections, even apoplexy, depend on the cerebral organization. But,
by our ignorance with respect to the functions of the brain, far the
greater number of the deranged manifestations of the mind have
not yet been generally considered as disorders of the cerebral organi¬
zation. I think, however, that, as in the disorders of any other
organic part we always consider at the same time its deranged
functions, and in observing the deranged functions we think of its
disturbed organization, our proceeding in regard to the brain ought
to be the same. Those who speak of diseases of the mind alone
may speak with the same reason of diseases of the mere vital prin¬
ciple in liver complaints, or in disturbed digestion or in its idiosyn¬
crasies. Such physicians may confine their plan of cure to a moral
treatment of the archeus, in cases where a person cannot digest mut¬
ton or cauliflower.

ce Meanwhile I am obliged, in a certain degree, to render my
considerations conformable to the general division of nosography ;
but the time may come when the derangements of the mental ope¬
rations, and the disorders of the brain, will be classed in the same
order, and only the different disorders of the brain will be spoken,
of, as is actually the case with the five senses and their organs ;
when it will be admitted that the deranged functions, of the mind
are sympathic or idiopathic affections of the cerebral organs ; finally,
when it will be believed that what happens in all other bodily parts
occurs in the brain, viz. that every perceptible derangement of the
organization does not visibly affect the function , and that every disturb¬
ance of function is not accompanied with a visible alteration in the or -
ganizeiion . Accelerated circulation of blood does not always derange
the function of the stomach, nor that of the brain. There are cases
on record where a considerable disorganization of the lungs bj?d not
disturbed respiration, and was detected only after death.” — p 3 %

VOL. VIII, - NO, 45. G G

22& . Analytical Review *■

We confess that this reasoning so much accords with our
own views of the subject, that we feel pleasure in quoting it ;
not merely because it strengthens our opinion, but because we
feel assured that the more generally it is impressed, the more
certainly will the present erroneous views of insanity give way,
and a more rational practice be consequently substituted.

In treating of “ Diseases of the Brain f we must pass over
our authors remarks on cephalalgia, vertigo, lethargy, cata¬
phora, earus, lipothymy, ana syncope, in order to notice con¬
siderations more immediately relevant.

Apoplexy is indeed a state of disease most intimately con¬
nected with that of insanity. The decided proofs insane persons
exhibit of disordered circulation while living, are a priori reasons
for expecting those morbid appearances almost always exhibited
within their crania, when examined after death. The most
casual observer must have observed how often an attack which
begins with symptoms of insanity terminates in apoplexy; and,
vice versa , symptoms of undue determination of blood to the
head are frequently precursory to insanity. This has forcibly
struck us in our own morbid examinations of the crania of those
who have died insane ; and we are happy to find two such
accurate pathologists and able physicians as Drs. John Cheyne*
and John Arm strong*!- lay such particular stress on the analogy
of mania and apoplexy. Among the physical causes of insanity
in La Salpetricre, Dr. Esquiro! computes about one in six from
apoplexy ; and from a table of 277 deaths of insane persons, he
found as many as 37, or almost one seventh, from the same
cause. According to the morbid examinations of modern pa¬
thologists, the evidence of diseased action in the circulation of
insane persons is generally clear. Indeed, it is impossible to
treat of insanity without embracing a view of the pathology of
apoplexy ; nor should we, in our medical treatment or prognosis,
ever overlook this relation. Apoplexy, therefore, is prominent
in our author’s consideration of cerebral diseases. Of his diag¬
nosis of apoplexy there is little necessity to speak ; but on bis
pathology of it we feel it necessary to be a little more explicit.

cc The proximate cause of apoplexy is connected with changes
of the brain, which may go on for a considerable time. This opinion
is founded on the previous disorders of its functions, and on the
various organic changes detected on dissection. Undoubtedly the
scalpel in the hand, or dissection after death, is the best way of in¬
vestigating the seat of the proximate cause of diseases. In dividing
the scalp there is often a great flow of blood from the frontal and
occipital veins ; the membranes of the brain are often thickened,
the arachnoidea is sometimes opaque, the veins turgid with dark

* On Apoplexy and Lethargy.

t Illustrations of Typhus, &c.

Spurzheim’s Observations on Insanity.

227

vlblood ; in general a great congestion or determination of blood to
the head is observed. The consistency of the brain is different, as
is the case in other individuals who do not die apoplectic. Three
appearances are particularly remarked, viz. there is an extravasation
of blood in the ventricles, or at the basis of the brain and cerebel¬
lum or there is a serous effusion, sometimes accompanied with
suppuration or tumours ; — or there is no extravasation at all. Ac¬
cordingly, long ago, apoplexy has been divided into sanguineous,

serous, and nervous. . , . .

cf With respect to sanguineous apoplexy it may ne asxcecl, on

what sort of laceration the effusion of blood depends, whether on
dilatation and weakness; or on erosion and suppuration: whether
on the large or small vessels ; and in what part of the brain i he
blood-vessels may break at all parts of the brain and cerebellum, m
the cavities and at the surface, in the same way as in other parts, on
the legs, for instance, in the abdomen or thorax. An effusion, how-
.ever, at the basis, towards the medulla oblongata, produces the most

certain and sudden death.” — p. 45.

" A serous apoplexy is observed in adults under circumstances

which in children produce hydrocephalus acutus ; that is, in indi¬
viduals with an inflammatory diathesis oi the brain, where the
great determination of blood to the head produces a serous effusion.
In strong individuals it may appear as phremtis. # In weak persons
its pro cress is slow, and the modified appearances induce those phy¬
sicians, who consider merely symptoms and not the nature of the
diseases, to speak of different diseases. There are however acute
mid chronic inflammations in the brain as m any o er par
body, and every where the same morbid changes may be observed.

« Serous effusion is not so unusual m adults gs it is behaved. It
as often found in those who die of chronic mama, or who had b -

come idiotic from that disease.’ p. 47- . „

“ In nervous apoplexy no effusion at all is detected on dissection.
This will be the case if persons die of strong mental aflecu = ,
extreme and sudden joy, fear, anger ; quidam sub eoitu £0™™. As¬
phyxia in carbonic gas is ia kind of hondr^c

plexy sometimes occurs m delicate, n\ ste , . J t

Subjects, but it is not to be confounded with asphyxia, or appa p

death, where all the powers are only

lity remains. In such cases, indeed, it is literally true j - *
have confidence even in death. Then putrefaction aione u f
live sign of dissolution.” — p* 48.

■ The treatment of apoplexy fotindgd on these views is highly

aPPin)rspeaking of Phrenilis, our author expresses astonishment
that inflammation of the brain is so seldom ’ a"idea

that it^'never^resentf^except'^when accompanied by delirium.
He likewise adds that he has

Ze, and whose cerebral functions were entirely suppressed,

G G 2

228 Analytical Review.

but whose brains shewed unequivocal marks of inflammation.
There surely is nothing novel in this observation. Dissec¬
tions prove, that, in the head, in almost all cases of fevers,
there are evident signs of turgesccnce of the vessels, or of in¬
flammation. Dr. John Armstrong says, 44 so far as my re¬
marks have extended, the brain and its investing membranes
are more subject to inflammation in typhus than any other
parts of the system.” And in the remittent or yellow fever of
tropical climates, evidence is almost uniform of congestion or
inflammation in the brain ; and similar appearances were dis¬
covered in the brains of those who died of the malignant fever
that so much prevailed among the military and inhabitants on
the Continent towards the conclusion of the late war. Hap¬
pily too, a much more rational mode of treatment has followed
these enlightened pathological views of fever.

Dr. Spurzheim adds, that it is a common error to suppose
that phrenitis occurs only in adults. We were not ourselves
aware that such an error prevailed ; at least, in England ; we
presume, therefore, that he must refer to foreign, and not to
British practitioners. They who were acquainted with the
practice of the late and lamented Dr. John Clarke, or who have
read his 44 Commentaries on the Diseases of Children,” will
recollect, that he maintained that phrenitis or inflammation of
the brain occurs more frequently in children than in adults.
Every one knows bow commonly it is the cause of hydrocepha¬
lus, to which children are more particularly liable.

Oil 44 Hydrocephalus acutus ,” our author is rather copious.
He urges the necessity of distinguishing hydrocephalus, or
dropsy of the brain, from hydrocephalus acutus ; and with res¬
pect to the former, as he deems it to be incurable, cautions
against the attempts of medical art to remove it. Of the acute
form he describes three stages, and observes,

“ As in any other part, so in the brain, the frequency of its dis¬
eases coincides with the greatest energy of its develop ement.

44 Scrofulous, weak, delicate, and also stout and strong children
of a fair complexion, are subject to this disorder. Those whose
brain is developed early and rapidly, and whose mental powers show
a great and premature energy, are most liable to be affected with it.
In such children, the activity of the brain is greater, and a larger
quantity of blood is determined to it. Those who think that round
heads are more subject to this complaint are mistaken. The most
beautiful configurations of head are no security against this evil.
I he children of families, where other individuals have been carried
off by the same affection, are exposed to the greatest danger.” — p. 55.

sc There are physicians who flatter themselves to have cured hy¬
drocephalus acutus ; others deny its possibility. 1 am of the opi¬
nion of the latter. I have already mentioned that, often, all the
symptoms which accompany an effusion in the brain are observed*

Spurzlieim’s Observations on Insanity. 229

no serosity is detected on dissection. This is the case in children
who die in a few days under perfect insensibility, strabismus, dilata¬
tion of the pupil, deep sighing, grinding the teeth, convulsions.
Such cases may be treated with success : I have seen it done by
Dr. Gall, and have done it myself; but we think we have only pre-
vented the effusion. Cures of that kind happen in the first days,
while the morbid action of the blood-vessels, and not effusion, pro¬
duces the alarming appearances. I do not know7 any case of cure,
when the progress of the disease wras slow7, and all symptoms of the
third stage had appeared.

te It results that v7e consider hydrocephalus acutus itself as in¬
curable : it can only be prevented.”— p. 60.

The observations of our author upon hydrocephalus refer
almost exclusively to the acute form, as it appears in children:
hut although unquestionably this is a very important part of
pathology, when treating of diseases of the brain, yet it can
scarcely be said to relate to insanity ; because true insanity is
chiefly confined to adults. But when treating, generally, of
pathology, in its relation to insanity, it might have been ex¬
pected that our author would have taken more notice of those
collections of water so commonly discovered in different parts
of the brains of maniacs, both in the ventricles and between the
pia mater and the surface of the brain. Bonetus, Morgagni,
and others, had made observation of the frequency of this oc¬
currence ; but attached no importance to it. But our departed
and valued friend, the late Dr. S. F. Simmons, from whose
intercourse we derived much practical information, considered it
a fact particularly worthy of notice ; and the more so, because of
theyuniformity of its occurrence, in cases where the patients were
known to have been addicted to hard drinking: and, hence, from
the morbid appearances, he inculcated the necessity, in mania,
of lessening the determination of the blood to the brain, and of
moderating the preternatural excitement of that organ.

The author now proceeds to the treating of “ Insanity , or
Mental Dera?igements and, in the first section, considers u De¬
finition and Name.” It were happy indeed if diseases could be
reduced within strict nosological rules, and that the name should
always describe the disease which we mean to refer to. There
can be no question, that the confusion that has ever prevailed
among nosologists in the classification and nomenclature of the
various forms of Mental Derangement, has tended to retard
our knowledge in all that relates to this subject. But this con¬
fusion has arisen rather from attempting too much, than from
having done too little.

Nothing appears more absurd, if the idea of the influence of
moon be discarded, than retaining the word lunacy, to express
an insane state of the human faculties. Lunacy, from its
etymology, conveys the impression that mental derangement

230 Analytical Review .

is absolutely under the influence of the lunar system; an opinion
which leads to inferences dangerous in medical as wellas in
j uridical decisions. The word, Lunacy, therefore, as applicable to
the state of the human mind, ought to be abolished from medical
language. As a general term,, there is none perhaps less ob¬
jectionable than Insanity.

f<r I have/’ says Dr. Spurzheim, ee divided the functions of the
mind into feelings and intellectual powers. Now from what I have
said it follows that the derangements of the five senses only do not
constitute insanity, and that there may be insanity without derange¬
ment of the intellectual faculties, as they are commonly spoken of
It is also certain that the diseased functions of the feelings are not
always insanity. Our appetite may be deranged, and we may be
fond of unusual savours, as of coals, chalk, &c. ; physical love may
be subject to various aberrations, as in unnatural desires ; various
idiosyncrasies may occur in other feelings ; — the individuals, how¬
ever, as long as they preserve a power over their actions, are not
considered as insane, just as memory, judgment, and imagination,
may be extremely weak and incorrect, and may commit continual
errors without being considered as insanity. Yet there is insanity
with respect to the feelings and intellectual faculties. In what then
does insanity consist f

“ With respect to the morbid affections of the senses, and to
the errors of the intellectual powers, we are insane, if we cannot
distinguish the diseased functions, and do considerjthem as regular ;
and in the derangement of any feeling we are insane, either if we
cannot distinguish the disordered feeling, if, for instance, we really
think we are an emperor, king, minister, general, &e. or if we
distinguish the deranged feeling, but have lost the influence of the
will on our actions, for instance, in a morbid activity of the propen¬
sity to destroy. Thus, insanity , in my opinion, is an aberration of
any sensation or intellectual power from the healthy state, without being
able to distinguish the diseased state ; and the aberration of any feeling
from the state of health, without being able to distinguish it, or without
.Ike influence of the will on the actions of the feeling. In other words,
the incapacity of distinguishing the diseased functions of the mind , and
the irresistibility of oar actions, constitute insanity I — p. 70.

Whether our author has here been more happy in his defi¬
nition of what constitutes insanity than his predecessors, we shall
leave to the judgment of our readers.

It is a great error, says Dr. Spurzheim, to consider the mind
as one single power, or to derive the feelings from the intellectual
faculties. 44 The mind is an aggregation of powers, which may
act and be disturbed individually, as is the case with the ex¬
ternal senses and voluntary motion. Every disturbance, how¬
ever, of any faculty is not insanity, but merely the want of the
faculties which constitute liberty?’ For an elucidation of the
Doctor's meaning of liberty , which we profess we do not, as
here Introduced, understand, he refers to his work on the

Spurzhe’mfs Observations on insanity. SSI

Physiognomical System, second edition —a reference, by the bye,
which is met with at almost every page, and which imposes
on the reader the trouble, and perhaps the expense, of having
the said System at his elbow as a vade mecnm for whatever may
be obscure in the work before us.

It is justly said, that, in medical jurisprudence, with regard
to insanity, there are two considerations of high importance ;
viz. partial and intermitting insanity. We confess we are not
entirely satisfied with the author’s explanation of the former or
partial insanity. He asserts that there are as many sorts of partial
insanities as individual powers of the mind— a position with
which to accord, we must first admit, without limitation, the ex¬
istence and operation of his organs of the manifestations of the
mind. But here we again beg it to be understood, that, al¬
though allowing that Brs. Gail and Spurzheim have exhibited,
through the medium of comparative anatomy, many examples
favouring their theory; and that we are ready to concede that
their physiology of the cerebral functions is entitled to as much
credit as any that has preceded it, yet we cannot so far approve
as to adopt their reasonings and deductions.

Dr. Spurzheim proceeds to inquire, what are lucid intervals ?
Dr. Haslam, in his “ Observations,” has entered into an elabo¬
rate investigation of this question. It certainly is an important
one, in a juridical point of view. But yet we think that, with¬
out the intervention of Mr. Locke, or any other metaphysical
philosopher, an answer may be given that might satisfy the
scruples of the law, as well as those of our own conscience. A
lucid interval is that period when the mind is sane and capable
of exercising a sound judgment. By a sound judgment, we do
not mean as to one, two, or more particular points ; but as to
every point with which the mind was, previously to derange¬
ment, cognizant. But Dr. S. says, that in insanity experience
shows that the intellectual powers may increase. To this we
have to observe only, that any extraordinary and sudden incre¬
ment of the intellectual powers above the ordinary standard
of an individual’ s capacity, is as much a proof of mental
aberration, as when they, without apparent cause, as quickly
descend below it. If there be a preternatural and sudden
display of intellectual powers, the judgment cannot be supposed
to he coincident ; and, therefore, that state alone is insanity ;
and the return to the ordinary understanding would alone con¬
stitute sanity. By way of illustration, Dr. S. says, “ some per¬
sons cannot distinguish colours, and take red for green ; but
they see perfectly well the size, form, and distance of the ex
ternal objects : hence their judgment at the same tune is defec¬
tive and lucid, or, if I may say so, sane and insane.11 But
surely this may rather be called a morbid defect of the optics.

tSw Analytical Review,

than a defect of the judgment. Several similar cases are re¬
corded : in some the cause was congenital ; in others, heredi¬
tary ; but in such cases the judgment, which implies experience
and reflection, is in no way concerned.

Our author raises numerous queries “ whether, in partial
insanity or in intervals, the patients are to be considered as in¬
capable of transacting their own concerns, and as free from all
responsibility for their actions ?” This part of the subject is
pretty clearly understood in our courts of law. The query is
merely put ; not answered. As Dr. S. therefore throws no
new light upon it, we may be excused from entering upon the
consideration of it. Perhaps our readers may agree with us that
there are some subjects discussed in this section, under the title
of “ Definition and Name,” that appear rather out of place.

If it be objected that we have not attempted to make our
author’s divisions and inferences intelligible, we must plead
guilty ; and candidly confess, it is because we doubt if he be
quite intelligible to ourselves.

“ Symptoms of Insanity — The exordium to this section
contains truths, which ought to be regarded in all disorders, as
well as in those affecting the mind.

“ A description of morbid phenomena, which are observed in
insanity, will guide our power of distinguishing the diseases, or the
causes of the morbid appearances. It is certain that the majority
of medical men have a too great tendency to consider the symptoms
as the disease, and it is particularly the case in insanity. Symptoms,
however, are only deranged functions. Now the same function
can be deranged by various causes, and the same cause may derange
various functions, and hence produce various symptoms. Fever
alone is not the disease, but merely a morbid phenomenon ; and the
circulation of blood may be accelerated by different morbific causes.
In ..the same way, inflammation will produce various symptoms
according to the functions of the parts which are affected. Refrige¬
ration may produce head-ache, sore eye, sore throat, tooth-ache,
cough, vomiting, diarrhoea, p. 79-

“ In insane people the functions of automatic life, such as diges¬
tion, circulation, respiration, nutrition, secretions and excretions,
may or may not be disturbed ; their disorders may take place in
various degrees ; and on account of the absence or existence of such
symptoms, the elucidation of insanity will only become more simple
or complex. Their detailed consideration belongs to the pathology
of automatic life, I here intend to relate only the disorders of
animal life.”' — p. 79*

It is evident, however, that nearly the whole contents cf
this section are compiled from other writers, and little that was
not before known is added. We may plead the authority of our
author himself to justify this observation ; who, as if anticipating

Spurzheimh Observations on Insanity . 238

such an impression, gratuitously allows that he has u preferred
extracting examples from other writers, not because he has not
seen such cases , and sometimes repeatedly, in different mod-houses,
but because such facts, being admitted by other observers, will
perhaps be more easily admitted by adversaries.1’

The next section is upon the “ Division of Insanity
wherein Dr. S. inquires whether insanity is a generic term, and
may be divided into several species ? He states that the oldest
division known is that by Hippocrates, into melancholia and
mania; in which he is followed by Galen. Perhaps it is not
very material for our present purpose; but as Hippocrates is
quoted as authority, we cannot help noticing that we believe
the Sage of Cos no where mentions Mania. His division, if
it deserve that distinction, is into Phrenitis and Melancholia :
the former of which he derives from Phrenes , septum transver-
sum, or diaphragm ; which, by the antient physicians, was
supposed to be the seat of the mind and wisdom, and also
of genuine phrenitis. Insania is described and treated of,
and may be considered synonymous with mania. But it is
evident that Hippocrates had no very definite idea either of
phrenitis or insania ; for although he describes each as arising
from different causes, yet in his book De Affectionibus it would
appear, that he sometimes confounds them : Ubi perpetua cum
febre insania ( phrenitis dicta ) oceupat, &c.

Dr. Spurzheim takes an ample review of the modern divisions
of insanity. But of what use, we would ask, are these divisions
and subdivisions? Were they founded on causes, physical
or moral, then they might be reduced to some fixed principles ;
but as these nosologists have taken symptoms as the basis of
classification, such divisions must ever prove as instable and
variable as the symptoms themselves. We agree with the
author, that Dr. Hallaran’s is the least exceptionable division ;
because resting strictly on causes only. But neither can we
admit the division of that observant physician to be correct ;
since he refers one of his species to mental causes , and denomi¬
nates it mental insanity ; whereas we are satisfied that insamty
always has its origin in some derangement of organic functions ;
yet that the effect may be elicited by a mental, i. e . moral
cause. With this opinion we find Dr. S. coincides ; but refers
to the section on the “ Causes of Insanity n for his reasons.
The uiost common division is into mania and melancholia ; but
this is entirely arbitrary, and is purely regulated by the symp¬
toms. Willis notices this division ; but at the same time infers
how little it can be depended upon, by adverting to the frequent
alternations from mania to melancholia, aiidWce versa.

Another division might be established according to the extent
vox/, vin. — no. 45. n ii

Analytical Review,

and degree of insanity, viz. the faculties of the mind may be entirely-
prohibited from manifesting themselves ; or their activity may be
too great : or their natural manifestations may be altered or alien*
ated. The state of inactivity, where the faculties cannot manliest
themselves, is imbecility or idiotism. It is to be remarked tha. this
expression is commonly applied to the intellectual faculties, because
understanding was considered as the basis of the mind. Acco *
in® to our investigations, however, it may happen with the fetln gs
as well as the intellectual faculties. Such complete inactivity may
exist in every primitive faculty of the mind, or m several, or in all
together. It may be from birth, or from a later event. _ Experience
shows that it is so ; and only our anatomical and physiological dis¬
coveries of the brain, and philosophical inductions can explom such
facts. Different names, therefore, ought to be pointed out. Mwtis ,
for instance, might be called the diseased inactivity of any faculty o,
the mind from birth; ar.d fatuity if the patients have manifested
the powers of the mind, but have lost their activity by an eventual
cause. There is then a partial and a general idiotism, and a partial

and general fatuity. . «

“ A second sort of derangements of the manifestations of the

mind is, when its faculties are too active, and beyond the influence ol
the will. This is, perhaps, never the ease with all faculties ; but it
happens often, partially, with the propensities, sentiments, am in¬
tellectual powers, as may be understood by the symptoms which i
have related in the preceding section. Such hallucinations may be
continual or intermittent, and the latter regular or irregular More¬
over, in succeeding fits, the too powerful activity may take place m
the same faculty, or in different mental powers ; so tnat lor unstan- e,
in one fit the patient despairs, and m another commands the worui.
Volumes of facts illustrate this truth. p*

There are passages in Dr. Spurzheim s writings, wherein
his tenets are so intertexled, that it is impossible to render ms
meaning, without liability to raisinterpretatation, in any other
than his own words ; and the above is one of them. On such
occasions, it is most candid to let him speak m propria persona.

The other divisions of deranged manifestations ot the mina
are, when its faculties are too active and beyond the influence
of the will ; where they are altered or alienated m their
specific appearance, that is, they may be morbid m quality, as
when the eyes see every object red, the taste is pleased w.
chalk, or when the patient fancies he has the itch, or is made
of butter, &c. Another is, as to the event, either curable o
incurable ; that is, the cause can or cannot be removed : a divi¬
sion of all others certainly the most difficult ; and which, if he
learned Doctor cpuld accurately define, ne womd merit 1 rumor-

^“Tauses of Insanity r No argument is requisite to shew
the importance of this section. It is here we ought to look lor
that illumination which the researches and discoveries ot Dis.

Spurzheim’s Observations on Insanity . ^35

Gall and Spurzheim may be supposed to have thrown upon
this occult subject. The causes of insanity being once satis¬
factorily developed, we may trust that the exertions of human
genius would not be vainly exercised in relieving the greatest
affliction to which man is doomed.

First, Dr. Spurzheim examines whether there are diseases
of the mind, or whether the proximate cause of insanity be only
corporeal; second, the seat of this proximate cause; and,
finally, the nature of the causes of insanity.

I. — The proximate cause of insanity is corporeal. — Former
writers, says our author, have spoken of diseases of the mind ;
some have admitted both mental and corporeal causes; and a
few have acknowledged only corporeal diseases ; and with the
latter he decidedly agrees.

“ The idea of mental derangements must not, however, be con¬
founded with mental causes. Certainly the manifestations of the
mind may be deranged ; but I have no idea of any disease, or of
any derangement of an immaterial being itself, such as the mind or
soul is. The soul cannot fall sick, any more than it can die. As
this point is so important in practice, when it is neces k. l ,-fy to act a.-d
to cure, or when institutions for such unfortunate creatures as are
insane persons, are to be established, I shall enter into more details.
I consider the mind in this life confined to the body, of which it
makes use ; that is, the powers of the mind want instruments for
their manifestations ; or, these manifestations are dependent on the
instruments ; cannot appear without them ; and are modified., di¬
minished, increased, or deranged, according to the condition of the
instruments or organs.”~~p. 101.

Without adopting the author’s language, we do not hesitate
in coinciding with him, that there can be no such thing as a
disease of the mind ; for the mind, being immaterial, is insuscep¬
tible of disease like an organic and material substance. Human
judgment must be absolutely freed from this much-contested
and prevalent, but erroneous, impression, ere any improvement
in the treatment of insanity can be effected. We may here,
perhaps, be permitted to quote wdiat we have elsewhere ex¬
pressed, which will shew that we have not imbibed our opinion
from Dr. Spurzheim that « insanity always originates in a
corporeal cause : derangement of the intellectual faculties is

bpt the effect*.”

The origin of the perplexities in which physieians have been
involved reading the causes of insanity, may be traced to those

* Some Observations on the Pathology of Insanity , by G. M. Bur-
bows, M.D., Repository , vol. vi. p. 279 ; Cursory Remarks on a Bill
jor Regulating cf IIc.d-Hcv.ses, fyc* Sfc. by the Same, p. 102.

H H 2

Analytical Review.

metaphysical dogmas with which philosophers and psychologists
have engaged when studying the human mind. We are ori¬
ginal enough to think, and bold enough to avow, that we be-^
heve the causes and the cure of insanity would have been better*
understood, if Descartes, Condillac, and Locke, had never
written at all ; and that whenever derangements of the mental
faculties are treated as arising from corporeal causes, and inde¬
pendent of all metaphysical and abstract reasoning, a more suc¬
cessful method of cure will be the happy consequence. ..

Dr. Has! am, who cannot in general be accused of timidity,
seems to be afraid, however lightly, to touch this delicate suing,
and asks pardon (vide Observations on Madness, p. 240) for hav¬
ing so done. But it is evident, that, contrary to his conviction,
he is only acquiescing with popular notions. V» e shall, however ,
dismiss the subject for the present; merely remarking, that e\ cry
day adds strength to our opinions. The lights of pathology win
soon disperse the darkness of mysticism; and the period ^is not
far distant, when it will be as great a scepticism to doubt the
corporeal origin of mental derangement, as hitherto it lias been
to consider mind dependant on matter.

Ignoratur enhn , qu(E sit natara animai ;

Nat a sit, an contra nascent ibns insinudur.

We are not, in regard to these mysteries, any wiser than

Lucretius. * .

Dr. Spurzheim investigates whether “ Insanity is Connate
dtid Hereditary S'* and quotes several high authorities, to which
he adds his own, to convince us that it is both. If experience
be authority, there can be no room for doubt. This is certainly
a question deeply implicating the happiness of society at large,
•as well, as of individuals ; and on which none ought to decide
without the maturest consideration. But on this point we have
Ho hesitation, for it is one which we have seriously examined.
How is it possible to be sceptics, when we know families in whom
insanity has been manifested generation after generation; and
others, in several of whose children of the same generation the
most decided insanity has been exhibited ? If we grant that in¬
sanity were a disease of the mind, we might side with those who,
because the doctrine militates against some favourite hypothe¬
sis, deny tSie possibility of its propagation ; but, believing as
we do, that insanity is the effect of diseased organization, oroi
some accidental lesion, we as entirely credit that it is connate
and hereditary in man, as we do the truth of the Bakewellian
principle of breeding u in and in’7 m the brute creation.
Corporeal beauties and defects may he propagated, and so
may those of the mind. That insanity does not necessai ily
follow because a person is born of insane parents, we ad-

Spurzheiiiu’ Observations on Insanity. 23?

mit ; for where it exists in a family, perhaps there never was
an instance vf all the children experiencing mental alienation.
Among a number, it is highly improbable that all shall be
placed in similar circumstances in life ; therefore although all
may have the same physical organization, yet. the particular
exciting moral or physical cause which has called forth insanity
in one child may not have occurred to another, who mav there¬
fore pass through life without manifesting a symptom of derange¬
ment. But suppose, if it were possible, that each should be
exposed to similar exciting causes : would not all be insane P
Barely more than one parentis predisposed to, or has been insane,
therefore the probability of wholly escaping hereditary taint in a
family may be equal ; for a child may partake much of the con¬
stitutional qualities of one parent, and little or notat all of thoseof
the other; hence, some of the children of suchaunionmaybe quite
sane, and others insane. This appears to us just reasoning ; and
we think we have met with facts that corroborate it. Hence then,
notwithstanding the puling of some pseudo-philanthropic rea-
soners about the misery which a belief of hereditary taint would
entail on very worthy families, we who entertain an opinion that
an opposite impression is encouraging the propagation of Cvil,
would caution those who value their domestic happiness, to be
wary in their matrimonial connections.

66 Age has an Injiuence on Insanity r Our author remarks,
that insanity, idiotism from birth excepted, is the most frequent
between 30 and 40, less between 20 and 30, still less between
40 and 50, and gradually diminishes, and is very rare after 60.
But he assumes this, as indeed he does most of his data,
upon the authority of others. We must doubt, however cor¬
rectly kept, if the registers of any public establishment furnish
true evidence as to the age when insanity is first manifested :
at least the tables of the Bicetre and La Salpetriere at Paris,
and those of Dr. EsquiroFs private house, differ remarkably in
their results. In examining this part of our subject, it should
be remembered, that few on the first attack are taken to a public
establishment, in comparison with those admitted into a private
one'; consequently the returns will not tally. Upon a much more
limited scale, of course, we have had a larger proportion of
insane under treatment after 60 than this account allows.

Dr. Spurzheim thus accounts for the rarity of insanity in
children :

■« The cause that children do not appear insane, strictly speak¬
ing, in my opinion is, because their cerebral organization is too de¬
licate, and does not bear a strong morbid affection without entirely
losing its fitness for the mind and endangering life. The disturb¬
ances of the organization appear merely as organic diseases, because

Analytical Review.

the functions are entirely suppressed. Later, in proportion as the
brain becomes firmer, it bears morbid changes longer without be¬
coming entirely unfit for its functions or causing death. Its func- ^
tions then are only disturbed, and appear under the symptoms
called insanity/’ — p. 106.

The justness of these observations is, we think, strength¬
ened by the fact, that water is most frequently found in the
ventricles of the brains of the insane, without any disturbance to
the animal functions having been at all manifested; while there is
every probability, that water is never effused into those cavities
la young children without the most violent derangement of
those functions, and that the general effect is death.

« Sleep is often disturbed in Insanity /’ Uneasy and dis¬
turbed sleep, or entire sleeplessness, is, as well as cx other
diseases, a precursory symptom of insanity; and all the delusive
Impressions of dreams take place in insanity. Hence Hr. S.
infers, that

as disturbed sleep, sleeplessness, and dreams, in common life and
in other diseases, are considered as the effect of corporeal causes, why
should we, in insanity, admit another cause tor the same symptoms?

— p. 113.

The concluding results in his first division of causes- pecu¬
liarly deserve our approbation ; we would not wish to spea;<
more to the point :

“ T hus, from observation and reasoning, it results that the proxi¬
mate causes of the deranged manifestations of the mind must be
considered as corporeal. The soul, in its deranged manifestations
of feelings and intellectual powers, is no more diseased than in the
disturbances of the five senses, and voluntary motion. In palsy, the
cause is not looked for in the mind, but in the instruments by which
will is propagated, or voluntary motion performed. In the derange¬
ments of hunger and thirst, of hearing and seeing, smelling, tasting
and feeling, the seat of the proximate cause is admitted in the res-

Eective organs by which these powers are manifested. It ought to
e the same with the internal operations of the mind. Indeed, a
too assiduous attention has hitherto been paid to the developement
of moral or metaphysical causes, while the corporeal, indisputably
more within the sphere of human understanding, have been greatly
neglected. If the mind were diseased, it ought to be cured by
reasoning. I think however with Haslam, ‘ the good effects which
have resulted from exhibiting logic as a remedy for madness must
be sufficiently known to every one who has conversed with insane
persons, and must be considered as time lost/

As to the effect of reasoning with the insane, we shall
repeat the proverb : Insanus om?iis fur ere credit cceteros.

II. — The proximate Cause of Insanity is in the Brain. The
.considerations under this title are infinitely varied. We shall

Spurzheimh? Observation * on Insanity. 233

select the only matter of them which appears most deserving
of comment.

The Doctor assumes that the brain is the organ of the
mind, and that the manifestations of every primitive faculty of
the mind depend on a peculiar part of the brain,

“ and if all primitive powers of the mind and their respective organs
be once ascertained, it k evident that the cause of insanity will be
looked for in the brain, and the cause of the deranged manifestations
of every special faculty in a peculiar part of the brain.”

but he confesses, that his knowledge in this particular is not
sufficiently advanced.

On the subject of e< Morbid Phenomena of the Brain in
Insanity f we are, as often before, referred to Dr. Spurzheim’s
work on Physiognomy. But he truly remarks,

<c I add, the brain is an organic part, and we must not expect to find
more in it than in any other part of the body. Nay, as its organi¬
zation is the most delicate of the whole frame, organic changes may
occur which are imperceptible on dissection ; since this is also the case
in other parts, which may be affected by various diseases, without
offering tne least morbid appearance after death. The stomach, for
instance, and intestines, have often suffered for a long time, and the
most skilful anatomists cannot detect any thing different in their
structure after death. On the other hand, neither vomiting nor
v/ant of appetite have taken place in persons in whose stomach mor¬
tification w~as found after death. Abscesses have been observed in
the livers of persons who have died without any one of the com¬
mon symptoms of hepatitis.

“ I know that anatomists and surgeons of celebrity relate that
they could not find any morbid appearance in the examination of
insane persons after death, I reply, that various obvious differences,
as to size and form, of the brains of different sexes or individuals,
have also been overlooked, while they may be easily observed. I
really think that all morbid effects which are observed in other parts
may also be distinguished in the brain, such as a too defective or
too large developement of its substance, distension of blood-vessels,
inflammation, suppuration, serous effusion, dropsy, rupture, or ossi¬
fication of blood-vessels. I even maintain that morbid changes of
the physical appearances of colour and texture might be pointed
out in the brains of many who have died insane, if those w ho exa¬
mine them were better acquainted with the appearances of the brains
of individuals who had no particular determination of blood to the
head, and preserved their manifestations of the mind to the last
moment of life.” — p. 11 6.

They who contend, like ourselves, that insanity actually
depends on some alteration in the organic structure, will give
these sentiments of the author their assent. Modern researches
in morbid anatomy have proved beyond dispute, that the bodies
of those who have died under any species of insanity gene-

240 Analytical- Review* ■

tally exhibit some proofs of diseased structure or of deranged
action ; and we are clear, that if the inquiry "were always con¬
ducted with due skill and care, there is not one in whom some
morbid change would not be detected. In the present state of
our physiological and pathological knowledge, it would be rash¬
ness to pronounce there was no alteration of parts, and conse¬
quently no disease, because we could not discover any. It is
pathology only that can check the extravagance of hypotheses*
and develope the true causes of insanity.

v (To be continued .)

- - - - - -

IJ.

Account of an Epidemic Small Pox, which occurred in Cupar in
Fife in the Spring of 1817, and the Degree of Protecting
Influence which Vaccination afforded ; accompanied with.
Practical Inferences and Observations. By Henry Dewar,
M.D, F.R.S.E.- &c» 8vo. pp. 38. Cupar, 1817.

In our last Retrospect of Medical Science, we stated, with,
much regret, that we had received numerous reports of the
failure of vaccination as a preventive of small-pox ; and ven¬
tured to offer some suggestions of our own as to the causes of
these unfortunate occurrences. The little tract before us shews
that these failures have not been confined to the southern parts
of the island*. It gives the history of an epidemic small-pox,
which raged very widely in Cupar in Fife, although the greater
proportion of those that were attacked by it had been vaccinated
and passed regularly through the disease. The profession is
certainly indebted to Dr. Dewar for having brought the parti¬
culars of this epidemic before it; as well as for the opinions he
has been led to form on the subject ; and we trust his example
may create such an impartial investigation as shall fairly settle
the question : for, although we are most anxious to support
vaccination, having been convinced, from our own experience,
of its efficacy in preserving the constitution from the influence
of variolous infection, yet, we are still more desirous to see the
current of truth, in all medical inquiries, run clear and unpol¬
luted.

Before entering upon his subject, Dr. Dewar gives a brief
sketch of the various opinions of authors regarding the causes

* Since writing the above, we have been informed, that an
epidemic small-pox has also prevailed at Kerry, in Ireland, in which
many who had been vaccinated wrere affected.

Dewars Account of an Epidemic Small Pox. 241

of some of the failures of vaccination in preventing small-pox ;
and concludes with remarking, thai, 44 in investigating truth’
one of the first steps necessary, is, to make ourselves sensible of
the obstacles to it which exist both within and around us ;”
advice which it will naturally be expected he has endeavoured
to adhere to in pursuing his present inquiry.

A report having reached our author that an epidemic small¬
pox raged in Cupar in Fife, he paid two visits to that place ;
one on the 31st of May, and the other on the 4th of June ;
with the view of seeing the cases, observing the appearances in
those that had undergone vaccination, and collecting every in¬
formation regarding them, both from the domestic attendants
of the sick, and the medical gentlemen under whose care the
majority of the patients were placed. He found that “ the
multitude of simultaneous cases gave the best assurance 44 that
all" proceeded from the same radical contagion.” He received
the accounts of seventy cases; fifty-four of which 44 were said
to have gone through the vaccine disease,” and 44 sixteen had
either not been inoculated, or no vesicle had appeared after the
insertion of the vaccine virus.” In the whole there was a well-
marked eruptive fever ; and, except in “ eight of the inoculated,
and two of the uninoculated,” none of the cases were mild
through their whole course. One only of those who had been
vaccinated died ; while, of the sixteen who had not undergone
that operation, not less than six deaths occurred : 44 but, of all
who were attacked, none had been inoculated with the small¬
pox.” With regard to the vaccinated persons, however, it must
be remarked that in ten only 44 the operation had been per¬
formed under the inspection of medical practitioners. The
rest were inoculated by mid wives, clergymen, and other persons
not of the profession.” The severest case, with one exception,
occurred in an individual who had been vaccinated by the late
Dr, Grace : and this we shall extract, as a specimen of the mode
in which the others- are detailed.

f' Margaret 'Welsh, aged 11, daughter of a baker, delicate in
her habit of body, was vaccinated by the late Dr. Grace at the age
of five weeks. The parents can give no particulars relative to febrile
symptoms, but say that Dr. Grace was perfectly satisfied.

tf She had a nervous fever two years ago, and has been more
delicate ever since, especially for two months before her late attack.

44 On Thursday the 13th of March last, complained, while at
school, of head-ache; was a little better on coming home; complained
also of coldness in her back and limbs.

“ Friday, continued sick the whole day ; in the evening insen¬
sible. ,*«

<c Saturday, insensible. This evening a scarlet rash was observ ed

VOL. VIII. — no. 45. i i

242

Analytical Review.

on one cf her cheeks.—' Was insensible* in the night. The eruption
extended, and supposed to be the measles.

« Monday, Dr. Grace declared it to be the small pox. The
eruption continued to come out. On Tuesday it became stationaiy
for "some hours, neither going back nor making any progress. Some
wine was ordered, after which the pustules rose above the skin.

« This day they began to fill, and on Wednesday, Thursday,

and Friday, continued to fill. . .

sc Saturday, eruption began to decline in the order m which it
had appeared. She yawned the whole day, and had a bad night.
Apprehensions were now entertained that next day the secondary
fever would supervene, and her symptoms assume a still more

dangerous character. _ . „

- Sunday. Contrary to the apprehensions entertained, the iever
happily left her, and never returned. The eruption followed a
regular progress of desquamation, I he nails of the toes separated,
but not those of the fingers.

“ At present, (May 31,) face appears to have small but numerous
pits. Previously to this attack, she had a slight tenderness in the
interior of the nostrils. This lias disappeared, but an inflammation
of one eye, which she also had previously, has increased and
extended to the other.” — p. 9.

The other cases which were ascertained to have been vac¬
cinated by regular practitioners, did not partieulaily vai^,
except in point of severity, from that which we have just
quoted. In the other forty-four 4< the disease appeared in
various degrees of severity in about eight it was remarkably
mild ; and in none was there any secondary fever. k\ e extract
the fatal case.

“ David Philp, son of a master-wright, aged 11, was vaccinated

at an early age. # _

“ On the present occasion, was taken ill on a Sunday with a

complaint in his head. The eruption appeared on the following
Tuesday. On Wednesday, he was seized with a vomiting winch
never left him. On Tuesday and Wednesday, the interstices of the
pustules were occupied with a general rash similar to measles. This
however went in. Mr. Wiseman, a medical student, who attended
him, says, that the pustules were regular and thick. He continued to
complain much of his head. Leeches were applied on tne Thursday ,
and at the time he received considerable relief. Afterward however
he complained of severe pain in the abdomen and small of the back.
The bowels were not constipated, but the stools were preternatural,
and resembled minced meat. Petechiae were observed on his breast
before his death, which took place on Friday the fifth day of Ins
illness. After death his body was black with petechiae.” — p. 1 5.

* £( This word in its provincial acceptation, and as here employ ed,
has its meaning extended so as to include Delirium as well as Coma .

243

Be war's Account of an Epidemic Small-Pox .

The first of the cases of those patients who had never been
inoculated, detailed by our author, was the first or the second
case of the disease that appeared in the town, and by which the
contagion appears to have been spread. The patient was a girl
of thirteen years of age, the servant to the keeper of the jail,
who had been employed by the magistrates, about the end of
January, to burn the clothes of a child which had laboured
under small-pox, and belonged to a travelling mendicant from
Stirling. This girl died, as did three out of four of her sisters
who visited her and caught the disease. The other persons
who died, in this class, were, a weaver's wife who was in a state
of pregnancy when attacked, and another adult 30 years of age.
In the weaver’s family, three of the children, who had been
vaccinated, and were constantly with their mother during her
illness, “ escaped the disease."

Having detailed the particulars of the cases, Dr. Dewar
next proceeds to state the inferences which appeared to him
44 to be warranted by the facts." He 44 feyund no particular
reason for disputing the genuineness of the vaccine disease
which the fifty-four patients had received by inoculation for
although a comparatively small number only were vaccinated
by medical men, although no record of vaccinations was kept,
and there was no instance of the inoculation being repeated,
44 except when no vesicle appeared," yet it is justly remarked,
“ if the generality of the Cupar vaccinations were spurious, we
must pronounce the whole vaccine disease as known in that
part of the country to be spurious. Speaking or the test pro¬
posed by Mr. Bryce*, which ought to be invariably practised,
our author proposes to make the second insertion

“ at the most distant part of the body from the first, because the
locality of affections may have various degrees. An influence may
be conceived to extend from one point to a considerable portion ot
the body, without reaching the whole. It might therefore be
somewhat more satisfactory, and could be liable to no objection, to
insert the test virus in the thigh or leg of the opposite side, instead
of the opposite arm, especially as corresponding parts on the tv o
sides of the body might be supposed to have a peculiarly prompt
tendency to put on the same species of action. I have no suspicion

* Mr. Bryce’s test consists in making a second insertion of the vac¬
cine matter twTo inches below the first, taken from the rising pustule at
the end of the fifth day. If this produces a vesicle, which, although
smaller than the other, yet follows the same stages, only with an
accelerated progress, so that the crusts of both are formed nearly at
the same time ; then we may consider that tne const:, vruon has teen

fully affected.

I I 2

244 Analytical Review.

that any difference would actually arise from this cause ; but we
ought to avail ourselves of every atom of additional security/’ — p. 30.

Admitting that all the fifty-four patients had had the true
Vaccine disease, and that all the cases detailed were instances oi
genuine small-pox, the conclusion is, that vaccination “ did not
ultimately prove a certain preventive of svnall-pox ; yet it evi¬
dently gave, in some instances, a remarkable temporary or occa¬
sional protection a conclusion which leads Dr. Dewar to
propose the following queries :

“ Is the protection which it affords merely temporary^ Docs
it diminish in proportion to the lapse of time after the inoculation ?
Or, is it a casual and uncertain quality, the laws of which elude our
research ? depending on circumstances of weather ? on constitu¬
tion ? on the successions which take place among other diseases, or
definite changes of habit occurring in the individual ? or on the
peculiar qualities of different specimens of contagion ? or on other
circumstances which elude our notice p. 32.

The means which the National Vaccine Establishment pos¬
sess of circulating queries* might facilitate very much the
inquiry.

In supposing that vaccination affords “ a passible or probable 9
hut not a certain protection from an attack of small-pox/’ Dr.
Dewar conceives that in this respect there is a marked distinc¬
tion between it and the variolous inoculation. But this opinion
is founded on the assumption that the variolous inoculation is
a certain preventive of natural small-pox ; a point far from
being established ; but, on the contrary, rendered highly pro¬
blematical by numerous eases on record. At all events, the
cases he has brought forward, our author conceives, justifies the
conclusion, that vaccination at least “ secures the constitution
against the secondary fever, the principal danger of small-pox/'
Anxious as we are, however, to regard this as a positive law of
vaccination, we cannot admit it, unconditionally, upon the
evidence brought forward in this little tract ; although, from
what we have seen ourselves and heard from others, we think it
extremely probable : and hence fully accord with Dr. Dewar’s
“ practical conclusion, that vaccination ought still to be valued
and universally recommended/’ He finishes his remarks with
the following aphorisms, which he regards “ worthy of being
remembered for our practical guidance/’

“ That by vaccination we do not positively endanger life , By the
old inoculation, a disease was produced which was sometimes fatal.
The danger artificially created was immediate, while that which
it was intended to obviate was remote. Yet the former was com¬
paratively so small as to prevail on the reflecting part of the commu¬
nity to concur in encountering it. In the vaccine inoculation
however, we are saved all these painful calculations, because we

245

Dewars Account of an Epidemic Small- Pox.

eommuicate an affection attended with no danger, and the power of
which over tiie constitution is great but silent.

Aarain, allowing that the individual who has been vaccinated
is equally liable to small-pox with any other, (which no person will
be bold enough on the large scale to assert,) he is not liable to it in
the same form as if Vaccination had been omitted . This point cannot
be longer doubted; and, if we proceed at first on the supposition
that the small-pox succeeding Vaccination is exactly equal in risk
to the disease which used to be communicated in the old inoculation,
it must be allowed that we gain time in the life of the individual by
preferring Vaccination, fie is not subjected to the risk in the first
instance. Years may elapse before he is exposed to the contagion
small-pox : When so exposed he will in most cases be protected
from it by the cow-pox ; and, if at last he is attacked, he encounters
a risk only equal to that which would have been earlier incurred by
a previous inoculation with variolous matter.

u But this supposition is much less favourable than the truth.
The risk even at that late period is far from being so great. The
small-pox occurring in a vaccinated person is much safer than the
inoculated small-pox. It has never been maintained that the disease
induced by the variolous inoculation was always exempt from the
occurrences of secondary fever. On the contrary, some of the few
who died of the inoculation were cut off by that fever.

“ The most unfavourable conclusion therefore that can be
admitted is, that there may be the same risk of deaths from small-pox
after vaccination, as of deaths in the early stage of the inoculated small¬
pox. Thus the risk is not only deferred to a later period, but i»
ultimately far inferior to what it was under the use of the best
inoculation previously to the discovery of the cow-pox, and is in
fact reduced almost to nothing. What more can be reasonably
desired ? We do not expect to provide an absolute security from
all accidents.” — p. 36.

In closing this pamphlet, we must repeat, that the thanks
of the profession are certainly due to its author, for having laid
before it the facts he has recorded. The subject is one of too
vital importance to the welfare of the community to be lost
sight of ; but it must not be contemplated as a party question ;
nor be shackled by partiality for prior and long-maintained
opinions. Experiments should be made, and the results faith¬
fully and accurately recorded, without any bias that might
tend to mislead ; for while truth alone is the object of research,
it must be embraced, should it even destroy our most sanguine
hopes, and utterly overthrow the proud monument which we
yet fondly flatter ourselves has been raised to the honour of
Medical Science, by the introduction of vaccination.

SELECTIONS postponed for want of room.

24 6

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

ANATOMY, PHYSIOLOGY, PRACTICE OF MEDICINE, AND

SURGERY.

Dr. Granville’s Communications on the Progress of Medical

Science in France .

LETTER V.

44 lx my last letter I scarcely mentioned any subject relative
to surgical practice. The fact is, that great operations, as
veil as curious and important cases requiring them, do not
occur, fortunately, every day ; and the usual practice, of even
a Dupuytren, a Boyer, or a Dubois, offers little that can convey
either information or excite curiosity.

44 I have, however, reason to believe, that we shall soon he
called upon to judge, once more, of the genius and great dex¬
terity of the first of the three above mentioned practitioners,
in an operation of a novel kind for the extraction of urinary
calculi. I mean the cutting through the rectum into the
bladder, in man of course ; which operation has already been
performed more than once, and with success. For the present,
I am not at liberty to say more ; but in the Annuaire des
Hopitaux , the first number of which is intended to appear at
the conclusion of this year, the author will give a detailed
memoir on the subject, with plates.

44 A case of tetanus, in a young and strong subject, having
occurred to the same gentleman at the Hotel Dieu, he was
induced to treat it by means of opium. He had reached the
dose of twenty-four grains daily, and the patient had seen his
existence protracted to the thirteenth day after the accident,
with an evident amelioration in all the distressing symptoms
attending this terrible malady ; when the patient, by his impru¬
dent conduct it is said, died on the morning of the fourteenth
day, j ust as the greatest hopes of his recovery were entertained.

44 A case of rather an extraordinary nature has been com¬
municated to the Faculty of Medicine by M. Laroche Dan-
jeais. It relates to a wound caused by a large thorn which
penetrated into the stomach of an individual on falling, so as
to give free issue to its contents. A suture was made, the

Granville on the present State of Medical Science in France. 247

wound healed readily, and the patient was perfectly cured.
M. Percy has ascertained the fact to be perfectly authentic.

“ The fatality attending the cases of cystocele lias again been
illustrated, by an instance which has lately occurred at one of
the hospitals, and where a portion of the bladder protruded
through the inguinal ring. On attempting to reduce the hernia
by the taxis, urine was made to flow through the urethra.
The patient died in a few days.

u A preparation illustrative of an important point in phy¬
siological anatomy has lately been made in one of the Pavillions
of the Hospice de Perfectionnement. In injecting the veins of
the vertebral column, in order to ascertain their distribution
in a clearer manner than has hitherto been done, and while
pushing the injected fluid through the abdominal vena cava, a
communication was discovered of the lumbar veins, and several
branches of the azygos with the thoracic duct, particularly at
its origin near the reservoir of Pacquet. The duct was disten¬
ded by the injection thrown into it through these communica¬
tions up to one half its length ; a circumstance which clearly
demonstrates that the fluid could not have proceeded from
either the subclavian or the internal jugular veins.

“ In anatomy, I have further witnessed two curious facts,
which I shall relate, as likely to throw some light on a point
connected with medical jurisprudence; towards which science,
I have directed the small portion of time which my other
numerous occupations leave to me in this capital. The first I
shall allude to, is the dissection of twin male children, born at
la Mate mite last month, after the fifth month of gestation.
Neither of them gave the least signs of life ; nay, the last bom
came away completely enveloped by the membranes, which had
never broke, and contained the usual quantity of the liquor
amnii ; the placenta and membranes of the first born, quite
distinct from those of the other foetus, had been discharged at
least twenty minutes after without any accident. We examined*
the lungs with a view of making some experiments on the
pretended signs, said to be exhibited by these organs, of respi¬
ration having taken place. We found them having a compact
appearance, something like the substance of the liver, but of a
fine light flesh colour. On throwing them into water, they
floated on the surface of it, and this they did even when cut
into pieces. The whole mass weighed 216 grains. This ap¬
peared the more singular to us, as when acting upon the lungs
of another foetus of seven months, which had lived several
minutes and had evidently breathed, they sunk in the fluid;
leaving us in the perplexity which this double fact is calculated
to throw on the well-known aphorism derived from similar ex¬
periments in cases of asphyxia, strangulation, infanticide, he.

248

Foreign Medical Science and Literature*

<£ The next case is this : a woman was brought to bed, at
the same establishment, of a boy at his full time, strong, w'ell
made, and apparently healthy. After nine hours of an exist¬
ence, which had not created the least uneasiness, he was found
suddenly dead by the side of his mother, who was fast
asleep at the time. A suspicion arose that the child might
have been purposely or accidentally suffocated. An examina¬
tion of the body took place, and, on opening the abdomen, we
were rather surprised to find the stomach, spleen, duodenum,
and part of the free border of the ileum wanting. But on
pursuing the dissection further, it was soon found that those
viscera had passed into the left cavity of the thorax, through a
space left by the absence of the two posterior thirds of the
diaphragm, where they so pressed on the heart, as not only to
push it from left to right, but also to turn it in such a manner
that the posterior became its anterior part, with respect to its
position in the thoracic cavity. If I am not mistaken, how¬
ever, some such similar cases of mal-conformation have been
related by different authors.

<e Professor Dupuytren intends shortly to give a course of
lectures on pathological anatomy at the Hotel Dieu , in which
he will chiefly descant on organic transformations, and illus^
trate his details by numerous preparations, and occasionally by
actual dissections.

44 A man came to the Hotel Dieu some days ago with a
singular complaint. He had, from a fall, received a wound
just above the left eye, and the integuments had presented, at
the time of the accident, a triangular flap, the free apex of
w'hich was formed by one of the angles. A surgeon re-united
the wound and healed it by the first intention, after having
examined the bones, leaving a small opening only in its pen¬
ding part for the issue of any purulent matter that might be
formed beneath its integuments. Some days after the cure,
while sneezing, the man was not a little astonished to find a
tumour forming itself' just beneath the scar; and his anxiety
became greater, when lie found that on coughing the swelling
increased in extent both to the right and left. Succeeding fits
of coughing have since so augmented the tumour, that it has
surrounded the head ; and there can be but little doubt, as M.
Dupuytren suspects, that this is an emphysema, produced by
the air penetrating through the nose into the suborbital cavity,
from which it escapes by a fissure, occasioned by the fall of the
frontal bone, under the integuments which it raises, and has
gradually detached all around as it progressively accumulates.
What modus operand!- should be adopted in this case ?

u Several works on different subjects of medical sciejice
have been published since I had the pleasure of writing to you
before my visit to London. Amongst them, I must notice in

Gianville on the present State of* Medical Science in France. 24 9

a more particular manner the first volume of D’Alibert’s
Nosologic Aaturelle , which, as I gave you reason to expect,
was published m April last, forms the subject of conversation
at present amongst the medical profession. DA liber t has
endeavoured in this great work to class the numerous maladies
by which mankind is afflicted, in families, according to the
received method of the naturalists with respect to vegetable,
animal, and mineral bodies. His classification is founded upon
three great divisions of the phenomena which seem jointly to
contribute to the maintenance of the existence of man. These
relate, 1st, to the increase and preservation of man ; 2dlv, to
his numerous relations with the various objects that surround
him; 3dly, to the mysterious proceedings of the reproduction
of the species. These three divisions he calls, vie d1 assimilation,
vie de relation , vie de reproduction ; each serving for the founda¬
tion of a class. The first class is divided into ten families. In
the 2nd and 3rd there are fourteen families, forming a whole of
twenty-four. Each family is subdivided into genera, and a
genus often offers one, two, or more distinct species.

“ DAlibert in writing a system of nosology, or rather in
endeavouring to detail in the natural order of their occurrence
(tor his cannot be said to be a system) the maladies affecting
the human body, has thought it necessary to adopt a new
nomenclature whenever the establishment of new divisions
required it, and even when the insufficiency of old denomina¬
tions for his purpose demand it. Thus the names of the
classes, and all those of the twenty-four families, are new.
Not so with all the genera, and much less with the species.

“ The first volume contains the families of diseases belong¬
ing to the first class, to the number of ten, as I have already
stated, and may be thus reported :

44 1st Class, Trophopathies.

Morbid affections attacking the organs to which the faculty of
assimilation is essentially imparted :

(i 1st Family, Les Gastroses — morbid affections of the
stomach — 13 Genera; Polyorexia, Heterorexia, Dysorexia,
Polydipsia, Adipsia, Dispepsia, Lienteria, Autemesia, Gaste-
ralgia, Gastritis, Sauirrhogastrie, Gastrobrosie, Gastrocelie.

“ 2nd Family, Enteroses, 10 Genera : — 3rd Family,
Choloses , 11 Genera: — 4th Family, Uroses , 12 Genera: — 5th
Family, Pneumones , 8 Genera : — 6th Family, Angioses , 19
Genera: — 7th Family, Leucoses , 12 Genera: — 8th Family,
Adenoses , 5 Genera : — 9th Family, Ethmoplecoses , 6 Genera ;
10th F amily, Blennoses, 1 i Genera.

“ The symptomatic description tof these and their species,
their history and treatment, and a preliminary discourse

.. yol. vm. — m 45. k k

250

Foreign Medical Science and Literature.

detailing the progress of medicine from the earliest times to our
days, written in a very elegant and masterly style, form tie
contents of the first volume ; which is printed on grand papier
velin , in quarto, in a manner so splendid, that for a long wmle
no medical work has been published with so much display
of typographical brilliancy. Ada to this, that the woi is
illustrated in various parts with plates, which may be called
highly finished miniature paintings, representing various dis¬
eases taken from nature at the great hospital of St Louis, or
which the author is one of the physicians. Each volume cost*

1 10 francs to the subscribers. A

“ Another work offered to the public by subscription, an
the first volume of which has lately been published, is tie
’Mis to ire Medicate Generate et Particulierc dcs Maladies Epide-
miques, Contagieuses, et Epirexiques qui old paru en Europe
depuis les temps les plus recules, &c. The work is written y
Dr. Ozanam of Lyon, and will consist of five volumes octavo. >
I cannot say I am quite satisfied with the execution of the firs ;

64 Dr Double has published a second volume to his bernei- :
clique Generate ; a work of great merit, which is to consist of

three volumes. . ~ •, i

“ Dr. Eodere has recently sent to Pans from Strasmirg. Jj

his Treatise on Delirium, of which I shall speak to you more a
fully on a future occasion, as a work of great importance an i

worthy the attention of the profession.

“ A singular work in three volumes has reached me ron x
Italy, of which I may have occasion to say something i
another letter. It is intitled “ Elements of a New System
on the Theory and Practice of Physic (Jppoggtalo aUe so.e ,
Ics-tri della fisica animate It is from the pen of Dr. Bucel.ati, t
who has also written a small work on the prevailing diseases -
which proved so fatal to many of the inhabitants of Lombardy
during the last winter.” A. B. GRANVILLE. .

Paris i July 1817.

PATHOLOGY.

] J — -The following Description of a Polypous Tumour in
the Stomach, stretching into the Duodenum , by Dr. G. Bueschei !

of Paris, is not devoid of interest* . j

66 Maria Catharine Lefevre, aged 69 years, a wire, and the -

mother of several children, had been occasionally afflicted wUpl
different complaints, but altogether unconnected with that
which is about to be related, and of which she died. box*i
some months she had been suffering from diarrhoea, tne ^re¬
turns of which becoming more frequent, she was obliged al
length to go into the hospital. At this time she was attacked!
at intervals with vomiting of mucous matter, which, however j ii

' Vifie Bulletins de la FacuJte de Medccine departs } 181?, p. 676
Journal de Medecme , fyc. vol. xxxix.

Breschet on a Polypous rF umour in the Stomach. 251

4 I.

tlkl not return. The abdomen was tender to the toucli in se¬
veral places, particularly at the epigastric region and towards
t je light iliac ; she had frequent and often involuntary stools,
and gradually lost flesh. The tongue became dry and brown,
and the teeth covered with a blackish fur ; the pulse was very
sma l and frequent, the skin arid and hot, and the stomach very
painful. . This woman died after she had been a month at the
Hotel Dieu, where she had been attended by a skilful and ex¬
perienced physician, Dr. ilusson .

. opening the body, the mucous membrane of the small
intestines were found covered with ulcers, presenting an irregular
indented edge, with an unequal surface. The stomach , when ex¬
amined exteriorly, appeared less than usual; and about the mid-

xvn en»^lw* *se5 was contracted, as if slightly strangulated.
VMien opened, on its presenting surface it displayed a very re-
maikable tumour, rising from its smaller curvature, or the ver-
tebial side, near the orifice of the oesophagus; and measuring six
inches in length, and half an inch in diameter. The tumour,
which was nearly cylindrical throughout, and stretching from left
to right, passed through the pylorus, and projected into the ca-
' ^ ()l the duodenum about eight lines. At the part correspond¬
ing to the valve of the pylorus, it was slightly curved. It was
covered with the mucous membrane of the stomach : its colour
near^ the root was the same as that of the villous coat ; but to-
VKirus the apex, extending about three inches, it was of a violet
or brownish hue. The whole of its surface was spread with vas¬
cular ramifications. Its texture was dense, resisting, and appa¬
rently, at first sight, resembling those venous tumours which
the iLnglish surgeons term aneurisms by anastomoses*: but on a
more attentive examination, there was evidently no analogy
between them. The deep red tint displayed, probably de¬
pended on the stagnation of the blood at its apex, from being
partially compressed by the duodenal orifice of the stomach.
The texture which, although it was dense and evidently or¬
ganised, yet could readily be torn, and resembled that of some of
those polypous tumours which are occasionally found in the
vagina and uterus.

44 At some distance from this tumour there was a second, of
a smaller bulk. The mucous membrane was throughout very
pale ; but displayed rugas here and there in sufficient numbers.
ri he membranes intermediate between the mucous and peritoneal
^coat were thicker than usual. The contraction of the stomach,
which has been already noticed, seemed to be owing to this tumour

increasing in bulk at the expense of the substance of that viscus.

* Vide J. Bell’s Principles of Surgery, vpl, i. p. 456. and voL
iii. p._255.

K k 2

252 Foreign Medical Science and Literature.

ct The pyloric orifice was very open, and at the cardia the
mucous membrane of the oesophagus was seen changed in
colour, and terminating so as not to form a continuation with
that of the stomach. But this peculiarity, which is very evident
in the horse and some other quadrupeds, has already been
remarked in man by some anatomists.

44 Little information can be given as to the symptoms of
the deceased : it is certain that, during her stay in the Hotel
Dieu, she never complained of any acute pains in her stomach,
or of any deranged functions in this organ, which could have
caused a suspicion of the existence of any injury in this part.
Of this I have been assured by M. Hussom

44 I have described this extraordinary tumour under the name
of polypus, although I am sensible that this expression is
not strictly correct ; for if the antients indicated by this
word either the vegetations which have some resemblance to
this zoophytes, or excrescences, soft in consistence like polypi,-
in both cases the name of polypus is not admissible. Under
this name are commonly included excrescences, fungous and
sometimes even sarcomatous tumours, which are most commonly
situated in the mucous membranes. Nothing is, however,
more variable than the structure of these excrescences ; and it
is, undoubtedly, a defect in the language to describe under
the same name vesicular polypi of the pituitary membranes,
and fungous or sarcomatous and cancerous polypi of the same
membrane. An analytical distribution of the species in patho¬
logical anatomy ought to put an end to such confusion.”

CHEMISTRY.

III. — We have already noticed the general results of the
experiments of M.M. Majendie and Pelletier on Ipecacuanha ,
and have now to lay the details before our readers, as contained
in the memoir intitled 44 Recherches Chimiques et Physiologiques
sur V Ipecacuanha*

64 The authors of this memoir, being thoroughly convinced
that we are still far from possessing all the knowledge upon the
nature of this valuable root which the present state of chemical
science permits, have subjected it to new experiments, which
have furnished many striking results of great importance to
chemistry as well as to medicine.

44 After having briefly traced the history of ipecacuanha,
and having cursorily indicated the principal results obtained by
the latest chemists who have examined it, Messrs. Pelletier and
Majendie immediately point out the method which they followed
in the analysis of the brown-coloured ipecacuanha furnished by

* Annates de Chimie et dc Physique , and Journal de Pharmacia
<$’C. 1817, p. 145.

Pelletier and Majen die’s Analysis of ipecacuanha . 253

the Psycotria emelica. They first examined the cortical part,
which they treated with successive portions of cold sulphuric
ether, and finally employed a slight degree of heat ; so that
all the parts soluble in this vehicle might be taken up : after the
ether, they made use of highly rectified spirit, and renewed it
until it ceased having the slightest effect, even when raised to
the boiling point. The powder of ipecacuanha, thus treated
by these re-agents, was dried, and afterwards subjected to the
action of cold and boiling water successively. What remained
after having resisted all these experiments was regarded as
ligneous and inert matter. Each of the products obtained by
the different operations, afterwards became the subject of a par¬
ticular examination.

ce The etherial tinctures were of a fine yellow colour. On
being distilled, the first portions that came over were inodorous;
the last smelt very perceptibly of ipecacuanha. The residue of
the evaporation furnished a fatly matter , of a brownish yellow
colour when in mass ; but when dissolved in alcohol or ether,
it communicated to the solvents a golden yellow colour. This
matter possesses scarcely any taste ; but has a very powerful
odour, resembling that of the essential oil of horse-radish, which
becomes unsupportable when exposed to much heat. When
diluted in any vehicle, the odour is analogous to that of ipeca¬
cuanha. It is, therefore, to this substance that we must ascribe
the smell of the root. The fatty matter is heavier than alcohol,
but nearly of the same weight as water. When heated, it im¬
mediately melts. The action of heat separates from it a very
volatile oil, of a penetrating odour ; but the greater part of the
matter undergoes a ehange before being volatilized, and fur¬
nishes die same products as are obtained from the decomposition
of vegetable substances containing much hydrogen, when ex¬
posed to the action of heat. The oil which is procured has
not now the properties and smell of that of which we have
spoken, but is entirely empyreumatic. If, on the other hand,
we distil the fatty matter with water, the water is strongly im¬
pregnated with the smell of ipecacuanha. Iridescent circles,
formed by an excess of volatile oil, appear on its surface.

u Hence we perceive that ipecacuanha contains two sorts
of oil : the one, essential, and very volatile, which is the odorous
principle ; the other, fixed, and fatty, having little or no odour,
and insoluble in water, but soluble in ether and in alcohol.

“ The alcoholic tinctures deposited, upon cooling, some
slight flakes, which, when separated by filtration, were found to
be wax. These tinctures were of a brownish yellow colour,
and, when evaporated in close vessels by the heat of a sand-
bath, they left a residue of some consistence and of a reddish
saffron colour, which was again taken up by cold water, and

f.34 Foreign Medical Science and Literature .

was nearly all dissolved ; a little more wax still separating bv
this means. This new aqueous solution being also evaporated^
the product was very deliquescent* slightl y acid, of a bitterish
taste, and a little acrid ; it had not any smell. It was attempted *
by means of carbonate of barytes, to separate the acid from it.
It took it up from the solution ; but the too small portion pre¬
vented the separation from it of the whole of the carbonate of
barytes employed. The authors are of opinion that this acid is
the*gallic ; because the acid liquor had the property of chang¬
ing into a green colour a solution of the acetate of lead. The
solution, after having been treated with carbonate of barytes*,
was precipitated by a proportionate quantity of acetate of lead >
which almost completely discoloured it the sub-acetate dis¬
coloured it entirely. The greyish precipitate which was thus
obtained, after having been well washed, was dissolved in dis¬
tilled water, and exposed to a current of sulphuretted hydro¬
gen, in order to separate the lead. After this series of opera¬
tions, the matter remaining in solution was found to be essen¬
tially emetic, and as possessing alone the principal property of
the ipecacuanha. It has been examined with much care, and
makes, in the memoir, the subject of a particular paragraph*
which we shall extract entire.

44 Of the Emetic Principle . — The experiments which we
have related, have already made known some of the properties
of the emetic principle ; such as its solubility in water, its
deliquescence, the action exercised upon it by alcohol, and its
insolubility in ether ; but finally, to make it better known, we
will present in a methodical manner the actions exercised upon
it by the chemical agents with which we put it in contact. The
emetic principle, when dried, appears in the form of transparent
scales, of a brownish red colour, nearly inodorous ; the taste
slighly bitter and a little acrid, but by no means nauseous.
The emetic principle does not undergo any alteration in any
degree of heat less than that of boiling water, and is not fused
at a higher temperature ; it swells, grows black, is decomposed,
gives out water, carbonic acid, a small quantity of oil, and
some acetic acid ; leaving a very spongy and light charcoal ;
but no traces of ammonia could be discovered in the products,
which indicate that azote does not enter into its composition.

44 It is not altered by exposure to the atmosphere ; if the
air however be moist, it deliquesces ; water dissolves it in all
proportions without altering it ; and it cannot be crystallized by
any method.

44 Sulphuric acid, when diluted, does not exercise any
action upon it ; but when concentrated, it carbonizes and des¬
troys it. Nitric acid, as well warm as cold, destroys it, and
takes a fine red colour; if the action of the nitric acid be con-

Pelletier and Majendie’s Analysis of Ipecacuanha. 255

tmued, the colour changes to yellow; nitrous vapours are dis-
engaged, and crystals ot oxalic acid may be obtained ; no bitter
yellow coloured matter is formed.

44 T. he muriatic and phosphoric acids dissolve the emetic
principle without altering it ; by saturating these last, we may
extract the emetic princiole. ,

Acetic acid is one of the best solvents of the emetic
principle. Gallic acid, on the contrary, precipitates it from its
aqueous oi alcoholic solution, and forms in it a very intimate
combination. The abundant and flaky precipitate which is
formed is of a dirty white colour, and sparingly soluble; but a
certain quantity of it, however, remains in the liquor. The
emetic principle loses in this combination the property from
which it receives its name, viewing its action upon the animal
economy.

64 The aqueous or alcoholic tinctures of gall-nuts forms
also with this principle a very abundant precipitate. The
tartaric and oxalic acids have no action upon it : the alkaline
solutions, when diluted, have no action upon it ; but the con¬
centrated alkalies completely change the nature of this sub-
stance.

u The alkalies dissolve the precipitate formed by the gall
nuts with the emetic principle. Iodine, dissolved in alcohol
and poured into an alcoholic tincture of the emetic principle,
forms in it a reddish precipitate, which appeared to us to be a
combination of iodine with the emetic principle. The small
quantity, however, which we obtained of the precipitate would
not allow us to examine minutely its components.

“ Of the salts which we placed in contact with the emetic
principle, none had so powerful an action upon it as the acetate
of lead ; it forms in its solution a very abundant precipitate,
and this is especially the case with the sub-acetate. When we
make use of the acetate of lead of commerce, which contains
more acid, the precipitate is less abundant, and the fluid re¬
mains slightly coloured. Hence we perceive, that the acetic
acid rather opposes the precipitate.

44 The proto-nitrate of mercury has not at first any action
upon the emetic principle; but after a little time a slight pre¬
cipitate is obtained.

“ The deuto-chlorate of mercury causes a rather more
copious precipitate.

44 Tile precipitate formed by the muriate of tin is also
rather small. The salts of iron have no action upon the emetic
principle when this is deprived of all the gallic acid.

44 The antimoniated tartrate of potass exerts no action upon
the emetic principle : this is an interesting fact, as the two sub-
sta nces are often administered together in medical practice.

256 Foreign Medical Science and Literature .

cg The decoction of cinchona produces a slight precipitate
in a solution of the emetic principle ; but the precipitate is not
to be compared, in regard to quantity, with that produced by
an infusion of gall nuts.

44 The vegetable salts have no action upon the emetic
principle ; neither have sugar, gum, gelatine, and other vege¬
table and animal matters. Ethers and oils do not dissolve it.
We shall afterwards treat of its action upon the animal
economy.

44 In reviewing the properties of the emetic principle of
ipecacuanha, we must allow that it is a substance sui generis.
The numerous experiments which we made upon it, in order
to separate it into several principles without being able to do
so, its emetic property, and the action exercised upon it by the
gallic acid and by gall nuts, make us regard it as a peculiar
substance, a direct vegetable principle ; and this is the more
probable, as we have found it in emetic plants belonging to
very different families; for example, in the callicocca ipecacuanha ,
the viola emetica , &c. We have named it emetine (from b/ueio,
vomo), which indicates its most remarkable property, and the
plant from which it was first obtained, the Psycotria emetica .

u There remain to be noticed the products furnished by
means of the water employed as a solvent for the portion of
ipecacuanha, which contained nothing more that was soluble
either in the alcohol or the ether. This water, after being
macerated at the ordinary temperature, was become mucilagi¬
nous ; it left upon evaporation a greyish substance, which,
when washed in alcohol, separated from a colouring matter,
which was recognised as being of the same nature with the
emetic principle just mentioned. The white residue had all
the characters of gum ; a little oxalic and some mucous acid
was obtained by treating it with nitric acid.

44 Cold water not producing any more effect, we made use off
boiling water, which, in its turn, dissolved a considerable quan¬
tity of a substance recognised by the authors to be starch. A
little iodine added to the liquor immediately determined a fine
blue colour.

44 M. M. Pelletier and Majendie finish the chemical exami¬
nation of the Psycotria emetica , and reckon as ligneous matter
the residue, insoluble in the different menstruo employed.

44 They mention, as a very singular fact, the intimate
combination of the ligneous matter and the fecula, of which
very perceptible traces were found at the eighteenth boiling.

44 The mean of many analyses gave the following as the
proportion of the components of the cortical part of this
species of ipecacuanha :

Pelletier and Majendie’s Analysis of Ipecacuanha . 257

F atty and oily matter. . . 2

Emetic matter (emetine) . . . 16

Wax . 6

Gum . 10

Starch . 42

Ligneous matter . 20

Loss . 4

100

“ The analysis of the woody pith or meditullium of the
same root afforded the following results :

E metic matter (emeti ne) . L15

Extractive, not emetic. . 2 45

Gum . 5 00

Starch . 20 00

Woody matter . 66 60

Some traces of fatty matter .

Loss . 480

100 00

44 The inert extractive had nearly the characteristics of
the extracts generally obtained from woody substances, and
was separated with difficulty from the emetine, the specific
property of which it weakened ; it, however, differed from it
in as much as it w*as not precipitated either by tincture of
galls or the gallic acid, whilst the emetic matter formed copious
precipitates with these re-agents. The small quantity of the
emetic principle contained in the woody meditullium of ipeca¬
cuanha justifies the practice of separating that part in the
preparation of the powder of ipecacuanha.

64 The Grey Ipecacuanha , the root of the Callicoca ipecacu¬
anha , deprived of its meditullium, and treated in the same
manner as the former, afforded the following results :

Fatty matter . 2

Emetine . 14

Gum . 16

Starch . 18

Woody matter . 48

Wax, a trace merely .

Loss . . . . . 2

100

44 Hence it is apparent, notwithstanding the analogy in the
results obtained from this analysis and those of the cortical
part of the root of the psychotria, that the latter, as it contains
more emetine, must necessarily be the more active.

44 In submitting the White Ipecacuanha , the root of the
viola emetica , to the same operations, Pelletier and Majendie

VOL. VIII. - NO, 45. L L

258 Foreign Medical Science and Literature ,

found the emetine so intimately combined with the other com¬
ponents, that it it was necessary, instead of using ether and
alcohol, to boil the powdered root in a great quantity of water, _
and form ap aqueous extract. This extract, treated with alco¬
hol at 40°, lost its colour and yielded a brown matter, that
was recognized as emetine ; leaving a white matter soluble in
water, which was gum, and an insoluble glutinous matter,
which yielded ammonia on distillation. Neither fatty matter
iior starch was found in the violet root.

44 One hundred parts yielded,

Emetine .

Gum.. . .

.......... 5

.... _ 35

Vigeto animal matter .

. 1

Woody matter . .

. 57

Loss., . .

.......... 3

100

44 In order to attain the object which Messrs* Pelletier and
Majendie had in view, it was still necessary to make physiolo¬
gical trials with each of the products of their analysis ; but as
no particular effect could be expected from the gum, the starch,
the wax, or the woody matter, it was necessary only to examine
the fatty matter and the emetine.

44 The fatty matter f sav they, 44 effects the smell and taste
in the same manner, but with more energy than the ipecacuanha
in substance. It might have been thence presumed, that it
would have a similar action upon the stomach ; but experience
did not confirm this conjecture. Large doses of it were given
to animals without any sensible effect being produced : many
grains of it were also several times swallowed by ourselves ;
but the only effect was a disagreeable and nauseating, but mo¬
mentary, impression on the organs of smell and taste ; and
even M. Caventou, who assisted us in our researches, having
taken six grains of it at once, experienced no other effect.

44 Very different results were obtained from the emetine :
half a grain being given to a cat, excited violent and long con¬
tinued vomiting, that terminated in a profound sleep which
continued for some hours, but from which the animal awoke in.
perfect health.

44 These experiments were repeated on many other cats
and dogs with nearly equal doses of emetine , and afforded
similar results ; that is to say, always vomiting terminating in
sleep, and awaking in health after a longer or shorter interval.

44 The experimentalists repeated these experiments upon
themselves, and obtained similar results.

44 Since then, the emetine has been administered as an emetic
to many invalids \ on all of whom it has produced the effects

259

Pelletier and Majendie’-s Analysis of Ipecacuanha.

usually obtained from ipecacuanha, without the disagreeable
odour and taste of ipecacuanha, the emetine being inodorous
and its taste merely a little bitter. But Messrs. Pelletier and
Majendie have not limited their researches to these^ points, but
have also endeavoured to ascertain the effects of large doses on
the animal economy. Twelve grains being given to a small
dog about two years old, vomiting was excited in less than half
an hour, and continued for a considerable time until the animal
fell asleep. But instead of awaking in a heal thy state, as in the
former experiments with small doses, it died in the night after
the experiment, about fifteen hours after it had swallowed the
emetine. On opening the body next day with all the necessary
precautions, it appeared evident that the animal had died from
violent inflammation of the substance of the lungs, and of the
mucous membrane of the intestinal canal, from the cardia to
the anus*.

“ On repeating these experiments with other animals, even
when six grains only of the emetine wrere given, similar results
were obtained : and this was the case when the emetine, instead
of being introduced into the stomach, was dissolved in a small
quantity of water and injected, either into the jugular vein, or
tiie pleura, or the anus, or into the muscular tissue ; in all, the
effects were similar : — at first, obstinate vomiting, thep sleep,
and death in twenty-four or thirty hours after the exhibition of
the dose. The opening of the body also, in all the cases, dis¬
played appearances of inflammation of the lungs and mucous
membrane of the intestinal canal.

44 These experiments prove thate?#e^’«ecannot be safely taken
in a large dose, and also the error of those practitioners who think
that ipecacuanha may be exhibited indifferently in greater or
smaller quantity ; because, if the dose be too large, the vomiting
induced corrects the evil. They also prove, from the action of
emetine upon the lungs and intestinal canal, the propriety of
administering small and frequently repeated doses of ipecacu¬
anha in the latter stages of catarrhal fever, of chronic pulmonary
catarrhs, and long continued diarrhoea. Many examples are
cited in the memoir, in which emetine in proper doses was ex¬
hibited to individuals affected with these complaints, and in
which its beneficial effect was more certain and constant than
that of ipecacuanha.

44 Similar experiments made with emetine obtained from the
different kinds of ipecacuanha and the viola emetica , by fur¬
nishing similar results, prove the identity of this substance,
and that it ought to be regarded as an immediate vegetable

* These effects resemble those produced in cases of poisoning
by tartar emetic.

L L 2

260 Medical and Physical Intelligence .

principle. As a medicine, it possesses all the advantages of
ipecacuanha, without its inconveniences ; having no odour, very
little taste, and being soluble in water. Its effects also are
more immediate ; and, when overdosed, its action can be in-*
Stan taneo.u sly paralysed by the administration ot a light decoc¬
tion of gall nuts ; a fact which M. itlajendie has ascertained
upon himself

44 From the whole of the experiments, it may be concluded

_ 1. That the particular substance we call emetine exists in all

•the species of ipecacuanha used in medicine, and on it depends
their medicinal properties : 2. That this matter is emetic and
purgative, and exerts a specific action on the lungs and the
mucous membrane of the intestinal cana!, and has also marked
narcotic properties : 3. That it may be employed instead of

ipecacuanha m every case in which this medicine is useful, the
dose being more easily regulated, and the eff ects more certain.”

PART V ;

MEDICAL AND PHYSICAL
INTELLIGENCE.

I. - SOCIETIES.

Royal Society.— June 26. The following papers were read by
Sir Everard Home, Bart. 1. Some account of the nests of the Java
swallow, and of the glands that secrete the mucus of which they are
composed. 2. Observations on the gastric glands of the human
stomach, and the contraction which takes place in that yiscus. He
also communicated a paper, by Dr. J. R. Johnson, containing obser¬
vations on the Hirudo complanala and stagnalis, now formed into a
distinct genus, under the name of Glossiphonia. — The President
presented a paper by W. Sewell, Esq. giving an account of the
cure of a diseased foot, arising from an injury of the coffin bone. — -
Mr. Pond, Astronomer Royal, read a paper on the parallax of the fixed
stars; after which the Society adjourned during the long vacation.

At a Meeting of the Associated Apothecaries and Surgeon-
Apothecaries oj England and, Wales , held by Public
Advertisement , at the Crown and Anchor Pavern, August the
20th, 1817.

The Eighth Report of the General Committee was read, as
follows :

Circumstances having rendered it expedient to convene a
General Meeting of the Members of the Association, its Committee
begs leave to detail the events which have occurred since the pub¬
lication of their last Report, dated 24th of April 1816.

261

Proceedings of the Associated Apothecaries ,

By a reference to that document, it will be seen what steps were
taken by the Committee to procure such alterations as appeared ad-
viseable in the Bill intended to be brought before Parliament by
the College of Surgeons during that session ; and also an amend¬
ment of the Apothecaries’ Act. The Royal College of Surgeons
did not, however, then introduce any Bill. But the Court of Assist¬
ants of the Society of Apothecaries, notwithstanding the declaration
of its Bill-Committee, “ that such practical inconvenience had not
arisen from the alledged defects of the Act, as to induce it to recom¬
mend to the Court of Assistants any immediate application to Par¬
liament,” did immediately afterwards intimate, that as the Secre¬
tary at War, Lord Palmerston, was about to bring in a Bill to amend
the Act, as far as it affected Army and Navy Medical Officers, the
Court meant to embrace an obliging offer of his Lordship of making
such other alterations in the Act as would correct its defects, &c. :
and Dr. Burrows and Mr. Field met the Bill- Committee at the
Hall, to discuss the points which were stated as requiring amendment.
This intention of the Society was made known to your Committee ;
and some Resolutions relative to the subject were passed on the 15th
of May. But the session closed; and the amended Bill was not
brought forward, either by Lord Palmerston or by the Society.

In January last the Chairman received a copy of a new Bill
which the College of Surgeons had arranged. This was submitted
to the Committee on the 21st of that month. The Committee ap¬
proved this Bill, as far as it related to the practice of Surgery ; but
reiterated its objection to the amount of the fees for diplomas, as
being too large ; considering that by the Act every person, hence¬
forward practising surgery, would be compelled to apply for a dip¬
loma; whereas, under present circumstances, his coming before
the College is entirely optional. A request was consequently trans¬
mitted to the College, that it would re-consider the subject of fees ;
accompanied with a copy of the following Resolution : viz. “ that
this Committee anxiously hope that the Royal College of Surgeons
will not neglect the opportunities allowed by the intended Bill of
examining into the qualifications of candidates in the knowledge of
Midwifery.”

This Bill was expected to be introduced early in the last session
of Parliament ; but that also has passed without any application
being made.

Five years have elapsed since your Committee wras appointed ;
during which, it has been reduced by the death of many valuable
Members, by secessions and other causes, from forty-five to about
twelve or fourteen effective persons ; — a number, by far too few to
perform the ordinary business of the Association, or to constitute a
due representation of the great body of General Practitioners.

The intended resignation of the Chairman, Dr. Burrows, is a
circumstance which your Committee has most sincerely to lament ;
for in him, from the length of time he has so honourably and zea¬
lously laboured in that very ostensible and important situation, all
the most material details of the business have centered. His re¬
tirement imposes the obligation of appointing a successor. It would be
an act of injustice to Dr. Burrows, if the Committee withheld from

£62

Medical and Physical Intelligence .

the Association, the fact, that so long' ago as May 181 5, he expressed,
and for very sufficient-reasons, his determination to retire from $ie
Chair ; but under the impression that the duties of the Committee
would most likely be terminated with the last Session of Parlia¬
ment, he acceeded to the general wish of the Committee, and was
prevailed upon to extend his valuable services till that period.
And although no application has been, preferred to parliament,
either by the College of Surgeons or by the Society of Apothecaries,
his anxiety and exertions have been unremitting to promote, as far
m was in his power, the introduction of a Bill for the Regulation of
Surgery, and the administration of the Apothecaries’ Act agreeably
both to its letter and spirit.

By the subjoined statement of the funds of the Association, the
Committee confidently trust it will appear, that a just regard has
been paid to so important a resource ; and although it may- be deemed
light to appropriate a portion of it for especial purposes at this
Meeting, yet it should ever be respected and preserved as a means
applicable (when real occasion exists) to the support of the Interests
of the General Practitioners in Medicine. Nor can the Committee
forbear expressing a hope, that the subscription book will still con¬
tinue open, in order that the fund maybe adequate to all possible
exigencies.

The remaining- Members of your Committee have thought it a
duty incumbent upon them to convene this General Meeting of the
Association ; that they may render to it an account of their pro¬
ceedings : and with the utmost respect, they here surrender the
trust which has been confided to them, and which they have en¬
deavoured to execute faithfully and usefully.

State of the Fund, May 1, 1817*

Law expences
Printing
Advertising ■

Sundry Disbursements
Meetings, Public <$o Com¬
mittee, dunng 4 -years.

Dr. £. s.
- - - 144 9

- - 77 18

- - 56 17

43 14

Cr.

£. s. d»

4 Balance of cash in hand at£ . , ,
last Audit (Sept. 3, 1813.) ^

9 10

i Subscriptions since received
j By S;de of the intended Bill
5 By return on Advertisements

146
7
3

o 1
7 7
13 6

j By 4 years Interest on Ex- l 201 8 7

John Hunte
11. S. Wells

r I

347 9
Auditors.

chequer Bill of £1000

1 Balance £220 19 4
\ Exchequer Bill £1000

568 9 1

Dr. Burrows having resigned the Chair, James Parkinson,
Esq. was unanimously elected to fill that situation : after which
the following Resolutions were passed.

1 . — Resolved, unanimously, That the most sincere thanks of this
Association be given to Dr. Burrows, for the indefatigable zeal,
ability, and disinterestedness, with which he has filled the Chan*
since' the formation of the Association in 1812: and for the manly
perseverance with which he met all the difficulties that were opposed
t > the passing of “ An Act for the better regulating the Practice of
Apothecaries,” Ac. ; by which the honor and respectability of the
- ofession have been upheld, and the public interest most import-
f tiy served.

Proceedings of the Associated Apothecaries , 253

2. — Resolved, unanimously. That a Purse of Five Hundred
Guineas be presented to Dr. Burrows, the late Chairman, as sen
acknowledgment ot the services lie has rendered to this Association,
to the Profession, and to the Public.

*>• Resolved, unanimously, That the above Resolutions be ad¬
vertised in the public papers.

4. -Resolved, unanimously, That the Gentlemen who may this
day be appointed Treasurers "to this Association be authorized forth¬
with to carry into effect the two preceding Resolutions.

5. — Resolved, unanimously, That the sincere thanks of this Asso¬
ciation be given to the Members of the General Committee;
who, for a period of five years, have, with unwearied zeal, ability ,,
and attention, devoted their valuable time to the interests of the
Association, and the general improvement of the Profession ; -and
who have consequently rendered an essential service to the public.

5. — Resolved, unanimously. That the thanks of this Association,
be given to the Treasurers for their services.

7- — Resolved, unanimously , That the Report of the General,
Committee, now read, be received and adopted.

8* — Resolved, unanimously , That this Association do continoa
permanent.

P* — Resolved, unan bn otisly, That this Association determines T>
use its utmost exertions to promote the improvement of those
branches of the Medical Profession exercised by General Practi¬
tioners, and to protect their interests.

10. — Resolved, unanimously , That the interests of the Associated
be entrusted to a Committee, with full powers to act according it®
its discretion.

11. — Resolved, unanimously , That the said Committee shall con¬
sist of twenty-four Members, resident in London and its vicinity ;
and that one moiety of them shall be Members of the Society df
Apothecaries, and the other moiety of Non-Members of that Society.

12. — Resolved, unanimously, That Messrs. Hunter, Upton*
M ells, Bowman, 1)e Bruyn, Brande, Cates, Drew, Kerri sot*
Shillito, Seaton, and Malim, Members of the Society of Apo¬
thecaries — and that Messrs. Parkinson, A. T. Thomson, Hu hex*
Cook, Haden, James, Reginald Williams, Hayes, Oglf*
Nevell Wells, and Edward Leese, Non-Members of the Society
— do constitute the present Committee.

Id. — Resolved, unanimously, That the present Treasurers to tin®
Association be desired, and are hereby authorised, to transfer to tie
Treasurers to be appointed at this Meeting, the balance of the fund
■of this Association which may be now in their’s, or the Banker .a
Messrs. Gosling and Sharpe’s hands.

14.* — Resolved, unanimously, That the monies belonging to fha
Association be invested in public securities, bearing interest ; zv i
be placed in the names of the three Treasurers now to be nominated;
except such balance as is necessary to defray current expenses.

1.5. — Resolved, unanimously, That Messrs. Parkinson, Hunter
and Upton, be Treasurers ; and that the signature of two of .tie
Treasurers be necessary to the disposal of any part of the fund.

16. — Resol ved, unanimously, ihat, in order to establish a com¬
petent fund to preserve the interests of the Association* further sjA-

264

Medical and Physical Intelligence.

scriptions be received ; and that any new Subscriber of One Gurnee
be enrolled as a Member of the Association.

17* — Resolved, unanimously, That subscriptions be received by
any of the Treasurers, and by the Bankers to tiie Association, *
Messrs. Gosling and Sharpe, No. If), Fleet Street.

] 8. — Resolved, unanimously, That the Committee he authorised
by this General Meeting to receive from any Member of this Asso¬
ciation any welli-authenticated case of illegal practising ; for the
purpose of submitting the same to the Court of Assistants of the
Society of Apothecaries for their prosecution.

ip. — Resolved, unanimously, That there shall be a General
Meeting of the Association held annually, on the third "W ednesday
in July, at two o’clock ; when any vacancy in the Committee, or
the office of Treasurer, shall be filled up, the accounts of the current
year be audited, and all other affairs relating to the Association shall
be reported.

20. — -Resolved, unanimously, That a fortnight’s notice shall be
given, by advertisement in the London Medical Journals, and in
two morning and two evening newspapers, of the time and place of
the annual meeting.

The Secretary being under the necessity of resigning— ^

21. - — Resolved, unanimously, That the thanks of this Meeting,
with a Purse of One Hundred Guineas, be presented to Mr. Ward,
the late Secretary, as a mark of estimation for his services.

22. — Resolved, unanimously, That the Treasurers be requested
forthwith to fulfil the object of this resolution.

23. — Resolved, unanimously. That Mr. John Powell ot New¬
man Street, be appointed Secretary.

24. — Resolved, unanimously, That the thanks of this Meeting be
given to R. M. Kerrison, Esq. for the zeal displayed by him in his
publications ; as well as for the general interest he has taken to
forward the objects of the Association.

05. — Resolved, That a communication be made from this Asso¬
ciation to the Court of Assistants of the Society of Apothecaries,
begging them to ascertain and publish a list of those persons who
were in practice up to the moment of the operation of the Act.

26. _ Resolved,' unanimously, That the thanks of this Association

be given to James Parkinson, Esq. for having accepted the Chair °,
and for the able manner in which he has conducted the business oi
the Meeting.

27. — .Resolved, unanimously, That the thanks of this Meeting to
the Chairman be advertised in the public papers.

28. — Resolved, unanimously, That the Report of the Com¬
mittee, the state of the funds, and the above Resolutions, be sent
to the Medical Journals for insertion. James Parkinson, Chairman.

II. - MEDICAL.

Vaccination. — Every information relating to this subject is im¬
portant. A respectable Correspondent calls our attention to the case
of a child, named Price, 14, James-st. Manchester-sq. who has been
dangerously ill of small-pox after small-pox inoculation ,* but which
was otherwise reported. In three rumours of failures 111 vaccination,
it was ascertained by competent judges that two were 1 aricella and
one Measles.

M edical and Physical Intelligence.

NOTICES OF LECTURES.

Medical School , St. Thomas’s and Guy’s Hospitals . — The usual
Courses of Lectures will commence in the beginning of October :
viz. At St. Thomas s, Anatomy and Operations of Surgery, by
Mr. Astley Cooper and Mr. Henry Cline ; Principles and Prac¬
tice of Surgery, by Mr. Astley Cooper. — At Guy’s, Practice of
Medicine, by Dr. Curry and Dr. Cholmeley ; Chemistry, by Dr.
Marcet and Mr. Allen; Experimental Philosophy, by Mr. Allen;
Theory of Medicine, and Materia Medica, by Dr. Curry and Dr.
Cholmeley; Midwifery, and Diseases of Women and Children, by
Dr. Haighton; Physiology, or Laws oHhe Animal (Economy, by Dr.
Haighton. ^ N.B. These several Lectures are so arranged as not to
interfere w'ith each other, or with the practice of the hospitals.

Medical School, St. Bartholomew’s Hospital. — The following
Courses of Lectures will be delivered during the ensuing Winter.
To commence on the 1st of October. On the Theory and Prac¬
tice of Medicine, by Dr. blue ; on Anatomy and Physiology, by
Air. Abernethy ; on the Theory and Practice of Surgery, by
Air. Abernethy ; on Chemistry and Alateria Medica, by Dr. Hue ;
oh Midwifery, by Dr. Gooch ; Practical Anatomy with Demon¬
strations, by Mr. Stanley. Further particulars may be obtained by
application to Mr. Wheeler, Apothecary at the Hospital.

St. George’s Medical, Chemical, and Chirurgical School. — The
Courses will commence the first week of October; namely — On
the Laws of the Animal (Economy and the Practice of Physic, by
George Pearson, M.D. ; on Therapeutics, with Materia Medica and
A1 edical Jurisprudence, by W. T. Brande, F.R.S. and George Pear¬
son; on. Chemistry, by Mr. Brande ; on Surgery, by B. C. Brodie,
F.R.S. Assistant Surgeon to St. George’s Hospital ; and Sir Everard
Home will give, as usual. Surgical Lectures, gratuitously, to the
Pupils of the Hospital.

London Hospital. — Lectures on the following subjects will
commence in October: Anatomy and Physiology, by Mr. Head-
irlgton ; Surgery, by Mr. Headington ; Midwifery, by Dr. Rams-
bottom ; Chemistry, by Mr. R. Phillips ; Materia Medica and
Pharmacy, by Mr. R. Phillips.

Middlesex Hospital.— Dr. P. M. Latham and Dr. Southey will
begin their Lectures upon the Practice of Physic and the Materia,
at the Middlesex Hospital, in the first week of October next. — The
Lectures on Midwifery and the Diseases of Women and Children, by
Dr. Merriman, Physician- Accoucheur to the Middlesex Hospital, and
Dr. Ley, Physician- Accoucheur to the Westminster Lying-in Hos¬
pital, will be' resumed in the same month.

Great Windmill Street. — Mr. Wilson and Mr. Bell will commence
their Lectures on Anatomy and Surgery on the 1st of October, at
2 o’Clock. Air. Bell will deliver a separate Course of Lectures on
Surgery in the Evening. The Anatomical Demonstrations Will be
given by Air. Shaw.

Dr. George Gilbert Carrey, Fellow of the Royal College of Phy¬
sicians, and Physician to St. Thomas’s Hospital, will commence his

VOL. VIII. - NO. 45. M M

256 Medical and Physical Intelligence.

Winter Course of Lectures on the Practice and Theory of Medicine,
and Materia Medica, on Wednesday, October 1st

Theatre of Anatomy, Blenheim Street.— Mr. Brookes and Dr. Ager
will commence their Autumnal Course ol Lectures on V\ ednesday,
October 1, at two o’clock.

For Continuation of Notices of Lectures, see page 270.

A METEOROLOGICAL TABLE,

From the 21 st of July to the 20 th of August 1817,

KEPT AT RICHMOND, YORKSHIRE.

230 Miles NW from London.

jD.

Barometer. ,

Therm, i

Rain

Winds.

Max.

Min. jl

flax 1

Vim.1

Gage.

30*

SW..SSE..

SW..

66;

NW.NE.

24'

NW.SW..

SE.SW...

SW...

29;29

05-

SW..

SW...

2929

SW..SE.

130,29

SW..

3129

wsw,.

X 29

WSW..

229

SW..SE.

27)29

SE.SW...

60 '29

SW..N.

68129

68'

NW..M..

62)29

SW..

4229

NW.

18 29

Vble.

9 29

WSW..

W..

>29

SE..

128

99,28

SW..

! 29

16 29

SE..SW...

t29

1029

ssw...

> 29

3529

SW...

1629

24i29

Ofl

1 SW.

17|29

45 29

3£

SW...

]l8'29

3 29

2£

L SW.SSE..

19|29

129

i 66

0‘

2 SW..

j20l29

9 29

) 69

S SW..NE..

The quantity of rain during the month of July

Weather.

1 3 4 Cloudy... 2 Rain..

1 Sun.. 2 R. 3 4 Cy..

1 Sun... 3 Cloudy...

I 3 Sun.. 2 4 Cloudy..

1 Rain. 2 Sun...

1 Cy.. 2 Sun.. & Sh.

1 Sun., and Showers.

1 Sun.. & Sh. 3 Rain...

1 Sun.. 3 Showers..

1 Sun..

1 3 S.. 2 Sh.. 4 Moon...

1 3 S.. 2 Sh.. 4 Rain..

1 Rain. 2 Sun..

1 Cy... 2 Sun.. 3 Sh.

1 S.... 2Cy.. 3 S..4 Stl....

1 Sun...

1 Sim.. 3 Cv.. 4 Rain.

1 Rain.... 3 Sun..

1 Sun., and Showers.

1 Sun..

1 Cy.. 2 R... 4 Light...

. 1 Sun... 3 Showers..

1 4 Rain.. 2 3 Sun..

1 Showers. . and Sun..

1 Showers, and Sun.. )
1 Cy.. 2 Sun.. 4 Rain..

1 Cloudy.. 2 Sun..

1 Sun... 2 Cy.. 4 Rain.

1 Sun... 4 Rain. 3 Cy.. I
|l Sun... 3 Showers..

was 3 inches and 19-100ths.

The diseases which have been under treatment this last period, were
Anasarca, Cholera Morbus, Cynanche Parotidea, C yrunche donsillam.
Diarrhoea, Erysipelas, Febris Typhodes, Gastrodynia, Hannorrhois, Icterus,
Leucorrhoea, Menorrhagia, Obstipatio, Ophthalmia, Rubeola, and Scorbutus.

It may be proper to remark that though there arc generally many cast &
remaining under treatment from the preceding report, yet they arc always
new ones that are noticed in the present.

METEOROLOGICAL TABLE FOR LONDON,
From the 20 th of JULY to the 20 tli of AUGUST, 1817,
By Messrs. HARRIS & Co.

Mathematical Instrument Makers , SO, High Holborn .

Therm.

6*5

1.9

299
29s

298
29 7
29
29
29

29
29s

30
297
29'

29 s
29s
297

299
299

30
29s
299
29 7
295

)3
\4

299

22s

29 8

297
29
29

29
29'

299

298
297
2 97

299
29'
29s
299
299

30
29 9
29 7
296
294
294
294
294
296

296

297
296
29'
296

Rain De Luc’s Hygrom.

Damp.

Rarom. Guage. Dry.

.10

.07

.04

.05

.12

.06

.10

.07

.14

.16

.19

.10

.05

.07

.09

.07

.04

.13

.10

.09

.07

.06

.09

.13

.11

.06

Winds.

5
7
5

3 W

2iSW

sw
w

NW
SW

sw
s

SWva
3 SW

sw
wsw
wsw
sw
sw
s

sw
sw
s

sw
sw
sw
sw
s
s

sw
$
s

4
4

5
7
5

SSE

wsw

ssw

Atmo. Variation

Fine Ram
Fine

Fine

Rain) Fine
Fine j Rain
Fine ! Rain
Rain; Clo.
Rain . -

Rain! Fine
Fine Rain

Cio.

Rain

Stor.

Fine
Fine
Fine
Fine
Fine
Fine
Fine
Fine
Fine

Fog [Fine
llain

Fine ! Rain
Fine i Rain

. Rain
I Clo.
Clo.
Clo.

Fine
Fine
Fog
Fog

Rain -

Rain; — —

Fine: -

Fine , -

Rain Clo.

Fine

Clo.

Rain

Fine

Clo.

Rain

LJiUUUtAWJf V/*. ~ - - *

Bill of Mortality from July 15, to August 1.9, 1817*

CHRISTENED

( M

Males, . . . 216

eraales . . 195

411

buried.

■{

Males . . 115

Females... ........... 171

316

July 22 July 29.

206
170

376

131

152

283

OF WHOM 1 ■<

HAVE DIED J

SMALL POX

Under 2 Years . 90

Betw. 2 and 3 . 41

5 and 10 . 17

10 and 20 . 8

20 and 30 . 29

30 and 40 . 31

40 and 50 . 29

50 and 60 . 24

60 and 10 21

70 and 80 . 16

80 and 90 ...... 8

90 and 100 . 2

100 0

. 28

Total ©f Small Pox.

Aug. 5. Aug. 12. Aug. 19.

196

250

226

476

176

187

363

309

326

635

177

194

371

177

* - 1 Total,

373 >(Jh>e weeks )

- j 2271.

167

143

■ - ) Total,

310 > (five weekt)
- - j 1643.

100

116

29.

.(five ueteht),.. 120.

A REGISTER OF DISEASES
Between JULY 20tli. , and AUGUST \$thj 1817-

DISEASES.

Abortio . ..

Abscessio. .

Acne .

Amaurosis .

Amenorrhoea .

Amentia..... .

Anasarca . .

Angina Pectoris....

Anorexia .

Aphtha laetentium.
anginosa..

$ «
o -a

ft Ik

v:5

Apoplexia
Ascites

Asthenia . j 36

Asthma . -. . 19

Atrophia .

Bronchitis acuta.. . .

- chronica.

Bronchocele .

Calculus... .

Caligo .

Cancer .

Carbunculus .

Cardialgia . . . I 12

Catarrhus . 52

Cephalalgia . . . 21

Cephahea. . 8

Chlorosis . 6

Chorea . 3

Cholera.. . 41

Colica . 22

- Pictonum . . . . . 7

Convulsio . . 5

Coryza . . . . .... 1

Cynanche Tonsillaris.. — 24

maligna.
Trachealis.
Parotidea. .
Lary ngea.

Delirium Tremens
Diabetes.

Diarrhoea . I 73

Dysenteria. . 15

Dyspepsia . 59

Dyspnoea . 14

Dyspha
Dystocia
Dvsuria. .
Ecthyma
Eczema. .

aia

DISEASES.

Eneuresis .

Enteritis . . .

Entrodynia .

Epilepsia .

Epistaxis .

Erysipelas .

Erythema losve......

Erythismus Merc..
Eebris intermittent ,

- catarrhalis ..

- Synocha.

Typhus mitior.

'lUi

gravior

Synochus .

remit. Infant....

Fistula.

Furunculus .

Gastrodynia .

Gonorrhoea .

Hsematemesis .

Haemoptoe .

Hsemorrhois .

Hemiplegia .

Kepatalgia . .

Hepatitis .

Hernia.. .

Herpes Zoster. .

■prueputialis.

Hydrocele.

Hydrocephalus . . .

Hydrothorax . . .....

Hypochondriasis .

.Hysteralgia . . . .

Hysteria .

Icterus.... .

Impetigo figurata .

- sparsa . .

- erysipelatodes .

- scahida .

Ischias .

Ischuria .

Lepra.. .

Leucorrhoea . . .
Lichen simplex.

Lumbago .

Alania . .

Melancholia....
Alenorrhagia...

Miliaria. .

Morbi in fantil.es*.

r «

19!

269

Total.

Fatal.

. 22

. 15

DISEASES.

Morbi Biliosif.

Nephralgia . .

Nephritis........

Neuralgia .

Obstipatio.

Odontalgia .

Opththalmia .

Otalgia .

Palpitatio .

Paralysis...* .

Paraplegia .

Paronychia .

Pericarditis .

Peripneumonia . .

Peritonitis . . . .

Pertussis . ,

Phlegmasia dolens.... .

Phlogosis .

Phrenitis .

Phthisis Pulmonalis..

Plethora .

Pleuritis .

Pleurodyne .

Pneumonia..... .

Podagra . . .

Pompholyx benignus.

Porrigo larvalis .

- scutulata .

- favosa .

Prolapsus . .

Prurigo mitis . .

— - senilis .

diseases.

£->

Psoriasis guttata .

- inveterata . . .

Pyrosis . .

Rheumatismus acutus _

- - chronicus.

Roseola .

Rubeola .

Scabies .

Scarlatina simplex .

ans'inosa.

maligna..

Scorbutus.

Scrofula...

Spasmi... .

Strictura . .

Strophulus intertinctus. ..

Sycosis menti .

Syphilis . .

Tabes Mesenterica

Tremor . .

Trismus .

Vaccinia .

Varicella .

Variola .

Vermes . . .

Vertigo.

Urticaria febrilis...
- tuber osa.

Total of Cases
Total of Deaths.

34
5
1

1764

‘ Morbi Infant lies is meant to comprise those Disorders principally arising from dentition or
indigestion, and which may be too trivial to enter under any distinct heads ; Morbi Biliosi , such
Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases.

Judging by the number of cases in the present Register, it may be con¬
cluded, that the town is generally healthy ; although great allowance must
always be made at this season for the number who frequent the country.

It does not appear that there is any disease at present epidemic in
London ; but in the adjacent villages. Scarlatina simplex and anginosa have
been very prevalent. We long ago noticed the fact of the infrequency of
this febrile affection in town, comparatively with the country; and it will
be seen by a reference to the Registers of the Repository , how low it is in
the scale of the diseases prevailing in this city, to what it was formerly.
Hence it may be presumed, that there is something in the atmosphere or
ceconomy of a populous town less favourable to its production; and hence
too, perhaps, we may call Scarlatina the Malaria of the country.

In a case of Epilepsy lately, peripneumonia supervened, which terminated
in hydrothorax, and death.

Two of the fatal cases of Typhus gravior were accompanied by coma
and petechiae.

Two children who died, last month, of Measles , previously laboured
under tabes.

The fatal case of Enteritis succeeded the operation for Hernia ,

SiO Medical and Physical Intelligence .

NOTICES OF LECTURES CONTINUED.

Dr. Davis, Physician to the Queen's Lying-in Hospital and to
the Lying-in Charity, will commence his First Winter Course of
Lectures on the Theory and Practice of Midwifery, and on the
Diseases of Women and Children, on Tuesday the 7th of October,

Dr. Clough, 68, Berners Street, Physician-Accoucheur to the St.
Maty-Ia-bonne General Dispensary, Sic. &c. announces the re-com¬
mencement of his Winter Course of Lectures, on the Science and
Practice of Midwifery,' &c. early in October.

Mr. Clarke will commence his Lectures on Midwifery and the
Diseases of Women and Children, on Monday, October 6th, at the
Lecture Boom, 10, Saville Eow, Burlington Gardens.

Dr. Clutterbuck will begin his Autumn Course of Lectures on
the Theory and Practice of Physic, Materia Medica, and Chemistry,
on Friday, October 3 , at bis House, No. 1, Crescent, New Bridge St.

Dr. Adams wall commence his Course of Lectures at \% Hatton
Garden, on the Institutes and Practice of Medicine, early in October.

Dr. U wins. Physician to the City and Caledonian Dispensaries, will
commence a Course of Lectures on the Theory and Practice of Medi¬
cine, at No. 1, Thavies Inn, Holborn, October 3, at 7 in the Evening.

Mr. R. Phillips will commence a Course of Twenty-four Lec¬
tures on Chemistry, at No. 66, Cheapside, on Monday, October 6th,
at; 7 o’Clock in the Evening. Tickets of Admission, and a Syllabus
of the Lectures, may be had of Mr. Phillips, No. 1, George Yard,
Lombard Street, and of Mr. Edenborough, No. 29, Poultry.

Mr. Good’s Course of Lectures on Nosology, Medical Nomen¬
clature, the Theory and Practice of Medicine, will commence on
Monday, Sept, 29th, at the Crown and Rolls Rooms, Chancery Lane.
The Introductory Lecture will commence at half-past 3 o’Clock ; the
subsequent Lectures daily at 8 in the Morning, The former will
be open to the Medical Public, including Medical Pupils, by Tickets,
to be had gratuitously at any of the Medical Booksellers.

Mr. Curtis, Aurist to the Prince Regent, will commence his next
Course of Lectures on the Anatomy, Physiology, and Pathology of the
Ear, Oc t 1st, at 7 P. M. at the Royal Dispensary, Carlisle St. Soho.

Quarterly Report of Prices of Substances employed in Pharmacy.

s. i). s. n.

A ea^t^e Gumini elect.

lb.

Aeidum Citricum

- Benzoieum

unc.

- • Sulphuricum

P. lb.

- - Muriaticuna >»

- Nitricum

- - Acetieum

unc.

Aleohf>l -

M. lb.

JSther sulphurieus

- reetifleatus

Aloes spicatae extractum

- lb.

— vulgaris extractum

•

Amrnen -

•

Ammonia- Murias

- Subcarbonas

A mygdala; dulces

Ammoniacum (Gutt.)

•

- (Lump.)

A nth f 'midis Flores

AMimonii oxydum

- - sulphuretum

. -

Antimonium Tartanzatum

Arsen iei Oxydum

Assafcetidse Gummi-resina

- lb.

Aurantii Cortex - 4

Argenti Nifcras • - ime. 6

Batenmum Perumaum - lb, S©

8
0
0
0
6
0
6
0
6
0
0

Balsamum Tolutanum - ■■

Benzoinum elect. - -

Calamina praqiarata -

Calumbse Radix :

Cambogia ‘ - -

Camphor a -

Canellfe Cortex -

Cardfumomi Semina opt. - lb.

| Cascarillas Cortex -

| Castoreum ... unc.
Catechu Extractum - - lb.

Cetaceum ....
Cera alba

. — — flava ....
Cinchona; cordifolise Cortex (yellow)

- lancifolire Cortex (quilled)

- oblongifoVue Cortex (red)

Cinnamomi Cortex -

Coccus (Coceinclla) • unc.

Colocynthidis Pulpa - - lb.

Copaiba - -

Colchici Radix -

Croei stigmata ... unc.

Cupri sulphas - lb.

Cuprum ammonlatum

Cuspariae Cortex

Confectio aromatica

4
3
3
3
3
6

9
16
17

3
7
1

Prices of Substances employed in Pharmacy . £71

Gonfectio Autantiorum

- Qpii

- Rosas caninse

- Ros® gallic®

- Seim® ...

Eraplastrum Lytt® - -

- Hydrargyrr

Sixtraetum Bdladorm® - unc.

— - - Cinchonas -

- Cinehon® resinosum

- Coiocynthidis

- Coiocynthidis comp.

- - Conii - -

y - Elaterii - -

- Gentian® ...

■ - - Glycyrrhiz® - ib.

- Hannatoxyli - ne.

- - Humuli ...

* - - Hyoscami - unc.

- Jalap® - . - Res.

- - Opii ...

• - Papaveris 4

- Rhni ...

- Sarsaparill®

- Taraxaci ...

Forri subearbonas - - lb.

— sulphas -

Ferrutn ammoniatum

- tartarizatum

Galbani Gummi-resina.

Gentian® Radix elect ...
Guaiaci resina ....
Hydrargyrum purincatum

- - — prscipitatum album

- - cum creta

Hydrargyri Oxymurias - unc.

- Submurias -

— — * Nitrico- Oxydum

- Oxydum Cinereum

- Oxydum rubrum

•j — ■*' Sulphuretum nigrum
— -■ — ; — rubrum

Flellebori nigri Radis - lb.
ipecacuanhas Radix

- Puivis ...

Jalap® Radix ...

- Puivis - -

Kino - - -

liquor Plumbi subacetatis JO. lb.-
— Ammonia* ->

— Potass® -
u nrmentum Camphor® comp,
saponis comp.

Lichen
JLvttas ...
Magnesia

Magnesite Carbonas

- Sulphas, opt.

Manna optima
— communis
Moechus pod, (30$. )■
Mastiche ...

eristic® Nuclei
Myrrha elect.

Onbanum
Opium (Turkey)
Opium (East India)
Oleum Amygdalariun
— Anisi
— Anthemidis
— Cassia-

lb.

3
5

4
1
0

5
0
0
1
7

3
1
<2
1
0

4
2

5
G

6
9
6
0
0
0
1

5
0
0
3

6
6

3
1
5

4
1

in gr.

line.

lb.

unc.

Caryophilli
Carui -

Juniperi Any. ...
Lavandula

Mench® piperit® - unc.
Menth® viridis Ang. -
r Piment® - - unc,

Ricini optim. - (per bottle)

4
9
6
0
0
0
9
0
8
6
6

5
0

6
0
6
0

0 10
6 6
4 0

48 0

0
0
0
6
0

0
9
6
0
6
6
0
6
0
6
6
e

5
10

unc.
■ rect.
P. lb.

cong.

(per 100)
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lb.

Oleum Rosmarini
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Oliv® Oleum
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Puivis Antimonialis
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Resina Flava - - lb,

Rh®i Radix (Russia) ...

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Ros® petala ....
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Sarsaparill® Radix (Lisbon)
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Sulphur -

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Prices of New Phiab per Gross. —
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QT2

LITERARY NOTICES.

Dr. James Johnson, Surgeon to His Royal Highness the Dolce
of Clarence, &c. &c. has in the Press An Essay on the Prolongation
of Life and Conservation of Health ; unfolding original views and
fundamental principles for their attainment, and embracing observ¬
ations on the nature, cause, and treatment of some of the principal
diseases which assail the British constitution in its native climate*

^ Mr. A. T. Thomson is preparing for the Press a New Edition of
The London Dispensatory. _ _ _ _

MONTHLY CATALOGUE OF BOOKS.

Account of an Epidemic Small Pox which occurred in Cupar, in
Fife, in the Spring of 1817 ; and the Degree -of Protecting Influence
which Vaccination afforded ; accompanied with Practical Inferences

and Observations. By Henry Dewar, M.D. F.R.3.E. .

An Attempt to establish Physiognomy upon Scientific P rmci-

ples. By John Cross, M.D. 8vo. ' _ . o

An Experimental Inquiry into the Laws of the v ital Function*,
with some Observations on the Nature and Treatment of Internal
Diseases. By A. P. Wilson Philip, M.D. F.R.S.E. &c. 8vo. .

A Treatise on the Nature and Cure of Gout and Rheumatism.
By C. Scudamore, M.D. 2nd Edit, corrected apd much enlarged. 8vo.
Medico-Chirurgical Transactions, \ oh viii. Part i.

Case of Jane Greenslade, whose Skull was Fractured, & c. by
Robert Semple, Member of the Royal College of Surgeons. 8vo.

Elements of the Natural History of the Animal Kingdom, by L.
Stewart Memb. of the Linnaean & Wernerian Societies. 2 vols. 8vo.

The' History and Practice of Vaccination. By James Moore,
Director to the National Vaccine Establishment, &c. Sec. 8-vo. _
Cases of Diseased Prepuce and Scrotum, illustrated with Etchings.
By W. Wadd, Esq. Surg.-Extr. to PL R. H. the Prince Regent. 4to.

^ Gerbaux on the Teeth, with Observations on the most frequent
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NOTICES TO CORRESPONDENTS.

In answer to the inquiry of several intelligent Correspondents, why their
•papers have not earlier insertion ? the Editors beg to refer to Lie great

_ 7 7 .. .. j.1 r* a. /tnuL-nh' ri~£ sPV.PVfll. of ifl.OXC 'WiLXCfl tlCLVC VC*’

Friends , half-a-s/ieei more uiun ‘-'g"1' — . - . y ,

Communications : by which regulation, every Communication will be

delayed a still shorter time .

We have been very much astonished at the receipt of a critique on a
recent publication, on our parts unsolicited, and not even bcariny the name
of the writer. The Work referred to, we have not seen ; therefore know no
more of its merifs than we do of the pretended critique, which we certainly

■shall not give ourselves the trouble to peruse. ,

This is not the first time that attempts have been made to make our
pages the vehicle of self-interested views. These attempts were, however, in

uuuue suspicion , we confess our su? pi - _ , , , , i

ignorant of the principles on which the Repository is conducted , and who

think sq meanly of its Editors.

THE

LONDON MEDICAL

REPOSITORY.

No. 46. OCTOBER 1, 1817. Vol. VIII.

PART I.

ORIGINAL COMMUNICATIONS.

• I.

AN ESSAY ON DISEASES

RESEMBLING

THE VENEREAL DISEASE*

BY A PHYSICIAN.

( Continued from. p. 199. )

PART III.

Of Cutaneous Diseases which may he improperly considered

as Syphilitic.

Head-ach, languor, dejection, and debility, with restless¬
ness and fever of a hectic character, are the symptoms which,
frequently usher in syphilitic eruption. It is often too pre¬
ceded by an efflorescence of the skin, resembling the roseola
annul ata. The common spot is flat, circular, slightly elevated,,
sometimes pustular like variola, but less prominent, without
interstitial redness, soon becoming squamous, sometimes con¬
fluent, and of a reddish or copper-coloured hue; it occurs
chiefly on the face, back, breast, arms, and shoulders. The
scale of it falls off, is succeeded by another of a darker coiour,
and the spot it' left to itself proceeds to ulceration. The erup¬
tion of syphilis sometimes appears in separate groups or clusters
of a o-yrated form, slightly elevated, and of a purplish red. vv hen.
the spot appears on the skin of the palm ot tne hands, or
(which does not very commonly happen) on the soles of the
feet, there are small separations of the cuticle frequently
recurring. Sometimes a tuberculated eruption appears^ of
VOL, vm. — no. 40. N N

2 ti? Original Communications .

dusky red colour, not containing a fluid, ultimately becoming
scaly and ulcerating. In short, the eruption puts on various
appearances, affected very much by inefficient attempts which
have been made to cure the disease by the inadequate adminis¬
tration of mercury. There is no description, no exclusive
mark by which a venereal spot can al ways with certainty be
distinguished at first sight. Too much stress is laid on the
copper-colour of the syphilitic spot, when in fact many other
eruptions have that hue in a greater degree. The copper-colour
of the spot is best detected by pressing the spot with the finger,
drawing the finger over it, and on withdrawing the pressure,
the tint will be discovered. The true venereal spot has,
generally speaking,- a fainter tinge of copper than any other
eruption.

But I must recollect that my present business is not to
enumerate every possible variety of the venereal spot, but to
point out such eruptions as may be mistaken for venereal
eruptions.

The eruption of Sibbens has the appearance of being pus¬
tular ; but Dt. Adams never could discover pus under the
the cuticle. It hardens into an irregular, dark brown, crusty,
ox strong scab. The venereal spot retains longer its copper-
colour, and afterwards, becoming more elevated, it retains more
the colour of the skin, and the scab when formed is more scaly*.
However closely the cuticular affection in this disease may
resemble a venereal eruption, we shall be very much assisted
in forming a diagnosis by attending to the history of the case ;
and to the first symptom, which will usually be found to have
appeared on the lips and mouth ; the knowledge too that the
disease is prevalent in the neighbourhood is important : all these
circumstances will afford great assistance in enabling us to decide
upon the nature of the complaint, which will sometimes be put
beyond doubt by the fungated character of the sore.

The eruption of yaws is the first symptom of the disease,
it we except a slight degree of fever, which is often unnoticed.
Small spots or protuberances less than the head of a pin appear
over the body ; these are particularly numerous in the face,
groins, axillae, and about the anus and pudenda, in which
situations the spot is largest. The crop, when numerous, is
composed of smaller spots than when there is a scanty eruption.
The spots come out at different times, new ones appearing as
the earlier spots dry. The cuticle giving way, a foul crust or
slough is formed, from under which red fungous excrescences
often spring up, which, from their resemblance to a raspberry,
obtain for the disease (of which they form a striking ebarac-

* Adams on Morbid Poisons.

An Essay on Diseases resembling the Venereal Disease. 275

ter) the name of yaw, or frambaesia ; the former being an
African term for that fruit which in French is called framboise.
During the progress of the complaint, there is no constitutional
disorder nor much pain, excepting in those cases where the soles
of the feet are affected. A V lien the eruption appears on asiy
part possessing hair, the hair gradually becomes white. The
spot of frambaesia is characterized then by a slough with a
consequent fungus, and scab. The constitution is generally
equal to the cure of the disease, which seems to wear itself out,
and the habit once freed from it is ever after unsusceptible of a
fresh attack. Such a case will seldom occur in Europe ; and
when it does, attention to the history of the case with the want
of preceding primary symptoms, and the presence of concomitant
symptoms, and more especially the fungated character of the
sore, will guard us against mistaking the disease for syphilis.

Elephantiasis is aname which has beenconfounded with lepra:
lepra, which is the true name of a scaly disease, being often by
some writers given to elephantiasis, which is a tubercular diseast*
which last name has also been by the moderns applied to another
complaint, more commonly known by the name of Barbadoes
swelled leg. True elephantiasis, called also elephantia, leo,
or leontiasis, satyriasis, satyriasmus, and herculeus, and by
Arabian writers juzam or judam, is accurately and partiuclarly
described by Aretseus ; it is the disease known also bjf the
name of Syrian or Arabian leprosy, or lepra Arabum ; in con¬
tradistinction to the true leprosy, which has the title of lepra
Grecorum. The disease in its worst form is characterized by
the appearance of smooth shining tubercles, of a hue paler at
the commencement, becoming of a sanguineous or dusky red as
the disease advances. These tubercles appear on the face, alse
nasi, eye-brows, forehead, and extremities. Great deformity of
the visage is produced, the alse nasi become swelled, scabrous,
and spread out ; the eye-lids thickened, beset with small tuber¬
cles, the skin surrounding the eye is contracted into a circular
form. The forehead loses it smoothness, the skin of that part
and of the cheeks grow thick, tumid, rugous ; the external ea y
enlarged, thickened, and fuberculated ; the lips frequently
tumid and tuberculatcd, and consequently shortened so as to
expose the teeth. The beard never appears if the disease occur
before puberty ; after that time it is lost, or is visible only in
the interstices of the tubercles. The hair ox the eye-brows,
pubes, axillae, &c. falls off; and the voice becomes hoarse and
indistinct. The disease advancing, the tubercles crack, be¬
coming covered with a white furfuraceous substance, and after-
wards ulcerating. The throat and nose are affected with tuber¬
cles and destructive ulcerations ; the breath is very offensive ;
the generative organs disappear ; glandular swellings sometimes

N N 2

276

Original Communications,

form in the groin; the tuberculated skin of the extremities
becomes divided by fissures and ulcerates, or is corroded under¬
neath by dry sordid scabs, so that the fingers and toes become
gangrenous, and separate joint after joint*.

The disease is hereditary, not contagious. Where this disease
is prevalent, the symptoms of it are so strongly marked, and so
well known, that it appears impossible that it should be con¬
founded with venereal disease ; but where it occurs more rarely,
and where its form is modified, it is possible that the two dis¬
eases may be confounded, more especially where the habits of
the patient render it probable that the case may be venereal.

Case.

Mary Cooper, aged 26, gave the following account of herself
Some time about the year 1805 she had two small sores in the
vestibulum, a thin discharge from the vagina, and a slight
swelling in the right groin. She took pills ; the symptoms
disappeared ; her mouth not being affected. In about six
weeks afterwards an eruption appeared on the face in the form
of a rash, on the chin and cheek, and afterwards on the left
thigh ; itching violently. By the advice of a medical man she
rubbed in mercury, and took pills. After thrice rubbing in,
her mouth became very sore ; she therefore discontinued the
inunction, but took the pills for about nine weeks. Her mouth
was so much affected, and the ptyalism so great, that she could
scarcely articulate for two months. When under the influence
of the mercury, her forehead and nose were attacked with large
red pimples ; large tubercles then appeared on the arms and
legs, which were preceded by great pain in the limbs, which
went away on the coming out of the eruption. The eruption
itched violently, then ulcerated and scabbed over. The scabs
fell off repeatedly, and when they finally came away (which
was in eleven months from the first appearance of the tubercles),
they left large white eschars. During this period her arms and
legs had become contracted, in consequence of the ulcers in the
bends of the arms and in the hams. She went into a hospital,
where she used the warm-bath, and took diet drink (or decoc¬
tion of sarsaparilla), with sublimate drops (a solution most
probably of muriate of mercury) ; her sores were dressed, and
all of them were healed at the end of five months, excepting
those on the face. She next rubbed in mercurial ointment
every night for four months, which made her mouth sore. She
was now discharged, her skin being free from eruption and
sore. After continuing well four months, large sores appeared

* Bateman’s Synopsis of Cutaneous Diseases : Adams on Morbid
Poisons.

An Essay on Diseases resembling the Venereal Disease. 277

on the cheek ; she used the diet drink and drops as before for
three months, and again got well. In less than two months
the eruption again came out on her face, and over the whole
body. The drink and drops were again taken for four months;
the sores appeared to be better for a time, but soon became as
bad as ever. She had at this time an eruption on the face and
nose; a few on the body, and sores on the arms, legs, and
thigh. The tubercle which constituted the eruption was pro¬
minent, red, and was sooner or later covered with a dark brown
crust. When I first saw her (which was in May 1808), the
face, nose, and forehead, were affected with these tubercles;
the ulcers on the body and extremities were pale and indolent,
shewing no disposition to spread. It was evident that the
ulcerations had been very general, as her body was covered
with broad white eschars. She had latterly been taking decoc¬
tion of the wxxxls, and sublimate, without benefit. A part of
one of the alas nasi was corroded, and the skin round one eye
contracted. After trying the powder of the root of mezereon
for seven weeks with some slight amendment, I omitted it, and
gave her arsenic in combination with a little laudanum and
tincture of red lavender ; applying externally a wash, in the
proportion of about two drachms of Dr. Fowler’s solution to
half-a-pint of water. This plan succeeded beyond expectation.
In a few days her appetite and spirits became much improved;
the sores, which before shewed no disposition to heal, rapidly
healed ; and the eruption subsided quickly. She began this
plan August 23, 1808 : on the first of October following, no
sores or scabs remained on any part, a few red spots only being
left in the face ; and her general health was very good. I saw
no more of her from this time, and cannot therefore say whether
the cure was permanent or not*.

I cannot positively assert that this case was mistaken for
£ venereal case, although it probably was, if we may judge by
the liberal use of mercury at one period. It certainly was
thought to be a venereal affection by the patient, who obtained
admission into a venereal hospital ; and it may therefore be
fairly presumed that her case was at least considered doubtful,
by her being suffered to remain in a place exclusively devoted
to venereal patients. I considered her account of its progress to
be verv correct; for being much interested in the case, I took her
statement at different times, and always found her accounts
correspond.

This case shews the necessity of minutely enquiring into
the history of a disease ; had that been done in the case of this

* I take this case from notes made at the time.

•278

Or igincil Commumca t ions .

woman, she need not have associated for so many months with
infected women of the town, labouring the whole time under the
imputation of having a syphilitic disorder. These observations,
which cannot be too strongly enforced by precept, and by.
example, apply strongly to another case which occurred not long
after the one just related, and which I shall also transcribe :

Case;

Elizabeth Evans, aged 23. stated her case to me as follows*:
—In 1804, in the fourth or fifth month of pregnancy, (she
being unmarried,) she noticed a thin discharge from the
vagina unattended with pain or uneasiness. She lay-in in Sep¬
tember of the same year ; the discharge continued : she again
became pregnant, and was brought to bed in November 1805.
The discharge lasted until November 1807, in which month
a swelling appeared in the right groin, which became as
large as a hen's egg. Poultices were applied to it, and in five
weeks it subsided. She was menstruating just before the
appearance of this swelling; but this ceased as well as the dis¬
charge, and neither secretion has since re-appeared. For this
swelling she took mercurial pills for six weeks, which affected
her throat; and, when under the influence of these, she went out,
on a snowy day ; at night she felt chilly ; pains attacked the
back and extremities, and she ultimately lost the use of her
limbs. With the pains, tubercles appeared on different parts
of the body, seventeen in number, distributed as fallows : on
the forehead ; internal angle of the right eye ; right aiae nasi ;
left cheek ; angle of the mouth ; left shoulder; left arm; spine;
rio-ht thigh ; right shin : on each of these situations, one tuber-
cle ; on the left thigh, two; and on the left hip, five. These
tubercles soon ulcerated, forming spreading sores. She was
attended by a surgeon from the middle of January to the latter
end of February (1808). Under his care all the sores healed
excepting that on the forehead, that at the internal angle of
the right eye, and that on the right pinna nasi : these two last
bad united, forming an irregular sore which extended across the
nose. The os frontis was partly exposed. She now applied
to a hospital, where she became a patient in the beginning of
March 1808. In addition to her sores, she had slight pains in
her limbs. Here unfortunately for her, but a slight inquiry
was made into her former symptoms; and, from the inspection
of her present state, her case was considered as venereal. She
rubbed in mercury from the 3rd of March to the 28th of the same
month, which made her mouth very sore. She then took nitric
acid, guaiacum, and mezereon ; and whenever the mouth was

* This was taken down in 18 Op.

An Essay on Diseases resembling the Venereal Disease. 279

tolerably 'well, mercury was administered from time to time in
the form of muriate of mercury ; a few doses of which invariably
affected hei mouth, which was more or less sore till the Febru¬
ary following (1809). I speak latterly from my own knowledge,
as I saw her every day, although she was under the manage¬
ment of another. Common digestive ointment with a little red
precipitate of mercury constituted the dressings. At this time
she came under my care: I made an inquiry' into the history
of her case, which she gave me as above ; I of course did not
consider the symptoms as syphilitic. The sores now shewed
not the least disposition to heal. The sore on the forehead was
% cry extensive, and thin scales of hone had separated at different
periods. Her health was much impaired by. having been
closely confined for nearly a year in a mercurial ward, the whole
of which time she was more or less under the influence of mer-
ciny. I gave her two table-spoonfuls of the following mixture
twice a day, continuing simple dressings :

A Solut. Arsenic. Dris Fowler, gutt. lx.

Tinct. Opii. gutt. xl.

- Lavend. C. §ss.

Aq. distillat. §v. Misce.*

Soon after the use of this medicine the sores assumed a
more healthy appearance ; scabs formed on the surface of them ;
anu wiien these fell off, they left a sound surface underneath.
\\ hen I iast saw tins patient, winch was in the May following,
the face was quite wrell ; a very small sore or speck remained on
the forehead, which I attributed to the presence of a thin scale
of dead bone which had not separated, but this was hardly to
be noticed. Her health was much improved, and she had lost
tnat languor and dejection of spirits which had so long weighed
her down.

I have related these cases at length, in The hopes that the
practitioner may be induced to hesitate, before he condemns a
patient to the punishment of a long course of mercury. Both
were under the management of men, high in the profession,
whose practice was chiefly in venereal complaints. I take no
merit in detecting their error, as I had more leisure than they
had to inquire minutely into the history and progress of the
disease ; which being done, I could not possible consider the
symptoms to be syphilitic.

Lepra generally attacks the extremities, extending to the
breast and shoulders, and to the loins and sides of the abdomen.

* This is the manner in which I always administer arsenic. I do
not assert that it is the best method, but I have found no reason to
alter my practice.

280

Original Communications .

The hands become affected ; the face but rarely ; the scalp m
also attacked. The eruption comes out first under the form of
small, round, reddish and shining elevations of the skin, at
first smooth, but in a day or two exhibiting thin white scales on.
their tops. These increase to the size of half-a-crown, still
continuing oval or circular, and are covered with shining scales,
encircled by a dry, red, and slightly elevated border. The
scales sometimes accumulate, so as to form thick crusts. If
the scales or crusts are removed, the skin appears red and shin-
jng, verv smooth, and free from the cuticular lines m the be¬
ginning, but marked, in the advanced stages, with long deep
lines and reticulations, not always coinciding with those of the
adjoining surface. There is but little inconvenience attending
the eruption when it is mild in degree and extent, a little itch¬
ing excepted ; but where the eruption is more diffused, and
much inflammation is present, there is great soreness, pain,
heat, and stiffness. The constitution however is not disturbed*.
The spot of lepra is sometimes very small, and its scales
very white : this constitutes the lepra alphoides, which is confi¬
ned to the extremities. The patch is sometimes of a more dark
and livid hue, and is then termed lepra nigricansf . The vene¬
real leprous spot is smaller ; its surface and margin more smooth
and soft; thecolourof its base, generally speaking, is of a darker
red or copper colour, resembling more the lepra nigricans than
the other forms. To describe every variety of cutaneous affec¬
tion, "which, separately taken, might be considered upon inspec¬
tion as venereal, would not only exceed the limits but also the
design of this Essay. Whenever a patient shews us an erup¬
tion, the nature of which we do not exactly understand, we
should inquire what constitutional symptoms preceded its ap¬
pearance, whether any primary affections resembling those of
syphilis have been present; if they have, we must carefully ascer¬
tain if possible the character of them. Whether sore-throat has
been or is present ; if so, what the character of that sore-throat

is. Whether any state of stomach, or any thing taken into the
stomach previously to the appearance of the eruption, or expo¬
sure to cold, may have led to it ; or whether it is possible that
the occupation of the patient, such as the trade of a baker, or
the employment of a washerwoman, may be the cause of it
(in which last cases the eruption will be on the hands and
wrists) ; and whether want of cleanliness may not have produced

it. A spot which resembles that of syphilis occurs sometimes
unattended with any constitutional disorder, excepting perhaps
languor and debility ; which spot is not circular, but rather pen¬
tagonal. The eruption may be the effect of mercury, consti-

* Bateman.

t Ibid.

An Essay on Diseases resembling the Venereal Disease. 281

luting the affection which has been described under the names
of hydrargyria, eczema, or erythema mercuriale, and, mercurial
lepra. A very small quantity of mercury sometimes brings on
this eruption, such as an alterative dose of calomel, or even the
sprinkling red precipitate on a sore. The period at which it occurs
is uncertain; but generally within the first fortnight. Cold is
mentioned by many as the exciting cause; but in two well-marked
cases that came under my notice there had been no exposure
to cold; both happened in the autumn; but not one case occurred
in the venereal hospital in the course of the whole following
winter. As one of the subjects of these cases was a male and the
£>ther a female patient, and as in both the affection was very
violent, I shall here insert the cases.

Case.

William Wright, aged 27, had a large sore behind the
corona glandis, for which he was ordered to rub in mercurial
ointment. He began bis course on the first of October ; this he
persevered in till the fifth of November following, having m the
course of that time used about Jiv of ointment. On the morning
of the last-mentioned day he was extremely hot and thirsty, and
he complained of great itching, chiefly about the organs of gene¬
ration, and at the upper part of the thighs, with a thickened
and greasy appearance of the scrotum, and tumefaction of the
prepuce, together with great dejection of spirits. On the fol¬
lowing day there was a general florid appearance of the skin; an
eruption then came out in the groins and upper part of the
thighs in the form of small pustules, extending itself, in the
course of two days, over the breast. At this time (November
8), the ears became hot and tumefied, and a general oozing of
a purulent fluid took place from the pinna and lobe of each ear,
and from the skin covering the angle of the lower jaw. On
the following day a pustular eruption (resembling the pustular
venereal eruption) appeared on the arms, beginning on the
hand, extending upwards ; the eruption extended downwards
to the legs, the appearance at the upper part of the thighs being
that of a general diffused redness. November 14th, on the
breast a few pustules remain ; on the fore arms the puctules
have discharged their fluid, but on the backs of the hands
they are very prominent and large, filled with a greenish pus.
The pulse and appetite natural; great dejection of spirits.
The skin covering the angle of the lower jaw encrusted with *
scabs.

December 3. The patient’s health suffered considerably from
confinement ; there was extreme debility; he was ordered out of

VOL. VIII. — no. 46.

o o

Original Communications.

the hospital for change of air, and I never saw him afterwards.

I much fear that he fell a sacrifice to the disease.

Case.

•

Elizabeth Mash, aged 16, had gonorrhoea and bubo. Sim
was ordered to rub in on the 7th August. On the 20th of
the same month (having then used about an ounce anu a half o
ointment), very small red pimples in a confluent state appeared
on the chest, attended with great itching, in the course of the
day becoming general over the whole body. The eruption
did not appear (to the naked eye) to contain a fluid.

On the 25th the eruption was covered with a fine thin
white desquamation, the skin in many places appearing as if
covered with flour. The general health not much affected
27th. The eruption is now no longer defined (except in a
few places), appearing like a general erysipelatous inflamma¬
tion ; one general blush of a bright Ted colour having, in the
different parts of the body where it terminates, a determined
edge, disappearing on pressure. The white desquamation has
nearly disappeared, and there is a slight effusion from the parts
that have thrown off the thin scales. 30th. Cuticle peeling off
in large white scales, with great effusion from the parts undei-
neath, which are of a deep tinge ; the discharge particularly
copious in the angles of the thighs, making the linen quite stiff*.
The arms and thighs swollen. Great heat, with frequent and
strong pulse. During the first part of the following month
(September), the cuticle continued to peel off in large flakes
from the trunk and extremities ; the face and neck as if covered
with flour. The effusion from the thigh continuing. Septem¬
ber 20th, Cuticle has finished peeling off. Thighs well.

I have related these two cases, as they comprehend the diffe¬
rent appearances of this disease, which will be sufficiently distin¬
guished from syphilitic eruptions, by attention to its characters,
progress, and symptoms, and especially by its coming on when
the patient is under the influence of mercury. Even where the
disease of the skin is caused by a small portion of mercury, and
appears more partially, it will still be distinguished by its ap¬
pearance, by its white desquamation, by its not leaving a spot
or ulcer, and by its disappearing in the course of a few weeks.

Ulcerations' on different parts of the body may be mistaken
for that ulceration which is the last stage of the venereal spot.
„ It is impossible to enumerate every kind of ulcer that may at
first view, from its situation and appearance, be mistaken for a
venereal ulcer. We must form our diagnosis from the history
of the case, from previous and concomitant symptoms, from the
knowledge that mercury has or has not been used, from the

Chapman on Serous Effusion . 283

effects of it upon symptoms where it has been employed, and
particularly from the character of the spot which preceded the
ulcer. The venereal secondary ulcer has generally unequal
hard edges ; its surface smooth and red, sometimes fungous ;
the discharge from it viscid, tough, and offensive ; sometimes of
a greenish yellow, seldom attended with much pain. The scor¬
butic ulcer is a spongy sore, fungous, with livid edges, dis¬
charging a thin bloody sanies, connected generally with debili¬
tated habit. The scrofulous ulcer is pale, indolent, not very-
sensible or painful, discharging a colourless unhealthy viscid
fluid, with edges not much raised, of a glassy pale-red appear¬
ance, sometimes tumefied. The sore generally sunk in, some¬
times forming fungous granulations, but commonly smooth and
void of granulation. They are often accompanied with consti¬
tutional symptoms and affections of the body, which sufficiently
mark the nature of the ulcer.

The cancerous ulcer is irregular, and commonly unequal.
Its edges hard, thick, indurated, and irregular ; reversed in
different ways, inverted, retorted, or serrated ; and very painful.
The discharge a thin, foetid, dark-coloured, acrid sanies. The
ulcer is progressive, attended with lancinating pain ; and, un¬
fortunately, it is incurable in the present state of our art.

(To he continued.)

II.

Observations on Serous Effusion . By Edward Chapman^

Bath, Surgeon.

Besides mortification, abscess, and resolution, there is
another very frequent termination of inflammation ; which, as
it consists in the exudation of serum or coagulable lymph from
the exhalants, or the extremities of the arteries which are the
subjects of the disease, may properly be termed serous effusion .

This serous effusion, as one of the consequences of inflam¬
mation, has, I believe, very generally been omitted to be
considered as such by writers on this subject; and for the
knowledge of this very important fact, the profession is
indebted to Dr. Parry of Bath, who has recently given the
subject very ample investigation in his Elements of Pathology.
It is the more astonishing that this circumstance should have
escaped the attention of even the earliest physiologists, since it
is perhaps not less frequently the method which Nature adopts
for the relief of inflammation than any of the three afore-

o o 2

Original Communications. f

mentioned and universally admitted ; nay, instances the most
familiar to us are constantly occurring, tending to illustrate,
in a most forcible manner, not only the frequency with which
it supervenes to local excitement from inflammation, but that ,
it is the means which are naturally instituted for the cure of
inflammation in almost every situation. This a blister-plaster
very happily exemplifies, by the serous effusion which uniformly
succeeds to the inflammation excited by its application on the
surface of the skin; and a similar effect is very generally
occasioned through a medium precisely the same, namely, by
the excitement of an increased arterial action or determination
of blood by the exhibition of beat.

These instances, however, are confined to the cuticular
surface ; but the serous effusion consequent on inflammation is
by no means confined or peculiar to the structure of this part,
or the method by which the inflammation is excited ; but on
the contrary, as will be seen in the sequel of these remarks.

In common, however, with the three distinct kinds of inflam¬
matory termination mentioned, and universally admitted, serous
effusion takes place with a greater or less degree of frequency,
depending on the structure and ‘situation of the parts which
have suffered from previous inflammation. Mortification is
more frequently the consequence of inflammation in those
parts which are sparingly supplied with blood ; such, for
instance, as tendon, bone, fascia; because from the extreme
deficiency of their circulation they are incapable of sustaining
without such an occurrence the sedative effect uniformly pro¬
duced in every situation from previous excitement. Morti¬
fication, again, very rarely occurs to secreting membranes,
whatever be the extent of the inflammation ; and abscesses in
a very few instances are met with in bone, tendon, or ligament,
but most frequently are, produced as the consequence of inflam¬
mation in the muscle or the cutis vera.

In like manner, therefore, as the other modes by which
inflammation is usually terminated are influenced by the
structure and situation of the parts suffering from inflammation,
just so is serous effusion in a great degree the effect of the
same cause, although not entirely confined to parts of a mem¬
branous structure, and of these to serous rather than to mucous
membranes .

If inflammation happen to the pleura, and the attack be not
sufficiently acute, to destroy life, in the generality of cases, under
judicious treatment, it will terminate favourably in resolution :
or, in other words, the membrane will recover its natural state
without having suffered any sensible disorganization or injury
of structure : were, however, in saich a case the inflammation

(Chapman on Serous Effusion. £S5

to be unarrested in its progress by any medical means* anti
be permitted to proceed to its natural termination, in an equal
n umbei ol eases Nature, with a view of relieving- the membrane
horn the existing inflammation, by occasioning a relaxation of
* * ^-x- 1 unties ot the vessels, or exhalants opening on the surface

of the pleura, would cause an adequate effusion of serum into the
ca\ ltv of the chest, and thus hydrothorax would be produced,
1j pon die same principle, it inflammation of the peritoneum under
the same circumstances occur, and, unassisted by art, be allowed,
as in the afore-mentioned instance, to proceed to die natural cure,
in the greater number of cases it would happen, that the in¬
flammation would be relieved by the unloading the vessels of
a quantity of serum proportionate to the degree of inflam¬
mation, and thus ascites would be established. Hydrocele is
produced in a manner precisely similar as the effect of previous
inflammation of an existing determination of blood to the
tunica vaginalis; hydrocephalus from an increased arterial
action in the vessels of the serous membrane of the brain ; and
hydrops pericardii from a determination of blood to that mem¬
brane, being a serous one in common with the pleura, and by
a duplieature of which it is itself constituted.

from these observations it would appear, that dropsical
accumulations, in whatever cavity they may have taken
place, are uniformly the effect of one and the same cause;
namely, an increased determination or influx of blood to the
vessels of the part by which the cavity is bounded. But in
objection to the admission of this opinion, and more especially
as it applies to dropsy of the belly or ascites, it may be urged,
and indeed I have heard it stated, that in a majority of
eases the accumulation supervenes to no one symptom indi¬
cative of peritonitis ; this being fairly deducible from the
absence of all pain, and a sufficient degree of general disturb¬
ance to occasion a suspicion of its existence.

As the substantiation of this objection, although limited in
its applicability to the single case of ascites, would bear forcibly
upon the general principle, namely, that dropsy is invariably the
effect oj an augmented circulation , cither local or general ; yet
it should be stated, that, notwithstanding it is maintained that
the quantity ot serum effused into the abdomen in common
with every other cavity, is the effect of the afore-mentioned
cause, it is not implied, neither is it necessary to the production
of the disease, that actual inflammation shall have preceded
such effusion ; since it is susceptible ot proof, that the circula¬
tion in any given part may suffer augmentation from various
causes to an indefinite extent, without the presence of any
inflammation in the part so affected.

2§§ Original Communications.

There Is a very material and important distinction to be
made between what is properly termed by Dr. Parry simple
excessive determination, and inflammation : an increase oi
circulation, although invariably concomitant with inflammatory ^
action, yet is by no means peculiar to or characteristic or such a
state ; for we have commonly an undue influx or determination
of blood by the internal carotid arteries to the brain m the
absence of phrenitis, and to the lungs by the bronchial arteries,
occasioning dyspnoea, without the existence of pneumonia ; and m
common with such examples, augmented circulation m the
peritoneum, pleura, the serous membrane of the brain, tunica
vaginalis, &c. ; and as its consequence, dropsy of the several
cavities of which these membranes constitute the boundaries,
without any indication of the presence of inflammation.

But in the adduction of instances exemplifying the necessity
of distinguishing between the two distinct states of augmented
circulation, in as much as it may occur with or without inflam¬
mation, we need not descend into the detail of diseased actions,
but simply confine ourselves to phenomena which are hourly
occurring, without any, even the most trivial deviation from
the healthy state. By a variety of impressions of which
the brain is susceptible, and under every emotion of the mind,
such, for instance, as anger, joy, hope, fear, Sec., the quantity
of blood usually circulated through the cerebral vessels suffers
a very considerable and remarkably sudden augmentation ; and
so great is the increased determination to the brain at the time o,
deep meditation, that I have repeatedly seen as the consequence
of such determination, a motion correspondent with the systo.es
of the heart imparted to the head, which, otherwise, when un¬
influenced by this circumstance, remained perfectly at rest.

Hence the fact of the existing difference between excessive
determination and inflammation arising out of the circumstance,
that the former is not peculiar to or characteristic of the latter,
and that augmented circulation commonly occurs both m dis¬
eased and healthful actions independent oi any inflammation,

aPP0n thebother hatdfthe majority of authors have considered
that dropsical accumulations are commonly the effect ot a di¬
minished activity on the part of the absorbent vessels. On
examining this opinion, it occurs to us: do the absorbents possess
in themselves the power of varying their degrees of activity .
and again, under what circumstances are they influenced so

1 p

Although our knowledge with respect to the absorbent ves¬
sels and the phenomenon of absorption, is at present extreme y
limited ; yet all the facts, to the possession of which we have

Chapman on Serous Effusion, 287

arrived, illustrate in a manner the most striking, and combine
to prove, that the absorbent vessels are destitute in themselves
of any power by which they are enabled to increase or diminish
then- actions : Moreover, it involves in doubt the generally
admitted fact, that they are capable by a power inherent in
their coats, of conveying materials to the circulation ; and even
forcibly suggests the idea, that they are simply passive tubes,

and hat all their functions are referable to the princinle of
capillary attraction . r l

They who have advocated the opinion, that dropsical accu¬
mulations are commonly the effect of a diminished activity
o the absorbent vessels, should not have remained satisfied
with barely being enabled to account by such means for the
accumulation, and consequently have deduced an inference at
vanance with the idea, that dropsies are uniformly occasioned
y avjgmented circulation ; but they should have examined how-
far the absorbents are liable to suffer from a diminution of
activity. ^ From such an investigation, they would discover that
this diminished activity of the absorbents is incapable of bein£
directly induced by any power of their own; that every increast
or decrease is produced indirectly ; and lastly, that their func¬
tions^ vary in their extent with the quantum of circulation, with
whicn they uniformly bear a relative proportion. In proof of
the dependance of the absorbent powers on the quantum of cir¬
culation ; or, in other words, that whenever the circulation is
increased, the absorbent powers are diminished, and vice versa -
a very familiar example is afforded by the rapid absorption of
tat, which uniformly takes place, as the consequence of a decrease
m the quantum of circulation. If a man be in health, and his
.-nooe ot life be such as to induce in his constitution a state of
plethora, the absorbents become exceedingly inactive, and an
accumulation of fat consequently takes place ; if from any cause
nowever there should exist a necessity for the abstraction of
bmod tor the administration of sedative medicines ; or, if by

y • i . i in the circulation should be induced, in
proportion to this decrease will the powers of the absorbents be
increased, and the accumulation of fat be diminished. This
however, is only one among the very many instances tending to
prove the existence of this general principle. We very frequently
avail ourselves of it advantageously in the treatment of dis¬
eases ; and I am inclined to think, that a knowledge of it is of
more importance to the practitioner than any other with which
we are acquainted.

In the application of blisters on the surface of the skin for
the purpose of promoting the absorption of depositions of
whatever kind, whether pus, serum, &c. we expect that effect
through the medium of determining to the skin an increased

Original Communications •

quantity of blood ; and so, by diminishing it in the subjacent
parts, to increase the activity of the absorbents. In some cases
of hydrocele, the keeping up a constant determination of blood
to the external scrotum by means of blisters, emetic tartar, &c.
will, in consequence of the diminished circulation in the tunica,
vaginalis, hot .unfrequently occasion the absorption ot the fluid.
To say more on this head is quite unnecessary, since on further
investigation of the subject it will be found, that instances
may be multiplied acl infinitum, each in itself sufficiently to
establish that the absorbents are entire dependant in their
exertions on the circulation, that they are incapable of in¬
creasing their activity but by a diminished circulation, and that
they are incapable of decreasing tire same but by an increase of
the circulation.

Admitting, therefore, that diminished activity on the part
of the absorbent vessels be the more immediate cause of dropsy,
it is very evident, that this diminution is the effect of an increased
circulation, either general or local, in the part, into the cavity
of which the accumulation has taken place ; and since the
augmented circulation alone is sufficient to account for the
effusion, without the interference of the diminished activity of
the absorbents, it leads to a practice precisely similar ; as it
implies that dropsical accumulations, in whatever cavity they
may have taken place, are invariably the consequences of
augmented circulation.

Taking this view of the subject, if would appear that as the
cause of dropsy is uniformly the same, the indications of its treat¬
ment would also be the same, in every variety of the disease. But
however, as in every cavity into which an effusion is likely
to supervene to previously augmented circulation there are
situated organs, any impediment to the functions of which is
of greater or less importance, this subject had better be treated
of under distinct heads.

III.

On the Cure of Bronchocele by Pressure. By James Holbrook,
Monmouth, Member of the Royal College of Surgeons in
London.

Several cases of bronchocele having lately come under my
notice, and having been able to collect little satisfactory infor¬
mation from books on the subject, I am induced to request ihe
insertion of the following in the Repository .

Holbrook on the Cure oj Bronchocele hy Pressure .

From the number of cases that exist in this part of the
country, I think the disease may be said to he here endemic ;
although, as far as I can learn, this circumstance has never had
tiny particular attention bestowed on it.

Befoie my settling in this town, the disease was only known
to me by name ; no case having come under my care. I
therefore had formed no other notion of the disease than the
general one, of its being an enlargement of the thyroid gland,
and that it was often peculiar to particular countries : but
remarking their frequency in this vicinity, I think the circunJ
stance worthy of particular notice, and entertain a hope that it

some relief to the subject of so

unsightly a disease.

Amongst the vulgar these tumours have the name of wens %
and, from remote superstition, various charms have been had
recourse to for their removal, such as the application of a dead
man’s hand, &c.

T ne fir st case that came under my notice for treatment was
that of a poor woman, to whom I was sent for by a gentleman
who resides a short distance from this town, whose kind atten¬
tion to the poor labouring under disease is well known. He
had an opinion that the tumour w^as of a size that nothing but
an operation could relieve her. Indeed, the state I found her
in fully warranted this conclusion.

The tumour, of an enormous size, hanged down and rested on
hei bieast ; respiration was almost totally obstructed; her voice
was hoarse and difficult ; and her countenance full and livid.
Something was absolutely necessary to be immediately done.
The removal of such a tumour was out of the question.
Considering, therefore, that under such a state the circulation
cf the blood through the lungs must be considerably impeded,
and that in all probability an inflammatory state of the mem¬
brane ot the larynx and trachea must exist, together with
general congestion of blood in the parts, I preferred a large
bleeding from the arm. By this, my expectations for a time
were fully answered ; but, unfortunately, the relief was tem¬
porary. The situation of the patient became desperate; but,
as she wras resigned to any thing that might afford the smallest
prospect of relief, it was determined, as the only likely means,
to tie the superior thyroideal arteries, being, I believe, the only
approved way of performing this operation.

Dr. Bevan of this town did me the favour to accompany
me to the proposed operation ; but unfortunately on our
arrival at the house our hopes were disappointed by the patient
having suddenly expired, apparently from suffocation.

DISSECTION.

An opportunity was afforded of examining the morbid

wol. vm. — no. 46. TP

990

Original Communications.

parts. The integuments were turned back on each side, and
the tumour dissected out, together with the larynx, trachea,
and principal arteries, with the parts of the carotids from
which they were given off. The whole together weighed
about ten pounds. The trachea was completely encompassed, .
the two lateral portions of the tumour meeting behind ; which
circumstance may account for the great impediment to respi¬
ration. Some slight appearance of inflammation appeared to
exist in the internal membrane of the larynx and trachea, but
hot sufficient to account for the fatal termination. On cutting
into the tumour no alteration of structure appeared to exist,
except a few cells containing a watery fluid, but simply an
increased growth of the gland, rather firmer than natural.
The vessels supplying the gland appeared larger than usual.

From the above statement no new light would appear to be
elicited that might induce a more successful practice than has
hitherto prevailed in treating this disease. I was happy,
therefore, to adopt any hint which might guide my future
practice.

A friend of mine, once a practitioner in surgery, informed
me, that in his youth he was afflicted with a bronchocele which
progressively enlarged until he took to wearing neck-handker¬
chiefs, after which it gradually disappeared. Reflecting after¬
wards on his own case, he considered the subsiding of the
swelling to have been occasioned by the pressure of the
handkerchief. fTe determined, therefore, to try its effect on
others, and the result answered his expectations.

Upon this information, and having reason to believe, from
the dissection of so advanced a case as the one related, that no
specific diseased action exists in these swellings, I resolved on
giving pressure a trial in any cases that might again come
under my care.

Of seven cases in which I have since used this method, all
have been lessened, and two incipient ones were completely
removed by it.

In each of these patients there existed an unusual irritable
state of the system, accompanied with a quick pulse ; although
none of these ever complained of ill health.

Still supposing that a general increased action of the san¬
guiferous system might give a tendency to the enlargement of
the gland, X did again, in one or two of the above cases, have
recourse to bleeding, and I think with advantage. At the
same time, in all of them, I should observe, that I endeavoured
to con iron l the circulation by digitalis, usually combined with
burnt sponge, and in conjunction with the pressure.

Some may perhaps attribute the benefit which has accrued
in these cases to the effect of the digitalis or burnt sponge ;
but my own conclusions are in favour of the pressure*

Hastings9 Observation on the Motion of the Blood , 291

IV.

Farther Observations and Experiments on the Motion of the Blood ,
By Charles Hastings, Edinburgh.

In Medical Science, we have but too often to lament the
imperfection of our knowledge of the animal economy; and this
is assuredly true as regards the phenomena of the circulation.

The author of the following observations does not profess
to throw any new light on this subject ; but he wishes to
demonstrate the fallacy of some late opinions.

With this view, he will first endeavour to disprove Dr.
Johnson's assertion, that the arteries are of the same canacitv
during the systole and diastole of the ventricle*.

The arteries being elastic tubes, and subject to the physical
laws of tubes in general, may have their capacity for contain¬
ing matter increased in three ways :

Their diameter may be increased, the length remaining the
same ; or their length may be increased, their diameter re¬
maining the same ; or these two effects may be combined.

Let us now inquire whether any or all of these effects take
place in the case of the arteries: let us investigate the evidence
upon the subject.

And first, (as we before contended it was) whether, from
the impetus with which the blood is propelled from the ven¬
tricle, the diameter of the arteries is encreased ?

There is certainly opposition of opinion amongst physiolo¬
gists on this point.

Bichat, from experiments on dogs, is led to deny that the
diameter of the artery is increased during the contraction of
the ventricle*[*.

Dr. Parry has more lately been occupied on this subject ;
but has not, when cutting on the arteries of dogs, horses, and
sheep, been able to discover any alteration in the capacity of
the vessel by the most accurate measurement. |.

The indefatigable and accurate Haller says, “Mihi quidem
de phenomeno ipso dubium nullum superest. Etsi enim
utique non rarum est, in vivtf animale inciso pulsum nullum
adparere, neque videri arterias dilatari, tamen frequentes satis

* Dr. Johnson’s Observations on 1st Experiment in his Reply tg
Dr. Parry.

t Bichat, Anatomie Generate.

1 Parry on the Pulse.

v p 2

292

Original Communications.

observationes sunt, utique dilatationem et oculis, et tangent!
digito fuisse manifestam, ut arteriae arcum majorem describant,

dum dilatantur*.” . ,

Spallanzani made numberless experiments on cold-blooded
animals, as frogs and lizards ; and some to prove this very
question : he found, on repeated trials, by passing a nog
around the aorta, of a somewhat larger diameter than the ves¬
sel, that the space included between it and the vessel was much
less during the pulsation, but became more considerable during
the contraction of the vessel ; and, in some cases, the dilatation
was so great, that the lateral capacity of the vessel was in¬
creased one halff. Besides, he found, on several trials, that
the aorta of salamanders, after being cut out of the body, con¬
tracted and dilated as long as the heart.

Majendie, after mentioning Bichat’s opinion, has these
words : “ Ils sont, par exemple, evidens dans les grosses arteres
telles que faorte pectorale ou abdominale, surtout dans les
grands animaux ; mais, pour les rendre apparens sur aes
arteres plus petites, il faut faire 1 experience suivant : mettez
h decouvert sur un chien fartere et la veine crurale dans une
certaine etendue, passez ensuite derriere ces deux vaisseaux
une ligature, dont vous nouerez fortement les extremites a la
partie posterieure de la cuisse; de cette maniere le sang arteriel
n’arrivera au membre que par fartere crurale, et ne retournera
au cceur que par la veine ; mesurez avec un compas le diametre
de fartere ; puis pressez la entre les doigts, pour y intercepter
le cours du sang ; et vous la verrez peu a peu diminuer de
volume au dessous de fendroit comprime et se vuider du sang
qu’elle contenait. Laissez ensuite le sang penetrer de nouveau
encessant de la comprimer, vous la verrez bientot se distendre a
chaque contraction du ventricule, et reprendre les dimensions

qifelle avait precedemment^.,5

We have frequently discovered alternate increase and
decrease in the diameter of the larger sized vessels, but
certainly not in the smaller ones.

The evidence then comes to this : the increase and decrease
of diameter has been seen and described by many authors, but
not by all; an d because a few have not seen the dilatation,
are we to discredit many authentic witnesses, and assume that
it does not happen ?

Are we to set aside the testimony of Spallanzani P and con¬
clude, that it was an optical deception which induced him to say.

* Haller's Elementa Physiologic?, tom. ii. p. 238.
t Spallanzani on the Circulation, p. 146 — 167.

$ Majendie’^ Precis Ettmertfaire de Physiologic 3 p. 319*

Hastings’ Observations on the Motion of the Blood . 293

that the vessels nearly filled the ring during pulsation, but left
a larger space during contraction ? Or,

Are we to affirm, that the immortal Haller was misleading
us, in saying, that in many instances he had not seen the dik\
tation ; although the instances in which he had were too
numerous to admit his doubting the fact ?

No : We must refer our not always detecting the dilatation
to the imperfect mode by which we scrutinize these operations
of Nature. We cut down on a vessel and expose some inches
of it ; we, bv separating from its [natural connections, and
roughly handling it with our fingers and dissecting knives,
expose the vessel to a very violent stimulus ; this, by irritating,
excites a strong contraction in the vessel, which often enables it
to resist the impetus of the blood, which, in the natural state
of things, dilates it.

That this contraction does takes place by stimulants is
directly proved by experiments.

Dr. Thomson found the arteries in the frog’s foot contract
by the application of ammonia*.

Dr. Parry’s experiments shew, that the mechanical stimulus
to which the artery is subjected by denuding it, causes it to
contract, although the action of the heart continues : in experi¬
ment 24, on first laying bare the carotid it wasV|§f of an inch
in circumference; after being denuded half an hour, it was
only of an inch-f*.

yerschuir, who published an inaugural dissertation at
Gottingen in 1766, after having described the dilatation which
takes place in the artery, recites the effect of exposing it hi
these words : 44 Observari, nempe, in primis sub experiment!
initio arterias diametro minores adparere, solitoque contrac¬
tions, dum pulsus vix oculis erat conspicuus, nec observabilis
fere in diastole et systole diametri mutatio arteria ad digiti
attactum inveniebatur rigida, dura sentire tamen potui digitis
rnotuni quemdam parvum, celerem, tremulum a cordis hsec non
pendere exin manifestum, quod quandoque non simul in omni¬
bus arteriis, quas denudaveram, hrnc observare liceret, unius
nempe arteria pulsus erat quandoque parvus diameter contracta,
&c. dum alia arteria pulsu satis libero imo celeri a forti agita-
batur : post aliquod tern pus smpe cessabant haec symptomata,
arteria diameter augebatur pulsus erat liberior et fbrtior
egregie observabilis J.”

The writer has several times cut down on the carotid artery

* Thomson on Inflammation.
t Parry on the Pulse .

:|; Verschuir de Aqteriartm et Venarum Bci Irritabili, p. 22.

294 Original Communications .

in dogs, and more than once the irritation produced various coru
tractions in some small vessels which were given off, and the
size of the vessels became greatly diminished. These facts are
sufficient to shew that the irritation of the vessel may frequently
prevent the dilatation in a denuded artery.

The weight of evidence then is decidedly favourable to the
opinion of those who hold the diameter of the vessel to be in-
creased during the contraction of the ventricle.

The next question to be solved is, whether or not the arte¬
ries become lengthened during the contraction of the ventricle ?
if the tube be lengthened and its diameter not diminished, it is
quite clear the capacity must be increased.

Haller might be here referred to ; but as Dr. Johnson has
appealed to Bichat, he can have no objection to part of the
reasoning being founded on so firm a basis. After having said
that he could not detect transverse dilatation, and that the
arteries are not extensible in this manner, he observes, u Dans
le sens longitudinal, les arteres sont plus susceptible d’alonge-
ment que dans le precedent. On peut s’en assurer en tirant ces
vaisseaux pour en faire la ligature sur un moignon ampute*.”

Again, “ II y a alors deux temps dans le mouvement du
sang rouge : 1°. contraction du ventricule; dilatation legere du
systeme arteriel par le sang qui y entre ; locomotion generale ;
passage dans le systeme capillaire d’une portion de ce sang
rouge : tous ces phenomenes se passent dans le meme instant ;
c’est le temps ou le pouls vient frapper le doigt, celui de la
diastole. 2°. Dans le temps suivant, le ventricule se relache
pour se remplir de nouveau ; moins pleines du sang, les arteres
reviennent un peu sur elles-memes ; toutes reprennent la place
qu’elles avoient perdue pendant la locomotion : c’est le temps
de la systole, temps purement passif, tandis qu’on le croit tres
actif pour les arteres •f*.”

Here then we find Bichat, the most accurate experimenter
of his time, asserting that this locomotion and lengthening of
the artery are quite evident in the living animal ; and these have
been generally allowed, till Dr. Parry’s experiments have been
accounted by some as throwing doubt on the subject; although,
certainly, the result of these experiments by no means counte¬
nances such a doubt.

Dr. Johnson makes two of these experiments the grand
fulcrum on which he supports his hypothesis. But that gen¬
tleman need not be reminded, it is not the result of two experi¬
ments that is to guide us ; we must sum up and review the
whole evidence, and draw our conclusions accordingly ; by so

* Bichat Amt. Gen. tom. ii, p. 307. t Ibid, p. 336.

Hastings’ Observations on tfie Motion of the Blood 29%

doing, we shall find Dr. Parry’s experiments oppose the very
opinion it is intended they should support. We need only
refer to experiments 1, 2, 3, 4, 5, and 7, in which there was no
longitudinal movement detected, and to experiments 6, 8, 9,
10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 22, 25, in which it was
e\ ident. From these experiments, we must conclude that
there is longitudinal movement ; for in six instances only it
was not detected, whilst in fifteen it was observed.

It is very easy to account for the want of locomotion in the
six cases ; for persons in the habit of making experiments must
have been subject to the same fallacy ; in cutting down on the
artery in the neck, the head is held so far back, and the parts
are put so much on the stretch, that no movement can take
place; but it always happens if the head be raised to its
natural state when this operation is performed.

That Dr. Parry was subject to this fallacy may be collected
from the 10th experiment : “ when the neck was stretched out,
the influence of the systole of the ventricle on it was obscure ;
but apparent when it was bent in a somewhat natural posture,
as the dog lay on his side.”

And let it not be said that this motion was trivial. In one
instance, in which it appeared slight, the carotid advanced/^ of
an inch ; and in others, 4 4 there was various modes of locomo¬
tion, such as lateral, forwards and backwards, and longitudinal
in both directions,1’ Here then the evidence Dr. Johnson ad¬
duces turns upon himself.

The writer may add, that lie lias frequently had occasion
to lay bare the carotid and femoral arteries in dogs and rabbits,
and, when the parts were not put on the stretch, could always
detect the longitudinal movement.

From this then it appears, that the evidence is decisive as
to the lengthening of the artery during the systole of the ven¬
tricle ; and we have before shewn this lengthening must cause
an increase of capacity in the tube.

From the inquiry we have instituted, it appears as clear as
arjy fact can be, that the capacity of the arteries is increased
during the contraction of the ventricle ; we have fully ascer¬
tained, that the lengthening of the tube does take place ; and
we have adduced most undeniable evidence that the diameter
of the canal is increased.

In the paper which the writer had the honour of submitting
to the medical public in the Repository of March, it was stated,
on the assumption of the longitudinal movement, that there
must be an increase of capacity. He leaves it to be judged,
whether he has not shewn from experiments, now adduced,
that this longitudinal movement does take place ; and
whether it is not strictly consistent with philosophical deduction
to shew, from geometrical calculations, that certain results must

2gg Original Communications .

ensue from that movement : and he answers Dr. Johnson * *
question, where is the applicability of calculations from Luclid,
m the words of Lord Bacon Verus experientiae ordo, pn-
mo lumen accendit, deinde per lumen iter demonstrate, incipi-
endo ab experientia ordinata et digesta, et minim e prsepostera .
aut erratica, atque ex ea educendo axiomata, atque ex axioma-
tibus constitutis rursus experimenta nova, quum nec verbum
divinum in rerum massam absque ordine operatum sit.

But lest the numerous facts collected from the most authentic
sources should not be sufficient to overthrow that theory of the
circulation which denies that the arteries are active agents in the
circulation*, we will next notice some of those numerous phe¬
nomena which arise from the action of arteries ; eithei pi edu¬
cing motion of the blood where the action of the heart cannot
be supposed to reach, as in the vena portae and placenta , or
occasioning irregularities in the distribution of the blood, sucli
as the determination of the blood to the cheeks during the act
of blushing, or the immediate production of inflammation by the
application of stimuli, as seen by Dr. Thomson in the web of
the frog’s foot*!*, and by Verschuir and others m numberless
instances in the arteries of warm-blooded animals^.

But the writer has lately been engaged in some experiments
to ascertain the state of the vessels of an inflamed part, and
every day facts have occurred to him, in which the smaller ves¬
sels produced motion in the blood quite independant of the
action of the heart.

In experiments in which bis friends, Mr. Archer and Mr.
Hawkins, assisted, it was found, that by the application of am¬
monia to the web of a frog’s foot, the blood, in all the instances,
moved very slowly ; in some, the motion was not perceptible *
and, in two or three instances, the blood was found to take a
retrograde current towards the heart in some of the large
vessels.

In Fig. 1, the web in its natural state is represented with a
large sized vessel formed by several smaller ones.

Fi°\ it represents a part of the web with the same vessels as
thev appeared in the microscope ; the blood was flowing for
some time with great celerity from the branches tow ards the
trunk ; no oscillation nor impulse could be detected ; the
stream was uninterrupted from right to left.

* That Dr. Johnson does deny both the larger and smaller
arteries afford any assistance to the heart, may be learnt from Ins
observations on the first experiment in his reply to Dr. Parry.

t Thomson on Inflammation .

* Verschuir dc Arte? iarum et Penarum Hei Irritabili .

Hastings’ Observations on the Motion of the Blood. 297

The vessel was transfixed, as is shewn in Fig. 3, by a needle,
which acted as a ligature, and prevented the flow of blood
through the vessel. The blood took immediately an opposite
direction in all those vessels which united to form the large
transfixed vessel, and flowed into vessels in the middle toe with,
just as much rapidity as it had before flowed in an opposite
direction. Mr. Ralph Sherwood assisted in this experiment,
observed the appearances, and took the annexed sketches of
the vessels*.

This experiment has been repeated several times, and
always with nearly similar results ; sometimes the blood moved
more slowly after the puncture ; and frequently the blood did
not take a retrograde direction in all the vessels, but only in
two or three ; but the greater part of the blood was always cir¬
culated in a directly opposite current ; while in some, by means
of collateral branches, it moved in the accustomed direction.

Here then we have the vessels circulating the blood with
great rapidity, in a current directly opposite to that in which it
would be propelled by the action of the heart.

The same result is related by Georgius Ernestus Remus, in
an inaugural dissertation published at Gottingen : “ Ligavit in
ranae mesenterio, Haller optimus preceptor, sanguis utrinque
circa ligaturam non adcumulatur ; fugit ille supra ligaturam
versus cor, iste versus intestina et vitat enatum ex vinculo
©bstaculum ; inanitur tunc perfecte obstructa arteria,” &c.

These facts are quite inconsistent with the supposition, that
the arteries do not possess a power by which they assist the
heart : and we have here a proof of the impropriety of the too
strict application of the laws of hydraulics ; improper, says the
renowned Blumenbach, because it is absurd to refer the motion
of the blood through living canals to the mere mechanical laws
of water moving in an hydraulic machine.

It next comes to be considered, whether Dr. Johnson’s
assertion, that during auricular contraction and ventricular
dilatation the blood is quiescent, is supported by any facts of
other authority.

It was attempted to be shewn in our last communication, that
this opinion was an assumption devoid of all proof Rut Dr.
Johnson, referring himself to Bichat, says, that that accurate

* As Mr. Hastings grants us permission to give the engravings
or not of these drawings as our judgment leads, we have omitted
them ; because we conceive that the testimony of Mr. H. and his
friends will scarcely be doubted. But we cannot refrain from compli¬
menting Mr. Sherwood for the elegance and delicacy of his delinea¬
tions, nor omit the opportunity of remarking on the extreme utility
of this elegant art to every lover and student of anatomy, — Editors,
vol. viii.— no. 46. Q et

298 Original Communications .

physiologist maintained alternate quiescence and motion in the
mass of blood. It appears, however, that he certainly labours
under some misconception regarding the opinion of Bichat ; tor
it appears to be impossible to read that author’s work without .
finding the most direct contradiction of any such alternate rest
and motion ; for he denies that the action of the heart has any
effect on the blood in the capillaries. “ Le sang, une fois ar¬
rive dans le systeme capillaire, est manifestement hors de 1 in¬
fluence du cceur, et ne circule plus que sous cede des forces
toniques ou de la contractilite insensible de la partie*.’
Again, “ D’apres tout ce que nous avons dit jusqu’ici, il est
evident que le sang arrive dans le systeme capillaire, ne s y
meut que par finfluence tonique des solides : or comne la
moindre cause altere, change leur proprietes, il y est sujet a une
infinite de mouvemens irreguliers. I^a moindre irritation le fait
reculer, avancer, devier a droite, a gauche, &c. Dans 1 etat
ordinaire, il se meut bien en general dune mamere umforme
des arteres vers les veines ; mais a chaque instant il pent trouver
des causes d’oscillations irregulieresf.”

Majendie, in his late publication, thus speaks of the opinion
of the alternate motion and rest: 44 Cette opinion \ient d etie
soutenue tout recemment par un medecin anglais, M. le Dr.
Johnson ; il a meme fait construire une machine qui, selon lui,
rend la chose evidente ; mais il suffit d ouvrir une arteie sur un
animal vivant, pour voir que le sang sortira d une maniei e con¬
tinue, sacadee, si Partere est grosse, et uniforme si Partere est
petite. Or, faction du coeur etant intermittente, elle ne pent
produire un ecoulement continu. 11 est done impossible que

tes arteres n’agissent pas sur le sang*.

Almost every day, for a month, the writer had occasion
to observe the circulation ; and, in company with seyeial
friends, has subjected the web of the frog’s foot to micro¬
scopical observation. In healthy circulation, nothing like
impulse or oscillation could he detected \ the blood passed
through the vessels in an uninterrupted stream ; and in no
instance, except from pressure on the animal, or some such
cause, could the least irregularity be seen.

Dr. Johnson next alleges, that different authors have given
very opposite accounts of the motion of the blood when the
vessels have been viewed through a microscope ; and that they
are all unanimous in saying the blood is not alternately in motion
and at rest, which is what Dr. Johnson contends for. A refer¬
ence to these authors will shew the accuracy of his inferences.
But how he could have read and referred to Dr. Thomsons

* Bichat Anat. Gen . tom. ii. p. 50q. f Ibid, p. 513.

J Majendie’^ Precis Element, de Thysiolo. p. 321.

Hastings’’ Observations on the Motion of the Blood. 299

experiments on the blood vessels, as supporting his assertion,
is inconceivable ; for every experiment and every observation
of that author decidedly contradict the opinion, that the blood
is alternately quiescent and in motion. He says, “The circula¬
tion of the blood, as seen in these three orders of vessels, the
arteries, intervening capillary vessels, and veins, in the web of
the foot of the frog, placed as has already been described, goes
on in an uninterrupted stream. We perceive the globular
structure of the blood, it is true, in the capillaries and in the
venous branches ; but we no where perceive in these three
orders of vessels, during undisturbed circulation, any thing
like impulse or oscillation*.”

Now the cause of Dr. Thomson's not seeing the globules in
the large vessels was on account of the velocity of the motion of
the blood.

From the facts that have been stated, we may fairly draw
the following conclusions :

1st. In the larger arteries, dilatation takes place on the
contraction of the ventricle ; on the relaxation of the latter,
the former contract ; and thus keep the blood in motion.

2dly. In the smaller blood vessels, the blood moves, in
healthy circulation, in a constant uninterrupted stream.

3dly. The arteries are endowed with a contractile power, by
which they can, in certain circumstances, circulate the blood
independent of the action of the heart.

We might now go into an investigation of the truth of the
hypothesis by which Dr. Johnson accounts for the motion of
the blood in tire venous system ; but we will leave the conside¬
ration of the circulation of the blood in the venous system for
the present, hoping to take it up at some future period.

In the part of the subject we have imperfectly considered,
it has been our endeavour to give a clear exposition of facts ;
and we have now only to request a fair and candid consideration
of our statement : the question rests on its own intrinsic merit,
and there we leave it without farther comment.

*** Since this paper was forwarded, the writer has had occasion
to remark the state of the arteries in eighteen instances. Of these,
notes were taken at the time, and the following is a short exposition
of them .* —

In three cases, the artery, when exposed, was to the eye quite
quiescent ; but the pulse was evident to the finger, without making
such pressure as to reduce the diameter of the vessel.

In four cases, a motion in the artery was evident to the eye ;
but not in such a degree as to enable us to determine whether
the motion was longitudinal or alternate lateral dilatation and
contraction.

* Thomson on Inflammation , p. 77*

a q 2

300

Original Communications.

In eleven instances, the pulse was very evident to the eye
when the vessel was first exposed ; at each contraction of the
ventricle, it was palpably extended longitudinally, and dilated
laterally : these motions generally became more obscure some time^
after exposure, in consequence of the denuded portion becoming
permanently contracted to such a degree that the diametei was

lessened one-third.

That we might not be deceived as to the lateral dilatation, we
had recourse to Spallanzani’s test, and passed a thread aiounc t g
thoracic and abdominal aorta of a dog, so that it might embrace
the artery without compressing it : the ligature was tight during
the systole of the ventricle, and lax during the diastole.

These experiments were made on the femoral arteries anu aortc

of dogs, cats, and rabbits. . . . ,

Other results were met with still more decisive m demon¬
strating the active power of the arteries; which result, tiie waiter
intends, at a future opportunity, to make fully known.

A Case of Aneurism? from a Puncture of an Artery in t he

Operation of Bleeding . By John Dunn, of Pickering,

Yorkshire, Mem. of the Roy. Col. of Surgeons in London.

George Medd, aged 43, a farmer in Pickering Marishes,
applied to me on the first of May 1813, with all the appearance
of a purulent consumption. He had been ill for about six
months; and now had a severe cough, quick pulse, profuse
night sweats, copious expectoration of purulent matter, difficulty
of breathing, with pain and constriction across the breast. A
few ounces of blood were ordered to be taken from the ai m,
which my pupil performed on the vena media basilica. Me
unfortunately punctured an artery. A very rapid current of
blood immediatly followed, escaping per saltern , of a lively red
colour, and which very soon filled the basin. He called me
into the room, and I applied to the part a compress widen
stopped the haemorrhage. The artery which must have been a
branch from a high division of the brachial artery, or thd humeral
trunk itself, was very superficial ; and seemed from its strong
pulsations to be on the outside of the fascia ; an instance of
which I have met with in dissecting. He never fainted after the
bleeding ; but rode slowly home. The blood, which was chiefly
arterial, although mixed with some venous, exhibited a cupped
appearance, and a peculiar light coloured greasy size. The
bleeding seemed to have materially relieved his chest p but his
night sweats continued as bad as ever. His arm in a few days
began to be rather stiff, painful, and contracted. In about a
month a smooth little tumor formed, becoming oy degrees red,

Dunn on a Case of Aneurism from Puncture in Bleeding. .301

inflamed and throbbing. With regard to the state of his lungs
at this period, he appeared to have advanced only to a certain
point oi recovery, and there to remain. As his arm now gave
him much trouble, and I found he lived too far from me to
obtain my wishes by a well-regulated pressure, I ordered him
to Pickering. A loose tourniquet was applied to the arm ; I
then laid the tumour open as carefully as I could. A jet of
blood spouted out ; but instead of finding the artery which I
had taken much pains to discover, I could see nothing but a
mass of coagulated blood, which had insinuated itself in all
directions between the fascia and muscles. I enlarged the
wound, first screwing the tourniquet tighter to prevent the blood
impeding my views ; but I then relaxed it again to discover the
orifice of the bleeding vessels ; still I could not perceive it ; for
the moment the tourniquet was relaxed, the cavity was filled ;
so that I found it utterly impossible to get at the vessel, except
by a fresh incision in the middle of the humerus. This I per¬
formed on the inside of the biceps muscle, below the anasto¬
mosing branches. The artery was tied without dividing it
across; the tourniquet was relaxed, when a sudden flow of
blood immediately followed, which however I concluded came
from the veins. Each wound was strapped with adhesive
plaster, a flannel roller applied, and my patient put to bed
with the limb in a relaxed position. It is extraordinary that,
although he was much reduced, and had lost a great deal of
blood during the first part of the operation, yet he never
fainted away.

The temperature of the arm was never reduced by the
interruption of the circulation. On the third night he was
rather delirious. The next morning I perceived an increased
heat and beating about the arteria profunda magna humeri ; the
radial artery also faintly pulsated. In two or three days more
I loosed the roller, when the wound at the bend of the arm, as
well as on the upper arm, was almost completely united. This
kindly union I attributed to opening the aneurismal sac, and
removing the coagulated blood. The ligature did not come away
for several days ; and then the ring of it was entire, which shews
it must have cut its way through the artery. Whether this
mode of tying the ligature is not as effectual a security as com¬
plete division at the first, I will not pretend to determine.

My patient soon recovered not only his arm, but from the
disorder of his lungs ; and he was quite restored, with the aid of
bark, acids, and a generous diet, to perfect health.

A few months back he had a slight pleuritic affection from
a cold ; but it subsided very easily, without any expectoration.

Were his phthisical symptoms cured by the new action
excited by the operation, or from the loss of blood, or both

302

Original Communications.

together? The ease may tend to. shew, that, when labouring*
under pulmonic affections patients can endure severe operations,
even with advantage to a constitutional complaint.

VI.

A General View of the Diseases usually occurring in Boys during
the Period between Infancy and Puberty in Christ s Hospital r,
exhibited in a Synoptical Table , and accompanied wiihp radical
Observations. By Henry Field, Member of the Society of
Apothecaries, London, and Apothecary to Christ’s Hospital*

( Continued from Vol. VIII. p. 8 2.J

f ' '

; TABLE OF DISEASES.

1817

June

1817.

‘July.

1817.

Aug.

! 1 PimnnollA f r>n ] i AVI S . . .

j y lIcliiLliv/ LLHlOIilUi xo •••

£> t*1 a bn n c\ ZkY\ <T1 . . . .

^ lc4/l#XllcX cvii^mciocv » • * * * * • * * *

ft "FaTwiq Stmoflpis . . . . ...

1 Aa Tnecic - . . . « . . .

ILrernirpy . . . .

(\ /mif l st . . - . . . . .

T 'Ploiivnrj'imp . . .

q "NJimcpa fra strnrlvnia vel OiarrliCGci...

n Vpff i rm . . . . . .

jj Is > Cl tig U . •••••••••••••••••••■•••• •

? A Vovi nl o nncf V OPPinatinyiPTB . . . . . .

' 2

11 Varicella . . . . . . .

iQ IptpniQ . . . .

1 d ( 'iVucCir'i'itQCS .. . .

, 1

£ n.J MO tJL.pl tUO V — / U/ v ul 1 A HtvAiO «*»•*«»»»••»•»»

1 l 1 Tvv'tri'TiPTmQ unrlnsiim . . . . . * .

? ££ T Tt lira Vi a . . . .

I /-» Prnrirrfv nmhs . . . .

1ft OriQ intpviip pviilpprat.ro . . .

HI Pnrntie: Hpm orna . . .

Totals .

The summer quarter has been attended with much rain,
though by no means so cold as from the wetness of the season
might have been expected. The month of June produced
eight or ten of the hottest days in succession, which have been
known in this country for many years. From Wednesday the
18th to Thursday the 26th, the thermometer attained between
three and four P. M., from 76° to 86°. On five or six of those
days it was upwards of 80° in the open air at Christ’s Hospital,
suspended from a window looking due east.

The diseases of this period, if we except complaints of the
primse via?, have been neither numerous nor important, and

Gaitskell on Puerperal Convulsions subsequent to Parturition. 303

dlmlfthTAumiT obsel;vations- The paucity of cases in
+ .1 i & ’ mus^ 1,1 some measure be attributed to

to the annual vacation, and the conspmipnt * c

of the boys consequent absence of many

VII.

A 'TPrml ConvMr Sequent to Parturition. By

U ii -iam Gaitskell, of Rotherhithe, Member of the

Royal College o. Surgeons, and of the Society of Apothe-
canes m London. J ^

}*RS- G; > of slender make, active disposition, and temperate
«bits, aged twenty-nine, was delivered, after nine hours XuS
labour, without the aid of manual ’assistance. In Xty

tracdons ‘a P aCenta 7S CX,pe!1fd ^ the na‘unJ uterine col
tractions, accompanied with the usual discharge. For two

Jb“n after th'|S’ *e remamed tranquil and undisturbed ; when
. - i • i se, wit I gi eat care and attention, removed her to the bed.
Ac this time she was cheerful and apparently free from coml

an "our ,7^ ! 1° 1“'’’ remained composed about

t Jd V suddenly awoke, shrieked aloud, and in-

scantly became convulsed. Her lips were blue, the features
woe distoi ted, and every muscle appeared successively affected -
and she was completely insensible. This awful visitation all
tacked her just three hours after parturition. At this juncture

mv ar^v /Th4 3 *°Ugh onV forty minutes elapsed before
Xvl R -‘ee We? reP°rted t0 !'ave occurred in the
1 , . J'fllg surprised at tne unusual circumstance of this

case, being the only one m more than 4000 labours I have
a enc ed, I was particularly attentive to the symptoms. They
were characterised by strong encephalic irritation ; the eyl
were rolling m their orbits, the muscles of the face and extremi¬
ties stiongly convulsed, with foaming of the mouth, and grind-

!nf of.,t 'c ,tee[fl ; t,!e Pu,se no, hard, and contracted ; the skin
,’V 1 le c‘leeks Hushed ; and the lips of a purplish red'. The
abcotnen was not unusually distended ; but on pressure the
symptoms were aggravated.

Under these appearances, so different from what I expected
having looked for internal haemorrhage or convulsions from ini
aimiou rather than from high arterial action, I immediately ab¬
stracted sixteen ounces of blood from the arm ; upon which the
symptoms i anated. But this favourable change was of short
duration, for another severe paroxysm followed ; which, forcing
the compress from the arm, caused a larger flow of blood than the
tirst Jn a short time the pulse became soft and less frequent -
the akin cooler ; the muscles more tranquillized ; and composed

Original Communications »

sleep ensued. The next morning she was visited by Dr. Blundell,
who^ave his decided approbation of the practice which had
been&adopted, and recommended a repetition of venesection,
unless the pulse should very much falter; at the same time a
saline purgative was prescribed, which was with difficulty m-
troduced into the stomach but operated well on the boweR
As the pulse was quick and hard, the skm warm, and the bra,n

much oppressed, with great abdominal tenderness I bled the

patient again, which afforded the most effectual relief, From
this time the case improved. The skm became umve1^^
moist ; the bowels discharged copious blank ana offensive stools
the bladder acted voluntarily ; the lochia flowed freely ,

reason began to dawn. , ,

Toast and water, thin barley-water, and tea were the o Y

diet allowed; with a cool temperature, and abstraction from

light and noise. Under tins treatment the mind was gradual y
restored the breasts became distended with milk, and m six
days convalescence was established. Mrs. G., finally, perfectly
recovered, and was able to nurse her child.

AUTHENTICATED CASES,
OBSERVATIONS, and DISSECTIONS.

LV. _ Case of Cough, with Watery Expectoration.

In May last, Miss B. a girl about eleven years old, with
light hair/ and delicate complexion, laboured under a most
harassing cough, and a copious expectoration of a tbm waterv
fluid The fit* of coughing were particularly troublesome at
Si when they were s'aid to last sometimes five minutes; so vio¬
lent indeed that she grew “black in the face. Various remedies
had been tried, such as opium, hyoscyamus, and the like, withou
relief. The bowels were said to be torpid, the evacuations being
of a dark colour ; but, as senna-tea was had recourse to when¬
ever the bowels were sluggish, stools were obtained pre ty regu¬
larly There was an evening accession ot level daily. » ■
was ordered to take a pill of the pil. hydrarg. with ant.mon.al
powder, followed by a draught of salts, senna, and I extrat .
Laxaci. She took, after the operation of these medicines, a
draught two or three times a day, each containing about halt
a drachm of sulphate of magnesia, with a scruple of extract,
taraxaci, and a drachm of decoction of aloes. 1 be stoo.s c -
tfnued dark for several days. This draught was next exchanged
for one composed of infusion of gentian with carbonate of soda
and decoction of aloes. Under this treatment, effusion of the.
watery fluid was checked, and with it the cough ; and she

rapidly recovered.

Spurzheirns Observations on Insanity .

90S

PAR T II

ANALYTICAL REVIEW.

Observations on the Deranged Manifestations of the Mind , or
Insanity. By J. G. Spurzheim, M.D. Licentiate of the
College of Physicians in London, Physician to the Austrian
Embassy, Author of the “ Physiognomical System of Drs*
Gall and Spurzheim,11 &c. with Four Copper Plates, Lon¬
don. Iioyal 8 vo. pp. 312. Baldwin, Cradock, and Joy,
1817.

( Continued from p. 240. )

III- — u Nature of the Causes of Insanity It appears
then, that Dr. Spurzheim always looks for the proximate cause
of insanity in the organization of the brain. He contends,
that appearances of insanity are merely symptoms of the de¬
ranged functions of the organs of the mind : hence, when the
organ ol self-esteem or benevolence or combativeness, &c, is
deranged, the symptoms will be different from those proceeding
from the disorders of other organs ; therefore there are as
many sorts of symptoms as there are primitive faculties of the
mind, as well as of their combinations. And thus he explains
why melancholia and mania are often the same disease, and
interchange; and why the same treatment may be success¬
ful in both cases, and why in others it may differ, and yet
arrive at the same end.

“ The causes of insanity/' says Dr. Spurzheim, “ may be idio¬
pathic, that is, confined to the head ; or sympathic, viz. residing in
other parts and influencing the brain.”

Idiopathic causes either exist from birth, or originate from
subsequent events ; the latter are mechanical, proceeding from,
accidents ; or dynamical, proceeding from the deranged func¬
tions of the vital powers. Connate insanity is always idiotism,
complete or partial. From birth the cerebral organization may
be too defective and unfit to perform its functions : a brain too
small is always accompanied with imbecility. To illustrate this,
a plate is given, containing six figures of different modifications
of heads, all taken from nature ; three of which represent the
heads of three living idiots. Dr. S. observes, that of the greatest

VOL. VIII. — no. 46. K R

306 Analytical Review.

number of idiots from birth, the heads, particularly the fore¬
heads, are too small : a fact of which we have certainly seen
many examples.

This leads our author to some remarks on the form of the
skulls of Cretins and Albinos, which singularly favour the
above inferences. But the skulls of different Cretins differ
in shape, as well as those of idiots. Hence there is no form of
skull peculiar to Cretinism, any more than there is to idiotism.

« In Cretins, and in idiots in general, the manifestions of the
mind are more distinct, the inclinations more subordinate to the
will, the ideas clearer, and the natural language more significant, in
the same proportion as the organization of the brain is more per¬
fect.” — p. 122.

Many observations follow to exemplify the modifications of
idiotcy. In partial idiots the five senses are often perfect ;
while others manifest the intellectual powers in various degrees
only; but are destitute of consciousness and perfect will.
Hence they are classed among the insane.

u Idiopathic occasional Idiotism — -That state of the cere¬
bral organs and functions is here noticed, which every expe¬
rienced observer must have met with in children ; and which m
often manifested by a display of precocious intelligence, that
rarely continues to be exhibited when they arrive about puberty;
and which peculiarity disposes them to affections of the head,,
and decline of intellectual powers before that period is completed.

« Sometimes,” says Dr. Sptxriheim, “ children are born in per¬
fect health ; they improve in body and mind, acquire notions of the
external objects, reason on them, and manifest feelings in a regular
manner ; but accidentally lose the manifestation of the mind, and
become complete or incomplete idiots. Children naturally dis¬
posed to such a disease are of a great nervous sensibility, and rickety
subjects, of an irritable temperament. Their cerebral parts often
increase too rapidly, and there is not sufficient time for the organs
to grow solid. The activity of the mind is sometimes stronger than
the brain can bear ; and it is a common observation, that too early
genius is often too soon exhausted. Moreover, the brain of such
children easily suffers by different accidents, such as blows on the
head, spirituous aliments, insolations, especially during the time of
dentition. The blood is carried in greater quantity to the head, and
inflammation of the brain and its membranes is easily produced. The
children often die of the disease, or its effects, of which I have
spoken under the name of Hydrocephalus' acutus. Sometimes the
children overcome the disease, and escape with life ; but theokiergy
erf their talents is lost, and the hopes of their parents imbittered.
— p. 133.

Where this precocious activity of the intellects is mani¬
fested in children, the consequences might, by proper precau¬
tion, be probably guarded against. But, unfortunately, infants.

307

Spurzheinfs Observations on Insanity.

evincing extraordinary genius, instead of being managed with
caution, to gratify a foolish vanity, generally become sacrifices,
like tender plants, to too much forcing.

. ^ °t withstanding several well-authenticated cases, the possi¬
bility of children becoming insane, is still by many denied.
Dr. Spurzheim contends, that “ As insanity consists in the
suppression of clear consciousness and will, there cannot be any
doubt that children can become insaneT Surely this definition
implies idiot cy rather than insanity. We entertain no doubt of
the existence of real insanity in children, because we have
known adults, who, during and from infancy, were subject to
decided aberrations of intellect. Of those having “ a suppression
of clear consciousness and will,*” we have now under our direc¬
tion three children of the ages of a year and a half, four, and
eight years, who have never manifested clear consciousness or
will ; but yet there is not a total suppression of those faculties.
The configuration of the skulls of all these children is peculiar,
and smaller than the common dimensions. If they live, they
will probably fail into fatuity.

Fatuity F is often the result of chronic melancholia, but
more often of chronic mania induced by a fall or a blow on the
head, or from sudden fear. It frequently succeeds epilepsy,
catalepsy, delirium with fever, kc. particularly in persons ori¬
ginally endowed with slender intellects. Febrile diseases in
general weaken memory, and other intellectual operations ; but
such patients commonly recover the manifestations with their
strength. But sometimes fatuity lasts for life; and in these
cases it arises from some organic changes which unfit the brain
for the manifestations of the mind.

“Idiopathic mechanical causes of Insanity. — The manifestations of
the mind may be deranged by various mechanical causes, not only
from without, such as violent blows, a fall, fracture or depression of
the skull, but also from within, by exostoses, for instance, or hydatis,
ossified blood-vessels, various tumours, a collection of pus, of water,
or a congestion of blood. As by similar causes the manifestations
of the mind are often suppressed, so they may be excited, or aliena¬
ted. 1 have mentioned cases where violent blows have produced
idiotism : on the other hand, there are also examples where, by the
same causes, in stupid persons, the manifestations of the mind ac¬
quired more energy.” — p. 13,8.

Instances are quoted of the manifestations being much
changed, from the effect of blows on the head.

Innumerable facts testify^ that the intellectual faculties
undergo very evident changes from accidents to the head, and
that the mechanical lesions they occasion, are frequent causes of
insanity or fatuity. In all such cases however coming under
our observation, we cannot say we have been so fortunate as to

it r 2

SOB

Analytical Review.

see any one instance where the understanding has been im¬
proved by the applications of blows to the head ; a circumstance,
very discouraging for those who have to instruct the natuially
stupid, and who might be disposed to try the experiment. On ^
the contrary, we believe that the eflect is always a deterio¬
ration of intellect. In numerous cases, various morbid ap¬
pearances, Dr. Spurzheim says, observed in the heads of PCl“
sons who have died insane, have been considered as mechanical
causes of insanity ; while such organic alterations ought to be
considered rather as the effect of the diseased state of the brain
which produced insanity and the organic changes. This opi¬
nion coincides with that of several authors. _

Dr. Spurzheim is anxious also to correct the error, that a
thick skull is the cause of insanity ; whereas, in his opinion, it is
an effect of it. He supposes that from chronic diseases of the brain ,
and from chronic insanity, this organ diminishes in volume , and
that the internal table ot the skull follows the external suiface
of the brain, while the external table of the skull remains m
its natural position ; and he asserts, that this disunion of torn
two tables of the skull is often observable at the upper part of
the orbits : a statement which we are not sufficiently veised in
craniology to confirm or contradict.

€C Is the Shape of the Head a Cause of Insanity f — Dr.
Spurzheim notices the opinions of other authors upon this suo-
iect ; and corrects a misconception of Dr. Pmel, who states, that
Dr. Gall maintained the possibility of knowing whether any
one is predisposed to insanity or not, by the external shape of
the head. Such an inference is here denied. We, however,
perfectly coincide in the opinion, that a too diminutive brain is
unfit for the full exercise of the intellectual faculty.

“ It is a fact,” says our author, “ that by far the greatest number
of those who are insane by pride have the organ of self-esteem laige
in proportion to the other organs of the mind. It does not follow,
however, that every one who has this organ large must become
insane by pride, nor that every one who has this organ small will
be absolutely exempt from such an hallucination ; for every small
organ may be excited by diseased affection, and shew too gieat
activity and deranged manifestations. The influence of the size
seems to be obvious, since the greatest number of persons, insane
with peculiar hallucinations, have the respective organs larger.

■ p. 144.

He then pursues a chain of reasoning to account for various
hallucinations; pointing out the peculiar and corresponding
forms in the head, as demonstrative of the propensity to these
specific aberrations. But the greatest difficulty in understanding
the diseases of the brain, he says, results from the infinite modi¬
fications to which organization is liable. W e have no facts to

309

Spurzheinfs Observations on Insanity.

contravene this doetrine. But we will forbear from saying more*
than that we wish for and expect proofs, ere we yield oar con¬
viction to it

“ Idiopathic Dynamic Causes of Insanity? — These compre¬
hend all causes which immediately influence the functions of
the brain. Our author thinks, that “from the preceding con¬
siderations it results, that a peculiar developement of the indi¬
vidual parts of the brain predisposes to insanity : and hence
takes occasion to remark on the relation of extraordinary
intellectual endowments with insanity

The relation of genius to insanity, is a trite remark ; but
it does not the less, perhaps, puzzle metaphysicians. Dr.
Spurzheim accounts for it by supposing, that a too great energy
of one power disturbs the balance of the healthy functions, and
that the power is sometimes so energetic, as to act independently
of the will. The admirers of Drs. Gall and Spurzheim will
pity us when we declare, that we prefer the reasoning of the
poet to that of these philosophers ; and incline to the opinion
of Horace, so beautifully imitated by Pope, who ascribes intel¬
lectual perfection to

- - — ■ That Directing Pow’r,

Who forms the Genius in the natal hour :

That God of Nature, who, within us still.

Inclines our action, nor constrains our will i

Thence our author proceeds to the examination of the
various other causes disposing to insanity ; to enumerate which,
would lead too much into detail. However, we will briefly
notice, that he regards as causes, an inflammatory state of the
brain, increased arterial activity, or diminished circulation in
the veins ; and to these disorders he j ustly attaches great effect*
Upon this subject he refers to Dr. Parry’s Work on the Pulse.
Again, various morbific causes may affect the brain alone, as
well as other parts, such as rheumatismus vagus, repelled cuta¬
neous affections, &e. ; and these morbific causes often act
upon the brain by metastasis ; and he thinks we may suspect
some such cause, whenever insanity alternates, or is interchanged
with morbid affections of other parts.

The second sort of dynamic causes of insanity are those
which concern the use of the cerebral functions, or the exercise
of the manifestations of the mind. The most active powers of
the mind produce insanity most easily ; hence the Doctor ranks
amativeness (desire, we presume, in plain English) as the first ;
because the most powerful feeling. Religion is, he conceives,
another fertile cause ; and he adds some very judicious reflec¬
tions upon it, as predisposing to insanity. Disappointed am¬
bition, reverse of fortune, and various other affections of the
feelings, are also assigned.

'310 Analytical Review.

A high state of civilization, which induces too much luxury
and refinement, as well as excessive study, are also mentioned
as common causes of insanity.

Our author concludes this part with remarking, that scienti- __
fie professions which naturally excite the feelings, such as those
.of priests, poets, &c. more dispose to insanity than the pursuits
of geometricians, mathematicians, and natural philosophers.

44 Syrnpathic Causes of Insanity.”— Every cause which
immediately affects the brain, and deranges the manifestations
of the mind, is sympathies

The diseased state of any of the viscera of the abdomen, or
indigestible aliments, narcotics, poisons, or worms, often affect
the brain by sympathy ; intemperance of any kind, and espe¬
cially of spirituous liquors, is a frequent cause, and is particu¬
larly dangerous to persons who have a predisposition to insanity.

44 It may be in general observed that one deranged function of
automatic life may derange one or the other, or all, the functions
of animal life ; and, vice versa , one disordered animal function may
derange one or the other, or all, the functions of automatic life.
Moreover, each diseased part of automatic life may affect any other
automatic function ; and in the same manner, in animal lite, one
deranged function of the brain may disturb any other. The indi¬
vidual conditions of the parts, however, and their modifications of
irritability, are infinite, and can only be observed in given cases
without any other knowledge, but that such is the caseff— p. IDO.

These considerations, Dr. Spurzheim adds, explain why
insanity is more frequent between twenty and forty years of
age : the feelings and intellectual powers are then most active ;
evil habits are formed ; and an infinite number of causes at
this period operate to produce more disorders of the body and
brain, than later in life ; but the brain in adults is strong
enough to suffer morbid disorders, which in children terminate
in death.

We are rather surprised that Dr. Spurzheim, in the enume¬
ration of sympathizing parts, should have forgotten to particu¬
larize the viscera of the thorax. The reciprocal action between
the disorders of the Jungs and the brain are not infrequent;
neither have they escaped the observation of pathological writers.
The pathology of the heart is too little advanced yet to judge
how far its diseases affect by sympathy the functions of other
organs. In fact, we impute sympathy, from visceral derange¬
ment, to be a much more common cause of insanity than Dr.
Spurzheim appears here to do. Indeed, in his Physiognomical
System, he has enlarged more on affections of the brain from
sympathy, than he does in this Essay, although it is exclusively
upon mental derangement.

Sexes. — Women, generally, are more subject to insanity
than men. This is natural to imagine. The many more phy-

bpurzheimV Observations on Insanity . 311

sieal causes, such as menstruation, pregnancy, parturition,
actation, &c. to which the tender sex is exposed, will sufficiently
account for it. 44 By a severe necessity attached to the duty
l at ^ature has assigned her, says Cabanis, woman is subjected
to many accidents and inconveniences ; her life is almost always
an alternate succession of good offices and of suffering ; and
too often the suffering predominates.” Whether, if exempt as
much as males from such physical causes, females would, as
Aretaeus, Coelius Aurelianus, and other antient authors contend,
)e less liable to insanity, is perhaps a question impossible to
solve ; yet these are data whence we might justly infer, that
moral causes have a greater effect than physical causes in de¬
termining a majority of insane females. The physical causes of
insanity must be nearly the same in all civilized countries in
2 egard to females ; but the moral causes may differ very widely"
and will be always regulated by the state of society. Thus la
x iauce, where public morals have long been more relaxed, and
vJiere all the vices which affect the passions most predominate*
the proportion of insane females to males is greatest. In Great
Britain, within the last halt century, the errors of female edu¬
cation have become more universal : hence the morals of even
tne inferior classes are more corrupt ; and the consequence is a
most sudden and alarming revolution in the female mind: and
hence this country ranks next to France in the number of insane
women. In Prussia and Austria the case appears to be reversed :
tneie we find most insane men ; while in Pensylvania, two men
me enumerated as insane, to one woman. We do not pretend

measure the state of public morals by the guage of the mim-
ne?' of insane in tnese several countries. "We say what we know
to be true of France and of England ; but must leave to others
tne solution of the enigma, why, in Prussia, Austria, and
America, the proportion of insane women to men should be the
reverse of what it is in the two former nations.

i Insanity is frequent in England? ’ —— We have before
ahuded to Dr. Spurzheim’s assertion, that insanity in Great
Britain is endemical. Here he again falls in with the common
belief, that it is more frequent in Great Britain and Ireland, in
proportion with the population, than in any other country of
Europe; and that in England it is most frequent. We shall
not blush, if we exhibit a little of John Bull’s pertinacity, and
rebut this charge by stating our opinion (certainly an opinion
only), that insanity is not more frequent in Great Britain than
in other countries where civilization is equally advanced ; nay,
still farther, we believe that insanity is less frequent in England
than in Ireland or Scotland.

If we may trust to report, and the returns of various public
and private establishments for the reception of the insane, then it

313 ' Analytical Review .

is evident that insanity is exceedingly prevalent in foreign conn-
tries, as well as in Ireland, and in Scotland, Of the number ot
insane in the latter, there is more precise information ; aridj
comparing the returns under a recent order of the House oi .
Commons*, there is reason to suppose, that it contains a
greater number of insane persons, according to the extent os

its population, than England. . ,

This fact is no less alarming in a political than in a moral
point of view. It argues a great change in the physical and
moral constitution and habits of a people, hitherto justly con¬
sidered as the most reflecting and industrious, and as sober as
any in Europe. Is this lamentable change to be ascribed to
the rapid introduction of manufactories, and commerce, and
wealth into Scotland ?

It would be irrelevant here to enter deeply into so interest-
in or an inquiry as this question presents ; and we may find other
opportunities of investigating it. Suffice it, that Dr. Spurzheim
points out many circumstances, both in the physical and moral
life of our countrymen, that predisposes to this dreadful malady.

The following passage contains impressive trutos. It is a
cause however which must be ever operating wherever religious
liberty is regarded, as in England, as a constitutional bulwark :

« Religious feelings are extremely active in this country, and
may act without any restraint. Every one who thinks himself en¬
lightened enough, or perhaps inspired by supernatural influence,,
may preach to all who will listen to him. Whether he understands
human nature, or is an artisan ; whether he has studied the feelings
of man, or has been employed in manual labour, that, is no matter.
He may consider the individuals of his congregation all alike, and
speak to the mild, gloomy, and timid, as to the disobedient, hard¬
hearted, and stiff-necked. He may damn to hell and eternal pains
all those who do not believe with him. 1 am convinced that a gloomy
preacher who does not know the God of Christians, and the method
of instruction of the great Apostle, who modified his speech accor¬
ding to those to whom he spoke, in order to save them all, easily
deranges a tender mind by his picture of a jealous God, oi a God
of wrath and of vengeance, by a language which is perhaps neces¬
sary to guide his own feelings. Indeed, how often must an anxious
mind be overpowered I Moreover, it is easily conceived that in¬
dividuals, who are anxious for their eternal beatitude, and listen to
so many different explanations, torment their brains m order to find
truth. Now, if at the same time other feelings are excited, it must
occur that reflection and will are lost. *p. l6(>.

* 630 out of 839 parishes in Scotland have made returns : the
number of lunatics returned was 3,486 : but the total number is
represented as 4,300, of whom 800 only are confined ; 291 m fit
places ; 331 in improper ones ; and about 500 inadequately, oa kept

by relations.

31 S

Spurzheim’s Observations on Insanity.

Moreover ambition, and that “ selfishness, which is the s*\ji
of commerce,1’ are also in England active agents. “ In short j
it seems to me,” says this observant foreigner, <£ that in Eng¬
land all feelings, selfish and liberal, religious and moral, low
and high, are extremely active.”

Thus the powerful activity of the mind seems to me a great
cause why insanity is so frequent in England ; and, indeed, it is a
singular fact, that the greatest desire of man, his personal liberty,
also has its bad effects. — “In despotic countries,” says Dr. Rush,
“where the public passions are torpid, and where life and property
are secured only by the extinction of domestic affections, madness
is a rare disease.” — p. 16?.

T he authorities of the pedestrian traveller, Stewart, who
spent some time in Turkey, of Dr. Scott who accompanied Lord
Macartney to China, and of Mr. floxes, a native of Mexico,
are quoted to prove the rarity of insanity -in those countries!
Here our nationality and our natural affection for political and
.civil liberty interfere, and induce us to repel so foul a reproach,
as this sentence implies, on that freedom which we conceive
constitutes the chief happiness of man.

History, both sacred and -profane, affords abundant testi¬
mony, that various species of insanity prevailed throughout
Asia and those parts of Africa that were known and civilized
in very early periods. The Sacred Scripture abounds with
proofs of it. As early as the fifth century of the Christian era,
there was a large house for the reception of lunatics at Jerusa¬
lem. In the twelfth century, Benjamin of Tudela found in
Bagdad a spacious building, called u Dal Almeraphtan, or the
■House of Grace,” for the reception of those who lost their
senses in summer. There they were kept in chains till they
were cured. M hat traveller has not heard of the mad-house
at Constantinople, and of the horrible treatment the patients
receive there ? or of the Muriston” at Fez, in Morocco, once
so celebrated, when that city boasted a university and a school of
medicine-? If the walking Stewart, and others, did not hear
of any of these establishments in their travels, it is probably
because being reduced to a .comparative state of barbarism, in
all these countries such establishments are now confounded with
prisons, or are insignificant or extinct ; and not because there
are not numerous insane persons requiring confinement. At
all times we believe there was a tolerable share of despotism
^extant in these countries ; at least none will be hardy enough
to deny, that there is not now quite a sufficient degree of it
.to check the bad effects of too much personal liberty.

In truth, insanity is no where so common as wherever
•the Turkish dominion prevails. And when we advert to
their indolence and sensuality, their abuse of opium, tobacco,
VOL. viii. — m 46. s s

314

Analytical Review.

&c. we cannot wonder that the physical as well as moral
and intellectual functions of the people should he greatly de¬
praved, and frequently alienated. 01 China, we know too little
to rely on ; of South America we have certainly the autho¬
rity of Humboldt, that among the native Indians insanity is *
unknown ; and this may fairly be imputed to their simple and
nncontaminated manners. It is probable, that their task-mas¬
ters are not quite so free from this scourge of civilization, it
is also true, that insanity is scarcely known among the African
slaves in the West India Islands.

Dr. Spurzheim admits four general forms of insanity —

ee viz. idiotism, which is partial or general ; fatuity, also partial or
general; irresistibility, if any power be so active that the will has
no influence on its actions ; and alienation, if the manifestations of
the faculties are deranged in their quality, and the intellect is in¬
capable of distinguishing the derangement. These four forms
designate different states of insanity, while mania and melancholia
are merely sorts of alienations/’ — p. 17T

Although thus reduced to four forms, and the fewer the
better, yet we fear our author's arrangement is not founded on
legitimate inductions ; for it is certainly a little extraordinary,
that he avoids adducing any sufficient reasons for the several
divisions he has here adopted*.

“ Suicide u The morbid inclination to suicide is the same
disease which is commonly called melancholy, only producing
that singular effect/1 From examples he infers, that in many
cases suicide is the effect of corporeal disease. Those who kill
their relations and then themselves, or that kill others in order
to be put to death, lie considers as modifications of suicide.
As the propensity to suicide is a symptom only of insanity, and
as insanity is regarded by our author as the effect of organic de¬
rangement, it is of course natural to infer that suicide has a
corporeal and not a mental origin.

Dr. Spurzheim believes that suicide is in some countries and
districts endemical, in others epidemical. A variety of authors.

* It is surprising, and it excites our regret, that Dr. Esquiroi,
■who has so distinguished himself by his luminous observations on
mental derangement, should, in a paper very recently reported on
by Dr. Pinel, to the Royal Academy of Sciences of France, have
attempted a division of different sorts of hallucination of the senses.
According to this new arrangement, the first sort is that which affects
the true sensation of hearing ; the second, of hearing and seeing ;
the third, of hearing, seeing, taste, and smell, united ; the fourth and
fifth, comprehends the aberrations of all the -senses. The utility of
this arrangement, in a practical point of view, we profess we cannot
perceive.

315

Spurzheim s Observations on Insanity.

both antient and modern, have attested the same. Nor do we
oCl tii at it is at all improbable that certain physical and moral
causes may exist in particular districts and societies, superindu¬
cing this species of madness. That this propensity is hereditary,
we have had the clearest evidence in many families whom we
u\e professionally attended. In one family, we knew it to
nave been developed in three successive generations: — in the
second generation, three brothers and two sisters between the
ages of thirty and seventy years immolated themselves ; it is
strongly indicated in the last surviving brother, and in the
progeny of all of them.

1 he delineation of the morbid symptoms commonly observed
m these unfortunate beings is exceedingly well drawn ; but at
too great length to quote. Ample proofs are stated of much,
constitutional derangement in all such cases. Excessive feeling
suddenly and strongly excited, may indubitably produce im¬
mediate self-destruction, and perhaps without any apparent
constitutional derangement ; but, we should be inclined to
pronounce that there was a disposition of organization in all
these cases favourable to such hallucination.

Our author here forcibly adverts to the popular impression,
in cases of suicide, homicide, & c., that it is a crime justly im¬
putable on the perpetrator ; but which a philosophic physician,
he says, would judge in a quite different manner. This pro¬
position involves a nice question of jurisprudence; but which
however we cannot discuss.

The crime of suicide all Foreigners are fond of imputing as
peculiar to the English ; but upon comparing the Bills of
Mortality of London and Paris, it will be found, that the
i rench at least have no grounds for reproaching the English
on this account.

Fits of Insanity — Idiotism and fatuity excepted, in¬
sanity, says Dr. Spurzheim, is often intermittent, like many
nervous complaints, and has exacerbations and ramifactions.
As to the cause, he treats the antient opinion, that the moon
has an influence, as entirely destitute of truth. But, he asks,
if a too great determination of blood to the brain, and lesions
of die brain from exostoses or violent depression of the skull, &c.
be predisposing causes, how it comes that the same predisposing
cau^e may continually exist, and only at certain periods the
blood is carried in larger quantity to the brain, and various
morbid symptoms take place ? This query is difficult of solu¬
tion; nor can we acknowledge that explanation which the author
himself gives, is at all satisfactory.

Periodicity in the animal economy has led Drs. Gall and
Spurzheim to some singular speculations in regard to its in-

Analytical 1 ttvittfr*

fluenee on tbe female constitution. The subject is ctirious, and
is treated with much ingenuity.

« Dr. Gall first made the observation, that at certain periods
snore women menstruate than at others, and that in a lunar month •
there are two such periods. This periodicity with respect to men¬
struation must be understood as follows. There are many females,
who have their menses within eight days ; they, independently of
bodily size and temperament, form a class, and without a violent
cause, such as strong affections, they belong always together, with
this difference only, that several overcome' that inconveniency m a
greater or smaller number of days ; but within eight days all indi¬
viduals of that class menstruate. There is another class ot females,
■who also, independently of bodily size or temperament, have their
menses at another period with the same modification as those of
the former. Both periods happen within a lunary month. It must,
however, be observed, that the season and weather have an influence
On the periods ; in the spring and in hot weather they commonly
anticipate, and their effect is greater. At other times they post-'
pone, but always the whole class anticipate or postpone, which
indicates, that the cause is general. In a small number of fe-'
males, menstruation is sporadic. Extremely weak and delicate
women feel the influence of both periods ; for that reason some
females are unwell every fortnight. Many women think that it is
always the case at the same date of the month, but they are mis-'
taken, and were not attentive enough."' — p. 192.

He finishes liis argument with some speculations also on the
calculations of females as to the periods” of conception and deli-'
very. For bis elucidation of the influence of periodicity on the
nature of man, we must content ourselves with referring to the
work itself.

On the “ Means of preventing Insanity f Hr. Spurzheim-
declines entering ; conceiving that the best rule is — to avoid
the causes of insanity.

« Prognosis of Insanity?' — The same terms, Hr. Spurzheim
conceives, should1 be used in the prognosis of insanity as are ap¬
plied generally to other diseases. It is curable or incurable ; the
curable is acute or chronic, and is cured with more or less diffi¬
culty. Diseases from dynamic causes should be considered cura--
ble ; the term incurable should be applied only to an organic al¬
teration, which cannot be restored to a healthy condition : such for
instance,- as a suppurated internal organ, ossification of blood¬
vessels, effusion of blood, or serous matter into tbe cavities of
the brain, a tumour, &c.

“ We must,” says our Author, ec confess that hitherto medical
art has acquired very little merit in the cure of insanity ; nature
alone does almost every thing. It is, however, interesting, and

Sspurzheitn’s Observations on insanity .

317

£ven necessary, to know what nature can do, in order to understand
and appreciate fhe merits of the art.

d he prognosis of insanity, like that of any other disease, de¬
pends on the predisposition of the patient, his bodily strength, the
particulars of his constitution, sex, age, the nature of the disease'
and its cause ; its duration, the organic change it has produced in
the brain, and the degree of our knowledge/' — p. 197.

Religious melancholy generally terminates in death ; mad¬
ness from inebriety is rarely cured, because permanent abstinence
is seldom if ever in habitual drunkards attained. If the diffi¬
culty of prognosis is uncertain from sympathetic causes, it is
unhappily quite certain, when the causes are idiopathic ; no
permanent recovery can then be pronounced.

Maniacal patients, it has been observed, recover in larger
proportion than the melancholic. The reasons are various,
yet some are obvious, mania for instance, is more alarming,
therefore relief is soonest sought for, and the necessary ap¬
plications made. Cases of melancholia gradually arise, go
on for years, and are consigned to neglect and chance ; the
precursory symptoms being too often considered as the effects
of a fanciful and wayward imagination. Dr. Spurzheim justly
censures the friends and physicians of patients who permit
the advances to melancholia to proceed, as if they did not
originate from bodily causes. This neglect is certainly one of the
most fruitful sources of insanity. It may be received as a?
maxim, that in the ratio with the duration of the symptoms,,
the facility or difficulty of cure may be prognosticated.

Yl e hope and believe, for the credit of medicine, that the
Doctor is clearly in error when he alleges, that nothing is ever
done for the relief of the symptoms of melancholia, and that it
is deemed incurable when under some of the circumstances he
has described. We have never seen any form of melancholia*
unless it were connected with some organic defect, in which we
should consider the cure quite hopeless. Rut we agree, with
him, that the most violent attacks of mania generally recover
in the gradual manner which he relates, and that such mode
of recovery promises the strongest hope of permanency. He
thinks, that if insanity (the acute form of mania we presume
is here meant) degenerate into fatuity, or if emaciation be
increasing* notwithstanding the patient eats voraciously, the
ease is hopeless * for “ incurable changes have taken place in
the substance of the brain, in its membranes, or blood-vessels.1*
Remissions and intermissions are favourable, for they shew the
cause is not so active, and that organic changes do not so easily
take place. The prognosis is particularly favourable if the
successive paroxysms are weaker. If there be no alteration
sf pulse, the cure is more difficult ; because the cause is

318

Analytical litbiew.

idiopathic. The prognosis is unfavourable if there be violent
chronic head-ache, especially pain in the neck ; or in cases
where drastic remedies fail to produce effect, or if blisters
neither vesicate nor inflame the cuticle.

The important question, how long insanity can last before
it should be considered incurable ? our author refers to the
decision of other authorities ; which leaves it precisely in statu
quo.

According to most writers on insanity, patients with a
propensity to suicide are seldom cured ; but from this conclu¬
sion Dr. Spurzheim dissents ; and we accord with him : for,
from experience, we insist, that like other forms of melancholia
it is curable; but where it has been gradually developed,
and is not the result of any sudden and vehement emotion
affecting the feelings, it is very apt to recur.

With no part of Dr. S.’s doctrine do we more cordially

acquiesce, than that, if in insanity

« -\ye immediately employ the proper means, and continue the true
treatemnt for a sufficient length of time, the number of the curable
eases will greatly enlarge. In many cases the power of. nature,
without support, is insufficient; and in many others it is more
difficult to repair the mischief induced by improper treatment ot
insanity, than it would have been to cure the original complaint ;

iust as It often happens in other diseases.

<c if re-convalescents return to their primitive tastes, pursuits,
and habits, it is a good indication of their final and complete re¬
establishment ”—p. 204. _ Equally true it is, that “Insanity, as
well as other diseases, is liable to relapses.”

Where the insane are placed under circumstances as favour¬
able to life as the sane, we agree with the author, that, in
chronic cases, they may attain great age. But it is conti aiy to
reason and experience to conclude, that if mania or melancholia,
originate m disease of some important viscus, or even m de¬
rangement of any organic function, such condition can m a

general way admit of longevity.

« Treatment of Insanity” Reflecting that we are examin¬
ing the work of a Professor who has been labouring to discover
the organs of the mind; and that, according to his own account,
be has in this succeeded bevond all his predecessors ; and
always allowing him a great degree of ingenuity, we were
ivillino* to give the most candid consideration to his observations

on a subject still veiled in such mystery. .

In fact, we expected a practical illustration of those theories
which go to subvert all antient doctrines and to erect new ones
m their place ; that from the wonderful discoveries of Dis. Gall
and Spurzheim of the organs whence emanate tne manifes¬
tations of the mind, that' such manifestations would be more?

Spurzlieinis Observations an Insanity. 310

under subjection and direction ; and that when, bv the per-

these iLraedProfbssoiswere born to^nalk Jl™ 5 H th,a*
healing art, and relieve the load of human woes ““ “ th“

we read dm ioL^eont^^ff^ be when

s.derations in which the patients are mosTbterelted, S^re
.peuence and our own conscience attest our ignorance! We

notVt all satisfaitofJTr’ ^ ™eth°d °f curinS iusai% »
of

the author is nothing ! and that he is too honest todlim that
^no.vlalge to which he has no pretension 1 To what then do
his « Observations” tend 1 Some might be supposed to inquiiT
Quid dignum tanto feret hie promissor hialu ? We wih not
lep y Parturient mantes, he. because our author has unques-
lonabiy many merits, not the least of which is, his adherence
to the corporeal origin of insanity ; and because he thereby has
eeitainly contributed m a very great degree to the dispersing of

as mdthe r a°?S " f " Ph,.losoPfL£;rs alld physicians had entertained
as to the causes of insanity. 1 0 attain this is no smali triumph •

S^lianyTrutl.r1 °e<™i'em*> Paves tbe "«y ^ the admission

T B,Ut "7”"'11} .P,roc.ecd f° examine what is said under “Moral
Treatment? which includes habitation, nourishment, coercion
and personal treatment. ' *

13r. Spurzheim reports many prevailing and gross impro-
pneties as to scite, accommodation, confinement, association,
and general treatment. He describes even worse mad-houses
and more horrid scenes than were detailed in the exaggerated
Reports of the Committee of the House of Commons: but
we nope, for the sake of our country, that the Doctor’s
accounts are derived from Ins foreign travels. In this res¬
pect we must observe that there is nothing said but whit
has been written by all the newspaper-writers of the dav •

wmeb, however true and philanthropic, it would be superero-
gation to repeat. . 1

„ '" Principal Requisites of a Mad-House .” Here, also, we
nnd little that is novel or worthy of notice. Nothing indeed
that any person might not design who had had the inspection
ot the numerous plans for mad-houses which have appeared

Analytical Review.

Perhaps, without any extraordinary effort of ingenuity, one
much more eligible than the two accompanying plates delineate

"-t SSSte .0 detect, tl,.t ™j«w, like .11 .
other paper architects., can chalk out plans, hut forget how the
S to be found to realize them. We agree with lnm,
that expensive embellishment of such edifices is shameful waste,
and know, that accommodation is too often saciihce y
rost incurred in erecting a fine and superfluous poitico. .

"goule comments are next added on the recent y lejec e
Bill for the Regulation of Mad-Houses— a measure so pre-
Dosterous, as, in a particular manner, to have called forth oui
animadversions and opposition; but which, having been a-
tended with com plete^ success, there is no occasion here to
renew We hope Dr. SpurzheinTs strictures may tend to
introduce more judicious regulations, ana that he will find his

of... *.*«*

fir;!; - VS K”5*-

the impracticability , in many cases, ot P'<«-ui g , ,

of a physician, &c. during the paroxysm; and, therefore, the
difficulty of ascertaining ^whether such person be rea y '"s*n® ’
and he asks, “ how then ui the mean while shall t.ie patient be
disposed of?” His proposals to nfcviate tins difficulty are
puerile indeed, and shew his ignorance concerning the civil in,
dilutions and customs of this country. The following sug,
gestion appears ludicrous enough :

« As the physician often cannot have the least confidence in the
account which the patient gives of himself, the ^rgyman ot tffii
parish or of the congregation, who is supposed to know vhib hock,
has the best opportunity to furnish the evidence. p. ~

There is, however, one remark with which we entirely coin*.
tiJe and which should never be forgotten ; viz. that patients in
® ute cases of mania require speedy and regular assistance to
prevent that disorganization which might lead to protracted or
incurable insanity, than which nothing is more true

Dr Spurzheim makes many exceedingly good obseivatio is
on the subject of Did" for the jnsane. Granting that
insanity is capable of two divisions only, mama and mtlnn,
cholia could the most ignorant or indifferent suppose that any
one system of dieting can be equally proper for patients m both

thest^ states ]ar or ratller unpopular subject of “ Coercion ,
our author dilates; and speaks with just abhorrence of tne
excessive rigour sometimes exercised.

Spurzheiirfs Observations on Insanity. 321

As to the u Treatment of the Feelings ” and of the “ Intel¬
lectual F acuities ,” as far as they are expressed by different
hallucinations, there can be no question that Dr. S. is correct
in advising that it were better to modify the treatment accord¬
ing to the cause of the derangement. To attempt correcting
or eradicating any particular hallucination by punishment,
opposition, derision, or reasoning, is equally weak and futile.
Tut of all means, deception is the most dangerous : it miphfc
answer a good purpose in certain conditions of mental de¬
rangement, if practised without detection ; but the consequences
of a failure would more than counterbalance the probability of
success, and cannot justify the experiment.

In the treatment of the insane, there is no one particular
attended with such extreme difficulty and delicacy as their
moral management. It is here where the greatest skill is
manifested, and where those peculiar talents which fit for the
task are exhibited to the most advantage. If directed with
judgment, we are convinced that the hallucinations of one
patient or class of patients might be brought to counteract, and
perhaps assist to cure those of another class, &c. It is here, in
short, may be displayed that discrimination and finesse which
experience only can teach ; and which has sometimes been
applied with such judgment, as to induce the unobservent to
imagine, that some individuals have possessed a power some¬
thing super-human in the managing of the insane. Recovery
must always be wonderfully influenced by the personal qualifies^
lions of those who direct, as well as of those who attend upon
the insane. “ I expect the least effect,” says our author, “from
reasoning wherever strong feelings are deranged. Reasoning
will rather excite than diminish them.” “ To argue a madman
out of any particular hallucination,” as Dr. Ferriar has aptly
remarked, u is folly ; and to attempt to surprise him into
rationality is attended with great hazard ; for if it does nojt
have the expected success, it will inevitably make the patient
worse.” Be it ever remembered, that

“ One clear idea, wakened in the breast
“ By memory’s magic, lets in all the rest JM

“ Occupations for the Insane .” None, we think, who have
been accustomed to associate with insane people can with
justice deny the influence and good effect of external objects
upon them, if those objects be selected with judgment. Inde¬
pendent of what may be produced from mere occupation, we
have seen the most indisputable advantage derived through the
medium of the senses of sight and hearing ; and we know no
reason why equal benefit may not be obtained through the
other senses. We must concur with the author’s astonishment^
VOL. viii. — m 46. T T

322

Analytical Review.

that no more contrivances have been invented to occupy and

amuse those mentally deranged. ...

Our author re-urges that which lias been judicious, y
observed by former writers, and especially by Dr. Hallararu
He points our very forcibly the necessity that such occupation
be adapted to correspond as nearly as possible with the capacity
of the patients, and that it be entirely opposite to the halluci¬
nation possessing the mind ; and he expatiates on the pai ticu.ar
benefit of employment when in a state of convalescence.

« Inspection and Visitation We must be indulged here
in some remarks ; for we apprehend there is more meant unto i
this head than meets the eye. Perhaps if we possessed tne
somnambulistic faculty of clair voyance , which the disciples or
Mesner sagaciously consider a sixth sense, we should be atae
to divine the precise object of some observations we here meet
with. Our percipient faculties, however obtuse, are not blind
to tlie prospect of such agreeable appointments as inspecting
commissioners, &c. So let it be. We shall not examine very
scrupulously into motives, but content ourselves with effects;
and declare our sincere satisfaction, it any motives tend to
elicit aught that will alleviate the condition of the afflicted.

Much is said respecting asylums for the insane. As this is
a subject of interest to but few of our leadeis, we shall be sue-
cint in our observations.

It may be very confidently predicted, that there never will
be an institution competent in all its departments for the
reception' and recovery of the insane \ unless it be elected and
maintained by the nation ; and unless it be placed undei such
direction and management as to preclude tne influence or an
private considerations and local prejudices.

Dr. Spurzlieim is perpetually in this section speaking as if
the British, like all other governments, had cognizance of every
charity in the kingdom. But Englishmen know and boast,
that the most noble charities in the empire generally owe their
rise and support to private benevolence.

We maintain, that there never will be an establishment for
tlie insane, possessing all the requisites, and worthy of the
nation, until a portion of its resources be appropriated to that
purpose.

It is far from our intention to impugn the management of
road-houses by non-professional persons ; on the contrary, we
believe many of them are conducted with great care : but if
under persons not medical they are well conducted, can any
reason be alleged why they should not be equally well, if not
better, managed by medical men ? Surely there are many
reasons for concluding, that where medical Knowledge is com-

323

Spurzheim’s Observations on Insanity.

bined with the other requisites, the person so qualified offers
the best claims to confidence.

44 But who ought to be the inspector?” 44 I think,” says
pr. S., 44 any active, charitable, and conscientious man, who
knows the nature of insanity and the wants of the patients.”
But where, we would ask Dr. S., are men to be found “ who
know the nature of insanity and the fwants of the patients ?”
If> as he says in the same page, 44 insanity is a corporeal
disease,” how can 44 any active, charitable, and conscientious
man” be fitted for an inspector? We are convinced that
inspectors ought to be educated to the medical profession ;
that they should be men of solid judgment, and have salaries
sufficient to make them independent of any other professional
pursuit.

We now come to the last, and perhaps our readers may
expect the most important, part of the work before us ; viz. the
“■ Medical Treatment of Insanity .” But we must check such
expectation, by reminding them of the Doctor's confession in
his exordium, that he is ignorant of the methodus medendi.

Those writers who have inclined to the opinion, that in the
majority, if not in all cases, insanity does not arise from organic
lesion of the brain or of other parts, but impute mental derange¬
ment chiefly to moral causes, naturally rely little on the aid
of medicine for its cure. Dr. Pinel, from the success attending
moral treatment in Prance, and that system of therapeutics
which the French term, medecine expect ante, which, in other
words, is almost doing nothing at all, is disposed to this opinion.
The good sense, indefatigable zeal, and great humanity, which
that excellent physician has displayed in regard to the insane,
has received the reward he so ivell merits, in the unbounded
confidence his government has bestowed on him. He has had
at his disposal ample means for the execution both of his moral
and physical views in regard to the treatment of the insane.
Placed in such happy circumstances, he lias been able to achieve
much ; and when the results are compared with those of the
English hospitals for the insane, it will be seen that he has
reason for drawing inferences favourable to his own plan of
treatment : and hence, perhaps, he is persuaded, provided that
the moral means are commensurate, that the medecine expectante
or natural means, will generally be adequate to the cure of in¬
sanity, without the aid of pharmaceutic art. But they, who with
Dr. Pinel, draw such an inference, are very likely to err; because
the medical system practised in our hospitals having been noto¬
riously routine, and the moral means being as notoriously
defective, the effect of medical treatment has never had a fair
trial.

Truer philosophical views of the pathalogy of insanity begin

t x 2

g24 - Analytical Review.

to be developed; and we have no hesitation in prophesying
that a very different report of the number of the cured in this
country will consequently soon appear, as the result of our
improved knowledge and mode of treatment. i

That accurate observer. Dr. Rush, intuitively remarked,
that it was, perhaps, only because the diseases of the moral
faculty have not been traced to a connection with physical
causes, that so few attempts have been hitherto made to lessen
or remove them by physical, (medical,) as well as rational and
moral remedies. The justness of this remark begins at length
to be felt, and acknowledged. Equally indisputable is Dr.
Spurzheim’s observation, that those who have treated insanity
as a corporeal disease have discriminated too little , and t at
they have applied to the alleviation and suppression of symptoms
rather than to the causes of them.

“ Insanity,” says our author, " however, and its symptoms,
present as much variety with respect to causes and circumstances as
any other disease ; and it cannot be treated by any general method
as by bleeding, vomiting, purging, blistering, bathing, the use ot
opium, caustics, digitalis, mercury, &c. f here is not, and there
cannot be, a specific remedy against insanity. 1 here are specifics
against determinate diseases, under whatever form they appeal, 01
whatever part they affect ; but the morbid symptoms of the lungs
have no specific remedy, because the functions of die lungs may
be deranged by various causes, as by inflammation of the lungs, bac.
digestion, hysteric affection, and according to these causes the treat¬
ment must be modified. The same must be done in the brain.

« There is no doubt that nature often cures insanity. But, as
in other diseases the patient is often relieved by art, and would die
Without it, so it is in insanity. Medccine expectant e , though practised
by Hippocrates, can no longer satisfy any rational pathologist.
Nature has been observed long enough in insanity, and we know
what she alone can do, viz., cause a great number of insane persons
to become fatuous ; indeed, further indolence deserves to be repro¬
bated. The usual treatment of insanity is merely symptomatical :
in mania they bleed, in melancholia they purge. p. 2 7 0.

Our author does not fail to embrace the opportunity which
presents of examining and censuring that systematic and iou-
tine plan of treatment of insanity usually hitherto adheied to
in England. He is very severe on the opinions ot the medical
attendants and practice of a certain * London hospital for the
insane. Neither does he spare M. Pinefs medical treatment.

were pleased however to see that ne does ample justice to
Mr. Nesse Hill of Chester. They who are not so w edded to
scholastic rules as to be blind to original observation, will
acknowledge with us, that by perusing that gentlemans « Essay
qji Insanity" they have derived much information.

Spurzheims Observations on Insanity . 32 5

After exposing the common errors, our author then
concludes, “ I am of opinion,’ ” says he, “that the medical
treatment of insanity must be entirely reformed ; it is to he
reduced to sound principles of pathology in general.” And
agreeably to those views, the plan of treatment he proposes, is
sufficiently judicious; but possesses nothing sufficiently novel
or remarkable to require us to detail.

“ Treatment of Mechanic Causes of Insanity?— Mechanic
injuries of the brain produce various derangements of the cere¬
bral functions ; and from all violent causes may originate all
the disorders derived from the nervous and cerebral systems;
amongst the most prominent of these disorders certainly is
insanity.

" l11 the greatest number of cases, no surgical operation is
indicated ; but very often blows derange the functions or the brain
in distributing the circulation of blood or the delicate structure of
tne cerebral fibres. I have seen individuals, the operations of whose
mind were entirely suppressed, by their head being violently shaken,
while organic life continued its functions. Many persons feel head¬
ache, vertigo, giddiness, or become insane ; and if such individuals
die sooner or later after the injury, congestion of blood is detected.
Hence it happens in the head, what we perceive in external bruises ;
and the curative plan is obvious : bleeding, application of ice, snow,
.or cold water on the head, aspersion with ether ; the bowels are to
be kept open, and every thing which carries the blood to the head
avoided, as spirituous liquors, indigestible aliments, costiveness,
violent affections. Moreover, whatever removes the blood from the
head must be employed. To this end a more upright position is
preferable, mild evacuaiits to open the bowels, low diet, See. Some¬
times a great weakness of the blood-vessels remains for a long time,
and the general treatment is to be continued, as washing the head with
ether, cold water, cataplasmata of aromatic herbs boiled in wine, and
every tiling that can give tone to the blood-vessels. After the first
period, bleeding will be of less use; but whatever can determinate the
blood to the head must be avoided, as walking in hot weather,
dancing, going on horse back, swimming, stooping, &c.” — p. 284.

Blisters and vomiting he proscribes ; the latter especially
as being highly improper, where injury of the head has been
sustained, or great determination to it obtains. If an Inflam¬
matory state of the brain follow an external injury, and symp¬
toms of insanity supervene, the treatment will follow the
general principles of pathology, and the antiphlogistic plan
should be adopted.

“ Treatment of the Idiopathic Dynamic Causes of Insanity?

- — According to our author’s notions, there are three different
states of the cerebral organization ; each requiring a different
treatment. The functions of the brain may be deranged beyond
ail doubt by over stimulus ; but it may affect one part, says he*

326 Analytical Review .

more than another, and hence produce a variety of symptoms.
He contends, that in erotomania, or nymphomania, for instance,
the cerebellum suffers most ; in fury and mania, the middle
lobes; in too great self-esteem or pride, the ceiebial paits at
the vertex of the head, &c.

ff The hypersthenic state of the brain may be only local, that
is, confined to the brain ; or it may be combined with various symp¬
toms of automatic life; in the same way as the affections of other
parts are local, such as ophthalmia, diarrhoea, &c., or are accompa¬
nied with various other symptoms.”— -p. 28b.

And there is the most decisive evidence of preternatural im¬
pulse of blood to the brain. The treatment of these secon¬
dary symptoms is, bleeding behind the ears, cold applications
to the neck, and low diet ; and examples are known where the
cure has been effected by spontaneous bleeding 01 cold. #

This state of the brain or its parts, is difficult to detect if it
be local ; but is rendered more easy to be understood if con¬
nected with morbid appearances of automatic life.

Dr. Spurzheim notes some errors which certainly often pre¬
vail, and ought to be corrected ; first, that violent delirium
and fury are the signs only of the inflammatory state of the
brain ; while it is clear that inflammation may exist without
such symptoms, and yet such symptoms may attend without
an inflammatory state of the brain ; second, that an inflamma¬
tory state of the brain sometimes exists unattended yith pain.

The brain, proper, is not in fact sensible ; and in this res¬
pect differs from the nerves. Numerous dissections have in¬
duced our author to coincide with Dr. Powell’s Observations*,
that 4C inflammation of the brain is by no means infrequent,
while we rarely And it unaccompanied by the symptoms,
which (according to the theoretical opinions of the schools)
should designate phrenitis. The symptoms are referable rather
to oppression of the nervous power than to increased activity
of the blood-vessels.”

cc Fury.” says Dr. Spurzheim, “ depends only on the excitement
of the organs of c omb ati v sue s s and destructiveness, while a too
great activity of cautiousness produces meiancholy oi despondency .

— p. 289-

Reasoning upon this sentence, we are tempted to inquire,
if anv form of insanity originate in the derangement of these
and other organs of the bramular mass, in what way medical
treatment can aid the cure ; unless application be made imme¬
diately to those particular organs which are deranged m their
actions P For instance, if fury or mania J'uvibuiidcL depend only

* Medic . Trans, , vol. v.

327

Spurzheinff? Observations on Insanity.

on die too great excitement of the organs of combativeness and
destructiveness, it is only to bring into play, that is, to excite
the organs of benevolence, or veneration, or self-love, or appro¬
bation, to counteract the ill effects likely to ensue from the
over activity ol the two former organs. .Again, if the organ of
cautiousness is too active, we would not let the patient sink
mto despondency, but bring forward the organ of hope to its
relief, flow these different organs are at our will to be brought
into activity, or, when too active, how to be mollified, since our
author- does not direct, it cannot be expected from us. This
then is surely a great defect; for of what utility is a new
system of - the manifestations of the mind in therapeutics, if,
when disordered, they cannot be managed ?

Further, we must hesitate ere we can venture to admit
die propriety of including in one sweeping and indiscrimi¬
nate conclusion, that erotomania, fury, despondency, reli¬
gious fanaticism, pride, liberality, &c. are to be treated by
64 lowering.”” On the contrary, until it be supported by much
stronger arguments than any Dr. S. adduces, we feel it a duty
to caution his admirers and our readers against the fatal con¬
sequences that would inevitably ensue were such a theory
adopted as a constant guide in practice. Whenever we felt
assured that the case was what the Doctor terms a hypersthenic
(inflammatory we prefer) state of the brain, we certainly should
prefer the remedial plan proposed. From arteriotomy, or
cupping at the temples or behind the ears especially, we
have found the most immediate and decided good effects where
local depletion was indicated ; but general bleeding must
be resorted to with more caution, and with a discriminating
reference to the previous state and constitution of the patient.
It should he recollected, as Dr. S. observes, that 44 the quantity
of blood or the great activity of the blood vessels is not the
cause of insanity ; it is not 'plethora vera ; buff (especially
perhaps in cases of melancholia) 44 congestion from weakness.”

u It is, indeed, a great error to confound congestion with inflam¬
mation. In the latter, bleeding is the genuine remedy, and the
whole treatment must be lowering : while in the former, at the
beginning, a part of the blood must be removed in order to procure
a free circulation to the rest ; but the cause of the congestion, viz.,
weakness, must be removed by other means." — p. 248.

The third state 44 of the brain in insanity from idiopathic
causes, our author says, may be called nervous.” It has many
symptoms common with the second, but it is more dangerous.

“ It exists in very irritable, delicate, and so called nervous tem¬
peraments, where violent or long continued disagreeable affections,
as anger, jealousy, envy, offended self-love, sorrow, grief, disappointed

Analytical Review.

love, &c. have exhausted the bodily strength. In such individuals,
all diseases offer a more severe and dangerous character, because thy
vts medicatrix natural is enfeebled, and the symptoms are deceitful.
Appearances of inflammation, and crudities in the digestive organs,
are too often considered as causes, of insanity, while they are, llKe
insanity, the effect of the same morbific cause. . 1

« The treatment of this state is not bleeding, purging, or vomit¬
ing, but antispasmodics and tonics / — p. ^9^*

From the above considerations, we gather an explanation
« why medical practitioners often bestow much praise on the
virtues of a remedy in the cure of insanity, while others,
equally respectable, decry it as useless, and a tim'd party
declare it to be pernicious.”

Treatment of Insanity from sympathic. causes.

« The greatest number of these cases may be reduced to four
sorts : viz. insanity is the result either of atony, or inanition of the
whole * or of repelled cutaneous affections ; or of disturbed func¬
tions of parturition, or of the deranged digestive organs. I he cases
occur, as to number, in an ascending proportion as the divisions are
mentioned, so that the first (from mere inanition) are the rarest, and
the last the most common.” — p. Spb.

There are many sensible and useful observations unfolded
in discussing these respective considerations; but they are
such as may suggest themselves to any intelligent practitioner
accustomed to the medical care of the insane. I he author
Judiciously and largely avails himself of the practical hints
of other writers, especially of Dr. Hallarans; and he fi ee y
discusses the utility of various remedies which have been tried
by them. That which he here says of suicide may be equally
applied to the treatment that has been practised indiscrimi¬
nately in all forms of insanity.

“ The incongruity of remedies administered in this form ot
insanity [Wcidel is inconceivable. As the disease is chronic, and
its nature not understood, one remedy after another has been tried,
and sometimes the most opposite things employed at the same time.
The patient is bled, purged, vomited, blistered ; he must suffer
issues, or setons ; swallow opium, digitalis, and mercury ; he is
plunged into cold water, takes warm baths and whatever has ten
used in medicine is prescribed ; and — what is to be expected the
patient is not cured.” — p. 300.

Hay in o' deprecated the medical treatment, he makes the
following Opposite reflections upon the application of moral
treatment in aid of medicine. t

“ In this form of insanity the lowering treatment is to be avoided *;
the whole proceeding must be enlivening, animating, and tonic.
The lancet is destructive, and reasoning good tor nothing. Ihe
behaviour towards such patients ought to be easy, kind, and accent-

Spurzheira’s Observations on Insanity. 329

S«WitR1l°0k? °f coraP,ae®nc.v> aI,d not impatient, rough and
R,dlcule nns'14,1? be entirely prohibited. Change of
npu rV ’ aU .occuP ^tlon mind, are of the highest importance,
ined scared according to the possibility of removing the

%w m,stan,ce> ‘l delicate female with great sensibility be
ivlnlk ! f d^"k"d or bratfl husband, and for that reason
can e ’ t!V1 ib° dlfficu’t l° enre.the disease without removing the
menf Th®directl°n of the feelings, and the whole moral treat-
ZTr/‘fC 0t Sreat importance, but not always sufficient ; and the

monk a ProPer medical treatment is much greater than is com-
moniy understood.” — p. SOI.

Dr. Spurzheim adds a summary upon the use and effects
°t purgative medicines, the due action of the skin, the exhibition
of diuretics, bathing, digitalis, and the swing.

He concludes this part with an axiom which ought always

to be impressed, that 44 the mind as immaterial cannot undergo
any physical change .” &

One word or two more, and we finish our analytical
labour. Dr. Spurzheim, in concluding, says, it was his
intention 44 to contribute to the elucidation of this most com¬
plex, most difficult, and entirely neglected branch of medicine .”
x\ow we are astonished how any one possessing his infor¬
mation can assert, that insanity is an 44 entirely neglected
panel o medicine ; and must suppose it a loose expres¬
sion, without reflecting on its literal interpretation. It is
quite impossible that a subject is 44 entirely neglected” which
either specially or incidentally has employed the pens of
lend reels of writers. Had it been observed, that almost every
} 'L,nq’ ^mce antient physicians, which had been written upon
it had been to little or no purpose, we might have coincided:
but science is not entirely neglected because merely it does not
advance : it is clear, however, that our researches must have
taken a very devious course, when so much industry and aroa*.

ment have been employed, and yet so little proof of improvement
is exhibited.

There is another point also in the learned Doctor’s pero-
ratjon, upon which, with great deference, we, after the most
careful deliberation, are inclined to be a little sceptical; and
that is, that 44 the new ideas he has communicated are founded
on observation:” although we are fully prepared to concede
that 44 the manifestations of the mind in their state of health
and disease, during many years,” may have been^4 the favourite
occupation of his intellectual powers,” and that they may

continue to be so ; yet still there are reasons why we are
sceptical.

We have assigned no inconsiderable share of merit to Dr.
Spurzheim for the many judicious remarks his book contains
illustrative of the pathology of insanity, and for ingenuity
von. viii,- — no. 46. u u " J

j0 Analytical Review- %

of argument. But at the same time, except as far as regards
such “opinions as are founded upon or are a part ot his
craniological or physiognomical system, and therefore peculiar
to himself and his coadjutor Dr. Gall, we cannot award our
author the meed of originality. This is neither the place
nor the time to oppugn their tenets: but wherever they
ahre attempted to be obtruded as a guide to practice, we reel
it our duty to remind our readers, that these physicians, and
those who adopt their doctrines, must pursue their inquiries
with a great degree of diligence, upon a very enlarged held,
and for a much longer period, before their deductions can be

admitted as legitimate. , . . _ „ , • v

Without pretending to be acquainted with Dr. Spurzheim s
biography, yet it appears to us, that the very nature ot Ins
researches must have precluded him from a local habitation for
any great length of time. He is yet a young man. He may
have, and we dare say has, visited more establishments tor t le
reception of the insane than any other physician, and theie ore
he may have a general knowledge of their advantages and
defects ; but that sort of inspection does not lead to the con¬
secutive inference, that he is better informed on the nature ot
dr with the treatment of insanity than others, bucli oppor¬
tunities no doubt would be very favourable for his craniological
and physiognomical observations; yet his experience m toe
treatment of insanity may have been extremely limited.

We think too, that this work itself bears internal evidence,
that the practice he recommends is not the actual result ot
his own observation. His constant reference to the practice c
other physicians, his hesitation as to the actual effects ot the
remedies they propose, the want of original cases to 1 ustrate
his reasoning, his system of generalizing likewise, are all proofs
that his statements are hypotheses, and Ins reasoning no inoi e
than theory : and as such, we put ourselves on our guard lest
we should be led, or be the cause of leading others, into a
confidence in Dr. Spurzheim’ s doctrines and inferences which

might prove dangerous. .

Although it is one of the novelties of these novel times, to
fed a foreigner impugning our vernacular tongue as too poor to
express, in philosophical language, appropriate ideas; and there¬
fore with the authority of a profound philologist, gravely coming
new words; yet we will not, by examining his pretensions to thfc
task too closely, be hyper-critical. Notwithstanding this
affectation, and that his style is obviously unequal, and
appears as if the work of different writers, yet it is suffi¬
ciently perspicuous to evince that Dr. Spurzheim has gi eat
talents; that he has read much and seen more; and that
he is well acquainted with mankind. Possessing these qualifi¬
cations, and tinctured with no small share of enthusiasm, he

331

Elaine on the Diseases of Dogs.

boldly advances his pretensions ; and where lie cannot fairly
comince by logical inductions, he very ingeniously substitutes
t lat species ot sophistry which is difficult to refute, because,
it is founded on hypotheses, the justness or fallacy of which
can be proved only by the test of futurity.

1J.

Canine Pathology , or a full Description of the Diseases of
Dogs ; with their Causes , Symptoms , and Mode of Cure ,

Ey Delabere Blaine, Veterinary Surgeon, and Professor

of Animal Medicine in general. 8vo. pp. 234 London,
1817. Boosey. tv >

. nature, the oeconomy, and the habits of the lower

animals be objects of interesting inquiry to the naturalist, and
their anatomy to the medical philosopher, surely a knowledge
of their diseases can neither be unimportant nor unprofitable to
the practitioner of the healing art. To one of the morbid
affections of the dog, in particular, the attention of the profes¬
sion has been forcibly impelled, by the awful consequences
which result to man from the bite of the animal in that state ;
but hitherto the disease in the dog which produces that in the
man has been scarcely investigated ; although it appears obvi¬
ous that the more rational mode of examining into its nature as
it attacks man, would be first to trace it from its supposed origin
in the dog. But if the examination of the nature of rabies in the
dog has been overlooked, still more have the diseases generally
affecting this valuable, although humble, companion and ser¬
vant of our species been neglected ; and even the slightest
attention to them has been most improperly regarded, not only
b.% a waste of time, but as a professional degradation. As Mr.
Blaine must have been at one time susceptible of these impres¬
sions, in common with every other member of the profession,
we are not surprised that he should now reflect, with u some
pride and self-approbation,11 that he is “ the first person in this
country who has systematised and brought forward a [the]
regular medical treatment of the diseases of these animals,
founded on a knowledge of their anatomy and animal (eco¬
nomy ;1r and we are satisfied that those who peruse his work
will not only exonerate him from disgrace, but yield him their
thanks; and that his exertions in the cause of the brute crea¬
tion will secure to him the approbation of every humane and
benevolent mind.”

To justify his deviation from the regular track of his pro¬
fession, and to shew that, besides inclination, “ the powerful
operation of accidental circumstances11 led to his adoption of the

u it 2 .

332 Analytical Review.

line of practice which he follows, Mr. Blaine lias given ^ a
sketch of his professional life in the preface to his volume. Vv e
do not. conceive it necessary to make any extracts from that
narrative; but shall pass on to the Introduction, which con- ^
tains a slight sketch of the natural history of the dog, and seve¬
ral very interesting anecdotes illustrative of his sagacity and

high moral qualities. .

Our author agrees with Buffon in supposing that all the
tribe of dogs has sprung from one common stock ; but, instead
of supposing with that great naturalist that the sheep dog was
the common parent, he thinks 44 the species which approac ies>
nearest to the original is the Asiatic or Indian dog , eaten by tne
natives.'” He conceives the original dog must have been in¬
tended to outstrip in speed the animals he preyed upon ; hence
4t the sharp-pointed head, the small upright ears, c.eep oie
quarters, with great length and strength in the hmdei ones ,
qualities which are eminently possessed by the Asiatic dog, who
is besides 46 ferocious, suspicious, watchful, and sleeps lightly ;
and further possesses the seeds of generosity, fidelity, and gta-
titude. Accidental circumstances, change of climate, and arti¬
ficial causes, are sufficient, in his opinion, to account foi all tie
varieties of form in the tribe ; while most of the moral qualities
of the animal are altogether the result of cultivation oi domes¬
tication with man. To illustrate these qualities, many anec¬
dotes, as we have already remarked, are detailed, either from
our author's own observations, or on good authority.

Our author commences the proper subject of his work by
some general remarks on the effects of remedies on dogs, and
the mode of administering them, which convey several facts o*
considerable importance to those who, being engaged in expe¬
rimental inquiries on the effects of poisons or of medicines on
the animal ceconomy, choose the dog as the medium of their
experiments. Thus we are informed tnat ten grains of calo¬
mel, which is by no means a destructive dose to a human sub¬
ject, has killed a large pointer ; that three drachms of aloes
may be taken by some large dogs with impunity ; and that it
is almost impossible to poison a dog with opium, a drachm pro¬
ducing but little effect; while, in general,. the largest dose that
can be oiven is 44 returned before its narcotic influence is felt."
The difficulty of administering substances to dogs has been felt
by all experimentalists; and we confess the knowledge of the
directions contained in the following paragraphs would frequent¬
ly have saved us much trouble.

<c Place the dog upright on his hind legs, between the knees of
a seated person, with his back inwards (a very small dog may be
taken altogether into the lap). Apply a napkin round his shoul¬
ders, bringing it forwards over the fore legs, by which they become
secured from resisting. The mouth being now forced open by the

333

Blaine on the Diseases of Dogs.

pressure of the fore finger and thumb upon the lips of the upper
jau , the medicine can be conveniently introduced with the other
hand, and passed sufficiently far into the throat to ensure its not
being returnea. The month must now be closed, and kept so, until
tne matter given is seen to pass down. When the animal is too
strong to be managed by one person, another assistant is requisite
to nold open the mouth * which, it the subject is very refractory, is
best effected by a strong piece of tape applied behind the holders or
tangs of each jaw.

1 he difference of giving liquid and solid medicines is not con¬
siderable. A ball or bolus should be passed completely over the
root of the tongue, and dexterously pushed some way backwards
and downwards. When a liquid remedy is given, if the quantity is
moie than can be swallowed at one effort, it should be removed
fi om the mouth between each deglutition, or the dog may be strang¬
led. The head should also be completely secured, and a little ele¬
vated, to prevent the liquid remedy from again running out.

l<r Balls of a soft consistence, and those compounded of nauseous
ingredients, should be wrapped in silver or other thin paper, or
they occasion so much disgust as to be returned.” — -p. 4.

T his section contains also some excellent remarks on (e the
intenseness of mental feeling” in the sick dog, and the necessity
of attending to its effects, which may be perused with advantage
by the majority of medical practitioners. In the observations
on the operation of astringents, the fact is stated that sugar of
lead (plumbi superaeetas), when injected per vaginam in ute¬
rine haemorrhages, to which bitches are liable, 66 often produces
violent cholic.”

The article Breeding contains some curious physiological
observations. rJL he effect of the male parent on the progeny,
for example, is well illustrated by the fact that bitches, by
uniting in their oestrum with any clog, however large, often die
in their pupping time 6i from the excessive size of the puppies.”

T he appearance of the young to either of the parents, however,
does not seem to be regulated by any fixed laws ; for some¬
times the puppies are of a mixed breed, between that of the
father and of the mother, when they differ ; while occasionally
some are of the same breed as the one parent, and some of that
of the other : thus a pointer bitch, breeding by a setter dog,
will produce some pointers and some setters. \Ve may remark
that something analogous to this obtains in the human species ;
for, occasionally, in the family of a negroe woman by the same
white man, we see some of the children extremely dark, with
features closely approximating to those of the African, while
the others have the features of the father, and are nearly as fair
as European children. Our author is disposed 44 to think that
bitches are capable of superfoetation but he does not support
Ills opinion by any very satisfactory reasoning.

Bronckocele is a common complaint in some particular breeds

334 Analytical Review .

<£$&gs ; arid Mr. Blaine remarks, 64 the treatment is not diflU
cult, nor unsuccessful, wlien early adopted. In the human
species the reverse is the case ; and we believe we may assert
that the internal remedy he recommends, a combination of
'imrnt sponge and nitre , has failed in the hands of most medical
practitioners. W e would nevertheless recommend a tnai of
Jiis external application, which is composed of equal parts of
mild mercurial and blistering ointment, and is ordeied to be
rubbed upon the swelling once a day, “ wrapping- up the neck,
with a bandage, to prevent the ointment from being rubbed
off:” but as an application to the human skin, it might be ad-
Tiseable to take one part of the blistering ointment only to three
of the mercurial.

On the subject of the Distemper, our author asserts that,

« in England at least, hardly any dog escapes it.” The attack
commences at no fixed age, but generally before the dog attains
his full growth, and seems to depend on a constitutional pre¬
disposition. Second attacks are not uncommon; but a third
attack is extremely rare. Its symptoms resemble, in some
decree, those of violent catarrh in the human species ; and,
like it, the occasional cause is cold ; but it is also contagious,
and the danger is in proportion to the youth of the animal.
It is now and then attended with a particular eruption, and
almost always with diarrhoea and convulsions. The treatment
is vomiting and purging in the commencement, followed by
febrifuge medicines and astringents ; or, if convulsions be pre¬
sent, by a compound of ether, laudanum, camphor, and am¬
monia. The fits, when present, are shortened by sprinkling
cold water in the face, and by soothing language, the -intense-
ness of the mental feeling being much augmented while dogs

are labouring under this disease. _

We would recommend to Mr. Blaine, the trial 01 inoculating
cfogswithvaccine lymph, as a preventive from the distemper ; since
from the experiments of M. Nauche of Paris, ( See Journal de
Mcdecine , Chirurgie et Pkarmacie , Mars 1817J although
not very satisfactorily detailed, yet they afford sufficient reason
to suppose, that vaccination in many instances proved a pro¬
phylactic against the contagion of this morbid affection, so fatal
to the canine race.

Dropsy , in most of its varieties of form, is by no means an
uncommon complaint in dogs. It is not so frequently iaiopa-
thic as in man; but is generally the consequence of some
organic affection, as, for example, old asthmas, diseased liver,
and obstinate or neglected mange. Tapping has been resorted
to by Mr. Blaine ; but with as little permanent utility as this
operation affords in man ; nor have diuretics proved more suc¬
cessful. Contrary to what might be expected, hydatids are
rare in these animals.

Blaine on the Diseases of Dogs .

, observations on Feeding and Exercise may be perused
with advantage by those who, following sedentary occupations,
indulge freely in the luxuries of the table.

Dogs are subject to both acute and chronic Hepatitis , as
well as Pneumonia, , Gastritis , and Enteritis. In all these com-
j) amts the practice differs but little from that which is em¬
ployed m similar affections in the human animal.

The most important article in the volume, and that for
which we have chiefly brought it before our readers, is that oa
it a Dies, vwncn, toe work being of a peculiar nature, is treated
of under the title « Madnessf The advantages our author
possessed for observing this disease in all its bearings, and the
morbid changes connected with it, in the system of the dog
have been, perhaps, never before enjoyed by any person; and
when we also consider his capability of profiting by the oppor¬
tunities he enjoyed, the facts he has brought forward become
highly interesting and valuable.

Mr. Blaine justly regards the term hydrophobia, when ap-
P]ied to designate this disease in the dog, as highly exception¬
able ; since the animal, “ instead of shewing any dread of water,
in most instances seeks it with avidity, and laps it incessantly.™
He notices the evils that this opinion has led to, in lulling into
dangerous security persons bitten by dogs actually rabid ; and,
in particular, refers to one instance, m which an eminent phy¬
sician, on being consulted by a person bitten, ii recommended.
t;.at no precautions might be taken," because he was informed
the dog could drink.

<r His advice,” adds our author, “had it been followed, might
have caused the death of three persons. Fortunately for them, his
opinion was not attended to, and I dissected the wounded parts out
of eacii ot them. In five weeks, ari unfortunate spaniel, who had
been bitten by this same dog, became mad ; and in six weeks a
horse, bitten by him, became mad also.” — p. pp.

It often happens, however, that, from a paralysis of the
lovei jaw, the dog is unable to swallow the water which he s®
eagerly laps; but, even in this case, so far from betraying
dread or disgust to water, Mr. Blaine remarks, “ I have fre¬
quency seen the nose thrust up to the eyes into a vessel of cold
water, purposely to enjoy the sense of cold occasioned thereby ™

Another absurd popular error, combated by our author, is
the opinion that the worming a dog, which is merely removing
the fraenum from the tongue , “ will prevent his becoming rabid
at any future time.™

As far as the dog is concerned, the term madness , although
adopted by Mr. Blaine in compliance with general prejudice's
regarded as improper ; as in very few instances are the mental
faculties much, distorted, and the animal recognizes the voice of

330 Analytical Review.

his master, and is obedient to it, frequently to the last moment
of his existence.

« In other animals, however, there is more propriety in the
term * for even the peaceable sheep become astonishingly ferocious
in this malady. In the rabid horse, the sight is most terrific: I
have seen one clear a six-stall stable of racks, mangers, standings ,
and posts; and every thing, but the bare walls, was levelled into
ruins around him. On the mal-appropriation ot this widely-
diffused term I shall have numerous other occasions of remark-
mg.” — p. 102.

Another opinion still, which our author endeavours to con¬
trovert, but certainly we think with less force, is that which
supposes, that the disease is occasionally bred in the dog who
exhibits it; while he maintains ‘‘that every rabid dog must
have been previously bitten and this opinion he grounds
“ in long experienced’ and a mature consideration of the sub¬
ject, Consistent with this doctrine also, he conceives it is
erroneous to suppose, that the disease is more prevalent
durin cr summer than in winter.” We do not mean to atiempt
to weaken the force of these remarks ; but we must confess we
cannot shake off so completely our fostered prejudices as im¬
plicitly to adopt them. We are willing to admit, however, that
« tradition and error may have implanted these prejudices m
our mind in common with that of the public, and that we mav
find on attentive examination and from experience, that they are
wholly without foundation.”

Our author’s description of the symptoms of rabies is not
very methodical ; but in our analysis or it we snail endeavour

to give it a more perspicuous arrangement. # .

When a healthy dog is bitten by another which is rabid, the
disease seldom shews itself before the third or fourth week after
the accident ; sometimes the seventh week passes before the
symptoms are apparent ; and occasionally three 01 four or more
months elapse. Accidental circumstance, however, hasten toe
attack ; as, for example, a long and fatiguing journey ; a cold ;
or, if the animal be a hitch, the presence of the oestrum.
Something also depends on the part that is lacerated , for when
the head has been bitten, the symptoms of rabies sooner ap¬
pear. The first symptoms are very obscure, and consist chiefly
m some peculiarity of manner in the animal ; as, for instance,
the picking up and swallowing of straw s, threads, paper, and
many other things that a dog will not eat when he is well: he
gnaws also every article within his reach ; there is a great pre-
diliction for applying the nose to any thing that is cold ; and he
frequently scratches and bites himself, particularly in the part
which was bitten. The appetite is not much impaired-, althoug
some cases are attended with sickness ; but the taste is often so
depraved, that the animal eats his excrement and laps his urine.

337

Blaine on the Diseases of Dogs.

ilFter a day or two, the dog generally leaves home and roves
about, displaying a great antipathy to other animals, particu¬
larly his own tribe, and biting every dog that comes near him.
He seldom however attempts to bite a man, unless hunted into
fury, or otherwise much irritated ; but occasionally very little
irritates him, such as the merely presenting to him a stick or
the foot. The usual meekness of the animal is often conspi¬
cuous to the last, particularly to his master ; but sometimes,
whilst every mark of tractability is displayed, “ he will be
very likely to turn on a sudden, and snap at the person who is
caressing him. ’ When roving about, some dogs are silent ; but
tne majority howl or bark with a very altered tone of voice,
which is readily distinguished from that of health. If an
affected dog come up to another —

“ kttle or large, he goes up and smells to him, in the usual way of
dogs, and then immediately falls on him, usually giving him one
shake only : after which, lie commonly trots off again in search of
another object. The quickness with which this attack is made, very
frequently surprises the bitten dog so much, as to prevent his im¬
mediately resenting it: but nothing is more erroneous than the
supposition, that a healthy dog instinctively knows a rabid or mad
one. 1 have watched these attacks in numerous cases, and I have
seen the mad dog tumbled over and over, without the least hesita¬
tion, by others that he had attacked.” — p. 113.

ihe younger the dog is, the greater is the disposition to rove,
the more striking are the symptoms of mental alienation, and he
is proportionally wilder and more mischievous. These are the
usual symptoms of the disease in the dog; but scarcely two
cases are alike in any of the particulars. Our author ascribes
this diversity to the parts principally attacked.

“ When the inflammation exists most in the bowels, it generally
produces an affection of the neck and throat. This affection consists
in a trifling enlargement of all the parts around ; the tongue hangs
out, and is discoloured, and, from a partial paralysis of the muscles
or deglutition, there is frequently a difficulty, but never any disin¬
clination to swallowing. In such eases there are also greater heavi¬
ness, stupor, and distress, with a marked weakness of the hinder
parts. It is this kind, from the dropping of the jaw, that sportsmen
are led to call dumb madness ; but it is evidently incorrect so to
call it, because it is often accompanied with howling.

On the contrary, when the lungs are the principal seat of
the affection, there are usually much more quickness and irritability
in the dog’s manner. Fie rather barks, with a hasty and altered
tone, than howls. He snaps at passing objects, as flies, and shakes
his chain, or the vessels he drinks out of," with seeming violence :
but all this is the irritability of a moment ; for the voice of his
owner will generally quiet him at once. As in some cases, however,
both the abdominal and thoracic viscera are nearly equal partakers
of the specific inflammation ; so these symptomatic appearances ;

VOL. VIII.— 'NO. 46. XX

33S Analytical Review.

often blended, and appear, though in mitigated degrees, in the same*
subject.” — p. 110.

The eyes are commonly red and suffused in the early stage
of the disease, and now and then ulceration of the pupil super- •
venes. The animal often displays symptoms of uneasiness in
the bowels, by gathering straws and applying them to the
bowels ; and costiveness is always present.

Sportsmen notice two varieties of rabies, which they deno¬
minate dumb and raging. The former is the more common ;
and is usually attended with a considerable affection of the
mouth and throat.

“ To speak anatomically, the whole of the pharynx and larynx
are tumified, and the surrounding muscles affected with paralysis.
From this cause the lower jaw drops, and is incapable of remaining
closely applied to the upper. The tongue becomes also affected
with the paralysis, and hangs pendulous without the mouth. A
similar torpor apparently pervades the blood vessels of these parts,
which become filled with venous blood : the tongue in particular is
black, more especially so at the apex or point : sometimes a black
stripe extends along the whole extent. The paralysis extends to the
back of the oesophagus, from which a great difficulty is frequently
experienced in swallowing ; but in no instance is any dread of liquids
expressed ^ nor does even the attempt to swallow appear to give
pain. The larynx, participating in the affection, occasions a deep
choaking kind of noise, which seems to issue from the bottom o£ the
glottis.

« Sometimes the mouth is quite dry and parched ; at others it
is very moist, and a quantity of saliva continually flows from tne
.jaws. When the mouth is affected in tills manner, the sufferings of
the poor animal are extreme, for his thirst impels him to oe con¬
tinually lapping ; but the paralysis of the lower jaw prevents his
retaining the liquid in Ins mouth, and it falls out as fast as taken
in.” — p. 115.

The duration of the disease varies very considerably. . It
seldom proves fatal before the third day ; hut few dogs survive
the seventh. The average deaths happen on the fourth and
fifth days.

Our author had many opportunities of ascertaining the
morbid appearances presented by dissection in dogs affected
with this disease, and he has availed himself of them. .When
there has been much irritability, panting, and disposition to
mischief,, the brain and its membranes exhibit marks ot increased
vascularity ; and the same is the case with the lungs, one side
of which is generally more inflamed than the other ; and when
the animal has actually died of the disease, the Jobes of this
viscus are found black and gangrenous. W lien however there
has been a disposition to collect straws, and to place them under
the belly, and to swallow indigestible substances, as hay, rope,
wood, coals, &c. the stomach and bowels chiefly are inflamed 3.

339

Blaine -on the Diseases of Dogs ,

tmd the above enumerated substances are found united, and
forming a crude mass in the stomach. This is regarded by our
author as one of the most certain evidences of the previous
existence of the disease. The mesentery, the liver, and the
diaphragm, also occasionally exhibit marks of inflammation ;
but this Mr. Blaine regards as altogether sympathetic. In the
majority of 'cases, some inflammatory appearances are visible
at the posterior part of the mouth, and in the pharynx ; and a
peculiar inflamed spot, which is highly characteristic of the
disease, is always discovered at the back of the fauces.

Mr. Blaine very justly remarks, that neither in the dog nor
m the human animal ought we to place much reliance on any
method of preventing the disease after the bite has been in¬
flicted, except the part be excised. This can always be effected
in man ; but in animals it is sometimes difficult to discover the

parts that have been bitten ; and consequently he was desirous
to discover some preventive of the attack, and he is fully per¬
suaded lie has accomplished this in the following recipe, which
he obtained from “a cottager of the name of Webb, near
Watford.” We subjoin it, not because we would place much
reliance on its efficacy; but that it may be submitted to a fair
trial on dogs ; for we should be sorry to find the safety of any
of our fellow creatures confided to its powers.

“ The following, which is an improvement on the original for¬
mula, is that which, after much experiment, I find the best method
of preparing the remedy : —

Take of the fresh leaves of the tree box... 2 ounces

Of the fresh leaves of rue... . 2 ounces

Of sage . . . half an ounce.

Chop these finely, -and, after boiling them in a pint of water to half
a pint, strain and press out the liquor. Beat them in a mortar, or
otherwise bruise them thoroughly, and boil them again, in a pint of
new milk, to half a pint, which press out as before. After this, mix
both the boiled liquors, which will form three doses for a human
subject. Double tiffs quantity is proper for a horse or cow ; two-
thirds of it is sufficient for a large dog, calf, sheep or hog ; half of
the quantity is required for a middling sized dog ; and one-third
_ipr a small one. "These three doses are said to be sufficient, and are
directed to be given, one of them every morning fasting. Both the
human and brute subjects are treated in the same manner, according
to the proportions directed.

In the human subject I have never found it produce any effects
whatever but a momentary nausea from disgust. To prevent this
disgust operating disadvantageously, the old recipe directs it to be
given two or three hours before rising, which is not a bad plan, be¬
cause it will be less likely to be brought up again by such precaution,
which so large and unpleasant a dose might otherwise be. Neither
m any animal, except the dog, have 1 ever witnessed any violent
effects from the exiiibition of this remedy. In dogs, however, I

x x 2

340

Analytical Review.

have frequently seen it produce extreme nausea, panting and dis¬
tress ; in two or three it has even proved fatal : but, as I conceive
that it is more likely to be efficacious, when it shews its effects on
the constitution ; and as, at the same time, it is proper to guard
against these effects being too violent: so it is prudent abiaj's to
begin with a smaller dose than the one prescribed, and to increase,
it each morning till it shews its activity, by sickness of the stomach,
panting, and evident uneasiness. In such cases, perhaps five doses

are not too much. _ . . ,

« In along and successful practice, I have given this remedy to
nearly three hundred living beings. About fifty human persons
have taken it, eight; or nine horses, several sheep, and a few cows
and hogs. The rest were dogs ; but in almost all I was enabled to
trace the history of the danger, to a conviction, that the animal con¬
cerned had been bitten by a dog unquestionably mad. Out of this
number, I am happy to state, and which I conscientiously and
solemnly do, that only nine or ten instances oi failure have occurred ;
but candour obliges me to own, that four or live or these were pal¬
pable and fair cases ; for the medicine was given apparently with
every caution.” — p. 128.

Our author nevertheless leans as he ought to do to the supe¬
rior safety of excision ; but he thinks “ it is of no consequence
that the excision or cauterization should be immediately effected ;
as it is equally efficacious if done at any time previous to the
secondary inflammation of the part bitten.” Vv e would accord
with this opinion did we conceive it likely that individuals
would as readily submit to excision alter some time has elapsed
from the infliction of the bite, as directly alter it has been in¬
flicted ; but as .this is not to be expected, we are of opinion
that the excision cannot be too soon effected ; although it ought,
not to be left undone, should even some days have passed,
under the impression that it is then too late*.

The only notice we conceive necessary to be taken by us
regarding mange , which is the subject of the next section, is to
mention the idea of our author, that u the canine mange is
capable of producing the human itch A "We are not. prepared
to deny the assertion, but we doubt its accuracy ; for as very
few dogs escape an attack of mange, were it capable of com¬
municating scabies to the human subject, we should find the
disease more prevalent than it is, particularly among the lower
classes of people, among whom, few families are without a aog.

Rheumatism is a disease almost as common to the dog as to
man ; but in the quadruped it is attended by some peculiarities.
Thus in the dog, it is never present without affecting the
bowels ; and paralysis of the hind legs is also a common ac¬
companiment of the complaint, when it affects the lumbar

For our particular opinions on this subject, see Repository, vol.
iii. p. 4? -54.

Ainslie on Balsam of Peru in Phagedenic Ulcers. 341

muscles. The treatment recommended by our author, consists
of the internal exhibition of purgatives combined with opium,
the use of the warm bath, and the local application of an em¬
brocation composed of oil of turpentine, spirit of hartshorn,
laudanum, and sweet oil, in equal proportions.

Dogs are very subject to taenia, the lumbricus teres, and
ascarides : they are also troubled with another kind of worm
which is not found in the human body, and which Mr. Blaine
describes very vaguely, by saying that it has a short body re¬
sembling that of a maggot, and a red or black head. There is
nothing new in the treatment recommended ; but we are sur¬
prized that he appears to be ignorant of the effects of oil of
turpentine in taenia.

We conceive it unnecessary for us to go through the re¬
maining articles of the volume, which are of a nature that ren¬
ders them interesting to those only who are immediately con¬
cerned in the treatment of canine diseases.

In concluding, we have only to remark, that in a general
point of view, this volume is certainly interesting, as extending
the limits of pathology, and affording an illustration of the ii£
duence of morbid causes on the animal frame, modified by
habit and circumstances. Yet reflecting that its author re¬
ceived a regular medical education, we have been struck with
the limited knowledge of physiology it displays; and the few
efforts he appears to have made to illuminate many important
questions in the doctrines of animal life, compared with the
many opportunities he possessed. In a second edition of the
%vork, he may supply this deficiency ; and we would also re¬
commend him to improve his style of writing, and to correct
the many grammatical inaccuracies that deform the pages of the
present.

PART III

SELECTIONS.

On the Use of Balsam of Peru in Sphacelous and Phagedenic
Ulcers. By Whitelaw Ainslie, M.D.

As the information contained in the following letter has, we
believe, never been published in Europe, no apology is neces¬
sary for its appearance in the pages of the Repository. —Editors.

To the Honorable Court of Directors of the East India Company.
Honorable Sirs,

I some time ago transmitted to the Superintending Surgeon
of the Centre Division of the Madras Establishment, for the

312

Selections.

information of the Medical Board, a Letter containing an ac¬
count of a new method of treating a dangerous and but too
common disease m our Indian dominions, and invo.tr mg, m t.ue
detail, virtues in a medicine which I believe have not hitherto
been particularly noticed. I was gratified to learn that my
paper had been well received, and that measmes haci m cmisi.-
quence been taken, to have the mode of practice recommended
amongst the professional men of this Coast.

A continuance of success in the management of the same
malady, since that period, has emboldened me to Adiess to
your Honorable Court, through the Superiors of my line m this
country, a more specific account of what I have done, fiom a
conviction, that any well-intended tract, on a subject of puonc
utility, front whatever servant it may come, cannot be unwel¬
come to you ; and as X conceive that in this way 1 have an opt-
ed the most proper channel, through which X could e\ er pos¬
sibly hope to advise the medical men of England of what had
been found worthy of attention in the climate of Asia.

There are, X believe, few diseases to whicn the human name
is liable, that have oftener baffled the skill of our surgeons, in
all parts of the world, than those called Ulcers, and which form
a very numerous and multiform class. It is not my puipose at
this time, however, to particularize the different kinds which
have been treated of by many late able writers ; nor io point
out how far m every case, what may have been i ecomm ended
as advantageous in the cure of them in cold climates, has been
thought beneficial in wanner latitudes ; though I must confess
that "the field is a very fair one for ingenious and useful discus¬
sion, and unquestionably one hitherto but little trodden : X shall
therefore without further delay, proceed to lay before you the
immediate object of this report, in communicating what has
come within my own observation, regarding some or the worst
Xiinds of ulcer in this country; with an account of a mode of
treatment, which, as it is uncommon, may perhaps be in some
measure interesting ; and, from its having m every instance in
which X have had recourse to it, been attended with success ;
may at least be deemed worthy of a more extensive trial.

"Whilst X had charge of the Field Hospital at Hurryhur,
(in the months of March, April, and May, 1803,) which re¬
ceived the sick of the Grand Army then under the command of
His Excellency General Stuart ; it was with peculiar uneasiness
that I witnessed the great havoc committed by what are caded
the sphacelous and phagedenic ulcers. They were at that time
confined almost entirely to the native corps, and especially to
such as had been recently exposed to great fatigue, cold, mois¬
ture, and poor living in unhealthy districts ; most of the Sepoys
who were so affected, ascribed their misfortunes to slight
causes ; such as scratches, bruises, &c. but which, in place of

Ain she on Balsam of Peru in Phagedenic Ulcers . 343

healing up kindly, soon became foul and painful ulcers ; the
discharge ichorous and offensive, the edges rugged, and attended
with a degree of inflammation for several inches round. These
sores for the most part spread rapidly, not unfrequently laid the
bones bare, and were accompanied in every instance with the
greatest debility and anguish in the patients ; whose appetites
soon became impaired, their pulses quick and feeble, and in f&ct
s. nectic diathesis was evidently induced from the absorption of
moibific mattei, of a most dangerous nature. Every external
application, and every mode of bandaging and management was
yad recourse to, at different times, as recommended by Messrs.
i3(, 11, Home, &c. but, 1 am concerned to say, with little or no
good effect, nor did bark and wins seem to be of much service -
and trie few cuies we did accomplish, were never without ^reat
;oss oi suostance, nay, sometimes the limb itself; and but too
frequently left the patient emaciated and drooping. I could
not help feelmg for the sufferings of so many valuable men, and
legretted that some more efficacious remedy had not been dis¬
covered, to arrest the progress of this most lamentable disease ;
atid this regret I oftener than once expressed to Dr. Berry, the
-superintending surgeon of the division to which I belong a
gentleman, from whose professional research I have on many
occasions experienced the most flattering support. His cause
of anxiety on this occasion, he informed me, was not less than,
mine, and he was at much pains to explain to me all that had
been done, in such dangerous cases, by several of tlie surgeons
of his extensive circuit. After my return to the Carnatic,
about, I think, the end of August 1803, it was not for many
months that I had a phagedenic ulcer under my care, 'when
one occurred in a Lascar of the second battalion of artillery at
St. J nomas s Mount; aware that it something more powerful
tnan any tnmg I hau formerly used was not applied, I should
in a few days witness a repetition of all the sad symptoms that
nad caused me so much distress at Hurryhur; I was determined
to try what could be done, and bethought me of the balsam of
Peru, a medicine for some years past almost entirely neglected.
But as I knew it to be stimulating in a high degree, and at the
same time balsamic, I could suggest nothing from which 1 could
more reasonably look for advantage. The Lascar’s sore, when
I first saw it, was not larger than a crown piece, situated near
the inner ankle of his left leg, and first brought on, he said, by
a slight blow; it was foul, offensive to the smell, and evidently
phagedenic ; the patient was weak and irritable, his appetite
gone, nights restless, and his pulse weak and fluttering. I
immediately ordered the sore to be dressed twice daily with
hut moistened in the balsam of Peru ; and the better to judo-e
of the effects of the application, I prescribed for him So

344

Selections*

internal medicine whatever : at the end of twenty-four hours
T was happy to perceive that the sphacelous parts were begin¬
ning to slough off'; by the third day, the face 01 the sore was
quite clear, and in a clay or two more, fine new granulations,
being seen on its surface, I found my purpose effected, and
laid aside the balsam, for which I substituted common cerate
dressings, with a tighter bandage. The sore, thus reduced to
the state of a simple ulcer, healed up kindly in a short time ,
about a fortnight after this, I had the good fortune to experi¬
ence equal success from the balsam, used m the same way, m a
case of irritable phagedenic ulcer, upon a soldier s loot, ot the
second battalion of artillery, and which was communicated to
Dr. Berrv, in my Medical Journal for December 1MU do
this man' however, I must observe, as he complained of most
excruciating pain, I gave a bolus every night of two grams o.
opium and two of camphor, but to these medicines I did not

in any degree ascribe his recovery. _ . , .

It was at this period that I visited the naval hospital at

Fort St. George, accompanied by the surgeon in charge (Mr.
Underwood), who was so obliging as to shew me every remark-
able case at that time under his care. Gut of about e>00 sick
seamen, there were nearly 200 afflicted with malignant ulcers,
such as we see mentioned by Home*, Lindf, and most pani-
cularly by Dr. Trotter^, in his valuable work mtitled Mechanic
Naulica. This last mentioned gentleman, m more parts than
one of his book, speaks with horror ot the malady, and with
much regret at the so frequent want of success in the manage¬
ment of it. Many of the ulcers in the naval hospital at
Madras were dreadful to look at ; in some, large portions o
the bones of the leg were exposed, and, in spite ot the most
humane care and attention, not a few ot the patients were
rendered lame for life ; in others, amputation became neces¬
sary ! ; and all, who had ulcers of any extent, seemed evidently
to suffer from the absorption of ichor and putrefaction. W hat
Mr Underwood found most benefit from, were tincture of
myrrh and Venice turpentine, in the way recommended m the
Edinburgh Practice of Medicine (Vol. m. p. o()4) ; he also
used occasionally a solution of lunar caustic and red precipitate
But he seemed above all to place reliance on the most strict
attention to diet, which he ordered to be light and nourishing.

* gee Hornets Treatise on Ulcers, p. 10(5.
f See Lindt? Treatise on the Scurvy, p, 154, 155.

+ See Trotter's Medicina Nautica, vol. ii. p. 179°

II Mr. Underwood informed me, that he sometimes found aitei*
amputation the sphacelous affection attack the stump itself.

Ainslie on Balsam of Peru in Phagedenic Ulcers. 345

1 did not hesitate to inform him of the great advantage I had
found in cases of sphacelous and phagedenic ulcer from the
external application of the balsam of Peru, and advised him
by all means to trjT it in his hospital; but he has not yet
informed me with what success. However, I was not suffered
to remain long in doubt regarding the powers of this remedy
in cases of malignant ulcer after a long sea voyage ; the fleet
ot Indiamen that arrived at Madras about three months ago,
from England, had been nearly seven months at sea, and,
having on board 300 recruits for the Coast Artillery, I found
several amongst them scorbutic, though in a slight degree.
Some little time after their reaching the Mount, and coming
under my care, it was necessary to punish two men; and
though the punishments were moderate, (neither of them
having received more than two-hundred lashes,) I soon saw
what I had to expect from the event : their backs, in place of
healing up kindly as is commonly the case, shortly put on an
ugly aspect, and, towards the end of the third day from the
flogging, two little ulcers made their appearance on the parts
that were most bruised, each about the size of a rupee, with a
white viscid matter inside, and uneven edges. Before I had
recourse to the balsam of Peru, I was resolved to see what
could be done with other remedies, and with the exception of
the gastric juice* of gramenivorous animals, which in cases of
this nature has been recommended by Dr. Harris*)*, a physician
of the navy, as well as by Dr. John Harness];; there is nothing
which has been advised by any late writer, whether external or
internal, that I did not try, without, I must say, the smallest
lasting good effects ; it is true, that the tincture of myrrh and
turpentine, the solution of lunar caustic, the camphorated
spirit and alcohol, did occasionally, for a time, operate in clear¬
ing away part of the corroding matter ; and the bark, wine,
and tinct. ferri muriat. gave, I thought, a degree of support to
the sufferers : yet, the effects of all these were but transitory ;
the sores increased daily, and no relief was gained in regard to

* The late Mr. Justamond, we are told by the author of the
Edin. Practice of Med., used this remedy in similar cases many
years ago.

t See Horned Treatise on Ulcers , p. 107.

+ See Medicina Naulica , vol. ii. p. 223. — Mr. Stewart Henderson,
in the Medical and Physical Journal, has given an excellent account
of this ulcer to the world, as it appeared to him in the naval
hospital at Antigua in 1780. He mentions it as one of the greatest
saourges amongst our seamen, and it would appear that he placed
his chief reliance in treating it on the hydrarg. nitrat. mb. and
camphorated spirit as external applications, with the bark internally.

VOL, VIII. — NO. 46. Y Y

346 Foreign Medical Science and Literature .

the general feelings of the patients. Before I began to apply
the balsam of Peru, the ulcers on the men’s backs were each
as large as a common sized hand, deep, frightful, and most
offensive to the smell, in spite of frequent washings writh ^
decoction of bark, tincture of myrrh, and the nitrous acid.
The patients were otherwise extremely weak, languid, and
spiritless, their pulses quick and fluttering, appetites gone,
nights restless ; in fact, labouring under the most wasting
hectic diathesis, and to all appearance hastening to dissolution.
To the ulcers of these two recruits, the balsam ot Peru was
first applied on the same day ; but to the one man I continued
the use of bark and wine internally ; from the other they were
stopt ; but both went on with their ripe fruit and light farina¬
ceous diet. I shall not detain you, Honourable Sirs, with more
particulars; suffice it to say, that, from the first day s applica¬
tion of the balsam, the sores put on a favourable appeal ance,
the mischief was in fact arrested, and the patients seemed to
feel an almost immediate relief ; by the end of the third day
the sores were clean, and bv the end of the fifth, new granula¬
tions were every where seen rising up; their pulses, appetites,
and spirits returned to their natural state ; and they again
enjoyed sleep without an opiate, which they had not done for
many nights before. The ulcers being thus reduced to the
state of simple sores, the balsam was discontinued for otner
dressings, and the men were discharged for duty. These two
cases were detailed at full length in my Medical Journal loi
March 1806, forwarded to the Medical Board at Fort St.
George.

(To he continued. )

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

ANATOMY, PHYSIOLOGY, PRACTICE OF MEDICINE, AND

SURGERY.

Dr. Granville’s Communications on the Progress of Medical

Science in France .

letter vi.

tc At one of the last meetings of the Society of the Faculty
af Medicine, M. Esquirol read a Memoir on Epilepsy, in which
he relates that, having had occasion to examine about filteen

"Granville on the present State of Medical Science in France. 34 7

subjects who had died in consequence of severe paroxysms of
that disease, he constantly found the superior portion of the
spinal marrow in a softened state, and of a grey or rosy colour.
1 his led him to apply the moxa several times on the vertebral
column in a young girl in whom the paroxysms of the disease
returned with the menstruation. By this treatment the pa¬
roxysms became at first less frequent, and of much shorter
duration, till they ceased at last altogether.

“ There is a young woman now living at Versailles, aged
twenty-four,, and married, who has never menstruated, and in
whom there is reason to suspect the non-existence of the uterus.
rlhe external parts of generation are very imperfect. There is
an opening of a very small diameter, at the bottom of which a
largish orifice serves for the passage of the urine. No other
part of the vagina is visible. The woman never suffered any
material inconvenience from this singular conformation till the
epoch of her marriage, when the wish of remedying, if possible,
this imperfection by an operation, led the parties to call in sur¬
gical assistance. Nothing as yet has been done for her. The
finger introduced through the rectum cannot discover any sign
of the existence of the womb.

“ An operation on the rectum was, within these three days,
performed by Boyer at La Cbarite. You may recollect the
memoir this gentleman read on the strictures of that intestine.
The present was a case of this kind ; and Boyer not only made
an incision through the sphyncter, but brought away a portion
of the diseased intestine. A very abundant haemorrhage took
place a few hours afterwards, and the patient died next day—
not from, the latter accident, but, as I have reason to suspect,
from a portion of the peritoneum having been brought away
with the intestinal fragment, by which an opening w7as made into
the cavity of the abdomen, giving admittance to blood and the
fecal matters.

44 The eighth volume of the Transactions of the Medical
Society of Emulation has just appeared. It is a valuable col¬
lection of facts, which I shall make it a point more particularly
to detail in a future communication.

1,4 Dr. Portal has informed me, that his great work will
shortly be ready for the press, for which numerous mate¬
rials have been collected from the most authentic sources,

44 De Causa et Sede Morborum.” It will be in five volumes,
octavo, and will contain the History of the Diseases he, as well
as many of his colleagues, have had occasion to observe during
a very long practice, accompanied by a description of the organic
lesions discovered on dissection.

44 M. Esquirol will shortly publish the history of all the
organic alterations he has met with in the course of his practice

y y 2

•348

Foreign Medical Science and Literature.

in dissecting the bodies of insane persons who died at the Sal-
petriere, and which have been very numerous.

4i Of the many lectures given in this capital, that of Orfila,
on Medical Jurisprudence and Toxicology, illustrated by nu¬
merous experiments on dogs, in which I assisted, is just finished. *
Crowds of students and others are now attending Vauquelm
on Animal Chemistry and Cuvier on Generation ; both which
courses are of the highest interest and importance.

44 In the department of the profession more immediately
my own, that of Midwifery and the Diseases of Vv omen and
Children, I have many important and curious facts which I
might communicate. But I must reserve them lor the work I
shall publish on those subjects on my return to England.

44 You will in the mean while oblige me by announcing to
the public that I shall have ready for publication, early in 181 8^
a work, in two volumes, with plates, on the Actual State ot.
Science and Scientific Instruction in France; including a general
and detailed account of the System of Medicine and Surgery,
the hospital establishments, scientific men and their writings,
and a description of every object connected with science in
general. A. B. GRANVILLE."

Paris, July 20, 1817.

XI.— Cure of a Case of Chronic Trismus, with an induration
of the muscles, by Dr. Jasinsky.

44 Majorkowa Szlagu, a native of Lomza, in Poland, twenty
years of age, was received into the Policlinicum on the 22 d
December 1814. Her condition was as follows : she was of a
pretty robust constitution, her eyes and complexion lively, her
right cheek perceptibly swoln,on both sides very large scars to be
seen, which extended as far as the ears, and the muscles of the
right cheek were entirely indurated. On the inner suriace of the
masseter muscle the constriction and induration was so strong,
that it felt like a flaxen chord, and it was scarcely possible to
introduce a finger between it and the gums, whereby the jaws
were so firmly locked, that not the point of the little finger, nay,
scarcely the head of a large pin could be introduced between the
teeth; and some callosity also was plainly felt in the articula¬
tion of the jaw. The appetite was good, but the patient could
take fluids onlv ; the belly was somewhat hard, the pulse quite
regular, and also the menstruation. No traces of syphilis were
to be observed. This state originated from fire, which occa¬
sioned a long suppuration, and scrofulous metastases. It had
been rendered worse by her having caught cold, and subse¬
quent rheumatism.

44 She was born of healthy parents, passed through the
iqfantine diseases, and, according to her own words, had

349

Jasinsky on a Case o f Chronic Trismus.

always enjoyed good health ; altliougli some swelled glands of
the neck proved her not to have been entirely free from scrofu¬
lous diathesis. ri he menses made their appearance when she
vwis fourteen years of age. She was married the same year,
and in the course of a twelvemonth was safely delivered of a
boy. i our days alter being brought to bed, a fire broke
out m the house, when the flames firing her bed, her neck was
burnt in such a manner, that the skin, and the muscles, such
S j the platysma myoides, sterno-cleido mastoideus, & c. together
with the back part of the ear, were burnt. The effects extended
to all the neighbouring parts, and nearly took a twelvemonth
in healing, leaving a large scar ; but the patient still could move
the jaw, and found herself pretty well, till about four months
before, when a sudden fright, and violent cold, brought on an im¬
mobility of the lower jaw, which she could neither move down¬
wards nor sideways; and of course mastication was impossible;
therefore she was forced to live upon fluids. Various remedies
had been applied, but without success ; and for the sake of
getting cured, she undertook a journey of 130 German miles to
Eerlin ; but had the misfortune of being more than once over¬
turned into the water on the road, from which she again
, caught a violent cold.

“ The great destruction of the muscles, which had already
become callous, togetherwith the articulation of the jaw, and the
long existence of the evil, gave an unfavourable prognosis.

1 he indication was directed to the local dissolving and moli-
fying the induration and contraction, and also to operating vi¬
gorously upon the lymphatic and absorbent systems. For this
purpose, I prescribed— Calomelanos, Sulph. aurati, ana,
gr. ii. Sacchari albi Syrupi. q. s. fiat Pulv. disp. dos. Nro. 6.
Morning and evening, half a powder.— Extr. Cicut. drachm
m Pulv. Hb. Cicut. q. s. ut fiant pil. Nro. 120. Two pills to
be taken three times a day, increasing the dose one pill every
second day. — Unguent Althaeas Ung. Hydrarg. ana, % ss.
Camph. tere. 3 i. ; to be rubbed in on the indurated parts every
day. Perpetual blisters behind the ears, and continued warm
cataplasms of linseed and cicuta on the cheek and jaw, together
with warm oaths, were also ordered. These remedies were con¬
tinued for three months without interruption, except when on
the appearance of salivation, they were set aside fora few days.
The doses were gradually enlarged, so that at last 4 grains” of
calomel and 16^grains of Extr. Cicut. were taken every day.
The condition of the patient improved gradually durum the
application ; and about the beginning of April” she was so
fair recovered, that instead of not being able to move the
jaw nor open her teeth at all, three fingers could now be
introduced between her teeth, and she was able to move the

350 Foreign Medical Science and Literature.

iaw in every direction , so as to chews, meat and other solid vic¬
tuals very well. Besides, the induration of the muscles and
ligaments had almost entirely disappeared. .

« Thus, in the course of four months, her former complaint
was entirely removed ; when a new swelling of the glands, par¬
ticularly those of the groins, took place, together with an acrid
floor albus, which however was not of a syphilitic nature, but
plainly bore the character of a former latent scrofula. ^ ^How¬
ever, this complaint was soon removed by the addition of Resin.
Guiac. to the above remedies, and the outward application of
lime-water, and she was dismissed perfectly cured. —Ii iifeicinds

Journal .

MATERIA M.EDICA.

HI.— M. Dub uc. Governor of the island of Martinique,
having transmitted to M. Alibert, principal physician of St.
[Louis’ Hospital, Paris, a quantity of bark, the external charac¬
ters of which resembled those of cinchona , some specimens
were given to M. Cadet, who examined them ; of which he has

published the following account A ^ ^

“ The specimens do not appear to have been ail taken *rom
the same tree. Their general colour is brownish grey ; some
of the pieces are thin and slightly wrinkled, like the epidermis
of Angustura ; others are thicker and rugose : while some ex¬
actly resemble quilled cinchona, and are here and there studded
with whitish dots, similar to those left by lichens upon pale

cinchona bark. . .

u The colour of the powder of these specimens of bark is a

deep shade of greyish brown ; the taste is considerably more
bitter than that of the best cinchonas, but less so than that of

Angustura. > . ,

64 A strong decoction of the bruised bark has a ^eiy deep

colour, and becomes turbid on cooling. 1 he addition m gela¬
tin to a warm decoction prevents it from becoming iiiibid,
without doubt by augmenting its density. Ibis cnaraeteristic
is common to this bark and to the pseudo-Angustura. This
decoction, filtered after being cold, is transparent and always ot
a deep colour, and tastes at first sweetish, but afterwaids ex¬
tremely bitter. It is copiously precipitated by tartar emetic,

but not at all by a solution of glue.

44 The aqueous infusion, made in the cold, is affected by
gelatin and tartar emetic in the same manner as the decoction.
Sulphate of iron throws down in it a greenish black or slate-
grey precipitate. The supernatant fluid left upon its precipi¬
tate for twenty-four hours, acquires a beautiful green colour.

* Journal de Fharmack, Nov. 181 6, p. 509-

Hebreard on a Scirrhous Tumour of the Brain. 351

The same phenomena occur on treating the true Angustura in
nla"Re’j, ^'trate ot silver forms in it a precipitate of
* ,f ,C° °pr of cof!.ee’ WItl’ "»ilk in it, which is permanent. Sul-
} a e of copper throws down a deeper coloured precipitate. It
if "0t P/e“P'tated by muriatic acid; but the addition of prus-
, te June gives the fluid a beautiful green colour ; and it
deposits, at the end of twenty-four hours, a slight blue preci-

“ From these experiments the species of bark under con¬
sul elation seems to resemble, in some respects, the pseudo-
Anguslura , yet it cannot be regarded as a false Angustura.
it is, nevertheless, proper to be cautious in employing it as a
medicine, until the character of the tree from which it is pro-
cined has been ascertained.” *

nr u -—Description of a Scirrhous Tumour of the Brain, by

dEEREASD, one of the Physicians of the Bicetre*.

- Simonet. — The individual in whose head this tumour was
found, was sixty-three years of age, and a baker. He was sent
to the Bicetre from the Hospital * la Pitii, where he had been
unsuccessfully treated for paralysis, which had insensibly come
upon him without any evident cause.

« During seventy-five days that this patient was in the
incetre, he never quitted his bed, except to be placed in an easy
cnatr. He articulated with difficulty; but nevertheless he
was sufficiently understood to convince all who were about him
tua. his mind was not deranged. He could move the lower
Irnibs without pam; and although the upper extremities were
more under Ins controul, yet he could not carry any thing to
n,- mouth. I he digestive function however was not impaired,

. , ? bu,k’ which was considerable when he entered the hos¬
pital, increased during the first and second months he was there.

. the commencement of the third month, the paralysis having
increased so much, the patient lay like an inanimate mass
ill Ins bed ; gangrenous sores appeared on the sacrum and the
trochanters ; and he died on the 25th of April without a
struggle. He was conscious of his situation until the last mo.
mesit oi his life; and about an hour before he died, remarked
to tne nurse, that he felt he was dying. (.Te sens que je m'en

. “ Dissection . V. The body was blackish ; and, on the

incision ot the integuments, poured out a great quantity of
black blood, particularly from the head. 2°. The honey cra¬
nium and tiie dura mater presented nothing remarkable 3»

,. * "l hhpaper was read before the Society of the Faculty of Me-

d.eme of Pans, on the J at of May last, and published in its bulletin
oi that month, vide p. 399 .

352 Medical and Physical Intelligence .

The pia-mater was reddish throughout and a little dncKcned ?
and some granulations were apparent on the convex surface of
the brain. 4°. The cerebrum and the cerebellum were denser
than usual ; and this was more remarkable at the cerebral pro- .
tuberance and the origin of the spinal marrow. 5°. At the
plain surface of the left hemisphere between the part which rests
on the tentorium of the cerebellum and the fissure of Stlvms,
we observed a projection, which appeared to the touch different
from the rest of the cerebral substance ; and, after having made
an incision through the pia mater and the arachnoid coat, where
they covered this projection, we found it was produced by an
incysted tumour involved in^the medullary substance, which
was evidently altered all round the tumour, being softer for a
line in thickness, and of the colour of wine lees, b . 1 his
tumour was the size and form of a hen’s egg ; its upper surface
was unequal, (bosselee), and the under, even ; the direction ot
the larger end was forwards and outwards, and lodged m the
medullary substance, to which it slightly adhered ; the smaller
pointed backwards and inwards, and communicated with the
ventricle. 7°. The incision of the tumour displayed the homo¬
geneous brownish aspect of scirrhous tumours ; and also their
lardy consistence. 8°. The thoracic organs were in a natural
state, and the abdominal were covered with much fat.

Reflections. Incysted tumours are not unfrequently met
with in the substance of the brain. M. Nysten has lately com¬
municated several interesting cases of that kind to the Society ;
and it is remarkable, that, as in his cases, my patient experienced
a paralysis that gradually increased, but he was not afflicted
with convulsions ; a difference, not less essential, also existed m
the nature of the tumour, which appeared to me to be scirrhous
and was enveloped in a cyst.”

PART V.

MEDICAL AND PHYSICAL
INTELLIGENCE.

I. - SURGICAL.

Extirpation of the Uterus.— Mr . Newnham, of Farnham,has re¬
cently extirpated, by ligature, the inverted uterus of a woman at
the menstruous age ; who appeared to be rapidly sinking, exhausted
by suffering and a great discharge. The operation was attended
with complete success ; and the woman now, nearly six months
since, is quite healthy.— Mr. Newnham means to publish the detail*
of a case so interesting to science and creditable to his own talents.

Medical and Physical Intelligence.

353

II. - PHARMACY.

Ophthalmia. — The powdered seeds of the Cassia Absits, an annual
pxant which grows in Egypt, has been long employed by the
Egyptians, under the name of chichm, as a remedy in ophthalmia.
X)r. Frank, of \ ienna, has confirmed by his experience the efficacy
oi this remedy, and considers it superior to any colyrium. The
powder is prepared by washing the seeds repeatedly in cold water,
then drying them in the sun, and, when they are thoroughly dried,
powdering them in a marble mortar. The powder must be passed
through a fine sieve, then rubbed up with an equal quantity of
sugar, and preserved in a well-corked bottle. The proper time for
applying the chichm is after the violence of the inflammation is
somewhat abated. It is applied in the evening, by laying the
patient horizontally and introducing between the eye-lids a small
portion of the prepared powder. Its sensible effects are an instan¬
taneous but moderate sensation of heat, and an increased secretion
of tears.

Dr. Frank conceives the plant might be cultivated in Europe.

III. - PHYSIOLOGY.

Birth of a Child thirty -six hours after the death of its Mother. — The
following is the substance of the deposition of several witnesses
before the Coroner of this very extraordinary physiological fact.
An inquisition was taken on the body of Hannah Homer, wife of
Mr. Homer, of 65y Turnmill Street, Clerkenwell. She was in the
eighth month of her pregnancy ; and was in good health and spirits
on the Saturday night, when she went to bed without any complaint.
On Sunday morning between six and seven o’clock she awoke, and
complained of the cramp in her legs but she got better in a few*
minutes by having them rubbed. At seven o’clock she arose, and
was in the act of getting out of bed, when she exclaimed f Oh ! my
stomach,’ and fell on the bed and expired. Mr. Austin, surgeon of
Bed Lion Street, came directly and bled her, and other means to
recover her were used, but without success. About the middle of
1 ^vas seen, and was then undelivered,

nor were there any signs of it. Between six and seven o’clock on
Monday night, Ann Terry was walking on the side of the bed on
which the deceased lay, and observed the body move and the clothes
lifted up. She was so terrified that she fell into a chair almost
insensible ; she was taken out of the room, and told that what she
said she saw was only her fancy. No one went to see the deceased
until the next morning, when she and another person took the
clothes off the deceased, and found she was delivered of a child,
which was lying on the right side of her quite dead and cold. On
Tuesday the body of the deceased and child were quite black, and
so changed, that the features of the face of the former were scarcely
distinguishable.

The late Dr. John Clarke, in his lectures on the physiology of
the uterus, relates a somewhat similar circumstance ; but we do not
remember the particulars attending the case. — Editors.

Perception of colours in a blind person. — A correspondent informs
us, that a lady of the name of Evoy, St. Paul’s Church-Yard,

VOL. VIII.— no. 46. z z

354 Medical and Physical Intelligent

Liverpool, has been blind since the 4th of June 181 6, arising, as
she supposes, from water in the brain. About seven months ago,
she perceived she could read by the feel, and e\en yy i ~
through a magnifying glass held at about the common focus She
can tell the colour of substances that are put into a glass bottle , .
and, if it is a mixed colour, can describe the mixture A piece oi
cloth or stuff was presented to her; she said it was brown, whilst
the person who presented it and the by-standers choug k ‘ .

it was black ; she, however, persisted it was brown, and when it
was held horizontally it proved to be brown. If an intervening
substance be placed between her hands and face, it diminishes the
acuteness of her feeling ; because, as she observes, it Pieyen s <
breathing upon her fingers. She can tell tne time y S P _

the glass oi a watch; and one being presented to her, she said s
never saw such a watch as that, for it had but one ingei , noi ^
minute was over the hour finger, which caused her to ima6 -

it had but one finger.

IY. — -MEDICAL STATISTICS. _

In the fourth volume of the Repository, p.441,DR.,uniRows
published some - Observations on the Comparative Mortality of Paris
and London in 1818 and 1814 /’ during which latter year the Fienc
capital was subjected to many of the casualties attendant on a siege

and occupation by foreign troops. . . . -onTmt pui

To those v/ho are fond of statistical researches, it cannot fail

be an object of interest to examine and compare We ’tables ot mm -
tallty of a city during a year ot profound peace, (*, ) *

when it was exposed,(X814)to all the calamities ot a de.ttuctive wai.

Review of the Tables of Mortality of Paris, for the year 1816, as
drawn up by the twelve Municipalities.

The number of deaths in 1 8 1 6 . 1 9,80 1

_ _ _ _ _ _ _ _ _ — 1815 . 21,549

The diminution in . 1816 . - 1 •'

Domiciliary deaths . 12,489 ; as follows :

Males . . . 6,1761 12/189

Females . • — . . 6,$1j j •

The^e were of bodies deposited in the Morgue. . . 2 < 5

And in the different hospitals . •• ••• as&1IoWs:

Females.... . . . * . 3,629- f . ^

Xhe number of persons who died of the small pox m 18 lb... 150

as follows :

Males . . /^\l5Q

Females . . .

The number in 1815 was. ...... ..UK)

Decrease . . . . 40

The Suicides during 1816 amounted to 188; as follows t-

Males . . . •“*1||il8S

Females . . op)

In 1815 the number was only 1 to.

Males.

Females.

Totals.

From a dav to 3 months .

..2,899...

...1,735..

....4,134

- 3 to 6 months, .

.. 157...

... 129-.

- 6 months to a year _

.. 277...

... 212..

.... 489

- 1 to 2 years . ..

.. 385...

... 395..

.... 780

2 to 3 .

.. 257...

... 202..

.... 4.59

- - 3 to 4.., .

.. 171...

... 143..

.... 314

- - 4 to 5.. .

... 106..

.... 230

- 5 to 6 . .

.. 95...

... 118..

.... 213

6 to 7 .

92...

... 06'..

188

7 to 8... . .

- - 8 to 9 .

... 40..

... 93

— 9 to 10 . . .

... 34..

.... 68

10 to 15 .

... 188...

.... 332

15 to 20 .

.. 255....

.. 263..,

.... 518

20 to 25 .

... 88 1...

.... 667

— 25 to 80 .

.... 362..,

.... 592

30 to 35 . .

.. 281....

... 415...

.... 696

- - 35 to 40.,..,., . . .

.. 253....

.. 403...

,... 656

- - 40 to 45 .

289-...

... 397...

45 to 50 .

350....

454...

... 804

50 to 55 .

. 456....

.. 425...

... 881

55 to 60 . .

. 496....

.. 438...

... 934

- 60 to 65 .

. 627.. .

.. 598...

..1,225

65 to 70 .

. 611....

. 586*..

.. .1,197

- 70 to 75 . .

. 537....

. 665...

...1,202

75 to SO . .

. 387,...

... 842

- - 80 to 85 . . .

. 251....

.. 410...

... 66l

85 to 90 .

. 81....

.. 152...

... 233

00 to Q5 .

Q....

34...

95 to 100 .

• • • • 4

1 ... .

1...

The particular diseases of which those enumerated died, are
not as heretofore given.

* In a city like Paris, with a river like the Seine, and little na¬
vigation, how great a proportion of these 278 should be carried to
the account of suicide ? In the whole of the port of London in the
same year, only ] 05 were drov/ned ! See further remarks on this
interesting subject, Repository, vol. iv. p. 456.

f The prodigious difference of mortality of infants from birth to
three months, and from three to six months, is truly accounted for by
Mr. Barrow in his “ Observations on the Moi'tality of Infants in Paris;”
Repository , vol. v. p. 289.

356

Medical and Physical Intelligence.

V. - LITERARY NOTICE.

Dr. T upper has in the press A Comparative View of the Present
State of Medicine in London and Paris; also, An Inquiry into tue
Doctrine of Gall concerning the Physiology of the Brain and Innate
Dispositions.

Vi. - MISCELLANEOUS.

Sir James Earle, Master of the Royal College of Surgeons, late
Surgeon to St. Bartholomew’s Plospital, &c. died on the 22d ult.

Mr. Copeland Hutchison has been elected Surgeon to the West¬
minster General Dispensary. _

A METEOROLOGICAL TABLE,

From the 2 1st of August to the 20th of September 1817,
KEPT AT RICHMOND, YORKSHIRE.

230 Miles NW from London.

i n Barometer,
p* Max. j Min. B

Therm, j Rain

A ax’ Alin. Gage.

Winds.

■s

Weather. j

m 29 73 2S

I..’ 1

Sun.. |

|22|29 7729 73

w.w. 1

Sun..

J23 29 66 29 57

16 ^

Y..EbN. 1

3 Cy.. 2 Sun.. 4 Ram

2429 40 29 15

s.. 1

3 4 Cloudy.. 2 Sun..

|25 28 76 28 72

341

5..ESE.. 1

Sh. 2 Sun. 3 Rain...

126 28 79 28 79

241

SbS..NE.

L Sun.. 3 Rain..

127 29 2429 13

65-

091

\rE.

L Sh. & Sun. 3 Cy..

12829 3529 24

331

STW..

1 Cv.. 2 Sun.. 3 Rain...

129 29 49129 43

14.

ESE-ENE.

1 Rain.. 3 Cloudy..

30 29 40,29 33

ME.SE..

1 Sun. 2 Cy.. 3 Rain..

131 29 55|29 45

S..SW...

1 Sun,.

1 29 74 29 73

SW.

1 Sun.. !

1 229 75 S

>9 60

SW.SE.

1 3 Cy.. 2 Sun.. 4 R.

1 3 29 63 $

19 55

SE..SW.

1 Mist... 2 Sun.. 4 R..

1 429 84 S

29 8S

SW..

1 S....2S..3Cy... 4Stl...

1 5 29 86,5

29 74

SW..S..

1 Sun...

1 6|29 80

29 SC

) 67

SW.

1 Sun.

! 7|29 80

29 7-

b 67

SW..SE..

1 Sun....

1 8 29 76

29 7(

) 67

SSW..SE..

1 Mist... 2 Sun...,

9 29 86

29 8‘

2 64

NW.NE.

1 Sun. 2 Cloudy...

1 10 29 76

29 7

3 61

NE.E.

1 Mist...

111 29 73

29 64j 68

SE..SW.

13 4 Cy... 2 Sun..

1 12 29 66

29 5S‘ 67

l SE..SW..

i Cy.. 2 S.. 3 R. 4 Stl..

1 13 29 76

29 7

4 59

W.-SE..

1 Sun...

Il4 29 82

29 82 59

Vble.

1 Sun..

11529 84

29 81 69

1 ENE.

1 Cloudy... 4 Rain.

1 6 29 7 S

29 77 65

SE.

1 Mist.... 2 Cloudy...

17 29 77

29 69 62

SE..NE.

1 Cy.. 2 Sun.... 4 Mist

1829 57

29 53 66

1 NE.NW..

1 Cy.. 2 Sun.. 3 Rairt..

1929 &

L 29 62 59

. 5

0 NW.

1 Rain.... 3 Cloudy,.

|20 29 , 7.‘

1 29 72 64

NW.

11 3 4 Cy... 2 Sun..

The quantity of rain during the month of August was 3 inches and
78-100ths.

The diseases under treatment were Cephalalgia, C ynanche^ Tonsillaris,
Diarrhoea, Dyspepsia, Erysipelas, Febris Catarrkahs,Gastrodyma, Obstipa-
tio. Ophthalmia, Paralysis, Rheumatismus, and Scorbutus.

METEOROLOGICAL TABLE FOR LONDON,

From the 20 th of AUGUST to the 19th of SEPTEMBER, 1817,

By Messrs. HARRIS & Co.

Mathematical Instrument Makers, 50, High Holborn.

Therm. SBarom.

Rain iDe Luc’s Ilygrom.
Guagej Dry. Damp

64 57 296
21 59 65 5129s
22159 65 54'296
23* 62 64 57|299
24*59 62 55 297

€

QQ7

29°
29 9
29°
294

.05

.07

.09

Winds.

26*57 60 55 <-2

91 c<

>94

27 l

>7 63 57 2

!9a 3

I9b

28 l

19 65 55$

>96 $

191

59 66 56$

19‘ 5

19~

Iso

51 67 55$

299<

298

59 69 53

29s

299

59 65 51

299

301

57 67 59

299

62 72 60

29s

299

63 70 58

3G1

61 69 58

301

62 70 60

299

63 72 59

296

299

60 72 58

29°

61 68 58

60 69 57

6i 67 55

63 66 57

29°

,63 67 59

29CJ

299

t-64 68 57

> 62 68 5c

5 60 65 5a

r 58 64 51

>29

3 29 8

3 '59 65 5"

r29

8 298

9 58 62 5.

5 29

s 29o

.15

.08

3
2
2

5
5
5
4
4
4
3
3

SW
W
NW
N
4| E
SE

.14 0 0

.05

.08

2
0
2
3
5
5
5
10
7
5
3

SSE

SW
SW
SW
,, ESE
6 E
W
W
S

NE
ENE
N
NE
NE
W
5 NE

5
4
4
3
3

■N

ssw

Rain
Rain Finel
Rain!

Atino. Variation

Fine!

Fine

Rain Clo.

Fog
Rain
Cio.

Clo.

Rain
Fine
Clo.

Fine Clo.
SSW Fine

S Fine

E Fine

SE Fine

W Fine

SE Fine

E Fine

Fine
N Clo.

N Clo.

SE Clo.

W Fog

NE Fine

N Fine

NE Fine

N Fine

E Rain

Fine

Rain ! Fine !
- 'Fine

Quantity oi xvani lttueu m wc muuw* o 7
Bill of Mortality from August 19; to September l6, 1817

{

CHRISTENED.

Au s. 26.

Males . . . 290

Females . 273

Sept. 2.
254
221

Sept. 9.
208
206

buried.

{

563

Males . 166

Females . . . “19

385

OF WHOM \
HAVE DIED)

■ 4

Under

Betw.

2 Years . 103

2 and 5 . 33

5 and 10 . 18

10 and 20 . 18

20 and 30 . 29

30 and 40 . 55

40 and 50 ...... 40

50 and 60 . 55

60 and 70 . 35

70 and 80 . 25

80 and 90 . 12

90 and 100 . 2

SMALL POX

475

170

186

356

101

22'

414

139

122

261

Sept. 16.

148
140

(B>uo\ Total,
1740.

126
123

249 1

Total,

1251.

Total

66.

358

A REGISTER OF DISEASES
Between AUGUST 20 th, and SEPTEMBER 1 Qth, 1817.

DISEASES.

Abortio .

Abscessio... .

Acne. . .

Amenorrhoea .

Amentia .

Anasarca .

Angina Pectoris.....

Anorexia . . .

Aphtha lactentium .

Apoplexia .

Ascites .

Asthenia .

Asthma. . .

Atrophia .

Bronchitis acuta....

- chronica.

Bronchocele .

Calculus .

Cali go .

Cancer . ..

Carbunculus .

Cardialgia. .

Carditis .

Catarrhus . . .

Cephalalgia .

Cephalsea .

Chlorosis . .

Chorea .

Cholera . .

Colica.. .

- Pictonum .

- - calculosa . .

Convulsio . .

Coryza.... .

Cystitis. .

Cynanche Tonsil-la ris .

- maligna... .

- Parotidea. . .

Delirium Tremens.

Diarrhoea... . .

Dysenteria . .

Dyspepsia . .

Dyspnoea... .

Dysphagia . .

Dystocia . .

Dysuria .

Ecthyma . .

Eczema .

Eneuresis . . i

Enteritis.. .

Total.

• Fatal.

DISEASES.

Total.

«#.

r.-

)*+

Ehtrodynia . . .

Epilepsia . * . .

Epistaxis . . . .

Erysipelas. . . . . .

Erythema Iceve . .

Exostosis... . . .

Febris intermittent . .

• — — Synocka .... . .

— — Typhus miiior......

— — Typhus gr avion ...

- Synockus . . .

- remit. Infant .

Fistula . . .

Fungus. . . . .

/ 1

Furunculus.,..,... .

Gastritis . . .

Gastrodynia .

Gonorrhoea . .

Haematemesis . .

Haemoptoe .

- 2

Haemorrhois . . . .

Hemiplegia . . .

Hepatalgia . . .

Hepatitis...... .

Hernia... .

Herpes Zoster .

— — — — nr pm f Mu v .

1 7

- - — — ]fj fa j ft / / <? _

-L *

Hy drarthv rus ...............

Hydrocele . .

Hydrocephalus . . .

Hvdrothorax . .

O’

Hypochondriasis . . .

Hysteralgia.... . . .

Hysteria .

Hysterics . . . .

Icterus . . . .

Impetigo figurata .. .

— - erusipelatodes ...

Ischias . .

Ischuria . . .

Lepra . . . . .

Leucorrhcea ... . .

Lichen simplex . .

Lithiasis . . .

Lumbago.... .

•2

Mania . . . .

Melancholia . .

359

diseases.

Total.

Fatal.

Menorrhagia .

Miliaria .

Morbi Inf untiles* .

Morbi Biliosi f .

Nephralgia .

Nephritis .

Neuralgia .

Obstipatio . .

Odontalgia .

Opththalmia .

Otalgia . . .

Palpitatio . . .

Paracusis .

Paralysis . . .

Paraplegia .

Paronychia .

Peripneumonia .

Peritonitis . . —

Pertussis .

Phlegmasia dole ns .

Phlogosis . .

[

Phthisis P ulmonalis .

Pityriasis . .

Plethora . .

Pieuritis .

Pieurodvne .

Pneumonia . . .

Podagra . . —

Polypus .

Porrigo larvalis .

Prolapsus..., . .

Prurigo mitis .

- - senilis. .

b\ 1

DISEASES.

Psoriasis guttata .

- inveterata .

Purpura hasmorrhagia ....

Pyrosis .

Rachitis .

Rheurnatismus acutus .

- chr onions..

Roseola .

Rubeola .

Scabies .

S e arlatina s imp 1 ex . .

anginosa.

Scirrhus.

Scorbutus .

Scrofula .

Spasmi .

Splenitis .

Strictura .

Strophulus intertinctus.

- conjertus .

Sycosis, menti .

Singultus.

Syncope .

Syphilis .

Tabes Mesenterica.

Vaccinia . .

Varicella . .-.

V ariola .

Vermes . .

Vertigo .

Urticaria febrilis . . .
- evanida..

Total of Cases
Total of Deaths.

5
2

4
2
1

5
2
6:
3
2
1
1
3

1875

161

* Morhi Infaniiles is meant to comprise those Disorders principally arising from dentition or
indigestion, and which may be too trivial to enter under any distinct heads ; Morbi Biliosi , such
Complaints as are popularly termed Mliovs, but cannot he accurately classed. _

Observations on Prevailing Diseases.

Cholera and Diarrhoea , the usual concomitants of the autumnal season,,
are at present rife ; but not in so great a degree as sometimes. Typhus
also bears a larger proportion to the other diseases in the Register than
iisual ; several of the cases were attended with petechia? ; but, happily, the
mortality from it does not demand particular notice.

One of the fatal cases of Apcplexia was of the serous kind : the patient
had, for some time, been in a state of fatuity.

In the fatal case of Dysenieria, besides ulcerations of the large and
small intestines, a tape-worm, four yards long, was found.

Variola, which has been so long epidemic and fatal, is subsiding ; the
mortality from it is very much diminished.

Two of the fatal cases of Hydrocephalus began with the symptoms of
Phrenitis, which appeared to be succeeded, on the third day, by effusion,
and caused death on the seventh day from the first attack.

A case of Roseola accompanied' the formation of the pustule after vac¬
cination.

360

NOTICES OF LECTURES.

Dr. Marcet intends to give a Course of Clinical Lectures at
Guy's Hospital during the next Winter.

Mr. Guthrie, Deputy Inspector of Military Hospitals, will com-
mence his Autumn Course of Lectures on Surgery, on Monday the
6th of October, at five minutes past Eight in the Evening, in the
Waiting Room of the Royal Westminster Infirmary for Diseases of
the Eye, Mary-le-bone Street, Piccadilly. Medical Officers of the
Navy, the Army, and the Ordnance, will be admitted gratis, on ob¬
taining a recommendation from the Heads of their respective depart¬
ments. For particulars, apply at No. 2, Berkeley St. Berkeley Sq.

Mr. J. J. Pettigrew, F.L.S. Surgeon-Extraordinary to their Royal
Highnesses the Dukes of Kent and Sussex, will commence his Win¬
ter Course of Lectures on Anatomy, Physiology, and Pathology, on
the 17th of October, at Eight in the Evening. For particulars,
apply to Mr. Pettigrew, Bolt Court, Fleet Street.

Mr. Clarke will begin his Lectures on Midwifery and the Dis¬
eases of Women and Children, On Friday, October ioth, at No. 10,
Saville Row, Burlington Gardens.

Mr. Gaulter will commence a Course of Lectures on Physiology,
at No. 10, Frith Street, Soho, on Thursday, October the 9th, at
Eight o’Clock. 3

Mr. Thomas Bell is appointed to succeed the late Mr. Fox as Lec¬
turer on the Structure and Diseases of the Teeth at Guy 's Hospital.

MONTHLY CATALOGUE OF BOOKS.
Observations in Surgery and Morbid Anatomy. By William
Wadd, Esq. 4to.

The Trial of Robert Sawle Donnall, Surgeon and Apothecary,
late of Falmouth, Cornwall, for the Wilful Murder, by poison, of
Mrs. Elizabeth Downing. By Alexander Frazer. 8vo.

Chemical Amusement. By Frederick Accum. 8vo.

The Principles of Diagnosis, & c. By Marshall Hall, M.D. 8vo.

NOTICES TO CORRESPONDENTS.

For want of space , the favours of Mr. Guthrie, Mr. Dickinson, Mr.
Blackett, Mr. Hitcnin, 3$c. were unacknowledged in the last Number. .

The Observations of a Surgeon upon a part of the Essay on Diseases
resembling the Venereal Disease, which has occupied a large portion of the
pages of the present Volume, we shall defer until the Essay be finished
when of course, like all other papers in the Repository, it will be open to
fair criticism and discussion.

Dr. Davis’ Communication came too late for the present, but shall cer¬
tainly appear in our next Journal. Mr. Diamond’.?, Mr. Holbrooks, and
Mr. Rawlins’ are received.

The Editors are concerned to find, that many of the impressions of the
Plate of Dr. Davis’ Craniotomy Forceps, accompanying the last Repository ,
are so faint, as to give a, very imperfect representation of that instrument .
The Plate has therefore been re-touched ; and a more perfect print will be
delivered to every Subscriber, in exchange for his imperfect one, who will
apply either at Messrs. Longman and Co.’s or at the Printer s.

THE

LONDON MEDICAL

II E P 0 8 1 T O R Y.

No. 47. NOVEMBER I, 1817. Vol. VIII.

PARTI.

ORIGINAL COMMUNICATIONS.

AN ESSAY ON DISEASES

RESEMBLING

THE VENEREAL DISEASE.

BY A PHYSICIAN.

( Concluded from p. 283. J

PART IV.

Of Ulcerations of the Nose and Face which may be mistaken for

Syphilitic Jffections.

Syphilis having remained in the 'habit unsubdued, will pro¬
ceed to attack the nose. The patient will complain of a stuffing
and fulness of the nose ; a viscid offensive mucus is secreted,
sometimes tinged with blood ; there is a tenderness of the ossa
nasi, and loss of smell. Ulceration follows high up the nostril
or on the cartilage, not commonly on the outside. Such a case
is called venereal ozoena. The ossa nasi seldom become diseased
in this complaint. The disease will, if suffered to proceed, ex¬
tend to the ossa spongiosa, to the horizontal lamella of the
superior maxillary bone, to the vomer, and to the ethmoid bone.
The septum nasi will be eaten away, and the alas nasi sometimes
ulcerated.

It is particularly important to decide properly upon the
nature of diseases attacking the nose, it being a part where no
disease can maintain its ground long without considerable injury,
as no portion of the substance of it can be lost without defor¬
mity and disfiguration being produced. ; so that a disease whic&

vol. vm.-^m 41T. 3 a

362 Original Communications .

in the first instance was of comparative insignificance, may be¬
come very formidable if allowed to proceed.

Inflammation of the membrane lining the nostril may be
produced by common causes, such as exposure to cold, blows,
common catarrh, or by the application of irritating substances,*
Eulness will accompany the inflammation, and it is possible that
small ulcerations may form ; but the disease being local, it will
most probably disappear without doing mischief and without
being confounded with any thing of a specific nature. In irri¬
table habits, however, a small ulcer may spread, and being ir¬
ritated by the finger-nail, it may lay bare the cartilage or possi¬
bly expose the bone, and thus lay the foundation of a tiouble-
sotne malady. Such a case will, however, be known not to be
syphilitic by the history of the case, and by the want of other

symptoms. . y

The nose may become the seat of a complaint wmch may
create a great deal of distress and alarm, while m another situ¬
ation the same affection is disregarded. A pustule, for instance,
may attack the cartilage, and by being irritated with the nail,
may form a slough so deep, that this, when it separates, shall
expose the cartilage, which may scale aw ay, and lay the foun¬
dation of a troublesome ulcer, which will most probably be con¬
sidered as syphilitic or as cancerous.

Case.

Thomas M — k — m, Esq. a person of a full habit, applied
to me in May 1810, having an ulcer on the septum nasi^ in the
left nostril, The sore was deep, with hard, raised, florid edges.
The cartilage was exposed, and it afterwards exfoliated through¬
out its whole extent. The outside of the nose was florid and
rather tumefied. He felt no pain in the ulcer. I found that
lie had, at different periods of his life, been subject to eruptions
and tubercles in the face and in other parts of the body. ri he
first attention was attracted to the nose when the complaint was
in a state of ulceration, so that its mode of accession could not
be made out ; but I considered it probable that it might be of
the same nature with the eruption to which his face had long
been subject. I gave him arsenic internally in the form before
mentioned*, and directed him to fumigate the nose with sulphu-
ret of mercury ; lie continued to take the arsenic for six or
seven weeks, after which time, bark was given in decoction.
After the plan was first commenced, the progress of the ulcer
had been arrested ; but the process of healing went on so
slowly, that seven or eight months elapsed before the septum
was restored to its healthy state. He continued well for a short

Page 27 9«

An Essay o?i Diseases resembling the Venereal Disease,, 3G3

time, but bis general health became soon much impaired from
confinement to his room, which was rendered necessary by an
accident which he met with in the knee. Soon after this, lie
complained of pain in the right side of the head, attended with
languor and loss of appetite. The bowels were attended to,
and bark and arsenic were administered. His head was for a
time relieved, but the pain soon returned, attacking the upper
part of the nose and forehead. The pain in the nose soon be*
came so great as to cause great alarm in his mind. There was
a slight tenderness of the ossa nasi. In a little time I disco¬
vered very high up in the left nostril, a large ulcer, deep and
florid, shewing a tendency to spread in every direction. He
would do nothing for a few days; and when I next saw him
the ulcer had increased considerably in size, looked very angry,
and was very painful. The pain in the head and in the outside
of the nose were very troublesome. I ordered for him as
follows :

R Hydrarg. Muriat. gr. ii.

Solut. Arsenici (Fowler.) Jiss.

Tinct. Lavend. C. 3 i . f. Solut.

Cujus cap. KYI xx. ter die ex haust. seq.

R Cinchona?,

Rad. Mezer. 3ij.

Has. Guaiaci lign. 3vj.

Antimon. Sulphur. 3x.

Aq. puree ibv. coque ad Ibij. et cola.

R Decoct, ut supra §iss. f. haustus.

I directed him to continue the fumigation. In a few days the
sore wore a more favourable appearance ; the mezereon heat¬
ing his stomach was omitted, and sarsaparilla substituted.

He commenced this plan in the latter end of January 1811.
In a few days more the sore was reduced to less than half its
original size. The plan was continued with little alteration,
and at the end of a few weeks the disease entirely disappeared,
and he has ever since been free from eruption. Although this
case was not considered as syphilitic, (nor could it be suspected
from the high character of the patient,) it still is very possible
that it might have been so, had the affection of the nose been
preceded by primary symptoms, or been accompanied by sore
throat or cutaneous affection. It was by many persons, (not
medical men,) thought to be cancerous ; but in spite of the
clamour of his friends, this gentleman steadily and confidently
persevered in the plan which I had prescribed, until the healing
of the ulcer put an end to all their apprehensions and to his
sufferings. Great light was thrown upon this case by the pre¬
vious history of the patient’s health, and by the knowledge that

364

Original Commun i cations *

tlie forehead, face, and back had been constantly subject to a n
eruptive affection.

In scrofulous habits there may be pain of the nasal bones,
with a discharge of foetid matter, followed by destruction of the
septum nasi ; the system exhibiting, generally at the same time *
Strong marks of scrofula, which sufficiently attest the nature of
the disease. A scrofulous ulcer may be seated externally on
the nose, there being present perhaps similar ulcers in the
cheeks. These ulcers will have the scrofulous character by
which they will be known, as well as by the history of their
accession and progress. An indolent superficial sore on the
Septum nasi, and rawness of the inside of the nostril, may arise
without any evident local cause or constitutional disorder, in
persons who are subject to soreness of the scalp or to aci id dis¬
charge from about the ears. The nose is, in this case, mostly
inflamed ; the sore being covered with a dark scab, 'I his case
is, perhaps, connected frequently with scrofula.

Fulness, pain, with increased secretion from the nose, may
proceed from polypus ; but an accurate examination will dis¬
cover the cause of these smptoms* which might at first iead to

the suspicion that ozeena was forming.

A long perseverance in the use of mercury may produce
disease of °the ossa nasi, which not unfrequently become carious.
This case will be distinguished from syphilitic ozeena by the
knowledge that the disease has come on, after, or during a long
mercurial course ; and that the bones of the nose are not as
usually attacked by syphilis as by other diseases, by the presence
of ulcerated gums, or of sores in the mouth, of a superficial,
diffused, whitish appearance, and by observing that the affec¬
tion is aggravated by the continuance of the mercury.

Acne rosacea, or gutta rosea of the nose, consists of red
tubercles, together with a shining, uneven,, granulated, livid
appearance of the end of the nose, which is often much en¬
larged. It is a chronic affection, and is generally the tell-tale
of good living and free drinking, and cannot be mistaken for a
syphilitic affection, (even when the tubercles ulcerate), if at¬
tention be paid to the history and character of the complaint.

Sometimes a disease appears in one cheek in the form of a
flat tubercle of a brown livid colour, unattended vith pain, the
disease proceeding slowly across the face from one side to the
other, taking the nose in its way, ulcerating all before it, and
healing in one part while it spreads in another. Sometimes
several small tubercles unite. Such a case constitutes lupus.-
Solitary tubercles of the face may ulcerate, and such ulcers may
spread ; such have been called noli me tangere, he. : all these
are by Dr. Willan included in the term lupus. There will be
little danger of mistaking any of these cases for the effects of

An Es say on Diseases resembling tire Venereal Disease. 36S

syphilis, if attention and observation be employed. The history
©f their accession will point out their nature. It is possible,
however, that those who judge hastily, may condemn a case of
this kind. I recollect an interesting case that I met with, where
the patient, Sarah Die, had an extensive ulceration of the upper
lip, which had destroyed a portion of the lip. The ulcer had
no elevation of its edges, but was gradually lost in the sound
skin, and it gave but little pain. She said that several men of
eminence had seen her, some of whom said the disease was
cancerous, while others said it was venereal. The ulcer not
answering to the description of that caused by either of these
maladies, I inquired accurately into the woman’s history, and I
found that she had, some time before the attack on the lip, had
two tubercles under the left eye, which disappeared sponta¬
neously. I gave her arsenic in the manner before mentioned,
which in a few days improved the appearance of the sore.
Within three weeks from her first taking it, her face was attacked
with erysipelas, and when the tumefaction occasioned by this
subsided, her lips appeared quite sound and well.

In elephantiasis, the nose is sometimes destroyed. In one
case which Dr. Adams saw at Madeira, the loss of the nose was
the only mark of the disease above the waist ; but the signs of
the disease below this part were sufficiently indicative of its real
nature, such as the appearance of the parts of generation,, two
swellings in front of the thighs, and foul ulcer of the whole legs.
But the disease may be so modified as to appear more as a local
affection, being confined to the face, nose, or lip ; the ulcer pro¬
duced bv the disease in this form, is more likely to be con¬
founded with cancer than with syphilis; it may be traced to
small brownish tubercles, which have gradually proceeded to
ulceration. The ulcer seldom is attended with much pain ; it
is slow in its progress, combining as it were (according to the
observation of Mr-. Pearson), the destructive powers of the
cancer with the indolence of scrofula. Sometimes a disease
attacks the nose, which although from the history and appear¬
ance we do not consider it as venereal, yet still we find some
difficulty in giving a name to.

Case.

Catherine David was said by her medical attendant to be
labouring under a cancerous complaint, which was expected to
prove shortly fatal. She had just been brought to bed when
I was called to see her. I found a large irregular sore occupy¬
ing the whole of the left side of the nose and part of the left
cheek, extending upwards to within one-eighth of an inch of
the left eye. The right ala nasi very tumid, red, and painful.
The upper lip penetrated by a deep irregular furrow. She

366 Original Communications ,

complained of great pain, not only of the sore, hut oi tlir
right ala nasi, in which part she described it as lancinating and
severe. She got no sleep ; her anxiety and debility were very
great. Her account of her case was this: nine years ago she had a
kick on the nose from a cow, which occasioned tumefaction anti
pain. In about a year after, she received a second blow on the
same part. In another year, an ulcer appeared in the nose,
which discharged a purulent matter and gave great pain , two
or three pieces of bone came away. Her throat was sore aboiu
this time. Some time after this she had very violent pain m
the arms, which yielded to warm applications. About half a
year before I saw her, the ulceration appeared on the nose
externally, preceded by hardness, tumour, and severe shooting
pains. I found that the ulcer had destroyed the septum and
part of the pinna nasi. She was a married woman, who had
the reputation of having been infected by her husband
formerly, and her disease of the nose had been considered as
syphilitic. I merely dressed the sore with an ointment com¬
posed of hydrargyrus cum sulphure and common cerate, and I
gave her an arsenical mixture, of which she only took a verr/
few doses in consequence of a nausea which had long troubled
her. It was extraordinary that the poor woman experienced
almost immediate relief soon after I first dressed hei. In less
than three weeks the sore had skinned over, the tumour and
redness of the ala nasi had subsided, and the pain was gone.
She has remained free from disease ever since. Here then is a
disease exciting great alarm, and yet disappearing as if b\
magic ; for I can scarcely say that any thing was done by art.
although some gave me the unmerited credit of curing a
cancer°of the face. The ulcer was a spreading one, having its
first origin from a blow which produced induration, and it was
attended with severe pain. Of course it was not cancer. It
could not be considered as syphilitic ; and the pain attending
it was greater than that accompanying elephantiasis. I have
sometimes thought it was possible, that the action that was
ooing on in the uterus might have prevented the healing of
the sore, which was easily accomplished after deliveiy , but

this is merely conjecture. . r

Cancer attacking the nose and the lips may be mistaken tor
a venereal attack. The preceding induration, the lancinating
min, the progressive destruction caused by the disease, the
presence of diseased absorbents in the vicinity, the history oi
the case, and the absence of other symptoms ; all these will
attest the character of the disease. Many persons assert, that
the upper lip is not attacked by cancer m the fust instance .
have seen a case, however, which proved fatal , but the progress
of the disease was very slow, and the symptoms comparatively

An Essay on Diseases resembling the Venereal Disease . 367

wild. The patient, Edward Lewis, a middle aged man, had,
some years before I saw him, had a tumour on the upper lip,
which, together with a considerable portion of the lip, was
destroyed by caustic. The part healed. About a year before
be applied to me the lip became hard, and it shortly after
ulcerated. The ulcer spread, attended with shooting pains.
The edges of the wound were thick and hard, the whole
border of the lip was ulcerated, and a part of the sore extended
upwards towards the septum nasi. The lip was by degrees
destroyed. He described the sensation constantly as that of a
flashing in the face. I did not see him laterly, but I under¬
stood that the poor man took to his bed, and gradually sunk
and died, with no great increase of the sore or of the pain.
He lived about two or three years after I saw him first.

I was from time to time in the habit of seeing a poor miserable
old woman, in whom the whole of the upper lip, with the lower
part of the aim and septum nasi, and the teeth and the bone
of the upper jaw, were all destroyed — the whole presenting a
most horrible sight. The disease was in full progress. The
corners of the mouth were obstructed by large pendulous
tumours, smooth, and covered with skin. There w^as no
evident ulceration. She had had a blow on the nose from the
head of a child sixteen years before I saw her ; induration
succeeded, and a small tumour appeared on the nose, from the
ulceration of which sprang the dreadful malady. She suffered
considerable pain, and lingered a very long time.

An abscess of the antrum maxillare or highmorianum may
possibly be mistaken for ozcena ; discharge from the nose, and
uneasiness and pain between the nose and cheek being present.
But the seat of the uneasy sensations, the absence of disease in
the nose, and of other constitutional symptoms, together with
the history of the case, will point out the nature of the affection.
In abscess of the frontal sinuses, the pain will be higher up
than in ozoena, more resembling head-ache ; and if it should
proceed from the presence of any living thing, delirium will
probably be present.

The nose may be affected by what are termed pseudo¬
syphilitic diseases ; but these cases must be distinguished byr
the rules already laid down.

Of Ulcerations of the Tongue which may be mistaken for

Syphilitic Ulcerations .

A venereal affection of the tongue is a rare and anomalous
appearance of that disease. It generally begins in the middle
of the tongue in the form of a spot, which is painful, degene¬
rating into an ulcer, which discharges an offensive matter, the

Original Communications.

edo-es having, what Mr. Pearson terms, a mulberry appearance.
He says lie has seen an affection of the tongue where it was
the only venereal symptom. It occurs where the disease has

existed for several months. ; .

An ulcer of the tongue derived from a tumour may take

place in persons who are subject to tubercular eruption.

Mercury will produce very troublesome ulceration ot the
tongue, chiefly seated on the edges of it; but it is scarcely
possible that such a case can be mistaken.

1 Troublesome ulceration of the tongue may be produced by
a lagged tooth, and unless the cause be removed by hung or
by extraction, the sore will continue to exist. 1 be cause ot

such ulceration will be evident.

When the tongue is attacked by cancer, the disease may
first appear as a tumour or fungus, or the attention may first be
directed to it when in a state of ulceration. In an incipient
form of the disease, or in the early stage of the ulcer, its
nature may not be immediately detected ; out a short time
will explain its true character. In an advanced period of the
disease, the destruction of the tongue, the affection ot die
"lands of the neck, which have sometimes a stony haroness,
together with disease of the parts in the neighbourhood of the
malady, as the thyroid gland, the pharynx, fee. will eave no
doubt as to the nature of the disease. It may still, however,
at an earlier period, be distinguished from a venereal affection
by the circumstances and history ot the case. Mercury will
heal the venereal ulcer while it aggravates the disease, or at
least is inefficacious when used in a cancerous affection. We
meet with cases which resemble cancerous or venereal affections
of the tongue, and which it would be difficult to refer to any
particular 'disease; it is sufficient, however, for us to be able
to distinguish such cases from either of those two diseases, and
if we are enabled to cure our patient, it is not oi miicn rmpoi-
tance what name we give to tbe complaint.

Case.

A masculine married woman, about 50, applied to me five
vears ago. She bad in the centre of the tongue a deep irre-
lular ulcer with inflamed edges. She first noticed a tumour
in the part five months before. I gave her arsenic, and used
local applications for three weeks. The ulcer spread. I t ten
lave her hydrargyrus muriatus in tbe quantity of A gr. three
Imesaday. In a few days I found the ulcer deeper, more
painful, much wider, tbe loss of substance being considerable,
f ordered her to take gr. ss. of calomel night and morning
In a fortnight the sore was reduced to one third of its former
size, and it was no longer painful. Her gums were slight y

An Essay on Diseases resembling the Venereal Disease. 369

affected. She pursued the plan for a short time longer, and
got quite well.

\ 3. here was not the slightest ground for suspecting this case
to be venereal. It shews that we should hesitate before we
give a disease a name, and that we should try the effects of
different remedies before we condemn a case as cancerous. It
shews too, that one form of mercury will succeed where
another fails. This happens also in treating venereal sores.
Calomel internally may cause a sore to heal which resisted
mercury when rubbed in by the skin. Since it has been found
that an extirpation of a portion of the tongue is not an opera¬
tion of danger, excision has probably been resorted to in cases
which might have been cured by less formidable means; but
when we delay the extirpation of a portion of the tongue in
the hopes that we may cure the disease in some other way, we
must at the same time take care not to let slip the opportunity
of removing the disease, by suffering it to proceed beyond the
reach of the ligature.

Of the Diseases of Bones which may be mistaken for the Effects

of Syphilis.

Enlargement of the periosteum and bones belongs to the
second order of secondary symptoms. The bones most liable
to be affected in syphilis are those which are hardest in their
texture and which lie near the surface, and their cortical part
is that part which is attacked. Such bones are the os frontis,
the ossa parietalia, ossa palati, the horizontal plate of the
maxilla superior, the vomer, the lamella of the ethmoid bone,
the lower part of the anterior surface of the tibia. The ossa
mala?, ossa nasi, ossa palati, the clavicle, the sternum, the
radius, ulna, and fibula are seldom affected ; the three last,
Mr. Pearson says, only in old persons, or in those who have
used mercury unsuccessfully. The bones of the hands and
the feet, the libs and the femur, are very rarely affected with
this disease. When the venereal virus attacks the bones,
pains like those of rheumatism are felt in the limb or in the
neighbourhood of the bone ; tenderness of the part succeeds,
soon amounting to pain. The pain is of a gnawing, fixed,
distressing kind, increased by pressure, and becoming more
severe as evening comes on. Mr. Abernethy observes, that it
comes on at a progressively later hour as the disease advances.
A circumscribed tumour forms, of an indolent appearance,
enlarging slow ly. Although the swelling may be considerable,
it does not follow that the bone must be much enlarged, since
a thickening of the periosteum and an imperfect suppuration
succeeding to inflammation of that membrane may be the
principal cause of the tumour. The matter thus formed is

VOL. VIII. — NO, 47. 3 B

gyQ Original Communications .

not true pus, but a thin glairy gelatinous fluid. The paw
arises chiefly from the distention ot the periosteum, lne
ultimate effect of the disease having attacked the bone, is
generally caries. When the disease attacks the skull, the bones
become thickened, frequently from a deposition of bony matter
into the diploe of the bones ; they become ulcerated externally,
the ulcers being very irregular, having more the appearance ot
the bones being worm-eaten than of the ulcers being produced
by the action of absorbent vessels*. Head-ache attends this
form of the disease. Sometimes the cranium is affected with
ulceration and with protuberances at the same time, fne
disease may perforate the skull, causing constant pain m the
head, delirium and disorder of the senses, and spasm,

A node may occur during the primary symptoms ot
syphilis, being caused by mercury. Where mercury has been
used in large quantities, nodes will frequently appear on the.
bones of the head and limbs, attended with severe pains.
Such cases may be considered very commonly as syphilitic.
In all cases of doubt, consider the node as not being the effect
®f the venereal virus. If it have come on where much mer¬
cury has been used, sufficient to eradicate preceding symptoms,
or if it come on during a course of mercury, you would not
consider it as syphilitic. There is seldom any necessity tor
coming speedily to a decision. We may first try what other
remedies will "do, and we can at last but have recourse to
' mercury. The same observations will apply to caries ; recol¬
lecting, that a caries of the bones of the nose, of the palate,
and of the unguis, is more frequently produced by mercury

than by syphilis. m

Scrofula frequently attacks the bones, affecting them with

enlargement and caries ; the latter sometimes succeeding to
the former, and sometimes occurring as the primary affection.
Scrofula generally attacks the cancelli of bones, so that the
disease may have "extended a considerable way and have made
great progress before any symptoms appear externally, bcro-
?ulous enlargements on bones are more diffused, more gradual
in their progress, attended with less acute and more ceep
seated pain, and lead to more extensive suppuration than
venereal enlargements of the bones. The disease, when no
primary external enlargement appears, is more obscure ; it is
attended with acute pains throughout the whole bone, which a,
the latter stage of the disease becomes tumefied, and at last,
becoming carious, gives passage to the confined matter. 1 he
bones in scrofula have a deficiency of phosphate of lime winch
renders them brittle, particularly the long bones. iheie

* Baillie’.s Engravings of Morbid Anatomy.

An Essay on Diseases resembling the Venereal Disease. 371

generally will be marks of scrofula in the system, which,
together with the history of the case and the want of venereal
symptoms, will distinguish scrofulous affections of the bones
from venereal affection ; such as tire common scrofulous
appearance of the person, general languor, and diseased
secretion.

An inflammation of the tibia producing enlargement and
consequent suppuration is not an uncommon terminatiop of
fever. Children and young persons are frequently affected
with tenderness and inflammation of the integuments of the
tibia, which disappears either spontaneously or after gentle
purgation.

An enlargement of the tibia, or any other bone, may be
the effect of fracture or of blows ; it is often connected with
disorder of the digestive organs.

By a little attention and- a little patience the nature of all
these affections will be made out.

It is, says Dr. Adams, universally admitted, that Sibbens
never attacks the bones but by spreading from the soft parts.

When the yaws are imperfectly cured by mercury, nodes
and caries may ensue. Here the history of the case must
point out the nature of the affection.

If a syphilitic node remain after a full, complete, and
judicious course of mercury, it is to be considered as a simple
enlargement, and no longer as a specific affection.

Lastly, if a node disappears in one part of a bone and
appears in another part, such an enlargement is not to be
considered as syphilitic.

Pseudo-syphilitic nodes have much more of the inflamma¬
tory character than syphilitic nodes *.

Of Pains which may be mistaken for Syphilitic Pains.

Venereal pains affect muscular fibres, aponeurotic expansions,
and articular ligaments, generally aggravated at night.

> You cannot always determine the nature of pain in the
limbs. I think that pain in the limbs is an attendant frequently
on gonorrhoea ; I have at least seen it connected with that
affection, where there appeared no evident cause of paim
Persons who are under the influence of mercury, often acquire
pains from exposure to cold; and mercury will induce pain in
the head and limbs without any cold being applied. The pain
mav be what is called rheumatic. But we are too apt to calf
all pains rheumatic; the fact is, that we know nothing of the
immediate -cause of pains in the muscles and limbs. Plow often

* Carmichael.

3 b 2

372 Original Communication#.

do we see pains brought on by checking a cutaneous aif ection ;
and relieved by the appearance of the eruption, whether it be
made to appear by medicine internally, by stimulants externally,
or by the efforts of the constitution, and whether the eruption ^
appear in that part where the pain was situated, or in another ;
for instance, a man may be disabled from walking by a violent
pain in one thigh ; he rubs some stimulating application, such
as turpentine or sulphuric acid in that thigh, and an eruption
shall break out immediately on the other thigh, or over tne
whole body, and relieve the pain. I have seen this occur
where the patient was subject to a cutaneous affection. Ihe
subject is interesting and worth pursuing, but I am straying
from my tract.

Venereal pains attack the bones, generally speaking, and
the shoulders and arms. Rheumatism attacks the joints, and

the soft parts. . .

Mercurial pains will be known by their coming on during,
or immediately after, a course of mercury ; not being usheied
in with the general febrile indisposition which ushers in the
secondary symptoms of syphilis, and not being situated perhaps
in the same parts as preceding syphilitic pains.

When pains in the limbs are of doubtful origin we must
attend to the history of the case ; it they are syphilitic they will
be relieved by mercury ; and, if there be no strong contra-indi¬
cation, we may try what small doses ot that mineral will do,
after the common remedies of warm-bathing and anodyne dia¬
phoretics have failed; or we must wait until some new symptom,
coupled with the pains, leaves us no longer in doubt as to the
nature of the complaint.

Condylomata , Sfc.

Hemorrhoidal tumours are the only malady likely to be
mistaken for venereal excrescences about the anus ; but an ac¬
curate examination will ascertain this cause of swelling.

Ulceration of the Uterus.

Venereal ulceration of the uterus is a very rare disease,
described by Mr. Pearson. The symptoms are, great heat,
and pungent darting pains about the uterus ; great pain dining
coition, and a flow of blood frequently after the act. It has
the power of infecting men with chancres. On examination
the uterus is found rather enlarged, and small, even, smooth,
superficial ulcers near the os uteri, hot and extremely tender
to the touch. The disease may continue in this state, Mr.
Pearson says, many months, without producing secondary
symptoms ; but the health gradually declines, and the patient
sometimes becomes hectical.

Davis’s Reply to Mr. Rawlins on the Craniotomy Forceps. 373

The disease which, will probably be confounded with this
complaint is cancer of the uterus ; from which it will be dis^
tinguished by the w^omb being moveable, not much enlarged,
by there being no unevenness of the os uteri, no fungus, the
pain not constant, no disorder of the system, or sense of weight
in the part. &

There are many other ways in which syphilis, if suffered to
remain long in the habit, may affect the patient ; such affections
are rare, but it may be expected that I should at least notice
them. Loss of sight, of hearing, and of voice, hectic fever,
atrophy, and a state resembling phthisis, have been the con¬
sequences of the disease, and these have been relieved by
mercury. A paralytic affection, and an ague of a quartan type,
have also been mentioned among the sequelae of syphilis, which
nothing but mercury could relieve. It is sufficient to enumerate
these possible effects of syphilis. They may be confounded
with similar affections produced by other causes ; but it is not
probable that similar diseased states, not arising from syphilis,
will be mistaken for venereal affections.

FINIS.

On the Craniotomy Forceps of Dr. Davis , in Reply to Mr.
Rawlins of Oxford. By David D. Davis, M.D. Phy¬
sician to the Queen’s Lying-in Hospital, to the Lying-in
Charity, &c. &c.

I beg to acknowledge my obligations for the repeated and
extended notices which have been taken of my Craniotomy For¬
ceps in the London Medical Repository *, and more especially for
the honour of the favourable opinion of me, as expressed in
the last number, (September,) in reference to the letter of u the
venerable accoucheur” of Oxford. I am unwilling, however,
that the kind apology of the Editohs for me should remain
my only shield against the effects of Mr. Rawlins’ unqualified
and unrounded counter pretensions.

It does not often happen that useful inventions are left
unmolested by attempts of envious or interested men to dis¬
parage their merits; and among such attempts the most frequent
are those, like the present, which have for their object the
subversion or vitiation of the claim of an Inventor to the credit
of originality. In being made the object of a public attack of
this kind, I might indeed feel, that my accuser has placed me

* Repository , vol. viii. No. 43, 44, 45.

374

Original Communications .

in the society of some of the greatest benefactors to mankind ;
but I do not suppose that any privilege which might be pre¬
sumed to attach to such a class of persons, would be considered
as forming a sufficient excuse to me, for not accepting the high __
toned and most spirited challenge of my veteran assailant upon
this occasion. I beg to state, that I have an extraordinary
dislike for combats of this kind ; but, I feel that I must
meet this practised champion*, for two reasons and indeed
they are no other than the motives which usually actuate men
upon such occasions; viz. first, to shew my courage — and I rather
think that I feel less afraid than most persons do, who go out in
defence of their wounded honour ; and, secondly, to prove the
rectitude of my cause ; which I trust I shall be able to establish
incontrovertibly upon the basis of truth and candour. I beg
however to declare, that i do not mean to charge more than once;
the occasion in my opinion not requiring a waste of ammunition.
On the other hand, I do not intend to fire in the air; and, if my
antagonist should be left dead, or dangerously wounded, on the
ground, it will be the obvious consequence of his own presump¬
tion, as indeed, is common in such cases; and I shall not affect
to feel any compunctious qualms of conscience upon the subject.

E Tke yip op, Trpodvpov, dr} rd\a kcu tocos cXkij .

“ So they hanged Haman on the gallows that he had prepared
for Mordecai.”

The operation of craniotomy is required to be performed
when the foetal head is too large to be expelled through the
natural passages by the parturient efforts of the uterus ; or
when, in the absence of such efforts, delivery cannot be effected
by any other means compatible with the security of the mother’s
life. In its application to the dead foetus, and perhaps in some
other circumstances of extreme difficulty, this mode of delivery,
in common with general embryotomy, was unquestionably
known to the antientsf . But we are indebted to times com¬
paratively modern, and chiefly to the obstetric practitioners of
this country for the developement of those rational and fixed
principles, founded equally on an enlarged humanity and on
accurate knowledge of the subject, which are now received as
constituting its moral sanctions and professional obligations. Cra¬
niotomy, as the term imports, is simply theoperation by which an
aperture is made into the cranium. Its intention is to reduce the
bulk of the foetal head by the consequent escape or removal

* See Rawlins’ Dissertation — versus Dr. Osborne, p. 11, et
sequent.

t Hipp. Op. Cura. Fresii. tom. i. p. 618. Phil, apud fEtium. tom.

iv. serm. 4, cap. 23.

Davis’s Reply to Mr . Rawlins on the Craniotomy Forceps. 37 &

either of a part or of the whole of its contents. In some cases,
this aperture, made sufficiently large to admit of the spontaneous
discharge of a considerable quantity of brain, is all that is
necessary to be done, in order to ensure a speedy and a pros¬
perous delivery; which, indeed, is then effected by the unassisted
efforts of the uterus. In many others, however, in order to
accomplish our purpose, we are obliged to apply more or less
force of extraction, either as a substitute for the exhausted
action of the womb, or as an auxiliary to that power when it
might be imprudent to entrust the result to its doubtful or pro¬
tracted efforts. It may therefore be asserted that in all more
difficult cases of labour of this class, the application of extracting
force to finish the delivery is an essential counterpart to the
operation of craniotomy. For affording the assistance here
presumed necessary, a great variety of instruments have been
devised and recommended. In order, however, to enable such
of your readers, as may not be familiar with subjects of this
kind, to appreciate the precise amount of merit actually due to
recent inventors, it may be upon the whole useful, if not quite
necessary, to take a cursory and compressed view of the inven¬
tions of former times, which they pretend to have improved'
upon, or superseded.

The instruments hitherto proposed or recommended for
extracting the dead foetus, or for completing the delivery when
the head has been already opened, are reducible into three
kinds or classes, which, to avoid tediousness, it will be con¬
venient to consider collectively. We have them therefore all
included under the genera — 1st. of hooks— 2nd. of extractors
upon the principle of the tire-tete of Mauriceau ; (those of
Amand Waldgrave8 and Levretb not belonging to our subject)
— and, 3rd. of forceps.

The use of instruments of both the first and last genera
is probably coeval with the practice of instrumental mid¬
wifery itself. Let us first consider the claims of the former.
Instruments of the hook class have been distinctly recom¬
mended by Hippocrates', by Celsusd, and by iEtiuse. Hippo¬
crates states the necessity in some instances of making use of-
two instruments of this kind, the one to antagonize the other;
thus clearly anticipating the double crotchets of modem times.
Albucasisf, the last of the Arabian writers, gives figures of the

a Vide Joan. Carol. Voigt. Dissert. Chirurg. Haller Disputat.
Chirurg. tom. iii. p. 472.

b Levret sur l’ Art. des Accouchemens.

c Hippocrat. loc. citat. d Cels. Op. 1. vii. cap.

* 2Etii Op. loc. citat.

* Spacch. Gynscc in Albucasi, cap.4xxvii, p. 41b.

376

Original Communications.

obstetric instruments known and used in his time, and amongst
them we have two specimens of hooks. Ambrose Fare* *, the
father of modern surgery, gives figures of instruments of the
same kind. Gregoireb, Peu, Maynard, and almost all the,
authors who have written upon the subject during the last and
preceding centuries, might be added to the list of improvers or
approvers of instruments of this class. But, notwithstanding
the high antiquity and almost universal adoption of embryulcia
and its instruments under various modifications, I have always
felt the strongest objection to their use, as being unsafe in
certain circumstances in the most cautious hands, and as being
extremely dangerous in those of rash, awkward, or inexperi¬
enced practitioners. The blunt-hook, which I believe is a
modern invention, if used carefully and properly, may indeed
be admitted as an exception to this remark : but its powers are
very limited, especially in head presentations requiring the
operation of craniotomy ; not to add, that this less dangerous
form of embryulcia has been attended in many instances with
deplorable consequences.

Under the second genus of embryotomy extractors to
which I have referred, we may enumerate at least four
varieties: viz. the tire-tete of Mauriceau0 ; the extracting
wings appended by Burton to Quid’s terebra occulta11; M.
Donavia’s simple contrivance of a little wooden cylinder and
riband, as given to the public by Baudelocquee ; and a modi¬
fication of the same contrivance in a more operose form in the
lately introduced extractor of Professor AssaliniV The
common and characteristic principle of all these instruments
is, that they are exclusively applied to the interior surface of
the foetal skull transversely across the aperture through which
they have been introduced. To the part of the mechanism so
applied there is attached at right angles a handle, made of some
accessible or convenient material, by wrhich the operator is
instructed to draw down in the direction of the axis of the
pelvis. To this class of instruments there are also substantial
objections, affecting equally their power and their safety, and
affording, unquestionably, a very ample and sufficient apology
for the attempt to supply the profession with better.

a Les (Euvres d’Ambroise Pare, edit, a Lyon, 1641, Fcl. p. 608-9-
b Voigt . toe . cilat.

* Trade des Maladies des Femmes Grosses} tom. i. liv. 2. p. 3677
41 Burton’,? Midwifery, p. 230. plate 1 6.

* Baudelocque's System of Midwifery, Heath’s Translation, vol. iii.

p. 167® f Trans . Society of Arts for 181b.

Davis' Reply to Mr. Rawlins on the Craniotomy Forceps . 377

But I must hasten to the consideration of our third and
last genus of embryotomy extractors : viz., the genus forceps,
in which are merged the claims of Mr. Rawlins and other
modem inventors. The use of instruments having the forceps
form ol purchase is most assuredly no modern invention, and
much less a novelty of recent date. To illustrate this remark,
however, and to enable the reader to distinguish intelligently
between facts and pretensions, I shall take the liberty once
more of subdividing this genus, which is a numerous one, into
two or three species or varieties.

Under the first subdivision, I shall place the species com¬
pressing or crushing forceps. It appears probable, perhaps
not absolutely certain, that Hippocrates alludes to instruments
of this kind when he advises the head to be seized T hi CO L £ rp hi a.

I am disposed to believe, that the misdachs of Albucasis, and
more especially the larger forceps, were also, at least in part,
intended to diminish the bulk of the foetal head by the effect of
compression. I am aware of Smellie’s opinion on this subject1’;
but I cannot reconcile it to the barbarous appearance of the
instruments themselves, as exhibited in the figures given of
them by Spachiusc* As to another instrument of the same
author, the forfex dentatus, of which we have also an engraving
in Spachius, it is expressly- told, that it was to be used for the
purpose of breaking down or crushing the head of the foetus'1.
This same power appears to have been possessed by the pieds
de griffons of Ambrose Pare6, which was, however, more
particularly intended by its inventor for the envelopement and
extraction of the child’s head when separated from its trunk
and left in utero. I need not add, that compressing forceps
might be, and it is probable generally were, used for the
additional object of extraction.

Again. Embryotomy forceps admit of another and very
important subdivision, founded upon the different modes in
which the opposite parts or halves of the instrument are
connected together or adjusted for their common object of
extraction. The different claws of Ambrose Fare’s pieds de
griffons are fastened together and impelled to act by an
apparatus similar to that of the once celebrated specula matricis#
The structure of Fried’s forcepsf partakes considerably of the
same sort of contrivance. All other instruments properly

a Hip. Loc. Chat. — See also his Commentator, M. C. Rheums.
Comment, vi. Spacch. Gynoes. p. 683. b Smellie’^ Preface*

c Albucasis apud Spacchium, p. 446.=

A Idem, p. 447- e Ambr. Par. p. 608. ei sequent,

f Voigt, de Cap. Infant , Abrupt. § xl. p. 46'p.

vol, viii. — xo. 47. 3 c

378

Original Communications,

denominated craniotomy forceps that I have ever seen or
heard of are connected together by some sort of joint, situated
in or about the centre of the instrument, and common to each
half of it. But this connection may be effected either by a
rivet joint which is only moveable on its own axis, or by some
other mode of junction admitting of the separation at pleasure
of the two blades It is probable that all the instruments of
this kind known to the antients were fastened together upon
the principle of our rivet joint. Here also are to be classed
all the forceps of this tribe best known in modern times . viz.
those of Puisseau, Sehurer*, Lyon, and the lithotomy forceps
of La Mottef. Of these, the power is nearly equal; all of
them, with the exception of La Motte’s, being armed with
long transfixing teeth. The instrument of l)r. Lyon s (formeily
of Edinburgh) is best known in this country. rI o the instrument
makers here it is better known under the designation of
Haighton’s tooth-forceps ; because, I apprehend, that Di.
Haighton is in the habit of recommending it m his estimable
lectures upon midwifery. In common with those of Puisseau
and Sehurer, it is really a very useful and convenient instru¬
ment, and, like them, wrell adapted for the extraction of the feetus
m cases of moderate confinement or distortion. But it unfor¬
tunately happens, that a great majority of difficulties of this
kind depend upon want of sufficient space at the superior
aperture of the pelvis, where the application of rivet-jointed
forceps might be attended with much difficulty and inconveni¬
ence, and where generally, and m all cases of great confinement,
the purchase would of necessity be too limited to admit of a
sufficiently powerful exertion of extracting force. This
remark, I am very certain, is perfectly intelligible to such of
my readers as are practically acquainted with the difficulties
to which it refers. For want of power to introduce the blades
singly, so as to enable the operator to command an ample
purchase above the confinement or distortion occasioning the
arrest, the profession was still under the necessity, in the
more difficult cases of embryotomy, to have recourse to its
blunt-hooks and crotchets. But such a power has for many
years been accessible to it ; perhaps, like some objects of
sensation, too near the organ to excite a distinct impression v
it having been presented to us in a great variety of forms in
those instruments which are most familiar to us : viz. the
modern obstetric forceps for extracting the living child. But
the merit, as in this instance, of transferring the application

* Disput. Chirurg. loc. citat.
t La Motte. Obs. pp. 247, 250, 403, 404,

Davis'1 Reply to Mr. Rawlins m the Craniotomy Forceps. 379

of a principle from one piece of mechanism to another is not
to be undervalued on account of its obviousness or simplicity ;
and it must attach, however much or little it may be, to the
person who was first to make the transfer.

Now, unfortunately for the claims of Mr. Rawlins, I have
it in my power to prove, that the merit of it, so confidently
arrogated by him, does not in fact belong to him ; or, in other
words, that 6i lie was” not i( the real first inventor of,” what he,

I think rather improperly, calls “ the reflected forceps.'’

About two years ago, I communicated to my instrument-
maker, Mr. Ewing of Drury Lane, an idea for the construction
of a craniotomy extractor, capable of being applied by opposite
and moveable surfaces to opposite surfaces of the metal skull,
upon the principle of two parallel blades adapted to one
common handle. Rut this is not necessarily a part of our
present subject. Some time afterwards, with the view of
adding to my collection of lecture or shew instruments, I
sought the opportunity of seeing those of some of my friends;
and among the antiquated curiosities of that kind belonging to
my friend and colleague, Mr. Charles Clarke, I found a rusty,
clumsy, complicated-looking, old instrument, having essentially
the character of forceps with parallel blades and a moveable
joint. The joint was an imperfect specimen of Giffard’s,
rendered heavy and inconvenient by an auxiliary screw
apparatus. The convex surface of the internal blade was
armed with long teeth, which, upon being separated from its
antagonist external blade, came to be fully exposed. I he
handle of the internal blade w7as produced into an inconvenient
blunt-hook, and the appearance of the instrument altogether
was such as to excite feelings not very uncongenial with those
which might be expected to accompany its use, I, however,
recognized in its properties, provided its obvious and capital
faults could be remedied, the substratum of an useful instru¬
ment, superior, indeed, both as to power and principle, to my
own extractor. It possessed the property distinctive of our
second subdivision : viz. that of forceps parallel at the blades
and separable at a common ami moveable joint. iSow it
appears to me probable, that this was the first instrument of
the kind that was ever made. I regret that I have not been
able to trace its history. I have, how ever, the authority of
Mr. Clarke for stating, that it has been in his collection ever
since he can remember, and certainly prior to the ciaie of Mr.
Rawlins’ publication. It is distinguished from all preceding
instruments having parallel blades, by its adoption of Giffaid s
joint. This new application of the loose joint constituted,
indeed, its only novelty ; the teeth, the parallelism, and the
curve to answer to the curve of the sacrum, being known

3 c 2

380

Original Comm unica l ions.

before, and applied with considerable effect in the forceps of
Schurer. But be it remembered, however, that in conse?
quence of this one step in improvement upon its predecessors,
it became, to all intents and purposes, an example of a pair of
forceps upon the principle of those which Mr. Rawlins has .
since designated the reflected-forceps.

This analysis, while it exhibits in a striking point of vietv
the tardy progress of improvement and the doubtful value of
each presumed advantage gained in this department of our
art, is manifestly subversive of the pretensions and fatal to the
claims of the Oxford accoucheur.

But, it may be asked, whether, having thus so completely
defeated my competitor, I have not at the same time been
committing an act of felo de se upon myself? If I had been
the sort of person that Mr. Rawlins took me for, or rather
wished to represent me: if I had borrowed the principle of
Mr. Clarke’s instrument, a principle, however, well known as
applied to the common obstetric forceps, without reference to
the source whence it was more immediately taken ; there might,
indeed, be some ground for such a suspicion. But what is
the fact ? I have reason to believe, that Mr. Rawlins was
informed by Mr. Aikin, the secretary to the Society of Arts,
some time before the publication of his letter in the Repository ,
that several instruments, shewing the nature and progress of
my improvement, were exhibited by me to the committee of
mechanics of the said society, before they came to the adjudi¬
cation of a premium for my specific improvement upon them.
Among the instruments so exhibited, was one made upon the
model of Mr. Clarke’s, the first constructed specimen, as I
conceive, of a pair of forceps, having parallel blades and a
moveable joint, and very superior, notwithstanding its faults,
to the more modern forceps of Mr. Rawlins. This fact, I
apprehend, will be considered a sufficient protection to my
character against the imputation of dishonour, attempted to be
attached to it by that gentleman. I did not, indeed, make a
similar presentment of the reflected-forceps, for a reason which
I trust will be deemed perfectly satisfactory : viz. that I had
never seen nor heard of them. I certainly knew that Mix
Rawlins had written a tract upon the properties of the obstetric
forceps, having seen his name in medical catalogues as the
author of a dissertation on that subject. 1 have now to regret
that I had not been induced to read it ; and I would observe,
that from the improper use of the partitive article in the run¬
ning title of the dissertation, I was not likely to look into it for
information upon the subject of embryotomy. Medical author^
are so numerous and the productions of the majority of them
are so worthless, that I am under the necessity of being very

Davis' Rephj to Mr. Rawlins on the Craniotomy Forceps. 381

select in my choice of books for my own reading. Moreover,
it may be somewhat habitual with me to be rather shy with
strangers, more especially if they have not the good luck to be
pretty well recommended to me. In the case of Mr. Rawlins'
dissertation, I was unfortunately supplied with a motive for
the full exercise of my constitutional reserve. In a copy of
manuscript lectures upon midwifery, which were delivered
nearly twenty years ago by a teacher and practitioner of his
art of the first eminence, I had read the following passage :
44 Since the invention of these,” (Johnson's forceps), 44 Mr.
Rawlins of Oxford has written a philippic against the double-
curved forceps, and recommended straight ones of his own
invention, but which in reality were made and used eighty
years ago.” For the authenticity of this passage, I beg to
refer to Mr. Overend, an ingenious surgeon and a very experi¬
enced practitioner in midwifery at Sheffield, to whose kindness
I am indebted for the present use of it. I here quote it as
an apology to Mr. Rawlins for my seeming neglect of his
essay. As a further excuse, perhaps not a very valid one, I
would beg to state, that in having omitted to acquaint myself
with the contents of Mr. Rawlins' tract, I have sinned in very
respectable company ; all my obstetric friends whom I have
spoken to upon the subject having been equally guilty. I am,
indeed, disposed to believe, that there may not be a single pair,
or but a single pair, of the reflected-forceps to be met with in
the whole town.

As to Dr. Mulder's pleasant compliments to our author,
more gratifying, it would appear, from having been presented
to him in barbarous Latin, they are so carefully expressed and
.so provokingly qualified, that, in my opinion, they have a very-
similar power to that of the negative quantities in Algebra*.
I should also observe, that, had the approbation of this book¬
making foreigner been really worth boasting of, it ought to have
bad reference to the subject under consideration ; whereas, on
the contrary, he does not say a single word either as to the use
or merits of the reflected forceps. But why has this invention
of Mr. Rawlins been treated with so much neglect ? Either
the glimmer of the new light was so feeble as not to be seen, or
the refulgence of the meteor was so glaring, and its transit so
sudden and rapid, as to have paralysed the faculties of those
whom it came to benefit !

This leads me to solicit attention to the properties which
are peculiar to my craniotomy forceps, which have already pro¬
cured for thepi the honour of the distinction alluded to in Mr.

* Vide l list. Lit. ct Critic, Auct. Johan. Mulder, p. 162,

382 Original Communications .

Rawlins’ letter, and which, I am satisfied, will have the effect
ultimately of ensuring for them a place amongst the obstetric
instruments of all intelligent practitioners in the kingdom. It
has been already remarked that craniotomy forceps, having fast
joints, have generally been armed with sharp transfixing teeth.
In the first elfort of improvement upon them, as in the case of
the instrument in Mr. Clarke’s collection, it was natural to
retain the method of purchase at the grasping surfaces pre¬
viously known, without immediately considering how far it
might be convenient or safe to adopt it in forceps having a
moveable joint : or it might be retained, partly from want of
thought to anticipate objections to it, and partly from want of
ability to provide a safer substitute — the ingenuity of the in¬
ventor having possibly been already exhausted. Without,
however, thinking it necessary to settle this point, I would
assume it as a fact, that any instrument having a given number
of long and sharply-pointed teeth, projecting at right angles
and without protection from one of its surfaces, could not be
introduced into the vagina, carried up four or five inches above
the external orifice, as in some cases might be required, and
then withdrawn or adjusted at pleasure, without the risk of
doing mischief. Such was the instrument in Mr. Clarke’s
collection, which he, and probably all his predecessors in the
same school, had been in the habit of exhibiting to their pupils,
as a piece of ingenious but cruel curiosity, for the last thirty or
forty years. I consider the peculiar structure of its grasping
surfaces, now adverted to, as its principal fault, and what pro¬
bably had the effect for so long a period of preventing its admis¬
sion into obstetric practice. In this application of Giffard’s
lock, the inventor failed to reconcile the safety of the old instru¬
ment with the improved power of the new. That desideratum
was therefore left for future attainment. I am happy in the
belief that it has been completely effected in the contrivance for
protecting the teeth of the external blade peculiar to my instru¬
ment.

In the adoption of this contrivance I am not aware that I
have been anticipated by any other person, nor has the princi¬
ple of it been applied, as far as I know, to any other piece of
mechanism that has ever existed. As to its merits, I have made
no exorbitant pretensions. The simplicity of the idea was such
as to require no efforts of profound thinking or elaborate com¬
binations to arrive at it. I acknowledge, however, that it did
not occur to me till after the failure of other expedients to attain
the same object ; and, after all, I feel that I am more indebted
for the suggestion to frequently repeated demands upon my
attention to the subject, than to the possession of any peculiar
aptitude of mind for mechanical improvements,

Davis1 Reply to Mr. Rawlins on the Craniotomy Forceps. 3S3

Having said thus much, I may be permitted to offer it to
the acceptance of my brethren, as an instrument in which the
requisite properties of ample power, perfect safety, and great
facility of application, are more effectually combined than in any
other form of craniotomy extractor that I am acquainted with.

- - f<r Si quid novisti rectius istis ,

Candid us imperii ; si non, his utere mecum

As to the reflected forceps of Mr. Rawlins, which he has so
artfully attempted to identify with mine, they are not worth
their price, whatever that may be ; and as an improvement
upon those of Schurer or Lyon, they are actually worth nothing.,

“ E meglio esser testa di Luccio che coda di Storione.”

In very easy cases indeed, depending upon a moderate di¬
minution only of the usual dimensions of the pelvis, where the
short diameter of the superior aperture might still amount to
about two inches and a half or upwards, they might possibly,
with a little trouble and repetition of attempt, enable the opera¬
tor to effect his object. Rut in many such cases the natural
forceps appended to the human hand, the fingers and thumb,
aided by the efforts of the uterus, and the effect of a little
waiting, would generally answer every purpose. It has been
my higher aim to meet the greatest difficulties of the art, com¬
patible with the safe possibility of delivery by the natural
passages. For the relief of cases of great distortion, such as
was probably that to which Mr. Rawlins has made allusion in
page 35 of his Dissertation, I take upon me to assert, that the
reflected forceps are not possessed of sufficient power. I ground
my assertion — 1st, upon my general knowledgeof difficulties of
this kind ; and I would here observe that my official engage¬
ments are such as to afford me more opportunities of seeing
cases of this description in one or two years, than it is probable
he can have had during the whole of his long and active pro¬
fessional life* : and, 2dly, upon the fact, that, during my pro¬
gressive improvement of my own forceps, the use of much
better and more powerful instruments than Mr. Rawlins1 re¬
peatedly disappointed my hopes. Without disparagement to
the one, or the concession of much merit to the other, it may
be freely admitted, that the Oxonian instrument may have
some properties in common with mine. The same thing may
indeed be said of the blacksmith’s pincers, mentioned by Burton.
They have, it is true, two handles in common : so had those
of Hippocrates. They have two blades in common : so had

* See p. 81 and 82 of the Dissertation, where the author states,
that he has attended upward of five thousand labours.

Original Communications.

those of Albucasis. Their blades are alike parallel and curved:

were those of Schurer. They are alike moveable at the
faint : but this is a property which it has been proved belonged
to an instrument of much earlier date than either. The great
and incomparable superiority ol my instrument to that of Mr*
Rawlins’ consists in the method peculiar to mine lor ensunng
a safe and tenacious purchase : in this consists the differential
quality. A general resemblance cannot be admitted as con¬
stituting identity of character. Veri-similitude is often like
truth : the moon has some properties in common with the sun*
and Plato’s unfeathered cock was promoted, by the definition
of its master, to a very near resemblance with Plato himself.
A craniotomy extractor without power, or with only a very
limited degree of power, is a sort of absurc.ity. It does no,
perhaps want the one thing needful, but ceitainly a one
most needful. Without this essential property it can be con¬
sidered only as an imposing semblance of what it pretends to
be; as essentially imperfect in its nature as a watch would be
without a spring, an eye without an optic nerve, a jest without
wit, or a man without a soul. Such is truly the character of

the reflected forceps of Mr. Rawlins. .

I have to apologise for the length of this communication.
It will occupy much more space in this valuable mi sc cl any
than I had intended ; but I have wished to put my readers m
full possession of the facts of the case. I am not conscious ol
having made a single remark, or having deduced one inference
not warranted by the facts advanced. I therefore do not
anticipate any necessity for a renewal of the subject.

V HI.

Cases of Hernia Cerebri , with Remarks. By Richard
Moyle, Jun. Penzance, Member of the Royal College of
Surgeons, London.

There are few parts of surgery in which such opposite
modes of treatment are recommended as in fractures of the
skull ; and it is evident, that, notwithstanding all the facts
which have been accumulated on this subject, it is still a desi¬
deratum to draw the line of practice within much narrower
limits than it is at present : for whilst some practitioners urge
the necessity of applying the trephine, although no bad symp¬
toms be present, others trust to the lancet and purgatives, and
delay the operation until the appearance of those symptoms
yrhich, in their opinion, can alone justify its use. Since the

385

Moyle’s Cases of Hernia Cerebri.

days of Pott, the trephine has been less frequently used ; the
general practice rather coinciding with that of his successor,
Mr. Abernethy, and few modern surgeons thinking “ that
perforation is absolutely necessary in seven cases out of ten of
simple undepressed fractures of the skull*,”

The same diversity of opinion that existed with respect to
the immediate treatment of the injury, extends to some of its
consequences ; as is but too clearly exemplified in referring to
those authors who have written on fungus, or hernia cerebri .
If the remarks here offered be correct, this is a very appropriate
term,, as it really implies a tumour formed by the protrusion of
some portion of the substance of the brain ; and the disease can
exist only when, with the loss of part of the skull, the conti¬
nuity of the dura mater is destroyed ; either by the edges of a
depressed bone, by some foreign substance being driven forcibly
through it at the time of the accident, or by subsequent ulcer¬
ation. The date of the appearance of the tumour will be
found to correspond with one or other of these circumstances :
while the increase is connected with the increased action of the
cerebral arteries, which, from their very delicate structure,
easily yield to any extraordinary impetus ; when that uniform
support the other parts of the brain receive from the skull and
dura mater is destroyed by a partial loss of both.

The tumour does not necessarily depend on any ruptured
vessels of the brain, but may be occasioned merely by their
dilatation, owing to their debilitated state, and to the increased
action of the larger arteries at the basis of the skull ; the
throbbing of which may be sensibly felt at the denuded part
through the whole substance of the brain. The pia mater,
being deprived of its usual coverings, and unable alone and
unsupported to maintain its position against the increased
pulsations, gradually yields to the expansive force from within,
and, with the subjacent portion of brain, is protruded by
degrees, and thus the hernia is formed.

In those cases in which the pia mater is lacerated, the
denuded brain is pushed through the aperture, and on the
I moderate or increased action of the arteries, connected with the
pia mater being entire or injured, depends in some measure
the slow or more rapid growth of the tumour. It was from
this pulsatory motfon that some of the older surgeons were
induced to consider this disease aneurism. In the usual ac¬
ceptation of the word they were wrong ; yet, without doing
any great violence to terms, some of the vessels of the brain
may be considered nearly in an aneurismal state.

Mr. Abernethy’s opinion of the disease being produced by

* Pott, p. 130.
VOL, Till.'— no, 47, 3 D

386 Original Communications .

“ an effusion of blood into the substance of the brain,” may be
sometimes correct ; but in by far the greater number of cases
no such occurrence takes place, nor is his mode of treatment, of
“covering the tumour with some mild dressing,” and “carefully
avoiding all pressure,” sufficient, except in very mild cases.*
Founding his practice on the theory of a ruptured blood-vessel,
he advises (p. 61), that “ if the tumour continues to increase,
we have reason to suspect that the coagulum, from want of
room to protrude, is enlarged internally ; or that by plugging
up the orifice in the bone, it prevents the escape of some fluid
collected within the cranium ; the obvious mode of relief here
appears to be to enlarge the opening in the bone in proportion
to the extent and increase of the tumour a dangerous, and
frequently an useless, operation.

Mr. C. Bell states, that this disease sometimes arises “after
a venereal caries of the skull, where it is natural to suppose
there was no previous injury of the brain;” shewing that it
may be produced without the bursting of a vessel. It shews
also, that hernia may be formed whenever the cerebrum is
unprotected, without any injury or much increased action of
the arteries of the brain ; unless, indeed, we suppose their
action to be increased by the irritation occasioned by the exfo¬
liation of the bone. This author calls it fungus, but thinks it
an organised tumour; Mr. Abernethy thinks it not organised,
but coagulated blood.

We are sometimes told of the operation of the trephine
occasioning this disease by wounding the dura mater ; but
surely such a circumstance rarely if ever happens. Who ope¬
rated more frequently than Pott ? and yet it is not a little
singular that he does not seem to have once met with a case of
hernia cerebri. A century ago, in the trepanning days of
Heister, perhaps it might have happened oftener ; for, in
speaking of the use of the trepan, he says, “ it is extremely
difficult, if not impossible , for you to take out a piece of the
cranium by this instrument without injuring the subjacent
dura mater*.”

Mr. Hey, in his Observations on Surgery, has related twro
cases that are particularly instructive, although he has not
drawn any practical conclusions from them himself; as his
attention was chiefly directed to the introduction of his circular
saw in the room of the trephine in depressed fractures of the
skull. He says, “ a fungus about the size of a nutmeg arose
from the brain, and had a strong pulsation. I made no
pressure on the fungus, but only applied mild dressings.

* Heister, translation, p. 379*

3S7

Moyle's Cases of Hernia Cerebri.

generally dry lint ; at the end of three weeks the fungus was
reduced nearly to a level with the rest of the wound, which
then healed quickly.” In the 2nd, “an oblong fungus arose
through the aperture in the dura mater ; but with simple
dressings, without pressure, the fungus retired as the cicatriza~
tion advanced , and the boy got well.”

These were both undoubtedly hernim cerebri, although of a
mild kind. In the first case, it is not clear whether it was
reduced by sloughing, or by the growth and pressure of the
granulations; but in the second, we have an instance of the
natural return of the hernia by the gradual pressure of the
newly formed cicatrix : a valuable case, as it proves not only
the organization of the tumour, but its being part of the brain;
for we can scarcely think the boy would get well if the tumour
that retired was coagulum.

The case that more particularly led to the present remarks
was one that lately occurred, in which there was a very ex¬
tensive fracture with depression, and a portion of the cranium
driven through the dura mater. After the operation of the
trephine, the difference of the pulsation, when the fingers were
applied on the dura mater and on the pia mater, was too sen¬
sible not to be noticed ; being on the first indistinct, and on
the other strong and bounding. From this lacerated opening
a hernia gradually protruded, and at the tenth day from the
accident it was about the size of a pigeon’s egg. The appear¬
ance of this tumour gave rise to a number of unpleasant
anticipations, and my hopes of a favourable result in a case
that, independent of this tumour, had not an alarming sympr
tom, were on the decline.

I well recollected the fatal result of a similar case, in which
nothing but lenient measures were adopted ; but the tumour
continued to increase, until it reached the size of an orange,
and the patient, after languishing some vyeeks, died of convul¬
sions. In another case, it was removed by the knife ; but the
termination was equally fatal. The object of the operation
was to expose “ the ruptured blood-vessel but no such cause
of the disease could be found, and the boy was nearly dying
under our hands from a profuse haemorrhage that was poured
out from the mouths of many divided arteries in the cortical
and medullary substance of the brain, to which, from their
delicate structure, no ligatures could be applied.

One cannot but be struck with the jarring opinions ad¬
vanced by different authors respecting tumours arising from
the brain. Some, as we have already noticed, contending that
they are organized^ others, that they are merely coagulated
blood:

This confusion has arisen from their applying indis^

3d 2

488 Grig inal Commun i cations', ,

nately the same terms to diseases that widely differ, both its
their nature and mode of treatment. It is essential, therefore,
that they be distinguished.

As the terms fungus and hernia cerebri are familiar to us,
they may still be retained.

The term Fungus Cerebri may be applied to those
unorganized tumours that arise from the brain ; consisting of
coagulated blood, of a fibrous texture, of very rapid growth,
seldom appearing before the tenth day , accompanied with coma¬
tose symptoms, and generally proving fatal. Mr. Abernethy’s
two cases, Nos. 15 and 16, may be quoted as examples of this
affection.

Hernia Cerebri is not only an organized tumour, but is
a protrusion of part of the brain. It generally appears in a
few days after the accident, frequently before the fifth ; bleeds
freely on being touched ; has a very strong pulsation ; is of
slower growth, and not so dangerous as fungus. Neither is it
attended with coma . Of such are Key’s cases, which he calls
fungi.

It will be proper to mention the best method of preventing
the protrusion of the hernia, before proceeding to detail the
treatment.

In cases of injury of the head, where there has been a loss
of bone, the divided portion of scalp should be laid down on
the dura mater, without any dressing intervening ; but when
there is much extravasation between the dura mater and the
skull, it must be left to the discretion of the surgeon to decide
how far it would be right to attempt to procure adhesion
without leaving at least some channel for the discharge to
escape. In all cases, in order to prevent the protrusion of a
hernia,, it is necessary to give the brain that uniform support
which it had been deprived of by the loss of bone. As we all
feel an antipathy to the word pressure, when talking of the
treatment of injuries of the head, it may not be amiss to
explain what is meant. If, after the operation of the trephine,
the surgeon were to place any firm unyielding substance
within the fractured edges of the bones and bind it down firmly,
he might as well have spared himself the trouble and his
patient the danger of the operation ; for, although he might
prevent a hernia,, his patient would still labour under symp¬
toms of compressed brain ; but if this substance be of sufficient
span to rest on two or three parts of the sound undressed bone,
no pressure that he could apply would affect the brain. By
this remark, however, it is not meant to imply that any violent
pressure is necessary ; it will be merely sufficient, after the
adhesive straps and dressings are on, to apply a piece of tin
plate over them , so hollowed as to adapt itself to the head, a

389

Moyle's Cases of Hernia Cerebri.

considerable part of which it should embrace, and it may be
tied moderately firm with straps under the chin, or round the
head. Occasional bleedings from the arm, purgatives, low
diet, saline mixtures with digitalis should be given, and every
thing be avoided that can tend to excite vomiting ; while the
head and shoulders be kept elevated.

As Fungus Cerebri is occasioned by the giving way of
some blood-vessel, no method is so likely to hinder such an
event from occurring, as by lowering the circulation by repeated
bleedings, and by giving support to the unprotected brain ; for
it is easy to conceive, that a vessel may be seriously injured and
yet recover its tone by this treatment, that would burst if left
unsupported to the increased pulsation of the larger arteries.
But, although this treatment is proper before the fungus makes
its appearance, yet it would be highly injurious afterwards ; and
as these measures tend only to prevent the occurrence of such
diseases, we are next to consider the method of cure.

In Hernia Cerebri, we are to be guided by the size and
appearance of the tumour. If it be small, and the granulated
surface of the pia mater has a healthy aspect, we are to endea¬
vour gradually to reduce it, by keeping the patient with his
head and shoulders much elevated ; by opening the jugular
vein, and dividing, if necessary, the strictured part of the dura
mater with the probe-pointed bistoury ; and then by applying
gentle pressure at first, and increasing it by degrees. I recol¬
lect very well in Eddy’s case, about to be detailed, that on
pressing the hernia with one hand for some time, and then ap¬
plying the fingers of the other to his wrist, to ascertain whether
I could detect any difference in the pulse, that the tumour was
lessened ; but, unfortunately, the idea of drawing any practical
fact from this circumstance did not occur at the time, or I think
the application of the ligature might have been avoided. How
often blood-letting is to be repeated, or how long this pressure
is to be continued, and to what extent, can be determined only
by the result; for it must be recollected, that the effect of
pressure in this instance is very different from what would
follow a depressed portion of skull. In one case, the brain is
reduced within a smaller compass than is natural, to the evident
derangement of all the animal functions ; in the other, from the
want of support, and by the increased action of the blood-ves¬
sels, the delicate substance of the brain expands, and occupies
a larger space than it did before, and forms that disease, which
the support of the displaced bone would have prevented, and
which it is now our object to cure.

If, notwithstanding all our efforts to reduce the hernia, it
should still continue to protrude, or shew any disposition to
slough, it becomes necessary to remove it ; and by firm com-

390

Original Communications.

presses to prevent any further protrusion. The pia mater, all
round the base of the tumour, should be divided with the knife
before the ligature is applied, that as little of that membrane
as possible may be included in it. Thus the dangerous haemor¬
rhage occasioned by removing the tumour with the knife would
be avoided ; and the inflammatory symptoms that might super¬
vene on a ligature on the pia mater be lessened.

In our endeavour then to cure this disease, we are closely
to imitate Nature ; and natural cures seem to be effected in two
ways ; first, by compress ; second, by ligature.

First. — By the growth of the granulations from the scalp
acting as a gentle compress, and giving support to the denuded
portion of brain. The hernia 66 retiring as the cicatrization
advances.”

Second. — By the stricture of the dura mater obstructing
the circulation, and thus acting as a ligature ; the tumour
sloughing and falling off* by degrees. Whether this portion of
brain is ever removed, or its place supplied by the expansion of
the other parts, is a curious question for physiologists to deter¬
mine.

The first case that gave rise to the foregoing remarks oc¬
curred on the 27th of March 1816.

Case I.

Samuel Eddy, aged twenty years, a miner in the parish of
St. Just, was carelessly riding on the arms of a capstan, whilst
a heavy weight was lowering down into a mine. After a short
time, the capstan went round with unusual velocity ; he became
giddy and fell. On falling, he was struck with one of the arms,
knocked with great violence against a wall, and taken up appa¬
rently lifeless. I saw him in a few hours afterwards, and found
all the scalp covering the os occipitis turned back on his neck,
with a considerable portion of the pericranium detached ; there
was no appearance of any injury of the skuli ; the scalp was
replaced, and a few ligatures applied. He was sensible at times,
and, f requently putting his hand to his head, complained of pain
there, and entreated me to leave him that he might sleep, and
then he should be better. He vomited a great deal ; his eyes
were not very sensible to light; the pulse 74; and he complained
of being cold, and he frequently shivered. On laying open a
small wound on the os frontis, in which there was much extra-
yasated blood, I discovered a considerable fracture, extending
in one direction across the right parietal bone, nearly to the os
occipitis, with the fractured edges of the bone, separated to one-
eighth of an inch, down under the temporal muscle and forward
to the orbit, and in the midst of these a depressed portion of
bone. The pericranium was detached to a great extent, and

391

Moyle's Cases of Hernia Cerebri.

theie was extravasated blood on the dura mater, which was
punctured by the depressed bone.

1 lie trephine was applied twice, and I regretted that I had
not taken Heys saw with me. After the bone was elevated,
the paits were covered with simple dressings, but without any
pat tieular supjwrt to the denuded portion of brain. He lost a
great deal ol blood before and during the operation, from
the division of the temporal artery ; and no means were taken
to suppress it.

2nd day. 1 found him more sensible. He vomited on being
moved, and brought up a solution of magnes. sulph. that had
been given to him. The pulse was 90.

# 3rd. -^e had passed a restless night : there was much pain
m Ins head, and the pulse was stronger. I took away ^xvi»
of blood.

4th. He was in less pain, and had passed a quiet night.
1 he bowels were not open ; I therefore gave him some extract,
colocynth. C. which he could swallow with difficulty. I now
observed rather a rising of the brain, where the dura mater

had been punctured, and the pulsation was very evident in
this part.

5th. The patient passed a tolerable night ; was sensible,
and tne pulse 96. His bowels not being sufficiently opened, I
ordered an enema. The hernia was more evident ; it bled on
appling the sponge to it. It was certainly covered by the pia
mater; I applied dry lint to it; the vomiting had ceased ; the
dura mater had recovered its situation, the extravasated blood
being removed. He was faint on being taken out of bed to iro
to stool.

6th. The pulse 84, and soft ; I gave him infus. sennae
with magnes. sulph. The hernia was increased, and bled
freely on being touched; the bowels were opened twice, for
which he got out of bed himself, but was exhausted by the
exertion. The wounds discharged freely.

7th. The pulse 88, and soft. The hernia increased; he
is quite sensible, and there are no symptoms of coma,

8th. Pulse 88.

9th. Pulse 84.

10th. Pulse 80.

11th. Pulse 80, and soft. The bowels lax; and he is
going on well, except that the hernia continues to increase. It
was larger than a pigeon's egg, and the pulsation in it very
strong. I confess my ideas of the nature of the tumour were
at this time very confused ; I had no conception that it was a
protrusion of the brain, or I think there would have been no
difficulty in reducing it. Being anxious to get rid of it, as I
considered it the greatest impediment to the healing of the

392

Original Communications .

wound, I applied a ligature, as I dreaded the haemorrhage that
I had seen occasioned by the knife.

12th. The pulse 84, and rather harder ; he felt pricking
and darting in his head, and a throbbing in the tumour ; but
passed a good night. The senses are perfect ; the wounds more
sensible, and had rather a glassy appearance. The bowels are
not so open.

13th. The pulse 74, and soft ; the patient was very sen¬
sible of the throbbing in the tumour from the time the ligature
was applied. The bowels were regular; I tightened the ligature
so as to cut off the hernia, excepting at one small shred that
still held it, and then divided this with an abscess lancet. On
examining the tumour, I found the ligature still adhering to a
membranous substance ; which proved to be part of the pia
mater, that had dipped down between the convolutions of the
brain ; I could easily turn it back with the probe. It was at
this moment that I first felt convinced of the nature of the
disease.

The throbbing ceased on the removal of the ligature, and
the map felt very well, and was able to get out of bed without
assistance. The fracture that extended towards the os-occipitis,
was filled up with granulations : and the surface of the brain
from which the hernia had been removed, was dotted with specks
of blood from the divided vessels. I applied a large piece of
cork, hollowed out a little, (being the only substance at hand,)
and bound it down firmly, letting it rest on the sound part of
the cranium, with some dry lint under it.

14th. The pulse was 78. He felt the pulsation from the
time the wound was dressed yesterday ; the bowels are regular ;
he was able to get out of bed, his appetite is good ; the hernia
is not protruding ; I re-applied the compress ; he sleeps well ;
there was a good deal of discharge from the wounds, but the
patient complained of the back part of his head being very
uneasv.

15th. Pulse 80, and soft. He smiled to day when I came.
I applied adhesive straps and a tin plate over his head, and tied
it firmly down.

16th, 17th, 18th. He was just the same. The pulse 72. I
laid open the scalp of the occipital bone, and gave vent to a good
deal of pus. The part had become exquisitely painful. He
does not feel any pulsation. The hernia is not protruding.

10th, 20th, 21st, 22nd. Was going on very well. He sat
up to day, moved about the room, and looked out of window.

23rd. He was not seen to day, as he was so well yesterday.

24th. He complained of great prostration of strength, was
low spirited, and had some rigours. The wounds looked very
well ; there was not the least appearance of hernia, the spot

393

Moyle’s Cases o f Hernia Cerebri „

being covered with healthy granulations ; but he could not bear
the light, and complained of difficulty in opening his mouth.
The pulse was 80 and weak.

R Decoct. Cinchonas, f^xii.

Tinct. ejusdem, f§i.

Sp. Ammon. Arom. f3iij. ft. Mist, cujus capt.
coch. iii. ampla tertia quaque hora.

I hoped the rigors and stiffness of his jaw proceeded from
cold, not wishing to class them amongst the “ mala signa” of
Celsus,

“ Maxillarum atque cervicis rigor.”

25th. I found him better ; the pulse was firmer, and the
rigors not so frequent. I observed, that, notwithstanding the
extensive injury of the cranium, and the separation of the dura
mater, and the pericranium to a considerable extent, only a
small part of the outer table would exfoliate.

26th. The pulse was 80. The spasms were much stronger,
and I now perceived unequivocal symptoms of tetanus, accom¬
panied with profuse sweats and great weakness.

27th. The pulse was 90. The patient had a violent spasm
whilst the wound was dressing, and threw himself back on the
bed quite rigid; the spasms returning every three or four
minutes. It is unnecessarv to copy every particular from the
notes that were taken down each day ; it will be sufficient
to state, that the pulse got up to 120, the spasm became more
violent, and the man was completely rigid at times. His skin
became very hot and dry, although he lay quite naked under
the window. He took considerable quantities of tinct. opii.
without any effect; at one time f3iss at a dose. The gra¬
nulations became quite flat, and the brain much sunk ; but
the part from which the hernia had been removed was the
lowest. The senses were perfect.

On the thirty-third day there was a discharge of pus from
the brain, and when the spasms came on, it started out from a
little hole in the direction of the fracture towards the ear.

On the 6*th of May he died, being the fortieth day frqm the
accident, and the thirtieth from the ligature being applied.

His friends would not consent to his head being opened ;
but the parts were examined superficially, without any thing
particular being observed, except the abscess in the brain, which
I think may be fairly considered the cause of his death, and not
the hernia cerebri. We have many instances on record where
the symptoms have been very similar without any hernia ; for
instance, in Pott’s Works, Case XII, p. 105, where the patient
died on the thirtieth day from the accident. He was convulsed

VOL. vm. — no. 47. 3 E

394

Original Communications .

in all his limbs; had locked jaw and abscess in the brain ; and
that matter should form after the brain has sustained such evi¬
dent injury, is not to be wondered at, when we see that it some¬
times follows an injury of the scalp, without the skull being
hurt. (Abernethy, Case IX. fob 27.)

Case II.

The. next case that I shall notice, will be one that occurred
in my father’s practice, nearly thirty years ago ; but the subject
of it is still alive. It is not only remarkable for the hernia
cerebri, but as being one of the first in which the practice of
removing a considerable portion of scalp was discontinued in
this part of the country ; and by which circumstance perhaps
the patient’s life was preserved.

*6 James Neluddra, aged about ten years, son of Mr. Jolm
Neluddra of Marazvons, was, on the 15th of March 1788, thrown
from a horse with great violence against the pavement, and
taken up quite senseless, and in a comatose state, with frequent
vomiting. On examining his head, no wound appeared ; but
a considerable tumour of the scalp was found, which extended
over the left parietal bone; and, on dividing the scalp, a quantity
of blood mixed with brain, flowed freely from the incision ;
which was continued to the lower part of the parietal bone, from
which the scalp was completely separated. On examining the
skull, a fracture was discovered the whole length of the parietal
bone. At the upper part there was a depression, through
which the brain was discharged at every pulsation ; and a tri¬
angular portion of the skull, about the size of a shilling, was
found to have penetrated the dura and pia mater. After the
detached bone was removed by the forceps, the flow ot brain
■was greatly increased. The scalp was divided along the course
of the fracture, but no part of it removed. The wound was
dressed with dry lint and the scalp brought over it, which served
as a compress to prevent the further effusion of the brain. The
discharge of cerebrum continued for three or four days, and the
patient remained in the same senseless state as when he was
taken up from the pavement, with a general paralysis of the
whole body for twenty-three days , when his senses returned, and
the paralysis gradually disappeared.

No inflammatory symptoms took place ; but, about the
seventh day, a fungous tumour appeared from the wounded
part of the meninges which still kept open, and in a day or two
pushed through the aperture in the cranium to the size of a
small pullet’s egg. It had a regular pulsation. Compressions
of lint were applied to keep it within the skull without effect ;
but by a continued pressure with the finger it was discovered*

Moyle’s Cases of Hernia Cerebri. 393

that the whole tumour could be replaced within the cranium ?
although on removing the pressure it re-assumed its usual size.
The patient, when he became sensible, did not complain of any
particular sensation during the time the compression was mak¬
ing, which was very effectually done by a piece of flexible tin
plate, that extended across the parietal bones, and was secured
by ligatures under the chin.

44 As the discharge from the wound was but little, and no
unpleasant symptoms appearing to arise from the pressure,
the tin plate was not removed for two or three days ; when the
tumour was found to be much diminished. The compression
was afterwards increased by the addition of several pieces of
lint. This plan being pursued for several weeks, the hernia
was effectually got under, and the wound completely cicatrized
about the 2 1st of July. No convulsions appeared at any stage
of the illness. The young man, after the accident, enjoyed his
senses as perfectly as before, and he is alive at this time, twenty-
nine years since it happened, without experiencing any com¬
plaint arising from the injury done to the brain.’’

Case III.

Was that of a miner, who was hurt in Chaeewater mine, in
the parish of Kenw vn ; and a considerable portion of the left
parietal bone was driven into the substance of the brain. 44 The
poor fellow was so terribly mutilated, that I had not the least
idea of his living many hours. Being from home when I was
called to him, and having no forceps, I was obliged to introduce
my finger two inches under the cranium in order to get at the
detached piece. To my great surprise, the next morning I
found the man alive and sensible; and, after a few days, the
wounds put on a kindly appearance, except a considerable her¬
nia cerebri, which protruded in consequence of the increased
action of the arteries of the brain. Very gentle pressure,
scarcely any more than to prevent its further protrusion, was
the only means resorted to. After some little time, a slough¬
ing came on, and at the end of about six weeks the wound was
completely healed. His general health was apparently good ;
but very soon after the wound was healed, he became paralytic
on the right side ; and about eight weeks after the accident, as
he was sitting up in bed, and taking his breakfast as usual, he
complained at once of a violent pain in his head, and expired
in a very short time. As I could not obtain the consent of his
friends to open his head, the cause of his death remains a matter
of conjecture. There had been no symptoms of matter form¬
ing. Might it not have been from over-distension of thos®
vessels which were weakened by the accident ; or from the

306 Original Communications.

giving way of some vessel, and thus occasioning apoplexy ?w
The above is an extract of a letter from a friend of mine who
attended this man, dated 13th of September 1816.

Case IV.

Occurred in this neighbourhood a few years ago. I saw the
lad who was the subject of it, a month since, and on inquiry
about the case, I was obligingly furnished with the following
particulars by Dr. Penneck, who attended him.

Oliver Bodinar, eight years of age, fell on the 13th of
October 1809, over the cliff* at Newlyn, on some pointed rocks
on the beach ; the perpendicular height of the cliff was twenty-
four feet.

He was comatose, and had all the symptoms denoting com¬
pression of the brain. There was a small wound of the scalp,
which, on being enlarged, exposed a fracture on the left side of
the os fronds, with a small triangular piece of the cranium
driven in on the brain, some portion of which exuded from the
wound. He was trephined, and the bone elevated. The stupor
Went off gradually, and the next day he was more sensible.
He was bled, and purged repeatedly. The scalp was brought
over the denuded bram, and kept in situ by adhesive straps ;
but as a great deal of tension came on, they w ere loosened, and
on the third day a hernia cerebri appeared, which gradually in¬
creased to the size of half an egg. It vras unattended with
coma ; it bled on being touched, and had a strong pulsation.
The wounds were now dressed superfi daily ; but as the in¬
flammatory symptoms subsided, the flaps w ere again brought
forward, and retained by straps of adhesive plaister, firmly ap¬
plied. The hernia retired by degrees as the wound cicatrized ;
but there was a fulness in the part for some time after it was
healed, which was reduced at the end of three months ; but
even after this, some small exfoliation of bone came away.
The boy enjoys good health at present, but no bone has been:
reproduced.

Case V.

A son of Joseph Lukey, of the parish of Perran-Uthnoe,
about eight years of age, received a violent blow on his bead
from the kick of a horse, on the 24th of April 1813. The
flow of blood was great, with portions of the cerebrum mixed
with it. On enlarging the wound, a considerable part of both
the parietal bones was found to be depressed ; the boy w as in¬
sensible and comatose, with frequent vomiting. The depressed
parts were removed by means of the forceps and levator, w hen
a large wound of the membranes appeared, through w hich
the brain issued at every pulsation. On the next and follow¬
ing days lie was more sensible and able to speak. About the

397

Moyle’s Cases of Hernia Cerebri.

sixth day a tumour arose through the wound in the dura and
pia mater, and was attended with convulsions. Compressions
of different kinds were applied without success ; and therefore
on the eleventh day the tumour was removed by the knife.
The haemorrhage was so profuse as nearly to prove fatal imme¬
diately after the operation ; and he died in two days after¬
wards.

In this and the second case, the hernia appeared on the sixth
and seventh days ; but there was a discharge of brain in each ,
which retarded its appearance. This, and the following case,
have been alluded to m the former part of this paper.

Case VI.

A son of Jervis Shug, of St. Ives, aged eleven years,
received a violent blow on his head by the fail of a stone from
the roof of a house, on the 23rd of March 1808. On exami¬
nation a considerable wound was discovered on the scalp,
covering the right parietal bone, which being laid bare by the
division of the integuments, a very extensive irregular fracture,
with great depression, appeared in view. The depressed part
was elevated without the aid of the trephine, and several
detached pieces of bone were removed, by which a large aper¬
ture in the membranes was made, and through which the brain
flowed freely. The boy was comatose for some time after the
depressed pieces were elevated, when his senses were imperfectly
restored. For four or five days portions of the brain continued
to be discharged ; but, independent of this, his symptoms were
more favourable, and continued to be so till about the tenth
day, when convulsions took place on the left side of his body;
and a fungous tumour arose through the meninges, which in
a few days grew to a considerable size. I cannot charge my
memory by saying positively, whether symptoms of coma came
on on the first appearance of the tumour, but they certainly
were present afterwards. Caustic was applied to the protruded
part, and pressure was continued for some time; but all proved
ineffectual : he lingered with frequent and violent convulsions
until the 28th of April, when he expired in a fit.

I considered this to have been a case of fungus cerebri, that
ought to have been removed by the knife. Caustics are highly
improper in all cases, either of fungus or hernia.

Whenever hernia cerebri supervenes to an injury of the
skull, it undoubtedly adds very considerably to the danger of
the case ; yet, in attending to this formidable disease, we must
not overlook the most injured state of the brain, and its invest¬
ing membranes : nor must we attribute the death of our patient
soldi/ to this cause, as perhaps fhe event would frequently
prove fatal, even although no such disease existed.

398 Original Communications.

Authenticated cases,

OBSERVATIONS, and DISSECTIONS..

LV. — A Case of Cephalalgia.

A marine officer, twenty-seven years of age, who had
served actively in a hot climate during the last eight years, had
long complained of head-ache and general indisposition. When
he reached England (about Christmas last), he had constant
nausea and frequent vomiting of every kind of food. A thick¬
ening of the pericranium had existed while he Avas in India,
which had been reduced by leeches and blisters ; it was still
however perceptible, but was removed by a repetition of the
same means.

The patient had never had syphilis in any form. The head
was considered as the seat of the mischief. Abstractions of
blood, by leeches and cupping, were employed very frequently ;
large blisters were applied to different parts of the parietal,
temporal, and occipital bones, in succession, as the situation
of the pain dictated, and they were kept open by the unguen-
tum cantharidis.

For a long time he was rather improving ; but about five
weeks before his death, a numbness, chiefly of the right hand,
arm, and leg, came on 4 which never proceeded to complete
paralysis ; but the original malady was obviously gaining ground
from that time, and the patient died in a fainting fit in the night.

The alvine secretions were carefully attended to during
the whole illness (since his return to England), and the
stools were of the natural appearance.

Examination post mortem .- — The dura mater, where it covered
the cerebellum at itsposterior and inferior part, was thickened and
converted into a substance resembling cartilage ; which diseased
state had communicated itself to that part of the cerebellum lying
in close contact with it, and extended considerably into its sub¬
stance. The other parts of the cerebellum were softer than usual;
being pulpy and shewing marks of disorganization. The indu¬
rated state had extended into the theca vertebralis, as far as the
finger could reach. The cerebrum was rather softer than a
healthy brain thirty-four hours after death ; the dura mater was
healthy ; some water was found in the ventricles ; the pineal
gland was ossified at its anterior part ; that is, distinct particles
of bone were detected in it. The arachnoid membrane, in
various parts, shewed signs of previous inflammation, being
thickened and discoloured in such places, particularly where it
covered the optic nerves at their point of decussation.

The thoracic and abdominal viscera were not examined, as
no particular derangement of their functions had appeared.

Cases of Podagra , Pleuritis 9 and Ascites .

S9&

I A I. — A Case of Podagra.

Piiis occurred in a stout and otherwise healthy woman, and
exhibited every symptom characteristic of the disease. She
was treated by scarifications of the inflamed spot, and the con¬
tinued application of evaporating lotions. The bowels were
freely and repeatedly purged by means of calomel and saline
purges ; and as the symptoms declined, which happened in a
very few days, a weak decoction of yellow bark, with carbonate
oi soda, was administered three times a day. The Reporter
has never seen a ease of acute podagra yield ‘in so short a space

of time; the patient being able to walk with ease in five days,
> — T. ■ J

- IA II.— Case of Pleuritis, attended with Abscesses within the

Pericardium.

A case of pleuritis terminated fatally in three days from its
commencement. Upon examination post mortem , there were
found, besides the inflammation of the pleura, a considerable
thickening of that membrane, and an effusion of serum and
coagulable lymph into the left cavity of the chest. The heart
was also very much enlarged, and adhered to the pericardium.
When the pericardium was cut through, two abscesses were
seen, one near the origin of the large vessels of the heart, which
was about half the size of another situated on the left side of
the heart, containing nearly four ounces of scrofulous pus. The
pericardium over these abscesses was about one-eighth of an
inch thick. The heart itself was healthy.

L\ HI.— Case of Ascites , terminating in Paralysis and Apoplexy 0

Mu. Bishop, a farmer, aged fifty-two, applied to the Reporter
Oil the 2oth of Jane last. His abdomen was exceedingly dis¬
tended with water, and the whole of the lower extremities were
anasarcous. Ilis breathing was short from the distension of the
abdominal cavity, but no symptoms of effusion into the chest
were present. The collections of water had formed within a few
weeks, and his health had for some time been disordered. The
secretion of urine was scanty. The urine coagulated on heino*
heated. There was some tenderness of the right side extend^
i ng to the epigastrium. He was directed to take pills com¬
posed of digitalis, squill, mercurial pill, and gamboge, and a
mixture of large doses of acetate of potash, with nitre, vinegar
of colchicum, and aether. During the three succeeding days,
the discharge of watery fluid by the bowels was extremely
great; several gallons were voided, a quantity of phlegm and
bile were thrown off by vomiting. During this time the squill
was omitted, and the vehicle of the mixture was infusion of

400 Original Communications,

calumbo. At the end of this time the whole of the anasarcoiis
deposit was removed, and the ascites had disappeared. On the
2nd of J uly, at one in the morning, he had an attack, the con¬
sequence of which was a considerable stiffness of the right arm
and leg, with a difficulty of moving them, and an inability to
finish any sentence or answer, the hesitation in the articulation
being connected with a forgetfulness of the subject of conver¬
sation. The pulse was neither languid nor slow. There was
no pain ; no difficulty of breathing ; nor defect of sight nor
smell ; neither was there any difficulty in forcing out the
tongue ; and the pupil was unaltered. The action by the
bowels ceased on the accession of this attack. W as it from a
cause like that producing syncope on the sudden removal of
water by paracentesis ? Why should the ventricles of the brain
be supposed to have been distended by water just at the mo¬
ment that the system was emptied of its dropsical accumula¬
tions ? The following was prescribed :

R Tinct. Benzoes, C. Jiii,

Mucil. Acacise, 2>vh
Sp. jEther, Comp. Jsso
Sp. Ammon. C, 3hi*

Mist. Camp, §iv. Misce,

Cap. ^i. 2da quaque hora.

Next day he was better. The hesitation in the speech was
gone ; and the stiffness and inability to move abated. He
made more urine, which deposited a yellow copious sediment ;
and the urine coagulated on being heated. The Reporter
ordered the tinct. benzoes, with ether, gentian, camphor, and
aloetic tincture. July 4th. He had passed a good night ;
pulse 82 ; urine as yesterday ; no evacuation since the attack
on the 2nd,

If Potassse Acetat. 3iii»

Potassas Nitr.at. %ii.

Decoct. Aloes, C. 3v.

Infus. gentianse Comp, givss,

Sp. Ether, C. §ss. Misce.

Cap. §i. 2 da. quaque hora.

Having had no evacuation, he took, also, a rhubarb
draught. On the morning following he had a loose motion
of a good colour. The abdomen became a little distended
in the last three days ; his appetite was bad, but the tongue
very clean ; and there was no prominent symptom but de¬
bility. Ele continued in this state until the 6th of July.
The Reporter saw him at eleven o'clock on that day, when
he remained without any particular change. He ate his
dinner at one o’clock ; at two, asked for his medicine ; when
his wife who had gone out of the room for a tea-cup, on her
return found him black in the face and dead.

Bancroft's Essay on the Yellow Fever.

401

PART II,

ANALYTICAL REVIEW.

A Sequel to an Essay on the Yellow Fever ; principally intended
to prove , by incontestable facts and important documents , that
the Fever called Bulam or Pestilential has no existence as a
Distinct or a Contagious Disease. By Edward Nathaniel
Bancroft, M.D. Fellow of the Royal College of Phy¬
sicians, Physician to the Army, and late Physician to St.
George’s Hospital. 8vo. pp. 487. London, 1817. Callow.

If this work were a mere answer to Dr. Pym and Sir
James Fellowes, and the continuation of a controversy, which
those who wish well to the profession must lament, if not
reprobate, we would forbear from noticing it : but when truth
is really the object cl research, and when its establishment is ot
so much importance to the lives and welfare of mankind, we
enter into the discussion with an ardour only surpassed by that
of those who have begun and carried on the inquiry.

Doctor Bancroft, in his first chapter, examines the statement
of the symptoms which have been regarded bv Dr. Pym as
diagnostic of the Bulam or Pestilential fever, and the proofs
66 alleged to support its real entity.'1 The first ot the symp¬
toms, “ the peculiar shining or drunken appearance in the
eyes,” he regards as by no means peculiar to the Bulam fever;
and although such a state of the eye sometimes occurs, yet
that, as well as other appearances of these organs, “ depend so
much on their particular condition in each subject, and on the
degree in which the brain is affected , and the blood determined
to the head, that tliev must always be too variable to form any
part of the character of this disease.11 The second symptom*
the excruciating head-ache “ confined to the orbits and fore¬
head, ” our author also considers useless as a diagnostic*
because it frequently extends to the temples, where it is iclt
even more severely than in the forehead ; and it is besides s
“ frequent occurrence in remittent fevers.’1 As to the third
diagnostic of Dr. Pym, the absence of remissions in the
Bufam fever, he brings forward the authority of Drs. Aicjiua,
Gonzales, and the other Spanish physicians, who describe the
vol. viii. — no, 47. 3 ¥

402 Analytical Review.

Carthagena, Cadiz, and Malaga Epidemics, which Dr. Pym re¬
gards as identically the same with that of Gibraltar, to prove that
remissions are of frequent occurrence ; but even were it true
that no remissions occur in the Bulam fever, yet this, he con-’
tends, cannot be regarded as characteristic of that fever, since,
according to Dr. Pym himself, the bilious remittent, in its more
violent form, sometimes proves fatal on the second or third day
without evident remission. 44 How then,” he demands, 64 in this
case, is the latter form of fever to be known as different from
the other ?” The fourth diagnostic mentioned by Dr. Pym,
the general absence of yellowness of skin, or if any discolour¬
ation do take place, its being only of a very pale lemon colour,
when the disease terminates favourably, our author considers,
at variance, not only with the reports of the Spanish physician^,
but with the statements of Sir J. Fellowes, Sir Joseph Gilpin,
and also of many of the medical officers in Gibraltar, in their
answers to Deputy-Inspector Fraser. The yellow suffusion he
regards as liable to be governed by casual circumstances, and
observes, “I have never seen a yellow suffusion but when there
had been some vomiting previously but, as it depends on the
compression of the liver, by the violent contractions of the
abdominal muscles and the diaphragm, during the action of
vomiting, if the liver be comparatively small, and so lodged,
under the ribs as to be guarded from compression, cases may
occur in which, although there be 44 incessant and violent
vomitings, ” yet the skin 44 may remain clear of any tinge of
bile.” With regard to the fifth characteristic, founded on the
duration of the Bulam fever, he remarks, that although it is
true that in its most aggravated form it runs its course in from
one to five days, yet, that 44 oftener it continues for a longer
time;” and according to the evidence of Dr. Arejula, Sir
James Fellowes, Dr. Burnett, and even some of the cases of Dr.
Pym himself, it appears, 44 that this diagnostic is contrary to
fact, and ought consequently to be rejected.” The sixth and
last of Dr.. Pym’s diagnostics, 44 the peculiar inflammation of
the stomach, which in most cases that prove fatal terminates
in gangrene, or in a diseased state of the internal or villous
coat of that organ, accompanied with a vomiting of matter
resembling coffee grounds,” Dr. Bancroft considers as peculiarly
defective ; and contends, that Dr. Pym was bound to describe
this 44 peculiar inflammation and the more so from its being
said that it terminates in gangrene, which is a very uncommon
result. As to the black vomiting, the authority of almost
every writer on the subject proves, that it is common in severe
cases of the ordinary bilious remittent of warm climates and
thence it cannot be regarded as characterizing Bulam fever.

Our author takes advantage of Dr. Pym’s loose mode of

403

Bancroft's Essay o?i the Yellow Fever ,

writing, in mentioning the comparative degrees of heat in the
three forms of Bulam fever; which, although he describes it as
burning hot11 in the second form, yet “ is greater,” he says, in
the third ; and observes, with some degree of exultation, 44 how
the skin, under disease, can be heated to a higher degree than
burning hot , is not quite intelligible.”

He finally contends, that Dr. Pym has completely failed
also, in his attempts to prove, that the ardent or yellow fever is
not one of the Protean shapes of miasmatic fever, and that his
endeavours to prove the contrary, 44 like his diagnosis of the
supposed Bulam, are mere illusions.” Now although we do
not accord with the propriety of the language in which these
positions are stated by our author, yet we must admit their
accuracy. From every fact we have been able to collect in the
course of our reading on this subject, we have no doubt that
the ardent or yellow fever and the bilious remittent of warm
climates are merely modifications of fever arising from the same
cause; and “that,” as Dr. Bancroft observes, c 4 both kinds
occasionally interchange their forms and are converted into each
other : that the ardent or yellow fever never occurs as an
epidemic, but in places where the bilious remittent often pre¬
vails ; and where it does occur as an epidemic, in persons not
habituated to the climate, the natives and long residents are
usually attacked by it in the milder forms of remittent fever
and therefore it is unreasonable to pretend, that the ardent
fever is a distinct and peculiar disease.

In the second chapter, Dr. Bancroft examines another
peculiarity of the supposed Bulam fever, as described by Dr.
Pym, that of 44 its attacking the human frame but once.”
Admitting for a moment the existence of this fever, our author
advances sufficient proofs to shew that the Spanish physicians
and others were fully aware of the effects of seasoning, or a
long residence in a warm climate, in rendering persons less
liable to its attacks ; and hence he refuses to give Dr. Pym the
merit of a discoverer, which he has claimed. The liability or
non-liability of individuals to second attacks was thought of
sufficient importance to form 44 a subject of inquiry by His
Majesty’s Most Honourable Privy Council; ’ but in the reports
delivered by the superior medical officers of the Navy to the
Commissioners of the Transport Service on this occasion, lor
the satisfaction of their lordships, the experience of these
gentlemen is decidedly against the non-liability. To this host
of evidence, the opinion of Dr. Ferguson, Inspector of Mili¬
tary Hospitals in the Windward Islands, is added, as well as
our author’s own experience ; from all of which it appears,
that although a residence in a warm climate, particularly after
an attack of ardent or yellow fever, certainly renders the

3f2

404

Analytical Review .

constitution less susceptible of a second attack of that disease,
yet that it can be taken a second time, and may prove fatal in
the second attack.

With regard to relapses in Bulam fever, which Br. Pym
supposes rarely or never occur, Br. Bancroft adduces the
testimony of Drs. Gray, Dickson, and Denmark, with that of
Mr. Tobin of the Navy, and Messrs. Lea, Weld, Amiel, and
Martindale of the garrison of Gibraltar, who have witnessed
relapses, to prove the contrary ; and in particular, he has
quoted the following sentence from the report of Br. M4 Arthur,
which is conclusive on the subject. 44 A relapse in the Bulam
is by no means uncommon. I experienced it myself, and
patients have relapsed under my care, who died with black
vomit.” Nor is the assertion of Br. Pym, it appears, less to
be depended upon, when, 44 in distinguishing the Bulam from
the bilious remittent fever,” be represents the latter (at p. 61)
as being 44 almost always combined with affections of the liver ;
patients after recovery from the remitting fever being very
generally subject to obstruction or disease of that vise usd'
This opinion is in direct opposition to our author’s own ex-,
perience.

(e Dyspeptic affections, and diarrhoea or dysentery, are the more
common sequel of repeated attacks of remittent fevers ; and these
with diseases of the spleen are frequent consequences of repeated
and protracted inlermittents : dropsies, likewise, are sometimes a
consequence of either of these species of fever; but compared with the
above, I have found chronic affections of the liver to be rare.” — p. $5.

The extensive evidence brought forward in this chapter is
highly creditable to the industry of our author; and has per-,
feetjy convinced us of the fallacy of the opinion which main¬
tains the existence of the Bulam as a distinct fever; whilst it
completely disproves the allegations of those with whom that
opinion originated.

In the third chapter, Br. Bancroft enters upon the exami¬
nation of the evidence on which the opinions regarding the con-
tag ous or the non-contagious nature of the fever in question
are supported. It would be as impossible for us, as it is un¬
necessary, to follow him through the crowd of satisfactory testi¬
mony which he has brought together, in maintaining his former
assertion of its non-conlaqious character ; we need only affirm,
that we arc perfectly satisfied ; and can anticipate no Other re¬
sult from its perusal by any one whose mind is equally un¬
biassed and open to conviction. We regret to observe, that
many of the quotations made by Dr. Pym in support of his
position, appear favourable to that opinion only from the unfair
manner in which these quotations are made ; whilst the real
sentiments of the writers are decidedly inimical to the idea of

405

Bancroft’s Essay on the Yellow Fever.

the .contagious, nature of the disease. Thus Dr. Nooth's au¬
thority is advanced by Dr. Pym, as supporting the opinion of
the contagions nature of the epidemic that raged at Gibraltar
m 1804; whereas, when the evidence is fairly examined, it ap¬
pears that Dr. Nooth had used the term contagion not in the
strict sense, “ but in the sense now often allotted to the term
infection , as meaning a morbific matter not produced by the
living body.” The real opinion of Dr. Nooth is conveyed in
the following quotation of a letter written by him to the Sur¬
geon-General, on the 2nd of February 1805, nearly four months
afterwards :

(C for my own part, I am well convinced that the epidemic fever
that lately raged amongst us was the consequence of the extreme
heat, drought, and calms, that prevailed from the middle of April
to the end of October ; and as to the infectious nature of the disease,
it is by no means so clear a circumstance as the public are apt to
imagine : 1 have, I must confess, still my doubts upon the subject,
and 1 cannot be convinced, by what 1 have seen, that the disease
is personally infectious .” — p. 99-

The term infectious in this quotation, is evidently intended
to signify what is strictly meant by the word contagion ; and
hence the conviction of Dr. Nooth of the non-contagious nature
of that epidemic could scarcely he more clearly expressed.

But it would be of little avail merely to oppose opinion to
opinion in a question of so much importance, and therefore our
author, after exposing the undue advantages his opponent has
endeavoured to take of him, brings forward the more positive
evidence of facts in support of the opinion he maintains. For
the satisfaction of those of our readers who have not had the
opportunity of seeing the works from which Dr. Bancroft has
drawn this part of his evidence, we select a few of the more
Striking passages.

Dr. Burnett, after mentioning the cessation of the epidemic
of 1804, at Carthagena in January 1805, the last patient hav¬
ing been received into the hospital on the 23rd of that month,
adds,

“ On the fifth of February following, a French frigate, having
on board the wounded of the Arrow sloop, which she had cap¬
tured a few days before, after a gallant resistance, arrived in the
harbour ; the wounded were immediately landed, and placed in the
same beds and bedding, in which several patients, who had died
of the prevailing fever, had lain, without the beds or bedding having
been either washed or aired ; yet not one of these men was attacked
with the disease in consequence.” — p. 11 6.

Dr. Fym, our author observes, opposes this important fact
by saying, that as the ravages of the disease had already ceased
before the French frigate was brought in, and as u its existence

406 Analytical Review,

was at an end,” there was nothing singular in the Frenchmen
remaining free from it.

“ We know, however, certainly,” continues Dr. Bancroft, “ upon
the highly respectable authority of Dr. Stewart of Grenada, which
even Dr. Chisholm must admit, that in that very island the bedding
and cloathing of those who in 1 793 took the Bulam Fever, in the town
of St. George, and afterwards sickened and even died in the country,
did not communicate fever* to any person whatsoever ; and this was
also the fact in regard to the same fever at Dominica, as Dr. Clark has
attested : and as Dr. Pym assures us (p. 8), that “ the contagious
powers of this disease are increased by heat,” the contagion ought
in these islands at least to have manifested itself It has indeed
been stated by Dr. Stewart, that, “ in the fatal cases, the bedding
and cloathing were commonly destroyed ; but as this was never done
till after the patient’s death, sufficient time must have intervened,
even in these cases, for a previous communication of the disease,
if contagion had existed. A like testimony of the non-communica¬
tion of the disease by the cloaths, &c. of those who were ill of the
fever, acknowledged by Sir Gilbert Blane, Sir James Fellowes, &c.
to have been the Bulam, during its prevalence in Leghorn in 1804,
is given by Dr. Palloni in the second volume of the Edinburgh
Medical and Surgical Journal; and similar testimonies may be
found in every part of the United States of America in which the
disorder in question has prevailed, and also in Spain, as will soon
appear from the declarations of Dr. Arejula, &c.”~-p. 11 6.

The following extract, given by our author “ from the
Keport of Mr. Nieli on the Bulam Fever,” exhibits in a strik-
ing point of view the effect of local circumstances in producing
fever in every respect simila rto the ardent or yellow fever of
the West Indies in its worst form, and consequently the Bulam
of Dr. Pym :

“ In the year 1801, when Surgeon of a sloop of war going out
on a secret service to the Red-Sea, after doubling the Cape of Good
Hope in the best possible health, we arrived early in the month of
April at Johanna, situated between Madagascar and the coasts of
Africa ; an island of great fertility, producing tropical fruits,
vegetables, rice, &c. in wild luxuriancy. On our arrival at this
delightful spot, as our stay was to be but short, every thing was
instantly prepared for wooding, watering, and procuring fresh beef,
vegetables, and fruit for our use ; and for the accomplishment of
these various duties different parties were appointed, but none.

f & Dr. Stewart, who conceived the fever in question to be con¬
tagious, says, with great candour, in his letter to Dr. Hosack, “but
I must observe that I met with no instance of the disease being
communicated to others, either visitors or attendants,” by those
who were seized with this fever, “ after their return to the country.”
See his letter to Dr. Hosack, at p. 188, voh iii. of the American
Medical and Philosophical Register.”

40?

Bancroft’s Essay oil the Yellow jPevei*,

except the watering party, composed of twelve individuals, slept, or
remained on shore, during the night, while we remained at this
island (seven days). Soon after sailing, symptoms of lever of an
unusual kind appeared, which in a few days attacked the whole of
t ie watering party m an aggravated form, excepting one who had
the command : he had served in the West Indies before, and escaped
•w ith a very trifling attack. The general symptoms were, an op*
pressed pulse, pungent heat on the surface, bloated countenance,
a dull, heavy, inflamed eye, violent head-ache, pain at the epigas¬
tric region, and an invincible irritability of the stomach ;°the
vomiting m all cases distressing, of a bilious nature and a yellow
greenish aspect, which towards the fatal termination of the disease
assumed a dark brown olive or chocolate colour. In none of the bad
cases were remissions well marked, and in most of those who died
2 y ehow suffusion of the skin of a lemon hue, was conspicuous only
a short time previous to death ; in all, however, after death, this
appearance was common. The discharges by stool manifested a
simnar variety, but they were so highly corrosive and acrid as to
excoriate the anus and nates, and to excite the greatest dread in the
patient on the approach of the evacuation.”

. " It may be sufficient to state, that, out of the twelve men thus
violently attacked, six died : those who recovered had not the dark*
coloured vomiting ; and their convalescence was extremely tardy,
adany of the men who had occasion to be on shore during the whole
of tne day, were attacked with fever, but in a milder form : and in
tneni it always observed distinct remissions, and in a few cases
intermissions were witnessed. In this instance, had the ship’s crew
landed and slept on shore, the disease would most probably have'
affected tne whole, which would have improperly given rise to (a.
behet of) the existence of contagion, and that we had received ‘ a
highly contagious disease’ at this island, as the Hankey, it was said,
dm at Bui am : but here we see it clearly defined and a limit cir¬
cumscribed on its sphere, beyond which it could not pass ; we see
it confined to those most exposed and at night : those doing duty
on shore during the day only we perceive affected in a trifling degree L
and none suffered of those who were but little exposed to the influ¬
ence of this island by working : the officers therefore experienced a
complete immunity from this fever, except one who had it slightly.’"

Having established the fact that a fever exactly resembling
tlie Bulam, but devoid of contagion, can be produced by u ex^
halations from the soil,” Dr. Bancroft next adduces evidence
equally satisfactory, 64 to prove the production of the remittent,
and of the ardent, yellow, or Bulam fever at the same time, in
the- same situations, and from the same local cause, i. e. febrificr
exhalations from the earth.” The Report of Dr. McArthur
(No. 7), contains the following instance :

" April, 1809, about eight hundred prisoners of war, taken at
the Saints, arrived at Barbadoes. Five hundred of these men were
conscripts, and very recently from France. Some of the prisoners

408

Analytical Review .

were put on board the Highland Lass, prison-ship ; others werf
confined in the town-jail ; and the remainder, about five hundred,
were placed for temporary security in an old barrack situate on the
margin of the marsh-land, near St. Ann’s, which had for a long
time been deserted on account of the unhealthiness of the situation.
The army and the navy were at this tune perfectly healthy, no case
of Yellow Fever having appeared for months before. Towards
the end of April many of the prisoners in this barrack w ere attacked
with a Remittent Fever attended with bilious symptoms ; and soon
afterwards several cases of real Yellow Fever occurred, of which
several died, with the black vomit , esteemed by Mr. Pym as a charac¬
teristic symptom of the Bulani Fever. At this time the prisoners
in the jail, and on board the prison-ship, whom I visited daily,
continued perfectly healthy. Both the Remittent and the Y el low
Fever here appeared to arise from the name cause ; and L feel
assured, had the prisoners continued in the same place of confine¬
ment until a later period of the season, that a dreadful mortality
would have been the consequence. Fortunately for them, they
were soon removed into transports, in order to be conveyed to
England, and with their removal the fever ceased.”— p. 142.

The same writer, in noticing the non-contagious nature of
the fever which prevailed at Barbadoes from 1804 to 1809, and
which, he considered from a comparison both of the symptoms
and the appearances on dissection, was undoubtedly the fever
denominated Bulam by Dr. Pym, adds,

“ no place could be better adapted to propagate and disseminate
contagion than the building which we occupied as an hospital in
Bridge Town until May 1807- It was situated about a quarter of
a mile from the wharf where the patients were landed and on the lee-
side of the town, confined by miserable huts, huddled one upon
another. The patients and their bedding were carried through the
town to this place by such labourers as we could hastily employ
for the occasion. They were obliged to rest and take shelter from
the sun in any house that would receive them ; and to the credit of
the poor white and coloured inhabitants, they never were forced
from their doors. The nurses, washerwomen, and sempstresses,
were black or mulatto women, who daily visited their families in
our neighbourhood ; and as there were no accommodations for any
description of officers in the hospital, lodgings were procured for
them in various parts of the town, and they were received without
hesitation, labouring under the most malignant form of the dis¬
ease, even in articido mortis. Yet, with this free communication
with the inhabitants in every part of the town, the fever did not
spread generally, nor partially, neither in its aggravated, nor its
milder form. If it be contagious, in what way can we account for
the native inhabitants of Bridge Town escaping every degree of it
during a period of five or six years?” — p. 147.

From a summary of the opinions delivered in the Reports
transmitted to the Privy Council,, it appears that three only of

Bancrofts Essay

on the Yellow Fever.

, 1

tlie twenty-four gentlemen from whom these were obtained
state decidedly that this disease is contagious ; while sixteen
have as positively denied the existence of a contagious property,
in it. Not contented, however, with this majority, our author
quotes largely from a communication of Dr. Ferguson, the In¬
spector ol Hospitals in the Windward Islands, to Sir James
McGregor, in which the most incontestible proofs of the non-
Contagious nature of the fever are detailed. The following pas¬
sage struck us so forcibly, that we cannot avoid adding it to
our quotations :

y. “ At BarbadbCs } our hospitals of late have been m a regular
course of importation of Yellow Fever from the navy, but not even,,
inoculation * has been able to produce the disease upon any member
of the Hospital Corps ; by whom, I may truly say, that the sick
have been received with open arms : for the anti-social doctrines of
ideal contagion are not preached among us here, to the prejudice
df duty and humanity.” — p. 188.

In the fourth chapter. Dr. Bancroft treats of the prod action
of fever on board of ships from the foul state of the holds;
ti fact which he formerly maintained ; but which he has been
erroneously stated to have denied, because he denied the possi¬
bility of such causes producing contagious fever. He shews
that many of the articles forming the lading of vessels, either
as 'food or merchandize, are susceptible of putrefaction or de¬
composition ; and from various parts of them breaking down and
getting amongst the ballast, as soon as they find the requisite
quantity of moisture, these naturally undergo that decomposition
which becomes the source of ^febrific miasmata.*” In inter-

tropical climates, the effects of these causes in producing ardent
fever have been too frequently observed. We shall extract a
few of the instances brought forward by our author.

In the Thetis, in 1809, the Report states, that the' fever did
not appear until the hold was broken up, when about a dozen of
liien so employed were taken sick, and that four out of five carpen¬
ters who lifted the limber boards (lied,” — p. 20Q.

Dr. Johnson, at page 101 of his work, relates, that

■* V ^ ■ .ir ' .V :: *

€( in the month of February, 1800, Yellow Fever of a very severe
description, broke out in his Majesty’s schooner Trinidad, at Bar-
badoes, which was evidently occasioned by the stench arising from

“ * Hospital- Assistant Moon, on opening the body of a patient
that had died of very aggravated Yellow Fever, wounded his finger ;
the wound produced high inflammation, similar to what occurs in
the dissecting-rooms in England, running up the course of the
lymphatics to the glands of the axilla, with’ symptomatic fever, but
do more.”

| K.

volt. VlXL-^-HO. Yt/. SJ'Gr '

410 Analytical Review.

dirt, filth, and stagnant water in her hold : for as soon as the latter
was washed and cleaned, and scuttles cut for better ventilation, the
Fever disappeared.” — p. 211. / ; i h

These accounts are further confirmed by a statement of the
fever that appeared under similar circumstances in the Regalia
transport ; and by copious extracts from two unpublished com¬
munications of Dr. Ferguson to the Army Medical Board,
partly on the subject of the Childers sloop of war, in which
the fever broke out during her passage from Trinidad to
Carlisle Bay, in August 1816.” In this vessel not only the crew
and the medical officers were attacked, but two surgeons of other
vessels, who volunteered their services on board of her, were
seized ; and one of them fell a victim to the virulence of the
fever. This ship, after having been blown out to sea, with
fifteen effective hands only on board, arrived at Antigua, where
she was ordered to be cleaned.

The hold of the ship was found to be in so extraordinary a
state of filth, fermentation, and impurity, as most amply to account,
in the opinion of the Medical Staff of the Navy, for the rise, progress,
and continuance of the fever, that had prevailed on board her. Since
her purifications she has continued perfectly healthy, though she
has taken many fresh hands on board.” — p. 230.

In an extract of a letter from Dr. Ferguson to our author,
dated 15th of August 1817, the state of the air in this ship is
thus described :

<e In my narrative respecting that ship, left with you yesterday,
I alluded to its covering a Report from Dr. Wray, Physician to the
Forces, wherein he particularly mentions the hold to have been so foul
and offensive, that he found it impossible to descend into it. The same
thing occurred to myself, and was mentioned in different Reports
and letters to the Director-General. At the time when I attempted
to go down into the hold, the seamen declared that on different oc¬
casions, when they were sent there, the candles would not burn ”

W e regret that no analysis was made of this atmosphere ;
not because we think it possible to discover febrific miasmata
by chemical tests, but from the circumstance of the candles not
burning, the ascertaining the state of the atmosphere would at
least have thrown some light on the nature of the decomposition
in which these miasmata were, in this instance, generated. Our
author thus reasons upon the probable nature of miasmata ;
but, in extracting the passage, we must premise, that we do not
give it to our readers as containing an opinion with which we
fully accord.

How these miasmata vary in their nature or their composi¬
tion, we know not ; and can only conjecture, by taking into our
consideration the several matters existing in those places, from which
these miasmata appear, by their effects, to have been extricated, and

411

Bancroft \? Essay on the Yellow Fever*

also the gaseous fluids, which similar matters are known to produce
by the decompositions to which they are naturally disposed in the
temperature prevalent at those places.—- Vegetables., by decompo¬
sition, afford carbon, hydrogen, and oxygen ; animals afford the
same, with the addition of nitrogen and a surplus of hydrogen, in
proportions suited to the formation of ammonia. But the effect of
this nitrogen, or of the ammonia thus produced upon the carbu-
retted hydrogen gas, which results from vegetable decompositions
alone, has not been yet ascertained ; nor do we know how the ex¬
halations, produced by the joint decompositions of both animal and
vegetable matters, differ from those of decomposing vegetables only.
Berthollet, in the second volume of the Memoires de la Societe
d’Arcueuil, contends that hydrogen, carbon, and oxygen, may com¬
bine in unlimited proportions, and form various combustible and
insalubrious gases, which he would call oxy-carburetted hydrogen :
but Dalton and Henry think that oxygen is not an essential element
of these compounds, and that hydrogen and carbon, forming alone
carburetted hydrogen, or hydro-carburetted gas, are capable of unit¬
ing in but few proportions. This gas may be copiously extricated,
by stirring the mud at the bottom of stagnant water ; and we may
at least conjecture that, with some modifications, marsh miasmata
principally consist of it ; the air collected immediately over, and
close upon, the surface of marshes, having been found to contain
hydrogen and carbonic acid gas in large proportions. But chemistry
possesses so few means of separating the immediate principles of
bodies without a destruction, or instant recombination, of some of
them, that we may probably never be able to detect, or ascertain,
the constituent parts, and much less the varieties, of marsh miasmata,
or to discover that substance in which their febrific power resides”
— p. 246.

This chapter is terminated with an interesting account of
the epidemic fever at Sierra Leone, in Africa, in 1816.

The fifth and sixth chapters are dedicated to a detail of the
epidemic yellow fever in Spain from 1800 to 1804; and the
epidemics at Gibraltar from 1804 to 1814. In the commence¬
ment of the first of these chapters, our author charges his op¬
ponents with having unfairly stated his opinion ; and with
having endeavoured to make others believe, 44 that in alledging
marsh-miasmata as the cause'' of ardent or yellow fever, he
had 44 exclusively contemplated those vapours or exhalations
which arise solely from a distinct, ostensible, or formal marsh ;n
whilst his real opinion, as expressed in his Essay, is, that these
miasmata may originate in any soil containing 44 no more mois¬
ture than is really necessary for a complete decomposition of the
vegetable and animal matters therein,1’ provided the tempera¬
ture be not less than 80° of Farenheit, and therefore that it is
not necessary that obvious marshes should be in the vicinity of
any place, although the fevers appearing there are the effects of
miasmata arising from the soil. The prevalence of remittent

3 g2

412 /imly dcal Be mew.

.fevers both at Cadiz and Gibraltar during the summer and
autumn, demonstrates the presence of such miasmata in these
places, which is sufficient for our author’s purpose in explaining
the appearance of ardent fever there, under certain states of
the atmosphere. In having thus established his point, we think
our author has unnecessarily endeavoured to confirm it by rea¬
soning (in nota) upon a passage of Jacob’s Travels in the South
of Spain, in 18Q9 and 1810, which describes Cadiz to be built
on a peculiar structure, formed from a basis of Pechstein, con¬
taining a mixture of 44 shells, pebbles, quartz, sand, and marble,
so intermixed and hardened in the course of years, as to form a
compact kind of §tbne,”'

fC Perhaps/' says our author, “ this peculiar foundation of
Cadiz may, by its disposition to absorb and retain moisture, operate
like clay in promoting the formation of fever exciting miasmata/'

Now we believe it may be proved, that clay does not readily
absorb moisture, but promotes the process here noticed by re¬
taining it upon its surface and in its cracks without absorbing
it ; and by allowing it to stagnate in conjunction with any animal
and vegetable matter with which it may come in contact.
Chalk, which is both absorbent and retentive of moisture in a
high degree, is not a soil favourable for the formation of febrific
miasmata ; and it is probable, that if the structure described
by Mr. Jacobs, contributes to the production of miasmata
around Cadiz, it is owing to its preventing the waterfront pass¬
ing through it ; and hence what remains unevaporated, acting
on the supernatant soil at the suitable temperature, facilitates
the decomposition of the animal and vegetable matter contained
in the soil.

By the contagionists, the Andalusian epidemic of 1800 is
said to have been imported in the Dolphin, a ship that came
from the Havanna and touched at Charlston, South Carolina, in
its way / but our author has proved the impossibility of such
an importation, as no fever existed at either of these places' be¬
fore the Dolphin left it, and she communicated with no /other
place; facts which, from the evidence he has adduced in their sup¬
port, are iucontestible. The Spanish physicians themselves do
not positively ascribe it to importation ; although from the quo¬
tations Dr. Bancroft has made from , the work of ArejuhL, their
ideas on the subject appear to be extremely confused. Sir
James Fellowes also, even at the moment in which he is endea¬
vouring to gain credit to the story of the Dolphin having im¬
ported the disease, is so cautious as to say, that he cannot
04 offer any decided opinion as to the origin of the epidemic at
Cadiz in 1800/’ Dr. Pym unhesitatingly asserts, 64 it wras
traced to importation.”

Having proved that the Andalusian epidemic was not im-

418

Bancroft’s Essay on the Yellow Fever .

ported, our author proceeds to adduce evidence to establish the
tact of its having arisen from local causes. During the spring
months, cold heavy rains and violent winds were so frequent,
as almost to destroy any appearance of spring ; and these were
succeeded in the summer by intense heat and the prevalence of
the east wind, or lev an ter, as it is termed ( Levante seco y ahrasa -
.dor ) ; causes, which Dr. Bancroft observes were sufficient to
give the bilious remittent the utmost violence which miasmatic
fevers can acquire.

“ The heavy rains and extraordinary cold of the spring months
were exactly suited to create in the human body that unusual accumu-
lation of excitability and inflammatory diathesis, which would
afterwards render it highly susceptible of the most dangerous excite¬
ment, and at the same time to afford to the earth an abundance of
moisture, which, being afterwards acted upon by the scorching dry
east wind, and a temperature of nearly 90° of Fahrenheit, would pro¬
duce and maturate a copious supply of the most virulent miasmata ;
and these, aided by the sudden transition from a very cold spring to
a temperature exceeding that of the West Indian islands, must of
necessity exasperate the fevers, when produced, in the highest
degree.’" — p. 284.

The proofs in favour qf the local origin of the fever as it
appeared in Malaga, Carthagena, and other parts, are equally
satisfactory ; and, in advancing them, our author has pointed
out the inconsistencies of Sir James Fellowes, and the vague
manner in which the evidence by which he has attempetd to
establish the contagious nature of these epidemics is brought
forward. The evidence even of Dr. Arejula, whom Sir James
lias lauded as the highest and most respectable of all the Spanish
authorities in support of the alledged contagion of yellow fever,
is rather against his position, whilst it is in itself so inconclu¬
sive as to be 6C insufficient to give even the appearance of pro¬
bability to that which he endeavours to prove and hence our
author concludes this chapter with the following query :

“ And is it credible, if the yellow fever had really been conta¬
gious, that among the many thousands of persons who fell victims
to it, and the still greater number of thousands who were attacked
by it. Dr. Arejula would not have been able from his high official
situation, which procured him the best means of information, to
collect proofs of tips fact, less equivocal ^han those on which he has
found it necessary to rely .?/’-— p. 330.

With regard ;to the epidemics that .appeared in Gibraltar in
1804 and 1814, our author admits that, in the description of the
place which he gave in his Essay, several inaccuracies had crept
in ; but nothing that could affect the conclusions he drew res¬
pecting the* production of febrific miasmata there. He traces
•the epidemic of 1804 to “ the accumulation of decomposable

414

Analytical Review.

I ,

matters within the town, and the long prevalence of a dry and
scorching east wind, which produced a very high atmospheric
temperature, without any salutary ventilation of the place ; and
ridicules the story of its importation from Cadiz by a person of
the name of Santos, as related by Dr. Pym and Sir J, Fellowes,
that individual having actually left Cadiz a week or two before
the period which Dr. Arejula, after the most deliberate inquiry
and the best information, u has fixed as the earliest (period) at
which the disease had occurred in that city.” He proves, also,
the absurdity of believing the affidavit of Mr. Pratt, who affirmed
that he had had the fever at Cadiz ; and stated that, after he
had been ill eight days, and whilst he laboured under the black
vomit , the most fatal symptom of the disease, he removed to
another quarter of the town and recovered. He treats the de¬
claration of Sir J. Feilowes that that affidavit was 44 very satis -
factory ” to himself, as one made in a moment when 44 he must
have laid aside the exercise of his reason as it contains evi¬
dence on its face 44 of the absolute impossibility of its being
true,”

The fever at Gibraltar first appeared about the end of
August, in a filthy spot called Boyd’s Buildings, where Santos
kept a shop, and to which its ravages were for some time limited,
which 44 limitation,” he remarks, 44 is eminently characteristic of
fevers produced by local causes.” It afterwards appeared in
various parts of the town ; but so similar was it to the ordinary
bilious remittent, that it was declared to be that fever by 44 a
meeting of medical gentlemen, ci vil and military, assembled by
order of the government, on the 15th of September and, with
the exception of Mr. Kewning, who declared it at first 44 to be
malignant and highly contagious,” this opinion continued to be
maintained until 44 its violence and increased mortality,” with
the prevalence of a similar fever, supposed to be contagious, at
Malaga and other places in Spain, changed it : but 44 the facts
which the recurrence of this fever in subsequent years has made
known, have since induced a majority of the medical officers at
Gibraltar to reject altogether the idea of its contagious nature.

It is a curious fact, that, at the time the yellow fever of 1813
made its appearance in Gibraltar, that garrison 44 was in strict
quarantine Jhr several months before the malady made its appear¬
ance, and a Board of Health was sitting almost daily, on account
of the plague which had broken out at Malta a fact not re-
conciliable, if it were proved that the fever was imported ; but
readily so, if we suppose it to have originated from local causes.
It was believed to be highly contagious by the inhabitants of
the town ; but the error of this opinion was clearly pointed out
by Mr. Humphreys, in a paper published in a contemporary
journal; and its origin traced to 44 the immense collection of

415

Bancroft’s Essay on the Yellow E even.

animal and vegetable matters,” arising from an overcrowded
population, “ during the dry summer months, remaining stag¬
nant from May until the end of August, and which became
roused into action in the autumnal season by the partial rains,

len the quantity of water is not sufficient to propel them
through their respective drains.” The fever of the following
year is traced, with equal satisfaction, to local causes. One of
the most interesting of the testimonies adduced, is the following
from a Report to the Transport Board, made by Dr. Gray,
late Physician to the Mediterranean fleet.

. “ ri;he inhabitants can always foretel the approach of an easterly
wind, fiom the offensive odour which arises from the privies, sewers,
&c. ‘ The shallowness of the sea-beach along the line wall , is often a

source of mischief ; the sewers do not discharge their contents suf¬
ficiently into deep water, and when mixed with other materials
thrown over it, the air must necessarily be vitiated, from these pu¬
trid fomites.’ — f The bilious Remittent Fever is more or less endemic
m the summer and autumnal months along the southern coasts of
Spain, Italy, and the Mediterranean islands. The inhabitants of
sea-ports, and towns in the vicinity of marshes, swamps, &c. are
most liable to this disease, when the heat is unusually great and op¬
pressive. Strangers, particularly those from northern latitudes, are
first attacked, and in a more violent degree than the natives.’ ” _ p. 329.

Dr. Gray thus describes the symptoms of the disease in its
aggravated state, which correspond accurately with those of the
supposed Bulam fever.

Great prostration of strength, excruciating head-ache, referring
to the forehead and orbits, eyes turgid, flushed countenance, oppres¬
sion at the praecordia, general pains of the back, loins, and calves of
the legs, great irritability of stomach and bilious vomitings ; vellow
suffusion of the skin ; if proper evacuations are not resorted to in
the commencement of the attack, such as bleeding and copious
purging, delirium shortly supervened, and towards the fatal ter¬
mination of the disease petechias, haemorrhages from the nose and
mouth, with black foetid stools. I have also observed, in some in¬
stances, the matter ejected from the stpraach (in the last stage) of a
dark colour resembling the grounds of coffee.’ Dr. Gray adds (as
before stated), f during this long period of serving, I can not recall
to my recollection a single instance of fever’s being communicated
from one person to another, either amongst medical attendants or
nurses/ ” — p. 390.

This description of the disease, and the opinion of its non-
contagious nature, are further con firmed by evidence drawn
from the answers of the majority of the medical officers of the
garrison to the queries of Mr. Fraser; and our author appears,
to our judgments, to have fairly made out his case, 64 that the
fever which has prevailed epidemically several times within the
present century at Gibraltar, originated from domestic and at-

410 Analytical Review.'

mospherical causes, and was destitute of any contagious pro¬
perty.” ^ .

We thitik it unnecessary to enter into any particular exa¬
mination of the evidences brought forward in the seventh chap¬
ter, which treats “ of the epidemics in Spain from 1810 to 1814;
also at Stony Hill in Jamaica from 1808 to 1816; and in Bar-
Badoes in 1816 and shall therefore pass on to the Conclusion,
to which are added some “ Observations on the Evils resulting
from Quarantine and other Regulations as connected with the
Yellow Fever.'” In reverting to the facts and arguments he
has advanced, to prove the object for which he contends, Dr.
Bancroft conceives he has rendered it evident that Dr. Pym
has completely failed in proving the existence of the Bulam
fever as a disease sui generis ; and equally so in his proof that it
was imported, and possesses contagious properties. He observes, ‘

It is notorious that the latter fever has never prevailed in any
place, or at any season, in wrhich remittent fevers do not occur, and
that it is invariably preceded, accompanied, and followed, by them ;
and as they are the acknowledged offspring of those fever-exdtmg
exhalations called marsh-miasmata, and as these miasmata are known,
at the times and situations in which a high temperature prevails, to
aggravate the remittents, and Convert them into violent continued
fevers, similar in every respect to that form of fever called Pestilen¬
tial or Bulam (which only occurs, as a consequence of this high tem¬
perature) would it not appear natural to all unprejudiced minds,
when the latter becomes prevalent simultaneously with what are .
called Bilious Remittents, to refer hoik to one and the same cause
(a cause notoriously adequate to produce both) y rather than adopt the
improbable and strained supposition of two very different, if not
opposing, causes, occurring and operating with epidemic violence at
the same time and place"; and one of them at least (contagion) never
manifesting itself at any time, or at any place, in which the other
does not prevail/’ — p. 459*

Believing in the correctness of these opinions, he thinks it Ills '
duty 66 to recommend to His Majesty's government the suspen¬
sion or abolition of all quarantine regulations, so far as they res¬
pect theyellow fever*;” and concludes with the following remark:

* We are much surprised to observe, in a Report of the Faculty „
of Medicine of Paris, in answer to some queries of the Minister of"
the Interior, relative to the necessity of preventing the introduction
of the yellow fever into France by commercial intercourse, that the
French physicians recommend the strict enforcement of the quaran¬
tine laws ; at the same time that they are by no means satisfied of
the contagious nature of the fever ; and acknowledge that the placer
where it has appeared present local circumstances sufficient to pro¬
duce it. — “Des conditions propres a favoriser l’alteration putride
des matieres animales et vegetales arretees et stagnantes/’ — -Vide
Jmirn. de Medecine , vol. xxxix/p. 449°

417

Medico-Ckirurgical Transactions.

In regard to the fourth clause of the first report made by the
College of Physicians to His Majesty’s most honourable
1 rivy Council, concerning Dr. Pym’s publication, in which the
College state their belief that e the cold of our climate would not
prove a preservative against the contagion’ (of the Yellow Fever),
because ‘ it appears that, during the months of October and Novem¬
ber, when the fever raged at Gibraltar, Malaga, and Leghorn, the
temperature was greatly below the average heat of our summer,’ it
may be observed that this fever has never appeared at these or any
other places, without a previous occurrence and prevalence dining a
considerable time . of a degree of atmospherical heat , whicli is rarelu
lelt here, and which, when felt, never continues a sufficient time to pro¬
duce the disease; which degree of atmospherical heat seems indis¬
pensably necessary to the preparation and maturation of the fever-
exciting miasmata. This explanation (which, through ah erroneous
belief in contagion, has been overlooked) will, f conceive, upon due
consideration, remove all apprehension of the possible existence of
the Yellow Fever in the British Isles/’— p. 466.

Our readers must have already collected, from our passing
remarks, the opinion we entertain of Dr. Bancroft’s work ; and
we do not hesitate, on a retrospect of all the evidence, to state
unequivocally, that he has fully satisfied us of the truth of the
position he is anxious to maintain. That the same effect will
be the result of the perusal of his volume by every one who sits
down, as we have done, with an unprejudiced mind to the task,
we have no doubt ; and we have only to regret that the spirit
of controversy has, in some few instances, led him to use stronger
language in speaking of his opponents, than we wish to see
prevail in scientific discussions.

To find that yellow fever is really not contagious, and that
it originates in local causes, which may be brought under the
controul of man, or at least may be avoided because they are
known, must prove a source of high gratification to every friend
of humanity : and we can conceive few triumphs more satis¬
factory than that which our author must feel, in having been
able to bring together a mass of evidence capable of incontro-
vertibly proving so important a truth.

Jledico-Chirurgical Transactions , Volume VIII. Part I. 8vo.
pp. 315. London, 1817. Longman and Co.

The exertions of the respectable Body which issues this
half-yearly volume, continue unabated ; and it is our duty to
bring its labours before our readers. But, as the periods which
intervene from the appearance of one Part to that of another,
are so short, and the circle of their readers is now so much
VOL. VIII. — NO. 47. 3 II

418

Analytical Review.

widened, we do not think it necessary to enter as minutely into
the analysis of each paper, as has hitherto been our custom.
The present Part contains thirteen articles ; of which, eight
are Surgical, two Pathological, and two only strictly con¬
nected with the Practice of Medicine. How far this majority of
communications can be regarded as a proof of the superior
ardour of the surgeons, and the consequent improvement of
surgery, we will not pretend to decide ; but it is at least highly
creditable to that branch of the Profession.

The first of the pathological papers which we shall notice,
is by Mr. Howship, and intitled, 44 Observations on the Morbid
Structure of Bones , and an Attempt at an Arrangement of their
Diseases The previous and valuable inquiries of Mr. How-
ship, which are before the Profession, may be regarded as pre¬
paratory to that now under examination. He nevertheless
modestly doubts his adequacy for this part of his task, in which
so little aid can be obtained from books ; for with the exception
of Mr. Hunter, who had studied it profoundly, scarcely any
physiologist has written professedly upon the subject. The
previous inquiries , however, of Mr. Howship, his knowledge
of the use of the microscope, and the advantage he enjoys of
having recourse to Mr. Heaviside’s very 44 valuable and exten¬
sive” collection of diseased bones, have afforded him great faci¬
lities in the prosecution of his investigation, and enabled him
to overcome most of the obstacles which presented themselves.

The circumstance of the existence of a membranous ex¬
pansion within the medullary cavities of the large bones, was
pointed out by Havers and some other anatomists ; and from
having occasionally seen small arteries entering the substance of
bones, they were led to infer a vascular structure in these organs ;
but our author justly conceives, that 44 the existence, vascula¬
rity, and functions of the membranous sheaths, within even the
smallest tubes and canals contained in bone,” was first demon¬
strated by himself.

ff The small space,” he remarks, “ occupied by the blood-ves¬
sels of the canals, compared with that which is found to be allotted
to the secretions and membranes of these cavities, distinctly prove
that the circulation must, under all circumstances, enjoy as much
freedom here as elsewhere ; and the intimate connection formed by
these canals between all parts of the bones and the surrounding soft
parts, affords the strongest ground for believing, that the minute
vascular and membranous organization of the bones is as susceptible
of impressions from irritation, or sympathy, as the muscular, glandu¬
lar, or other soft structures of the fabric.” — p. 62.

He maintains, that the same laws which regulate the pro¬
gress of irritation or inflammation in membranous parts, regu¬
late and direct also 44 the sphere of irritation in the diseases of

419

Medico - Chirurgical Transactions,

bones.” He dissents from the opinion held by some writers,
that <c an effusion of purulent matter upon the bone, operates
bv dissolving the ossific structure and assumes it as a point
upon which many of his observations rest,

<c that in every case in which bone is acted upon, the soft solids^
have been in close contact with it, that consequently the sections of
all the minute cavities must give an accurate outline of the external
figure of the contents, and that whenever bone is removed it hap¬
pens through the immediate agency of absorption.” — p. 65.

From remarking also that the minute longitudinal canals
become uniformly larger in some diseases of bones, whilst some¬
times they retain their smooth polished surface, and sometimes
become rough and uneven, be has been led to the discovery of
the singular fact,

“ that under the influence of some diseases, the membranes of these
canals become absorbing surfaces without losing their naturally
smooth even texture, while in others they not only become thicker
and more vascular, but take on a granulated structure externally,
where the surface of absorption acts upon the surrounding bone.” —
p. 65.

He does not, however, conceive, that absorbents exist in the
minute longitudinal canals in bone, the mean diameter of which
does not exceed ^J^th part of an inch ; but concludes, that
“ the minute branches of the veins are in these minute canals
appointed to perform the office, and conduct the function of
absorption. With regard to the mode in which the condition
of bone is changed to admit of its absorption, he ventures to
suggest the following opinion :

“ My own opinion is, that in every instance where bone is ab¬
sorbed, the process is commenced by the agency of some power
exerting itself in the blood circulated over the part, by which the
state of the animal principle is changed, and the particles of earth
let loose, so as to be ready for removal by absorption ; and although
v e yet know very little upon the subject, 1 think I shall be able to
demonstrate that the interstitial absorption of bone takes place by
the different modifications of action of the same vessels, and the same
membranous sheaths. There is the slow absorption incident to
growth and* health ; and that widen occurs in connection with
healthy inflammation of bone ; besides the absorption that takes
place during the existence of venereal complaints, and the use of
mercury ; and many others.

ie It is presumable that the extremely minute circumstance
which has been demonstrated to exist in the interstitial parts of
bone, may, like the other systems connected with the machine, be
capable of varying and modifying the actions of its vessels in a
manner peculiar to itself; and that- dependent on the variations' of

;j h

420 Analytical Review.

action in the blood-vessels, will be the particular affinities, at one
time favoured, and at another retarded. It also seems to me ex¬
tremely probable that the galvanic influence, which in some late
experiments has been found to exert a power as curious as unex¬
pected, in arranging and separating the elementary constituents of
animal fluids, is evolved in the blood, by the action of the vessels
upon their contents ; and that the particular arrangement of the
vessels regulates the resistance and motion of the blood in such a
manner as may best insure the evolution of the precise measure of
animal electricity that is required for the production and disposition
of the new combinations.” — p. 69.

There is too much fancy in the above explanation to pro¬
duce a conviction of its probability on our minds ; at the same
time we must confess, that any opinion we have formed on the
subject is not better founded.

Having premised these general remarks, our author pro¬
ceeds to the consideration of the diseases of bones ; and, for the
sake of method, lias attempted an arrangement of them “ ac¬
cording to the more obvious characters of each affection, ” under
the nine following divisions :

“ 1. Alteration of external figure , not arising from general swelling,
bvt most commonly from a deposit of newly formed ossific matter, upon
the surface of the honey

This division includes nodes, exostoses, the appearances
produced by the formation of new joints, the ossification subse¬
quent to necrosis, and the callous thrown out in fractures.

2. Enlargement, from swelling of the original substance of the

honey

Under which are arranged the appearances produced by
spina ventosa.

“ d. Enlargement of hone, connected with an increased interstitial
deposit of ossific matter , producing a more dense and compact texture
than natural , as happens in healthy ossific inflammation .

“ 4. Enlargement more or less perceptible, with a disposition to
absorption and disorganization of hone, either operating from the inter¬
nal or medullary cavity, when the parts of the bone are progressively
separated and absorbed ; or acting upon the external surface , when a
succession of superficial exfoliations are thrown off.

“5. Absorption, without enlargement ; a consequence of peculiar
excitement, more or less diffused through the general Structure of the
large bones, tending to weaken their sides, and render them liable to
fracture from slight causes.

cc 6. Change in the figure of adult bone, from absorption removing
in succession the more internal parts of the structure, weakening the
general fabric, and rendering it by degrees incapable of supporting the
weight of the body, or the action of the muscles."— p. 72—7.

M edico- Chirurgical Transactions. 421

Under this division are placed the appearances produced
bv niollities ossium.

. “ 7* Partial death, or necrosis of bone ; sometimes the remit of

inflammation and abscess within the bone, but most frequently the con¬
sequence of disease in the soft parts covering it.

8. Change in the figure of growing bone ; dependent upon the
more or less perfect removal of the phosphate of lime from the ossife
i exlure, the organization of the bone in other respects being unaltered.

<( 9’ Loss of firmness, with absorption and disorganization of bone;
induced by a depraved state of constitution, in some instances nearly
allied to scurvy, and connected, with decomposition of the gelatin of the
ossific structure." — p. 78 — 9.

In the present paper, Mr. Ilowship has confined his obser¬
vations to the first of these divisions ; under which, he has
placed appearances resulting from a specific disease, as the ve¬
nereal ; those depending on purely local action, excited, for
example, by external violence ; and those produced by the de¬
position ol ossific matter, u as the natural means of repairing
injuries of various kinds.”

The first of these appearances, u partial swelling of the ex¬
ternal surface of bonef seems to our author to be 46 the result
of some external cause, applied either in the form of pressure
or bruise.^ The state both of the periosteum and of the mem¬
branes of the bony canals, is not that of health, yet not very
different from it, and is perfectly local. In some instances,
however, 4* the whole substance of one side of the cylinder of a
bone is affected; but the structure of the tumour thus produced
44 differs in no respect from that of healthy bone.” In some
cases, the alteration is 44 the result of a gradually increased se¬
cretion of medullary matter into the longitudinal canals in
others, it is 44 the consequence of an increased secretion of
ossific matter ; which, however, is still deposited as in health.”

Tne engravings of the specimens of these affections, selected
by Mr. Ilowship to illustrate his description, are well executed
and extremely satisfactory. As an instance of the secretion into
the medullary space, he describes apart of the cranium ofa man
who had been insane for many years, which is preserved in Mr.
Heaviside's museum.

“ The left parietal bone is raised up into an unequal tumor ex¬
ternally, consequent to an increased secretion of ossific matter into
the medullary space, or diploe, between the two tables of the skull.
The distance between the separated tables of the cranium, at the
thickest part of the tumor, is about an inch ; the basis covering an
extent equal to about four inches. The natural figure of the cavity
of the cranium remains unaltered.” — p, 60.

I/Ir. Thomson, one of the Editors of the Repository, in

4*22 Analytical Review.

recent visit to Paris, saw a similar instance in a fresh skull
in the dissecting saloon of the Hospital de la Charite. The
individual, who died in the hospital, was not known to have
ever been insane, nor to have had any particular affection of the
head ; but Mr. Thomson could not learn the history of the dis¬
ease of which he had died. On sawing through the skull-cap at
the vertex, in a direction parallel to the coronal suture, the right
parietal bone was found to be thickened so as to form an irre¬
gular tumour externally"? the thickest part of which exceeded
an inch, whilst the cavity of the cranium was perfectly natural.
The bony deposit had been apparently made into the diploe,
which, however, was nearly obliterated ; whilst the thickened
portion had the aspect of the most healthy bone*. The left
parietal bone was also elevated in a similar manner ; but in a
much inferior degree.

On the subject of “ the ossijic action of the vessels of the
periosteum producing nodes or exostoses our author brings
before his readers the examination of two kinds of structure,
rhe one, “ a circumscribed scale or lamina of bone upon the
natural surface, resulting from an inflamed state of periosteum;
the other, attended with thickening of the periosteum and the
effect of a more or less diseased state of the membrane, “which,
continuing to increase in volume during the progress of the
disorder, assumes new characters, determining the kind and
quantity of the ossifie secretion, conformably to the age and
constitution of the patient.1’ This ossifie secretion takes place
upon the undisturbed surface of originally-formed bone, and in,
some instances the deposit is not “ immediately upon the ori¬
ginal surface,” but into the texture of the periosteum, a very
fine lamina of which is interposed between the original bone
and the new formation. Our author has given a good micro¬
scopic representation of a specimen of this kind of deposit.

In the formation of exostoses, “ the measure of irritability of
the system” regulates the consequences of the disease and the
pain attending it : and our author has brought forward suffi¬
cient examples to prove, that the disease is in the periosteum ;
and the spongy mass, however large, is completely separable from
the bone round which it forms. In one specimen of the disease
which he minutely examined, he found, that the structure “ of

* This skull was examined chiefly as affording an admirable
illustration of the fallacy of Drs. Gall and Spurzheim’s physiog¬
nomical hypothesis ; the external form of the skull displaying an
extraordinary developement of the organs of Hope and Conscien¬
tiousness without any corresponding cerebral enlargement.

Medico- C hirurgical Transactions ^ 423

ihe various ossific masses” of which the tumour was composed
was ‘ finely laminated or fibrous, proceeding in a divergent
course from the central part of the disease .” He supposes “ the
first deposition of the ossific matter took place in the form of
small irregular masses,” which were afterwards rendered foliated
the. °peration of the soft parts of the disease. A o-ood
engraving js given of the disease; and from the manner in
which Mr. Howslnp has treated this first division of his subiect
we anxiously look for the sequel of his labours ’

Fhe next paper, according to our arangement, is the “His -
tory oj a Case of Rupture of the Brain and its Membranes,
arising from the accumulation of Fluid in a case of Hydroce¬
phalus Inter nusC By John Baron, M.D.

,1 Tlns was a case of congenital disease, and the head, when
the child was brought to Dr. Baron, measured twenty-eio-ht
inches in circumference. It, however, became again smaller
after a tumour on the top of the head, the size of a goose’s
appeared, accompanied with an increased flow from the
urinary organs, and it went on decreasing while this flow con-

wileCi i Ut w^en n stoPPec^ the head again rapidly enlarged.
U hen the rupture took place, 44 a watery discharge tinged with
olood was seen to ooze from the nostrils and mouth ;” and this
continuing to the last, the head, which was diminished by it
1 !,e ver aSain ac(]uired its original magnitude. It was remarkable]
that when this oozing was by any circumstance diminished, the
urinary discharge increased in a corresponding degree. The
intellectual faculties were not much developed, and the child
never 44 made the slightest attempt to articulate.” At the death
or the patient, the head was nine inches less in circumference
than it was before the swelling on the top appeared. The
following were the appearances on dissection : _

A little to the right side of the falx the dura mater was rup¬
tured, as was demonstrated by a well-defined circular opening near¬
ly one inch m diameter, which communicated directly with what
was the external tumor and the interior of the brain. Through
this opening I evacuated between three and four pints of fluid
which was contained in a bag formed by both hemispheres of the
bram: ;j/ie expansion of the brain was so great, that round the
margin of the opening of the dura mater, it did not equal the thick¬
ness of a shilling ; and under the opening it had entirely disap¬
peared proving that it had given way when the dura mater yielded

and allowed the fluid from the internal cavity to escape into the
outward swelling. r

“ The cerebellum was entire, and the organs of the different
nerves seemed unimpaired. I could not well examine the ethmoid
bone, but I easily passed a probe through it into the nose.”— p. 54.

( To be continued .)

424

Selections.

PART III
SELECTIONS.

Extraordinary Case of a Blind Young Woman who can read by
the Points of her Fingers. By the Rev. T. Glover.

(To Dr. Thomson.)

r Srn,

Being lately on a visit at Liverpool, I had a favourable
opportunity of witnessing the exercise of an extraordinary
faculty possessed by a blind young woman, named Margaret
M4Evoy ; and I have been induced, by the request of my
friends, to send the results of my experiments ior insertion in.
your Journal.

Without pretending to give a medical report of this
singular case, which an abler pen is preparing for the public,
I shall briefly premise that Miss M‘Evoy is a native of Liver¬
pool, and about 17 years of age. She became blind in the
month of June 1816, from a disorder in the head, which was
supposed to be water on the brain, and which was tieated as
such : she was partially relieved by a discharge from the eais
and nostrils. She has since experienced two returns of the
same disease, and each time has been relieved by a similar
discharge of fluid. .A portion of this fluid has, I believe,
been analyzed by Dr. Bostock. She has remained completely
blind from the time of her first attack. She first discovered by
accident, about the middle of October 1816, that she could

read by touching the letters of a book.

Having blindfolded her in such a manner that I was certain
not a ray°of light could penetrate to her eyes, I made the
following experiments, most of which had not been tried befor e.
I copy the results from notes taken on the spot, and nearly in

the order in which they were made

Exper. L— I presented to her six differently coloured
wafers fastened between two plates of common window glass.
She accurately named the colour of each. She pointed out,
unasked, the cracks and openings in the wafers. Being asked,
while touching the surface of the glass above the red wafer, if
the substance under might not be a piece of red cloth or paper,
she answered, u No, I think it is a wafer.’

Exper. 2.— She described the colour aijd shape of trian¬
gular, square, and semi-circular wafers, fastened in like manner
between two plates of glass.

Instance of Reading by the Points of the Fingers. 42.5

card ftCr'J'~:70r ‘n® ^vett Prismatic colours, painted on a
lieht hL8 A 'e ,f?ll0WIns? ,,ames : scarlet, buff; yellow, green,

°rLPurP,e> blac. As the orange paint

Zt fideC'’r 18 ‘T"1 buff "'as correctly applied to" it.
first oTiho h I 16 Sulal; SPectrl,m being thrown by a prism,
dLtine -V I V fiK? th|" on the pahn, of her Lnci, she
which thev CfCn ^ i tJC dlffefent e°lours, and the positions
3.e , 2t 7pl ; °n ,h6r h,Mds and h ogers. She marked

“ s ’fn the coIo,,rs became faint, and again vivid,

SseSedTriT1 paSSage 0f a cI°ud. On one occasion she
oerceidni h t ’e "*? somf h.inS black upon her hand ; but
fimS s g |0m0Ve, S leSaid 11 "as the shadow of her own
affbrded hl "tf , ''’aS C°1Te,Ct- The prismatic colours have
_■ i , ,le gieatest pleasure which she has experienced

S enev', neSS^ th? Tio!et rays 'vere tile least pleasant.

°“e never a prism m her life. 1

decWed'h l~ne prism being put into her hands, she
s • f „ v- d • ,v lue S‘a?s ’ but, on turning it, she immediately
'] \ 1 V 1 !10t ’ 11 ls coloured ; it has colours in it and

colours ”C « h 1 m rlger What she calied “ bent stripes of
, hf c.ould. discover no colours on that side of the
pnsm on which. the direct rays of light fell.

Exper. 0.— She perceived the coloured rings formed by

ElTZi Ft, \ tW0^M!ed plates of glass. ‘ She said she
7,. 6 11 a‘ the edge of her fingers flying before them.

i ,7' ®everal attempts were made to ascertain whether
| discover colours in the dark, by presenting differ-
ity coloured objects to her hands, concealed under a pillow,
bhe aiways faded ; every thing appeared black. On one
occasion she said a green card was yellow. .

., \ JJCr- 8-— She read a iine or two of small print by feeling

letters. She next read through a convex lens at the dis!
tance of nine inches from the book. The principal focal length
f die lens is fourteen inches. While reading, she gently rubs
the upper surface of the lens with the tips of her fingers; she

ha 1 .»1UC! eaSIel’ t,hr°Ugh the ,en? than without it; she says
. e „e Lf aPPcar larger, and as If they were printed on the
as». A pen-knife was laid on the line which she was reading
and she immediately perceived and named it. °

. fPer- 9.— A concave lens being put into her hands, she
.lied to read through it at the distance of seven or eight inches,
but said that the letters were till confused. As she moved the

, tow.ards th,e book, she at length perceived the letters, but
(> iseryed that tuey were very small. She could not read easily
until the glass was laid on the paper.

JLxjjct. 10. feh e lead common print by feeling on. the upper
in-face of a piece of common window glass held twelve inches
vot. viii, — no. 47. 3 i

Selections .

426

from the book. At a greater distance she could not read ; but
could read much easier when the glass was brought nearei to
the book. In like manner she perceived through the glass
several coins spread out before her ; told which had die hea j
which the reverse upwards ; pointed out the position or the
arms, crown. &c.; read the dates ; and observed, unasked, that

one half-guinea was crooked. .

Exper. 11.— On applying her finger to the window, she

perceived two newly cut stones, of a yellow colour, lying one
on the other, at the distance of twelve yards. She described a
ivorkman in the street, two children accidentally passing by, a
cart loaded with barrels of American flour, another with loaves
of sugar, a third empty, a girl with a small child in her aims,
&c. One of the company being sent to place himself m duterent
positions, she marked every change of position as soon as any
one with his eye-sight could have done. A middle-sized man
at the distance^ of twelve yards did not appear, she said, above
two feet high. As he approached nearer, she observed that
she felt him grow bigger. All objects appear to her as it
painted on the glass.

Exper. 12. — A stone ornament in the shape of an orange
she took for a real orange, feeling through the plain glass, at
the distance of two or three inches; at the distance of fifteen
inches, it appeared no larger than a nut ; at thirty .inches dis¬
tance, it was diminished to the size of a pea, the brightness of

the colour remaining undiminished. ,

Exper. 13.— On touching a plane glass mirror, she said that

she felt the picture of her own fingers, and nothing eSse.

Exper. 14. — Holding a plate of plane g!ass three or four
inches before the mirror, she was then enabled to perceive the
reflected image of herself. When the mirror was giaduahy
removed further off, she said her face diminished. ^ All objects
constantly appear as a picture on the glass, which she touches.

Exper . 15. — She perceived through a plane glass, as before,
the image of the sun reflected from a plane mirror ; also toe
sun itself. She said she was not dazzled with it, but found it
very pleasant.

'Exper. 16, — She accurately described the features of two
persons whom she had never seen before, holding the plane
glass at the distance of three or four inches from the face.

Exper. 17.— Several small objects were held over her head.
She perceived them all through her plane glass. On one occa¬
sion she asked, doubtingly, if a three-shilling piece was not a
guinea ; but raising the glass, and bringing it nearer to the

object, she corrected her error.

* Exper. 18.— She was unable to distinguish colours by the

tongue; but holding between her lips the red, yellow, blue.

Instance of Reading by the Points of the Fingers. 427

and white petals of different flowers, she told the colour of
each accurately.

Exper . 19. — She accurately distinguished polished glass
from natural crystals by the touch. She declared three several
trinkets to he glass, which were believed to be stone ; being
tried by a file afterwards, they proved to be paste. She also
distinguished between gold, silver, brass, and steel ; likewise
between ivory, tortoise-shell, and horn. “ Gold and silver,1’
she said, “ feel finer than the other metals : crystals feel more
solid, more firm, than glass.”

JExper. 20. — She could not discover, by feeling, any differ¬
ence between pure water and a solution of common salt in
water.

These experiments were frequently repeated and varied,
during the space of three days that I had the opportunity of
seeing her, with the same results.

I must observe that this faculty of distinguishing colours
and objects is more perfect at one time than at another : some¬
times it suddenly and entirely fails ; then every thing, she says,
appears black. This sudden change seems like to what she
remembers to have experienced when a candle has been extin¬
guished, leaving her in the dark.

She says that she has not been taught by any one to distin¬
guished colours by her fingers ; but that, when she first
perceived colours by this organ, she felt convinced that they
were such and such colours, from the resemblance of the
sensations to those which she had formerly experienced by
means of the eye.

From the preceding facts, it appears evident that Miss
M4Evoy has perceptions, through the medium of her fingers,
similar to those which are usually acquired through the medium
of the eve. With respect to the manner how she acquires them,
and the necessity of an intermediate transparent substance
when she does not actually touch the object, I shall offer no
conjecture.

I have only further to add, that she has no apparent moti ve
for attempting to impose upon those who visit her, were such
an imposition practicable. She receives no remuneration from
visitors. On the contrary, the mere presence of a stranger
agitates her considerably for a time ; so very weak and delicate
is her state of health. Any noise and bustle affects her still
more painfully : and I am ashamed to say, that some of her
visitors have showed a great and culpable disregard for her
feelings, and subjected her to much unnecessary inconvenience.

I remain, Sir, &c. T. Glover.

Stonytmretj Aug* 25, 1817.

( Annals of Philosophy , No. 58.)

3 i 2 '

Foreign Medical Science and Literature.

428

PART IV.

FOREIGN MEDICAL SCIENCE
AND LITERATURE.

- - - - — - - - im.ra^

ANATOMY, PRACTICE OF MEDICINE, AND SURGERY.

I. — 44 Description of an Uncommon Petrifaction of the
Heart. — Dr. Weber, teacher of anatomy at Saltzburgh, whilst
lately making some demonstrations upon the diaphragm to his
pupils, on the body of Sergeant Ploudek, 79 years of age, on
opening the thorax, found, to his no small astonishment, a
morbid metamorphosis of the heart ; which, if not without a
precedent, is certainly exceedingly rare. Professor Ehrhard
asssisted him in the most minute examination of this heart, and
the following observations were the result of their joint ex¬
amination.

44 The heart, together with the pericardium, which was
found to be consolidated with it in every part, the vena arte-
riosa, as far as its transit into the lungs, the aorta ascendens,
together with the aortic arch, weighed one pound two ounces
and a half common weight*. The size or circumference of
the heart alone could not be ascertained, it making, together
with the pericardium and the petrified mass, which would
improperly be called ossification, but one substance. The
circumference of the whole is one foot one inch and a half.
The length from the basis of the heart to its point, is five inches
and a quarter. At the bottom of both ventricles and towards
the processus of the larger vessels of the heart, much fat was
found on severing the pericardium. The vena arteriosa as well
as the aorta, had an uncommon diameter ; that of the aorta
ascendens, the sides of it being pressed flat together, was two
inches ; that of the arch of the aorta, the sides being compressed
in a similar manner, one inch and three quarters. The aorta
descendens, together with the arteria femoralis and cruralis, had
also a larger diameter than common, and the integuments of all
diese distended vessels were thicker than in the ordinary state.
On the vessels, cartilaginous patches, like indurations, were here
and there observable; but on the more distant vessels, such as the
arteria cruralis in regione inguinalis, and arteria pudenda com¬
munis, and arteria poplitea, as also on the arteries of the soles

* We know not whether German or English w eight and
measure are meant.

Weber on an Uncommon Petrifaction of the Heart. 429

of the feet, petrified spots appeared. But the most important
and striking pathological appearance was found in the heart
1 tself . Inis and the pericardium were consolidated, and re-
scmnled to toe touch two oyster shells, each forming a mass
whicti was flat and concave on the outside, and flat and convex
on the inside. The one was 'situated forward upon the rio-ht
ventricle and auricle, the substance of which was petrified
throughout, as was the right atrium cordis in part : the other
mass was situated backwards on the left ventricle, stretching
over the bottom of it into the substance of the pericardium and
tne heart. Both these petrified masses were connected together
by processes formed of the same matter on the hinder or under
surface of the heart.

“ petrified mass was on the fore part full two inches in

length and three in breadth, exclusive of the processus, which
will be more accurately defined in describing the petrified mass
on the loft side. It was about half an inch in the thickest part.

llie petrified mass on the leftside, or back part, was two
inches and a quarter in length, and three inches and a half in
breadth, and about one inch thick. From it a process was
formed over the whole posterior lower surface of the heart, of a
similar petrified substance, one inch long and three inches broad,
which joined the petrifaction on the right side.

1 ne light atrium cordis, where it is formed by the upper
and lower vena cava, is in a common state. The 'left atrium
cordis and auricula are completely free from petrifaction, so is
the right ventricle for the most part, and the point of it is en¬
tirely free. The left ventricle about the rim of the heart is
pai tiy, and the point of the same is altogether, free from petri¬
faction. The diameter of both ventricles and of each atrium
corchs is somewhat larger than usual ; for the rest, the valvula?,
together with their attaching sinews, are quite perfect. The
ventricle atrium on either side the veins and arteries imme¬
diately issuing from the heart, were filled with clotted blood ;
with this difference, that the blood in the right atrium, ventricle,
and vena cava, was black but the left ventricle; atrium, and
aorta, instead of coagulated blood, contained a coagulated yel¬
lowish lymph, which half filled the cavum aorta? in particular.
The lungs were perfectly sound, except their inner surfaces which
covered the pericardium, and with which they were in part con¬
solidated. Both receptacles in the pleura contained about four
pounds of brown water. The cartilages of the ribs could all
be cut through with a knife, though the subject was seventy-
nine years of age. Both kidneys, although otherwise sound,
contained on their outer surfaces several hydatids. The bladder
was very small and contracted, but the vesiculce seminalis and
prostatas were particularly large. The latter was almost half

430 Foreign Medical Science and L iterature .

Its large again as the usual size, but not degenerated. The left
vesicuhun was very large ; and on the right side two of them
were observed that already were divided at the transit of
the vas deferens, each of which was of the usual size, but not
degenerated.

u The following few pathological data could be collected
from the life of this old man : He possessed a stout body and
lively temper ; and, for the greatest part of his life, had en¬
joy ed good health. About eleven years ago, however, he had
been ill of the jaundice for about three weeks. Soon after he
was seized with a violent spasm in the stomach, which had since
returned almost every year till his death, most commonly to¬
wards the end of winter, and every time it lasted for eight or nine
weeks. Since that period, he was troubled with indigestion
whenever he indulged himself a little. According to his own
expression, he felt a continual throbbing sensation in the sto¬
mach, the removal of which alone, would, in his opinion, make
him quite well. The source of this indigestion and those
spasms in the stomach, vras doubtless the heart undergoing the
above-mentioned metamorphosis ; which, by its somewhat
greater expansion, or the greater irritability of the stomach, or
its heavy pressure on the latter through the diaphragm, inter¬
rupted its functions. About sixteen weeks from the time of his
death, he was seized with the spasms of the stomach for the last
time ; and about four weeks before his death, he is said to have
suffered much for four days, from a pain in his side, both day
and night, which was very violent, particularly on the left side
of the breast. His pulse was hard and equal, but not frequent ;
a violent cough, and some oedema on his arms and feet, were
also observed.

u There is no doubt but that this acute disorder was
an inf animation of the heart, during which, the consolida¬
tion of the heart with the pericardium, and that of the latter
with the lungs, took place. A general dropsy succeeded ; on
which account he was received into St. John’s Hospital at
Saltzburg; but when this complaint was nearly removed, his
pulse became irregular, and he died quite exhausted.” — Salts -
burgh Medico-Chi rurgicat Papers.

II. — Whatever can throw any light upon the pathology of
Epilepsy is too important not to be generally interesting : hence
we conceive a translation of the following extract of a memoir
on that disease, which was read by Dr. Esquirols at the sitting
of the Society of the Faculty of Medicine of Paris on the 17th
of June last, will not be unacceptable to our readers.

“ Case L A girl, who was attacked with epilepsy at
twenty-eight years of age, on arriving at her thirty-third year.

431

An Extract from a Memoir on Epilepsy,

became maniacal in the intervals of the epileptic attacks, and
died at the age of thirty-seven. The dissection of the body
displayed a softened state of the spinal marrow towards the
eleventh and twelfth dorsal vertebrae. The softened medullary
substance was, of a light brown colour.

64 Case 2. A woman, who had long been epileptic, con¬
tracted a syphilitic disease in her thirty-first year. She took a
great deal of mercury, which occasioned an increase of the fits;
and she w?as attacked with temporary derangement sometimes
before, sometimes after, the epileptic accessions. She died at
thirty-seven, in consequence of an organic affection of the
uterus and ovaria. The lumbar extremity of the spinal mar¬
row was found to be comparatively denser than the rest of the
medullary substance.

44 Case 3. — — — - was epileptic from her infancy, and

had epileptic vertigoes every day. She was very choleric, and,
after her fits, made several attempts to commit suicide. She
died in a state of asphyxia during an epileptic fit. The me¬
ninges were found turgid with blood, and the spinal marrow
softened at its lumbar extremity.

44 Case 4. A girl, who became epileptic at thirteen years
of age from a fright, was often deranged after the fits: she was
sometimes furious ; and frequently affected with vertigo. She
died at nineteen, after many successive fits. On opening the
body, a suppurated point wras discovered in the white substance
of the posterior part of the left lobe of the brain ; the spinal
sheath was of a brownish colour towards the tenth and twelfth
dorsal vertebrae, and the inclosed medullary substance softened

7 */

at these two points.

44 Case 5. A girl was epileptic from birth (owing to her
mother having been frightened when pregnant with her), and
had fits every fifth day until the age of twenty ; when, after a
fit, she fell into a lethargy, and remained for an entire month
in that state. In the spring of the following year she was five
days in the same state, and died after a violent epileptic fit.
The arteries at the base of the cranium were cartilaginous and
ossified in many points: the sides of the aortic ventricle of the
heart were an inch in thickness, whilst the cavity of the ven¬
tricle was contracted to from five to six lines. Towards the
eleventh and twelfth dorsal vertebrae the spinal sheath was
brownish, and the medullary substance softened on the right
and left.

44 Case G. A female cook became epileptic at thirty-five
years of age, and was melancholy for two or three days after
each fit. At forty she died in a "state of asphyxia during a fit.
The whole external surface of the spinal sheath was studded
with small dull white osseous scales, from one line to two lines

482

Foreign Medical Science and Literature .

in diameter. Towards tlie seventh and eighth dorsal vertebrae.,
and the lumbar extremity of the spinal marrow, the medullary
substance was softened.

44 Case 7. A woman , of fifty-three years of age was
heightened, into convulsions, and remained epileptic. The fits
returned every second or third day, and with great violence,
until her fifty-sixth year ; when, the accessions becoming very
frequent for some months, she died after a fit, which left her in
a comatose state that continued for five days. Hydatids of
different sizes were found from the bulb of the brain to the
lumbar extremity of the spinal canal, contained in the sac
formed by the sheath. The medullary substance of the lum¬
bar extremity was softened, and the pituitary gland contained
a cyst full of a reddish-brown fluid.

44 Case 8. An infant was attacked with convulsion during
dentition, which degenerated into epileptic fits. After four
years of age they became more frequent ; and, when five years
and a half old, he had four or five fits every day, and became
paralytic. He died at the age of six years and a half. The
spinal sheath appeared as if injected, and the medullary sub¬
stance softened, and of a yellowish hue towards the sixth and
twelfth dorsal vertebrae.

44 1 ought to remark, that these eight cases are not chosen
from among many others, with the view of establishing a new
theory. Ten epileptics have died in the Salpeirierc, between
the 1st of February and the 1st of June. Nine of the bodies
were opened ; and in seven of these, I found diseased appear¬
ance of the spinal marrow, or its coverings. In one, the me¬
ninges were as if injected : in two, the arachnoid tunic of the
spinal marrow was greyish ; and in one, studded with osseous
points ; in one, hydatids were found in the sac, formed by the
spinal sheath, from the bulb of the brain to the lumbar extre¬
mity of the rachis. The medullary part of the spinal marrow
was softened in different portions of its length, more frequently
at its lumbar extremity ; in two instances, th e softening was less
evident ; and in two, the softened portions of the medullary
substance were changed in colour.

44 From these facts, may we not conclude, that some epi¬
leptic cases depend on lesions of the spinal marrow, or its coats ?
This species of epilepsy will be more readily acknowledged,
when the influence of the spinal nerves on the functions of
locomotion are compared with the violent state of the locomo¬
tive system during epileptic fits. These considerations having
led me to open the spine of epileptics, the facts justified mv
suspicions.

44 Induced by this induction, I applied four moxas along
the spine of an epileptic. The patient was sixteen years of age,

Sertuerner’s Analysis of Opium . 433

aiKl the {\ts recurred every eight or ten days, and always at the
menstrual periods. . Since the 22nd of April, the time when the
moxa was first applied, this girl has had three fits only, and two
menstrual periods have passed without an attack.

^ I do not pretend to draw any conclusions from this fact,
as the success was not complete ; neither can a solitary fact
prove any thing. . In publishing it, and the result of my dis¬
sections,. I am desnous of calling the attention of the profession
to an object of research, which I regard as so much the more
important, as epilepsy is a disease, to the seat of which, we
nave the means of positive access*.1’

CHEMISTRY.

111 '--AfAysis of Opium, particularly of Morphium and Meconic
Acad, considered as essential parts of Opium. By M.
Sertuerner, Pharmacopoli^t, at Limbeck, in the Kino
[anoverf*,

dorn of Hanoverf*.

“ Fourteen years have nearly elapsed since M. Derosne. an
apothecary at Pans, examined opium, and published the results
of his labours in the Annales de Chimie , vol. xl v. I was en¬
gaged. m an analysis of the same substance much about the
same time ; but the results of our experiments were so different
and so contradictory, that the subject lias remained undeter¬
mined. . Little attention has been paid to my Memoir ; it was
written in a hurry ; the quantities were small upon which I had
opei ated ; and some persons had repeated my experiments
without success. Convinced of the exactness of my labours in
general, although undertaken at an inexperienced age, and de¬
sirous of removing contradictions, I engaged myself fn a second
analysis of this singular vegetable substance ; and have had
the satisfaction of confirming my former observations and mak¬
ing new ones. It will he seen in the sequel that the method
and the observations of M. Derosne in the analysis of opium
were not exact; and that he has not discovered the part upon
which the efficacy essentially depends ; for he has mistaken for
this substance, which I call morphium, its combination with the
acid of opiuni. In making my observations public, I flatter
myself that chemists and physicians will derive some benefit
from them. They will throw a light upon the characteristics
of these two bodies and the constituent parts of opium. I
believe also that I have enriched chemistry with the knowledge
of a new vegetable acid (the meconic acid), and with the dfs-

’* Bulletins de la Facultc de Mcdecine de Paris, tome v. p. 421.

+ Gilbert’s Annalen der Phusilc, neuc false, vol. xxv. p. 56 • and
Annales de Chimie et de Physique, t. v. p.2L

VOL. VIII. — NO. 47. 3 K

134 Foreign Medical Science and Literature.

covery of a new alkaline base, morphium. -The lattei is a \ciy
singular substance, and seems to have some resemblance to
ammonia, and which, some day, will serve to explain the other
salifiable bases. Although my former observations upon opium
and its constituent parts are confirmed, there are also some tacts
which I have found to be different ; but I hope to be pardoned
my former errors, when my youth and the small quantities
operated upon are taken into consideiation.

“ i. OfMorphium. — 1. Eight ounces of dried opium were
digested in the heat with several portions of distilled water,
until it became no longer coloured. After having evaporated
the tinctures, we obtained a translueid extract, which became
very turbid on diluting it with water; but with the assistance
of heat, or by adding a still larger quantity of water, the trans¬
parency of the liquor was restored. The aqueous solution ox
the extract was saturated with an excess of ammonia, and a
substance of a greyish-white colour was precipitated, vhuxi
formed into translueid granular crystals. These crystals, alter
beino- washed with several portions of water, ar e morphiuvh the
efficacious part of opium, combined with a little extract and
meconicacid, as will be seen in the sequel of this Memoir.

" 2. This substance, after being dried, weighed sixteen

drachms. It was saturated with diluted sulphuric acid, m
slight excess, precipitated afresh with ammonia, and treated
several times with this alkali, in order to separate the extract.
But as this could not be effected, the precipitate was reduced to
an impalpable powder, and treated several times with a little
alcohol, which became very much coloured. By this means I
obtained nearly eight drachms of nearly colourless morphium.

ft 3. The small quantity of morphium which was dissolved
by the alcohol, was’ separated by crystallization. The ex¬
tracted matter which was contained along with the morphium
in the alcohol, as well as in the ammoniacal liquors, was not
pure extractive, but a combination of extractive with morphium,
of which the latter was the base. It is very soluble in acids
and in alcohol ; but sparingly so in water.. It coloured the
salts of iron green, by means of its extractive, and separated
from them a part of the oxide by its morphium. As pure
morphium is precipitated from its solution in acids in form of a
pearly powder, and since it crystallizes in parallelepipeds with
pbhoue faces, I presumed that n is the extiactive, comomed
with* the morphium, which changed its form into an almost
cubical grained crystallization. This is confirmed by treating
this substance with ammonia, which dissolves a part only of the
extractive, as it has something of the nature of an acid, always
Retaining some of the morphium, and making it difficult to se¬
parate them completely. Alcohol finished the separation, and

Sertueriier’s Analysis of Opiunt.

dissolved the extractive which remained with the rnorphium.
There is a very great difference between the extractive matter
separated by ammonia and that which is separated by alcohol.
The first dissolves in water with great facility, because it con¬
tains less of the morphium than the brown substance obtained
by means of alcohol : in the one, extractive predominates ; and
in the other, morphium. lienee we give the former, by means
of an alcoholic solution of morphium, the appearance of a re¬
sinous body, in which the morphium predominates and per¬
forms the functions of a base, A concentrated aqueous extract
of opium always gives these two combinations when treated
with ammonia.

44 4. In order to obtain morphium in its highest state of
purity* I dissolved it several times afresh in alcohol, and ob¬
tained it, by means of crystallization, entirely colourless, and
in regular paralielopipeds with oblique faces. The substance
which is obtained by treating opium with alcohol, according to
Derosne, crystallizes in prisms, with angles from 30° to 40°, and
reddens in a high decree the solutions of iron.

5. Pure morphium possesses the following properties
—It is colourless, soluble in small quantities in boiling water,
very soluble in alcohol and in ether, and may be made much
more so by the application of heat. Its solutions, from which
it crystallizes in the above-mentioned forms, are very bitter.
The aqueous and alcoholic solutions tinge rhubarb paper
brown more strongly than turmeric paper, and restore the blue
Colour of litmus paper after it has been reddened by acids. It
is not ammonia which produces this effect, because pure mor¬
phium does not contain any of it, as will be seen in the sequel
by treating this substance with caustic potash. It dissolves
with facility in the acids, and forms very remarkable neutral
salts.

44 The sub-carbonate of morphium is formed either by expos¬
ing morphium to the action of carbonic acid, or by decomposing
the solution by sub-carbonate of potash,

44 The carbonate of morphium crystallizes in short prisms.

44 The acetate of morphium crystallizes in small rays, and is
very soluble.

44 The sulphate of morphium is very soluble, and crystallizes
in ramifications.

44 The muriate of morphium forms plumose or radiated
crystals, and is more sparingly soluble than any of the other
salts with morphium ; and, if the evaporation be pushed tck>
far, cools into a brilliant silver-white mass.

44 The nitrate of morphium crystallizes in rays, proceeding
from a common centre.

44 I have not formed the mebonate of morphium ; but th$

3x2

436

Foreign Medical Science and' Literature,

suh-meconale crystallizes in prisms ; and I obtained it by treats
ing the aqueous solution of opium with alcohol. A large por¬
tion of water is necessary to dissolve it and separate it entirely
from opium.

64 The tartrate of morphium crystallizes in prisms, very
similar to those of the preceding salt.

a These different salts formed with morphium appeared to
me to be very hurtful to the animal constitution ; for, after
tasting them, X was always troubled with a head-ache. They
are very soluble in water ; almost all have a micaceous bril¬
liancy, and very soon effloresce when exposed to the air.

“ In the order of salifiable bases, morphium will stand after
ammonia, because it is disengaged from all its combinations by
this alkali. It will occupy the last place among the alkalies,
from which it is distinguished in having less specific gravity,
and in being incapable of saponifying oxydized oils. It has
less affinity for acid's than ammonia, and even than magnesia;
but it decomposes most of the metallic salts, as the sulphate,
the muriate, and the acetate of iron, several of the salts of
mercury, lead, and copper.

44 The acetate of morphium loses its green colour by means
of morphium, and, no doubt, forms with it a triple combina¬
tion, as with ammonia. It combines with the carbonic acid or
the atmosphere and with extractive, as the other salifiable bases.

44 Morphium easily melts by the application of heat, and
then has some resemblance to melted sulphur : it crystallizes
upon cooling. It burns very quickly ; and, by heating it in a
close apparatus, a blackish resinous substance may be obtained,
of a peculiar odour. It combines with sulphur when heated;
but is at the same time destroyed, and forms hydro-sulphuric
acid. I have not had time to determine exactly the elements
of morphium: but there is no doubt that they are oxygen,
carbon, and hydrogen ; perhaps also azote. The galvanic pile
little effect upon morphium, even in making use of a
f mercury. The globule, nevertheless, seemed to en-
alter in consistence.

44 ii. Of the Effects of Morphium on the Human Body. — ►
6. The most remarkable property of morphium is the effect
which it produces upon the animal oeconomy. That X might
ascertain tins with exactness, I tried experiments upon myself,
as well, as upon some other persons, being convinced that expe¬
riments made upon the lower animals do not afford any certain
results.

44 It is necessary to notice in a particular manner the terrible
effects of this new body, in order to prevent accidents ; for it
has been publicly declared that this substance has been given
in considerable quantities to several persons without producing

produces
globule c
large anc

Sertuerner’s Analysis of Opium. 437

any remarkable effect. If it were really morphium that was
ffiven in these cases, it would seem that it cou d not have been
dissolved by the. gastric juices. My former experiments in¬
duce me to mention expressly that this substance should only
. ie gben when dissolved in alcohol, or in a little acid ; because
it is very sparingly soluble in water, and that consequently it
cannot be leaculy acted upon in the stomach without the me¬
dium of these liquids. That I might ascertain with exactness
my own sensations, I engaged three persons, none of whom
were more than seventeen years of age, to take the morphium
along with me. but, warned by the effects which X had for-
merly experienced, I gave to each only half a grain, dissolved
in half a drachm of alcohol, diluted with some ounces of dis¬
tilled water. A general redness, which might even be per¬
ceived in the eyes, covered the whole body, but particularly
the cheeks; and the animal powers seemed to be raised. We
then took, half an hour afterwards, another half grain of mor-
phium. The effects already mentioned increased considerably,
and we experienced a transitory inclination to vomit, with a
sense of stunning in the head. Without waiting the issue of
this, we swallowed, a quarter of an hour afterwards, another
lialf-a-grain of morphium, in coarse powder, with some drops
of alcohol, and half an ounce of water. The effect of this
was instantaneous upon the three young men ; they expe¬
rienced an acute pain in the stomach, a sense of weakness, with
general stiffness, and faintness. I myself experienced similar
effects , and, upon lying down, fell into a kind of dozing vcveriej
attended with a sensation of throbbing in the extremities, but
chiefly in the arms.

“ These evident symptoms of poisoning, and especially the
faint state of the young men, occasioned me so much uneasiness,
that, without any consideration, I swallowed about six or eight
ounces of very strong vinegar, and gave the same quantity" to
the others. So violent a vomiting succeeded, that one of the
young men, of a delicate constitution, and whose stomach was
entirely empty, found himself in a very miserable condition.
It appeared to me that the vinegar communicated to the mor¬
phium this violent emetic property,

“ I then gave this young man some carbonate of magnesia,
which soon checked the vomiting; and he passed the night in
profound sleep. Next day the vomiting returned ; but soon
ceased upon taking a strong dose of the carbonate of magnesia :
but the want of appetite, the constipation, stiffness, and pain in
the head and stomach, did not cease for some days.

“ So, if we may judge from this rather disagreeable expe¬
riment, morphium, even in small doses, is a violent poison. Its
combinations with the acids may, perhaps, possess still more

438

Medical and Physical Intelligence .

powerful effects* I am of opinion that the last half grain had
a more energetic action, from arriving in the stomach in a con-
ccntrated state, and being there dissolved.

“ The other constituent parts of opium do not possess any
of the above-mentioned properties ; and it appears to me that
the principal effects of opium depend upon the pure morphium.
It belongs to medical men to investigate this subject. Hitherto
the combinations of morphium with meconic acid only have
been employed. We may also expect efficacious effects hi
several diseases from the different salts of morphium. From
my own experience, I am able to say, that a very violent tooth¬
ache, which would not yield to opium, gave way upon the ap¬
plication of a weak alcoholic solution of morphium. ^

« The meconate of morphium, which constitutes the effica¬
cious part of opium, being rather insoluble in water, pure
alcohol only ought to be employed for making the tinctures of
opium. These tinctures ought also never to be cooled too
much; because, when this is the case, morphium, combined
with some of the resinous parts, is precipitated from the ex¬
tractive and the meconic acid ; and hence such remedies are
less efficacious at a very low, than at a moderate temperature.
It would be desirable that medical men, competent for the task,
would soon engage themselves upon this subject ; because
opium is one of our most powerful remedies. — ( To he continued .)

PART V.

MEDICAL AND PHYSICAL
INTELLIGENCE.

I,— -SOCIETIES.

Society for Relief of Widows and Orphans of Medical Men in
London audits Vicinity, wider the Patronage of His Royal Ilighucis
the Duke of Kent, KG. K.G.C.R. ,

Officers and Directors for the Yeats I817D8.

Presidents.

Matthew1 Baillie, M.D. F.It.S. F.A.S., &c.

Vice-Presidents.

Sir Francis Milman, Bt,
Dr. Haworth,

Sir Gilbert Blane, Bt.
Dr. Dennison,

Sir William Bllzard
Mr. Heaviside
Mr. Ware,

| Mr. Norris,

Treasurers .

Mr. Haw.orth>
Mr. Ridout,
Mr. Simons,
Mr. Field.

Dr, John Sims, Mr. Upton,

Mr. Steele.

Medical and Physical Intelligence*

Dr. Maton,
Dr. Warren,
Dr. Frampton,
Dr. Farre,

Dr. Adams,

Dr. Laird,

Dr. Stone,

Dr. Cooke,

Directors.
Dr. Burrows,
Mr. Vincent,

Mr. Cartwright
Mr. Copeland,
Mr. Clarke,

Mr. Mathias,

Mr. Alexander,
Mr. Ring,

Trustees.

Mr, Malim,

Mr. Wells,
Mr. Tegart,
Mr. Simpson,
Mr. Wheeler,
Mr. Hunter,
Mr. Ewbank,
Mr. Wachsell.

Matt. Baillie, M.D. F.R.S, ,&c. James Norris, Esq.

Sir Hen. Halford, Bt.M.D..&c. James Upton, Esq^

Honorary Secretary , Secretary ,

Mr. Chamber laine. Mr. Watson*

At the Anniversary Festival, on Wednesday, October 29th, 1S1",
at Albion House, Aldersgate Street, His Royal Highness the Duke
of Sussex in the Chair, the following state of the Society’s fund,
for the last year, ending September 10th, 1817, was reported :

1816 — Receipts... £ 1,0 11 12s. gd. Disbursements... £5 99 13.?, 4d„
1817— Receipts... £967 66-. 5d. Disbursements... £52g 17 .?. 8d.
This Society was instituted in the year 1 788. The capital is
now £24,350 Three per Cent. Consols Annuities, and £200 Navy
I ne pei Cents, i tie sum oi £5815 has been distributed among
the Widows and Orphans of deceased members of this Society, some
of whose families have been left without any other provision what¬
soever. T he number of members is now three hundred and twenty-,
six. J ohn Watson, Secretary, Carlisle Street , Soho Square .

11.— pathological.

M. Royer Collard has reported the case of a melancholic, who
believed himself the object of persecution by a powerful triumvi¬
rate. ^ He complained that, about three years before, he had swal¬
lowed an iron fork, in one of his paroxysms of melancholy. He was
examined several times to find if any foreign body could be felt • but
none was detected. His digestive powers were generally good,
and the colour of his stools natural. At length he hun<* himself
with a bandage which had been applied to keep on a blister. On
opening the body, in the stomach a varnished iron fork was found,
the prongs of which were closely compacted together. The sto¬
mach was quite in a healthy state, as were also all the other viscera.

Biblioth . Med. ( Janvier , 1817).

III. - MEDICAL.

Indian Cure of Gonorrhoea and Gleet . — Mr. Craufqrd, a sur¬
geon in the service of the Honourable East India Company, on the
recommendation of a Hindoo, has used the Piper Cubeba in gonor¬
rhoea with the most beneficial results. “ The mode of exhibino- it
is to give a dessert spoonful three or four times a day, in about three
ounces of water. The discharge stops in about twenty -four hours.
It occasions moderate purging, flushing, and heat in the hands ;
but no fever, in one or two cases it produced swelled testicle. It
succeeded equally with Europeans and native#/ (Javanese J—
pdin. Med \ and Surg. Journ ., Oct .

440

Medical and Physical Intelligence .

Employment of Nux Vomica in Paralysis. — Mr. Thomson, when
lately in Paris, was shewn, by Dr. Fouquier, two cases of paralysis
under treatment with the nux vomica. In both instances, the
patients had recovered the power of motion in the paralytic limbs ;
and in one of them, the speech, which was lost previous to the ad¬
mission of the patient into the hospital (la Charite), was completely
restored. The remedy was exhibited in the form of extract ; and, at
the time of Mr. Thomson’s visit, was given to the extent of eight
grains for a dose three times a day. Dr. Fouquier stated, that it
had rarely failed of relieving the disease when the head was not
materially affected ; but it was most successful in cases of paraplegia.

The extract is prepared by macerating the nux vomica, pul¬
verized in rectified spirit for two or three days ; and then evaporat¬
ing the filtered tincture in close vessels at a very moderate tempera¬
ture. When properly prepared, the extract is intensely bitter.

Vesicatory — Dr. Alibert (Nouveanx Elemens de Therapeutique)
recommends the following as a useful formula : — -
14 Farinas Secalis,

— — Hordei,

Pastas, una quantum satis :

ad debitam consistentiam, ope aceti mbri, redigatur massa, cujus
superficies triginta vel quadraginta granis Cantharidum conspergitur.

Huic vesicanti majorem praebet energiam additio aliquot gutta-
rum alcoholicae Cantharidum tincturae.

Effects of Inhaling the Vapour of Sulphuric Ether. — Effects very
similar to those produced by nitrous oxide, result from inhaling, the
vapour of ether mixed with common air. A convenient mode of
ascertaining the effect is obtained by introducing a tube into the
upper part of a bottle containing ether, and breathing through it:
a, stimulating effect is at first perceived at the epiglottis, but soon
becomes very much diminished ; a sensation of fulness is then
generally felt in the head, and a succession of effects similar to those
produced by nitrous oxide. These are considerably augmented by
lowering the tube into the bottle, so as to admit of more ether being
inhaled at each inspiration.

In trying the effects of the etherial vapour on persons who are
peculiarly effected by nitrous oxide, the sensations were unexpectedly
found to be exactly similar ; and this was even the case in a person
who always feels a depression of spirits on inhaling the nitrous

oxide. .

It is necessary to use caution in making experiments of this
kind. By the imprudent inspiration of ether, a gentleman was
thrown into a very lethargic state, which continued with occasional
periods of intermission for more than thirty hours, and a great
depression of spirits ; formally days the pulse was so much lowered,
that considerable fears wrere entertained for his life, — Journal oj
Science and the Arts, Oct.

' IV. - CHEMICAL.

Chlorine.- — I)r. Ure of Glasgow, from the results of a series of
elaborate experiments, conceives he has fairly established the old

hfc died and Physical Intelligence. 444

tlseorr of Berthollet and Lavoisier regarding thfc composition of tin's
substance, m op^snmn to that of Sir H. Davy, now almost gene--
j * a' n‘‘ L e • - -is object was to obtain water or its elements from

2? f\d lecfmy sublimed muriate of ammonia j and this he has
edocted by transmitting such a muriate in vapour through lamina of
pure Sliver, copper, and iron, ignited in glass tubes ; water and hy¬
drogen were copiously evolved, while the pure metals were coL
verted into metallic muriates.

Chenopodimn Vvkaria— M.M. Chevalier and J. L. Lasse, Vne
nave analysed this Diant. and nhtnin**-! : _

have analysed this plant, and obtained the following ingredients
. r 1 ee suo-carbonate ot ammonia, resulting evidently from an
aitunai matter m a state of putrefaction, although in the living plant -
- . albumen; S . osmazone ; 4°. a small quantity of aromatic resin :
o . a_ mtier matter soluble 111 water and alcohol ; 6° Nitrate of
potash in great quantity ; 7° some acetate and phosphate of potash ;
o . tartrate of potash. The plant, when dried, loses its fetor, and
acquires a slightly aromatic odour ; but it, nevertheless, still exhi¬
bits the presence o, ammonia in it, by producing white vapours
V-lJ muriatic acid. — Journ. de Pharmacie, Sept. 1817.

Roe or Eggs of the Pike.— Vatiquelin has lately analysed these
^00') ana. ootamed the following' as their components * _

„ {fuch albumeni ^ oily matter; 3°. an animal sub-
s -mice, having some relation to gelatine; 4°. Muriates of potash,
soda, and ammoma; 5°. Phosphate of potash, lime, and magnesia;
6 . Sulphate of patash ; 7° Phosphorus.

. The char(:oal Procured by burning these eggs in a crucible, on
being exposed to a high temperature undergoes a species of fusion,
a d assumes tne form ot a paste, owing to the production of phos¬
phoric ac:a in considerable quantity: and that this arises from the
presence of free phosphorus in these eggs, Vauquelk considers
^robaole, from the following circumstances. The eggs before heinr
urnt were well washed with a quantity of water sufficient to take
r.o aL toe soluble phosphates ; and that it did not proceed from the
phosphate of lime, is evident, because acid phosphate of lime was
round after the combustion,

“ The presence of phosphorus in these eggs,* adds Vauquelin,
f pUS£ therefore be admitted ; and in this respect, and in many
otders, there appears to be a great analogy between the composition
of tne milt and eggs of fishes, and that of the substance of the
t ram, the spinal marrow, and the nerves.'’ — Journal de Pharmacie *
fcept. 1817. w *

Preparation of Morphium. The following process of M .
Robiquet for the preparation of this substance being more simple
than that proposed by M. Sertuerncr , we extract it for the use^os
such of our readers as may wish to prepare morphium, in order to
examine its effects upon the animal (economy.

“ A concentrated infusion of opium is to he boiled with a small
quantity of common magnesia for a quarter of an hour. A greyish
deposit in considerable quantities is formed ; this is to be filtered
and washed with cold water, and, when dry, acted on by weak

vol. vin, — ;no. 47. 3 l

442 Medical and Physical Intelligence ,

alcohol for some time at a temperature beneath ebullition. In this
way very little morphium, but a great quantity of comuring matter,

13 ^Thlf solid matter is then to be filtered, washed with a little al¬
cohol,' and afterwards boiled with a great quantity of highly rectified
alcohol ; it is to be filtered whilst hot, and the spirit on cooling depo¬
sits the morph him in crystals, and very little coloured, i his is to be
repeated two or three times with the residuum, and tne mbrphmm
obtained by each filtration is less and less coloured.”

' V. — -pharmaceutical.

Preparation of Extracts.— In the preparation of vegetable ex¬
tracts, in evaporating diabetic urine, &c. the last portion ot water is
expelled with most difficulty, and the last stage of tne process seems
most injurious to the product. To remedy these obstacles, Mr.
Johnson of Lancaster advises that small quantities oi rectify
spirit be added occasionally, by which means this stage is shortened,
and less injury is sustained. - — Annats of Thu. Oct.

VI. - BOTANICAL.

Camphor Tree of Sumatra.— Plants of this tree were raised at
Calcutta from seeds sent from Tassanooly by Mr Prince, the resi¬
dent at that station ; but they did not outlive the subsequent com
Season. From the examination of the seeds, however, which were
in a perfect state, it is evident that the plant is. not a laurus, as has
generally been supposed : but belongs to the genus Dry oh alanops ot
the younger Gartner : and lias been named by T. Colebrooke, Esq.
Dryobalanops Camphora. It is a large tree, a native of forests on
the north-western coast of Sumatra. The camphor is found m con-
i unction with essential oil in the heart of the tree, m portions or a
foot or a foot and a half, at certain distances. The tree, which is
first cut to the heart at fourteen or eighteen feet from the ground, to
discover the camphor, is afterwards felled and cut in junks of a
• fathom long, which are again split, and the camphor is found m the
heart, occupying a space iu circumference oi the tnickpess oi a
man s arm. The quantity found in a middling-sized tree, is eleven
pound ; and in large trees, double the quantity —Asiatic Researches ,

vol. xii.

Rheum Pahnatum. — Mr. Moorcroft, in a journey to Lake Ma-
nasarovara in Undes, in Little Thibet, discovered the rhubarb
plant ^rowing wild, on the side of a mountain near the village oi
Nili. *“I cutup,” says Mr. Moorcroft, « the roots of many large
plants. The leaves in several instances sprung from a little sound
bark, which surrounded a large portion that was rotten. Those
which were hard, were detached from the sound part oi the barn
near the surface of the ground ; but these shrunk much in drying,
and had but little of the rhubarb taste, colour, or smell, whilst the
sound fragments of the root of the preceding year were marbled
like the cut surface of a nutmeg ; some were yellow, and had the
peculiar qualities of the rhubarb, with a very large proportion oi
bright colouring matter which stained the lingers oi a gold tint t

Medical and Physical Intelligence. 443

biti. 1 presume the best time, for taking up the roots is September.”
On returning, however, in September, after the plants had run to
seed, Mr. Moorcroft cut up many roots, but found the whole more
or less spongy and rotten. — Asiatic Researches , vol xii.

Acer Pseudopl alarms. — At Carronpark, in the county of Stirling,
on March 7 and 8, 1816, Mr. W. A. Cadell, made the following
experiments on the sap of this tree. Incisions were made in the
bark of the trunk, five feet from the ground. The sap was quite
tiansparent and colourless, and flowed freely, so as to fill m tw7o or
three hours a bottle capable of containing a pound of wTater. At
night, the weather being cold, the sap froze, and hung from the
bark in isicles. Three bottles and a half were collected, weighing in
all 3lb. 4oz. Some days after this the flow of the sap from °the
incisions ceased entirely. In a few weeks after the tree was cut
down.

The sap was evaporated by the heat of a fire, and gave 214
grains of sugar, in colour resembling raw sugar ; in taste sweet,
with a peculiar flavour. After being kept 15 months, this sugar
■was slightly moist on the surface.

The quantity of sap employed in the evaporation was 24960 gr.
(3 lb. 4 oz.) ; the quantity of sugar obtained from it was 214 gr. :
therefore in smaller numbers 1 16 parts of sap yielded by evaporation
one part of sugar.

VII. - NOTICE OF LECTURES.

Mr. Curtis, Aurist to H. R. H. the Prince Regent, and Surgeon
to the Royal Dispensary for the Diseases of the Ear, will commence
his next Course of Lectures on the Anatomy, Physiology, and
Pathology, of the Ear, on Thursday, November 13th*, at the* Royal
Dispensary, Carlisle Street, Soho Square, at 7 o’Clock in the Evening.

VIII. — literary notices.

Dr. Johnson, of Portsmouth, has just completed a condensed
translation of Guilbert’s New Work on Gout, which is a transcript
of the celebrated article on Gout in the “ Drctionnaire des Sciences
Medicales.” It forms an Appendix at the end of Dr. Johnson’s
Work, which will appear on the 1st of December, under the
following title : “ The Influence of the Atmosphere, more especially
the Atmosphere of the British Isles, on the Health and Functions
of the Human Frame; embracing Observations on the Nature,
Treatment, and Prevention, of the principal Diseases resulting from
sudden atmospherical transitions,” &c.

Sir John Byerley is preparing for publication a Translation
of Professor Orfila’s New System of Medical Chemistry.

In the press. Two Letters on the contested Origin, Nature, and
Effects, of the Poor Law’s.

In the press, and will be published in a few days, the Trans¬
actions of the Association of the King and Queen’s College of
Physicians in Ireland.

Dr. Clutterbuck will shortly publish the Second Part of an
“ Inquiry into the Seat and Nature of Fever.”

3 L 2

444

A METEOROLOGICAL TABLE,

From the 21s£ of September to the 20th of October 1817,

IiEPT AT RICHMOND, YORKSHIRE.

230 Miles MW from London.

Baron

Max.

re ter.

Min.

Therm.

Max Min.

}

Rain

Gage.

Winds.

Weather.

■ 61

NNW.

1 Cloudy.. 2 Sun. ]

NNW.NE.

1 Sun... 2 Cv.. 3 R..

ME.

1 R. 2 Cy.. 3 Sun. 4Mn .

Vble.

12 4 Cloudy.. 2 Sun.

S..

1 Cy.. 2 Sun.. 4 Rain.

s w. . . .

1 Sun.. & Showers,

3W....

1 Sun....

sw...

1 Sun.. Sc Showers.

w..

1 Sun... & Showers.

W.NE.

1 Sun...

SW...WNW..

1 Sun... 2 Sun. & Sh.

NW...

1 Sun...

NW..N..

1 3 Sun... 2 Cy.. 4 Mn...

N..NE..

1 Sun..

NE.EbN

1 3 Cy.. 2 Sun. 4Sth.

6 30

EbN..

1 Cloudy...

. 7

1 Cloudy..

13 4 Cy.. 2 Sun...

1 Cy... 4 Sh. Sc Star!..

NW..

1 Sun.. Sc Showers.

NNW.,

1 Sun. Sc Showers.

N..

1 Sun.. 2 Cloudy..

NW..

1 3 4 Cy.. 2 Sun.

NbE.

1 Showers.. & Sun.

ENR..

1 Showers.. & Sun..

1 Sun... 2 Cy.. 3 Sh.

' 18

77 50

NE. .

1 Showers. 3 Cloudy..

F.NE,

1 Cloudy,. 4 Showers

68' 49

NbW.

I Sun.. 3 Showers..

j -■ r

The quantity of rain during the month of September mas 1 inch^-lOQths,

Observations on Diseases ct Richmond,

■The diseases under treatment were Aphtha*, Asthma, Cholera, Cynanche
Farotidcea, Cynanche Tonsillaris, Diarrhoea, Dyspepsia, Entrodynia, Febris
Catarrh alis, Febris Symplex, Gastrodynia, Haemoptosis, Icterus, Manors
yhagia, and Uiticaria.

A case resembling Phthisis puimonalis, of eight months standing, wag
speedily cured by purgatives.

METEOROLOGICAL TABLE FOR LONDON",
I-rom the 30 th of SEPTEMBER to the 19th of OCTOBER, 181'

By Messrs. HARRIS & Co.

Therm.

jBarom

! Rain
Guage

.57

;30

,'30

290

|299

29 s

.04

i29s

29*

299

298

2.5

29c

29 1

29*

29 4

.09

29 4

29°

29*

2.9 9

.10

29®

29 9

.06

5v>

29s

29'1

80 1

30 1

30!

301

6j47

3.0 s

30*

30 1

301

•

29 9

io!

29 9

29°

29 9

30 1

40 j

302

30*

302

30 1

15|48

40 1

299

16!-

42!

29 9

29s

.21

17>45

.54

18!44

29 s

29°

.09

-11.9144

44 j

299

.08!

De Luc’s Hygrom.
Dry, Damp.

l o

Winds.

wsw

3 NE

1 NNE

2 NNE

3 NE

NNE

Eva

NNW

NNE

wsw

NNE

0
OjN
OjN

o!ne

NE
I NNE
Eva
E

Eva

NNW

NNE

Atrao. Variation.

Fine

Clo.

Fine

Clo.

Rain

Fine

Clo.

Fog

Fine

Fog

Clo. •

Rain

Clo.

Fine

Clo.

Sho.

Rain

Fine

Clo.

Sho.

Rain

Clo.

Rain

Fine

Clo.

Fine

Hail

Fine

Clo.

nth of September, is 6 1- lOOths of an inch only.
Bill of Mortality from September 16, to October 14, 1817.

CHRISTENED.

| Males

Females.

BURIED.

( Males.....
Females.

r Under
Betw.

OF WHOM ■) .

RAVE DIED "

2 Years.
2 and 5
5 and 10
10 and 20
20 and 30
30 and 40
40 and 50
50 and 60
60 and 70
70 and 80
80 and 90
90 and 100

SMAIA POX.

Sept' 25.

Sept. 30.

Oct- 7-

253

152

. 210

•256

138

431

4S9

290

157

185

136

157

174

158

•— ’--r

- — -

314

359

294

- —

- r

— rr-

... ?9

... 12

... 6

... 21

... 36

... 32

... 17

... 13

... 2

Oct. 14.

291
267

358

198

189

387

- J

123

\ Total,
j 1771.

\ Total,

1352.

,,f TofaL
'l 95

440

A REGISTER OF DISEASES
Between SEPTEMBER 20th, and OCTOBER 1 9th, 1817-

DISEASES.

Abortio .

Abscessio .

Acne .

Amaurosis .

Amenorrhcea .

Amentia . .

Anasarca . . . ..

Anorexia..... . .

Aphtha lactentium . .

Apoplexia .

Ascites . .

Asthenia. . — . .

Asthma .

Asphyxia .

Atrophia . .

Bronchitis acuta ....

- - chronica.

Calculus .

Caligo .

Cancer .

Cardialgia .

Catarrhus . .

Cephalalgia . .

Cephaleea.. .

Chlorosis .

Chorea .

Cholera .

Coiica .

- - Pictonum .

Convulsio .

Coryza .

Cystitis .

Cynanche Tonsillaris .

- maligna... .

- - Trachealis . .

- - Parotidea. .

Diarrhoea...
Dysenteria. .
Dyspepsia...
Dyspnoea....
Dysphagia .

Dysuria .

Ecthyma....

Eczema .

Eneuresis ..
Enteritis....
Entrodynia
Epilepsia. ..
Epistaxis...
Erysipelas..

!«•••••«

'i r

-*->

E8 J

• 34

' 2

. AV

. 10

. 58

. 14

.. 3

.. 31

.. IS

.. Vi

. .

• • •

4 1

DISEASES.

3- IS

' &
I ^

Erythema Iceve .

vapid alum .

Exostosis.

Febris intermittent.. .

catarrhalis .......

Synocha.... .

Typhus rnitior...
Typhus gravior

Synochus .

remit. Infant —

Fistula....

Fungus .

Furunculus.. .

Gastrodynia . .

Gonorrhoea .

Heematemesis .

Hsematuria . .

Haemoptoe .

Haemorrhois ........

Hemiplegia .

Hepatalgia . .

Hepatitis .

Hernia . . .

Herpes Zoster......

• — - circinatus.

Hydrarthyrus . .

Hydrocele... .

Hydrocephalus .

Hydro thorax .

Hypochondriasis .

Hysteralgia .

Hysteria.. .

Hysteritis . .

Icterus .

Impetigo figurata. . .

— - erysipelatodes

- rodens.... .

Ischias . . .

Ischuria .

Leucorrhoea .

Lithiasis . .

Lumbago.... .

Mania.......... .

Melancholia........

Menorrhagia .

Miliaria .

Morbi Infantiles *

Morbi Biiiosit .

Neuralgia .

Obstipatio .

9
31

10
3

3
21

4
3

2
2
3

5
2
9
2
3

■2

447

diseases.

Odontalgia .

Opththahnia.. .

Otalgia .

Palpitatio .

Paracusis .

Paralysis .

Paraplegia .

Paronychia .

Pericarditis .

Peripneumonia.

Peritonitis .

Pertussis .

Phlogosis.

Phrenitis .

Phthisis Pulmonalis .

Plethora .

Pleuritis .

Pleurodyne . » .

Pneumonia . . .

Podagra .

Porrigo scutulata....

- favosa .

Prolapsus .

Prurigo mitis .

— — — formicans _

- 7 - senilis .

Psoriasis guttata. . .. .

— < ■

Fatal

DISEASES.

Total.

Pyrosis . .,

llheumatismus acutus. .....

- chronims...

Rubeola .

Scabies .

Scarlatina simplex .

ScirrhUs . . .

Scrofula .

Spastni .

Splenitis . . .

Strictura . . .

Strophulus intertinctus. ..

- volaticus .......

Syncope . .

Syphilis . . . .

Tabes Mesenterica .

Tremor .

Vaccinia . . .

Variola . . .

Vermes . . .

Vertigo .

Urticaria febrilis . .

- evanida .

Total of Cases . .

1749

Total of Deaths .

* Morbi Infantiles is meant to comprise those Disorders principally arising from dentition or
indigestion, and which may be too trivial to enter under any distinct heads ; Morbi Biliosi such
( omplamts as arc popularly termed bilious , but cannot be accurately classed. ’

Observations on Prevailing Diseases.

Much alarm has lately pervaded the public mind regarding the ex¬
istence of an infectious and dangerous fever in the Metropolis. The register
of the Medical Repository contains the report of some of the most exten¬
sive institutions for the relief of the sick poor, as well as those of several
eminent private practitioners ; and by reference to it, we are happy in
remarking, that no foundation exists for alarm. The synochus form of
fever has rather increased ; so has Typhus mitior. In some districts, it is
remarked by one of our most judicious reporters, the latter is frequent ;
but, in general, it is very mild and chiefly confined to the poor ; ancl hence
he appositely designates it Febris pauperum. In two cases, delirium oc¬
curred, with much of the character of mania ; but which gradually went
off as the strength returned.

. A case of Chorea was in a subject which, in the last Report, was af¬
fected by Epilepsia . Mercurials, cathartics, and tonics were used with
but little effect ; but a cure is nearly perfected by doses of a drachm of oil
of turpentine. The patient was a child between nine and ten years of age.

The fatal case of Scrofula was a child who had for a long time scrofu¬
lous ulcers and enlarged mesenteric glands.

A case of Ascites , which proved fatal, succeeded a violent haemorrhage
from the lungs. °

A case of Anasarca caused death by gangrene supervening.

Two fatal cases of Asthma were accompanied with anasarca*

MONTHLY CATALOGUE OF BOOKS.

Report on the Present State and Management of the Hospital?
for Insane Persons at Paris. 8vo. 1817.

Suggestions for the Relief of the Sick Poor and the Improve-*
ment of the Medical Profession in Great Britain. By John Dunn,
M.R.C.S Surgeon, Pickering, Yorkshire. 8vo. 1817.

A Letter to the Right Hon. and Hon. the Directors of
Greenwich Hospital, containing an exposure of the measures
resorted to by the Medical Officers of the London Eye Infirmary,
&c. By Sir William Adams. 8vo. 1817*

A System of Chemistry. By Thomas Thomson, M I). F.R.S
&q. A New Edition, entirely recomposed. 8vo, Vol. IV.

Results of an Investigation respecting Epidemic and Pestilen¬
tial Diseases. By Charles Maclean, M.D, 8 Vo. Vol. L

An Essay on the Chemical History and Medical Treatment of
Calculous Disorders. By Alexander Marcet, M.D. F.R.S. Royal 8vo„

Sketch of the History and Cure of Febrile Diseases, more
particularly as they appear in the West Indies among the Soldiers
of the British Army. By Robert Jackson, M.D.

Observations on the Casual and Periodical' Infuence of the
particular States of the Atmosphere on Human Health and Dis¬
eases, particularly Insanity. By Thomas Forster, F.L.S. &c. Svo.

A Sequel to an Essay on the Yellow Fever. By E. N. Bancroft,
M.D. 8vo.

A Narrative of the Case of Miss Margaret M‘Evoy, with an
Account of some Optical Experiments connected with it. By
Thomas Renwick, M.D. 8vo.

Pharmacopoeia Collegii Regii Medicorum Edinburgensis, 1817-
Svo.

Aphorisms, illustrating Natural and Difficult Cases of Ac¬
couchement, Uterine Haemorrhage, and Puerperal Fever. By
Nathaniel Blake, M.D. 8vo.

A Practical Inquiry into the Causes of the frequent Failure of
the Operations of Depression, and of the Extraction of the Cataract
as usually performed ; with the Description of a Series of new and
improved Operations. By Sir William Adams.

A Descriptive Catalogue of Minerals intended for the use of
Students. By James Maw.

NOTICES~TO CORRESPONDENTS. ~~

C&mmunications have been received from Dr. Merriman, Dr. Nicoh',
Mr. Ring, Mr. North, Mr. R. Bellingham, Mr. Dunn, $ Mr. Waldron*

Dr. Johnson pledges himself to answer, in a most satisfactory man¬
ner, the Observations of Mr. Hastings, and also of M. Majendie, on
his late papers respecting the Circulation of the Blood, as soon as his
new work is out of the press.

Communications intended for insertion in the subsequent Number
should be sent before the 1 2th of the month ; and should be addressed
(free of expense ) to Mr. JOSEPH MALLETT, Printer, 5R, War-
dour Street, Soho ; by whom Books for the Review Department, Articles
of Intelligence, fc. fc. will also be received „

THE

PART l

ORIGINAL COMMUNICATIONS.

On the Effects of the Nitre- Mu rid t ic Acid Bath in several
Surgical Diseases. By G. J. Guthrie, Deputy Inspector
of Military Hospitals, Lecturer on Surgery, &cl he.

During the last two years, at the recommendation of Dr,
Scott, we have tried the nifro-muriatic acid bath, in the York
Hospital, Chelsea^ in a variety of cases, both medical and sur¬
gical ; especially in those where the use of mercury was sup¬
posed to be indicated, and where it had failed of producing a
good effect, or had been obviously detrimental.

The manner of Using the bath, as well as the proportions
of acid, were varied ; it was tried as a pediluvium, as a bath to
the lower extremities, or to the whole body ; of a strength to
turn the skin and hails yellow, to produce the pricking sensa¬
tion that has been attributed to it, as well as an eruption of
pimples that were equally disagreeable ; and it has been used
so diluted, that many patients have immersed the body to the
head every other day, and occasionally every clay, from fifty to
eighty times, without perceiving any sensations upon the sur¬
face whatever, except those which are equally produced by
water of the same temperature ; that is, from 90° to 95° Fahr.

In our first trials the acid was used in the proportion of
three parts of nitric to one of muriatic ; and the acid so mixed
was not measured, but poured into the warm water until it
became very sour : this changed the colour of the nails, and was
only used as a pediluvium. By the advice of Dr. Scott, it was
used in the proportion of eight ounces to forty gallons, and sub¬
sequently to twenty gallons, when it was employed as a bath ;
and with these proportions the greater part of our experiments

VOL. viii.^no. 48. 3 M

450

Original Communications .

were made. In particular cases, and especially at a later period,
it has been used considerably stronger, with equal portions of
the two acids, and with three parts muriatic to two of nitric,
the quantity of acid being increased to twenty ounces in twenty
gallons of water, and even to two ounces to the gallon.

Having thus noticed the composition and manner of using
the bath, it is desirable that the general effects should be next
specified, according to the different proportions of the acids to
each other, to the water, and to the surface of the body exposed
to its influence : but this becomes exceedingly difficult, if not
impossible, from the circumstance of its not producing any per¬
ceptible effect on many persons on whom it has been tried, in
whatever proportions it has been used, except what might be
equally attributed to the warm water alone. I beg, however,
not to be misunderstood. I do not mean to imply that the
remedy has no powers ; on the contrary, it does occasionally
produce particular effects which are not usually attributed to
water alone ; yet I wish to give it as my opinion, that no de¬
pendence can be placed on any particular proportion, and that
it is very uncertain in its operation : although I am disposed
to believe, what I think many will as willingly concede, that
the larger the surface to which it is applied, provided it be not
of a strength to affect the skin, the more certain will be its
effect. It naturally follows, as a conclusion, that I can have
little or no reliance upon simple immersion of the feet and
hands. At present I recommend the bath, where there are no
abraded surfaces, to the whole body, except the head, in the
proportions of half an ounce to an ounce of the equally-mixed
acids to a gallon of water, at the temperature of 90° to 95°, ac¬
cording to the strength of the patient. If he have not strength
to bear a warm bath of that heat for fifteen or twenty minutes,
cr the use of it is inconvenient, I desire the person to sit down
in it ; and if it be used with the view of relieving pains in the
legs and thighs, I sometimes confine myself to the immersion of
the parts affected.

I have said the remedy sometimes produces no effect, or a
permanent effect which can be discovered the day after its use ;
yet the complaint for which it has been recommended shall
slowly subside or disappear, whilst in other instances it shall
remain stationary, or gradually get worse. In all these cases
I am aware it may be said that no effect has in reality been pro¬
duced, but that nature has caused the amendment or deteriora¬
tion by her own efforts, either properly or improperly directed :
but I dissent from this proposition, because I have seen in many
of these cases the good or bad
the use of the remedy, not
share in producing it.

result too evidently depend on
> believe that it had a principal

Guthrie on the Nitro-Muriatic Acicl Bath.

451

In general, the acid bath increases the quickness of the
pulse, causes, like the warm bath alone, a general relaxation of
the body, and, if continued, may produce syncope. On coming
out of the bath, a variety of sensations, in the same manner,
may or may not supervene ; when it agrees with the patient,
there is no perceptible effect, save a greater redness of the skin
than what the warm bath occasions. In others, there is swing¬
ing of the head, nausea and even absolute sickness, general
uneasiness, and, in several cases where there has been a pre¬
disposition to it, the testicle has suddenly swelled, become
painful, and even inflamed ; and this has again occurred on a
repetition of the bath after a certain interval of time. The
repeated use of the bath sometimes occasions a degree of general
excitement, the pulse quickens, the tongue becomes white, the
patient feels uneasy, or, as he expresses it, a little feverish : in
such a case it must be discontinued. In others, after a conti¬
nue^ use of it, the patient looks pale, loses flesh, and is certainly
debilitated. In some cases the immersion at once produces a
sensation of the mouth in an increase of saliva, and in others
the flow of it is more permanently increased : on examination,
the gums look red and swelled, although not affected in the
same way as by mercury, neither does the mouth emit the same
foetor. This state of the mouth and the increased flow of saliva
must be considered as symptoms which do not occur after
the use of the warm bath ; but there is another and principal
effect, which much more commonly, indeed I may say generally,
follows its use ; that is, a greater degree of regularity and in¬
crease in the alvine evacuations, and sometimes a greater desire
for passing urine, than has been experienced for some dime,
although there may not be an increase in the secretion of urine.
As Dr. Scott has truly remarked, in people who are disposed to
a naturally large secretion of bile, the quantity for the time
seems increased, and may require the aid of purgatives for its
removal. In those where the secretion of bile appears to be
deficient, in consequence of derangement in the action of the
liver, its effects are in many instances more remarkable than
those I have observed to follow the use of other remedies : it
gradually increases the secretion of bile, restores in consequence
the proper action of the intestinal canal, the evacuations become
more regular, more natural in colour and consistence, and the
functions of the digestive organs are altogether improved. In
some cases it even proves completely purgative. I am not,
however, prepared to say that this happy change, when it does
occur, will continue ; on the contrary, I am disposed to believe
it is only a temporary amendment ; and that, when there is truly
organic disease or derangement of structure, these good effects

3 m 2

452

Original Communications,

will soon cease, although they may, after an interval of time,
he again induced by a repetition of the remedy.

In one case this was shewn in a remarkable degree. The
patient had had the W alcheren fever during the expedition to
that island, and had suffered ever since from visceral disease,
with great and solid enlargement of the abdomen ; his bowels
were very irregular, an evacuation taking place only once in two
or three days. Shortly after he had commenced the use of the
bath, the bowels became regular every day, and continued so
for some time ; but they gradually returned to their former
state, although the bath was continued, and the man, finding
that no permanent benefit was obtained, preferred going home
to his friends in the country.

In another case the patient had been ten years at the Gape
of Good Hope, had suffered considerably from inflammation of
the liver, and for the last five years had been constantly unwell.
He laboured under severe pain in the epigastric and both hy¬
pochondriac regions, which was much increased at intervals |
he was unable to lie on the left side, and had occasional spasms
of the abdominal muscles, with so great a soreness of the sur¬
face as hardly to allow the slightest pressure. There was a
sense of great weight in the right hypochondrium, a sallowness
of countenance, loss of appetite, and general appearance of ill
health, '

This man took a variety of medicines, principally mercury
and laxatives, as his bowels were always irregular and confined,
and the warm bath was used to try the comparative effect of it
and the acid bath ; but, although persisted in for six weeks with
much benefit, still it had no effect on the bowels. At the end
of this period the acid bath was used instead of the warm bath,
and the effects on the bowels were observable the next day, and
have continued, with evident advantage to the patient.

This effect, which is certainly the most constant of any
which has been yet observed, is still, however, not general.
In many persons it does not take place, and in these it does not
appear to be useful ; so that we may, I suspect, attribute any
efficacy it possesses, especially in the cure of bilious complaints,
to its power of increasing the secretion from the liver and
intestinal canal.

The soreness of the mouth occurred in a few instances,
not more than six, on whom it was tried, under my immediate
observation, and then not to an}^ extent, which renders it doubtful
whether that state of the gums arose from any specific effect of the
acid, or whether it simply took place in consequence of the in¬
creased general excitement which ensued from its use after mer¬
cury had been previously and frequently employed ; which was
the case in four of the six instances alluded to. In the fifth and

Guthrie on the Nitro-Muriatic Acid Bath. 453

sixth, the gentlemen who used it for derangement of the functions
of the liver, as was supposed by their medical attendants, had not
taken mercury previous to using it, except as an occasional pur¬
gative; and they complained of its rendering their gums sore:
but it was not carried to any satisfactory extent. I have since seen
the mouth affected in several cases ; but, in all, the patients had
taken considerable quantities of mercury for the cure of their
complaints, although in some a year had elapsed since they had
omitted it. But whether it be dependant on this cause, or whether
it be the specific effect of the acid, is not sufficiently ascertained
to induce us to consider it as a regular effect of the remedy which
may be naturally expected when its use is persisted in to a cer¬
tain extent.

Sir James McGrigor, when surgeon of the 88th regiment in
India, in the years 1799 and 1800, tried the nitric acid bath,
alone and in conjunction with other remedies, in a great va¬
riety of cases, and with the best effect. On referring to the
papers he has been so good as to allow me to read, I find that
at: that period he had formed nearly the same opinion of its
effects as I have done more lately. He used it generally of a
strength to irritate, and to turn the soles of the feet and the
nails yellow, and repeated it sometimes even three and four
times in the day. He says, 44 that nitric acid used externally and
internally does affect the salivary secretion, I no longer doubt,
from the examination of not less than 800 persons, and from
measuring the saliva ejected. Salivation is not, however, a con¬
stant effect of the use of these remedies ; it is by no means so
much so as from the use of mercury ; and I do not recollect a
ease where the foetid breath or ulceration of the gums which
follow the use of mercury was remarked. The use of the bath
alone occasions a redness and swellingof the gums, and it never
fails to hasten a flow of saliva where mercury is used, as we
have often seen in desperate cases of hepatitis and dysentery ”

The opinion that the acid bath is an excitant, acting more
powerfully than the warm bath, receives some confirmation
from the circumstance of its use in persons suffering from
chronic inflammation of the eyes, rendering this state of disease
more active, although not at the same time more curable, which
is exactly opposite to the general effects of mercury in similar
cases.

In several cases of intractable ulcers, supposed to depend
on constitutional, not local causes alone, the bath had a fair
trial, with various success. The first case in which I saw it used
was that of a burrowing ulcer at the root of the penis, supposed
to have been originally syphilitic, and for which mercury had
proved ineffectual. It was used to the feet and legs so strong
as to change the colour of the skin ; and in this case it produced

454 Original Communications.

an increased flow of saliva with soreness of the mouth, but
without any curative effect, the man recovering many months
afterwards by common surgical means.

In a case of intractable ulcer of the nates, spreading in a
circular direction at its external edge, and healing at its internal
with a corresponding celerity, it totally failed, or was rather
detrimental.

In a third case, the patient, eighteen months previous to his
admission into the hospital, whilst in India, suffered from a
small eating ulcer on the left side of the nose and lip, which gra¬
dually spread across to the opposite side, producing a very
disagreeable and painful sore, which was also accompanied by
ulceration of the tonsils, and for which he underwent several
courses of mercury without any benefit: during his return to
England the ulcer healed by simple treatment, and continued
well until the month of December 1816, when it broke out
again on the right side of the lip, assuming its old action, and
spreading up by the side of the nose which was generally large
and increased from inflammation, whilst it also made progress
to the opposite side in the track of the old cicatrix, having
altogether an appearance that promised any thing but a speedy
cure. On the 20th of January he was put on the use of the
acid bath every second day, and directed to take two pints
of the decoctum sarsaparillae composition every twenty-four
hours ; and under this treatment, without any sensible effect
being produced, a gradual amendment took place until the
30th of March, when he was discharged cured of the ulcer, and
his general health greatly improved.

In this case, I consider the bath to have been of most
essential service, although the acid used was in small quantity,
twenty-four ounces to forty gallons ; and if future trials shall
prove it to be useful in other cases of the same description, so as
to destroy the idea of its being accidental, the remedy will be
valuable from this circumstance alone : for, when I first saw the
man, I had not the least hope of his recovery in as many months
as he was cured in weeks.

In chronic rheumatism, and chronic pains, I have found it
sometimes accelerate the cure, and especially when combined
with other means, without producing any perceptible effect
beyond the amendment of the patient.

An officer had been afflicted for several years with pains in
his limbs, which were so much increased on becoming warm in
bed that he could not sleep, and they often distressed him so
much as to induce him to get out of bed and roll himself on
the floor in agony. His general health was indifferent, he was
thin and sallow, the digestive organs were considerably deranged,
his bowels were irregular and flatulent, and his tongue generally

Guthrie on the Nitro- Muriatic Acid Bath.

455

white. He was relieved in the course of three or four days
by alteratives combined with narcotics, and by attending to the
state of the bowels : these remedies were persevered in for a
few days longer, when he was in every respect better, his sleep
improved, the pains diminished, but they were still distressing,
and occasionally severe. The acid bath was now ordered to
the feet and legs every night, and of a strength to produce
pimples on the skin, which were rather encouraged, within
bounds, than otherwise. It was continued, in addition to the '
remedies alluded to, for the space of three weeks ; at the end of
which period the gentleman had entirely lost his pain, slept
well, and was in a much better state of health than he had been
for a considerable time.

This case, which was under the care of Dr. Charles Forbes,

I consider a good instance of the utility of the bath in the
cure of chronic pains, judiciously used in addition to other
remedies : when tried alone, it has been generally unequal to
afford permanent relief.

In scrofula the effects have been equally variable ; it was
principally tried in cases where different glands were enlarged,
suppurating, or in a state of ulceration, and with the same
result as in every other disease in which I have seen it used :
in some few it appeared to promote a cure ; in others, the disease
remained for a time stationary; whilst in a third set every symp¬
tom was aggravated. It would be very desirable here, also,
to have it in our power to distinguish these cases one from
another before the remedy was resorted to ; but I have not been
able to observe, neither have any of the gentlemen who were
equally or more interested than myself been able to remark any
one sign or difference of appearance in those persons, which
could in the slightest degree guide us in the application of the
bath. The good or bad effect to be expected from it could not
then, by any previous observations of ours, be anticipated ; it
was ordered on speculation, and from the effects produced
during its use, we could only judge of the propriety of con¬
tinuing it.

I am however more disposed to believe, on an attentive con¬
sideration of the whole, that it will be found more useful in
those cases in which there is actual suppuration and ulceration,
than where there is only simple glandular enlargement.

In the most prominent case in which it was tried, the
patient had long laboured under the disease, had been sent to
the hospital as incurable, and was incapable of wearing any
thing round the neck from the ulcerated state of the glands
and parts extending round the neck in front from ear to ear.
Dr.J.Forbes and Mr. Dease, under whose care he was, determined
on trying the bath, as well as on using the nitro-muriatic acid

450 Original Communications.

internally. He commenced the use of the bath in the weak
, proportion, on the!5th of January, and continued it every other
day with little intermission until the 20th of April 1816 ; during
which time a soreness of the gums and an increased flow of
saliva had taken place, which may probably he attributed to
tile acid taken internally. The ulcers gradually amended during
this period, but about the latter part of it inflammation came
on in the part, and the man was attacked with fever; the acids
were now omitted, and he used the warm bath alone; but the
inflammation soon shewed itself to be truly erysipelatous^
rapidly extended to the forehead, and successively to the breast,
and indeed to the whole body. From the second day the delirium
was constant, and the danger extreme. The temporal artery
was opened three times in one day, and he lost upon the
whole a considerable quantity of blood : his treatment being
purely antiphlogistic. This case was altogether one of the most
remarkable of its kind I have seen, and the successful termina¬
tion of it was entirely owing to the constant attention, as well as
the decision and ability, of the gentlemen under whose care he
was. The man completely recovered from both diseases, the
last of which may, I am aware, be attributed by some to acci¬
dental causes, unconnected with the use of the bath ; but as I
have seen an erysipelatous inflammation occur after its use in
another case of the same kind, although in a less serious degree,
and without any beneficial effect, I am disposed to believe they
are not entirely independent of each other, although they do
not follow as cause and effect. The original disease is, however,
so serious and distressing, as well as for the most part incurable
by common means in the state to which I have alluded, that I
should have no hesitation in continuing the use of the bath in
those cases in which it appeared to produce a good effect, even
if T had reason to suspect from the constitution of the patient
that an attack of erysipelas would ensue. The misfortune we
have most to lament, is not however the sudden appearance of
this complaint, but the deterioration of the original disease, after
it has for a time remained stationary, or been considerably
ameliorated whilst the patient was using the bath ; and when
this is perceived, it must of course be immediately abandoned.

I have not used the mtro-muriatic acid bath for the cure of
the primary symptoms of syphilis, because it would have inter¬
fered with another object I had in view' ; but I am inclined to
believe it would be very useful in such cases. In the papers oi
Sir James MsGrigor to which I have alluded, I find the effect of
the nitric acid bath was to shorten the duration of the primary
ulcers; and when the acid was also given internally in conjunc¬
tion, that the ulcers were cured in as short a time as when mercury
was exhibited. But if it were not used for the cure of primary

Guthrie on the Nitro-M uriatic Acid Bath.

457

ulcers, it had a fair trial in many cases of secondary symptoms,
1* rom among them I have selected the following, as shewing
some of their different kinds and stages, and its effects upon
them. In some, where it may be doubted whether the cases
were, according to received opinions, truly syphilitic ; and in
others, in which the ill effects of repeated and protracted courses
of mercury will be discoverable,

Case I.

The Paymaster Sergeant of the 4th Veteran Battalion^
about the latter end of September 1816, whilst at Quebec,*
perceived a discharge of matter from the urethra, and shortly
afterwards an nicer made its appearance on the right side of
the corona glandis and fold of the prepuce, near the frsenum ;
for these he took about twenty-four mercurial pills, which did
not affect his mouth : the gonorrhoea got well, but the ulcer
remained the same, a few spots making their appearance about
this time on his neck. He embarked for England on the 27th
of October, and soon after saw the same kind of spots on the’
forehead and other parts of the body. On the 1 Oth of
November he was shipwrecked on the coast of Newfoundland,
where he was much exposed to cold and privations of every
kind, and the eruption rapidly increased. He came under my
care on the 26th of December, when he thought the eruption
better, that is, rather fainter in colour ; for he had not observed
any of the well-marked spots to disappear, some being small,
others on the forehead as large as a shilling, scaly, and having
the appearance of the syphilitic lepra ; his throat was rather
aore in swallowing,- but no ulceration could be perceived. The
ulcer on the penis, which was smaller than formerly, did not
look unhealthy at bottom, but was surrounded by a thick
hardened edge, extending to the touch under it, forming a welt,
and there were two or three little excoriations near it: his
general health was otherwise good. I pointed this man out to
the gentlemen attending as a good case of syphilitic eruption,
and a fair case in every respect to be allowed to run its own
course.

On the 14th of January the ulcer was healed, but the
hardness surrounding it remained, the eruption scaling and
fading in colour. On the 7th of February, as he made little
progress, the nitro- muriatic acid bath was ordered every other
day; between that and the 16th the welt on the penis ulcerated,
the scaliness of the ulcers disappearing slowly, and the mark
remaining. On the 20th he complained that the bathing made
him perspire, and that his eye was inflamed ; on examination
there appeared a slight redness of the conjunctiva, but the
pupil was irregular, and there was an uneasiness hardly amount*
vol. vni.— no, 48. 3 N

458

Original Communications .

ing to pain ; the extract of Belladonna was ordered to be ap»
plied. 22nd. The iris was in part amenable to the Belladonna,
shewing an irregularity of pupil on the outer and inner side,
as if it adhered to the capsule of the lens behind ; the external
redness increased in the manner peculiar to inflammation of
the iris ; the colour of which was not perceptibly altered, except
at the point of apparent attachment ; no pain ; the sight not
impaired. The spots on the body disappearing ; the hardness
on the penis subsiding under the ulcerative process, which is
slow. I did not consider it fair to push this experiment further ;
and as I knew the low inflammation of the eye would be best
relieved by mercury, I therefore directed him to omit the bath, to
rub in two drachms of the ungt. hydrarg. fort, every night, and
to take ten grains of the Pil.Hydr. three times a day. On the
24th, the iris was half dilated and regular, with little or no ex¬
ternal inflammation, and the pills were omitted. On the 26th, the
mouth being completely affected, the ointment was omitted ; ten
drachms having been used and twelve pills taken. March 4th,
the hardness around the site of the ulcer gone. On the 12th
of April lie was discharged perfectly well.

Case II.

A soldier of the 51st regiment received a blow on the eye
on the 9th of November, for which he came under my care, and
recovered from the immediate injury (vision having been pre¬
viously destroyed by inflammation) by the 2St.h of the same
month ; at this time he was attacked by fever and sore throat,
and called my attention to a papular eruption which was coming
out over his body, but particularly on his breast, arms, and
face. The fauces, on examination, were found inflamed, the
tonsils ulcerated,, especially the right. He confessed to having
had a sore on the glans, the mark of which was to be seen,
in the month of September, that he had taken a few pills, which
had not affected Ins mouth, and that the sore soon after healed.
The gentlemen attending supposed it might be venereal, and a
fair case to see the effect of mercury ; I rather wished them to
observe the case without it, and at all events none could be given
during the eruptive and febrile stages. Saline and antimonial
medicines were ordered, with common gargles. On the 5th of
December the fever subsided ; and the head-ache were relieved.
On the 9th the throat was easier, the papulae were acuminated and
resembling pustules. On the 12th, the sloughs in the throat sepa¬
rated; the fever was nearly gone; and the papulae were scaling, but
not scabbing. 18th. The eruption perfectly resembled Mix Car¬
michael’s plate of venereal lichen (Fig. 5. Plate 2nd) ; the throat
was better; but the ulcers not healing. Ordered the pulv. ipec.
comp. gr. x. three times a day, a gargle of lime water, and the

Guthrie on the A7 it ro-M aria t ic Acid Bath.

459

linimentum aeuginis. On the 10th of January, there being
little alteration, the nitro-muriatic acid bath wag added to the
treatment. On the 20th the throat was well, and the eruption
fading in colour. A pint of porter was ordered, in addition to
the meat diet, the man appearing very thin and weakly. In
the beginning of February the porter was omitted, and the
pulv. ipecac, comp. gr. xv. given twice a day. On the 20th, as
he continued weakly and the spots were fading, the powders
were omitted, and from this period he gradually or slowly
improved until the 12th of April, when he was discharged, fat,
well, and free from spots, excepting where a small mark remained.
He took no medicine after the 20th of February, and, although
he bathed to the neck nearly eighty times in the acid bath, no
effect could be perceived that might not equally be attributed
to the warm water.

Case III.

A soldier of the waggon-train, in March 1816, perceived a
bubo in the right groin, without any primary ulcer, for which
he was taken into the hospital ; the bubo suppurated, broke, and
kept him six months in the hospital, during which period he took
mercurial pills, rubbed in twenty-six nights, and in all had his
mouth made sore five different times. Soon after his discharge
he caught cold and had a sore throat, which was not well in the
beginning of December, when he caught another cold, and imme¬
diately after an eruption appeared all over his body, first about the
haunches, then on the breast, the shoulders, and the extremities.

On the 28th of December the tonsils were ulcerated, although not
very deeply, the body was covered with a copper-coloured scaly
eruption, small in size, and resembling Mr. Carmichael's plate
of venereal lichen (Fig. 6.) ; the general health was otherwise good.
He was ordered the most simple remedies ; a common gargle,
gentle opening medicine, and fifteen grains of the pulv. ipecac,
comp, twice a day : diet low. Under this plan he slowly improved;
the throat amended, the eruption faded, although it did not
disappear ; but he lost his strength and was placed on meat
diet. On the 4th of February he commenced the use of the
nitro-muriatic acid bath, and on the 8th changed the pulv.
ipecac, comp, for ibiss of the decoct, sarsap. comp. This plan
he continued until the 21st of March, when he was discharged
cured, having bathed twenty-two times without producing any
perceptible effect.

To the first case no objection will I think be made, as to the
syphilitic history and nature of the disease, by any one. The
symptoms were all slowly disappearing when the affection of the
eye induced me to excite a mercurial action, under which they
totally disappeared, and faster I conceive than they would have

3 N

460

Original Communications.

done without it. The quantity of mercury, according to
received opinions, was not, however, enough to secure the
patient from relapse : indeed it was not given to cure the
venereal complaint, but the inflammation of the eye. The
man is still under observation.

To the second and third cases, some will say they were ve¬
nereal, not syphilitic ; and others mav suppose that the mercury
taken in the first instance caused the developement of the
ulterior symptoms, which would not have appeared or remained
so obstinate if it had not been given. The cure in all three
might have been expedited at an earlier period by a gentle
course of mercury, although, in the two last, it was proved not
to be essential, although it might have been useful. In a fourth
case, exactly like the last, which occurred a year before, the
sudorific plan with the strong nitro-muriatic pediluvium was
tried for three months with little effect, the eruption fading but
not disappearing, when a gentle course of mercury perfectly
removed it.

The length to which this paper has already stretched, will
scarcely permit us to give the three following cases in detail. In
the fourth, a patient at Chipping Ongar, in Essex, about four
years back, contracted an ulcer on the penis, followed by two bu¬
boes, for which he went through a course of mercury without any
benefit, save the retrocession of the buboes, the ulcer gradually
deteriorating. In December 1813, he was again put on the use of
mercury, when the penis sloughed off, and several haemorrhages
occurred, which nearly destroyed him. The ulceration at last
healed, but was soon followed by sore throat, nodes, &c. ; for which
be underwent twelve more courses of mercury without any per¬
manent benefit. Towards April 1816, he was something better,
tind commenced the use of the nitro-muriatic acid bath, from
which he received no benefit at first, and was then ordered the
decoction of sarsaparilla, &c., with considerable effect. Having
caught cold, he relapsed, in July 1816; and remained in
various states of health until July 1817. During this period he
repeatedly used the acid bath : on one occasion, it affected his
mouth, and increased his pains ; on another, it was omitted in
consequence of its causing sickness and vomiting; on a third,
a swelling of the testis, and an increase of ulceration in the
throat. In July the man slowly recovered, and went out of
hospital ; but has since returned with all his complaints aggra¬
vated : he is again trying the bath, but I do not suppose it will
be more efficient than at a former period.

In the fifth, from the repeated courses of mercury, the
disease was considered mercurial ; he was admitted in Septem¬
ber 1815, and getting better under the use of the sarsaparilla,
when the acid bath was tried, but with evident bad effect ; the

Guthrie on the Nitro- Muriatic Acid Bath.

461

throat ulcerating, nay, sloughing largely ; the ulcers spreading,
and the pain increasing. The bath was omitted, and the
patient, after fifteen months’ suffering, was discharged cured ;
the good effect seeming to arise from the continued use of
gentle doses of mercury, combined with the more usual means
in such cases.

In the sixth case, the patient contracted a gonorrhoea at
Madrid, in October 1813. Without any other previous affection,
an ulcer appeared in the throat, in October 1814, which was
called venereal, and treated by mercury, during the adminis¬
tration of which he was exposed to wet and cold. The dis¬
ease followed nearly the same course noticed in the fourth case,
and with the same effects in regard to the acid bath. In July
1817, he was discharged cured, although in a debilitated state,
and has not had a relapse.

From these cases, and many others of the same description
in which it was tried, it will appear that the acid bath is like,
all others, an uncertain remedy in what are called the secondary
symptoms, or the sequelae of syphilis, or of mercury ; and
although it may succeed in some instances, where all other
remedies have failed, still it cannot maintain a character as a
principal remedy, entirely superseding the use of mercury and
those medicines more commonly administered. If I were to point
out those symptoms which did not appear to be benefited by its
use, I should name the ulceration of the throat and the pains
in the bones.

It is not a little remarkable that the nitro-muriatic acid
bath should have obtained a high character, although used in a
variety of ways, and in very different proportions as to strength.
It is on this account that I am disposed to attribute a part of
the good effects resulting from its use to the warmth of the
water. I am perfectly aware that Dr. Scott supposes the acid
to be equally efficient when used with cold water ; but there
are many eases in which it may be used cold with greater ad¬
vantage than warm, and I have one at present under my care ;
but I have not had sufficient experience to enable me to give
an opinion. I doubt it as a general position.

I have shewn that the acid bath has two principal effects: one,
that of promoting the secretions from the intestinal canal, even
with pain, and often proving completely purgative. The other,
although infinitely more uncertain, of increasing the flow of
saliva, and especially if mercury has been previously used.
It cannot then be denied to possess considerable power. As a
remedy, although extremely uncertain in its effects, it is pecu¬
liarly applicable in those diseases in which the use of mercury
and of alteratives is indicated ; in many cases it may and will be
successful where these have failed, but should not be relied on

462

Original Communications.

altogether as superseding their use. It will, on the contrary,
be found more efficient on many occasions when used as an
auxiliary, in combination with them.

In all cases of constitutional derangement dependant on
the state of the primae vim ; in nervous cases dependant on
the same cause ; in derangement of the function of the liver,
and of the chylopoictie viscera — it will often be found of essen¬
tial service. In many cases of this description we are uncer¬
tain whether there be alteration of structure or not, although
the derangement may be complicated with ascites or other
disease: if these complications be also cured, we think we have
cured an organic disease, and that our mode of practice or our
remedy is the more valuable. I do not believe the acid bath
alone is equal to mercury in the influence it exerts in this class
of diseases, although it is, even in them, a valuable aid. In
the cases I have seen or heard of, with the exception of one or
two, in which it was supposed to have had this good effect, the
rapidity with which it was induced, as well as my knowledge
of its. failure in others, have led me to believe that an alteration
of this kind could not have been so speedily accomplished.

To tnose who only value observations on a remedy when
they prove it to be decidedly good or had, I am aware my re¬
marks can be oi no use: to those who are disposed to make
trial of a remedy which has many good qualities, although it is
not always ceriain in its effects, yet is frequently useful, and
seldom or never detrimental, they may perhaps afford some
little assistance. My object in this paper has been to state
what have been the general results of the trials made of the
acid bath in the York hospital.

No. 2, Berkeley Street , Berkeley Sq uare.

ii.

Observations on some Points of Difference which obtain between
the Endemial Fevers of Marshy Soils and the Yellow Fever or
Inflammatory Endemics incidental in the West Indies to New-
Comers from Temperate Climates. By Nodes Dickinson,
Membei of the Hoy al College of burgeons m London,
Suigeon to the Forces, and IVI ember of the Mddico-
Chirurgical Society.

In its literal acceptation, the term fever might be expe¬
diently used to signify any deviation from health which should
be characterized by an increase of animal heat. And (as
regards West India febrile affections) it has been thus em-

Dickinson on West Indian Fevers.

463

ployed with great latitude, although this phenomenon is
common to morbid states of an opposite nature and tendency.

Y\ hen it is, however, considered in its application to a
specific disease under the designation idiopathic fever, its
literal import enters into a small part only of the definition of
such disease, which requires to be distinguished by an attention
to all its phenomena, to their causes, and to the effect of the
means adopted with a view to their removal.

ine remarks made here concerning idiopathic fever, are
merely introduced to shew some circumstances in which that
disease, occurring within the tropics, very materially differs
from the endemic of new-comers or yellow fever, as this has
been presented to the writer’s observation ; and not with the
view of elucidating the nature off idiopathic fever itself, which
has already been done by much abler hands.

Idiopathic fever, produced by marsh effluvium, sometimes
will not appear until many weeks after the application of its
cause. If the paroxysm does not prove fatal in the first attack,
the disease will remit and afterwards recur; going through an
indefinite number of similar stages, as at first, without the re¬
application of its original exciting cause, the marsh effluvium.

These circumstances having taken place in whatever class
oi subjects, and wherever the disease made its appearance, leads
to the inference of its affinity, and perhaps of its identity,
under every diversity of aspect in which it has been viewed.

In the writer’s attendance upon patients with marsh remit¬
tent and intermittent fever, he has often observed, that the
continued application of the effluvium did not increase the
symptoms of the paroxysm then present, nor did a removal
shorten its duration. But, being gone through, a removal
from the deleterious effluvium has sometimes prevented its
return, and is often the only remedy upon which any reliance
can be placed, notwithstanding its occasional failure.

After an attack of marsh fever, consisting of a repetition
of similar paroxysms, has been entirely gone through, and has
ended in the recovery of the patient, the successive re-appli¬
cation of the effluvium will be apt to re-produce the disease,
until the health be completely undermined, and is at length too
much enfeebled to sustain the febrile re-action. In these
circumstances, general debility, emaciation with visceral de¬
rangements, exhibit, in the persons of those who inhabit
marshy districts, a permanent state of langour, and in
strangers, such a condition of disease as nothing can remove
but change of climate.

The marsh remittent and intermittent is often increased in
violence by various contingencies, especially by the super¬
addition of topical inflammation. In its simple character,

404

Original Communications.

marked by great depression of vital power, the writer has often
seen it in the West Indies a most fatal disease. The pheno¬
mena are manifestly occasioned by the application to the living
system of an effluvium ; the nature of which, as also its mode
of action, remains undiscovered by any test of experiment yet
employed.

The symptoms which come on at the attack are produced
by a peculiar morbid impression on the vital energies, the effect
of the action of the exciting agent, the marsh effluvium. This
effect of the remote or exciting cause and the immediate fore¬
runner of the symptoms, has been denominated the proximate

Gel US G*

The phenomena of the attack appear to result from a
peculiar affection of the living power, unlike the symptoms
which constitute the appearances in inflammation. I hey do
not arise in regular order and succession, nor in . degrees
proportioned to each other. Tor instance, in a majority of
cases, a cold fit of considerable duration shall precede a hot
stage, and this latter shalL subside upon the appeal ance of a
profuse perspiration. But in certain cases, perfectly analogous
in all other respects, there shall not take place any cold fits;
while in others the cold stage succeeds the hot. In some cases
there is no hot fit ; and, frequently, the whole paroxysm shall
terminate without any perceptible increase or alteration of any
kind in either the secretions or excretions.

It may be noticed, that the severest cold stage the writer
ever witnessed came on while the patient was placed under
circumstances particularly favourable to the maintenance and
increase of his animal neat. He was in bed, warmly covered,
under the genial influence of a moderately cordial regimen,
and surrounded by an atmosphere the temperature of which
was from 86 to 90 degrees of Farenheit in the shade; 120— -130
in the sun.

The manifest sameness of the exciting cause of remittent
and intermittent fever makes it more than probable that they
are only varieties in form of the same disease. And as fevei
of type equally follows the application of marsh effluvium,
whether it occurs in temperate or torrid climates, it is also most
probable that it is every where the same peculiar morbid affect
tion. Nor will it appear necessary to call in the heat of the
tropical sun to give to marsh fever a character of malignancy,
when the devastation committed by the same disease in colder
climates is brought to recollection. It is, in fact, the disease
of every part of the world where marsh effluvium is extiicated
from the soil, and is liable to seize upon all who come within
the limits of its action.

If it has been found to attack strangers with ? certain

Dickinson on \ Vest Indian Fevers.

403

preference, it has been the weakly and enervated who were its
surest victims. Dreadful were the numbers the writer saw
under the mortal grasp of marsh fever at Prince Rupert’s
Dominico. They were subjects assimilated to the climate,
although strangers to that particular station, They were,
chiefly, men worn out by a long West India residence, and now
no longer susceptible to the disease which so often attacks the
strong and plethoric youthful European in situations remote’
from the influence of paludal soils. Whatever is the nature
of the action of the effluvium operating as the remote cause of
marsh fever, inducing the series of phenomena observed in it,
it does not appear to consist in simple excitement or debility ;
for the means that are adequate to regulate such simple change
of increase or decrease of the vital energy or action in certain
other morbid states, produce no analogous effect in their appli¬
cation to the removal of idiopathic marsh fever. If, for ex¬
ample, inflammation takes place in marsh fever and is subdued
by the necessary depletory measures, the febrile paroxysm will,
nevertheless, often pursue its course, and continue to manifest
its peculiar character of a disease marked by remissions and
exacerbations. Sometimes, indeed, an obstinate remittent,
rendered so by the super-addition of inflammation, and hence
assuming a continued form, has been found to give so much
way to the evacuations promptly applied to carry off the inflam¬
mation, as afterwards to become purely intermittent. In this
case, the continuance of the peculiar idiopathic febrile state, in
contra-distinction to inflammation, was made particularly
obvious, bv the subsequent recurrence of the paroxysms of
simple intermittent fever after the super-added inflammation
had been removed.

Until a more accurate knowledge is attained concerning the
nature of the morbid state which produces the phenomena of
idiopathic marsh fever, no rule of practice can obtain as
founded on the ground of an acquaintance with its proximate
cause. Accident appears, however, to have suggested certain
means, the remedial operation of which, in the cure of idiopathic
marsh fever, could scarcely have been anticipated by any reason¬
ing on their properties, d priori , or by consequence of any ascer¬
tained analogy. Such are, among others, antimony, hark,
arsenic, the cold affusion, certain impressions on the mind and
organs of sense, & c. he. which have been at times successfully
employed to check the progress of fever; or, in the period of
remission, to prevent its recurrence.

The mode of operation of the above mentioned, or other
means productive of equal effect in the treatment of marsh
fever, if it is at all susceptible of elucidation by any human
analogy, seems most referable to the property such means
vol. viii.*— ko. 48. 3 o

406

Original Communications .

possess of exciting a new action or change in the existing
unknown morbid state of the living system ; perhaps, in like
manner as mercury appears to act in the cure of true syphilis,
which seldoms fails, when properly' applied, although we are
ignorant of its modus operandi.

But it may be mentioned by the way, that this analogy,
whether it be well or ill founded, does not extend to mercury
the same power to cure idiopathic fever as it does the true
syphilitic disease. At least, in my experience, the same medi¬
cine has never evinced any specific effect as curative of any
form of marsh fever ; although of great value as a cathartic,
and highly beneficial in those visceral derangements which
succeed the primary disease. Nor has it ever proved curative
by its specific action in the states of great excitement which
occasionally take place in marsh fever, and which constitute the
inflammatory endemic or yellow fever.

In these it is oftentimes most difficult to induce its specific
operation, until, by bleeding and other evacuant means, the
inflammatory symptoms are subdued. Then the mercurial
action, as manifested by its exciting the salivary glands to
increased secretion, developes itself, although no additional
quantity of the mineral is employed. But the mercurial action
thus induced cannot be considered the cause of the removal
of the symptoms of the disease ; an effect which in this case
it accompanies, but does not at all produce. For the mercurial
action does not appear to be induced until the inordinate
excitement constituting the morbid state has first been subdued
by other means. In a word, mercury does not cure idiopathie
fever itself, neither does it cure simple inflammation ; but is,
on the contrary, often prejudicial if employed with that view,
either in the treatment of inflammatory fever, or in the adven¬
titious state of infiammation which sometimes accompanies
marsh fever, and also the local affection of the organs under
syphilis ; the peculiar morbid character of which, however, it
certainly possesses the power to destroy.

Some of the circumstances which tend to characterize the
marsh endemic, as the writer has experienced that disease in
the West Indies, having been thus
few facts to shew the discrepancy
fever of new-comers.

It is tfie last mentioned disease that the writer denominates
the inflammatory endemic. It is excited in susceptible subjects
by an effect which results from sudden change of climate, in
conjunction with violent exercise and intemperance, without the
influence of marsh miasmata or contagion.

Contrary to what has been remarked with respect to marsh
fever, an attack of the inflammatory endemic comes on sudU

noticed, he will next state a
between it and the yellow

Dickinson on West Indian Fevers. 4(1?

denly, with symptoms of increased excitement, in situations
where the remittent was never seen. It is severe in proportion
to the intenseness and continuance of the action of the exciting
•causes operating upon susceptible subjects. This susceptibility
consists in an inflammatory diathesis, which is acted upon by
the stimulus of a high and permanent degree of atmospheric
temperature. It is the idiosyncrasy which forms the sine qua
non of predisposition. If a severe attack is left to pursue its
course without controul, it rapidly advances from excitement
to exhaustion ; there is no remission. If subdued at the
onset, the disease is perfectly cured ; if we except the debility
which must necessarily result from the employment of every
active depletory means : there is no exacerbation. Neither
will there be any risque of a second attack at a future period,
unless the inflammatory diathesis has not been sufficiently re¬
duced by the first seizure, and the exciting causes are re-applied
to an inordinate extent ; or, unless a change of constitution
has been again induced by residence in a cold climate between
the periods of a first and second attack. These contingences
offer the only exceptions to subsequent immunity. Under
ordinary circumstances there will not occur a second seizure.

The inflammatory endemic is consequently not remediable
by the means that have been mentioned as successfully employed
to check the progress of idiopathic marsh fever, or to prevent
its recurrence. And it has been already stated, that the
measures adopted with efficacy to subdue the morbidly in¬
creased excitement which constitutes the inflammatory endemic,
will not cure simple idiopathic fever.

With regard to the prophylaxis, it obvious that the
most certain means of preventing marsh fever must be to avoid
the action of the miasmata, its exciting cause. When this
cannot be done, it is often requisite to support the tone and
vigour of the system by a more nutrient diet and the moderate
use of condiments and wine.

The inflammatory endemic can only be prevented by a
reduction of the excitement which constitutes predisposition,
and by avoiding exposure to intense heat, violent exercise, and
intemperance, which are its exciting causes. Removal from
stations on the sea coast in the West India Islands is, therefore,
equally preventive of both diseases, but upon opposite prin¬
ciples.

It is a successful prophylaxis against marsh fever, by
obviating the operation of its cause, the paludal effluvium.
It is preventive of the inflammatory endemic by the diminution
of temperature it affords, and often by preventing the opportu¬
nity and means of indulging destructive habits of intemperance.
The prophylactic efficacy of change of station in this case is in

3 o 2

468 Original Communications.

proportion to the degree of elevation and consequent reduction
of atmospheric heat. Without the same degree of elevation,
a removal from particular stations is preventive of marsh fever
merely by avoiding the influence of marsh miasmata, which
generally arise in low and consequently torrid districts.

The inflammatory endemic is peculiar to hot climates, and
to persons who have only been accustomed to temperate regions.
It principally attacks the youthful, sanguine, plethoric, and
robust.

It is the reduction of tone, which a certain period of resi¬
dence occasions in the constitution of new-comers, that secures
them against! ts seizure. It is a corresponding (atonic) state
of constitution which affords immunity to the native inhabitant.
Both the European and native West Indian become liable to
the disease if they change their climate for any considerable
length of* time ; although a first attack secures them against a
repetition of the same affection, they nevertheless remain liable
to marsh fever, should they come within the influence of the
effluvium which is its cause, and this as frequently as they
may happen to approach it.

These distinct diseases the writer has experienced at several
times, in different situations in the West Indies, to occur with
almost epidemic universality, under the circumstances essential
to the prevalency of each. In the one case, requiring numbers
of a similar habit to be introduced from a northern climate at
no great distance of time from each other ; in the other, only
requiring the subjects to be brought within the sphere of the
action of marsh miasmata. Thus, I have known them prevail
nt similar periods perfectly distinct from each other, and some¬
times in a state of combination.

Should it be suggested as difficult of proof, that marsh
effluvium did wot exist in the situations where it has been stated
that the inflammatory endemic or yellow fever prevailed, it
must be observed, that such affection, occurring at stations to
every appearance free from the influence of marsh miasmata,
has not assumed any of the symptoms characteristic of idiopa¬
thic fever derived from that source ; but, on the contrary, has
been at all times a disease of simple excitement, terminating
quickly in death or recovery.

Moreover, while the inflammatory endemic or yellow fever
lias thus prevailed in a severe degree in situations perfectly dry
and healthful to those accustomed to the climate, the remittent
fever has been not less prevalent in other districts of the same
polony in which the soil is marshy.

When the subject who has recovered from an attack of
the yellow fever visits the swampy district, he has generally
jbt'en seized with the peculiar fever its effluvium excites ; and

' Dickinson on West Indian Fevers.

at the same time that convalescents from the last mentioned
disease were removed to the stations in which young plethoric
Europeans were sustaining severe attacks of the inflammatory
endemic, with a view to perfect their recovery after havin'"
suffered by the fever of type. '

If it be conceived that marsh miasmata possess the pro¬
perty of exciting morbid conditions of the system, differing in
kind according to the climate and particular class of subject
affected ; exciting, for instance, in the languid constitution a
disease ot debility, and in the plethoric and healthful halft -
disease of violent inflammation ; and that in this view the
endemic remittents of paludal soils and the inflammatory
endemic of new-comers from temperate to hot climates
should be considered the same disease, only altered by the
application of its exciting cause to a variety of constitution •
fet it,^ m such case, be borne in recollection, that the subject
who is peculiarly predisposed to the inflammatory endemic or
yetiow fever, if he should be seized by the marsh remittent
may go safely through an attack of that disease without any
appearance of inflammation whatsoever, or he may die without
the manifestation of such appearance; while a new-comer
seized by an inflammatory endemic, shall perish within forty-
ejglu hours 01 the attack with the most strongly marked
evidence of inordinate general excitement and topical inflam¬
mation, without the least tendency to exacerbation and re¬
mission : and this shall occur in situations in which it is
impossible to imagine the operation of any noxious effluvium
derived from peculiar states of the soil, or from any ascertain¬
able impurity of atmosphere, or from any other alteration in it
independently of temperature.

I shall state, in conclusion, the following examples, which I
conceive to illustrate the distinction and difference noticedjn the
preceding pages, and to mark the propriety of making such
distinction in practice. &

1 First: a West Indian, or a native of a similar climate
wuo has resided in a dry and elevated situation, such for
instance, as Richmond Hill, Grenada; Monk’s Hill, Antigua -
Dorsetshire Hill, Saint Vincent ; Brimstone Hill, St. Kitts’ ke
will maintain as good a state of health as falls to the lot of
humanity in any other part of the world; taking, however, into
the account, that the condition of health of the native inhabi¬
tants of torrid climates does not often possess the character of
tone which obtains among the natives of temperate regions

Second : if such person removes to a cold climate, remains
there for a considerable time, and then returns to his former
heajthful station within the tropics; if he should, also, lire
in temperately, and suffer much exposure to the sun under

470 Original Communications ,

violent exercise soon after his arrival ; whatever degree of
trust he may repose in his West India nativity, it is most pro¬
bable he has sustained such change in constitution, that he
will have become liable to the disease which so commonly
attacks the natives of temperate climates : in other words, to
the yellow fever, although perhaps not in so violent a degree.

Third : whether the West Indian, already adverted to, has
returned from visiting a temperate climate, or has been always
resident in the torrid zone, if he should change his residence
from the healthy station in which he was first considered to
live in the vicinity of a marshy soil, he will, most probably, ere
long, sustain an attack of remittent or intermittent fever.

Fourth : should a person, circumstanced as above noticed,
be immediately removed from the influence of marsh miasmata,
he will, most probably, soon recover, after the existing
paroxysm has been subdued or has gone through its course ;
nevertheless, he will be liable to suffer repeated attacks when¬
ever he shall again visit the same neighbourhood, providing the
soil at such period possess the character of marsh. And if he
continues to reside within the influence of the noxious atmos¬
phere, his constitution may in a short time, perhaps, be sadly
undermined, although he shall scarcely suffer, as formerly, by
the regular and decided febrile paroxysm.

Fifth : if, on his arrival from a colder latitude, the West
Indian is at once stationed in a marshy district and takes the
fever, the attack may be rendered more severe and irregular in
its course from the super addition of inflammation, excited in
consequence of sudden change of climate, imprudent exposure
to solar radiation, or violent exercise and intemperance. But
where these exposures are wanting, the disease may only assume
its character of simple marsh remittent.

Sixth : if, on his return from temperate latitudes, the new¬
comer, as heretofore announced, reduces the habit of body by
bleeding, purging, and abstinence, and retires to a dry and
elevated station, he will probably remain exempt from febrile
disease.

That which has been stated with respect to the West Indian
will apply to the European or North American, with no other
difference than the greater susceptibility of these latter to
violent attacks of the disease of excitement soon after their
arrival within the tropics; from which the natives of hot
climates are perfectly secure until their return from colder
regions, and from which also the European becomes exempted
after such a period of West India residence as renders him
acclimate. This immunity, however, must vary in its extent
conformably with particular circumstances of predisposition
and exposure.

471

Dickinson on West Indian Fevers.

If the distinction between the endemial fever of marshy
soiis and the inflammatory endemic should possess the practica
advantage I apprehend, no small proportion of it must be
referred to the rule which such distinction is calculated to
establish with regard to the employment of depletory measures
in their treatment.

1 01 this discrimination directly leads the practitioner to1
weigh in his mind, and, perhaps, separate the appearances of
general inflammatory tendency with the actual inflammation of
certain organs, occurring in the ardent endemic of plethoric
new-comers, from analogous symptoms arising during the hot
stage of marsh fevers, in which fever there is sometimes the
gieatest depression of strength ; more especially when attack¬
ing the worn-out soldier, the debilitated West-Indian, the
weakly woman, or still more enfeebled child.

In the first case, the practitioner must be determined in the
liberal use of the lancet until the symptoms of inordinate
excitement aie subdued ; while he will not deplete m the view
of curing marsh fever, although the symptoms of re-action,
or the adventitious appearance of topical inflammation, may
demand judicious controul.

When a subject of a severe and sudden attack is an inflam¬
matory new-comer in the first stage of disease, who may
have been much exposed to heat in the most arid situation that
can be imagined, the practitioner will detract blood freely; he
will not be -regulated by periods of time, but by the actual
state of things ; he will not withhold his lancet, the sheet anchor
of his hope, and deserving all his confidence in the unavailing
anticipation of a remission, which is to be the signal for throw¬
ing in the bark to prevent the recurrence of the paroxysm,
b or lie will be well aware the existing symptoms of excitement
with inflammation extending to the vital organs must be
promptly subdued, or his patient be soon placed beyond the
reach of human aid. The freedom from heat and pain which
is liable to take place during the decline of a severe and
neglected case of yellow fever, however analogous to the
appearance of remission so much desired in the marsh endemic,
is a deceitful resemblance ; the presage of a fatal exhaustion,
soon to be followed by organic destruction.

Has not the want of distinction noticed in these pages been
among the causes of that difference of opinion and practice
which has subjected West India febrile affections to the most
singular opposition of treatment P “ some advising the liberal
use of the lancet ; and others, having frequently experienced
its dangerous consequences, almost binding themselves by a
solemn engagement never to recommend it again in idiopathic
fever within the tropics.”

472 Original Communications .

Under the baneful influence of an erroneous theory, which
regarded the yellow fever to depend on a putrefying diathesis,
the writer has often known the most serious consequences result
from the employment of diffusible stimuli ; while, on other
occasions, the disease being considered the offspring of marsh
miasmata, antimonials, exhibited to procure an expected remise
sion, and bark, poured in to prevent the recurrence of parox¬
ysms, have conjointly excited and kept up a state of vomiting,
only to cease with the life of the patient.

Fortunately, another and a better practice has, for some
time, deservedly obtained increasing confidence. Mosely and
Jackson chiefly led the way. The happy results of their
enlightened experience give to the practice a prompt and
decisive system of depletion in the first stage of yellow fever ;
an authority which, although under a variety of speculative
opinions, has more recently received abundant confirmation of
its intrinsic value by its very frequent adoption in the hospitals
of the navy and army, as well as through the writings of
Trotter, Pinckard, Dickson, Johnson, Irvine, Burnett,
Doughty, and many others of character and experience.

It may not be impertinent to inform the reader, that the
source of the present writers information on the subject of tro¬
pical fevers has been derived from a varied tour of duty among
the West India Colonies, between 'the years 1796 and 1814;
during which period he was stationed in Barbadoes, Saint Vin¬
cent, Martinique, Dominico, Antigua, Trinidad, St. Bartho¬
lomew, St. Martin’s, St. Christopher, Demerara, and Grenada ;
at which last mentioned island he was the senior medical officer
for ten years. The remarks thrown out in this paper have been
chiefly transcribed from the concluding pages of a manuscript on
yellow fever, in which that disease has been considered somewhat
more at length. The Tract here adverted to, composed from
official reports long since addressed, and at different times, to
the principal officers in charge of the Medical Department in the
West Indies, the writer proposes to hiring under the view of the
junior medical officers destined for West India service; with the
important aid of such collateral evidence as leisure and the access
to written authorities have recently enabled him to collect.

The writer begs leave to subjoin, that as it is his wish to
confirm the facts derived from his personal experience by the
testimony of other evidence, with a hope thereby of arriving at
some legitimate practical conclusions, lie ventures to solicit
information upon the subject from those of his professional
brethren who have practiced in the West Indies, and may
honour him with their correspondence.

17, Wigmore Street , Cavendish Square .

Ilf.

Observations on the Plague. Communicated by Henry
I Hobertsoxt, M.D. Coll. Med. et Academ. Ion. S. in a
Letter to Dr. McMullar, Physician to the Forces, &c. & c.

J\i\ Dear Sir, Cephalonid , July 181 hi

I forward to you the extract of a letter from the Late Mn
Charles Torrie of the Medical Department; because of the
Connexion of its subject to that of the observations on remittent
fever I formerly communicated to you. This extract is parti¬
cularly valuable, as giving the result of the experience of a.
young man of superior professional talents on the plague ; a
disease the most fatal to mankind, and consequently that which
most interestingly claims investigation; Of that disease Mr.
Torrie fell a lamented victim at Marathea, a village in the
eastern extremity of Corfu, January 11th, 181b, about the
twenty-third year of his age, while zealously and humanely
exerting himself for the relief of the inhabitants affected with
the plague. His fatal prepossession of the non-contagious
nature of that disease seems to have led him to disregard the
necessary and proper measures for preventing a too near ap¬
proach to the sick: but if he erred in this opinion, he is coun¬
tenanced by several celebrated men, both of our own and other
countries, who have promulgated their ideas upon this question.
Upon the whole, considering the letter highly creditable to the
author, I submit it to you.

It h as been thought proper to subjoin an extract of my
letter written in answer to Mr. Torrie’s request.

The plague, as it raged in the district of Leftchimo, in the
island of Corfu, seems first to have broken out in an inland
village (Marathea), the inhabitants of which are solely occupied
as husbandmen. This situation, though on a rising ground, has
at all times been unhealthy, in consequence of the marshes in
its vicinity, and the noxious exhalations that arise from the
olive groves with which the district is in greatest part covered ;
consequently the inhabitants have always suffered from remit¬
tent fever in its worst form ; and it had been unusually prevalent
during the preceding spring and summer. On this account I
then visited the district.

It is necessary to be observed that the rains set in early in
October 1815, and were unusually heavy during the whole
season* with a high temperature of the air ; the thermometer of
Fahrenheit having rarely sunk below 60°, even in the latter

vol. viii.— no. 48. 3 p

474

Original Comm umcaimw*

period of December : die wind most generally southerly, form¬
ing the u Constitutio temporis pestilens annus austrinus et
pluviusA- — Hippo .. Morb, Pop. S. 3.

The people being in this way shut almost entirely within
their low, damp, ill-ventilated cottages, which added to the
despondency and wretchedness arising from a total failure of
then crops for several successive seasons ; the remittent fever
seems, from different official reports, to have thereby gradually
degenerated into the pestilential disorder that desolates that
district ; as happened in the plague that for the second time
broke out in Athens, as recorded by Diodorus, and in that of
Saltzbach in 1768 ; and similar in its origin to the fevers of
colder climates, as the jail, hospital, and other varieties of what
is called typhus, which are well known to originate from certain
local causes, and are afterwards propagated by a peculiar mat¬
ter generated in the course of the disease. This opinion seems
to be rendered still more deckled in the case in question, as no
trace of' its being an imported disease can be made out, not¬
withstanding the strictest investigation on the immediate ap¬
pearance of the disorder, and the inducement of the high reward
of 1000 dollars offered by Government for information upon
that point I remain, very truly, jour's,

II, Robertson*

Extract of a Letter from Mr „ Torrie to Dr . Robertson.

Casa Trivoti via Rumanades , January 3} 1816*

C£ I had resolved, when I began to suspect the disease of
the Marathea of being different from what it was called at Corfu,
to send you an account of the symptoms* I was, however,
prevented by different causes* I shall now state them in their
regular order* Of the cause, I do not pretend even to offer
an opinion ; of the causes, however, of the extension of the
disease, I may be able to say something. I should not mention
the name of Cullen, were it not to shew how erroneous his de¬
finition is. He plants it among the Exanthemata, and calls it
a Typhus, highly contagious, accompanied with extreme de¬
bility, and, at certain periods, eruptions of buboes, &c. Now
it happens that it is neither a typhus, nor highly contagious,
nor accompanied always with buboes. On this point I shall
be happy to have your opinion.

Previous to the attack, the patient generally feels languid
and incapable of any great exertion. It, however, often hap¬
pens that he is affected with a sensation of cold, which some¬
times proceeds to shivering long before he experiences his usual
state of health. The first attack is always in the evening.
I have only met with one case that deviated from this ; and I

Eobertson m the Plague. 475

suspect that the cold fit had passed without observation This
can be easily conceived when I shall state— -I hare seen some
cases where no fever preceded the eruption of" buboes; but one
their appearance a kind of symptomatic affection shewed itself.
Thrs state* however* is soon followed by immense heat of skin*,
pain in the head, giddiness* the tongue is white* the eyes heavy
(by tin's I mean dull and muddy), the face loses its expression*
the pain in the head is confined to the temples and eyebrows*
the temporal arteries beat strongly but the most remarkable
affection is that staggering so well described by General Menou*
who said cc I have neither drank wine nor spirits* and yet I
feel as a drunken man.” This staggering increases with the
disease. The least exertion is difficult and dangerous. The
stomach partakes of the general irritability* and rejects
most things presented to it. The contents of the alimentary
canal are highly offensive. Stupor is present* even sometimes
immediately after the formation of the hot fit. The pulse at
first is small, hard, and quick* as in most internal inflammations*
After the appearance of buboes, it continues its quickness, but
often becomes fuller. The greatest indifference appears with
respect to life. After one* two, or three days, pain in the groins
or axilla announces the formation of buboes. Sometimes this
pain is extreme, and, if swelling does not soon follow, the
miserable being dies delirious. It happens* however, that these
local symptoms are sometimes absent. In women the axilla is
generally the seat of the buboes ; the contrary is. the ease in
men. The course of the disease is very various ; the first
paroxysm lias closed the career of several of the inhabitants of
Marat hea. This period lasts from the evening of the attack
to the close of the night following. It more generally lasts
longer. The third and' fifth days are those of greatest danger
the third informs us of the commencement of the bubo ; the
fifth of the abatement of the febrile symptoms. If the patient,
passes the fifth day, and the bubo is completely formed, he may
be often pronounced free from danger ; but the debility is often
so great, and the second fever so high, that coals can only be
then added to the fire.

The opinion that I have formed of the proximate cause of
this disease is much the same as that of youris respecting the
cause of the common remittent; and I conceive it to be much
akin to that fever. I do not allow the appearances of debility
(a word so often polluted) to blind me.

The treatment is simple. I have divided it into two periods :
the first, from the formation of the disease to the appearance of
buboes; the second, after their complete formation. The first
requires antiphlogistic remedies* topical bleeding, blisters*
purges : the second, bark, wine, opium* &c. &c.

8p2

476 Original Communications.

My plan of proceeding is this : — On first seeing the patient,
I order a blister to the head, and a close of calomel. Some¬
times I give salts ; but the irritability of the stomach generally
confines me to calomel and rhubarb. On the second day, if
the fever is high, I order a second blister to the head, and re¬
peat the purgative medicines.

Immediately that the patient experiences pain in the groin
or axilla, I appfy a blister to the parts, for a very obvious
reason. I have tried the actual cautery ; but four out of five
to whom it was applied died, and apparently from the great
irritation produced. I have also used hot water to the part ;
but it was carelessly done, and I do not think I shall soon re¬
peat it. I find the blister answers my purpose, and I keep up
the action by poultices. I find sudorifics of great use after the
local symptoms shew themselves. I employ the pulv. ipecac,
comp. Of the cold bath I can only say, that I think I cut
short the disease by it in one case ; but four of the unfortunate
people certainly fell victims to that treatment. They were not
fair trials, as one (byrthe-bye I did not know it till afterwards)
had an inflamed liver; the others were improper subjects.

Thus have I given you an imperfect account of the symp¬
toms and treatment of the disease at Marathea ; and I doubt not
but that, without any hesitation, you will call it-— the Plague D

(Signed) Charles Torrie,

Extract of a Letter from Dr. Robertson to Mr. Charles Torrie.

Corfu, January Qth, 181 6.

I have been much gratified by your description of the
symptoms and treatment of tne disease now under your in¬
spection, which, from the first, I had little doubt was nothing
but the plague. I never saw that disease, and it would be pre¬
sumptuous for me to enter into a detailed discussion upon it.
However, as it is a subject that has for many years attracted
my attention, and as I know you do not intend it as an un¬
meaning compliment by asking my opinion, I shall give it to
you in a very few words. I agree with you that the plague is
not typhus, nor perhaps are buboes essentially characteristic
pf it.

During the plague at Marseilles, and in that of Moscow,
this disorder has been met with as an intermittent. Livy
mentions the plague having once appeared at Rome, when in
all those recovering it assumed the quartan period. In Egypt,
and in Syria, the plague commonly makes its appearance with
the common symptoms of remittent fever, insiduouslv becoming
more and more aggravated ; and, having acquired its acme of
pialignaney, it gradually declines in the same way. The first

Robertson on the Plague. 477

O \

plague at Athens, though an imported disease, does not seem
to have been marked by glandular swellings, neither was the
sweating sickness*. But the connection of the plague with the
ordinary causes of remittent fever is still further shewn by the
similarity of the symptoms in both, these only differing in
degree ; while the few dissections of those dead of the plague
have shewn precisely the same appearances in the brain, &c. as
those you have seen in the remittent cases, only the changes in
the former have been found more material. But although I
admit with you, thus far, the connection between the origin of
the plague and remittent fever, I am far from thinking the
former is not a contagious disease, and 1 beg of you to be on
your guard in this respect. Perhaps you may say, this is
contradictory; but I explain it in this way: a more concern
trated state of the miasmata operating on people highly pre¬
disposed by despondency, bad diet, and other causes of depres¬
sion, must gradually generate a fever of increased malignancy,
by which at length the functions of those affected are so com¬
pletely disturbed, that the secretions, either gazeous or liquid,
if received into the system of a healthy person, have the effect
of producing in him a disease of a peculiar type and character;
and in this way it may be propagated through every climate
and in every season ; therefore, although I imagine that the
plague may originate from local causes independantly of con¬
tagion, yet we have incontestible facts to shew, that it is propa¬
gated most commonly by communication with the sick or by
fomites. I believe that in the same way the discordance of
opinions respecting the contagious or non-contagious nature of
yellow fever is to be explained. So far from supposing there
is any thing like debility in the character of the plague, I am
inclined to consider it marked by an excessive phlogistic dia¬
thesis, in which I follow very high authority (Sydenham). If,
therefore, I were to prescribe for such patients, I would en¬
deavour to extract blood, if possible, from the temporal artery,
to the amount of two, three, or even four pounds, and repeat it

* The plague broke out in the island of Cephalonia (July
18 id), and its ravages continued for weeks without being attended
to, in consequence of the report of the physician sent to examines
the first person who died of it, as being caused by an inflammatory
affection of his chest, because there were neither buboes nor patches
on his body. Others have died of that disease with precisely the
same appearances, and several others with the general characteris¬
tic of plague. It was ascertained that the contagion was brought
from Arta in Epirus by the first mentioned person, who carried
with him a Capot belonging to a family sick of the plague in that
place. This man died within twenty-four hours, after being
admitted to pratique from the lazaretto nearest his native village,
Eoniitata.

47$

Communicatim®*

according to circumstances. Small blood ings always do bam
in acute diseases, by augmenting the sensibility and irritability
of the system ; that evacuation must therefore be proportioned
to the severity of the disease, &c. I would, on account of the
irritability of the stomach, at first only give purgative clysters*
till I had freely opened the bowels. I would afterwards have
recourse to diaphoretics; and blisters, if the head still remained
affected. The buboes I would leave to nature, covering them
with some diaeholon plasters. I am fully persuaded that the
difficulty of bringing these buboes to suppuration arises from the
great excitement of the system, and the excessively stimulated
state of the minute vessels of the part, which run more rteadily
into mortification : all irritating applications must therefore do
mischief ; indeed I consider such practice, a priori, as rather
calculated to defeat the intention of forwarding the suppurative

process.

Why not follow the same practice in the plague as in other
cases of inflamed glands ? Cold bathing, you know, is not
thought proper in cases where there is a determination to any
internal organ. To conclude, an idea seems very prevalent
here, that it is contact alone by which pestilence is communi¬
cated. This I am very much disposed to doubt : the skin, in
a sound state, does not probably perform an absorbing function.
The surface of the lungs, however, although well demonstrated
as an absorbing and an exhaling organ, does not seem to be
sufficiently considered as having an effect in conveying con¬
tagious effluvia into the system of an healthy person : but as
this is a point of the last importance, I wish to call your atten¬
tion to it. I am convinced, from analogous facts,, which I can¬
not repeat now, that the gaseous or aeriform secretions of the
morbid subject are those most to be apprehended ; these pro¬
duce their effects by respiration ; consequently a well-contrived
muffler would be an instrument of the highest importance for
those going about the sick, as also by some appropriate dress
to prevent the effluvia arising from the sick being imbibed by
the clothes of the attendants, which ought to be changed and
hung up in some airy place as soon as the duty is performed,
otherwise they must act as a continued fomes. Inattention to
such circumstances has, I am persuaded, led to the belief that
contagion may exist in the system some time (even weeks)
before manifesting its effect ; an opinion, I may observe,
which is at least in opposition to every analogous fact, and
from which has arisen the incalculable inconveniences from
quarantine laws, as at present generally established. Upon the
above idea, I am persuaded that considerable improvement may
be made in the regulations of police as well as ol quarantine, as
measures for preventing the origin and spreading of epidcmiQ
disorders , (Signed) H. Robertson..

Coombs on the Gout .

IV.

Observations on Gout. By William Coombs, of Bath, Mem¬
ber of the Royal College of Surgeons in London.

Non docentibus, sed discentibus ; non enulitis, sed erudiendis.

It will, I believe, be universally admitted, that gout is
among the many salutary processes which occasionally take
place in the human, body for the purpose of removing diseases,*
which might otherwise have proved fatal.

From this generally acknowledged principle*, it will un¬
doubtedly become a question among many of my readers,'
th rough what medium Nature is enabled, by a process of so
painful a kind, to effect a change of such importance to the
human constitution ? In reply to which, it will be necessary
that I should direct the attention of inquirers to an investigation
of those symptoms which usually precede a gouty paroxysm.

Previously to the accession of a paroxysm of gout, the
symptoms from which the patient is accustomed to suffer are
rather those of a general nature ; as fever with its concomitant
symptoms ; as an affection of one or more particular organs,
such as the brain, stomach, or bowels ; the former originating
as a consequence of too large a proportion of blood in the
•System ; the latter from an improper balance in the circulation,
producing an increased momentum of blood to the various
organs affected. Numerous arguments might be here adduced
to prove, that the symptoms, of which I have thus spoken
generally, are fairly referrible to the causes which I have thus
assigned to them ; but in consideration of feeling persuaded
that the majority of my readers will readily acquiesce in , my
opinion, I have desisted from producing them.

I shall commence this inquiry in the first place by an
endeavour to ascertain by what means symptoms having their
origin in a general vascular fulness and an undue balance in the
circulation, by which the vessels of the brain or any other impor¬
tant organ become surcharged with blood, are susceptible of
relief by a gouty paroxysm ?

Were we to employ medical means for the removal of those
symptoms which result from a general vascular fulness, our
object would of course be to lessen the quantity of blood,
and produce a diverticulum for it from the vital organs,

* We seldom venture to make any comment on the Original
Communications with which we are favoured ; but we cannot allow
this assumption of Mr. Coombs to pass unnoticed. We refer him to
the Commentaries of He her den, and the writings of Drs. Sutton,
Scudamore, and many others, to be convinced of the fallacy of his
position,— Editors.

480

Original Communications.

which we should naturally expect to be surcharged. These?
objects are usually accomplished by the salutary efforts of
Nature in a fit of the gout ; for the dyspeptic symptoms,
which are almost always the concomitant of gout, cause the
patient to abstain from taking his usual quantity of food, and
thus an augmentation of blood is prevented ; while at the
same time the secretions are going on, and consequently the
quantity of blood diminishing. But should the efforts of the
stomach or bowels be inadequate to relieve the constitution,
it would be of importance to produce a sudden determination
of blood to the extremities, and this is effected by the local
inflammation of gout. The fever will be kept up in propor¬
tion to the quantity of blood necessary to be diminished; when
the blood from the extremities will again return into the
general circulation, or the vessels will be relieved by a deposi¬
tion from secretion in and about the parts affected.

Having remarked that the derangement in the functions of
the stomach or bowels appears to be an effort for the removal
of some constitutional disease, I may here introduce the opinion
of an ingenious medical friend of mine, who, when speaking on
the subject of the vis medicatrix natures, says, “ under this
view of the subject, the disorder of the organs of digestion
cannot be looked upon as the cause, but the cure of consti¬
tutional disease. The necessity for re-action exists, and if
the stomach and bowels can effectually contend with the evil
and conquer it, the more extended disturbance becomes un¬
necessary. People very prone to gout are seldom much
afflicted in the stomach; the disorder occurs at once, being
quickly excited, and the intermediate disturbances do not take
place. When the gout hesitates to come on, the disturbance
in the stomach and bowels is very great/'

In the other symptoms, where particular organs are af¬
fected, the relief afforded by a fit of the gout is most con¬
spicuously seen. Cases of epilepsy, mania, and other serious
maladies, have been frequently relieved and indeed sometimes
cured by it; for in these cases, resulting from an unequal
balance in the circulation and not always arising from a general
vascular fulness, the symptoms are relieved by determining
blood from the affected to some unimportant parts, as to the
extremities for instance in a gouty paroxysm.

But however salutary the process of a paroxysm of gout
may be, its being attended with considerable pain would
render its accession objectionable, particularly as we generally
have it in our power to supercede the necessity of its occur¬
rence by the application of medical means. I may heie
again quote from the same friend, “that natural processes
may be often safely and advantageously altered ; that new
ararngements may be brought about by medicinal means.

Coombs on the Gout.

48 1

involving less danger and bringing about quicker relief, than
by trusting to the arrangements which these powers would
naturally ^ produced1 Another principal objection to lie
made to the occurrence? of gout, is, that those who have been
once afflicted with it are rendered particularly liable to a
recurrence, even from the most trivial accidental causes. Our
knowledge or the state of the vascular system attendant on
inflammation' will readily shew why these parts should be more
susceptible of a return of the disease ; namely, the arterial
vessels, being kept in an enlarged state for some time, lose their
tonicity, or, in other words, are rendered incapable of exerting
their muscular power in contracting themselves to their former
dimensions, and thus a current of blood through them adequate,
to the production of gout generally supervenes.

The indications for the treatment of the symptoms preced¬
ing gout being so clearly pointed out, but little need be said
as to the means necessary to be employed for their removal.
Hor instance, in those who are suffering from vascular fulness,
our attention should first be directed to diminishing the quan¬
tity of blood in the circulation. General bleeding, therefore,
together with other antiphlogistic remedies, nauseating doses
of medicine, &c. should be used according to the circumstances
requiring them. In these symptoms, and in this stage of
the disease, drastic purgatives and emetics, such as the eau
medicinale, infos, colchic., &e. may frequently be had recourse
to with safety and success; they relieve the plethoric state of
the body by promoting an increased secretion from the stomach,
bowels, and kidneys; thus doing away with the necessity for
the accession of a fit of the gout.

In the symptoms preceding gout* and originating from an
increased vascularity m any important organ from an undue
balance in the circulation, we should endeavour to lessen the
quantum of blood sent to the organ ; and our purposes will be
best fulfilled by abstracting blood from the part by local bleed¬
ing, or through the means of counter irritation. In some cases
it may be even necessary to have recourse to general bleeding ;
but the urgency of the symptoms would of course guide the
practitioner. The internal remedies should consist of those
calculated to determine blood to the bowels or kidneys, solicit¬
ing them to increase their natural secretions, as one of the
modes of counter irritation. Antimonial medicines will also be
of service from the same principle, by increasing secretion from
the vessels of the skin.

The indiscriminate practice of giving wine and other stimu¬
lants for the purpose of 'throwing out gout , appears to me to be
highly improper. That they generally have the effect of pro¬
ducing gout, is certain ; acting in a manner that allows of an

VOL. VIII. — no. 48. 3 Q,

482 Original Communicaiioiis.

easy explanation ; for, by their stimulating properties, the/
increase the action of the heart : the stomach and bowels being
unequal to relieve the constitution, the necessity for the pro¬
duction of gout in the extremities becomes more urgent, and
fortunately for the patient it generally supervenes. Besides, as
we know that a sedative effect is at all times the sequel to
increased action, we cannot be surprised at the relief sometimes
afforded to the constitution by the use of the stimulating plan.
In short, the practice is on the Brunonian principle, and may
be in many cases attended with a very serious result. Were
we to give stimulants to patients having a tendency to a deter¬
mination of blood to the head, and suffering already, perhaps,
with a train of symptoms resulting from it, we should be
incurring the risk of producing some fatal affection of the brain,
by increasing the flow of' blood to that organ. When the local
inflammation constituting gout has taken place, it may not
be superfluous to remark, that we ought to observe con¬
siderable precaution in our manner of treating it, either by
internal or external remedies ; taking care to bear in mind that
as it is a curative process, it may be completing the work
which the stomach, or the other organs of digestion, had been
making ineffectual attempts to do.

Notwithstanding then the pain attendant on gout, its re¬
maining attached to an extremity for some time is frequently
indispensably necessary ; for were we to check it suddenly by
violent purgatives or emetics, or by the application of cold
externally, we should be risking a chance of determining a
superfluous quantity of blood to the stomach, or some other
organ essential to vitality, when they had already shewn their
incapability of re-acting sufficiently for the removal of diseases;
and thus produce a fatal result.

From these circumstances we can readily conceive why the
use of the eau medicinale has been sometimes attended with
fatal consequences ; while, on the other hand, its administration
has been followed bjr the most beneficial effects.

In the constitutional treatment of gout, we should pay
particular attention to the causes of its production ; whether it
originates from too large a quantum of blood in the system, or
from an improper state in the balance of the circulation ; our
knowledge of this will direct us as to the means necessary to be
employed. We should endeavour to solicit the stomach and
bowels to re-act, by the use of gentle laxatives, and to increase
secretion from the kidneys by the medicines usually employed
for that purpose.

As auxiliaries to the internal treatment of gout, the local
applications must next occupy our attention. ,

If we consider the gouty inflammation of a joint as a diver¬
ge ulum for a superabundant quantity of blood, there can be

Coombs on the Gout.

483

no hesitation as to abstracting the superfluity from the part
emg the plan most rational to be adopted : in short, the result
o mj pi actical observations, founded on the inferences deduced
liom tiie above reasoning, fully establish it.

-Leeches should be had recourse to, and be repeated accord-
mg to the degree and extent of the inflammation ; and the flow
° y°°' . *rom the orifices should be solicited by means of the

application of large and warm bread and water poultices.

It will generally be found that the patient will soon recover
trom the acute stage of the disease, if these means be adhered
’ r 4.1 Ihe parts will be left stiff' and painful from the
Slow inflammation existing. In this stage of the disease, the
application of cold water, or the evaporating lotion recom¬
mended by Dr. Scudamore, will be found "of considerable
service, and may be the means of rendering the parts less
susceptible of a recurrence of the disease, by restoring the tonic
power in the distended vessels.

Having now endeavoured to convey, in a manner as intelli-
gible as possible, my opinions with respect to the cause, progress,
and cure of gout; from which may be inferred, that I differ
most essentially from those practitioners whose treatment con-
sistspn the administration of stimulants, with a view of pre¬
senting metastasis to some vital part, or, as they more emphati¬
cally express it, for the purpose of throwing out the gout.

Pile object which Nature holds in view in the production of
a gouty paroxysm, is the removal of that quantity of blood
which is superfluous to the system, in order to prevent its being
determined to some organs essential to life ; and, for this reason,
the parts which are chosen by her for its reception are usually the
extiemities ; they being at once the most remote from the
oigan to be avoided, and at the same time those from which
tneie are to be apprehended consequences of trivial importance

°n 1 Wkh.this s^a^e plethora, which, I maintain, does
usually exist in the greater number of gouty patients ; or even
when there is a superfluity or redundancy of blood, or where,
fiom a temporary dispensation in the due balance of the circu¬
lation only, some momentous parts are in danger of being
surcharged, but which is prevented by the occurrence of gouty
inflammation ; then, under these circumstances, the ill con¬
sequences of sudden removal of the blood from the extremities,
by the topical application of cold, must be obvious.

The practice of Dr. Kinglake, in the use of topical cold
applications, has, I am inclined to think* shared the fate of a
very large proportion of once famous remedies ; which, from
having been too highly extolled, and recommended as applicable
to every case, and every stage of gout, have ultimately been
totally abandoned. It may be true, that under certain circum-

3 Q. 2

484

Original Communications .

stances the application of cold lotions to parts affected witn
gouty inflammation is extremely beneficial; but such effect, x
am persuaded, can take place only when, prior to the employ¬
ment of this remedy, the quantity of blood which is superfluous
has been extracted, or the patient from any other cause so re¬
duced, as to render safe the return of blood from the affecied
parts into the circulating system J

AUTHENTICATED CASES,
OBSERVATIONS, and DISSECTIONS.

LIX.— A Case of The racic Inflammation .

A medical man, of a delicate habit, and between tub ty anti
forty years of age, bad been for several months subject to. pains
of the chest, for which he had bled himself from time, to time. I
visited him in May 1S16, and found that he had, about a ioit-
night before I saw him, been attacked with what were considered
as symptotns ushering in simple fever. I or these he lost a smah
quantity of blood, and put himself under a course or anticaoniai
and saline medicines, confining himself to vegetables and whey,
He was extremely languid, feverish, with violent exacerbations
of fever at an early hour every morning; at which times the
cheeks were of a dark scarlet colour, and the palms of the nam^
were stained with a circular red spot, the heat of which was so
distressing, that he was constantly blowing upon them to keep
them cool. These attacks of heat were succeeded by picMv
copious perspiration. The bowels were regular ; the urine was
in sufficient quantity, of a light colour, without Deposit. ineie
was scarcely any expectoration, hardly any cough, except after
a deep inspiration, after much talking, or from tne admission of
cold air. 'The langour and debility were very great. The
pulse small, changing in frequency, from slight causes, from
between 80 and 00 to 110 or 120. lie had hteialiy- ta^en
nothing but copious draughts of neutralized lemon J nice aiiQ of
whey, "for the last few days; yet the febrile symptoms and
heat continued unabated. There was no pain. No rnaixecl
symptom was present denoting’ inflammation of the lungs. I he
symptoms, with the exception of the appearance oj the uiine,
put on rather the hectic character. f

I opened a vein, and, from the appearance of the blood, was
led to fill four tearcups with it, each containing three oi four
ounces; The crassamentum was very much cupped, very
tenaci \e, and the buff extremely thick. In about twelve
hours f oi . : cups more of blood, of a similar charactei, weie
taken avov, and within the next thirty-six hours eight cups
more were filled. At each time of bleeding lie was so weak that

485

A Case of Thoracic Inflammation .

he could scarcely turn in his bed. The whole quantity of blood
removed was computed at sixty or seventy ounces. The febrile
njrmptoms shewed some disposition to abate in violence; but
lie complained of a slight pain in the left side, from which part
a small quantity of blood was removed by cupping and by
leeches. In spite of all this treatment, the febrile symptoms
were yet very strong and distressing. The bowels were kept
in a proper state, and four of the following draughts were given
in the course of every twenty-four hours:

% Plumbi Acetat. g r. j.

Ext. Papav. Alb. gr. v.

Acet. vulgar, f §ss.

Aq. font. f$i. — M. Ft. haustus.

The dose of the acetate of lead was increased, until that he
took five grains every twenty-four hours. The vegetable re¬
gimen was continued. He persevered in the use of the lead
and vinegar for about three weeks, and under the use of it
the febrile symptoms gradually subsided, and he became con¬
valescent. He has continued to follow the exercise of his
profession, in which he is now (July 1817) actively engaged.

PA R T II.

ANALYTICAL REVIEW.

L Remarks on Insanity ; founded on the Practice of John Mayo ,
M.D. Fellow o f the Royal College of Physicians, and tending
to illustrate the Physical Symptoms and Treatment oj the
Disease. By Thomas Mayo, B.M. Fellow of Oriel Col¬
lege, Oxford. 8 vo. pp. 90. London, 1817. Underwood.

2. Observations on the Casual and Periodical Influence of parti¬
cular States of the Atmosphere on Human Health and Diseases ,
particularly Insanity : with a Table of Reference to Authors.
By Thomas Forster, F.L.S. Svo. pp. 89. London, 1817.
Underwood.

3. Observations on the Phenomena of Insanity , being a Supple¬
ment , fyc. ( vide preceding Article). By the Same. pp. o0,

4. Report of the present State and Management of the Hospitals

for Insane Persons at Paris ; translated from an Official
~ Report on the Hospitals in general of that Metropolis: with
an Appendix. Svo. pp. 63. London, 1817. Lndervvood.

L— If it be objected that the subject of Insanity occupies
too many of our pages, let it not be imputed to us as a pi edikx -

486 Analytical Revievo..

tion or a fault, but to the general interest recent events have
attached to it, and to the commendable zeal displayed in eluci¬
dating more fully one of the most afflicting and neglected
of maladies to which suffering human nature is exposed.

Having, in a late review of Dr. Spurzheim’s work on In¬
sanity, so largely dilated upon the subject, we intend being as
succinct as possible in our observations on the present occasion.

But the 44 Remarks'5"’ of a learned, experienced, and respect¬
able Physician, tending to illustrate the physical symptoms and
treatment of Insanity, must excite no ordinary interest. These
Remarks, however, are written by Dr. Thomas Mayo ; but for
what reason the Son becomes the substitute of a Father himself
so well qualified, we are totally uninformed. This bifold com¬
position is certainly as perplexing as it is novel ; and, from an
apologetic note, the authors seem sensible that it is exposed to
some degree of animadversion.

This Essay is dedicated to Lord Colchester ; a circum¬
stance, perhaps, immaterial, were it not that, in his address, Dr.
T. Mayo says, that 44 it treats a subject so interesting in its
nature, as almost to have been wrested by the Philosopher out
of the hands of the Physician — a sentiment so just, and so
much in unison with our own, that we shall again avow
our conviction, that, until the subject of insanity be treated as
one more peculiarly the province of the physician than the
moral philosopher, little progress will be made in developing the
cause, or any effectual improvement in the treatment of it.

Our author premises that he comprehends those forms of
madness which are viewed by the French waiters under
44 Marne et Melancholic in describing which, however, lie
does not pretend to imitate them ; neither, in adopting those
terms, does he accept the division they import; because, says he,

“ I find the phenomena of mania and melancholia run too much
into each other, to permit their being represented as maladies
distinct in kind.” — p. 3.

And he very truly observes, that the distinction endeavoured
to be drawn between the two has its foundation in moral rather
than in physical causes.

The opinion of modern authors, both French and English,
on the pathology of insanity, are next noticed ; and the various
essays ofDrs. Pine], Esquirol, and Du Buisson are referred to,
to prove 44 that the physical pathology of the disease occupies a
place secondary to its mental pathology and that, although
in the works of Drs. Arnold and Crichton, and even in that of
Dr. Haslam, we find many pathological histories, yet there is
in all of them too much that relates to the mind, and very little
to the body. Our author adds,

cc It lias very frequently been urged that little connexion can

Mayo s Remarks and Forster’s Observations on Insanity, tyc. 487

be traced between the phenomena, which dissection lays before us,
and prior phenomena of the disease. Such must be the case, as
lon^ as observations continue to be made on the plan above noticed.
Are there any laws of the economy, through which thickening of the
. mbranes can be traced to depression or elevation of spirits'? Be-
tv> eon this fact indeed, and the physical symptoms of inflammation,
taere is a well-established bond of connexion. Surety it is with the
physical, and not with the mental symptoms of the living subject,
that we must expect to associate appearances that disclose them¬
selves after his death/’ — p. 8.

lie also objects to Drs. Mason Cox and Du Buisson, that
it is surprising they should have found “ so much to be
said on physical treatment, and so little respecting physical
symptoms.” &

In adopting the term Mania, the Drs. Mayo (we must some¬
times^ speak plural! y) do not accept it as opposed to Melancholy.

The grounds they assume for their pathological views of
mania, are thus introduced :

" To regard insanity as an object of attention with reference to
it? mental phenomena while trie disease is quiescent, and to repress
it by coercion and medical measures while it is raging, is the first
plausible suggestion that would occur to the physician.

The disease, under this treatment, appeared to my father
uncertain of obtaining a present cure ; the patient was very liable
to relapse. . Tie looxed more attentively at physical symptoms ; he
sav. the insidious ravages of the disease in derangement of the gene¬
ral bodily functions, even while it was apparently quiescent.^ He
saw slight, but daily, exacerbations indicated by increased action of
the carotids and flushing of the face, and heightened from time to
time into forms of violent febrile excitation. M length, when the
slow process should have achieved its purpose, when disorgani¬
zation of the part might be supposed to have taken place, he saw
too functions oi that part, namely, the mental powers, sink into

sy.{C-a total nun, as morbid anatomy teaches us to associate with
disorganized structure.

T lius tner e appeared, as an object of treatment, a process of
inci eased action forming the basis ot the disease, paroxysms of
heightened violence occasionally supervening/’ — p. 1 j .

Dr. Haslam s dissections of the heads of insane persons are
mentioned, as best illustrating (although Dr. Marshall’s, in our
opinion, are equally relevant) the increase of action connected
with mania, as well as of the prolonged and continuous nature
of such vascular excitation: and the opaqueness of the tunica
arachnoides, so commonly seen, is considered as especially
indicative of this continued process of increased action. « In
consideration of its influence on our view of the subject ”
the question is discussed, whether this constitution of parts is
to be viewed as effected “ by a slow process of increased action
or merely as the sequel of an acute paroxysm, such as frequent-

488 Analytical Review :

]y occurs in the disease, and is analogous to a phrenitic
attack ?”

Having, as they conceive, established, by induction, these
data, our authors proceed to the details of their pathology and
inode of treatment. But these subjects are so blended, that, to
explain their views, it were preferable, perhaps, to give, after
their own example, a summary of them, with such comments as
occasion may elicit.

Accordingly, mama, we are informed, is attended by in¬
creased vascular activity in the circulation of the brain ; and,
in as far as this increased activity is prolonged and uninter¬
rupted, a depletory discipline must be continued; that as the
disease lurks in an insidious form, even after its active efferves¬
cence may have been subdued, the same discipline must be
sought for to combat it ; for u though the paroxysm of mania
be subdued, it leaves a mitigated excitement behind, which,
unless followed to its close by depletion, will revive the diseased

The disease at its commencement seems inclined to adopt
what we may call a remittent course, consisting of paroxysms or
violent exacerbations, with intermediate states of comparative
quiescence. This form of the disease ends in another, which may
be termed its continuous state ; — not absolutely distinct in kind
from the former, but one in which the states of excitement have
been so much reduced, and that of quiescence is so much elevated,
that this term seems nearly applicable from the uniform appearance
which the disease then assumes/’-— p. 20.

This is our author’s sketch of the disease, as viewed in re¬
lation to its physical symptoms and the treatment which those
symptoms indicate.

The importance of seizing the features of it at an early
period, he founds upon three considerations: — 1. that the
time required for effecting a cure is short in proportion to the
earliness of the period at which it commenced : 2. that the
patient, while left unmolested by depletion, is in personal
danger from the effects of his own moodiness: 3. that the
mildness of a paroxysm, when it supervenes, is in proportion to
the activity of depletion with which it has been preceded.

Some of the symptoms common to insanity are then de¬
tailed ; but as the Drs. Mayo profess that they are viewing £t the
disease in relation to the plan of treatment which we recom¬
mend, and to the symptoms on which it is founded, they decline
invading that extensive subject”! This conclusion pre-supposes
an entire knowledge of all the usual symptoms which characterize
insanity, and renders what is said on the diagnosis of little
utility to any but those experienced in all the phenomena of
it.

The pulse, it is remarked, if it be not more frequent than
in health, is quicker in each individual beat, and there is a

Mayo's Remarks and Forster’s Observations on Insanity, $e. 489

disproportionate action between the carotids and the radial
arteries ; that venesection or cupping in such a state of the
disease . will often produce evident temporary excitement,
amounting to a paroxysm ; that during the remittent stage
bleeding often evidently occasions head-ache* “ where head-ache
has oeen the only phenomenon wanting to complete a set of
symptoms usual [usually] co-existent.”

“ T]ie history of apoplexy/' adds our author, “ points out with
suftcieni evidence, that it there is a state of overactive circulation,
v lich pi educes head-ache, this state, heightened to a more intense
degree, will produce a heavy stupid feeling rather than pain. Thus
t ie process which lessens vascular action may occasion head-a^he ,y
— p. 24;

r ^ 'f' c thence to deduce* that the head-ache resulting
irorn depletion during the remittent stage of insanity is fi
desirable symptom, in addition to those already existing ?
that over-active circulation* already producing head-ache tolso
intense a degree as to bring on coma, is to be preferred ? and,
therefore, that the process of depletion* which lessens vascular
action, is to be pursued for the puroose of super-inducing
head-ache ?' 1 *

To justify his reasoning and inferences, Dr. T. Mayo, in
a note, quotes the practice of Drs. Scott and Curry in those
sympathetic affections arising from disorders of the liver, and
the circumstance* that cupping has developed the pain in that
vise us, and removed it from the sympathizing limb. But we
cannot allow that the analogy here attempted holds good.

i>ut the authors profess that it is their mam object to induce a
continuous form of insanity, as being the general precursor of
permanent recovery $ and pronounce, that, “ under an inter¬
rupted process of depletion, the disease proceeds through
paroxysm and remission until it has reached” this desired
(continuous) condition ; and that up to this point the course
of the disease lies ordinarily through paroxysms or exacerba¬
tions, diminishing in violence, but increasing in duration •
finally, they present, as adapted to these considerations of the
disease, their remedial plan, which consists

m occasional cupping or bleeding, — of the use of issues or setons,
- — of continued purgation, — of nauseating medicines,— -finally, of the
class of sudorific and refrigerant medicines. To this last-mentioned
class of remedies we attach, however, very secondary importance/'
■ — p. 26.

But although the system of depletion be so strongly recom¬
mended during a state of remission, yet our authors" appear to
vacillate in the line of practice which ought to be pursued
during a state of paroxysm.

vo l, viix.— -no, 48 3 ii

490 Analytical Review,

se A paroxysm is throughout to be resisted by medical means ;
but those adopted while it is impending seem most effectually to
determine its magnitude. On the question of depletion during the
paroxysm, there are contra-indicants to be considered. The patient
is in danger from exhaustion. Depletion has a direct effect in weak¬
ening him, an indirect effect in preventing his weakness by lessening
excitation." — p. 28.

The latter sentence leaves us rather at a loss to decide,
whether we should ehuse depletion on account of its direct or
indirect effect, since it appears it may produce two effects so
very opposite, as causing and preventing weakness. But let us
proceed :

ec Sometimes indeeed the complaint exhausts itself in one great
paroxysm, and out of that at once becomes continuous. Sometimes,
though rarely, it will terminate with the paroxysm. We regard
this, however, as one of the most important advantages of conti¬
nued depletion, that such violence of paroxysm is usually prevented
by it; since violent paroxysms are often fatal to the patient. Yet
are they the effect of that misjudging cautiousness which intermits
depletion as unnecessary during the remission, or even prepares a
portentous reaction by prescribing tonics to obviate the effect of
previous depletion. Our treatment appears at once to bring for¬
ward and to modify the states of excitement in madness. Such
have been its effects where the disease has been proceeding for
months, even for years, in the form at first described ; symptoms
increasing indeed, but maintaining their passive character. At
such a period, by bleeding and the use of purgatives, we have at
once brought forward the disease in the shape of modified parox¬
ysms. Had it continued its sullen march, it would at its own time
have burst perhaps into a fatal paroxysm, or have slowly proceeded
into fatuity.” — p.

Little reliance is placed on any remedies, except such as
come within the scope of depletory. Sedatives, or rather narco¬
tics, are casually noticed. Stramonium and belladonna have
been tried by Dr. Mayo, sen. till the fauces were dry and the
pupils dilated ; but he never saw any good obtained from their
use ; except once, when he treated a case of puerperal fever
with stramonium : opium he also but once found beneficial,
where insanity had been produced by intoxication. In the
enumeration of sedatives, we are surprised to find the digitalis
wholly omitted. The most satisfactory evidence has been
adduced of its influence on the circulation ; and, according
to our authors1 theory of mania, we should have thought it a
most important adjunct to their curative plan of treatment.

Some very judicious remarks follow respecting hereditary
insanity ; which hitherto has been weakly supposed to require
a different course of treatment to occasional insanity.

t£ If we are correct in our sentiments, w say the Drs, Mayo,
6( oil the subject of depletion, we are bound to impress them on

Mayo’5 Remarks and Forster’* Observations on Insanity, $c. 401

T]le ^nc^s those who start at the debility occasioned by
c epie ton, continued even into the apparent intervals of the
t lsease. If the patient be weakened during the remission, he
is on the other hand ensured against falling a victim to the
pai oxysm. 1 his may be true ; but such reasoning affords
uitie assurance of confidence in their own practice: in truth,
it leaves no alternative between idiotism and death. The ter¬
mination of the continuous stage, which the Drs. Mayo are so
anxious to produce, they say, may be produced at once, as
;ar as mental aberration is concerned, and the patient be
instantaneously restored to the fulness of his intellectual and
moral properties ; but his physical progress may probably be
ess lapid : although they have been gradually improving,
yet the improvement of the mental symptoms, we are assured,
is, however, ordinarily as progressive as those of the body.

Although the general necessity of practising daily depletion
throughout the continuous stage is urged, yet at this period,
it is lemarked, it must not be pushed to the same extent as
formerly. ^ Strong purgatives, we are advised, even when their
operation has not been violent, (by-the-bye, we have always
believed that the strength of a purge is indicated rather by its
operation than its proportions,) will often, during this stage,
produce fainting : nevertheless they are serviceable. Caustic
issues behind the neck apparent!?/ do good at this period. The
recovery of a patient has been evidently promoted by the
copious discharge from an accidental burn ; but during the
remittent form, a similar accident has occurred without any
advantage.

A capricious and fanciful depression of strength is said
often to attend the continuous stage of mania, that this
depression is lessened (a fanciful depression lessened !) by the
processes of depletion, and, it is added, that there is frequently
indeed much real weakness, attended even by anasarca. That
such a state may appear to indicate the exhibition of tonics is
acknowledged ; but it is asserted that tonics do harm in this
case “ as far as the disease is concerned for that while the
enfeebled frame demands their aid, and while they are operating,
mania is gaining ground ; and at all events it will be less
dangerous to strengthen by a tonic regimen than by tonic
medicines. J

Our perceptive faculties we fear are not yet sufficiently
developed ; for we confess, that in pursuing the authors’
theory and practice, we are quite led beyond our powers ; and
the following passage makes us totally despair of arriving at a
clearer view of either : perhaps our readers may be more for¬
tunate :

“ Again, if efforts made without avail to resist sensations of feeble*

3 e 2

49£ Analytical Review.

ness and muscular debility could prove the reality of such feeble-*
ness, it has possessed the strongest evidence of its being genuine,
that proof -of tills kind can supply, Where the philosophical efforts
of a well-regulated mind, assisted by bark and steel, have been
defeated, the patient has obtained strength out of weakness, and has
been re-established by a course of unintermitted, though gentle,
depletion/' ! — p. 38.

Dr. T. Mayo next proceeds to consider the sympathetic or
simultaneous derangement of other organs besides the brain ;
but tliis part is very slightly touched upon, and, in our opinion,
too slightly, considering how frequently insanity is sympa¬
thetically excited.

Some observations succeed on the treatmeat of mania when
appearing under the cloak of other diseases and in an acute
form, and wherein, no doubt, the depletory practice may be
very judiciously adopted.

In reply to the seif-put question, what is our prognosis ?
our authors answer, that they “ do not consider long prior
duration of the disease in itself, and absolutely, an unfavour¬
able circumstance/”

If the disease have passed into its continuous form, without the
co-operation of medical discipline, this we hold an unfavourable
occurrence. The disease may, however, at the end of many years,
still be remittent, with nearly the same symptoms with which it
commenced. In the continuous state oedema is a frequent pre-*
cursor of recovery. Should the disease go backward, and a parox¬
ysm or severe exacerbation be threatened at this period, as the action
pf the carotids rises, the oedema will suddenly disappear/’-— p. 53.

Other prognostics are stated ; but they are such only as
every one acquainted with insanity must have seen and decided
upon.

We have thus endeavoured to give as faithful an outline of
the pathological and therapeutical views of the Drs. Mayo as
the complexity of the arrangement of the work will permit.

In anticipation, our authors next proceed to the consideration
of the Objections likely to be oppugned to their views regard¬
ing insanity. Objections to those views we candidly avow we
entertain ; and these we shall, with all due deference, briefly de¬
rail. Of course we, as well as the authors, exempt insanity arising'
from vice of conformation, or from accidents producing dis¬
organization of the structure of the brain, from present
consideration.

Fully conceding, that the majority of examinations of the
heads of maniacs exhibits unequivocal proofs of morbid excite¬
ment of the vascular system, or of organic lesions, yet it does
pot follow, consecutively, that because such is the most frequent
htatc of the encephalon, that these morbid appearances are inva-

Mayo’s Remarks and Forster’s Observations on Insanity , $c. 403

11 ably seen in the heads of all those who have died mad. On the
conti ary , it is known that sometimes no morbid appearances at
all can be discovered. For authority, we might appeal to many
British and foreign pathologists ; but we will refer to one only,
whose testimony will perhaps be respected by Dr. Mayo as much
as it is by us ; it is that of Dr. Esquirol. In the comprehen¬
sive view, which that physician has taken of insanity in the
celebrated article in the Dictionaire dcs Sciences Medicates,
under the word “ Folie," he concludes his pathological in¬
quiries by nine corollaries; the sixth of which is, “ Bcciucoup
d' ouver tures de corps I alienee no'nt presente aucune alteration
quelconque”

ISiow we will admit that some alteration or peculiar modi¬
fication of the cerebral structure may exist, although impercep-
tible to the eye on the most minute research, and that this may
afreet the cerebral functions so as to produce lesion of the
mind. But if this change of structure be incognizable to
our gross perceptions, and while the physiology of the brain
is so defective, are we justified in urging the efficacy of any
specific methodus medendi upon the mere presumption of what
cannot be demonstrated ? If this cannot be answered in the
affirmative, does the negative prove it ? Will analogy support it?
No ! The majority of the crania of insane persons presents
on examination a great variety of morbid appearances. But
lias ^ not every morbid appearance, exhibited in the skulls
of the insane, been displayed in those who have died of other
diseases, but who were perfectly sane ? and have not various
organic lesions been discovered within skulls, the existence of
which, during the life of the possessor, could not, d priori ,
have even been suspected ?

Insanity will often and long remain, when the physical cause
whence it originated has ceased ; and this may be the case
whether that cause be an increased impetus of blood, or loss
of balance of the circulation, or viscera morbidly affected.
That derangement of the intellectual functions often pro¬
ceeds purely from disordered circulation, is strongly indicated
by the discrepancy in the stroke of the heart with the pulse of
the carotids, or the radial, or other arteries: an anomaly
common in persons actually insane. Local determinations
of blood are likewise frequent in those who are insane ; but so
are they also in the sane. But these irregularities, and many
other derangements of health, consist only in morbid actions,
not always effecting changes of structure.

These facts have induced the inquiry whether insanity
be an idiopathic or symptomatic affection ?

In some observations on the pathology of insanity which we

494 Anahjiital Review. -

ventured to offer*, we expressed our opinion that insanity is
most frequently, if not always, an effect ; and that it is more
often excited sympathetically, by a morbid condition of the
thoracic or abdominal viscera, than had hitherto been imagined.
This opinion was founded partly on the evidence of other's *
but we may repeat, that our own observations upon inspecting
the bodies of those who have died insane, have since still more
confirmed us of its truth. It is remarkable, and it is to be
lamented, that most of the examinations of the dead bodies of
insane persons have been confined to the head only ; some have
been extended to the thorax and abdomen ; but very few in¬
quirers have judged it expedient to look beyond the brain.
Hence, perhaps, the little light that pathologists have shed
upon this interesting subject.

When we witness in insane persons obvious deviations
in the performance of the vital functions ; when dissections
exhibit in their bodies morbid appearances which are equally the
concomitants of other diseases as well as of insanity ; and when it
is allowed that anatomical researches also shew, that many who
have died mad exhibit no appearance indicative of any organic
change of structure; nay, that the inquirer cannot discover whe¬
ther the mental derangement was idiopathic or symptomatic,
primary or secondary— how can a uniform system of thera¬
peutics be inculcated consistently with reason"?

It has long been an opinion, that, where insanity arose from
disordered arterial action, a torpor of the venous system super¬
vened, destructive of that equilibrium so essential to health of
the body, and perhaps of that harmony on which depends that
of the human understanding. Abstraction of blood, and other
means of depletion, which might be ve('y proper when the in¬
crease of arterial action commenced, or was predominant, would
in that state of venous torpor that follows excessive arterial
action, perhaps be very injudicious : it might produce real
debility, and, if persisted in, irremediable chronic dementia. "

We perfectly agree with our author, that

“ the phenomena of febrile disease have sufficiently proved that
increased action, whether combined with augmented vigour or with
weakness, may depend, at one period or another, on depletion for
its cure

and feel that medical science never achieved a greater triumph
than when the Brunonian theory was exposed and deserted.
But we cannot concede that the phenomena of febrile disease
and of mania are sufficiently analogous to admit of parity of
treatment. We believe that the one never has its origin in

* Repository, vof vi. p, 24$.

*\Iayo s Remarks and Forster’s Observations on Insanity , §c. 495

true debility, although the other frequently may: ergo, deplc-

treatm'n^f1101 *° be adillitted ^ a general principle in the
tieatment of insanity. r

Corroborative of' the many opinions obnoxious to those of our

oenero! 1 ?°!lnf tl.on ,of de,bi% with mania and the

of n r' | CaL'yi ^ <)eJ)Ie,tl0n 1,1 such cases, we may quote that
( Di. Edward Perava , Physician to the Hardwicke Lunatic

V iU?vin ^uol]n> III an admirable paper* on Ma-

macal D?lseases and the Methods of curative Treatment, ob-
seryes that So nearly is maniacal excitement allied to debiliti /,
turn I have witnessed tremors, fainting, and cold perspiration,

b !OLp su Ejects, on removing a smaller quantity of blood"
ttian is here specified (twelve or fourteen ounces).’* '

Bin, say our authors, 44 in mania, weakness would often
appear depending on some unknown condition ; by removing
v nch (an unknown condition !), depletion removes such weak-
ness. lms may be logic ; but we don’t understand it.
/ : SUCi; reas°mng and such treatment is calculated to

tuat state of the disease which to these Physicians an-
pear a great desideratum, viz. the continuous form, is very
possible ; and indeed such results coincide with general expe-

m t US nd \l\ m°St °ther countries» that long-continued
^p.etion by Food-letting will certainly induce a form of the
(a,-, ease so continuous, that — few patients submitted to it will
evel 0e restorer to the exercise of sound reason.

F "i have heard/' says Dr. T. Mayo, -in conversation with
F each physicians, and read m their works, that depletion pushed
far, and long continued, leads to a passive form of the disease very
dimcmt ox cure, if not incurable. This form of the disease they

a'WT r* r aiS° VleT-gSneral dePletion as leading to a legs
a,,ive form of the disease, which we call its continuous sta»e • bu*

Vlew this of mania as a natural forerunner to ^ery^

; {ere lb an apparent difference of opinion : under which we should*

either admit> that depletion has been carried
f . <f\ or. assert that it has been desisted from too soon. In the
, 11 13 not inconsistent with our views, that the complamt

dPoUiJ l—te *n fatuitF 111 the second case, we argue, that die
}a-S proceeded through its natural course into the continuous
. toge, which, we view indeed, as ending in recovery, if duly followed

We have acknowledged that the practice recommended mav
e occasionally, and especially in the incipient stage of insanity
ingjpy proper : sometimes cases present, in which we should

* Vide the Dublin Hospital Reports and Communications • ^
most interesting collection, just published. *

496

Analytical Review

think ourselves authorized to pursue a much more vigorous
system of depletion than is laid down in these tg Hemarksf7
But the elder Dr. Mayo advises the depletory system, 66 as
the most applicable in advanced states of insanity— as the most
certain of effecting a present cure^ — the least liable to end in
subsequent relapse.”

With the French writers we cordially coincide, and pro¬
nounce that such practice, without a much greater degree of
discrimination than the Drs. Mayo inculcate, will, generally,
lead to a state of fatuity. But a state o? fatuity, say they, is not
inconsistent with their views! If it he not inconsistent with
their views, that the complaint should terminate in fatuity, we
w ould inquire how such opinion squares with that in the pas¬
sage already quoted (p. 490), where it is more than implied,
that, next to a fatal paroxysm, fatuity is an evil most to be de¬
precated !

It is impossible to refrain from feeling some apprehension
for the consequences of the generalizing principle our authors
so unguardedly advance. They must be perfectly acquainted*
that JJenience/h a generic term, admitting of several species;
and that M. Esquiroi divides these into simple and compli¬
cated : and yet they use demence and fatuity as synonymous.
We are also told "that the French deem demence “ very
difficult of cure, if not incurable while they (the Drs.
Mayo) look iqx>n “ this form of mania as a natural forerunner
to recovery P1 Now the acute form of it, which must be the
form our authors similate with fatuity, and so much desire to
produce, M. Esquiroi says (See Diet, des Sciences Medicales,
tom. viii. p. 292) is easily cured; not, however, by depletion,
but with the aid of regimen, tonics, frictions, exercise, baths,
%c. &c. But it is the chronic form which is so difficult of cure;
the cases of which are represented to be in the proportion of
seven to two of the acute : and it is into the chronic form of
demence that we conceive the practice of the Drs. Mayo will
inevitably lead, if it be exercised in the indefinite manner they
recommend.

Ample room as there may be for complaint of neglect or
ignorance, yet we must not, in our fervor for improvement*
conclude that there was nothing regarding the treatment of the
insane to commend or worthy of attention prior to the late in¬
quiry. Every observer has not been blind ; and we are bound
to regard with respect the remarks of experience, even although
they may not emanate from doctoral authority. We are told
by the intelligent and philanthropic Take, that, in violent ma¬
niacal paroxysms, depletion having failed to procure quiescence,
a full meal of meat and good porter for supper produced the
desired effect ; and that “ this mode has since been very fre-

Mayo’s Remarks and Forster’s Observations on Insanity, c$t. 497

quently and successfully employed.” Now it follows, that if
Mr. Tuke, and there are others coinciding with his opinions
and practice, is correct, that the Drs. Mayo cannot be right in
their general principle of pursuing depletion through “ paroxysm
and reremjssion — either Mr. Tuke, and those acting like
him, or our authors must be wrong. Whenever novel views of
disease are promulgated, introductory to a novel system of the¬
rapeutics, it behoves every medical practitioner to investigate
the grounds on which they are founded. However high or
respectable in professional rank, and although he may have had
as “ extensive practice” as we are told Dr. Mayo, sen. has had
in insanity, yet we Cannot allow that even such pretensions jus¬
tify the withholding of the details of the cases which have led to
such inferences and practice : nor is it likely that the public will
accept the reason offered at the end of the fourth chapter, as an
excuse for the omission of them. ,

Anxious as we are for information on the subject of insanity,
and knowing as we do the ability of both these learned physi¬
cians to illustrate every subject within the circle of medical
science, still we cannot but lament that they have not been more
explicit. We know our fallibility ; and we hope we are open
to conviction ; but until further proofs establish the efficacy of
our authors’ system, we cannot discard our doubts. A full
description of mania might be dispensed with ; but an accurate
detail of the cases in which the practice recommended had
been successful, would perhaps have deprived scepticism itself
of every pretence for cavilling.

There is one obligation, however, which Science decidedly
owes to the Drs. Mayo, and which may have consequences infi¬
nitely more important than may strike indifferent observers. In
the concluding paragraph, as wadi as in the dedication, they de¬
clare that “one principal object of the Remarks has been to arrest
the encroachments of metaphysical speculation on the patho¬
logy of madness.” They who know how difficult it is to divest
themselves of tenets imbibed from Alma Mater , and which,
perhaps, have been cherished as undisputed dogmas of scholastic
faith, will appreciate, in two learned Members of the University
of Oxford, this proof of liberal and independent minds; which
scorn the mazes of metaphysics, when leading from the paths of
true philosophy, and retarding the attainment and diffusion of
useful knowledge.

2. — As the second hook coming under review affects to offer
Observations relating particularly to Insanity, we perused it
with a view of examining if it contained ought worthy of our
readers’ notice ; either in regard to what it professes to treat of,
or to health, or disease generally. With the- author we are un-

vol. vm. — no. 48. 3 s

498 Analytical Review. .

acquainted ; except as a disciple and ardent admirer of tli£
doctrines of Drs. Gall and Spurzheim, and, as an advertisement
at the end of this pamphlet announces him, as a great enthusiast
in speculative and abstruse inquiries.

It will be remembered that Dr. Spurzheim, in his work
on Insanity, offers some ingenious remarks on Periodicity ,
and its effects on the human system. Mr. Forster fancies,
we suppose, that he can elucidate what his master and
friend, with all his learning and ingenuity, has not been
able satisfactorily to clear up ; and therefore he ventures boldly
into the field to inform us of what none will deny — that
the influence of the atmosphere has a sensible effect on
our bodies, and is the cause of epidemic diseases. But he has
discovered, beyond dispute, that there is a periodical influence
occurring twice in twrenty-eight days, whicn affects the brain
and nervous system ; that it differs in different persons ; that
the symptoms of insanity are worse about this time ; and that a
great many other terrible things happen about these periods : —
information that must alarm all the good housewives in England,
and be very useful to the Editor of Moor’s Almanack. We
are also told that there are “ diurnal periods of diseases,1’ in¬
ducing paroxysms : for instance— about noon — at two and six
o’clock — at midnight, &c. &e. That there are likewise periods
which occur every second, third, or fourth day ; that there are
diseases having corresponding periods that all these evils,
enough surely to embitter the happiness of greater stoics
than we are, are visited upon plants, and all animals, quadruped*
as well as biped ; and, finally, that Insanity should be placed
among nervous diseases !

They who profoundly seek to explain the phenomena of
disease agreeably to the phases of the moon, or “ suppose the
influence of the stars to have a causal power,” or attempt to
identify the disorders to which humanity is subject, with atmos¬
pheric variations, must extend their u Itesearches” far beyond
the “ Modifications of the Glouds and, without reference to
obsolete authorities, trust only to the guidance of their own
observations. Nor will their conclusions on such subjects be
tolerated, till time has stamped upon them who 44 vex the
planets,” the seal of unerring experience.

3. — Scarcely were the sheets of the foregoing pamphlet dry,
when, lo ! another, in supplemental form, appears from the
prolific pen of the same author.

Second thoughts are best, says an old adage ; and Mr.
Forster exemplifies the truth of it. To speak with candour,
this posthumous effort is very superior to its parent. It is
evident, however, that vre are under more obligations to Div

Mayo's Remarks and Forsters Observations on Insanity , #c. 499

Thomas Mayo than to the ostensible author for its birth. Had
the former not published his “ Remarks ,” this “ Supplement ”
to the “ Obsei'vations ■” would never have seen the light.

Our author seems to have been quite electrified by the
perusal of his friend, Dr. Mayo's, Essay. He has warmly
and unreservedly adopted his pathological and therapeutical
views ; and with the assistance of the doctrines of his other
friends, Drs. Gall and Spurzheim, and with the aid of his own
important discoveries, has so amalgamated the whole as to form
a very specious theory; which cannot fail of being highly
acceptable to — those who coincide in opinion with the writer.

We congratulate him too upon a real improvement ; which,
considering the short space which elapsed between the appear¬
ance of these two pamphlets, is very creditable to his judgment :
we allude to the correction of his style of composition. It is
so much amended indeed, that we can hardly credit that both
were written by the same person. Seriously, we believe that
this gentleman has respectable talents ; and when passing years
have corrected the ardour and enthusiasm of youth and" ma¬
tured his judgment, we entertain expectations of his producing
works more worthy of himself and the sciences to which he
seems devoted.

4. — This short pamphlet is prefaced by an epistle to the
Hon. H. G. Bennett, M. P. — -a gentleman to whose zeal and
ability the public are much indebted, for the late Inquiry and
Report into the State of Mad-houses in the United Kingdom,
as well as for many other useful labours. It conveys many
judicious observations. The writer very delicately, but justly,
points out several egregious errors in the late measures contem¬
plated by the Legislator for the amelioration and improvement
of the state of the insane. Upon this subject, we will not dilate,
because we have already stated our sentiments upon it at great
length*.

The Report is an extract only, translated from a quarto
volume, published under the authority of the French Govern¬
ment, intitled, u Rapport fait au Conseil General des Hospices ,
par un des ses Membres , sur VEtat des Hopitaux , des Hospices et
de Secours Domicile , a Paris , de.puis le ler Jan. 1804, jusauau
1" Jim. 1814.”

This, being a mere official document, does not in itself admit
of analysis. Its details however at this juncture are peculiarly
important, when so many provincial asylums for the insane are

* Cursory Remarlcs on a Bill for the Regulation of Mad- Houses*
By G. M. Burrows, M.D.

3s£

500

Analytical Review.

aboujt to be erected in this, and the Sister Kingdom*. For the
fidelity of the report, we can in many particulars, from personal
observation, vouch ; and we recommend its perusal to all who
are interested in the subject^. Several very fully and clearly
constructed tables, embracing different views of the progress
of insanity in the Hospitals of Bicetre and La Salpetriere, are
annexed; with some expressive corollaries upon them by the
physicians, M.M. Hebreard and Esquirol.

To this Report the translator, who evidently possesses

* From a friend in Dublin, not less distinguished for talents
than for the rank he holds in the profession, we have been favoured
with the subjoined ; which may be an object of interest, especially
to our Irish readers :

A Sketch of a Division of Ireland into Four Districts ; an Asylum
for the Lunatic Poor to he attacked to each. Submitted to the

consideration of Government 4th of September, 1817-

No. I. — Counties of, 1, Donegal ; 2, Derry ; 3, Antrim ; 4,
Tyrone ; 5, Down ; 6 , Armagh ; I, Monaghan ; 8, Fermanagh.
The Asylum to be capable of accommodating 150 patients, and to
be placed in the vicinity of Belfast.

No. II. — Counties of, 1, Dublin ; 2, Louth ; 3, C avail ; 4,
Meath; 5, Kildare ; 6 , Wicklow. The Asylum to be capable of
accommodating 150 patients, and to be placed in the vicinity of
Dublin.

No. III. — Counties off 1, Kilkenny ; 2, Kings County ; 3,
Queens County ; 4, Par low ; 5, Wexford. The Asylum to be
capable of accommodating 100 patients, and to be placed in the
vicinity of Kilkenny.

No. IV. — Counties of, 1, Westmeath ; 2, Mayo ; 3, Galway ;
4, Leitrim ; 5, Sligo; 6, Longford ; 7 , Roscommon ; S, Clare. The
Asylum to be capable of accommodating 150 patients, and to be
placed in the vicinity of Athlone.

The existing lunatic asylum for Cork , united to Kerry, to be
enlarged if necessary.

The existing lunatic asylums in Limerick and Waterford, and in
Clonmel for the County of Tipperary, to be enlarged if necessary.

To The Rt. Hon. Robert Peel. (Signed) George Remey,

d In our Review of Mr. Cross's Sketches of the Medical Schools
of Pains ( Repository , vol. iv. pp, 370-470.), we gave an ample
account of the French hospitals ; and we embrace this occasion to
mention how much satisfaction we derived this autumn from a per¬
sonal inspection of them. Dr, Burrows had an opportunity of con¬
trasting the present state of these hospitals, but more particularly
of the insane establishments in and near Paris, with that which they
exhibited in 1802 ; and he thinks it an act of public justice to
testify, that the whole of them appear to him to have since received
very great attention and consequent improvement.

Report of the State of the Hospitals for Insane , at Paris. 501

judgment, and evinces that he has paid considerable attention
to the subject, adds a copious Appendix, containing his own
6C Suggestions for the Construction of Hospitals for Insane
Persons,” with an engraved diagram of a plan of a building
for this purpose.

These suggestions offer very many useful hints, also well
worthy of consideration; but we by no means think the plan unex¬
ceptionable: it neither admits of a proper classification accord¬
ing to the degrees or species of insanity, nor of an efficient
superintendance of the patients. Other objections might be
urged, if space permitted.

Anxious as we profess to be to promote every scheme which
appears calculated for the recovery of the insane; and where
that cannot be expected, for the maintenance of them in
that degree of health, comfort, and security, of which their
afflicted condition is susceptible ; yet we cannot omit this oppor¬
tunity of urging those concerned in the construction of such
places, not to be too precipitate in carrying their designs into
effect. An immense massof useful information, it is true, is already
before the public; yet such is the general interest excited,
that we feel confident much more will be elicited, from the
laudable determination of the Legislator to give the subject, in
every point of view, a full and dispassionate consideration
early in the next sessions of Parliament. But we believe,
that however excellent some of the proposed plans are, yet
that there is none of them so perfect but it will admit of improve¬
ment. W e know too, that the Report of Dr. Esquirol, who has
been commissioned by the French Government to inspect all the
insane establishments, both public and private in France, is
speedily to be published ; and we expect that, from this source,
much additional matter will be obtained, that may contribute
in no inconsiderable degree to the accomplishment of an object
so dear to humanity, as the restoration of the insane to their
intellects, to their families, and to society.

IT.

An Essay on the Chemical History and Medical Treatment of
Calculous Disorders. By Alexander Marcet, M.D,
F.R.S. &c. &c. 8vo. pp. 118, and 10 plates. London,
1817. Longman and Co.

It is truly gratifying to contemplate the change of opinion
which the last twenty years have produced with respect to the
importance of Chemical Science as a collateral branch of medical
education. It is now generally and minutely studied ; and the
pathologist willingly admits, that chemistry, in aiding belabours.

502

Analytical Review.

has, like irrigation, fertilized a soil, which, if hitherto unpro*
ductive, was so only from the deficiency of knowledge in the
cultivators to draw forth its riches. In no part of medical
science, however, has the influence of chemistry been more
conspicuously displayed, than in the light it has thrown upon
the nature of calculi, and the consequent improvements which
have resulted in the treatment of calculous disorders. Hence
the great value of every work that can render this species of
knowledge more familiar to the practitioner ; a fact which must
plead our apology for bringing before our readers this volume
so immediately after its publication, while many interesting
works of prior date still remain unexamined.

The object of Doctor Marcel’s Essay, to employ his own
language, “ is to describe and illustrate, by means of accurate
engravings, the characters by which the different calculi may
be distinguished ; to indicate the easiest analytical methods by
which their chemical nature may be ascertained ; and to point
out the modes of medical treatment which afford the best
prospect of success.” In fulfilling these intentions, he has
divided his subject into eight chapters; and although each of
these may be regarded as in some degree a distinct essay, yet,
by the judicious arrangement he has adopted, every one seems
a necessary link in the chain of information, which the whole
is calculated to complete.

In the first chapter, which treats “ of the different situations
in which calculi are found in the urinary passages, and of the
symptoms which they respectively produce,” our author sets
out with assuming the position, that as these concretions occur
independent of any specific agency of the urinary organs
themselves,” they 6i are liable to form in any of the cavities to
which the urine has access but at the same time the parti¬
cular form of some of these parts, and other circumstances
either natural or morbid, facilitate in them the deposition of
calculous matter. Thus in the kidney , from the peculiar
structure of the organ, producing “ a kind of double filtration
of the urine, which is highly favourable to the deposition of
an undissolved calculous matter,” concretions are frequently
formed. Our author has exemplified this fact by two engra*.
vings of kidneys from the collection of JYIr, Abernethy ; in one
of which the pelvis is greatly enlarged and distended with
separate calculi closely pressed against each other, and in the
other the concretion is a single mass moulded exactly to the
form of the cavity, greatly distended, however, with all its
ramifications. In both, the texture of the gland is much
altered. In cases of this nature, the secretion, is carried on by
the other kidney ; but occasionally, as Dr. Marcet remarks,
“ both kidneys are diseased to a most remarkable extent, anti

Marcet on Calculous Disorders . ,$03

yet life is preserved for a considerable time.’1 When the kid^
ney is thus distended, the concretions usually extend into the
superior part of the ureters , expanding it into a kind of pouchy
while the coats of the tube below it are considerably thickened.
We are rather surprised that our author has not mentioned the'
total obliteration of the canal of the ureters, which now and
then takes place when the pelvis of the kidney is filled with
calculous matter, two cases of which have come under our own
observation. He notices, however, a circumstance of rare
occurrence, that concretions may form in the duct itself; and
states that he has seen “ an instance in which the internal

membrane of the ureters was lined with a calculous con¬
cretion.

The situation of calculi in the bladder is illustrated by two
engravings ; in one of which the stone, as in the majority of
eases, lies free in the viscus, the coats of which are much
thickened and contracted round it ; while, in the other
64 several calculi are seen enveloped and fixed in distinct cysts
©r rugae, formed in the substance of the bladder.” He mentions*
an instance of a single stone being incysted in this manner
which weighed 3088 grains ; and yet the patient “ never had
the usual diagnostic symptoms of the stone, namely, sudden
stoppage of urine, pain in the glans penis, &e, and he had
never consented to be sounded.” The stone was found after
his death, and consisted of two distinct masses of lithic acid
cemented together “ by an intervening layer of crystalline
tnple phosphate.” The manner in which small* calculi are
occasionally impacted in the urethra is also illustrated by an
engraving from a preparation of Mr. Ahernethy. The stone
iC spheroidal, and the coats of the canal are very much thick¬
ened, particularly round the place where it is fixed. This ease"
adds our author, “ is the more instructive as the stone was
first mistaken for a stricture, and an attempt was actually
made to destroy it by the caustic.” The representation of
another preparation from the collection of the same gentleman
serves to exemplify the formation of calculi in the prostate
gland) when these were found embedded 111 its substance ; and
the manner in which they form a cyst in the lobes is also
displayed.

,._The symptoms attending the presence of calculi in the'
different situations we have noticed, are next briefly described
by Dr. Marcet. Among those diagnostic of stone in the kidney
he has overlooked one of the most striking, and which is so
much the more necessary to be mentioned, as it is not observed
to occur in mere inflammation of the kidneys when no calculus
is present. We refer to the dark appearance of the urine as if
it were mixed with coffee grounds* evidently depending on

50i Analytical Review. •

broken-down particles of blood, proceeding from the obscure?
but continued irritation of the kidney. When this occurs, in
conjunction with a dull heavy pain in the loins, there can be
very little doubt of the presence of calculus in the kidney.
Our author justly remarks, that a decisive diagnostic symptom
of the presence of calculi in the prostate gland “is still wanting.'1"
He notices a case which came under the observation of Mr,
Astley Cooper, u in which this pathological point was clearly
decided by manual examination.” A sensation of grating at
the neck of the bladder was perceived on passing a catheter,
“ and the finger being introduced into the rectum, some calculi
could be felt moving in a cyst within the prostate an ope¬
ration was proposed, but objected to by the patient, who died
a few years afterwards, when the prostate was found to contain
a number of calculi.

The second chapter, which treats 54 of the different preva¬
lence of urinary calculi in various districts and hospitals, and
of the comparative frequency of the disease in different coun¬
tries, ,1 contains some curious and interesting matter ; but we
must lament with our author, that this account is much less
complete than might have been expected, owing to no regular,
or at least ostensible, records of the cases of lithotomy “ being
preserved in many hospitals, and particularly in the largest
hospitals of London, St. Bartholomew’s, St. Thomas’s, Guy’s,
and the London hospital.” The only place from which a very
accurate statement was procured by him was the Norwich
hospital, in which a regular register of the operations has been
kept, and the calculi extracted preserved, for forty-four years.
To this collection our author had access, and was furnished
with an abstract of the records annexed to the calculi, from the
details of which the following table was constructed.

Returns of the Cases of Lithotomy in the Norfolk and Nor wich

Hospital, from 1772 to 1816 ; making d period of 44 years ,

Number of Operations.

Deaths.

Children
under 14.

Adults.

Total.

Children.

Adults.

Total.

Males .

227

251

478

Females...

- - .. _ -

2 35

271

506

u It appears from the above table, that the mean annual number
of cases of lithotomy in the Norwich Hospital, during the last forty-
four years, has been 11|, or 23 in every two years; and that the
total number of fatal cases, in the 506 operations, is 70, a pro-

Marcet on Calculous Disorders.

507

portion of deaths corregpending to 1 in 71 or 4 in 2 9. It ap¬
pears also that the proportion of females undergoing the operation,
is to that of males as 58 to 1000, or about 1 to 17; and that the
mortality from the operation in children is only about 1 in 1 8 ;
while in adults, it is 4 in 19, that is nearly quadruple.” — p. 25.

He lias given, also, a tabular view of the comparative pre¬
valence of the disorder, at different periods, in the same hos¬
pital, which we do not extract, as the variations of the number
of operations of lithotomy in any hospital depend on very dif-
feient causes, altogether independent of the prevalence of the
disease ; and, notwithstanding the average proportion of ope-
lations ol lithotomy in that hospital, corresponding to the total
number of patients admitted, is as one in thirty-eight ; a pro¬
portion greatly exceeding that in any other public institution,
to the records of which, Dr. Marcet had access ; yet, we think
there are scarcely grounds for concluding, that this circum¬
stance can be 44 traced to any peculiarities in the habits or
situation of that district.”

In St. 1 homas’s Hospital, in Cheselden’s time, the pro¬
portion which the operations of lithotomy held to the total of
patients admitted, appears to have been nearly as one for every
26S patients ; while in the last ten years, according to a state¬
ment furnished by Mr. rl ravers, it has not exceeded one for
every 528 patients : but this difference perhaps may be ac¬
counted for from the extraordinary reputation of Cheselden in
this operation. In St. Bartholomew’s Hospital for the last
five years, as Mr. Lawrence has endeavoured to ascertain, the
annual average has been about 44 eleven cases of lithotomy,
or one case in each [every] 340 patients and in Guy’s, al¬
though the statement is merely guessed at, the average may,
perhaps, 44 be considered as one in about 300 patients.” From
these data, our author conceives he is authorized in concluding
that lithotomy is less frequent in London than formerly ; a
fact that we think depends less on any change in the diet and
habits of the people, than in 44 the circumstance of calculous
patients not resorting so exclusively, as was formerly the case,
to the great London hospitals for the operation.” This,
in our opinion, arises in some degree from the more general
establishment of county hospitals ; but also in part from the
superior attainments of young surgeons of the present day,
enabling them more readily to operate in private..

In the Edinburgh Infirmary, the average of the operations
for the last six years has not exceeded two in the year, al¬
though the annual number of patients is about 2000 ; in Paris,
in Mopital de la Chante , the annual average is from ten to
twelve, the admissions being from 2500 to 2600 ; in FHopital
des Enfans Maladies , where 3000 children under the age of
fifteen are annually admitted, the average is about six. In an

VOL. VUI.-rNO. 48. 3 T

308 Analytical Review .

hospital at Clermont Fcrand in France, in which the annual
admissions are 2000, the average of stone cases for the last
twelve years has been six ; and at Rouen, out of 7300 patients
“ during the last eighteen months, twelve have been operated
on.1’ From Vienna no returns were obtained ; and very few
cases of the operation occur there, owing to a prejudice existing
against it : at Geneva, in a population of 30,000 souls, litho¬
tomy has been performed thirteen times only in the last twenty
years, and seven of the thirteen patients were not strictly Ge¬
nevese ; while at Lyons, which is eighty miles only from
Geneva, “ the disease is stated to be rather frequent.”

The Norwich table might be supposed to confirm the ob¬
servation, that a considerable number of the cases of calculi
occur in children ; but our author justly remarks, that 44 this
obtains only among the poor classes and even not among
these, if they be well fed. In the Foundling Hospital, for in¬
stance, into which 1151 children have been admitted within the
last twenty-seven years, three cases only have occurred ; and
in the Military Asylum at Chelsea, 6000 children have fur¬
nished one case only of stone.

From these inquiries, Dr. Marcet is led to conclude, that
“ the tendency to form urinary calculi must arise from some
general causes” independent of diet ; and keeping in view the
fact, that the disease is nearly unknown in tropical climates;
and that great changes in the urine are effected by different
states of the surface, he suggests it as a subject for inquiry,
“ whether there may not be some essential connexion between
the state of the cutaneous functions, and the greater or less
prevalence of this class of disorders.”

Having concluded these preliminary remarks, our author
passes on to the more immediate object of his task, and treats,
in the third chapter, of the different species of urinary calculi,
of their external characters, and of their chemical nature and
classification. He objects to that classification which has led
to the expressions renal, cystic, or urethral calculi, 44 with a view
to indicate that they had their origin in the kidneys, the blad¬
der, or the urethra and advances satisfactory proofs that the
varieties of calculi which the urine deposits are all 44 liable to
appear in the different parts of the urinary passages/’

Those found in the kidney differ from each other, not only in
shape, size, and external appearance, but also in their chemical
nature. When not in one mass assuming the shape of the
interior of the organ, (be more general figure is round ; but in
some instances they are of a polygonal form, commonly having
three flattened sides.

44 These/’ adds he, “ are sometimes of a fawn or yellowish brown
colour, sometimes grayish, their surface in either case being often
remarkably smooth, as if coated writh a fine varnish, or even in some

Mareet on Cell cut our Disorders. 509

instances having a degree of metallic lustre not unlike burnished
copper/' — p. 49.

The calculi found lii the bladder equally 44 vary11 in size,
01 m, and otner external qualities- They are spheroidal, egg-
shaped, almond shaped, polygonal with flattened surfaces, and
even sometimes almost cubic : “they vary from the size of a
few particles of sand agglutinated together, to that of a mass
aunost filing the bladder.” Their colour, which differs, often
indicates their chemical nature : thus, when of a fawn or ma¬
hogany colour, u they almost always consist of lithic acid;11
when wnite or greyish white, 44 they always consist of earthy
phosphats ; when dark brown or blacky hard in their texture
and tuberculated, they consist of oxalat of lime ; and when
their surface is uneven, crystalline, and “ studded with shining
tiansparent particles,11 they may be regarded as consisting
chiefly of the ammoniaco-magnesian phosphat. In specific
giavitv calculi vary between 1200 and 1900, water bein^
1000 ; and our author observes that, 44 when sawed through,
they exnale a faint animal smell/1 As it is probable that all
natural calculi originate in the kidney, the nucleus is usually
lithic acid; but any foreign matters introduced into the blad-
dei, a circumstance which experience has proved may happen,
almost invariably become the nuclei of calculi. But calculi are
not always homogeneous ; and Dr. Mareet correctly remarks*
tiiat their alternate layers often present specimens of each of
the various species of calculus*

The calculi found in the prostate gland seldom exceed the
size or a millet seed, are generally more or less rounded, and
of a yellowish brown colour. These external qualities of calculi
are exemplified in the plates.

Before entering upon the chemical examination of calculi,
our author gives a brief history of the discovery of their com¬
position. It is unnecessary for us to follow him in this part
or his tract ; and we have only to state that Scheele was the
first who developed the chemical nature of urinary calculi ;
ana that to the labours of Dr. Wollaston we are most indebted
for the knowledge we now possess on that subject. Fourcroy
is accused of having assumed Wollaston’s discoveries as his
own, a charge which undoubtedly requires to be cleared up;
and which we trust will arrest the attention of M. Vaquelin, his
associate in all his researches into the nature of calculi.

4 It is extremely painful," says our author, to be compelled
by justice to notice such an apparent want of fairness and candour
in a philosopher, who devoted a long and brilliant career to the
advancement of science. But unless this circumstance should here¬
after be satisfactorily explained, it will be impossible for posterity

3 T 2

Analytical Review. *

to overlook such an unjustifiable omission, particularly in a maii
whose great fame and peculiar merits as a chemical philosopher,
seemed to preclude all temptation to plagiarism.”

Our author enumerates the following as the component
parts of calculi : “ lithic or uric acid ; phosphat of lime ; am-
moniaco-magnesian phosphat ; oxalat of lime and cystic oxyd
and as one or other of these substances generally predominates
in every calculus, although any of them rarely exists singly,
he thus arranges calculi according to their components :

1. The Lithic Calculus, — 2. The Bone-earth Calculus, prin¬
cipally consisting of phosphat of lime. — 3. The Ammoniaco- Magne¬
sian Phosphat, or calculus in which this triple salt obviously pre¬
vails. — 4. The Fusible Calculus, consisting of a mixture of the two

former.— 5. The Mulberry Calculus, or oxalat of lime. - 6. The

Cystic Calculus, consisting of the substance called by Dr. Wollaston
cystic oxyd. — 7- The Alternating Calculus, or concretion composed
of two or more different species, arranged in alternate layers. —
8. The Compound Calculus, the ingredients of which are so inti¬
mately mixed as not to be separable without chemical analysis. —
p. Calculus from the Prostate Gland.”

As the chemical examination of each of these species is ex¬
tremely important, we trust a little prolixity in our analysis
will be readily excused.

1. The Lithic Calculus , which is the most prevalent, and
the external characters of which we have already noticed, is
easily dissolved in the pure fixed alkalies, 66 from which it xnay
be precipitated in the form of a white powder, by ali the other
acids.” Of the mineral acids, the nitric only dissolves the lithic
calculus, the residue, when evaporated to dryness, assuming a
remarkable bright pink colour. It is sparingly soluble in lime
water: blackens before the blow-pipe, emitting a peculiar
smell, u and gradually evaporates, leaving only a small quan¬
tity of white ash, which is commonly alkaline.” Destructive
distillation resolves it into a new and peculiar acid and a variety
of other products, which do not essentially illustrate its com¬
position.

2. Dr. Wollaston first ascertained that some calculi consist
entirely of phosphat of lime, “ and described their external cha¬
racters in the Philosophical Transactions for 1797, which our
author has transcribed. When pulverised, this species of cal¬
culus dissolves readily in the muriatic or nitric acids. Before
the blow-pipe it first blackens, from the charring of its animal
matter, then becomes white again, and may be ultimately fused,
if the heat be intensely urged ; thus differing from the phos-
phat of bones, which, as it contains a greater proportion of lime,
is not fusible by ordinary means. Dr. Marcet regards this
species of calculus as comparatively rare.

3. The A mmoniaco-M agnesiati Phosphat was first discovered

Marcet on Calculous Disorders .

511

as a constituent of urinary calculi by Dr. Wollaston. It never
forms the entire substance of a calculus ; but it is often seen
<s in the form of minute sparkling crystals diffused over the
surface or between the interstices of other calculous laminae,1’
which are soluble 44 in most, if not all, the acids.” During the
action of the blow-pipe this phosphat emits an ammoniacal
odour, and is imperfectly fused if the heat be strongly urged*
4k being reduced to the state of phosphat of magnesia.” Am¬
monia is also disengaged during the solution of this triple cal¬
culus in the pure alkalies, 44 the alkali combining with a por¬
tion of the phosphoric acid.”

4. The Fusible Calculus, which is of very common occur-'"
rence, was first distinguished by Mr. Tenant, and its chemical
characters developed by Dr. Wollaston. In its external ap¬
pearance it resembles chalk, being white and friable; and often
attains a large size, taking a pyriform shape, with a kind of pe¬
duncle at the broader end, corresponding to the neck of the
bladder; which is well illustrated by a good engraved figure.
It is a mixture of the triple phosphat and phosphat of Time;
and easily fuses before the blow-pipe. It is this calculus which
usually forms around foreign bodies introduced into the blad-
der; and the concretions that form 44 when urine is detained
in any of the passages, are of the same nature*.” We extract
the account of the method of shewing its composition.

44 If it be pulverised, and acetic acid poured upon it, the triple
Crystals will be readily dissolved, while the phosphat of lime will
scarcely be acted upon ; after which the muriatic acid will readily
dissolve the latter phosphat, leaving a small residue consisting of
lithic acid, a portion of which is always found mixed with fusible
calculus. This portion is generally minute ; but sometimes it is
more considerable, and in some instances it is so much so as to give
to the calculus an equivocal character.

“ From the acetic solution the triple crystals may be recovered,
with their characteristic appearance, by the addition of carbonat of
ammonia ; and from the muriatic solution, the lime may be pre¬
cipitated by oxalat of ammonia. As to the phosphoric acid, its pre¬
sence may easily be rendered obvious, after the separation of the
lime, by adding to the remaining liquor a solution of muriat of
magnesia, with some carbonat of ammonia, by which means an
ammoniaco-magnesian phosphat is immediately precipitated in its
usual formf. The neutral carbonat is better adapted to produce
this effect than the sub-carbonat.”

* For an analysis of a concretion of this kind, which formed in
the vagina of a child, by Mr. A. T. Thomson, vide Repository, vol.
vii. p. 111.

44 f The presence of phosphoric acid may also be shown by re¬
ducing it to the concrete state, by the blow-pipe, on a slip of la-

512

Analytical Review . .

5. The Mulberry Calculus was first discovered to consist of
oxalat of lime, united with some lithic acid and phosphat of
lime, by Dr. Wollaston. When finely pulverised^ it is soluble
in the muriatic and nitric acids$ aided by heat : and 44 when it
is digested with alkaline earbonats, the alkali combines with
the oxalic acid, and the carbonic acid with the lime.” On ex¬
posure of this calculus to a red heat, the oxalic acid is volati¬
lized, and the residue is quick lime. But oxalat of lime is also
found in some smooth calculi; and Dr. Marcet has met with
three varieties of small mulberry calculi, having a distinct crys¬
talline texture, which have been hitherto undescribed.

>'c They Were all of a pale brown colour, and the crystals of which
their surface was composed, though at first sight having the ap¬
pearance of mere square plates, proved, upon closer examination,
to be very fiat octahedrons.5'

6. The Cystic Oxyd was also discovered by Dr. Wollaston,
In external appearance it resembles the triple calculus, but is
more compact, is a confusedly crystallized mass, yellowish, semi¬
transparent and glistening ; and has been found remarkably
free from other ingredients. Before the blow-pipe it emits 44 a
peculiarly foetid smell ; and is so easily acted upon by reagents
that it is best known by its insolubility” in water, alcohol,
acetic, tartaric, and uric acids,” and neutral carbonat of am¬
monia. Like other oxyds, it unites with both acids^ and alka¬
lies, for which reason, and as the specimens Dr. Wollaston ex¬
amined were taken lrom the bladder, that celebrated chemist
named it Cystic oxyd; but our author details two cases in
w hich it w as unquestionably of renal origin. He, however,
does not propose to change the name.

7. Compound Calculi in distinct layers 44 are composed of
different species of calculous depositions disposed in layers
around a common nucleus ” The plates exhibit various speci¬
mens of these, and in particular one, 44 in which lithic acid may
be distinctly seen in the centre, pure phosphat of lime next to
this, then oxalat of lime, and ultimately the fusible crust enve¬
loping the whole concretion ”

8. Compound Calculi , with their ingredients intimately mixed .
Dr. Marcet refers to this head all calculi which have no cha¬
racteristic feature indicative of their belonging to any of the
other classes.

minated platina ; the acid, when thus urged, communicating to the
flame a peculiar green tinge. By processes of this kind, the natuie
of the component parts of calculi is easily ascertained ; but w hen
an exact knowledge of proportions is desired, more elaborate ope¬
rations ate required, some of which are pointed out in Dr. Wollas¬
ton's papers in the Philosophical Transactions for 179* an(f 1810.

Marcet on Calculous Disorders. 513

. Jl Dr- Wollaston lias ascertained that all the Calculi found
in the prostate gland consist of neutral phosphat of lime.

. lth regard to urat of ammonia, arranged by Fourcroy as a
species of urinary calculus, our author, in common with Dr. Wol¬
laston anu Mr. Brande, has looked for it in vain; although, from
analogy, he does not altogether deny its occasional existence in
human urinary calculi, having observed it in the urine of the
boa-constrictor. In the fourth chapter, Dr. Marcet describes
two nondescript calculi; one of which he has named xanthic
oxyd, front its property of forming a lemon-yellow compound
when acted upon by nitric acid ; and the other, fibrinous cal¬
culus, on account of its chemical properties corresponding closely
wttn those of fibnne. But as these are as yet solitary in¬
stances, he candidly admits, that unless other similar calcu'i
should occur to future inquiries, they “ would hardly deserve
any farther notice ” It is certainly not by the collection of
singular cases, and the description of solitary morbid produc¬
tions, that medical science is to be advanced ; but, by disseminat¬
ing an accurate knowledge of those results of disease which are
every day occurring.

In the fifth chapter an attempt is made to give some idea of
‘ the comparative frequency of the different species of urinary
calculi, by a tabular display of eighteen specimens of the Nor¬
wich collection, winch our author chemically examined, and
that of tuy;s Hospital, amounting to eighty-seven specimens.
,n h. e tlle llthlc calcuh constitute one third of the whole •
the fumble calculi are next in regard to frequency; the mim-
beis of the iusible and the mulberry are two thirds only of the
n umbei ot the Iithic; and the compound concretions, 44 one
third omy of the mulberry species yet by far the greatest
proportion deaths has been amongst patients labouring under
calculi of the compound or mixed kind. In Guy’s collection
there 18 a much smaller proportion of Iithic calculi ; while 44 the
fusible, the mulberry, and the mixed calculi, bear to each other
nearly the same ratio as in the former:” a proof, in the opinion
of mir author, that the calcareous nature of the Eastern counties
o England pas no share in the greater prevalence of calculous
complaints in these counties, the calcareous calculus bein<r com-
paiativel^ moie fiequent in London than in these districts.

Xhe sixth chapter, which is intended chiefly for the use of
those who are not very 44 conversant with chemical manipula¬
tions, treats 44 of the analysis of urinary calculi, with a view to
their easy discrimination.” Our author first points out the in
str undents requisite for this purpose, illustrating his description
by a sketch ; and then details the easiest modes of anal ysino’
those calculi which are most prevalent. A Iithic calculus mav
be generally known by its external characters ; but when these

514 Analytical Review.

are not distinct, a very small fragment of the calculus detached
by the point of a knife must be exposed, by means of a small
pair of platina tongs or forceps, to the action of the blow-pipe.

cf If lithic acid be its principal ingredient, the fragment blackens,
emits a smoke having a strong and characteristic odour, and is gra¬
dually consumed, leaving a minute quantity of white ash, which is
usually alkaline/'

The lithic calculus is also soluble in caustic alkali ; and, to
ascertain this fact, it is only requisite to scrape off a little of the
calculus into a watch glass, pouring on it a few drops of the
alkali, and to hold the glass over the flame of a lamp until the
solution be effected ; which, however, will generally not he
complete, owing to other substances being contained in the cal¬
culus. By adding any acid to the solution, a white precipitate
is immediately formed", if lithic acid be present. Or to a par¬
ticle of the suspected calculus, a drop of nitric acid may be
added, and heat applied ; if lithic acid be present, it will be
dissolved ; 66 and if the solution be evaporated to dryness, the
residue assumes a beautiful pink or carmine colour,” which is
imparted to water, in which this residue is soluble.

A phosphat of lime calculus, independently of external cha¬
racters, may be ascertained either by exposing a particle of it
to the action of the blow-pipe, before which it first blackens
and then becomes perfectly white, still retaining its form ; or
it may be pulverized and dissolved in dilute muriatic acid, from
which, if the excess of acid be not very considerable, the
lime may be precipitated in the form of an insoluble com¬
pound by oxalat of ammonia/’ The ammoniaco-magnesian
phosphat may be suspected to predominate when a calculus is
extremely white and sparkling ; but this is rendered certain by
the evolution of a pungent ammoniacal odour, on heating a
portion of the calculus, or pouring on it a few drops of caustic
potash. The property from which it has derived its name
enables us readily to distinguish the fusible calculus. When
melted, it runs into a globule., semi-transparent, and of a pearly
appearance. We have already noticed the method of analys¬
ing this calculus by chemical means. The mulberry calculus ,
although generally distinguishable by its external aspect, y£t, is
pot always so ; but, before the blow-pipe it swells out into a
white efflorescence, which is caustic lime, and changes the
colour of turmeric paper to red. The cystic oxyd , besides being
recognized by its unstratified structure, waxy appearance, and
peculiar odour when heated, is distinguished also by its ready
solubility “ both in acids and alkalies/’ The compound calculus
requires more complex and scientific methods of analysis,
unless it be composed of distinct layers, which can be separately
examined.

Marcet on Calculous Disorders.

515

Having finished the description of the means of ascertaining
the different species of calculi, our author, before entering upon
the treatment of calculous disorders, makes a digression from
his main subject to notice “ some other kinds of animal concre¬
tions not belonging to the urinary passages, both in man and
other animals. 1 The concretions he notices, are those found in
the various viscera, in the salivary glands, and in the intestinal
canal of quadrupeds as well as that of man. He mentions
having seen a calculus found in the rectum of an infant with
an imperforated anus, which closely resembled the fusible uri¬
nary calculus : and some of a caseous nature, that proceeded
from “ caseous matter actually formed in the intestines, from
milk taken as nourishment by the patient, and coagulated by
the gastric juices.” Some also of a very singular nature are
mentioned, in which the nucleus were grains of oats. The
concretions found in the intestines of the horse and some other
large quadrupeds, are composed almost entirely of the ammoni-
aco-magnesian phosphat. A large one found in a rhinoceros,
and given to our author by Dr. Wollaston, consists of the triple
phosphat u disposed in layers round a hazle nut, alternately,
with thin laminse of phosphat of lime.” This latter substance,
Dr. Marcet has remarked, usually forms part of the composition
of the balls of hair sometimes found in the intestines of the
cow and ox. The urinary calculi of quadrupeds are composed
of the two phosphats and the carbonat of lime, litliic acid
never ha vino; been detected in them ; although »t has been
found in the droppings of birds, the urine of the camel, and
the excrements of the boa-constrictor. Gouty cooler etions are
now generally known to be either, to use Dr. Marcels lan¬
guage, litbats or super-lilhats of sodse ; and biliary calculi to
consist chiefly of adipocire; but, although it is not noticed by
our author, yet we may mention, that carbonat of lime also has
been found in biliary concretions, incrusting a nucleus of adi¬
pocire, and forming that variety which lias been termed glauco -
crustaceous by Mr. A. T. Thomson, who first observed it*.

In proceeding to treat (i 'of the chemical and physiological
principles to be attended to in the treatment of calculous dis¬
orders,” the subject of the concluding chapter of the volume,
Dr. Marcet first examines briefly the u probable limits of the
powers of medicine” in these affections. He contends, that
although little or nothing can be expected from medicine in
destroying already-formed calculi, too large to be discharged by
the natural passages, yet in some instances, the sharp edges of
small calculi or grave f may be so blunted by the internal use of
chemical solvents, as to allow them to be passed “ with less

* Vide Medical Repository, vol. iv. p. 467*

VOL. VIII. — xo. 4S. 3 u

510

Analytical Review.

difficulty or inconvenience and that, at all events, the preva-
lence of the particular diathesis may be altered. Let us examine
his exposition of the facts on which these opinions are founded.

In taking a summary view of the practice in calculous dis-
orders, Dr. Marcet properly regards the substances to be acted
upon as unorganized bodies, although they are contained in
living parts ; and considers the chemical treatment to rest upon
the following general principles ;

“ Whenever the lithic secretion predominates, the alkalies are
the appropriate remedies ; and the acids, particular!}/ the muriatic,
are the agents to be resorted to, when the calcareous or magnesian
salts prevail in the deposit.”-— p. 148.

Hut the question, can acids or alkalies reach the urinary
passages ? immediately suggests itself. This, our author thinks,
experience enables us to answer satisfactorily in the affirmative,
as far as concerns the alkalies ; but with respect to the acids,
the reply is more equivocal ; and he is willing to admit, that
although both may pass through the circulation unchanged,
yet that the quantity is top inconsiderable to make much, if any,
impression upon pre-existing calculi. Still, however, the pre¬
vailing diathesis may be checked ; for even supposing that none
can reach the urinary organs, these remedies may produce be¬
neficial changes “ during the first stages of assimilation for
.example, by neutralizing excess of acid, or checking an alka¬
lescent tendency, “ or otherwise disturbing those affinities,
which, in the subsequent processes of assimilation and secretion,
give rise to calculous affections.” When an acid is indicated,
“from five to twenty-five drops of the strong muriatic acid, taken
two or three times a day, sufficiently diluted with water or
if an alkali be the remedy required, soda water, or from five to
twenty or thirty grains of carbonat of soda,” taken two or
.three times, are recommended by our author, In stating the
dose of the soda, he uses the following words : “ whether in
the state of subcarbonate or in that of neutral crystallised car-
honat f but we would suggest, that if the alkali be the useful
ingredient, he must know, as a chemist, the difference in the
.quantity contained in these two compounds ; and lienee the
necessity of prescribing a larger dose, when the carbonat is
employed. In our opinion, the dose is too small, in either case,
to prove beneficial. l)r. Marcet seems aware, that it may he
questioned whether the carbonats can act by their chemical
agency, quo alkali, in the- urine in calculous disorders? He
.states file affirmative as his opinion, and conceives the carbonic
acid itself may he beneficial, by producing u such stimulating
effects on the digestive organs, as to counteract, independently
of any direct chemical agency, the particular action which gives
pise to urinary concretions.” It is in this way only, in our opi-

Marce't on Calculous Disorders.

517

ttion, that the neutral carbonats, or soda water, can be useful ; ,
for if the alkali combine with the acid in the stomach, which is ,
chiefly the acetic, the acetate formed will more probably pass off
by the bowels than be again decomposed, and give the urine
alkaline properties. Eut the alkali, it is said, may be detected
in the urine ; that, however, we reply, is also the case when
magnesia is taken, which is generally admitted to act merely by
removing acidity from the digestive organs. Indeed it seems
evident to us, that if alkalies can produce any effect in calcu¬
lous affections, as chemical agents, they must be given in the
caustic form, and more largely than the majority of stomachs
can bear ; but it is much more probable that the benefit which
is found to follow from using them, results partly from their
neutralizing the superabundant acid in the stomach, and partly
from allaying irritation in the coats of the bladder and urinary
passages, (an effect which our author admits they produce,)
when they pass unchanged through the kidneys.

Some useful cautions are given regarding the use of mag¬
nesia, which our author has seen prove extremely hurtful in a
case in which the gravel deposited by the urine proved, “ on
examination, to be of the magnesian or fusible kind.'7 W e were
rather surprised, under this head, to meet with the following
sentence from the pen of Dr. Marcet—

<c the powers of which (magnesia) probably depend paftly upon its
aperient effect, and partly upon the absorption of redundant acid/'

Now wtc believe it is generally admitted, that magnesia is
not in itself aperient, and acts only as such when it meets with
acid in the primae vise.

One of the greatest difficulties attending the treatment of
calculous disorders, arises, undoubtedly, as our author remarks,
from the alternation of calculous deposits ; and consequently as
great attention is requisite to the state of the urine and its sedi¬
ment, the profession is indebted to him for making public the
following remarks of Dr. Prout on this subject :

“ When the urine contains urea in abundance, the phosphate
generally prevail ; while if the urine abounds in colouring and ex¬
tractive matter, we may conclude that the lithic acid is the prevailing
secretion. According to Dr. Pr out’s observation likewise, although
urea and lithic acid do not co-exist in urine in large quantities, when
the phosphats are deficient ; yet sometimes the three substances,
urea, lithic acid, and the phosphats, are found to exist together in
abundance.” — p. 169.

Dr. Marcet thinks the formation of the mulberry calculus
may be checked by the use of the mineral acids, 44 which have
the power of dissolving the oxalat of lime in its nascent state
but there is an insurmountable difficulty respecting this cale.Ur
lus3 as well as the cystic oxvd, the xanthic and the fibrinous

3 u 2

518 Analytical Review.

calculi, of which he is fully aware ; viz. there being “ no vestiges
of them discoverable in the urine, it is not easy to perceive to
what kind of alteration in that secretion it is most desirable to
direct the treatment, with a view to correct the calculous dia¬
thesis in question.” The beneficial effects of purgatives and
turpentine combined with opium in expelling calculi, are no¬
ticed ; but no explanation of the latter hazarded. Some brief
observations are offered on the subject of diet ; and our author
is of opinion, that as in some animals more lithic acid is secreted
v/hen they are fed exclusively upon animal food, it may be in¬
ferred, “■ that it might be detrimental to restrain patients af¬
fected with this kind of calculous, from taking a due proportion
off vegetable nourishment.” We would remark, however, that
as dyspepsia is a very probable cause of the continuance of the
calculous diafhesis, ii it cannot be said to originate in that mor¬
bid state of the d gestive functions, whatever can relieve the
dyspeptic symptoms, must necessarily tend to diminish the dis¬
position to the formation of calculi ; and we know no means
more likely to effect this than an animal diet and complete res¬
traint from vegetable nutriment. With regard to the direct
application of solvents to calculi in the bladder, by injecting
into that viscus weak solutions of the solvents, our author’s
opinion is, that the subject has not u yet been sufficiently in¬
vestigated.” He thinks that benefit may result from the prac¬
tice when sufficient evidence can be obtained as to the nature off
the calculus ; but much caution is required on the part of the
practitioner, and great patience and perseverance on that of the
invalid. In one case in which he employed the muriatic acid,
the quantity of the acid, which was at first two drops only in
four ounces of water, was gradually increased to twenty-three
drops, “ without producing any inconvenience, though the so¬
lution was often retained in the bladder as long as an hour.”'
'Ihe injection, however, besides the acid, contained in solution
half a drachm of opium. He properly advises, that the catheter
be left in the urethra ; and that always before using the injec¬
tion,- tne bladder should he emptied as completely as possible.

Upon the whole, we have no doubt that the profession will-
regard this volume as an important addition to those works
it already possesses, the value of which depends on their
practical utility ; as it brings the means of investigating a sub¬
ject which has hitherto been regarded as requiring a minute
knowledge of chemistry, and extreme nicity off manipulation,
within the reach of every practitioner; and consequently tend¬
ing to improve the treatment of calculous complaints. In
another point of view, it demonstrates the essential importance
of Chemical Science to the medical philosopher ; and is in itself
an. admirable model of the great advantages of simplicity in
scientific inquiries.

519

M edico-Chirurgical Transactions.

in.

Medico-Chirurgical Transactions , Volume VIII. Part I. Svo.
pp. 314. London, 1817. Longman and Co.

( Continued from p. 423 .)

The first of the Surgical Papers, is “ A Report of the Slate
of the Wounded on Board His Majesty s Ship , Leander , in the
Action before Algiers , extracted from a Letter from D. Quarrier ^
M.D. , Surgeon to the Leander.” The only circumstance of
importance in this paper, is the proof which it affords of the
advantage of immediate amputation without waiting for re¬
action. The horrors of the scene, which were awful, are well
and feelingly described ; yet, amidst these, Dr. Quarrier could
not perceive any of that “ dreadful perturbation and constitu¬
tional shock — that peculiar derangement of the sensorium”
which has been so frequently described by authors, as constantly
attending wounds inflicted by large cannon shot. . Dr. Quarrier
justly blames the indiscriminate use of the tourniquet in gun¬
shot wounds ; which, he says, is seldom required, “ excepting
in operating and we would add, that even in operating it is
now very generally laid aside ; few cases occurring in which,
if an assistant can be depended upon, its aid is essentially
requisite.

' Several interesting “Cases of Hernia Cerebri , with Observa¬
tions,” by Edward Stanley, Esq. form the subject of the second
of this class of papers. The principal object in this paper, is
to determine the cause of those protrusions of the brain which
have received the denomination of hernia cerebri. Mr. Stanley
conceives, that m every case there is either distension oi the
vessels or serous effusion : and the question necessarily suggests
itself, whether the surgeon ought immediately to remove the
protrusion, w or whether he will await the event of the natural
processes which it is likely will, at some period, be commenced
for getting rid of the protruded brain, and restoration of the
injured parts ?” Mr. Stanley confesses himself incapable of
determining which is the best plan of treatment. Another
question, also, naturally presents itself : “ whether, in the indi¬
viduals who have recovered after the loss of a part of the brain,
there is any regeneration of the cerebral substance? I. he
only facts known to our author, illustrative of this question,
are deduced from the experiments of Strueman, from which it
appears, that a new substance, of a yellow coloiu, thinnei
and softer than the genuine brain, arises from the exposed
surface, 66 and at the same time there remains an accumulation
of fluid in the ventricles/ The cases communicated in this

520

Analytical Review.

paper, are perspicuously described ; and a satisfactory plate is
given to illustrate the nature of the protrusion in one of them.

’Ihe thu d of the Surgical Papers is u 'The History of a Case
oj Ill-conditioned Ulcer of the Tongue, successfully treated f bv
Charles Lane, Esq. The arsenic m this case was administered
internally, and also applied to the ulcer of the tongue ; but the
most remarkable circumstance in the communication, is the
large dose of the solution, ten minims, equal to twelve ordinary
chops, which was at first prescribed ; and the extent it was
carried to, viz. to seventeen minims, repeated every eight hours.

Phe foui th case is the 6i History of a Case of Lithotomy , with
a few Remai ks on the best Mode of Making the Incision in the
Lateral Operation f by Samuel Cooper, Esq. After describing
a case on which the author operated with a common dissecting
scalpel, without a staff or director, he enters into an examina¬
tion of the operation as it is usually performed. He recom¬
mends an ample division of the integuments, and points out
the advantages “ of making the incision through the whole of
the parts cut in lithotomy, in a straight, regular, direct manner,
from the suiface of the skin in the perineum, to the termina¬
tion of the wound in the urethra and bladder.” This affords
the greatest space for the extraction of the stone, and averts the
evils to be dreaded from the repeated introduction of the for¬
ceps ; it insures the safety ofthearteria pudica profunda; pre¬
vents the rectum from being wounded ; and places the seminal
duct also altogether out of danger. The unparalelled success
of ^lieie Jacques, Cheseiden, Cosine, and some others, he as¬
cribes altogether to their constant plan of making “ a free
incision into the bladder;” and criticises severely the advice
which Scarpa has lately given in his Memoir on the Cutting
Gorget of Hawkins. He makes some rational objections to the
use of the gorget ; and, in every instance, prefers the common
scalpel or the beaked knife.

A Case of a F atal Hemorrhage from the Extraction of a
Tootn, by Richard Blagdex, Esq. constitutes the fifth surgical
communication. There was a peculiar predisposition to haemor¬
rhage m the patient, who had nearly lost his life, when a boy
f rom a similar, operation to that described in this paper. The
case contains no useful practical information, and is therefore
only an unprofitable addition to the numerous cases of a similar
description already on record. The carotid was tied, without
producing the expected benefit.

Idle sixth paper is the “ Account of a Case where a severe
Aervous Affection came on after a Punctured Wound of the Finder-
and in which Amputation was successfully performed f by James
VV ardrop, Esq. In his remarks on this case, in which the re-
n<‘\ after the amputation was instantaneous and permanent, the

521

Medico-Chi rurgical Transactions.

author 'endeavours to demonstrate the little reliance which is to
be placed on a simple division of a nerve, when it is wounded,
and the propriety oi amputating the limb in all cases of par¬
tially divided nerves, when it is “ followed by ail affection of
the nervous system in general.”

The paper following the above, is “ An Account of some,
remarkable Symptoms which were connected with a Painful Affec¬
tion of the Extremity of the Left Thumb , together with the Mode
of Treatment ,” by John Pearson, Esq.," E.R. S., & c. This
extraordinary morbid affection of the left thumb, which com¬
menced with acute pain, resembling that of a whitlow, and local
inflammation, gradually extended its influence, not only to the
arm of the originally affected side, but to the other arm ; and
ultimately to the lower extremities ; and rendered the patient,
who was a woman or quality, incapable of using exercise for
more than a few minutes at any one time. The patient, who
was in Scotland at this period, tried a great variety of means,
and particularly both the shower bath and immersion in the sea,
without any permanent benefit. She was brought to London,
and became Mr. Pearson’s patient. On considering the case
and the general state of health of the lady, Mr Pearson con¬
ceived the opinion, that the symptoms “ were immediately
connected with a morbid condition of the nerves distributed to
the extremity of the thumb.” The mode of cure adopted, and
which proved successful, was the producing an artificial exan¬
thema tose affection by means of the following liniment :

lx Olei Olivse, giiss.

— — Terebinthinae, giss.

Acidi Sulphuriei, Xi. — M.

This was rubbed on the left arm ; but half a drachm more of
the acid was added before it fairly produced its effect, which it
did after being used for twelve days.

“ The whole arm, from the shoulder to the hand, was red,
heated, tumid, and very painful. These symptoms became gra¬
dually more intense, and were diffused more extensively, increasing
progressively during five days. Within this period, a number of
small vesicles containing a pellucid fluid appeared on various parts
of the arm ; the face became swollen as in the acute erysipelas, and
vesicles were distributed on different parts of its surface ; the cellu¬
lar membrane of the eyelids was likewise so much distended as to
obstruct vision completely. The whole surface of the body, in¬
deed, partook of these morbid appearances ; hut the vesicles vrere
scattered very sparingly over the trunk and lower extremities.”

- — p. 260.

On the fifth day after the cutaneous disease appeared, the
thumb was agitated by a spontaneous motion, unattended with
pain, and the morbid sensibility completely abated. The other

Analytical Review .

symptoms also successively yielded ; and, in little more than two
months, 44 all appearance of the disease had vanished.’’

1 he paper concludes with some excellent physiological and
pathological remarks connected with the subject/

^Lhe last of the Surgical Communications is a detail of some
Cases of Fungus H nematodes , with Observations; by George
L angst aff, Esq. ; and an Appendix, containing Tivo Cases of
Analogous Affections , by William Lawrence, Esq. F.R.S. This
is, in every respect, a valuable communication; but it does not
admit of analysis, in the brief manner to which we have con¬
fined ourselves, in noticing the various articles contained in this
part of these Transactions.

1 he papers on the Practice of Medicine are two only in
number.. I he first, which is the fifth of the volume, is intitled
An Inquiry into the Origin and Nature of the Yellow Fever , as it
has lately appeared in the West Indies , with Official Documents
relating to the subject ; by William Ferguson, M,D.

If any doubts remain of the non-contagious character of
yellow fever, the facts brought forward in this paper are, in
our opinion, sufficient to dispel them in unprejudiced minds.
T_he instance of the Regalia transport, which has been so much
insisted upon as affording proofs of the contagious nature of the
disease, by the contagionists, is fully discussed by Dr. Ferguson,
and demonstrated, in a manner perfectly satisfactory to our
minds, to have originated from some “ green wood laid in at
Sierra. Leone, operating along with the foul ballast, to furnish,
wdien impregnated with the gases arising from putrid sea-water,
morbific patters, similar to those that, on land, arise from
marshes when exposed to the influence of the higher degrees of
atmospherical heat.”

In pursuing the subject generally, Dr. Ferguson gives it
as his decided opinion, that “ the pestiferous quality” of marsh
miasmata 44 does not necessarily depend either upon aqueous or
vegetable putrefaction, however frequently it may be found
combined with both.” It is generally destroyed by the pre¬
sence of much water, and neyer proceeds from the bodies of
pools, or lakes, but always from their margins, where there is a
paucity of water short of actual dryness. °

I think we may be able to explain,” says Dr. Ferguson, cc from
the various compositions of soil, its elevation, aspect, and texture, as
affording’ capacity to retain moisture, why every dry one can be
brought during an uncommonly wet season, through the influence
of tropical heat, into the state of a marsh that gives out noxious
vapours, and a marshy one approaching to dryness through previous
draught may be made perfectly healthy from the same abundant
rains.” — p. 1 SO.

After explaining the character of several of the West India

523

Media Chirtirgical Transactions .

islands in regard to these points, and the effects of their various
c inflates on Euiopeans, our author offers the following, as points
altogether unaffected by the conjectures connected, otherwise,
with the investigation of yellow fever.

1st. That the yellow fever never begins, and cannot con-
inue to exist m a temperature of heat lower than the ordinary tem¬
perature o the tropics, on the level of the sea ; which temperature
re not the ordinary one of agues, however moist the soil may be, but
Oi remittents and the higher degrees of ardent fever.

“ 2nd. That even within the tropics, it is confined in all the
islands to the sea-coast; and can only spread into the interior of
continents where the country is flat and low, possessing little eleva-
uon above that level, and retaining the above temperature.

. " That il: uniformly is more apt to arise and to spread where
miasmata, or what ivould constitute the elements of intermittent or
remittent fevers in colder countries, openly abound.

• • • r a comParatively high degree of bodily vigour and

rigidity of fibre,, such as the young sanguineous newly arrived
European ordinarily brings with him to the West Indies, is for the
most part essential to the developement of the disease.

“ 5th. That Europeans suffer in point of priority and severity of
attack, precisely in the degree that they possess the foresaid vigour
of constitution, and that when relaxed by long residence or other
causes, they become like the Creoles and people of colour, in a great
degree exempt from its influence.”— p., 138.

The whole paper is written in a masterly manner, and the
proofs are as conclusive as the nature of the" subject can admit.

The other medical communication is from the pen of Dr.
H. Scott, “ On the Internal and External Use of the Nitro -
MuriaLc Acid in the Cure of Uiseases ; 1 but as this is a subject
still under investigation, and as we shall have frequent oppor¬
tunities both of examining the value of the practice and the
theoretical opinions of Dr. Scott, we forbear at present from
entering upon its details.

Ine last papci of the volume which we have to notice, and
which does not strictly come under any of the divisions of our
arrangement, contains an account of a “ Rupture of the Stomach
and escape of its contents into the Abdomen f by John Cn ampton,
IVl.D. &c. with additional Observations by T’cnjahin Tit avers
Esq. F.R..3,

^ No prognosis could be formed from the symptoms, and
hence the ticatment consisted of means adapted to allay irrita¬
tion and pain ; b.ut on opening the stomach after death, the
cause of the sufferings became evident. u The perforation of
the stomach was perfectly circular, about the size of a pea, and
appealed to be the result or an ulcer on the mucous surface*
which had gradually penetrated the other coats. This ulcer
ass hollow and circular, nearly the size of a shilling, and had

vol. vm. — no. 48. 3 x

524 Selections .

the appearance as if it had been made with caustic, with the
orifice in its centre.''1 Such cases are curious, but not very
useful, as they set Art wholly at defiance.

In concluding the brief notices we have taken of the contents
of this part of these Transactions, we only regret we can re¬
mark, that, with a few exceptions, the communications are not of
equal interest with those in the preceding volumes.

Dr. Ainslie on Sphacelous and Phagedenic Ulcers.

(Concluded from page 346.)

I have since that period experienced the same happy effects
from the use of the balsam of Peru in a case of sphacelous bubo,
as noticed in my Journal for May last, and have now under
my care two more cases of sphacelous ulcer, in which I witnessed
th e same wonderful, X may say saving powers, of this long neg¬
lected drug. The one is in a recruit lately come from England,
who haying been blistered* on the abdomen during a bowel
complaint, had a dreadful sphacelous affection thereby induced,
and in all probability we should have seen the intestines laid
bare, in a few days, but for the balsam of Peru, which put an
immediate step to the disease.

The other case is in a soldier who has been ten years in
India, and whose back from a slight punishment put on a
sphacelous appearance, and who, I have no doubt, from the
rapidity of the first advances of the malady, would soon have
been carried off, had he not been rescued by the medicine in
question.

When applied to scrofulous sores, this balsam I have found to
have nearly the same healing quality; but scrofula being a disease
depending upon a particular state of the general habit, we are
not entitled to look for a radical cure from external applications.
It also, I have discovered, heals primary syphilitic ulcers : but
in such cases I should give a preference to the immediate use

* Dr. Plane also takes notice of the malignant ulcer being
brought on by this cause, as happened in the Ganges, 74, in the
West Indies in 1 796'.— Blanc's Diseases of Seamen, pages 506, 507 ,
3rd Edition,

Ainslie cn Sphacelous and Phagedenic Ulcers. 525

of some powerful escharotic, to prevent as soon as possible the
absorption of the venereal virus. But, however excellent may
be the qualities of this medicine in perhaps every case of foul
nicer, its great efficacy, as far as I have been able to judge, is
most conspicuous in what are called sphacelous and phagedenic
affections ; which are well known to be ever of a most dangerous
nature, and have been but too frequently found to set our best
exertions at defiance.

To proceed then, 1 shall simply state that phagedenic
nicer, however it may originate, is very frequent in India, as
well as amongst natives on shore, in the most interior districts,
as at sea, from the testimony of His Majesty’s Navy Surgeons,
who, in this country,! have been informed, are under the neces¬
sity of sending more men on shore with this than any other
complaint : at Bombay it has got the name of Gongola lethifera ,
where it has on various occasions been most destructive amongst
sea-faring men. In general terms, I should say that the pha¬
gedenic ulcer would seem to be induced for the most part by
slight external injuries operating upon an irritable frame,
already predisposed to the malady by some debilitating influ¬
ence ; such as long continued cold and wet, intense heat, heat,
and moisture combined, deficiency of nourishing diet, whether
animal or vegetable, great fatigue, watchfulness, and perhaps
the inordinate stimulus of ardent spirits inflaming a body,
breathing an unw’holesome air, and otherwise not properly sup-
Dorted. But in whatever manner it may be brought on, the
fcalsara of Peru appears to me to have extraordinary powers
in the cure of it; and so convinced am I of this, that in the cases
which have last come under my care of this dreadful malady,
to the virtues of the balsam alone , as an external application,
unassisted by any internal medicine whatever, have I entirely
trusted for a cure, and with success.

The chief things to be noticed on the first days using the
balsam, are, a certain sensation of tickling over the face of the
sore, the comfort the patient almost immediately feels from the
medicine’s destroying the offensive odour of putrid ichor; that
from this period the sore does not spread, the general ease the
person perceives in himself, and lastly the evident effects that
the remedy begins to produce on the appearance of the ulcer
by loosening the disorganized matter from the edges. On the
second dap much of this commonly comes away with the dress¬
ings, and the patient begins to complain that the balsam smarts
him excessively, from its being no longer in immediate contact
with corrupt slough, but with more sensible parts; his spirits be¬
gin to get up, and his pulse becomes fuller. On the third dap the
favorable symptoms are progressive, and I think that, for the
most part, by the end of the fourth or fifth day, the surface of

3x2

526

Selections,

the ulcer is clean ; sleep and appetite return, the wasting sweats
cease ; in short, the hectic diathesis gradually goes off. Every
day after this is marked by symptoms of recovery ; new granu¬
lations are seen rising up, red and firm ; and at this time I have
found it necessary to lay aside the use of the balsam of Peru,
and to substitute for it simple dressings, supported by a tighter
bandage, or by the adhesive plaister straps, as recommended
by Mr. Baynton of Bristol, to prevent the too rapid growth
of new substance , this, I say, X have been under the necessity
of doing, on two accounts— having observed that the balsam,
when the sore is once completely cleansed, not only smarts
extremely, but often causes to bleed the tender parts, which
its own regenerating power has produced. An ulcer having
thus been rendered simple, will of course, with proper care heal
up without further trouble.

This medicine no doubt operates in a great degree by its
stimulating quality, which is considerable; though this is but
a general piopei ty, there are certainly other occult virtues
which it possesses, as there are in all remedies which have un¬
common powers in particular diseases, and which, as depending
on the ultimate and characterizing essence of things, will, I fear,
long be out of our power to explain. The voracity, if X may
be allowed the expression, with which it consumes the ichor of
phagedena, is to me wonderful, as is also the capability it seems
to possess of expelling fetor. Nor must its balsamic effects be
overlooked, which give so much relief to the sufferers, and by
which it in a manner soothes whilst it afflicts ; for in the midst
of the most painful smarting from the application, I have often
heard the patient declare that he would willingly bear it, for
the sake of the ease and glowing comfort that ‘he knew by
experience must follow. J

Extract of a Letter from Air. James TEfse, Sturgeon of

patami to Dr. Ainslie .

,.xr. -r i , . September S, 1806.

\\ hen X took charge of the sick at Magore, I found no

less then ten cases of bad foul spreading ulcer in the hospital;
I thought of what you had done, and shewn me, at St. Thol
mass Mount, and fortunately finding about four ounces of the
balsam of Peru in the medical stores here, I lost no time in
prescribing it in the manner you directed ; in a few days all
the ulcers began to heal ; it must be mentioned, however, that
in two cases, where a gangrenous appearance prevailed, I
employed bark internally at the same time ; the sores one
excepted, continued to heal ; and this day, a single case
only remains in the hospital : this ulcer seemed to heal for
some Gays, and the balsam was in consequence omitted

527

Ainslie on Sphacelous and Phagedenic Ulcers .

but it suddenly and unaccountably again be aiv o \l and gan¬
grenous, when the balsam was resorted to with r bayk ; the
healing process recommenced in a few davs, > ■>' le ulcer
now cicatrizes admirably well. This is all t at I k-v* had in
my power hitherto to accomplish with the ba , yet

enough to convince me of its astonishing powers in phagedenic
sores ; If you wish to have any thing more particular, I refer
you to my Medical Journal for July, now at the Medical
Board.” (Signed) James Wise.

Extract of a Letter from Mr. Robert GoLmt, Assistant Sur¬
geon, at the General Hospital oj Fort St. George.

October 2, 1 SO fk

u You will be pleased to hear that I have just met Captain
Sneyd, Govenor of' the Navy Hospital of Fort St. George, who
informs me that Mr. Woolna, one of the surgeons attached to
that hospital, has tried the balsam of Peru in various cases of
phagedenic ulcer, and has ascertained its virtues beyond a
doubt ; I have not been able to see Mr. Woolna this morning,
but his account of the medicine is, I understand, this : —

“ The balsam of Peru, when applied to a malignant sea-ulcer,
immediately arrests its progress, cleanses it in a wonderful man¬
ner, softens and smooths the edges, and appears at once to
induce a healthy condition in the part : but he at the same time
remarks that, if continued long, it is apt to produce granulations
of so luxuriant a nature as to require escharotics to keep them
down ; he therefore advises, after the balsam has once cleansed
the sore, that it should be dressed with simple cerate straps
and lint ; should the sore again get foul, or shew a tendency
to spread, he has again recourse to the balsam with the same
happy effect, till, betwixt the two, the desired result of a com¬
plete cicatrization takes place.

“ In regard to what has come under my own observation,
respecting the use of the medicine in foul spreading ulcers, as I
informed you the other evening, I have had occasion to try it
but in two cases, in the General Hospital; in both of which it
was attended with complete success ; the one was a large foul ul¬
cer on the tibia of a middle-aged stout man, of long standing, and
which had failed my best endeavours to bring to a healing state,
by every mode of treatment that has lately been recommended
in such cases. I had not applied the balsam of Peru for more
than twenty-four hours, when I saw an evident change for the
better on the face of the sore ; in three days it was perfectly
clear, when I omitted the use of the balsam, and had recourse
to common simple dressings. In ten days the sore was com**
pletely healed, and the man discharged the hospital.

“ The other case was nearly similar to this, and attended

52 S

Fordo ? Medical S deuce and Literature .

with the sa ” ■ *
took v. i\ ■ j.)
administered.”

happy result, with tills difference, that the patient
ha of cynchona, which in the other cose was not

f$L Thomas’s Mourn 3d October , 1806.

A true copy, WHITELAW AINSLIE, M.D.

'Note.**—' The Court of Directors approved of Dr. Auislie's obser¬
vations, and directed the Governor Genera] in Council to make
them public.

PART IV

FOREIGN MEDICAL SCIENCE
AND LITERATURE.

CHEMISTRY.

I — Analysis of Opium , particularly of Morphium and Meconic
Add , considered as essential parts of Opium. By M,
Sertuerner, Fharmacopolist at Eimbeck, in the Kino-*
dom of Hanover.

(Continued from page 435.)

hi. Of the Acid of Opium or Meconic Add. — 7. Having
shewn the properties of morphium, we will now examine the
liquid from which it was precipitated by the ammonia. After
having evaporated it to the consistence of a syrup, a little
morphium in irregular crystals was deposited' Ammonia
caused a precipitate, which was almost entirely morphium, but
which is dissolved in the extractive if the ammonia be disen¬
gaged by beat. This extractive has the characters of acidity ;
but it cannot retain ammonia at an elevated temperature, and
combines with morphium, which combination we shall shortly
notice. After having evaporated a little morphium* by an
excess of ammonia, the extract of opium was filtered,' dis¬
solved in distilled water, the ammonia disengaged by heat, and
a solution of muriate of barytes added until there ceased to be
any precipitate. The precipitate, washed and dried, weighed
six drachms. It is a quadruple combination of barytes, mor¬
phium, meconic acid, and extractive, sparingly soluble in water.

44 8. I endeavoured to separate ’the morphium from the
extractive by means of alcohol, and to leave the meconic acid
pure in the liquid, by saturating the barytes with a sufft-

Sei'tuerner’s Analysis of Opium. 529

dent quantity of sulphuric acid. I succeeded in obtaining the
inecomc acid by evaporation ; but, as it was coloured, I was
obliged to suojeet it to sublimation. It melted first in its water
or crystallization, and then sublimed in fine long needles It
was colourless, of an acid taste, had all the properties of the
snong acids, and distinguished itself by its strong affinity for

. T ,°XK e c°l 1iron’ " ,il Precipitated from its muri»ic
solution, of a cherry-red colour, even when there was a slidht
excess of acid. Hut it did not indicate the presence of iron in
the ferrugeneous prussiate of potass, as I had at first thought,

J loin being deceived by the high colour of the acid which I had
employed. the apparatus unfortunately burst during the
sublimation, and the small quantity of acid which I had ob-
lamed was by this means still more diminished, so that I was
;)!'eyented from examining the salts which it formed with the
(uiterem. bases. I combined it only with lime, forming the
meconate of line, which is an acid salt, crystallizes in prisms,

) rather msoluole, and is not decomposed by sulphuric acid.

j. ic meconic acid does not produce any sensible effect
1 ,e -Hunan body. I have taken five grains of it without
experiencing any inconvenience. It appears to me, that it
weakens the effects of opium, and renders it more soluble in
water, as indeed do all the acids; and 1 am of opinion, that
tms property of the acids is owing to their forming salts with
n.orpiuum with an excess of acid; but we nevertheless find,
mat the other salifiable bases are often more hurtful to life in
combination with the acids, than when taken in their simple

state; and perhaps this may be the case with the salts of
morpmum.

•“ 9* The from wllic]l 1 had separated the morphium
anu the meconic acid was tinged of a red colour by the muriate
ot iron and by sulphuric acid. By evaporating it ‘to the eonsist-
ence of syrup, I obtained forty grains of a rather insoluble
' c? i°m, ^ ,J1^a f separated a little morphium by means of
aiconol, which hau been dissolved by the water and was precis
pitatea during the evaporation. By treating this salt with
sLupnunc acid, a sulphate of barytes and meconic acid were

iormeci ; this salt, therefore, must have been meconate of
barytes.

, I\* tne oilier parts soluble in water. — *10. Alcohol

having dissolved so little of the morphium from the quadruple
emu illation, I thought it must have been .'retained by the
extractive; and indeed the extract from which I had separated
tne meconate of barytes, after being diluted with water and
evaporated to the consistence of syrup, precipitated about
irty grains o, a mass, which I recognised fora combination
ot extractive with morphium, and which was dissolved by the

530 Foreign Medical Science and Literature.

alcohol, with the exception of a little meconate of barytes which
had combined with it. Thinking I had obtained some ex¬
tractive, I gave ten grains of it, in several doses, to one of my
pupils, who soon brought it up by vomiting. A little ammonia
formed a slight precipitate in it, which disappeared upon ex¬
pel] mg the ammonia by heat. I repeated this experiment
several times. The precipitate which was formed in it when
cold bv the ammonia had the properties of morphium, and
combined with the extractive when the ammonia was expelled
b\-r heat.,

64 These results determined me to re-dissolve the extract in
water. When this was thickened as usual, I gathered a little
of the precipitate by filtration; it had the appearance of mor¬
phium with much extractive, it was dissolved by alcohol, and
there were some crystalline traces of morphium. When I
added the ammonia in excess, the precipitate was very copious,
and almost the whole mass became ductile and resinous, which,
in a dose of five grains, produced the same effects as the extract
of opium, only in a smaller degree. This substance was very
little soluble in cold water ; it decomposed the metallic salts
like morphium ; it was soluble in the acids by saturating them,
and ammonia, which dissolved a good deal of it, deposited a
greyish mass, which was morphium combined with a little ex¬
tractive. I endeavoured to precipitate the extractive with the
morphium by means of sub-acetate of lead, and to separate the
morphium from it by means of alcohol ; but I obtained only a
little morphium, coloured by the extractive ; the remainder
seemed to me to have formed a triple combination. When 1
had decomposed the precipitate witn sulphuric acid, the extract
still possessed its hurtful influence, and, by the addition of am¬
monia, showed the presence of a resinous substance. It seems
to me, that morphium has a great affinity for extractive which
is perhaps highly oxidized, and forms different combinations
with it ; one containing a great deal of morphium, of which the
crystals mentioned above are formed ; the other containing a
good deal of extractive, which is precipitated by the ammonia
like a resinous substance, from the extract of opium separated
from its acid and from the morphium which was dissolved in it.
Although the oxidized extractive was combined in excess with
the morphium, the combination, nevertheless, possessed its
principal properties ; it was little soluble in water, very soluble
in alcohol and the acids ; it saturated the latter, and was pre¬
cipitated by ammonia, which, combining with the excess of
extractive, formed a substance soluble in water. . The extractive,
however, which combines with the ammonia still contains
morphium. I confess that I ought to have attempted still more
to have separated the morphium completely from it by means
of tether, the oil of turpentine, or concentrated alcohol^

531

Sertuerner’s Analysis of Ompium.

“ A combination of extractive with morphium may be
formed artificially, by dissolving the morphium with alcohol
and treating it with toe extractive of some other substance. It
belongs to the properties of morphium and of extractive of
combining together, because one possesses the character of a
base, and the other of an acid.

“ v. Of the parts which are not soluble in water. — 11. Not
having digested sufficiently the opium in water, I presumed
that tiie remainder of the opium still contained morphium and
ineconic acid. I treated it with half an ounce of weak mu¬
riatic acid and a sufficient quantity of water. After having
filtered the liquor, I added ammonia to it ; I obtained, without
counting what remained in the liquid, about two drachms of
morphium, combined with a good deal of extractive and a
pulverulent substance. The ammonia which had been added
in excess was disengaged by heat. The liquid, treated with a
solution of muriate of barytes, gave by evaporation a small
quantity of meconate of barytes.

“ 12. The residue from which the extractive, morphium,
and the meconic acid, had been separated, by means of water
and of muriatic acid, weighed one ounce five drachms; it was
almost clammy. I treated it with alcohol until it was no longer
coloured. By adding water and distilling the alcohol, I obtained
a brown substance, which had the appearance of a balsam, swam
upon water, and was almost insoluble in alcohol. It had the
odour of fish dried in smoke, and the taste of fat; it burned
with a flame, which deposited a great deal of soot ; and did
not produce any effect upon me or other persons, even in doses
of twenty grains. A small dog swallowed some drachms of it
without experiencing any pernicious effects. I digested one
part of this residue with oil of turpentine, and another with
sulphuric aether ; and I obtained, by the evaporation of the
solvents, a kind of caoutchouc, which appeared to me still to
retain a little of the brown substance, especially that which I
had obtained by the essence of turpentine. By treating the
residue of the opium, deprived of all the soluble parts, with
diluted sulphuric acid, I changed it into a mucous substance.

(( vi. Results afforded by the treatment off opium with cold
water. — 13. As heat might have had some influence upon the
results of my experiments, and not having as yet explained all
that Derosne says of opium, I varied them in the following
manner. 1000 grains of powdered opium were triturated in a
porcelain mortar with small quantities of cold water, which
was added at several distinct times. .After some hours the
liquor was filtered, the opium strongly pressed, and this treat¬
ment was continued until the water appeared colourless. This
very diluted aqueous tinctufe, evaporated very slowly, gave an
VOL. VIII. — no. 49. • 3 Y

■jM Foreign Medical Science and Literature.

extract different from the first, in not being at all disturbed
upon the addition of water. But ammonia and the ferrugi-
neons salts equally indicating the presence of meconate of
morphium. I think that it is an acid combination of these two
new bodies, because the tincture of litmus was reddened by
it. Alcohol does not decompose this salt extractive is dis¬
solved in it.

“ 14. The opium extracted by cold water was boiled for a
quarter of an hour in a little water. The filtered liquor
became very thick upon cooling, and had the appearance of a
decoction of cinchona, though not so high coloured, and acted
like the sub-meconate of morphium combined with a little
extractive. It was deposited upon the sides of the vessel in
the form of a brownish mass, in which, after some time, pris¬
matic crystals of meconate of morphium were produced.

££ 15. The residue was digested with alcohol at an elevated
temperature. The brownish liquor filtered deposited, after
having been cooled to 5°. C., the salt described by Berosne.
This salt, by means of its morphium, restores the colour of
reddened litmus paper, and has a weak action upon the ferru-
gineous salts by its me conic acid. At the same time there was
deposited at the bottom of the vessel a coloured substance,
which, when treated with alcohol, gave a little sub-meconate of
morphium. The residue, which was very soluble in alcohol
but almost insoluble in water, contained the combination of
morphium with the extractive and the brown substance, which
has been mentioned before (12). The combination of mor-
pluum with extractive is distinguished from resins by this
property ; also the extractive can be separated from it only
with difficulty.- Ammonia dissolves still less of it, and dimi¬
nishes its solubility in water. The remainder, treated once
more with alcohol, gave a coloured tincture, which was much
thickened by adding water, and did not regain its transparency
upon the addition of acetic acid ; hence it follows, that the
precipitate comes from an oik The solution contained so little
of the combination mentioned above, that the taste was
scarcely bitter.

“ 16. It follows from these observations, that cold water
dissolves the meconate of morphium with excess of acid, and
almost all the extractive ; and that the residue contains sub-
meconate of morphium, which is rather insoluble in water,
with a little extractive, which is easily dissolved by cold alcohol,
but is almost all deposited in crystals.

“ Conclusions. — 17. Without noticing the accidental mix¬
tures which have not been taken into account in this place,
but of which I have spoken in my former researches, the crude
opium of commerce is composed of meconate of morphium with
little acid, which is divided by warm water into insoluble sub -

533

SertuernerV Analysis of Opium.

meconate of morphium and into acid meconate of morphium , very
soluble m water ; supposing that there are no other vegetable
acids intermixed, which may redden the litmus paper" The
extractive, like tne morphium, is divided into two portions; of
which, one, which is free, dissolves in cold water ; the other
part, undoubtedly never oxidized, remains in the residue with
the sub-meconate of morphium, and forms by digestion with
alcohol some sub-njeconate of morphium, and a combination of
morphiurh with extractive, almost insoluble in water, but very
soluble in the acids

44 Water, when warm, dissolves more morphium than when
cold ; and morphium is precipitated in the cold from the liquor
in combination with a little meconic acid and extractive. The
resinous substance and the other constituent parts of opium,
have no influence upon its medical virtues ; because they are
almost insoluble in water as well as in alcohol. Hence there is
a great difference between the extract of opium which is pre¬
pared with warm water, and that which is prepared with cold ;
the latter being much more powerful than the former. The
N tinctures of opium ought to be prepared with pure alcohol, be¬
cause by it only are the combinations mentioned above dis¬
solved. These tinctures ought not to be kept in places where
the temperature is too cold, because some of the salt of mor¬
phium will be precipitated. These inconveniences might be
obviated by adding a little of the acetic acid, if we were sure
that the acetate of morphium possessed the same medical pro¬
perties as opium, or the meconate of morphium.

44 The extract of indigenous poppy-heads prepared with
distilled water, gave no signs of morphium when treated with
ammonia, even when acetic acid was added. It appears, that
this plant contains morphium combined with extractive. I
could discover no Traces of meconic acid in it. Other chemists
who have examined opium, seem to have obtained different results.

44 Appendix. — I bad proceeded thus far in my memoir*
when I had occasion to make the following observations upon
the preparation of morphium and meconic acid :

44 1. Take eight ounces of opium in powder, rub it up with
two or three ounces of concentrated acetic acid and a little dis¬
tilled water ; dilute the paste with two or three pounds of cold
water, arid filter the liquor. This slightly coloured solution con¬
tains acetate and meconate of morphium, extractive, and tfaccs
of the combination of extractive with morphium.

“ 2. Precipitate the morphium with ammonia, and evapr*
rate the liquor to a. fourth part ; upon its cooling, separate the
morphium by filtration, and precipitate the meconate of am¬
monia by a sufficient quantity ’of acetate of barytes. Upon
evaporating the liquid to dryness, there is still deposited a little
meconate. of barytes. The extract from which the acetates had

2 r 2

534 Medical and Physical Intelligence.

betgi separated by concentrated alcohol, is almost pure extrac¬
tive. I have taken it in a dose of ten grains without the least
inconvenience.

1 u 3. The residue (1) contains the combination of extractive in
excess with morphium, which is rather insoluble in water. I
treated it at several times with sulphuric acid diluted with six
parts of water ; and I decomposed the acid solution by am¬
monia. This decomposition was not complete, for there always
Remains some morphium with art excess of extractive, (of brown
meconic acid), and a trace of sulphuric acid. This acid ex¬
tractive , or brown meconic acid , is without effect : it is morphium
which communicates to it its pernicious properties.

6C Conclusions.-—- Crude opium then. contains neutral extrac¬
tive and acid extractive , which both exert no effect upon the ani¬
mal oeconomy. The latter is combined with morphium ; but;
it combines also with the meconate of morphium, and becomes
soluble in w'ater. This combination is decomposed only in part
by the water ; for the residue contains traces of meconic acid,
which, forming a triple combination with a large quantity of
morphium and extractive, dissolves in water only by degrees.
This is the reason why the extract of opium prepared with cold
water, contains only a part of the meconate of morphium, and
a little of the combination of morphium with the extractive.
By adding acetic acid, this combination loses a part of its mor¬
phium ; and the meconate of morphium separates from the

brown meconate of morphiumf ’

. » ^ ...... ....

PARTY.

MEDICAL AND PHYSICAL
INTELLIGENCE.

.iw. i i '■ i — mi»i . ■ ntw aT ... rl— i , . ■ V h.lA.ft ,« ■■ ...... ■mp ■ —

CASE OF THE LATE PRINCESS CHARLOTTE OF WALES.

The Editors, having been sufficiently apprized that the
Profession expected from them some account of this case, the
lamentable termination of which has spread such a settled gloom
over the British Empire; immediately, on learning that the
Physicians who attended it did not mean to publish any state¬
ment, (a resolution in the propriety of which, under the circum¬
stances, they perfectly coincide,) strenuously endeavoured to
obtain every information respecting it, from such sources as
could be depended on. Their exertions have been successful,
and they are now enabled to present a report to their readers,
which may be regarded as strictly authentic.

In prefacing their narrative, in this place, it is not for them

535

Case of the late Princess Charlotte of Wales.

to attempt to paint the simultaneous and wholly unprecedented
expression of unfeigned sorrow, which the death of this excellent
person, not less elevated by her virtues than by her rank, visibly
imprinted on the countenances of the inhabitants of this ex¬
tended realm. It spoke a language that could not be miscon¬
strued. The profession have participated in this feeling, in
common with their fellow subjects ; and have borne a part in
that extraordinary demonstration of respect for the departed,
which, perpetuated in the page of history, will be contemplated
by posterity as the most dignified tribute to individual worth, and
the sublimest triumph of virtue, which mankind have ever wit¬
nessed: a tribute honourable to the object of it in a degree fitted
to excite the envy of the proudest monarch?, and an eternal me¬
morial of the ardent feelings of an honest-hearted, brave, and
generous people. But as they are incapable of doing justice to
this part of the subject, they shall leave it to abler commen¬
tators; and proceed to detail the facts they have collected, as
far as regards the case in a medical point of view.

The Princess Charlotte, previous to her confinement,
was in good health, and immediately under the eye of her
accoucheur, Sir Richard Croft, who resided at Clermont for
three weeks, up to the moment in which she was taken ilL
Dr. liaillie, also, was in attendance, chiefly, we have been in¬
formed, on account of a promise exacted from him by the
Princess, that he would be near her on this occasion. . Her
spirits were excellent, and she anticipated only tire most fa¬
vourable issue of the event which was hourly expected.

She was first made sensible of her approaching delivery, at
seven o'clock, on Monday evening, the third of November; but
the labour pains were -so inefficient, although acute, as scarcely to
evacuate the water, which had ruptured the membranes at the
commencement of the labour; a circumstance, however, which
every accoucheur knows prognosticates nothing either uncom¬
mon or untoward. In this manner the labour proceeded*
slowly, for twenty -six hours; the Princess being frequently up
and walking about, from finding that the pains almost left, her.
when she was in the recumbent posture. About this time, also,
judging from the inefficiency of the pains, and the little progress
made in the labour, we understand Sir Richard Croft suspected
that there were either twins, cr that there existed some irregular
action of the uterus: and, as it was probable a consultation might
ultimately be required, he wrote to Doctor John Sims, re¬
questing his immediate attendance. He had, in the mean time,
provided whatever could be wanted, should it be found expe¬
dient to have recourse to artificial delivery.

Dr. Sims arrived at Clermont at two o’clock in the morning
of Wednesday, but did rot then see the Princess ; and, as the
came of this La 3 been grossly mis-stated, we think it proper, hi

536

Medical and Physical Intelligence .

justification of an honourable man, and so highly respected a
member of the profession as Sir Richard Croft is well Known to
be, to state, that we have been informed, from a quarter which
We must credit, that it was proposed by Sir Richard to Dr.
Sims, that he should then be introduced to the Princess; but
both Dr. Sims himself and Dr. Baillie thought his presence, at
that time, could not be productive of any benefit, but might
agitate the patient. Dr. Sims, therefore, declined entering the
lying-in room. No consultation was at this period necessary,
as the labour was evidently advancing, although slowly : but,
on hearing the statement of the situation of tiie Princess from
Sir Richard Croft, Dr. Sims concurred in the opinion that
every thing should be left to Nature.

About noon, on Wednesday, it, was first suspected that the
child might be dead, or that if might be born in a state of sus¬
pended animation ; and every known means of recovery were
immediately prepared. Still the labour continued to be scarce¬
ly progressive, the pains being such as tend to forward birth
rather by moulding the head so as to admit of its easy passage,
than by forcible expulsion. When this was completed, the
pains became more efficient'; and, at the termination of fifty hours
from the commencement of the labour, the Princess was de¬
livered, by natural efforts, of a still-born male child. No great
discharge" followed the birth ; but it was soon discovered that
the uterus was acting irregularly, and taking on the hour-glass
contraction ; and an unfavourable separation ox the placenta
was anticipated. This likewise, in some degree, accounted for
the protracted character of the labour.

At half-past nine ©'clock, a discharge of blood occurred.
Dr. Si-ms, who was then employed in an adjoining room in en¬
deavours to re-animate the infant, was instantly informed ot this
occurrence ; and, in consultation with Sir Richard Croft, agreed
that the immediate separation and removal of the after-birth was
necessary. It was effected with little difficulty, and was followed
by a very trifling discharge either of fluid or coagulated blood.

The Princess was now as well and composed as ladies
usually are immediately after delivery ; and continued so until
a quarter before twelve o’clock, taking frequently small supplies
of nourishment ; but at this time she became restless and
rather talkative, and complained of being sick. She vomited,
but nothing was ejected, except a little camphor julep, which
she had taken ; and at this moment her pulse was firm, steady,
and under a hundred. She again was composed. About half
past twelve, however, the breathing. became impeded ; the res¬
piratory organs were evidently under the influence of spasm, and
continued in that state until she breathed her last, at half-past
two o clock ; exactly five hours and a half after her delivery.

In this afflicting state of the case, Dr. Baillie and Dr. Sims,

537

Case of the late Princess Charlotte of Wales.

who had been called into the room when the breathing first
became affected, united their judgment and their skill with that
of ,311 Richard Croft, but in vain, to avert the impending cala¬
mity. Art proved unavailing, although everything which it could
devise, and which Experience could suggest, was attempted.

On the seventh of November, the body was opened by Sir
Everard Home, assisted by Sir David Dundas, Mr. Brande,
and the Apothecary of Prince ^Leopold's Household ; and, wre
believe, the following is a pretty accurate statement of the ap¬
pearances these gentlemen observed :

I he membranes of the brain presented their natural aspect.
The vessels oi the pi a mater were less distended with blocd
than was to be expected after so severe a labour. The ventn-
i.ies of the biain contained very little fluid. The plexus cho-
roides v>as ot a pa^e colour, and the substance of the brain had
its natural texture.

T he pericardium contained two ounces of red coloured
fluid. The heart itself and the lungs were in a natural state.
The stomach contained nearly three pints ot liquid. T he colon
was distended with air. The kidneys and other abdominal
viscera were in a natu ral state.

The uterus contained a considerable quantity of blood, and
extended as high up 1 11 the abdomen as the navel ; and the
hour-glass contraction was still very apparent.

1 h e foregoing narrative throws very little light upon the
immediate cause of the death of the Princess. The fluid
found in the pericardium might have obstructed the due action
of the heart ; but it is not easy to account for its presence
there, nor to conceive how so large a quantity could have been
effused during the short space of time that supervened to deli¬
very, before the breathing became impeded. The quantity of
the blood which was found jn the uterus might have induced
exhaustion ; but this opinion can only be conjectural, as it is
impossible todraw any certain inference from the rather indefinite
expression “ considerable,” contained in the Refokt of the Sur¬
geons. Imagination indeed has been busy, and a phalanx of ca¬
sual circumstances have been. arranged to account for the dissolu¬
tion ; some of which are ungenerously and too unguardedly, pot
to say maliciously, calculated to attach blame to her attendants ;
but we must deprecate such expositions, as unjust to the indivi¬
duals concerned, and in no degree honourable to the Profession.

We have been informed that the whole of the Royal Family
are liable to spasms of a violent description ; and to this heredi¬
tary predisposition, -and the increased excitability of the amiable
sufferer, owing to the tedious nature of the labour, are we left
to ascribe an event, which lias destroyed the flattering hopes
of the Nation, and lopped off the fairest branch from the stem
•*' of its Monarchal Succession.

538 Medical and Physical Intelligence.

A List of Persons who have obtained Certificates of their Fitness
and Qualification to 'practise as Apothecaries , and to act as
Assistants, from August 1, 1816, to July *81, 1817*

* * Those who are marked thus*, are authorised to practise in London and ten Miles round*
Those who are marked thus i, are Members of the Worshipful Society of Apothecaries.

Abraham, Thomas

Adams, Nicholas

Allen, J. N. Ulversfone, Lancash.

Allison, Wm. Bilhy, nr. Worksop

^|Anderson, G. H. Fleet-st. Loud.

Balrne, William Nettleton

Barker, WTilliam

Barter, Thos. Pool, Dorsetshire

Batty, Edward

Beale, John Evans, Gloucester
Beckett, Richard
Beeston, W. W. Wellington, Sal op
Bell, Thomas, Newport, Essex
"HBiddell, J. Middlesex Hospital
Bird sail, William
XRempass, J. C. Bristol
Bond, W. Y. Chvdleigh, Devon
Bowden, Samuel Fitzherbert
Brendon, P. 1L N. Hosp. Plymouth
Broadbent, R. Altringham, Chesh.
Brougham, S. Falmouth, Cornw.
Brown, Peter

*JBrowne, T. jun. Camberwell
Burfough, Rich. F. Dartmouth
Calvert, George
Cave, Thomas

Chapman, James, Kir ton , Suffolk
Clark, IT. Portsmouth, Hants.
Clark, Benjamin, Northampton
Clater, Samuel, Retford
* Cleave, Walter Oke, London
Coates, B. D. Huddersfield
Cooke, B. J. Stroud, Gloucestcrsh.
Cooke, William Henry
Critchley, Thos. ITodgkinson
Daniel, Edw. Burslem, Staffords.
D' Aranda, G. Billericay, Essex
Davidson, Thos. Inverness
Day, Edw. Elmsall, Bristol
Dixon, Charles

Dixon, A. Stourbridge, Worcester .
Dutton, Wm. B acton , Sufi oik
Duncan, J. Id. Wrotham , Kent
Dyer, William

Earle, Fran. Masham, Yorksh.
Kddowes, J. H. Loughborough
Eddowes, W. K. Belton, Leicester.
Ldraan, C. Alford, Lincolnshire

Edwards, Edw. Strood, Kent
Evans, Humph. Jones, Anglesca
Cj; Evans, Thos. Old-st. London
Fawdington, l’. Thirsk , Yorks .
Ferraby, Charles
Flint, Richard

Frankish, W. B. Birmingham
Ford, Jas. Hanley, Staffordshire
Ford, Rob. Highworth, Hilts,
Fosbrook, J. El Rugby, Warwick \
Fowler, Fred. Collumpton, Devon
Frost, Wm. Need ham-M a rket
*Gaitskell, William
Galindo, Richard Miles
Garlick. Joseph Prince, Leeds
Gilpin, Richard
J Gossett, Daniel
Gray, Thomas Nathaniel
* ^Griffiths, John
Grist, William
Grime, William
Hardy, William ^ ^ *

Haworth, S. Skipton in Craven
Raxby, Henry

Heelev, Jos. Walsall, Stafordslu
Henchman, Charles Wishaw
Hensleigh, H. Brixton, Devon
Hewett, Wm. Wright
Heynes, Charles Stokes
Hibbert, John Mason
Hill, John, Derby
Hodgshon, George, Darlington
Holland, Rob. Geo, Sheffield
Hounsell, John "

Hughes, William Anthony
Hunt, Sam. Loughborough
Hunt, Fran. Bath, Somersetshire
Human, Charles
Irish, Thomas Trenham
Kendall, W. Ashburton, Devonsh ,
Kirkby, N. W. Hull, Yorkshire
Knight, Geo. Debenham, Suffolk
Knowles, J. Todmorden
Lacy, Jas. Prior, Newark
Layman, William Henry
Ledbrook, L, Swerford, Oxfords*
Lees, Lloyd, Halifax, Yorkshire
Lessey, Thos. Manchester

List of Cert f calccl Apothecaries ,

Li veing, Edward
Longstaff, William Hilton
Mackeretb, George Wilson
Mac T ark, W illiam
Madden, Rich. Liverpool
Mark, Edward Robson
Marner, J. Attleborough , Norfolk
Martin, John Philip
Mart mean, Thos. Norwich
Mathias, William, Cardigcirk
*+ M'audsley, John, Pnnces-st.

Hanover-square, London
Maysmor, R. P. Ashburn, Derby s.
Meek, Robert
Metcalfe, R. Ives, Spalding
* Miles, John, London
Mills, Chas. A. Pulliam, Norfolk
Mimpriss, Thomas Roberts
Mitchell, H. High Ongar, Essex
Neville Win. H. Esher , Surry
Nicholson, Richard
Norris, W. Stourbridge , Worcester
Orton, J. Kegworth , Leicester sh.
Parson, C. A. Godaiming, Surry
P argeter, C. Fordingbridge , Hants
Pater, Henry Thompson
Paterson, Thos. Willis, Leicester
Paty, James , .

Peck, Thomas, Wellingborough j
Pitman, Wm. Andover , Hants
Poole, Winter Cuppage
Po Well, Morgan, Swansea
Puddicombe, Alfred, More ton-
Hampstead, Devon
Pughe, Robert

Radford, Thomas, Manchester
Reedal, Gabriel, Hull , Yorkshire
Richards, Henry
Richardson, John, Leeds, Yorksh.
Rogerson, Jos, Wigan , Lancash.
Rose, George
Salmon, Fred. Bath
Salter, John

•Sandford, Wr. N. Bridge-road,
Lambeth, Surry

*Saumarez, F. Newington, Surry

Sharp, J. St. Helen s, Lancash.
Smith, Benjamin, Lincoln

* Smith, John Simm, London
Snow, Wm. Barnstaple, Devon
Stables, Marsh. Hors forth, Yorks ♦
S tatter, Edward, Lancaster
Stephens, Hen. Redburn , IIerts%
Stevens, Wm. Newmarket
Stillwell, James

Stowe, Wm. Oxford
Swan, Arthur, Southwick, Hants
Tanner, C, Collumpton, Devon
Taylor, Wm. Cuekney, Notts.
Taylor, Charles, Plymouth
Thompson, Charles Matthew
Thorne, J.W. St.Teaih, Cornwall
Thornton, Wm. Booth

* To wry, Benj. Jolit, Gt. St. He¬

lens, London

Tozer, F. E. Mildenhall, Suffolk
Uttley, Jn. Todmorton, Lancash.
Wal ne, D. H. Norwich
Waterworth, Edward Plenry
Watkins, Daniel

* Weaver, Edward, Blackmoor-st.
Wentworth* Wm. Cambridge
^Wheeler, Wm. Lowe
Wheelhouse, Jas. Leeds, Yorksh.
* White Steph. lied Lion -St. Bondi

* Wbifp T?iVhrt?Vl

Wilde, G. R. Mildenhall, Suffolk
Wilkinson, Edw. Entwistle
Wills, Geo. Kingsker swell, Devon
Wilton, John
Wilton, Wm. Both Easton
Wrms tone, Thomas
WVitherington, E. Gt. Prescoi-sL
Wood, Thomas, Leeds, Yorksh.
Woodward, Thomas Charles
Wooler, Wm. Moore; Dewsbury
Worley, J. E. Sloney Stratford
W7 ray, S. Thoralhy, near Bedale
Wright, William, Liverpool
Assistants.
Obaldeston, Tnoraa's
Rollings, Richard

NOTICES OF LECTURES.

Dr. Merriman and Dr. Ley will begin another Course of Lectures
on Midwifery and the Diseases of Women and Children early in.
December, at the Middlesex Hospital.

Dr. Davis will commence his Second Winter Course of Lectures
on the Theory and Practice of Midwifery, and on the Diseases of
Women and Children, on Tuesday evening, January 6th.
vol. vm.-— no. 48, 3 z

540

LITERARY NOTICE.

Mr. A. T. Thomson’s Second Edition of the London Dispense*
tor v will contain all the improvements in Pharmaceutical Chemistry
and the alterations that have taken place in the British Pharmaco¬
poeias since its first appearance ; and also, synonymes of the names
of the articles of the Materia Medica, and the preparations, in the
French, German, Italian, Spanish, and Hindostanee, languages.
The work is already in the press.

A METEOROLOGICAL TABLE,

From the 21 st of October to the 20th of November 1817,

KEPT AT RICHMOND, YORKSHIRE.

230 Miles NW from London.

Ear oi
Max.

neter.

Min.

The

Max

:rm.

Min.

Rain

Gage.

Winds.

Weather.

21 29

NbW.NE.

1 3 Cloudy.. 2 S. 4 R.

22 29

NE.NW.

1 Mist... 2 Cy.. 4 Mil...

2329

NW.

13 4 Cy.. 2 Sun.

24|29

NW.

1 Cy.. 2 Rain.

251

NE.SE.

1 Cloudy...

SE.

1 Cloud... 4 Moon..

SW..SE..

1 S... 2 R. 4 Moon...

SW..S..

1 3 S.. 2 Sh. 4 Moon..

5W..

1 Sun.. & Showers.

SW...

1 Sh. & Sun.. 4 R..

sw...

1 R. 2 Sun.. & Sh.

wsw...

1 Sun... 4 R.

r29

SE..S..

1 3 R. 2 4 Cy..

SE.SW.

1 Mist.. 2 Sun..

SE.

1 Mist.. 2 S.. 4 R.

55 '29

SE.SE...

1 Mist.... 4 Star!..

47|29

SW.SE.

1 Sun... 3 Cy.. 4 R..

10 29 *

SE..

1 Mist... 2 S. 4 R..

07 28

SE..

1 Sun.. 3 R..

4729

SW..

1 Sun.. & Showers,.

4729

s..

1 Sun. . 2 Cloudy..

35 29

SE,.SW..

1 Cy.. 2 R.. 3 Sun..

27:29

SE.

1 Mist... 2 R..

38,29

w.sw.

1 Sun... 4 R.

1229

1 Mist..,. 3 R...

3128

SE..SW..

1 R.. 4 Moon..

70 29

SW..

1 Sun...

7229

Vble.SW..

1 3 Cy,. 2 S. 4 Moon..

9329

SW...W..

1 R. 2 Sun...

04 30

WbN..

1 3 C„ 2 Cy.. 4 Moon...

6229

W..SW...

1 Sun...

The quantity of rain during the month of October was I inch 40-100ths.

Observations on Diseases at Richmond.

The weather in this last period has been wet, but not very cold.

The prevailing disorders were chiefly seated in the stomach, bowels,-
and liver. Diarrhoea was very common, but readily yielded to a dose of
calomel at bed time with an aperient mixture in the morning. There w'ere
also some cases of Catarrhal and simple fever. Cases of Asthma, Dys¬
pepsia, Gastrodynia, Icterus, and Obstipatio, have been under treatment. .

METEOROLOGICAL TABLE FOR LONDON,
From the 20 th of OCTOBER to the 1 9th of NOVEMBER, 1817,

By Messrs. HARRIS & Co.
Mathematical Instrument Makers , 50, High Bottom.

Therm.

Barom.

Rain

Guage

De Luc’s
Dry.

Hygrom
j Damp.

Winds.

A r no. V ariation

45 47 44

299

29"

NNE

' Rain: -

Clo.

47 49 40

299

29 8

'NE

Fog

Fine

Rain

Cio.

43 50 41

29s

29 s

.05

Clo.

45 48 41

29s

NNE

Clo.

44 52 44

29 s

29s

.09

Fog

Fine

Clo.

Rain

44 50 41

29"

297

.08

45 49 38

29s

Fine

44 47 40

29"

29°

.06

Fog

Clo.

Rain

46 52 40

29 8

29°

.04

SSE

Fog

Fine

Clo.

45 49 40

29r

29°

.09

Rain

40 47 41

294

.13

ssw

wsw

Rain

40 48 38

293

303

.19

Wva

wsw

Clo.

Rain

Fine

42 48 34

30"

Fog

Cio.

Fine

45 47 49

303

302

301

ssw

Rain

54 57 50

302

.09

Clo.

Fog

50 53 48

301

Clo.

50 55 50

29s

299

SSE

Fog

Clo.

52 54 52

299

29s

.SE

Clo.

Rain

55 57 49

297

295

.11

SSE

Fine

Rain

50 51 47

29°

295

.06

Fine

Rain

49 52 50

29'

299

.13

Fine

52 53 49
51 54 49

29°

299

29s

,07

SSE

Clo.

Fine

Rain

Clo.

Fine

50 52 45

29'

295

.10

Clo.

Rain

45 50 47

2.9s

29'

.19

ESE

Fine

52 55 49

297

295

Clo.

Rain

Fine

50 58 50

295

29s

.03

Rain

50 53 47

298

301

.09

Clo.

Rain

Clo.

49 57 45

302

Clo.

Rain

18j49 53 45[30

302

SSW

WSW

Fine

19|47 53 39;303

304

.05

Fine

The quantity of Ram fallen in the month of October, is 1 inch and 65- lOOths.
Bill of Mortality from October 14, to November 18, 1817.

christened

BURIED.

{

OF WHOM > 2

IlAVE DIED /'•*

small

Oct. 21

Males . . . 343

Females . . 507

650

Males . 247

Females . 252

479

Under '2 Years .... ....122

Betw. 2 and 5 . 42

5 and 10 ...... 18

10 and 20 . 17

20 and 30 . 35

30 and 40' . 46

40 and 50 . 55

50 and 60 . 44

60 and 70 . 42

70 and 80 . 35

80 and 90 . 18

90 and 100 . 5

POX . 26

Total of Small Pox.

Get. 28.

Nov. 4.

Nov. 11

284

215

250

256

204

- — —

— ■ . -

- .

554

551

454

—

- ,

225

256

216

256

229

202

461

465

418

—

■ -

115

107

129

22 25

(five weeks). ..115.

Nov. 18.

280

201

- ^ Total,

481 > (five weeks)
- ) 2650.

196

210

- ) Total,

406 WJive weeks )
- ) 2229.

19
4

542

A REGISTER OF DISEASES
Between OCTOBER 20 Ik, and NOVEMBER 1 Qth, IS17.

. <

DISEASES.

s->

DISEASES.

Abortio .

Abscessio .

Acne .

Amenorrhoea.

Amentia .

Anasarca .

Angina Pectoris
Aphtha lactentium

anginosa.

Apoplexia .

Ascites. .

Asthenia .

Asthma . . .

Atrophia.........

Bronchitis acuta.. . .

- chronica.

Calculus .

Caligo . . —

Cancer .

Cardialgia.

Carditis.
Catarrhus ..
Cephalalgia.
Cephakea...,

Chlorosis.........

Chorea .

Cholera .

Colica . . .

- Pi donum.

Convulsio .

Cynanche Tonsillaris .

- maligna... .

• - Trachealis.

- Parotidca. .

Delirium Tremens.

Diarrhoea .

Dysenteria . . . .

Dyspepsia. . . .

Dyspnoea .

Dysphagia .

Dystocia .

Bysuria .

Ecthyma . .

Eczema . .

Eneuresis .

Enteritis.... . .

Entrodynia .

Epilepsia .

Epistaxis .

yysipelas.

4
2
26
16
4
14
41
7
2
6
1
67
24
59; 3

17
1

2
4

«l

5 1
23
4 1
8

17i

Erythema losve . . .

Exostosis .

F ebris intermit tent . .

— — catarrhalis . . . .

- Synocha .... . . —

- - Typhus mitior .

- - Typhus gr avion ...

— — Synochus .

• — — Puerpera . .

remit. Infant. .

Fistula.

Fungus . . <

Furuncululs . .

Gastritis-.... .

Gastrodynia .

Gonorrhoea . . .

Heematemesis .......

Heemoptde . .

Haem or r hois .

Hemiplegia . .

Hepatalgia .

Hepatitis acuta.....

- - chronica.

Hernia .

- humor rhalis .

Herpes Zoster.......

• - - circinatus...

- labialis .

Hydrarthyrus .

Hydrocele.... ......

Hydrocephalus .

Hvdrothorax .

Hypochondriasis. . .

Hysteralgia . .

Hysteria .

Icterus.. . .

Impetigo jigurata.

• - sparsa...,

- * — scabida...

Ischias . .

Ischuria.... ..

Lepra . .

Leucorrhoea . ,

Lumbago .

Mania .

Melancholia..
Menorrhagia.

Miliaria
Morbi Infant lies *
Morhi Biliosif

8
5

DISEASES.

Nephralgia .

Nephritis .

Neuralgia . . .

Obstipatio .

Odontalgia .

Opththahnia .

Otalgia . .

Palpitatio .

Paracusis .

Paralysis .

Paraplegia .

Paronychia . . .

Peripneumonia .

Peritonitis . . .

Pernio .

Pertussis .

Phlegmasia dolens... .

Phlogosis .

Phrenijis .

Phthisis Palmonalis .

Physconia .

Pityriasis .

Plethora . .

Pleuritis . .

Pleurodyne . .

Pneumonia .

Podagra . . . .

Porrigo scutulata .

- favosa .

Prolapsus .

Prurigo mil is .

- senilis. .

3
2

32
6

4
1

33
2
9
3

5
16
17
35

6
3
5
2
5

DISEASES.

Psoriasis guttata .

Purpura simplex. ... .

Pyrosis .

Rheumatismus acutus .

- - • ch ron icus. . .

Roseola .

Rubeola . .

Scabies... .

Scarlatina simplex . .

- anginosa .

maligna...

Scorbutus

Scrofula .

Spasmi .

Strictura . .

Strophulus intertmetus. ..

Sphacelus .

Syncope .

Syphilis .

Tabes Mcsenterica .

Tic Douloureux .

Tympanites..., .

Vaccinia . .

Varicella .

Variola .

Vermes .

Vertigo .

Urticaria febrilis .

- 1 - evauida .

Total of Cases
Total of Deaths.

5
1

6
36

2249

■ ^tls melnt lo those Disorders principally arising from dentition nr

n^fef 0X}’ ar,cl y,ay be too trivial to enter under any distinct heads ; Morbi Biliosi such

-omplamts as are popularly termed bilions, but cannot be accurately classed. * '

Observations on Prevailing Diseases.

The last month has been productive of an increased number of affections
or Lie cerebral functions., as the number of cases under Apoplexia, Paralysis
and Mania, evinces. J 3

Rubeola and Scarlatina are also more common ; and Variola still con¬
tinues its unsparing ravages. Four cases of the latter are reported after
vaccination ; one of which terminated fatally : and a young man Avho was
inoculated with smallpox when a child, fell a sacrifice to that disease in
the natural way.

The subject of Fever still occupies the public mind : we have, therefore,
thought it our duty to make particular inquiries respecting the extent and
site oi it. It will be seen by the present Register that Typhus mitier, Typhus
grr avion, and Synochus, have all increased since our last Report. Rut
w hatever the nature of the fever may be, and in whatever districts it pre¬
vails, it assuredly is not of a malignant character. In the western and south¬
western districts Typhus is scarcely known : in the north-west it exists,
but not greatly, and only among the poor : the same may be said in the

544 Prices of Substances employed in Pharmacy .

northern, where, although there are most cases reported, yet they are of the
mild kind, and almost wholly confined to the lower orders : among the same

classes it also prevails about Lambeth. .

In the north-eastern district, both Synochus and a contagious iever is
frequent among the poor, which our intelligent Reporter ascribes to the
ignorance and obstinacy of the friends 01 the sick pei sitting in visiting them.,
and preventing proper ventilation • and hence the necessity mid utility ot
insulating the sick entirely, by removing them into fever wards, or institu¬
tions provided for that purpose. This would be the surest mode of stopping
all fevers in limine, and of guarding against contagion in populous towns.
The City, and the eastern districts, are as free from contagious tever as
Westminster. Rut all accounts agree that there is more of a fever, call it
Typhus mitior or Synochus, than there was a month ago. Of the matter, a
Reporter, at the western extremity of the town, thus speaks :

st Xn the greater number of the cases of Synochus, which were of the form
of the bilious° remittent, there was a very peculiar secretion of bile, for this
climate; the alvine discharges in the commencement of the diseases having
very much the appearance of a mixture of soot or black sand in dirty watei ,
and, in one case, matter of the same appearance was vomited. The liver
generally felt tender when pressure was made over the hypochondrmm ;
and in a few instances the most intense head-ache and delirium accompanied
this symptom. Indeed the whole character of the disease was such as to
afford sufficient reason for thinking that, had it occurred in a^tropical di¬
mate it would have assumed all the characters of the Yellow Fever. The
blood presented a cupped surface and sizy coat, somewhat resembling glue ;
and when drawn in the state of the greatest apparent debility of pulse,
afforded the most satisfactory relief! The principal remedial means em¬
ployed, were bleeding, purging with large and repeated doses of calomel
and senna and the exhibition of the nitric acid largely diluted. Blisters
also were applied to the nape of the neck, and the body fieely sponged w^vh

vinegar and water. . , . ,

<s In one case the stools had the appearance above described, without

the presence of any fever. Purgatives were freely administered, without
producing any beneficial effect ; nor did their appearance alter, until the
nitro-muriatic bath was employed, and the acid also internally exhibited.

Quarterly Report of Prices of Substances employed in Pharmacy.

Acacias Gummi elect.

lb.

Acidum Citricum

•

- Benzoicum

unc.

- - Sulphuricum

P. lb.

— Muriaticum

•

- N itrieum

- - Aceticum

unc.

Alcohol ...

M. lb.

j4Sther sulphuricus

- rectificatus

Aloes spieat® extractum

lb.

— vulgaris extractum

•

A lumen

Ammonias Murias

— - Subcar bonas

Amygdalae dukes

Ammoniacum (Gutt.)

•

- (Bump.)

Anthemidis Flores

Antimonii oxydum

- sulphuretum

Antimonium Tartar izatum

“

Arsenici Oxydum

Assafoetid® Gummi -resina

- lb.

Aurantii Cortex

Argenti.Nitras \»

unc.

Balsamum Peruvianum

lb.

3. D.

1 o
28 0

6 8
0 7

1 8

4 0

3 0

5 8

10 6
14 0

7 6
5 0

0 6

2 4

3 8

3 0

12 0
5 0

3 0

I 8
8 0
3 6

8 0
5 0

7 0

30 0

S. D.

Ralsamum Tolutamun * - 20 0

Benzoinum elect. - - - 14 0

Calamina praparata * - 0 8

Calumb® Radix - - - 3 6

Cambogia - - ? 9 0

Camphora * - - - 7 6

Canell® Cortex - - - 4 0

Cardamomi Semina opt. - lb. 10 6

Cascarill® Cortex - - » 3 0

Castoreum - unc. 4 0

Catechu Extractum - lb. 3 8

Cetaceum - - - - 4 0

Cera alba - - - - 4 0

- - flava - - - - 3 9

Cinchona; cordifoli® Cortex (yellow) 6 6

- lancifoli® Cortex (quilled) 9 0

- oblongifolise Cortex (red) 10 0

Cinnamomi Cortex - - - 17 O

Coccus (Coecinella) - unc. 5 Q

Colocynthidis Pulpa - - lb. 20 0

Copaiba - *50

Colchici Radix - - - 3 0

Croci stigmata - unc. 7 0.

Cupri sulphas - lb. 1 2

Cuprum ammoniatura - 10 6

Cuspari® Cortex - -40

Coofcctio aromatica - - 11 0

Prues of Substances employed in Pharmacy. 545

une

unc
- Res

Confectio Aurantiorum

- Opii

' Rosa» canin®

— — Rosa; gallic®

- - Sennas

Emplastrunl Lytt®

_ - - Hydrargyri

•Extractum Belladonna; -

- Cinchona

— Cinchona resi nosum
- - - Colocynthidis

* - Colocynthidis comp.

• - - Conii

- * Elaterii

Gentian®

GlyCyrrhiz®

Hamatoxyli
Humuli
Hyoscami
Jalap®

Opii1

Papaveris
Rh®i

Sarsaparill®

T, . — Taraxaci
l ern subcarbonas - . jh

— sulphas
F errum ammoniatum
- — tartarizatum
Gaibani Gummi-resina.

Gentian® Radix elect
Guaiaci resina -
Hydrargyrum purificatum . '

- pr®cipitatum album

xr~ - cumcreta

Hydrargyri Oxymurias - une

- Submurias - . .

- Nitrico-Oxydum

- Oxydum Cinereum

- - Oxydum rubrum -

- Sulphuretum nigrum

*r .37 • . rubrum

Hellebori mgn Radix - lb
Ipecacuanha Radix - . I

, , - Pulvis

Jalap® Radix -

- Pulvis - *

Kino - - .

Liquor Plumbi subacetatis M. lb.

— Ammonia? -
— Potass® - . .

Linimentum Camphor® comp.

- saponis comp.

Lichen lb.

Lytt® - -

Magnesia -
Magnesi® Carbonas

- Sulphas, opt.

Manna optima -

— communis
Moschus pod, (30s.)

Mastiche ...

Myristic® Nuclei
Myrrha elect.

Olibanum
Opium (Turkey)

Opium (East India)

Oleum Amygdalarum

— ■ Anisi
— Anthemidis

— Cassi® - *

— Caryophijli

— Carui .

— 1 Juniper! An g. ...

— Lavandul®

— Menth® piperit® - unc.

— Menth® viridis Ang. -

— Piment® - - Unc.

— Ricini optim. - (per bottle)

in gr. unc.
lb.

lb.

unc.

4
6
2
2
2
7
3
1

4
2
0

5
0
0
1
4
4
1
2
1
0

4
2

6
12

7
6
9

8
0
0
0
1

3
0

4
0
6
6
0
0
0
4
9
0
6
0
9
9
3
0
0
0
6
6
9
0
0
0
0
0

3
2

4
4
1

4
48

6
8
6
1

4
6

5
5

4
6
0
0
0
9
9
8
6
0
4
9
0
0
0
0
0
0
8
6
6
6
0
6
0
G
0
10
6
0
0
0
0
0
6
0

unc.
■ reet.
P. lb.

Oleum Rosmarini
— Suecini 2 s. Gd.

— Sulphnratum
— ■ Terebinthin®

_kl — reetificatum - .

iv® Oleum - _ cong

— Oleum secundum
teris[:aPMte - (per 100)

S. D
0 9

Plumbi subcarbonas
— Superacetas
„ ~~ Oxydum semi*vitreum
Potassa Fusa -
— cum Calce
Potass® Nitras

— Acetas ...
— Carbonas
— Subcarbonas
— Sulphas jj
Sulphuretum
— Supersulphas
— Tartras
Supertartras
1 uul® Hydrargyri
Pulvis Antimonialis 3
Con tray erv® comp. ~ „

— Tragaeanth® comp.

Resina Flava - .

Rh®i Radix (Russia)

- (East India) opt. ■

Ros® petala - .

Sapo (Spanish)

Sarsaparill® Radix (Lisbon) .
Scammone® Gummi-Resina -
Sail® Radix siccat, opt. Ang.
Seneg® Radix - .

Senn® Folia
Serpentari® Radix
Simarouh® Cortex
Sod® subboras
— Sulphas
— Carbonas
— Subcarbonas

— — exsiccata -
Soda tartarizata
Spongia usta
Spiritus Ammoni®

~~ - aromaticus

— - fcetidus

~~ succinatus

— Cmnamomi
— Lavendul®

— Myristic®

— Piment®

— > Rosmarini

— ^Etheris Aromaticus

— 1 — Nitrici

— — Sulphurici

~ — Compositus

— Vini recti ficat us

Syrupus Papaveris
Sulphur

— Sublimatum - 3
— Lotum

— 1 Pr®cipitatum

Tamarindi Pulpa opt.
Terebinthina Vulgaris

- Canadensis

- Chia

Tinct. Ferxi muriatis
Tragacantha Gummi, elect. S
Valerian® Radix
Veratri Radix

Unguentum Hydrargyri fortius
. Nitratis

rr ~77 - — ; Nitrico-oxydi

Uv® Ursi Folia elect.

Zinci Oxydum
— Sulphas purif.

Zingiberis Radix opt.

lb.

unc.

lb.

2
22
15

unc.

0 6
0
0
G
8
4
(I
G
O
6
9

0 9

0 6

lb.

unc.

lb.

M. lb.

cone

5
4

6
7
6

4
0
6
2

5
2

6
6

5
4

6
4

4
7
6
7
7

5
O
0
0
G
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The Influence of the Atmosphere, more especially of the British
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Conversations on Botany, with Plates. ..

On the Nature and Treatment of Tetanus and Hydrophobia,
with some Observations on a Natural Classification of Diseases m

General. By Robert Reid, M.D. 8vo.

Pathologic Oculi, Generalis Pars Prior Nosologia. Auctore

D. C. Basse, Berolini, 1817- 8vo.

On Diagnosis, Part I. and II. By Marshall Hall, M.D. ^ b\o.
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An Essay on the Human Ear, its Anatomical Structure and

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Physiological Lectures, delivered before the Royal College ot
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INDEX

THE EIGHTH VOLUME.

— - * < i » —

Abscesses within the pericardium 399
Abdomen, a lumbricus from an ab¬
scess in the jg

Acer pseudoplatanus , experiments
on the sap of the 4.43

Acetate of potash, preparation of 31
Acid, benzoic, and alkaline benzo¬
ates, tests of the presence of iron 22

— a new 27

— boric, remarks on ib.

— - succinic - 28

— • acetic, components of ib.

-7- malic, constituents of ib.

gallic, of the Chinese nut-galls 29

— meconic, observations on the ib.

— rheumic - jb.

— prussic, found in bread and

recent juice of euphorbii ib.

— formic, components of 30

— oxygenated muriatic, a remedy

in hydrophobia 61

— sulphuric, on the ib.

— - effect of concentrated acetic, as

an epispastic 169

— prussic, antidote for 178

— nitro-muriatic, on the internal

and external use of, in the cure of
diseases 593

Acids, comparison of the composition of 30

— table of the effects of, on vege¬
tation 48

— query respecting the poisonous

effects of vegetable 73

Adams, Sir Wm. on the morbid
growth of the cornea 68

iEther, sulphuric, experiments on 31

effects of inhaling the vapour of 440

Affection, painful, of the left thumb,
and its treatment, an account of 521

— a severe nervous, cured by ampu¬
tation of the finger 520

Affections, enlargement of the in¬
guinal glands like venereal 185

- of the testis, like venereal 191

— ulceration of the nose and face

resembling syphilitic 361

Ainslie , Dr. IV. on the use of bal¬
sam of Peru in sphacelous and
phagedenic ulcers 341, 524

Alihert's Nosologie Naturellc, notice
of 249

— formula for a vesicatory 440

Amphiro, a new genus of worms 43

Amputation, C. Bell's observations on 67

— at the hip-joint ib.

— of a finger removing a severe-

nervous affection 528

4 A

Aneurism, rapid cure of a popliteal 178

— from puncture in bleeding 300

Antidote to prussic acid 178

Antimony, butter of, new method of

preparing 52

Aorta, Cooper's, operation of tying the 66
Apoplexy, on blood-letting in 58

— - its connection with insanity 226

— causes of ib.

Apothecaries, &c. Associated,.

notice of general meeting of the 176

— — - general, meeting of the 269

■ - the eighth report of the 260

- statement of the funds of the 262

- votes of, to Dr. Burrows 262-3

— annual list of certificated, and

Assistants 538

Arteries, on ligatures applied to 66

Arsenic, iodine a test for oxide of 73

— A. T. Thomson's observations on

Dr. Paris'* test of 177

— 1 Marshall's remarks on, review of 149

— experiments on, by the Editors 157

— method of employing nitrate of

silver as a test of 177

Asbury on the organ of hearing 199

— description of an instrument for

puncturing the tympanum 201

Ascending great heights, effects of 19

Ascent of sap in trees, on the cause of 46
Ascites, case of 399

Ashes of plants, copper detected in the 26
Assistants, List of Certifi¬
cated, and Apothecaries 538

Associated Apothecaries, &c.

notice of a general meeting of 176

Asylums, Lunatic, in Ireland 500

Atmosphere, effect of vegetation on
the 47

■— of London, half-yearly synop¬
tical view of the 74

Azote, combinations of, with carbon 40

Bancroft's , Dr. Sequel to an Essay
on the Yellow Fever, review of 401

Baron's , Dr. case of rupture of the

brain and its membranes 423

Baths of Mont d’Or, report of the 34

Bath, on the effects of the nitro-
muriatic, in surgical diseases 449

Bell , Char les, on the structure of the
cranium 9

■— on ligatures to arteries 66

— on fungus haematodes 69

— ’s observations on the tendencies
of wounds and operations to dis¬
order the lungs 65

INDEX.

Dell's, C. observations on amputation 67
Belladonna, effects of, in pertussis -57

. — remedy for tic douloureux 178

Benzoic acid and alkaline benzoates
tests of iron 22

Berzelius on the colouring matter of
the blood 179

Birth of a child thirty-six hours after
the death of its mother 353

BlagderC s case of fatal haemorrhage
from the extraction of a tooth 520

Blaine1 s Canine Pathology, review of 331
Bleeding, an aneurism from puncture
in 300

Blind person distinguishing colours
and reading with her fingers 353, 424

Blood, Prof Bollinger on the cir-
' culation, of the 13

• experiments on the transfusion of 17

— letting in apoplexy, on 58

— Berzelius on the colouring mat¬
ter of the 179

— Hastings on the motion of the 291

Blood-vessels of the spine, conges¬
tion of the, after convulsions 223

Blow-pipe, improvements on New¬
man's 21

Bones, diseases of the, mistaken for
syphilitic 369

— - on the morbid structure of 418

Books, Analytical Review of
Medical — Majendie's Precis
Element-dire de Physiologie, tome
ii. 131 — Parkinson1 s Hospital
Pupil, 2d edit. 143 — Marshall's
Remarks on Arsenic, 149 — Spurs -
helm's Observations on Deranged
Manifestations of the Mind, or
Insanity, 217 — Dewar's Account
of an Epidemic Small Pox, 240—
Blaine's Canine Pathology, 331
Bancroft's Sequel to an Essay on
the Yellow Fever, 401 — Medico-
Chirurgical Transactions, vol. viii.
part i. 417, 519 — Mayo's Re¬
marks on Insanity, 485 — Forster
on the Influence of the Atmos¬
phere on Human Health and
Diseases, particularly Insanity,

497 — Observations on the Phe¬
nomena of Insanity, being a Sup¬
plement, by the same , 498 — Re¬
port of the present State and Ma¬
nagement of the Hospitals for
Insane Persons at Paris, with an
Appendix, 499 — Marcel's Essay
on the Chemical History and
Medical Treatment of Calculous
Disorders, 501.

p— new, monthly catalogue of, 96, 1S4,

272, 360, 448, 546

Borax and the borates, obs. on 30

Brain, description of a scirrhous tu¬
mour of the 351

— and its membranes, case of rup¬
ture of the 423

. — diseases of the _ 227.

— morbid phenomena of the, in

insanity 239

Brands and Parke's analysis of the
Cheltenham waters 32, 33, 34

Bread, prussic acid in 29

— effect of carbonate of magnesia on 30

Bronchocele, on the cure of, by pres¬
sure 288

Brocks' , Dr. case of ruptured uterus 110

BrugnatcW s, Prof, remedy of hy¬
dro-chlorine in hydrophobia

Burrows', Dr. Cursory Remarks on
a Bill for Regulating Mad-houses,

&c.

— thanks and vote of a purse of

500 guineas to, by the Associated
Apothecaries, &c. 262-3

Blitter of antimony, new method of
procuring 52

171

Calcareous matter in the lungs 10

Calculous disorders, an essay on the
chemical history and medical
treatment of, review of Marcet on 501

Calculus, glandular, of an elephant,
examination of a 40

_ _ vaginal, examination of a ib.

Calomel and opium in dysentery, on 58.
Camphor tree of Sumatra, account of 442
Canine Pathology, review of Blaine's 331
Carbonate of magnesia, effect of, on
bread 30

Carbon with azote, combinations of 40
Case of the late Princess Char¬
lotte of Wales 534

Cassia absus a remedy for ophthalmia 353
Cassia, history of the genus 48

Catalepsia verminosa, a case of 209

Catalogue, monthly, of new
books, see New Books

Cataract, Dr. L. Label's operation for 68

- - - observations on 88

Cephalalgia, a case of 398

Cerebri, hernia, Moyle's cases of 384

- - Stanley's — — 519

Chapman's observations on Label's
operation for the cataract 88

— observations on serous effusion 283

Cheltenham mineral waters, new
analysis of 32, 33, 34

Chemical phenomena of heat 25

Chenopodium mdvaria , analysis of 441

Child born thirty-six hours after the
death of its mother 353

Chlorine, on the composition of 440

Christ’s Hospital, quarterly
view of diseases of boys in 80, 302

INDEX;

Cicada manmferens, account of the 44
Cinchona, Lambert's observations on 38

— method of infusing 50

— account of a new species of 350

Coccus lacca, account of the 45

Colchicum autumnale , sediment of,

a violent purgative 50

Colladon's account of cassia 49

Colours, on the cause of 23

— perception of, by a blind person 353,

424

Composition of acids, comparison of the 30
Conception and generation, new opi¬

nions on 15

Concretions, polypous, in the heart 61
Condylomata, of 372

Congelation, artificial, of water 178

Controversy between Drs. Gordon
aild Spurzheim 4

Convulsions, puerperal, subsequent
to parturition, a case of 303

— congestion of the blood-vessels

of the spine after 993

— cause of 16

Coombs on the gout 479

Cooper 's, Astley, operation of tying

the aorta ' 66

C ooper's history of a case of lithotomy 520
Copper, oxide of, employed in ana¬
lyzing vegetable and animal sub¬
stances 9g

— detected in ashes of plants 26

Cornea, on the morbid growth of the 68
Corrosive sublimate, iodine a test for 73
Cough, with watery expectoration, a
case of ' 304

Cow-pox, failures of, to protect
against small-pox 57

Crumpton's , Dr. J. case of rupture
of the stomach 523

Cranium, hints on the structure of the 9
Craniotomy forceps, descrip, of a new 70
— Dr. Davis on the 373

Cubeba piper, a cure for gonorrhoea
and gleets 439

Cutaneops diseases mistaken for
syphilitic, on 273

Cuvier's Memoir es des Mollusques 41
Datisca cannabina , components of the 36
Davis', Dr. new invented craniotomy
forceps 70, 213, 373

Davy, Sir II. experiments on flame 24
Decomposition of the earths, unsuc¬
cessful experiments on the 21

De, Merveilleux' s case of accumula¬
tion and retention of urine 212

Demonomania, case of 113

Density of water, the greatest 25

Delisle' s, M. theory of the malaria
of Italy 166

Dessaignes ’ experiments on galva¬
nism 26

4 A 2

Detvar's, Dr. Account of an Epide¬
mic Small- Pox, review of 240

Dickinson on the difference between
the endemic or marsh, and yellow
fever of the West Indies 462

Diseases resembling venereal, essay
on " 117, 187, 273, 361

Diseases of London, half-yearly
nosological table of the 75

- observations on the prevailing 95,

183, 269, 359, 447, 543

— monfldy register of the 94, 182,

268, 358, 446, 542.

- recapitulation of the 7 9

• — of Richmond, monthly obser¬
vations on 92, 180, 266, 356, 444, 540

— of boys in Christ’s Hospi¬
tal 80, 302

— Dr. Scott on the use of the nitro-

muriatic acid in the cure of 523

— Guthrie on the nitro-muriatic

bath in surgical 449

— of bones mistaken for syphilitic 369

— > of the brain 226

Discharges from the urethra in men

resembling gonorrhoea 127

— from the vagina 129

Dissections, Morbid, polypus in

the stomach, 165, 251 — of twin
male foetuses, 247 — transposition
of viscera, 248 — scirrhous tumour
in the brain, 351 — abscess in the
brain, 393 — abscesses in the peri¬
cardium, 399 — petrifaction of the
heart, 428 — of the brain in epi¬
lepsy, 430 — a stomach in which
a fork was found, 439 — of the

Princess Charlotte, 534
Dollinger , Prof, on the circulation
of the blood 13

Dropsy, remarkable morbid appear¬
ances in a case of 11

Dunn's case of aneurism from punc¬
ture in bleeding 300

Dura mater, puncturing of the her¬
nial sac of the 10

Dysentery, effects of calomel and
opium in 58

Earths, unsuccessful experiments on
the decomposition of the 21

Effusion, serous, observations on 283

Elephant, examination of the intes¬
tinal gas of an 40

- of a glandular calculus of an ib.

Emetic principle of ipecacuanha 254

Epilepsy cured by superacetate of lead 178

— on the cure of, by moxa 347

— on the pathology of 430

Epispastics, observations on 168

— concentrated acetic acid, used as 169

Ergot, on its poisonous principle 36

1— * a morbitj modification of rye 49

INDEX.

Erysipelatous inflammation, method
of treating 57

Esquirol, Dr . on the pathology of
epilepsy 430

Expectoration, watery, a case of
cough with 304

Explosion of a laboratory 179

Extirpation of the uterus, success of 352
Extracts, on the preparation of 442

Eye, refractive powers of the hu¬
mours of the 14

Fatuity, remarks on 307

Fauces, ulceration of the, resembling
' venereal 193

Ferguson , Dr. on the nature and
4 origin of yellow fever 522

Fever, observations on 53

— yellow, non-contagious 54

— — Thomas on the 205

— endemial cr marsh of the West

Indies 462

— typhus and synochus, observa¬
tions on 543

Fibre, muscular, on the conversion of 39
Field' s quarterly view of diseases of
boys in Christ’s Hospital 80, 302

Fingers, case of a young woman who
reads with the points of her 424

France, Granville on the state of
medical science in 164, 246, 346
Flame, Davy's and Porretf s obser¬
vations on 24, 25

Flour of wheat, components of 35

— of oats 36

— - of rice ib.

Foetuses, experiments on the lungs of 247
Forceps, Craniotomy, description of

Dr. Davis's 70

— Rawlins on the reflected 212

— • explanation of Dr. Davis' s cra¬
niotomy (with a plate) 219

— Dr. Davis on the, in reply to

Mr. Rawlins 373

Formula for a vesicatory 440

Fauquier , Dr. on nux vomica in
paralysis 51, 59

Functions, generative and nutritive,
history of the 131

Fungus hsematodes, observations on 69

— — cases of 522

GaitsJccll' s case of puerperal convul¬
sions subsequent to parturition 303

Galvanism, Dessaignes on 26

Gas, intestinal, of an elephant,
examination of 40

Gelatine, quantities of tannate of,
in different plants 37, 38

Generative and nutritive functions,
history of the 131

Generation and conception, new opi¬
nions on 15

Glands, affections resembling venereal
enlargement of the inguinal r 185

439

127

129

Glasgow, memorial of the Univer¬
sity of, against the Surgeons’ Bill
Gleet and gonorrhoea, piper cubeba
a cure for

Gonorrhoea, discharges from the ure¬
thra in men resembling

— from the vagina

— and gleet, piper cubeba a cure for 439

Good's Physiological Nosology, cor¬
rections of 91

Gordon and Spurzheim, Drs. con¬
troversy between 4

Gout, observations on the 479

Granville , Dr. on the state of medical
science in France 164, 246, 346
Guthrie on the effects of the nitro-
muriatic baths in surgical diseases 4-49
Hsematodes, fungus, cases of
__ — . observations on

Haemorrhage, fatal, from extraction
of a tooth

TIaslam, Dr. on management of the
insane

Hastings on the motion of the Blood
Head, shape of the, a cause of insa¬
nity

Heart, uncommon petrifaction of the
— - preternatural position of the

— polypous concretions in the
Hearing, Aslury' s observations on

the organs of

Heat and light, observations on
■ — . chemical phenomena of
Heights, effects of ascending great
Hernia, observations on, in infancy

— cerebri, Moyle's cases of

_ - - Stanley's cases of

Hernial sac of the dura mater ten

times punctured

HolbrooTc on the cure of bronchocele
by pressure

Home , Sir Everard, on conception
and generation

— on the sepia and shell vermes

Hooper's case of imperforated hymen 211
Horses, new mode of curing lame¬
ness in 175

How si tip on the morbid structure of
bones 418

Human (Economy, sketch of the 83, 97
Hunterian Oration, Norris' s,
(1817)

Hydrocephalus, observations on

— rupture of the brain from
Hydrophobia cured by oxygenated

muriatic acid

— Brugnatelli's cases of, cured by
hydro-chlorine

— in dogs, a remedy for

Hydro- chlorine a remedy for hydro¬
phobia r 171

Hymen, imperforated, a case of 211

Idiotism* idiopathic occasional 306

522

520

291

309

428

199

384

519

288

175

228

423

171

339

INDEX.

Inflammation, erysipelatous, method
of treating 57

— thoracic, a case of 484

Infusing cinchona, best method of 50
Inguinal glands, affections like the

Venereal enlargement of the 185

Inhaling the vapour of sulphuric
aether, effects of 440

Instrument for piercing the tympa¬
num, description of an 201

Insane, Haslam on moral manage¬
ment of the 62

-r— Persons at Paris, Report of the
Hospitals for, review of 499

— on inspection and visitation of the 322

Insanity, Dr. Spurzhcim's observa¬
tions on the deranged manifesta¬
tions of the mind, or 63

— ■ — review of 217, 395

— its connection with apoplexy 226

— Mayo's. Dr. Remarks on, review

of 485

— - Observations on the Influence of
the Atmosphere on Human
Health and Diseases, particularly,
review of 497

— - Observations on the Phenomena
of, review of 498

— symptoms of 232

— - division of 233

— causes of 234, 305, 307, 309

— — proximate corporeal 235

— hereditary 236

— influence of age on 237

— morbid phenomena of the brain in 239

— shape of the head a cause of 309

frequent in England 311

— fits of 313

— prognosis of 311

— ■ treatment of 323, 325, 328

Iodine a test for oxide of arsenic and

corrosive sublimate 73

Ipecacuanha, experiments on 50

— - Recherches Chimiques et Physi-
ologiques sur l' 252

— constituents of 257

Lactometer, description of Jones's 179

Laboratory, explosion of a ib.

Lam's case of ulcer of the tongue 520

Langstaff' s cases of fungus haema-

todes 522

Leacock's, Dr. experiments on the
transfusion of blood 1 7

Lead, superacetate of, a cure for epi¬
lepsy 178

Leslie's, Prof, experiments to pro¬
duce a low temperature 22

— on artificial congelation of water 178

Ligatures applied to arteries, obs. on 66
Light and heat, Observations on 23

List of Certificated Apothe¬
caries and Assistants 583

Lithotomy, returns of the cases of,
in the Norfolk and Norwich hos¬
pitals 501

— history of a case of 520

— observations on 67

LobeV s, Dr. L. operation for cataract 68

— — — observations on 88

London, synoptical view of the

atmosphere of, from Nov. 1816
to May 1817 74

diseases of, half-yearly nosologi¬
cal table of the 75

observations on prevailing dis¬
eases of, 94, 182, 269, 359, 448, 543

— meteorological table, monthly,

of 93, 181. 267, 357, 445, 541

— bills of mortality of, 93, 181, 267,

357, 445, 541
Lucid interval, what constitutes a 231

Lumbricus, a, from an abscess in
the abdomen 18

Lunacy, objection to the term 230

Lunatic poor, asylums for, in Ireland 500

Lungs, experiments on the, of foetuses 247

— disorders of the, resulting from

wounds and operations 65

— and trachea, effects of irritating

substances injected into the 167

Lychnis dioica, on the varieties of the 170

Lycoperdon solidum, a description
of the 176

Mac Lvov, Miss, case of, who reads
with her fingers 424

Mad-houses, Dr. Burrows' remarks
on a Bill for regulating 62

Magnesia, carbonate of, effects of on
bread 30

Malaria of Italy, M. Delisle's theory
of the 166

Manna, components of 52

Marcet's , Dr. Essay on Calculous
Disorders, review of 501

Marshall's Remarks on Arsenic,
review of 149

Majendie' s, M. Precis Elemcntaire
de Physiologie , review of 131

— and Pelletier on ipecacuanha 252

Medical Science, Retrospect

of, from January to July 1817 1

- in France, present state of, 164,

245

Medico- Chirurgical Transactions,
vol. viii. part i, review of 417, 519
Meeting, General, of Asso¬
ciated Apothecaries, &c. 260

Melancolie , Recherches sur la, par
Maurice Roiibaud-Luce 62

Membranes, rupture of the brain
and its 423

Mercury, on the volatility of 179

Mind, derangement of the internal
functions of the 225

INDEX.

Mollusques, Cuvier's Memoires des 41
Mont d'Or, reports of the baths of 34
Morbid poisons, mode by which
disease is produced by 17

Morbid Dissections, see Dis¬
sections Morbid
Mortality, weekly bills of, of Lon¬
don 93, 181,267,357,445,541

— of Paris for 1816 354

Morphium, mode of preparing 39

— Robiquet' s mode of preparing 441

Motion of the blood, on the 291

Moyle's cases of hernia cerebri 384

Moxa, epilepsy cured by the 347

Muscular motion, on the laws of 12

Narcissus Psuedo Narcissus, com¬
ponents of the 37

New-comers in the West Indies,
on the effects of fevers on 462

Newman's blow-pipe, improve¬
ments on 21

Nitrate of silver as a test of arsenic,
method of employing 177

Nitro-muriatic baths in surgical dis¬
eases, Guthrie on the effects of 449

- - acid, Dr. Scott on the use

of, in the cure of diseases 523

Norris' s Hunterian oration for 1817 66

Nosologic Naturelle, Alibert's , no¬
tice of 249

Nosology, Dr. Parkinson's new
system of 20

— Good's physiological, corrections

of 01

Notices of lectures, 96, 265, 2 66,
270, 360, 443, 539

— literary/ 96, 184, 274, 356, 443s

540

— to correspondents 96, 184, 272,

360, 448, 546

— - of general meeting of Associ¬
ated Apothecaries, &c. 176

Nutritive and generative functions,
history of the 131

Nux-vomica, effects of in paralysis,

51, 59

— treatment of paralysis by 164, 440

Oakley's case of demonomania 113
Oats, components of the flour of 36
(Economy, sketch of the human 83, 97
Ocythoae, on the genus 175

Oils, experiments on 31

Oldesloe, analysis of the mineral

waters of 34, 35

Onions, effects of chemical tests on
a decoction of 163

Ophthalmia, seeds of the Cassia absus
a remedy for 353

Opium, morphium the constituent of 39

_ anti-syphilitic power of 53

_ and calomel in dysentery, on 58

— Sertuemer's analysis of 433, 528

Organs of generation, on sores in
the 120

Ornithorinchus paradoxus , a new
fact respecting the 46

Pains mistaken for syphilitic, on 371
Palsy, on the shaking 58

— observations on 223

Paralysis, good effects of nux-vo¬
mica in 51, 58, 440

Paris, table of mortality of, for
1816 354

Paris' , Dr. test of arsenic 177

Parke and Brande's analysis of
the Cheltenham Waters 32, 33, 34
Park, Dr. on muscular motion 1 2
Parkinson's, Dr. nosology, notice of 20

— James, on shaking palsy 5S

— - Hospital ‘’Pupil, review of 143
Pathology of epilepsy 430

Pearson's case of a painful affection

of the thumb 521

Pelletier and Majendie on ipecacu¬
anha 252

Pericardium, abscesses within the 399
Pertussis, effects of belladonna in 57
Peru, balsam of, on the use of, in
sphacelous and phagedenic ulcers

341, 524

Petrifaction of the heart, a case of 428

Phagedenic and sphacelous ulcers
cured by balsam of Peru 341 , 524

Ph armacy. Price s of Su b s t an ce s
used in 270, 544

Phials, Prices of 271,545

Phosphorescent plant, a curious 48

Phymosis, of 130

Pike, roe of the, analysis of the 441

Piper cubeba a cure for gonorrhoea
and gleet 439

Plants, copper in the ashes of 26

— phosphorescent 48

Platinum, new facts regarding 26

Plague, Robertson and Torric on the 473
Pleuritis with abscesses in the peri¬
cardium, a case Of 300

Podagra, a case of 399

Polypes, new theory of 43

Polypous concretions in the heart 61

Polypus in the stomach, case of 165, 250
Portal's, M. theory of vomiting 166

Potatoe, components of the 37

Potash, acetate of, preparation of 31

on the solubility of supertar¬
trate of 169

Potassium, easy mode of obtaining 27

Poisonous effects of vegetable acids,
query respecting 73

Poisons, morbid, mode by which
disease is produced by 1 7

Preparation of extracts, on the 442

Pressure, bronchocele cured by 288

Prevost j M. on the cause of colours 23

INDEX.

Princess Charlotte of
Wales, case of the late 534

Prussic acid, antidote to 178

Puerperal convulsions subsequent to
parturition, a case of 303

Quarrier' s, Dr. report of the wounded
on board the Leander off Algiers 519
Question, Prize, of the Royal
Society of Edinburgh 176

— — of the Royal Academy of
Sciences and Literature of Brussels 177

— of the Socitte de JMcdecine
Pratique de Montpellier ib.

Rawlins on the reflected forceps 212

— Dr. Davis in reply to Mr. 373
Recapitulation of the diseases

in the monthly registers 7 9

Rectum, operation on the 347

Refractive powers of the eye, on the 14
Register of Diseases, Month¬
ly 94, 1 S2, 268, 358, 446, 542

Remarks on public bodies 1 _ 2

Report, eighth, of Associated
Apothecaries, &c. 260

— of the state of the wounded on

board the Leander, in the action
before Algiers 519

Resin, analysis of a new India 38

Respiration of tortoises, on the 170
RETROSPECTofMEDICALSciENCE
from January to July 1817 1

Rheumatism, Oriental method of
treating 58

Rheum palmatum , grows wild in
Thibet 442

Rice, Carolina and Piedmont, ana-
lysis of 35

— components of the flour of 36

Richmond, Yorkshire, Monthly

Meteorological Table of, and
Observations on the Diseases
of, 92, 180, 266, 356, 444, 540
Robertson , Dr. H. on the Plague 473

Robjquefs mode of preparing mor-

phium 441

Roc of the pike, analysis of the ib ,

Salts, neutral, observations on 30

Sap in trees, observations on the
ascent of the ' 46

— of the acer pseudoplatanUs, on the 443
Science, Retrospect of Medi-
CAL, from January to July 1817 1

Scott, Dr. H. on the internal and
external use of nitro -muriatic
acid in the cure of diseases 523

Senses, diseases cf the five 224

Serous effusion , observations on 283

Scrtuerner on the constituent of
opium, called morphiuni 39

— ’s analysis of opium 436, 528

175

93,

223

217

Sewell's new mode of curing lame¬
ness in horses

Small-pox, cow-pox failed to protect
against

— weekly mortality of, in London

181, 267, 357, 445, 441

— Dewar, Dr. Account of an Epi¬
demic, review of 240

Soaps, on the formation of 32

Society, Report of, for Widows
and Orphans of the Army Medical
Department * qq

— Worcestershire Medical & Surgical ib.

•— Royal, proceedings of 175, 260

— Linn.ean, proceedings of 175

— Royal of Edinburgh, prize

question of 4 jq

— Widows and Orphans of Medi¬
cal Men, anniversary meeting of 438

Spine, blood-vessels of the, congested
after convulsions

Sjpurzheim and Gordon , Dr$. con¬
troversy between

— on tlie Deranged Manifestations
of the Mind, or Insanity

- — review of

Sphacelous and phagedenic ulcers
( cured by the balsam of Peru 341, 524
Stanley's cases of hernia cerebri 519

Stomach, polypus in the, a case of

165, 250

— wound penetrating the, cured 246

— a ease of the rupture of the 523

Substances used in Pharmacy,

Prices of 270, 544

Suicide, cause of * 344

Supertartrate of potash, on the solu-
^ bility of 169

Synochus, or bilious remittent, very
prevalent in London 544

Syphilitic, anti, effects of opium 53

Table of the effects of acids on
vegetation 43

— Monthly Meteorological of Lon¬
don 93, 181, 267, 357, 445, 541

- -of Richmond, Yorkshire,

92, 180, 266,356, 444, 542
*— nosological, of the diseases of
London from November 1816,
to May 1817 75

— _ synoptical, of diseases of boys
in Christ’s Hospital 80 302

— of mortality of Paris for 1816 ’ 354
Tannate of gelatine, quantity from

different plants 37 3g

Temperature, experiments to pro¬
duce a low g cj

-r- on the density of bodies, effects

of 25

Tests of iron, benzoic acid and alka¬
line benzoates 00

I N D E X.

< Tests, iodine, for Oxide of arsenic
and corrosive sublimate
— nitrate of silver, for arsenic

_ A. T. Thomson’s observations

on Dr. Paris’

Testis, affections of, like venereal
Tetanus, observations on
a case of

Terebinthinas oleum, a remedy for
catalepsis vermin osa
Thomas’ explanation on the yellow
fever

Thomson, A. T. his observations on
Dr. Paris’ tests of arsenic
Thoracic, duct, communication of
the lumbar veins and azygos with
the ►

Thoracic inflammation, a case of
Thorina, properties of
Tic doloureux, remedy for
Tongue, ulcerations of the, resem¬
bling syphilitic
, — ulcer of the, a case of
Tooth, fatal haemorrhage from ex¬
traction of a
Torrie on the Plague
Tortoises, on the respiration of
Trachea and lungs, effects of irritat¬
ing substances injected into the
Transfusion of blood, experiments
on the

Trismus, chronic, on the cure of
Tumour, scirrhous, in the brain

177

178

191

246

209

205

177

246

484

178

367

520

474

170

167

348

351

Vaccination, reports respecting

Vagina, discharges from the, resem¬
bling gonorrhoea

Vapour of sulphuric acid, effects of
inhaling the

Vegetation, on the atmosphere,
effects of

_ _ table of the effects of acids on

Veins, himbar, and azygos, with
the thoracic duct, discoveries of a
communication of the

264

129

440

247

Venereal disease, Essay on Diseases
resembling the 117, 187, 21 o, o61
— enlargement of the inguinal
glands, affections like 1§5

Venom of the viper, experiments
on the 73

Vesicatory, Albert’s formula for a 440
View, Synoptical, of the at¬
mosphere of London, from Nov.
1816, to May 1817 _ 74

p— Field's quarterly , of diseases of
boys in Christ’s Hospital 80, 302
Viper, venom of the, experiments on 73

Volatility of mercury, on the

Vomiting, Portal’s theory of ^

Ulcerations of the fauces resembling
venereal

— of the nose and face, resembling
syphilitic

_ of the tongue, resembling syphi¬
litic

— of the uterus

Ulcers*, sphacelous and phagedenic,
on the use of balsam of Peru in

179

166

193

361

367

372

Ulcer of the tongue, a case of

Urethra in men, discharges from the,
resembling gonorrhoea

Urine, extraordinary accumulation
and retention of

Uterus, extraordinary case of rup¬
tured

_ a case of non-existence of the

— success of extirpating the

— ulcerations of the

520

127

212

110

347

352

372

Wardrop's case of nervous affection
cured by amputation of a finger
Warts on the organs of generation,
on

Water, effects of temperature on the
density of

— - Cheltenham, new analysis of the
. — strong chalybeate saline

_ strong sulphuretted saline

- - weak

— pure saline

520

190

32
ib.
ib.

33
ib.

Ul U OCU.11AV

_ sulphuretted and chalybeated ib.

_ ib.

magnesian spring
- saline chalybeate

— mineral of Oldesloe, P faff’s ana¬
lysis of

— artificial congelation of
Wearer’s case of catalepsia vermi-

nosa

rVheat, components of the flour of
'N orms, a new genus of, termed
amphiro

iiVxmnd penetrating the stomach,
cured

Pellow-fever, non-contagious 54

ib.

35
178

209

246

, Thomas's explanation of opinions

and practice respecting the

_ Dr. Bancroft’s Essay on a

Sequel to an Essay on, review of
— on the difference between en~
demial fever oi marshy soils and
the, of the West Indies
_ Dr. Furguson on the origin and
nature of the

205

401

462

522

N IS.

Printed by Joseph Mallet t, 59, Wardour Street , Soho , London .

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Full text of "The London medical repository. Volume 8, July - December 1817"

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