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CHIRURGICAL
REVIEW;
CONTAINING
A COPIOUS ACCOUNT
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OF THE
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VARIOUS PUBLICATIONS
IN DIFFERENT LANGUAGES,
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MEDICINE AND SURGERY.
Vol. V.
From MAY 1798, to MAY 1 799-
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- - QUJE NON FECIMUS IPSI
vix ea nostPlA yoco - - - - OvidL
LONDON :
PRINTED FOR THE EDITORS J AND SOLD BY T. BOOSEYj BROA©
street; and w* gilbert, dublin»
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CONTENTS
OF THE
FIFTH VOLUME.
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164,
Page.
1
9
26 40 101 67 81: 82 87
93 118
208 148 221 182
184 186
MEMOIRS of the Manchefter Society, p. 1, V. 5. -
Baillies Appendix to Morbid Anatomy Bree on Difordered Refpiration -
Cavallo’s Medicinal Properties of Factious Airs Duncan’s Annals of Medicine for 1797 - - 52,
Ware on the Fiftula Lachrymalis, Sec.
Lagrange’s Cours d’Etude Pharmaceutique, &c.
Foot’s Cafes of Veficas Lotura Wallis’s Eflay on the Gout -
Curry on Apparent Death from Drowning, ,&c.
Saumarez’s New Syftemof Phyfiology Fordyce’s Third DifFertation on Fever Blair’s Eflays on the V enereal Difeale Ferriar’s Medical Hiflories and Refledions Alibert’s Confiderations fur les Odeurs, &c.
Dumas’s Syfteme Methodique - -
Haflam’s Obferrations on Infanity, Sec.
Examen fait fur l’Exiflence d’un Fluide Aqueux dans les Cavites
Cerebrales, & c. - - - 198
Caillau’s Premieres Lignes de Nofologie Infantile, ou Eflai fur
la Did ribution des Maladies des Enfans en Clafles, &c. 1 99
Lombard’s Inftrudion furl’ Art des Panfemens, Sec, - ibid.
Turton’s Medical Glofiary - 200
Memoires de la Societe Medicale d’ Emulation - - 201
Jenner’s Inquiry into the Variolas Vaccinse - - 236
Crowther on the Difeafes of the Joints, See, - - 245
Stuart’s Medical Difcipline - - 256
JPerkins on the Influence of Metallic Trailers, Sec. - 258
Beddoes’ Ledures, Sec. on the Human Body - - 278
Turnbull’s Rules and Inftrudions on Ruptures - - 284
Weikard’s Medicine Simplified, Sec. - * - 285
Soemmering De Corporis Humani Fabrica - 286
Pearfon on Inflammatory Diathefis in Hydrophobia - 29!
Philofophical Tranfadions of the Royal Society of London,
part 1, for 1798 - 301
Cullen’s Clinical Ledures - - * 318, 420
Blfoard on the large Blood- veflels, Sec. * - 337
IV
Contents .
Crichton on Mental Derangement, &c.
Rumball on the Nature and Caufe of the Pulfe, &c. Willan on Cutaneous Difeafes, &c»
Hamilton on Hydrophobia;
Sue fur la Vitaiite *>
Report on Galvanifm -
Philofophical Tranfa&ions of the Royal Society of part 2, for 1 798 -
White on the Broad-leaved Willow Barb Medical Records and Refearches Ruffell’s Account of Indian Serpents Simmons on the Casfarian Operation, &c.
Coindet’s Obfervations on Animal Fat, &c.
Rollons Cafes of the Diabetes Mellitus, &c.
Pearfon’s Inquiry into the Cow-Pox Beddoes on the Venereal Difeafe Bell’s Syftem of Diifedions *
Bell’s Anatomia Brittannica
Hamilton on the Duties of a Regimental Surgeon
Hooper’s Medical Di&ionary
Horn’s Treatife on Leeches -
The Medical Diary for 1799 * * -
Brown on Scrophulous Difeafes « -
Leidenfroft Opufcula Phyfico-Chemica, See .
S^vigny’s Coile&ion of Engravings •» *
Page.
- 343* 436
358
361 376, 451
394> 495
L.ta 557 401 ’ 467
468, 5IO 478, JOI 489
- 498
- |Z4
544
535
565
568
57i
* “ 573
574 •? ibid.
575
576
- 579
PREFACE
V
■' J
PREFACE
ROM the length of time which has
elapfed fince the firft publication of the Medical and Chirurical Review, there are few fubje&s, it is prefumed, in any way connected with Medicine, or with Medical Philofo- phy, which have not undergone dif- cuflion, and which, confequently, have not found admiffion, into the prefent work. Many matters, indeed, of high importance, have fprung up, and many new and powerful remedies been difcovered, within the period al¬ luded to. Concentrated views of thefe
N
have, no doubt, their value, as tending more widely and Ipeedily to diffufe ufeful and important truths. Such
was
PREFACE.
was the end the Editors had In view in their undertaking ; and they truft their object has been attained. To the Medical and Chirurgical Re¬ view, they, with forae confidence, re¬ fer, as a compendium of the prefent ftate of Medicine, and of the moft material improvements which have taken place with regard to it, for -the laH ten years,
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THE
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No. XXV.
THE
MEDICAL and CHIRURGICAL
A .. V ' ,'W /
REVIEW.
JULY, 1798.
IIWI— Mil millMBSlilMniUP' TOI,P>
Art, L Memoirs of the Literary and Philofophical Society of Manchefler. Vol. 5 , part 1. 06lavo> 318 pages, price 6s, Cadell and Davies, London, 1798.
THE firft paper in the prefent eftimable colleftion* that bears any relation to our fubjedt, is by Mr. John Dalton, and contains fome extraordinary fafts relating to the vifion of colours. It has been obferved, he remarks, that our ideas of colours* founds, taftes, &c. excited by the fame objeft, may be very different in themfelves, without our being aware of it ; and that we may neverthelefs converfe intelligibly concerning fuch obje6ts, as if we were certain the impreffion made by them on our minds were exactly fimilar. All, indeed, that is required for this purpofe, is, that the fame obje£t fliould uni¬ formly make the fame impreffion on each mind , and that objetts which appear different to one fhould be equally fo to others. It would, however, fcarcely be fuppofed, that any two objefts, which . are every day before us, Ihould appear hardly diflinguiihable to one perfon, and very different to another, without the circumftance immediately fuggefting a difference VOL, v. B
m
2 Memoirs of the Manchejler Society } part 1, pot. 5,
In their faculties of vifion; yet fuch is the fa6l, not only with regard to the author of the paper before us, but to many others alfo. The following are hated as the characleriftic facts of the vifion of thefe per- fons :
c 1. In the folar fp eft rum three colours appear, yellow, blue, and purple. The two former make a contrail ; the two latter feem to differ more in degree than in kind.
c 2. Pink appears, by day-light, to be fky-blue a little faded; by candle-light it affuines an orange or yellQwifh appearance, which forms a Itrong contrail to blue.
4 3. Crimfon appears a muddy blue by day; and crimfon woollen yarn is much the fame as dark blue.
c 4. Red and Scarlet have a more vivid and flaming appearance by candle-light than by day-light.
c 5. There is not much difference in colour between a flick of red iealing wax and grafs, by day.
c 6, Dark green woollen cloth feems a muddy red, much darker than grafs, and of a very different co¬ lour.
‘ 7. The colour of a florid complexion is dufky blue.
* 8. Coats, gowns, &c. appear to us frequently to be badly matched with linings, when others fay they are not. On the other hand, we fhould match crim- lons with claret or mud; pinks with light blues; browns with reds,; and drabs with greens.
( 9. In all points where we differ from other per¬ sons, the difference is much lefs by candle-light than by day-light.’
The author has been informed of nearly twenty* perlons in the predicament here flated : feveral of which were of the fame family: it is remarkable that he has not heard of one female fubjedl to this pecu¬ liar, ty. None of them were aware of their actually feeing colours different from other people; but
imagined
Memoirs of the Manchejler Society , part 1 yvoL 5: 3
imagined there was great perplexity in the nam.es aferibed to particular colours.
‘ Obfervations tending to point but the caufe of this anomalous vi/iom . The firfi time I was enabled to form a plaulible idea of the caufe of our vifion, was after obferving that a fky-blue tranfparent liquid modified the light of a candle fo as to make it fimilar to day-? light; and, of courfe, reifored to pink its proper colour by day, namely, light blue. This was an im¬ portant obfervation. At the fame time that it exhi¬ bited the effect of a tranfparent coloured medium in the modification of colours, it feerned to indicate the analogy of folar light to that refulting from cone bullion; and that the former is modified by the tranf¬ parent blue atmofphere, as the latter is by the tranfparent blue liquid. Now the effect of a tranf¬ parent coloured medium, as Mr. Delayal has proved, is to tranfmit more, and consequently imbibe fewer of the r&ys of its own colour, than of thofe of other colours; Refle6fing upon thefe fafts, I was led to conjecture that one of the humours of my eye muff be a tranfparent, but coloured i medium, fo conftituted as to abforb red and green rays principally, becaufe I obtain no proper ideas of thefe in the folar fpeCtrum; and to tranfmit blue and other colours more perfectly* What feerned to make againft this opinion, however, was, that I thought red bodies, fuch as vermilion, Ihould appear black to me, which was contrary to fact. How this difficulty was obviated will be un¬ de rffood from what follows.
f Newton has fufficiently afeertairied, that opake bodies are of a particular colour from their reflecting the rays of light of that colour more copioufly than thofe of the other colours ; the unrefieCteci rays being abforbed by the bodies. Adopting this fa£t, we are infenfibly led to conclude, that the more rays of any¬ one colour a body reflects, and the fewer of every other colour, the more perfeCt will be the colour. This conclusion* however, is certainly erroneous.
B 2 Splendid
4 Memoirs of the Manchejler Society , part 1, vol. 5*
Splendid coloured bodies reflect light of every colour copioufly ; but that of their own mod fo. Accord¬ ingly we find, that bodies of all colours, when placed in homogeneal light of any colour, appear of that particular colour. Hence a body that is red may appear of any other colour to an eye that does not trail fruit red, according as thofe other colours are more copioully reflected from the body, or tranfmitted through the humours of the eye.
« ‘ It appears, therefore, almod beyond a doubt, that one of the humours of my eye, and of the eyes of my fellows, is a coloured medium, probably fome modi¬ fication of blue. I fuppofe it muff be the vitreous humour 5 otherwife I apprehend it might be difeo- vered by infpeftion, which has not been done. It is the province of phyfiologifts to explain in what manner the humours of the eye may be coloured, and to them I fhall leave it ; and proceed to drew that the hypothesis will explain the fafts dated in the conclufion of the fecond part.
c 1. This needs no' further illuftration.
* 2. Pink is known to be a mixture of red and blue ; that is, thefe two colours are re fie ft ed in ex- cefs. Our eyes only tranfm.it the blue excels, which Caufes it to appear blue ; a few red rays pervading the eye may Serve to give the colour that faded ap¬ pearance. In candle-light, red and orange, or fome Other of the higher colours, are known to abound more proportionably than in day-light. The orange light reflefted may therefore exceed the blue, and the compound colour con fid of red and orange. Now, the red being mod copioufly reflefted, the colour will be recognized by a common eye under this bn all modification ; but the red not appearing to us, we fee chiefly the orange excefs : it is confequent- ly to us not a modification but a new colour.
4 3. By a fimilar method of reafoning, crimfov , 'being compounded of red and dark blue, mud aflame the appearances I have deferibed.
* 4. Bodies
I
Memoirs of the Manchejier Society , part i, vol. 5. 5
€ 4. Bodies that are red and fcarlet probably relief orange and yellow in greateft plenty, next after red. The orange and yellow, mixed wjth a few red rays, will give us our idea of red, which is heightened by candle-light, becaufe the orange is then more, abundant.
‘ 5. Grafs-green is probably compounded of green, yellow, and orange, with more or lefs blue. Our idea of it will then be obtained principally from the yellow and orange mixed with a few green rays. It appears, therefore, that red and green to us will be nearly alike. I do not, however, underhand, why the greens (hould affume a blueilh appearance to us, and to every body elfe, by candle-light, when it (hould feem that candle-light is deficient in blue.
* 6. The green rays not being perceived by us, the remaining rays may, for aught that is known, com¬ pound a muddy red.
c 7. The obfervations upon the phenomena of pink and crimfon, will explain this fa ft.
c 8. Suppofe a body to refle£t red rays as the num¬ ber 8, orange rays as the number 6, and blue as .5 ; and another body red 8, orange 6, and blue 6: then it is evident that a common eye, attending princi¬ pally to the red, would fee little difference in-thofe colours; but we, who form our ideas of the colours from the orange and blue, (hould perceive the latter to be bluer than the former.
‘ 9. From the whole of this paper it is evident, that our eyes admit blue rays in greater proportion than thofe of other people ; therefore when any kind of light is lefs abundant in blue, as is the cafe with candle-light compared to day-light, our eyes ferve in fome degree to temper that light, fo as to reduce it nearly to the common ftandard. This feems to be the reafon why colours appear to us by candle-light, almofl as they do to others by day-light.
c I (hall conclude this paper by obferving, that it appears to me extremely probable, that the fun’s
B 3 light:
6 Memoirs of the Manchejkr. Society , part I, vol. 5.
light and candle-light, or that which we commonly obtain from combudion, are originally conftituted alike; and that the earth's atmofphere is properly a blue fluid. , and modifies the fun’s light to as to occafion the commonly perceived differenced
Account of' a remarkable Change of Colour in a Negro . By Miers Fifher.— Extract of a Letter from. Mr. James Pemberton to Mr. Thomas Wilkinfon.
Philadelphia, September 13th, 1796.
4 This day Henry Mofs, of African defcent, vifited me ; and produced a certificate, of which the follow¬ ing is a copy:
c I do hereby certify, that I have been well ac¬ quainted with Henry Mofs, who is the bearer hereof, upwards of thirty years, during the whole of which time he fupported an honed, character. In the late war he inlided with me in the continental army as a foldier, and behaved well as fuch. From the firft of my acquaintance with him, till within two or three years pad, he was of as dark a complexion as any African, which has changed without any known caufe to what it is at prefent. He was free-born, and ferved his time with Major Brent, late of Charlotte county. 1 -
j
4 Given under my hand the 2d day of September, ]794- Joseph Holt, Bedford County}
4 Henry Mofs has all tne features common to the. African race, though not ftrongly impreffed. He' is forty-two years of age, and five feet fix inches high. The borders of his face, at the roots of the hair on the finciput and defcending by the rHht ear, are, for nearly an inch in breadth, of a perfea European complexion. This ftripe, fomewhat en¬ larged in its dimenfions, is continued under the chin, and rifes, on the left cheek to within two inches of the ear, where it is intercepted by an irregular blotch or the negro fkin, about an inch broad, which detaches it from a correfponding ftripe on the left
fide
Memoirs of the Manchejter Society , part 1, vol. 5* 7
fide of his face. It paffes down the neck of the left fide about three inches, and is there two inches wide. Its margin is irregularly indented, refembiing iflands and peninfulas as reprefented on the chart of a fea- coaft. The back of the neck, the breaft, arms, and legs (as far as thefe could be expofed with decency in a mixed company) are of a clear complexion, in¬ ter fper fed with fmall fpecks of African colour, not unlike the freckles which appear on the fkin of a fair woman in fummer. The African complexion is completely difcharged from the upper eyelids. There is a fmall white freak under the right eye; and a larger one, nearly half an inch broad, with a margin irregularly defined, under the left. A white lift paffes round the mouth, fhaded by one of his na¬ tive hue reaching nearly to the chin, below which he has a very fair complexion. The back and palm of the hands are perfectly fair; yet ftripes of his for¬ mer colour pafs from the wrift along the fides of his hands to the ends of his fingers; and appear on the outfides of all his fingers. But in general on his limbs, where they are covered by clothing, or where fkin meets fkin, the tranfm illation is complete. The whole area of negro fkin would not, I am perfuaded, if properly meafured, exceed a fquare foot. His hair js1 undergoing a correfpondcnt change ; and whenever a white fpot can be difcovered, it appears foft like that of an European, and may be drawn out with eafe to a length of feveral inches: where the fkin re¬ tains its priftine hue, it is crifp like wool. On preffmg his fkin with my finger, the part which I preffed appeared white ; and, on removing my finger, it was fuffufed with red, as happens in Europeans. I examined the borders pf tfie black and white fkin, with a glafs which magnified confiderably, and which is known in Ireland by the name of a linen-teller. It was evident that the change was not external, or occafioned by the calling off of the epidermis; but that it was owing tp an affeftion of the corpus miico ■*
B 4 jinn .
8 Memoirs of the Manchejter Society , part I, voL 5.
fam. No fiffures were difcernible, but I perceived that there was a fmall and gradual elevation where the white and black portions met, without any dif- continuity on the external iurface.
c He gave the following account of his genealogy. His paternal grandfather was bora in Africa, and married a native Indian of this country. His father married a Mulatto, born of an African father and an Irifh mother His maternal grandfather was born in Africa.
£ He was firft fenfible of a change of colour in his fkin in February 1792. It commenced at the roots of his finger nails, extended to the firft joints, and went no further at the time. Two months after¬ wards the back of his neck underwent the fame change, which proceeded along the body, and gra¬ dually defcended to molt parts ufually covered by his clothes. The progrefs was flow in the firft, but more rapid in- the enfuing )ears. The alteration was made chiefly in fummer or warm weather; and could not be feen to make any progrefs in the cold months. He fays, he came to this city on the 26th of July: and that the remains of African complexion on his face and hands has fenfibly diminifhed fince his arri¬ val. This account is confirmed by Stephen Pafchal and others, who faw him twice, at an interval 'of thirteen days, in which time the difference was abun¬ dantly manifeft. He was this morning fhaved by a barber ; who fays, that he felt no obftru&ion to the razor, when it paffed over the white to the black part of his face, or on its return, which muft hare been experienced if thefe had been feparated by any difconti unity of the fkin.
c Since the change of complexion took place, he has been more fenfible of variations in the tempera¬ ture of the air ; and has had blifters and freckles in every part of his body, which was expofed to the fun by holes in clothes.
€ I put
9
Baillle’s Appendix to Morbid Anatomy.
* I put many queftions to him concerning his diet and mode of life, the ftate of his health, the dif- eafes to which he had been fubjeft, and the remedies employed for their removal; but nothing could be extrafled from his replies, which had the leaft ten* dency to folve this curious phenomenon.
* November 22d, Henry Mofs vifited me again. I examined his face, hands, breaft, legs, and thighs. The black parts are conflderably diminifhed fiiice I faw him laft. Hence I entertain no doubt that the change is gradually proceeding; and, fhould he live another fummer or two, that it will be complete.
* Miers Fisher/
Art. II. An Appendix to the Firft Edition of the Morbid Anatomy offome of the mofi important P arts of the Human Body. By Matthew Bailli e, M. D. F.R S. Fellow of the Boyal College of Phyfteians, and Phyjician to St. George’s Hofpital. Oftavo, 162 pages, price 2s. 6d. Johnson, London, 1798.
THE greater part of our readers are no doubt acquainted with the treatife of Dr. Baillie on the fubjeft of Morbid Anatomy ; a work intejefting both in its nature and execution. The fecond edition having lately appeared with confiderable enlargement, the author thought it but juft to thofe who had pur- chafed copies of the firft edition, tojmblifh a feparate Appendix to it feparatelyl This not only, he ob- ferves, comprehends what is new in the fecond edi¬ tion, but alio whatever has undergone any confidera¬ ble alteration fince the publication of the firft, in confequence either of better opportunities of obferva- tion, or of more reflection.
With refpeft to the fecond edition of the Morbid Anatomy, the author obferves, that befides additions furnifhed from his own ftores, fome are derived from
the.
JO BailhVs Appendix to Morbid Anatomy .
the obfervations of others, and efpecially from thofe vt Dr. Soemmering, Profelfor of Medicine in the Unh yeriity of Mayence, one of the moft diftinguifhed anatomifls of Germany. To the morbid appearances Dr. Baillie has fubjoined the fymptoms connected with them: but this part of the work is attended with many difficulties, and he feels it neceffary to befpeak in¬ dulgence on this head,
‘ The difficulties which attend an attempt to afcer- tain the fymptoms of difeafes, are derived fro pi vari¬ ous fources. The fame fymptoms are not uniformly connected with the fame morbid changes of Itrufture in the body. — in many cafes, too, the fymptoms are nearly the fame, where the morbid changes of ftruc- ture are very different.— This is particularly exempli¬ fied in difeafes of the brain and of the heart, — Patients often explain very imperfectly their feelings, partly from the natural deficiency of language, and partly from being milled by preconceived opinions about the nature of their complaints.— Medical men alfo, in examining into the fymptoms of difeafes, fome- times put their queftions inaccurately, and not unfre- quently miflead patients into a falfe defcription, from feme opinion about the difeafe which they have too haftily adopted. All of thefe are formidable difficul¬ ties, which obftruft the progrefs of our knowledge of the fymptoms of difeafes; but the accumulated obiervations of many individuals will probably, pt length, in a great meafure overcome them.’
Many difeafed appearances are deferibed in the prefect woik, to which there are added no corre- fponding fymptoms and this depends upon different caufes. I he frit is, that there are many morbid changes of ff.ru cl u re in the body, the correfponding fymptoms of which are not afeertained. The fecond is, that many morbid changes of flriuffure are pro¬ duced by caufes which difturb the conffitution fo iitdc, as to be attended with fymptoms top fhghtly inarxed for oofervation. The third and laft is, that
the
• /
Bai'llie?s Appendix to Morbid Anatomy. 1 1
the fymptoms belonging to fome difeafecl appearances fall to immediately under the cognizance of the eye, or of the touch, as to be included in a description of the difeafed appearances themfelves, and to render any further account of them Superfluous.
From the following heads, our readers will fee what they are to expebf in the Appendix before us. From the whole we Shall afterwards feleft a few of thofe which appear moft interesting, or which have the greatest practical tendency. Of many, the bare enumeration will Suffice.
The pericardium wanting. — A Singular mal-forma- tion of fhe heart. — The pleura almoft dry. — Water accumulated in the Subftance of the lungs. — Air- yeffels attached to the edge of the lungs.— Inflamma¬ tion of the thyroid gland.— Bronchocele. — Schirrus of the thyroid gland. — The thyroid gland converted into bone. — -The cartilages of the larynx converted into bone. — Ulcers in the cavity of the larynx. — Scrofulous Swelling in the pharynx. — Difeafed appearances of the thymus gland.— Steatomatous tumours adhering to the peritonaeum. — Air in the cavity of the abdomen. — • Calculi in the Stomach. — Taenia folium. — Taenia lata. — Trichuris. — Coats of the liver converted into car¬ tilage. — Cyil in the liver containing an earthy mat¬ ter. — Rupture of the liver. — Ulcers in the gall-blad¬ der.— The gall-bladder wanting. — The fpleen rup¬ tured. — Several Small Spleens. — The fpleen Said to be -wanting. — Scrofulous tubercles in the kidneys.— State of the kidneys in diabetes. — Hydatids of the kidneys. — Renal capfules fcrofulous and cartilaginous. — Little (tones in the renal capfules. — Polypus of the bladder. — Cyfts communicating with the bladder. — The bladder divided into two chambers.— Calculi. — Loofe cartilages in the tunica vaginalis teflis. — Malig¬ nant ulcer of the uterus. — Schirrous enlargement of the uterus. — An hermaphrodite in the human lpecies. - — A part of the pia mater bony. — Bony tumours preffing upon the brain.— Bony ridges irritating the
brain.
12 Baillie’s Appendix to Morbid Anatomy .
brain.* — Hydrocephalus. — Cavities in the brain con¬ taining a ferous fluid. — Aneuryfm of the internal carotid arteries on the fide of the fella turcica. — Lit¬ tle bags in the plexus choroides. — Round tumours adhering to the plexus choroides.— Difeafed appear¬ ances of the pituitary gland.
Such are the general contents of this valuable vo¬ lume. — The part which we flrft feledt relates to dif¬ eafed appearances of the ftomach.
c Appearances in Hydrophobia. On opening the bodies of perfons who have died from hydrophobia, the inner membrane of the ftomach is frequently found inflamed at the cardia, and its great end. The inner membrane of the pharynx and the cefophagus is alfo inflamed. The membrane is not thickened by the inflammation, but the inflammation fpreads as in eryfipelas, (hewing in fome places a diftindt line of boundary. This inflammation is commonly, I be¬ lieve, not very great.’
c Calculi in the Stomach. Calculi with different appearances have been defcribed as being occafton- ally found in the ftomach. They have never come under my own ohfervation, and are to be reckoned very uncommon* Moft of thefe calculi have been found upon examination to be biliary, and had been conveyed from the duodenum into the ftomach by an antiperiftaltic motion of this part of the fmall in- teftines.’
c Symptoms connected with the difeafed appearances , In inflammation of the ftomach, the following lym- toms are obferved to take place; viz. pain in the epigaftric region, which is increafed when any thing has been fwallowed, vomiting, often hickup, a pulfe fmall, frequent, and hard, heafo thirft, and a feeling of great debility.
‘ The fymptoms which are produced by fwallowing arfenic, are the fame with thofe which take place in a very violent inflammation of the ftomach; for arfe-
* 4 Vid. Lieutaud, Tom. I. p. iyd
me
Baillie’s Appendix to Morbid Anatomy . 13
nic a£ts upon that organ in no other way than by ex¬ citing in it a very high degree of inflammation.
‘ Hydrophobia is fufficiently characterized by the horror which the patient expreifes at the fight of any fluid that is offered to him, by the great difficulty experienced in fvvallowing, and by the flrong aliena¬ tion of mind which accompanies this dreadful difeafe.
* I have reafon to believe that ulcers in the fto- mach are often flow in their progrefs. They are at¬ tended with pain, or an uneafy feeling in the ftomach, and what is fwallowed is commonly rejected by vo¬ miting. This ftate becomes gradually worfe, and is very little relieved by medicine ; which may ferve as fome ground of diftinCtion between this complaint and a temporary deranged aCtion of the ftomach.
£ Cancer of the ftomach is attended with a fenfe of pain in that organ, which varies a good deal in its degree in different individuals. What is fwallowed is almoft conftantly rejected by vomiting, and there is frequently thrown up alio a dark coloured fluid, which has fometimes been compared to coffee grounds. Ti e patient commonly becomes emaciated, and the countenance fallow; the pulfe is frequent, and heftic fymptoms are formed.
c I am not acquainted with the fymptoms which are produced by a partial thickening of the ftomach unattended with ulceration.
‘ The accumulation of air in the ftomach is ac¬ companied with an unpleafant feeling of diftenfion, and a fvveiling may be felt externally in the epigaftric region ; wind paffes up by the defophagus, and there are occaftonal pains in the ftomach, produced by a
fpafmodic contraction of fome part of its mufcular coat/
The next chapter contains the difeafed appear¬ ances of the inteftines.
Tama . The taenia which is moft commonly found in the human inteftines, is of two kinds, viz, the tania folium, and the tania latad
Tania
14 Baillie’s Appendix to Morbid Anatomy,
c Tcenia folium. This taenia is frequently bred ifi the in te hi nes of the inhabitants of Germany, and ocA calionally, but rarely, in thofe of the inhabitants of Great Britain. It confifls of a great many diftinCf. portions, which are connected together fo as to put on a jointed appearance ; thefe joints are commonly of a very white colour* but are occafionally brownifb, which depends on a fluid or this colour which is found in their veffels. The worm is ufually very long, extending often many yards, and feldom paffes entire from the bowels. This circumftance has pre¬ vented the extremities of the tcenia from being often feen.
c The head of this taenia is fomewhat of a fquare form, with a narrowed projection forwards; in the middle of this projecting part, there is a diflinCl Gr~ cular aperture, around the edge of which grow curved fharp procefies. Near the angles of the fquare edge of the head, are fituated four round projecting aper¬ tures, at equal diftances from each other; this head is placed upon a narrow jointed portion of the worm, of confiderable length, and which gradually fpreads itfelf into the broader joints, of which the body of the worm is compofed.
c The body of the taenia confifis of thin, flat, pretty long joints, on one edge of which there is a projec-’ lion, with a very obvious aperture. In the fame worm fome of thefe joints appear confiderably longer than others ; this probably depends on one joint be¬ ing contracted, while another is relaxed. The aper¬ tures which we have juft mentioned, are generally placed on the alternate edges of the contiguous joints : but this is not uniformly the cafe ; they are fometimes placed on the fame edges of two, or even feveral contiguous joints. When thefe joints are examined attentively, there are frequently feen, in each of them, veffels filled with a brownifb fluid, and difpofed in an arboryfeent form. Aroui.d the edges of each joint,
' . there
Baillie’s Appendix to Morbid Anatomy. 3 5
there is alfo a diftindt Terpentine canal.* The laft joint of a taenia refembles very much a common joint rounded off at its extremity, but without any aperture..’
c Tania lata. The taenia lata is bred very com¬ monly in the inteftines of the inhabitants of Switzer¬ land, but very rarely in thofe of the inhabitants of Great Britain. The joints of which it is compofed are fhort and broad, and the aperture is not upon the edge of each joint, as in the folium, but in the mid¬ dle of its flattened furface. I have not feen either the head or the pofterior extremity of this taenia; but I prefume that they differ little from thofe of the folium.
‘ Other taenia have occafionally been found in the human inteftines, but they occur very rarely, and have not fallen under my own obfervation. - They would feem all to be formed upon 'one general plan.
‘ Trichuris . This worm has been occafionally found in the great inteftines of man, and more efpe- cially the c cecum. It refembles a good deal the afcaris, but is confiderably larger, and has a very long tranfparent tail To the heads of fome of them is attached a procefs or horn.’
_ Of Diabetes , Dr. Baillie obferves, that c opportu¬ nities do not frequently occur of examining the ftate of the kidneys m this difeafe. I have once, however been able to make this examination f in a fatisfa&orv
* e This, as well as theveflels difpofed in an arborefcent form, is very difnnUly feen injected in fome preparations which have been made, and given to me by an ingenious young burgeon, Mr. Carlifled
f The topical affe&ion of the kidneys in diabetes is apparent, not only from this, but from other examinations made after death. It ap^ pears to us, therefore, that the change in the condition of the urine fn this difeafe admits of a ready explanation, without recurring to the
theory of Dr. Rollo; — [See Medical Review, vol. 4, page 190) _ for
this would be needlefsly to multiply caufes. The ftomach and inteftinejt were to all appearance found : fo that there does not feem to be any
foundation *or Dr. jBaillie s opinion, of an imperfect formation of the chyle.
> manner*
16 Bailiie's Appendix to Morbid Anatomy .
manner, where a perfon had been long affected with diabetes, and had been a patient under my care at St. George’s 'Hofpital. In both kidneys the fuperfi- cial veins were much fuller of blood than ufual, form¬ ing upon their furface a moll beautiful net-work of veffels, the larger branches of which exhibited an arborefcent appearance. The whole fu bilance of the kidneys was much more vafcular than in a healthy hate, approaching a good deal in appearance to what takes place in inflammation. In both of them there was a very fmall quantity of a whitifh fluid, fome- w hat refembling pus, which was fqueezecLout through one or two infundibula ; but there was no appearance of ulceration whatever. The artery, the vein, the lymphatic veffels, and the nerves of both kidneys were in their natural ftate, The liver, at the fame time, I examined with care, becaufe it has been thought by fome to be the chief fource of difeafe in diabetic patients, but it was perfectly found. The ftomach and inteftines were alfo examined with attention, but no appearances occurred intthem which are not very common. From the ftate of the kidneys upon exa¬ mination, it feemed to me probable that diabetes depends, in a conftderable degree, upon a deranged fiftion of the fecretory ftrufture of the kidneys, by which the blood there is difpofed to new combina¬ tions. The effeCt of thefe combinations is the pro¬ duction of a faccharine matter. I think it probable, at the fame time, that the chyle may be fo imper¬ fectly formed, as to make the blood be more readily changed into a faccharine fubftance, by the aCtion of the kidneys. This opinion, however, is propofed with much diffidence.’
c An Hermaphrodite in the Human Species Exam-
fles of what have been called hermaphrodites in the uman fpecies have, when ftriCtly examined, been hitherto found to belong to the male or the female fex} but Dr. Storer of Nottingham has favoured me
Baillie’s Appendix to Morbid Anatomy. 17
\ *
with an account of a perfon fo ftrongly marked as an hermaphrodite, that no doubt can, I think, be rea- fonably entertained of this being the cafe. The per¬ fon to whom this Angular monftrofity belongs, is {till alive, and has been carefully examined by Dr. Storer and other medical gentlemen, very able to judge con¬ cerning it ; I ill all therefore take the liberty of infert- ing here, the account which Dr. Storer was fo obliging as to fend me.
c The perfon bears a woman’s name, and wears the apparel of a woman. She has a remarkably mafcu- line look, wTith plain features, Tut no beard. She had never menftruated ; and on this account fhe was de- fired by the lady with whom the lived as fervant, to become an out patient at the Nottingham HofpitaL At this time (he was twenty-four years of age, and had not been fenfible of any bad health, but only came to the hofpital in order to comply with the withes of her miftrefs. V arious medicines were tried without effedf, which led to the fufpicion of the hy¬ men being imperforated, and the menftrual blood having accumulated behind it. She was, therefore, examined by Mr. Wright, one of the furgeons to the hofpital, and by Dr. Storer.
6 The vagina was found to terminate in a cul-de- fac, two inches from the external furface of the labia. The head of the clitoris, and the external orifice of the meatus urinae, appeared as in the natural frac¬ ture of a female, but there were no nymphax The labia were more pendulous than ufual, and contained each of them a body refembling a tefticle of a mode¬ rate lize, with its chord. The mammae refembled thofe of a woman. The perfon had no defire of par¬ tiality whatever for either fexfi
The remarks on the difeafed appearances of the brain and its membranes, are too important to be palled over.
vol. v. C 4 A pari
18 Baillie's Appendix to Morbid Anatomy .
i
c A part of the pia mater bony . It occafionally happens, although I believe very feldom, that a por¬ tion of the pia mater is converted into bone. It has not occurred to me to obferve fuch a change of flruc- ture n this membrane, but Dr. Soemmering men¬ tions that a fpecimen of this difeafe is preferved in his cohesion.
f The brain very firm. The brain is fometimes found to be confiderably firmer than in a healthy date, to be tougher, and to have a greater degree of elafticity than ufual ; it will bear to be pulled out with fome force, and will readily re-aft fo as to reliore it- felf, or when preffed will recover its former lhape. Under fuch circiunftances the ventricles are fome¬ times found enlarged in fize, and full of water. The brain has even been faid to become fo hard and dry as to be friable between the fingers j and the medul¬ lary fuhftance, in thefe cafes, is reprefented as being much lighter than in a natural ft ate. It is probable, however, that thefe accounts are a good deal exag¬ gerated. It has been remarked that the cerebellum is very often unaftefted.
c Bony tumours pi (fifing upon the brain. Bony tu¬ mours are fometimes formed in the cranium, which prefs upon a part of the brain. They mod commonly confift of an irregular mafs, which is formed of bony proheffes, with a fleiliy fubflance filling up the inter¬ faces between them. Of this fort of tumour there are feveral examples in Dr, Hunter’s collection.
e It has fometimes happened, but very rarely, that all the bones of the cranium have become extremely thickened, and have encroached, by their growth, upon the cavity which contains the brain. Of this there is a remarkable fpecimen in Mr. Hunter’s col- leftion, where the bones of the cranium are at leaf! three times as thick as in the natural hate. They ar<j alio, in the cafe to which I allude, much more fpongy than ufual in their texture.
* A nodule
Bailiie’s Appendix to Morbid Anatomy. 19
c A nodule of a fubftance having the appearance of ivory, has alfo been known to be tormed in the bones of the cranium, and to protrude confiderably into its cavity. This too occurs very rarely, but a fpecimen of it is preferved in Mr. Hunter’s cohesion. What¬ ever may be the variety in the morbid proceffes, which produce thefe changes of ftru&ure in the bones of the cranium, yet their effefts upon the functions of the brain mu ft be nearly the fame, as they form a perma¬ nent caufe of comprefiion.
c Bony ridges irritating the brain . Upon the inner furface of the bafis of the cranium there is always fome irregularity. This confifts in numerous ridges and fmali eminences with depreffed lurfaces inter- pofed between them. It happens occafionally that there is a morbid growth of thefe eminences and ridges, forming fharp fpicula and (harp edges of bone. Thefe run into the brain, and irritate very violently the nervous fyftem.
* Hydrocephalus. One of the mod common ap¬ pearances of difeafe in the brain, is the accumulation of water in its ventricles ;* this generally takes place ■when a child is very young, and even fometimes be¬ fore birth. The water is accumulated in greater or lefs quantities in different cafes. It fometimes amounts only to a few ounces, and occafionally to many pints. When the quantity of water is very confiderable, the fornix is raifed at its anterior extremity in confe- quence of its accumulation, and an immediate opening of communication is thereby formed be¬ tween the lateral ventricles.*)* From this caufe too
a part
* c Mr. Home has known an inftance where water was accumulated in large quantity in the third ventricle, and had forced its way between the fine laminae of the medullary fubftance which compofe the feptum lucidum, without efcaping into either of the lateral ventricles. This may be faid to be a new htuation of hydrocephalus, and is of very rare occurrence. y
f 6 A diftinguifhed author has, in a late publication, infilled very ftrongly upon the exiftence of a communication between the two lateral
C 2 ventricles
20 BaillieV Appendix to Morbid Anatomy .
a part of the water paffes very readily into the third ventricle, and from thence into the fourth. The wa¬ ter is of a purer colour, and more limpid, than what is found in dropfy of the thorax or abdomen. It ap¬ pears, however, to be generally of the fame nature with the water that is accumulated in both of thofe large cavities. In fome trials which I have made, it partly coagulated upon the application of the com¬ mon acids, exalUy like the water in hydrothorax and afcites, or like the ferum of the blood.* But there is much variety in the quantity of the coagulable matter. In fome inftances the water in hydrocepha¬ lus contains a very fmall proportion of coagulable matter, and in others it is entirely free from it. This variety may probably depend upon foriie difference in the aftion of the fmall blood- veffels which pour the fluid out.
f When water is accumulated in the ventricles to a very large quantity, the fubftance of the brain, efpecially upon the lides and at the upper furface, appears almoft to be a fort of pulpy bag, containing
ventricles of the brain, and has expreffed great furprize that it has been denied by feveral teachers of anatomy in London. Without entering into any difpute about this matter, which in itfelf is of no great import¬ ance, I fha.ll briefly mention what appears to me to be the real date of the circumdances. The fornix at its exterior extremity lies loofe trpon a part of the thalami nervorum opticorum, and there is a fmall chink on each fide of the fornix leading obliquely downwards from the lateral ventricles to the anterior extremity of the third ventricle. While the fornix is allowed to remain in its natural duration, there feems to me to be no immediate communication between the lateral ventricles. But when the fornix is elevated (which maybe very eafily done), then the lateral ventricles communicate with each other; and the communi¬ cation is more or lefs according to the degree of the elevation. It may be laid, that the lateral ventricles dill communicate together by means of the third ventricle. This, however, does not feem to me to be properly a communication between the two lateral ventricles, unlefs any two cavities which communicate with a third, may be properly laid to communicate with each other.*
* 4 In one indance, lately, I found that the water of hydrocephalus depofited no coagulable matter whatever upon the application of con¬ centrated vitriolic acid.*
a fluid.
Bailiie’s Appendix to Morbid Anatomy * 21
a fluid. The corpus callofum is at the fame time burft, fo that a part of the water lies in immediate contaff with the dura mater which lines the infide of the upper part of the cranium. "I he fcull too, upon fuch occafions, is very much enlarged in fize, and al¬ tered in its fhape The cranium is exceedingly large in proportion to the fize of the face, ihe projections are very conliderable at the centres of offification, from whence the frontal, parietal, and occipital bones wTere originally formed, and the membranous divifions between thefe feveral bones are very wide. When the fcalp is removed, fo as to give an opportunity of looking immediately upon the cranium, the bones are found to be very thin, often not thicker than a (hil¬ ling, and there are frequently broad fpots of mem¬ brane in the bone. The reafon of this lad appearance
is, that offification takes place in many points of the membrane in fuch cafes in order to make a quicker progrefs, but the water accumulates too rapidly for
it, fo that fpots of membrane are left not converted into bone. When fuch appearances take place in hydrocephalus, the difeafe has been of long continu¬ ance, occafionally for fome years.
c Cavities in the brain containing a ferous fluid . Cavities containing a ferous fluid are fometimes ob- ferved in the fuhftance of the brain. They aimed conftantly occur in the medullary part of the hemif- pheres, and are generally lined with a tough fub- flance or membrane. They would appear to be the remains of the cavities formed by extravafated blood, in cafes of apoplexy, where the patients have not been cut off immediately, but have lived afterwards for fome months or years. The extravafated blood would feem in fuch cafes to be diffolved, and taken up by abforption; but the injury is not repaired, and a cavity remains afterwards tilled with a ferous fluid. *
* Aneuryfm
* 4 I had an opportunity of obferving, lately, a well marked cafe of this fort, in a perfon who had had federal attacks of apoplexy, and at
C 3 length
\
22 Baillie’s Appendix to Morbid Anatomy *
c Aneuryfm of the internal carotid arteries on the fide of the fella turcica. The internal carotid arteries are very apt, in perfons of an advanced age, to be¬ come offified, and the fame morbid change may be traced along their branches. It occurs, however, very rarely that they are diftended at any part into an aneurylmal hack, like the arteries in fame other parts of the body. I have been informed of an inftance of this kind, where both the internal carotid arteries, on the fide of the fella turcica, were diftended into a little aneuryfm.* One of thefe aneuryfms was about the ftze of a cherry, and the other was fomewhat fm alter. It is remarkable that in the only two in¬ stances which have come to my knowledge, of aneu- rifms being formed in the arteries of the head and brain, there has been an aneuryfm in both arteries in the fame fituation, and at the fame time. I once met with an aneuryfm in the two carotid arteries at the origin of the internal carotids, and in the cafe juft defcribed, there was an aneuryfm in the two internal carotid arteries upon the fide of the fella turcica,
‘ Difeafed appearances of the plexus choroides.— Little bags in the plexus choroides , The rnoft com¬ mon difeafed appearance of the plexus choroides is that of little round tranfparent bags, which adhere to it, and which have commonly been called hyda¬ tids. Thefe are generally about the fize of a garden pea, but fometimes they have been feen as large as a goofeberry. From feveral examinations which I have made of them, they would teem to be formed by a diftenfon of the vein which runs along the edge of the plexus choroides. I have been able to diftend them fully with air, by making an opening into this vein, and inflating air into it through a fmall blow¬ pipe.
length was cut off by one of them. Dr. John Hunter has obferved & good many inftances of it, and a cafe occurred fome years ago to Mr. vv ilfon, lecturer on furgery, whofe anatomical accuracy is well known* where the cavity which remained was of a very large fized f 1 owe my acquaintance with this cafe to Dr* Blanc.’
f Round
Baillie’s Appendix to Morbid Anatomy.
OQ
‘ Round tumours adhering to the plexus choroutes. Tumours fometimes adhere to the plexus choroiaes They -are fmall in their fize, are commonly ahnoit globular in their fhape, and occur but rarely. 1 1 ey feem to be of the fame kind with the round tumours which are fometimes found imbedded m the brain,
and I believe are fcrofulous.
‘ Difeafed appearances of the pituitary glaitd.
This gland is very little liable to be aped by dif- eafe. It has only occurred to me to obferve in it one morbid change. It was, m that care, ^ enlarged to twice its natural fize, and was converted into a iuo- fiance, poffeffing an obfcurely fibrous ftructure.
« Symptoms connected with the difeafed appearances. Inflammation of the dura mater is not diftmguifoed by any peculiar fymptoms. The fymptoms which belong to it, are the fame with thoie wmch a.! r.d inflammation of the other membranes, and even oiaer but little from the fymptoms which take place m m*- flammation of the brain itfelf. The fymptoms are, pain in the head, delirium, fymptomatic rever, and
fometimes convulfive motions. . f
‘ When tumours have been found ache ring to the
dura mater, or the other membranes of the brain, a long continued pain in the head has commonly been remarked, fometimes delirium, fometimes convul- fions, and fometimes, it has been faid, the ordinary
fymptoms of apoplexy. . , ,
' ‘ Where bony matter has been formed m the aura
mater, with (harp precedes growing from it, convul¬ five motions have very commonly occurred m various parts of the body, often a continued pain m the head,
and fometimes delirium. . ,
< In cafes where the veins of the pia mater hav$
been found turgid with blood, ftupor has very fre¬ quently occurred, fometimes delirium, and fometimes, it has been faid, even apoplexy m its perteft form.
< The fymptoms of inflammation in the pia mater are the fame with thofe which attend inflammation or the dura mater, and they have been already noticed.
C 4
*24
Baillie’s Appendix to Morbid Anatomy ,
c In inflammation of the fubftance of the brain, there is pain in the head, delirium, fymptomatic fe¬ ver, and fometimes coma.
c Where an abfcefs has been formed in the brain; pain, delirium, and coma, have been remarked, fometimes a paralyfis of a part of the body, and fome¬ times convulfion§. The left fymptom has been ob¬ served moil frequently to occur when the abfcefs has been formed in the tuberculum annulare, or in the medulla oblongata, or in the neighbourhood of thefe ftruftures, fo that the pus could air eft them by its preffure.
‘ The brain has been fometimes found more firm and elaftic than is natural in cafes of mania. I have- been informed, however, lately, from the beft autho¬ rity, that this ftate of brain is not common in maniacs; and that in them it is generally not more firm, nor more elaftic, than in people whole minds have always been found.
s The fymptoms which have been ob ferved to at¬ tend the, formation of folid, or encyfted tumours in the brain, are a permanent uneafinefs or pain in the head, fometimes delirium, fometimes convulfions, and fometimes, it has been faid, the common fymp¬ toms of apoplexy. It is worthy of remark here, that when tumours of any kind prefs upon the thalami nervorum opticorpm, or the optic nerves themfelves, within the cranium, vifion becomes impaired in va¬ rious ways ; and that when tumours prefs upon the tuberculum annulare, or the medulla oblongata, con¬ vulfions are very apt to occur.
‘ The fymptoms of hydrocephalus, are a pain in the head, ftupor, convulfive motions, picking of the nofe, grinding of the teeth during fieep, occafional flufhings of the face, a dilatation of the pupils, and towards the latter end of the difeafe, fquinting. The ftomach is commonly affefted with ficknefs, and the bowels are with difficulty afted upon by purgative medicines. In the beginning of this difeafe, the pulfe
25
Baillie’s Appendix to Morbid Anatomy .
is frequent but regular; when the difeafe has made a further progrefs, it is flower and irregujar ; and to¬ wards the latter end of the difeafe, it becomes again regular and frequent. Where the progrefs of the difeafe has been very gradual, and the patient has continued to live for fome months, or even years, the functions of the brain have been found, in many in- trances, to be lefs impaired than might have been expefted, till near its clofe.
4 Where blood has been e flu fed upon any of the membranes of the brain, the patient is more or lefs in a comatofe date, according to the degree of the effufion, or the different fufceptibiiity of the brain in different individuals to be affefted by preflure. In¬ numerable inftances (hew, that the brain will have its functions impaired in very different degrees, from the fame apparent degree of injury.
‘ When blood is effufed into the fubftance of the brain, apoplexy is produced, which is attended with the following fymptoms, viz. coma ; often ftertorous breathing ; a paralyfis, commonly of one half of the body; and often corn/ ul five . motions. The pulfe is flow, full, and generally very ftrong. When the pa¬ tient is not cut off at once, but live6 for fome time after the attack, the hemiplegia, which is aimed con- ftantly an effedt of this difeafe, is upon the oppofite fide of the body from that of the brain, in which the eff ufion of blood has taken place. This would feern to fhew, that the right fide of the body derives its nervous influence from the left fide of the brain, and the left fide of the body its nervous influence from the right fide of the brain,’*
* e Dr. John Hunter has made fome very accurate diffedions relative to apoplexy, and its conl'equences, which formed the fubjed of the Guldonian ledures, read by him, 1796, before the College of Phyh- cians. By thefe ledures, I have been enabled to give a more fatisfac- tory account of the appearances ednneded with this difeafe, than I Ihouid have been otherwifed
( 26 )
% * X.
4 . , » ' ...
Art. IIL A Practical Inquiry on Uifordered Ref piration , <8ft\ By Robert Bree, M . D>
[Continued from voL 4, page 548.)
\ , ■ f •
JN our laft number we entered at fome length on the nature and caufes of the convulfive althma, and are now to follow the ingenious author in the treatment, founded on his dodlrine of the difeafe. On this head, he remarks on the little encourage¬ ment afforded by former writers of great authority, who treated on the fubjedt ; and he attributes their want of fuccefs to the erroneous opinions entertained by them on the caufe of the difeafe. From this fource he traces the falfe indications they followed in attempting a cure. c It is time/ he fays, c that other indications fhould be purfued than thofe of relieving fpafmodic conftridtions of the bronchia and efferve-' fcences of the blood ; or let us rather become em¬ pirics, and take the chance of benefit from cafual experiment, and the happy fuccefs of blunder, than rely on diredfions which confeffedly do not point to the objedl of our wiflres, and may poffihly lead us to error.’
The author having experienced the difeafe himfelf with great feverity, was furni fired with the oppor¬ tunity of making trials, of which he appears to have availed himfelf with induftry and fuccefs. The juvantia and Icedentia were here ineflimable guides, as they always will be in medical inveftigation.
The ftates of difeafe in afthma are limited by a diftindt application of terms as follows:
c A Paroxyjm of Convulfive Afthma, is that ftatc of* the difeafe which has an Exacerbation at night as long as it lafts. Wfterr the intermiffion takes place, Afthma is not cured, and though the paroxyfm is generally attended by at leaf! Three Exacerbations , it fometimes is extended through many more, nor is
there
27
Bree on Difordered Refpiration , &
there any certain limit to their number. If it does not embrace fo many as three, benefit may be faid to be derived from fome operation of art or nature, when the patient has a confirmed predifpofition to the diforder; but we can never affent to the pro¬ priety of claiming an advantage over the paroxyfm, if the exacerbations are renewed as often as was cuftomary in former fits, or oftener than three times, if the difeafe is new. Much lefs can the word Cure be admitted to clofe the phyfician’s labour, or enhance the character of his fagacity, unlefs an entire change in the habit of his patient, comprehending vigorous digeftion, and eafy refpiration, fhould be well efrablifhed after the paroxyfm has been long overcome.’
The general effefts of the different claffes of me-
o
dicines are next given.
Cathartics are commonly injurious, and in fome inftances have brought on a paroxyfm.
Emetics are ufeful in three fpecies, but in the fourth, which depends on habit, they are to be avoided.
On blood-letting, the author obferves, . that, * many doubts occur on the propriety of bleeding in Afthma, in any fpecies of the difeafe. Before the pulmonary veffels have attempted to relieve them- felves by their exhaling orifices, blood may poffibly be drawn with advantage, but when effufiqn has taken place, a certain debility is indicated, and a lofs of contractile power in the coats of the veffels, which prudence will rather fubmit to during the ft, and attempt to remedy in the intermiffiom In this flate of the difeafe, nature purfues the path bed: adapted to her circumftances ; the efcape or ferous fluid gradually relieves the veffels, and ref¬ piration and abforption muff be relied on, with a falutary cough, to clear the air cells of the lymph. If evacuations of blood are dire&ed, the fudden depletion of the veffels will leave their coats without
the
i i
28 Bree on D {/ordered Befpiraiion> <Su\
the ftimulus neceffary to produce a contraction, equal to the fpace which the blood had occupied; the heart will participate in the injury* and will alfo be deficient in vigour of contraction. If, therefore, blood is to be taken* it ihould be drawn from the vefiels at intervals, and in fmall portions, which would allow of the contradtile power being exerted, in proportion as the veflel lofes its contents, and would not finally take fo much fluid away, as would leave it without the ftimulus of detention, fo effential to its return of health.
c But bleeding is an imprudent operation in every fpecies of Afthma, unlefs it be the fecond. In the firft fpecies I have repeatedly direfted it, but have never had reafon to think that the paroxyfm was fhortened an hour by the lofs of blood, and I have often been convinced that expe&oration was de¬ layed, and more dyfpncea remained in the intermif- fion, than was common after . former paroxyfms. In old people who have been ufed to the diforder, it is certainly injurious. In the fecond fpecies there are occaflonal topical inflammations, which this operation may relieve, but if it is carried far, there is the ftrongeft reafon to apprehend, that the pa¬ tient maybe plunged into afthma of the firft fpecies/
Sudorifics and diuretics are not of polltive ad¬ vantage. In complicated cafes of old people, iffues are ufefuh
Antifpalmodics may be expeHed to flop the fit in the firft Ipecies, if we attend to the hypothefis of a fpafmodie conftriction of the bronchia., but indica¬ tions from this theory are not to be depended upon.
4 Antifpafmcdic medicines,5 the author oblerves,
* have no certain efficacy in fhortening the paroxyfm of the firft fpecies of this difeafe. Exceptions may be made to this general remark, but they are not founded upon precife lines of diftindijon of the dif¬ ferent fpecies.
‘ In
Bree on D if ordered Refpiration , 8£c. 29
e In the fourth fpecies, which often appears in afthmatics, who may alfo be fubjeded to exciting caufes, occafioning one or other of the three former., antifpafmodics will not deceive the phyfician. Opium hands firft, but its value is frequently en¬ hanced by the addition ot aether. If thefe valuable medicines had been applied with proper difcrimi- nation of different fpecies of afthma, the practice would not have been fo frequently difgraced by failure in the expectations of relief from their ufes.
{ In the accefs of a paroxyfm of the firft fpecies, R. B. took four grains of folid opium, which pro¬ duced nearly an apopleCtic ftupor for two days. After a few hours, the moil debilitating ficknefs came on, with inceffant efforts to puke. The la¬ bour of the refpiratory mufcles was abated, but the wheezing evidently increafed ; a countenance more turgid than ufual, and intenfe head-ache at¬ tended. The pulfe was increafed in ftrength and quicknefs for a few hours, but then funk into great weaknefs.
c The paroxyfm fhewed itfelf four hours earlier than ufual the next day, and two grains more were taken when it was perceived to commence ; refpi¬ ratory labour feemed again to abate, but the anxiety encreafed to an alarming degree, as the ftupor be¬ came fo me thing lefs. The pulfe was now weaker, and frequently irregular. Loofe motions fucceeded, and a general fvveat. The energy of the paroxyfm then revived with exquifite diftrefs. A medical friend, who attended with great care to the progrefs of thefe trials, became alarmed, and endeavoured to promote puking, without effect. Biifters were ap¬ plied, and draughts of vinegar and ' pepper were given, interpofed with ftrong coffee and muftard. The patient was at laft brought back to a ftate more ufual in former paroxyfms, but with every care, the exacerbations were no fewer than nine, before ex- peroration, becoming gradually more copious, in¬ cluded
!
30 Bree on Difordered Rcfpiration , Kc,
eluded the fit. Notwithstanding the bad fuccefs of this experiment, opium was ufed in another pa- roxyfm after an active vomit, and bad confequences ftili enfued, though not fo extenfive. In the latter ex¬ periment, the extraordinary fymptom of a moft painful ftrangury came on, which continued feveral hours.’
Of expectorants he prefers ipecacohan, ammo¬ niac and fquill, and avoids oily demulcents as in¬ jurious. Heating expedlorants are to be corredted by their combination with other ingredients. Afa- foetida is condemned.
Of pneumatic remedies Dr. Bree fpeaks with little confidence, as to their efficacy in curing aflhma. He, however, propofes oxygen as an ally, with other means' of relief in the firii fpecies from mucous irri¬ tation. The authority which he appears chiefly to have confulted is, the reports of profeffors of this pradtice. We fliould have been better fatisfied with the refult of his own accurate experience; for furely the negledt which the pradtice feems to have fallen into, is a ftrong argument againft„ depending upon the vague cafes which have been brought forward in recommendation of the ufe of the gaffes.
It would be definable to know if the author had ever really obferved the miraculous effedt which oxygen has been affirmed to produce in aflhma, by Dr. Beddoes : ‘ No fooner,’ fays he, c does it touch the lungs, than the livid colour of the countenance difappears, the laborious refpiration ceafes, and the fun diions of all the thoracic organs go on eafily and pleafantly again !’
In the dry afthma, oxygen was obferved to be pofi- tively hurtful ; and hydrogen and hydrocarbonate were tried without benefit, by Dr. Thomas Bree, who had paid attention to this pradtice. The phyfiological rea- fons which Dr. Bree gives for the ufe of oxygen in the firff fpecies, viz. that excels of mucus in the air bladders makes its natural combination with the blood diffi¬ cult, are ingenious, and account in a feemingly fa-
tisfactory
Bree on Diforclei'ed R&fpiratioti, <Sfc. 31
tisfaftory manner for the good effed of this air upon afthmatics, if, in fad, they do perceive relief from infpiring it.
Stomachics are coniidered as abfolutely neceffary. Of thefe he recommends abforbents and vinegar feparatelv exhibited — Both eminently counteract the flatulence and diftention of the ftomach.
Chalk is recommended in ftrong terms as a means of cure in the third fpecies ; but this is not very readily difcriminated from the firft, and chalk may poflibly be more extenftvely applied where dyfpepfia is fo predominant as in general cafes of afthma. * The fuccefs which attends its ufe is only to be ac¬ counted for, by conli dering the influence which a morbid ftate of the ftomach may have on the adions of the refpiratory mufcles in this difeafe. This in¬ fluence is placed by Dr. Bree on juft principles in the 14th feed ion of his inquiry. And the correfpon- dence of the external mufcles with the irritated or¬ gan which they attempt to relieve, is a pathological fad which we deem highly important, as eftablifh- ing the greateft improvement which has been yet given in treating the difeafe.
Stimulants are injurious till after the third day in the paroxyfm, and we are cautioned againft their abufe. c I have never yet feen/ he fays c aether give eafe in the acme of the paroxyfm of the flrft fpec les. In many trials, the anxiety and the energy of refpiratory labour were certainly encreafeef/ Cold bathing is ftrongly advifed between the fits. Dr. Bree entirely coincides with the teftimony of Dr. Ryan as to the great benefit of this pradice, but found it manifeftly injurious in the paroxyfm.
Tonics are the grand means of cure, not exhibited in the paroxyfm, but in the intermiflion. Prepara¬ tions of iron are preferred. On this fubjeef he fpeaks as follows :
Ionic medicines, if we feparate a clafs of fto- machics from this general head, are not expeded to
2 be
52 Bree on Dlf ordered Rcjpiration^ <Sfc\
be ufeful in the paroxyfm of afthma. They have been applied partially, and abandoned capriciouily, by molt practitioners, in cafes of afthma during the
intervals. .
4 But a defideratum has always been a proper diftmbiion of Ipecific caufes. If tonics are given in cafes of difordered refpiration arifmg from fecret vo- . micae, fmall .tubercles, adhefions of the pleura, and .many other caufes of continued afthma, .what conic- quenee can be expected, but encreafe of difeafe, and accumulated mifchie.fr The recollection of every practitioner wall enable him to allow, that inflances of this complicated kind, have been confounded more or left with convulsive afthma of nofologifts, and when iron, or peruvian bark have been ex¬ hibited, thefe valuable medicines have met with unmerited difgrace.
4 But, befid.es this caufe for the rejeftion of tonics, the want of firmnefs in continuing the ufe of them, when properly indicated, is a great fource of their di (credit
4 A febrile affeftion comes on during a courfe of fteel or mineral w^ater, and the medicine is dift carded never to be refumed.
4 Peruvian bark loads the ftomach, and brings on dyfpnoea in one preparation, and it is abandoned without trying another of lighter digeftion, and more divided parts.
4 I can affirm, that in the intervals of the paroxyfms of the firft, third, and fourth fpecies of afthma, tonics are generally beneficial, and that a temporary incon¬ venience from the ufe of one form, fhouid incite the phyfician to find another, and apply it, never aban¬ doning the general intention.
4 In the fecond fpecies their advantage is more doubtful, and their exhibition muft be decided upon, by careful attention to remote caufes.’
After this general account of the effeCl of medi¬ cines, the author propofes the indications which are
* to
1
Bree o?i Difordered Refpiratiori , 8(c,
to be followed in treating the paroxyfm. Thefe are fuch as are naturally deduced from the caufes of the dibindf fpecies. They deferve great attention, as leading to confiderable relief of the diftreffing fymptoms ; but, excepting in that fpecies which is de¬ pendant on habit, the author profeffes only to im¬ prove the pradlice in the paroxyfm, by giving more certain data, founded on his numerous experiments. It is the intermiffion which appears to afford the op¬ portunity of eradicating the diforder, and by a rule of pradtice fimilar to that purfued in the iliorter in- termiffions of a quartan ague, by corroborating the fydem of the patient. It is only by removing the predifpofition that the difeafe can be cured, a confide- ration hitherto but little followed in pradtice, how¬ ever important.
‘ It is our duty/ fays the author, c to urge the ne~ ceffity of counteracting exciting caufes, and to fhew what condition of body it is, in which thefe caufes are buffered to operate their effedts. Unlefs this honed folicitude of the phyfician is anfwered by the firm fubmiffion of the patient, the latter cannot be¬ come impervious to the future attacks of aithma, though a paroxyfm has terminated in the mod per- fedt intermiffion.
‘ In the Firft Species it is obvious, that the proper indications are to be only anfwered by the ufe of medicines, which can give a contradtile tone to the pulmonary capillaries, encreafe the power of the domach and bowels, and promote abforption and drength through the whole habit.
c Peruvian bark, iron, cold bathing, exercife, change of air, oxygen, bitters, abforption, and acids, thefe are the means, which, diverffied according to their effedfs, will prevent the recurrence of pa~ roxyfms, by curing the condition ot body in which they are excited.’
c We mud continue abforbents from the clofe of the paroxyfm, making ufe of magnefia when the
vol, v, D body
34 Rree on Dif ordered FeJ1 piralion,
body is coftive, but preferring chalk in common in- fiances. This medicine, given in bitter infufions, will oppofe dyfpepfia as a temporary relief, but muff: not be relied upon for a more extenfive advantage. The preparations of iron are to be given at firft in fmall doles, and afterwards increafmg the quantity. If heat, or pain, occafionally attend, we muft fubmit, during thefe fymptoms, to fufpend their ufe, and fub- ftitute faline draughts with opium.
c In the Second Species , exhalation fhould be pro- moted from the veffels of the lungs, by the ufe of diaphoretics. Small dofes of opium are ufefully con¬ joined, and the patient fhould not be fubjeCted to the influence of irritating caufes, fuch as are known to exift in towns and manufactories.
‘ The Third Species is to be cured by the means pfopofed in the firft, but with a more free ufe of ab- forbents, and a more rigid attention to diet. Chalk and opium will aftonilh the afthmatic, by the excel¬ lence of their effeCts, when the irritation proceeds from dyfpepfia of the firft paflages only.
‘ The Fourth Species is cured by antifpaftnodics, which abate a fenfe of irritation from trivial caufes that cannot be avoided, and by a change of ideas and manner of life : by thefe means the habit of con- vulfive mufcular contractions is finally overcome, if thefe had not ceafed with the offending caufe which excited them.’
Some cafes are given which elucidate the princi¬ ples, and confirm the propriety of the author’s prac¬ tice. The moft ftriking will doubtlefs be confidered his own cafe, which, as wil! be feen below, appears to embrace the firft, fecond, and laft fpecies of the difeafe, in its fuccefiive periods. A cure was obtain¬ ed by arduous perfeverance in corroborating means, and attentive obfervation of the effeCts of medicines.
R. B. enjoyed general health in various fituations until 1783 ; when dyfpepfia firft attacked him at twenty-five years of aae. The fymptoms increafed
gradually
Bree on Di/ordered Befpiration 3 &'c. -35
gradually for four years. He was hypochondriac, fleepy after meals, and had conftant pains in the in- tercoftal mufcles.'
1788„ — Reading was painful, his eyes conftantly inflamed; ftupor came on every night, and apoplexy was apprehended. He had lived upon a very weak and fluid diet, and taken faline medicines very inju- dicioufly.
In the fummer, after awaking in the morning, he perceived fome wheezing in his expirations, but no dyfpncea.
In the autumn, after a catarrh, and fatigue in riding, he was feized in the ufual manner, with a paroxyfm of convulfive afthma of the firft fpecies.
In the winter, he had feveral paroxyfms, and pur* fued the means of alleviating them pointed out in the preceding feftions. His experiments frequently prolonged their duration, and the inter mifficins were neglefted.
For four years this difeafe preferved its character, and was remarkably excited by the following remote caufe. — The elevated flat of Solyhull is the higheft part of Warwickfliire, from which rivulets defcend to the eaftern and weftern oceans. The foil is gra¬ velly, but always moift with fprings ; the air is light, and continual evaporations make it cold. He W7as frequently called to this fpot by the ties of family, or motives of bufinefs, from a refidence forty miles dis¬ tant, and two hundred feet nearer to the level of the fea. In his firft vifit, after he had fuftained the afthma, he was feized with a very fevere paroxyfm on the evening of his arrival. He was laid up during his ftay, and the fymptoms had not fubfided when he purfued his road back. As he defcended from the high country into the rich paftures of Leicefterfhire, the dyfpnoea gradually went off, notwithftanding great fatigue. During four years he repeated this vifit in warm and cold weather, and under all c ire urn franc es,
D 2 feven
36 Bree pn D If order eel Refplration , &c.
feven times, but with the fame bad fuccefs in ever? attempt.
1792. — He had tried the effect of numerous reme¬ dies in the paroxyfm, and had attained fome advan¬ tage over it: dyfpepfia was lefs, and his general health improved, but he had not yet fucceeded in lengthening the intervals.
H e now purfued, more vigoroufly, the plan which he had adopted. He took iron in3 large dofes, and in all preparations, but preferred the ruft, which cor¬ rected dyfpepfia moft powerfully. He went into the cold bath every other morning, and took abforbent earths frequently, with bitter infufions, and rhubarb.
In the fummer, dyfpepfia was greatly abated, and the intermiffions became longer. In October, he went to Bath, and drank the water a few weeks with great benefit. Upon his return he refumed his tonics, and trufted chiefly to the ruft of iron, taking chalk more feldom. The cold bath was fufpended in the winter.
1793. — Some boils had appeared in the laft year, and they were now more frequent upon his face and body. The paroxyfm s did not come on fo often, but were excited by fatigue or cold, and by profeffional bufinefs, which he now determined to abandon ra¬ ther than his hopes of a perfect cure.
1794. — In the winter he was very free from diforder- ed re fpi ration, which he attributed to excurlions and a change of ideas in new purfuits. In the fpring he had two fevere returns, excited by duft of oats and hair pow¬ der, which revived dyfpepfia and gloomy profpefis. But he expectorated little, although dyfpnoea fub- fided with the paroxylm. His difeafe now approach¬ ed the character of the fecond fpecies, and the change was conlidered favourable. He alfo applied the principles of feCtion XV. to thefe attacks, and fecretly determined to oppofe a future invalion by fedatives, which he had long difearded as ufeleis in this in¬ tention.
An
Bree on Difordcred liefpirationl We, 37
An opportunity occurred twenty days after, when he completely flopped theparoxyfm at ^.commence¬ ment, by two grains of opium diifolved in vinegar with aether. He enjoyed a good night, and arofe in the morning without dyfpnoea or expectoration. He was now prompted to fee the event of a journey into W arwickfhire, but here the paroxyfm came as ufual on the evening of his arrival, when his mind was oc¬ cupied by the perceptions which he had before ex¬ perienced in the fame place, and which he had great anxiety to avoid. When he perceived the fympt'oms, he withdrew from company, and took a draught of cold water and vinegar, with forty drops of tinCt. opii. Relief foon came, but not extended to a per¬ fect removal of the affeCtion, which he attributed to the ftrength of influences operating upon habit,
The dofe of opium was repeated, and he had a good night, but no deep; in the morning, dyfpnoea without wheezing Further reflection ftrengthened his opinion that he was now under the dominion of a fecondary difeafe eftablithed in habit, and he deter¬ mined to anfwer the new indications , at any expence of effort which circumftances might demand. He recollected the aphorifm of Hippocrates on the con- vulfive difeafe of epilepfy, which had been dilated in the doctrines of many modern writers, applied to cuffom or habit, but not with the force which has been ffnce exhibited by the author of Zoonomia.
Military bufmefs was moft oppoffte to his former habits, and moft likely to turn the current of his ideas to diffever the chain of links bv which they revived old fenfations, or to obliterate their influence. Exercife near the fea, where the denfity of the air might co-operate with other means of cure, and the opportunity of bending his mind to the principles of a new fcience, were his motives for taking a company in a regiment ot militia, commanded by excellent of¬ ficers, who were his friends.
At the end of June he joined his regiment, en¬ camped upon a dry common, elevated above the
D 3 • plain.
38 Bree on D if ordered Refpiration , 8£c,
■ ■ ■ •
plain* and Hoping towards the fea at a few miles dif- tance, The colonel of His regiment is a father to his officers, and He permitted him to occupy lodgings, with his family, in the vicinity of the camp. He at firft avoided, with great care, errors in diet, which are exciting caufes copiouily provided at military tables. But after a few weeks he found great cau¬ tion was unneceffary, an accidental excefs having no bad confequence, He foon gave his whole attention to the fcene before him, and attempted to fill his mind with the images which it pre feinted. A new fyftem of taffies being ordered for practice of the regiment in camp, he employed himfelf in affiduous ftudy of its principles, and their application to aftive fervice.
During the fummer, and until late in the autumn, he had uninterrupted health. The vigorous fpring of elaftic youth again animated his frame, and was attended by fatisfaffion and ferenity of mind, which the capricious tyranny of his diforder had denied him for the preceding ten years. He generally arofe at four in the morning, and frequently marched fix miles, in the duft of two brigades of infantry, to be reviewed under a burning fun, and was on foot until noon before he returned to camp. When this duty was not executed, exercife was purfued in the camp ground, become equally dufty as the read, but nei¬ ther cough nor dyfpncea was excited. Dyfpnoea and hypocondriacifm were equally overcome; liberties were taken with every fpecies of diet ; no exertion feemed too confiderable, and fatigue was never felt. At the clofe of the campaign he flept conftantly in camp, and torrents of rain, which filled the tents with wet, and flowed through a Knightfbridge houfe, which he was favoured with, produced no alteration for the worfe.
1795.— The regiment was cantoned in the towns of Cambridgeffiire during the winter, and he had no return of afthma,
In
Bree on Difordertd Refpiration, 39
\ v*. - - \ ^ ■■■$— . '•3'^ ’J' • <.? • < iVi!
In March, he had orders to take three companies under his command, and to follow other divifions of the regiment to Hull. He was now fo confirmed in health, as to determine upon flnilhing his military ex¬ periments when this duty was difcharged.
Yet at Huntingdon, having taken cold and drunk bad wine, he had the terrentia of his difeafe, but . the progrefs of the lymptoms was fufpended by opium, and finally carried off in a bilious diarrhea.
At the end of the month, fully fatisfied with the fuccefs of an uncommon experiment, he refumed his regular profeffion, and to the prefent period, (July, 1797) has felt no fymptom of his former complaint. A flight dyfpncea came on with unufual exercife and heat laft September, and went off in a bilious diarrhoea, without taking the form of afthma. But what are the proofs of a perfect cure in this difeafe capable offo long intermiffions?
He has refided in Birmingham fince A u guff, 1795, a fituation of nearly equal altitude to that where he always met with a paroxyfm fince he knew the dif¬ eafe, and only feven miles from it.
The air is much rarified by numerous fires, and a population of 80,000 inhabitants, with particles of duff perpetually boating from the manufactories. He is, however, not fo imprudent as to abandon pre¬ ventive means.
In the fummer he ufes the cold bath frequently. If flatulence difturbs his ftomach, he oppofes the firft lymptoms of growing diforder by abforbents and bitters, always concluding this occafional plan by fteel, for feveral days, though the lymptoms foon leave him. After a catarrh, he takes the fame care to recover the tone of the pulmonary veffels and fto¬ mach: and with thefe attentions he has no apprehen- fion of the difeafe returning, although the exciting caufes are fo ready to aft.
' D 4
We
40 Cavaliers MedicinalBroperiies of Factitious Airs .
We have now gone: through the contents of this interefting volume, not more valuable for the mode of cure it inculcates, than for the information it con¬ veys of the inefficacy of many fafhionable remedies. It exhibits a much defer connexion between the practice recommended, and the theory on which it is founded, than any of the other publications on the fame fubjech We cannot, therefore, but recommend it to the attentive notice of our readers, ft ■ ' .
Art. IV. An Fffay on the Medicinal Properties of lute titious Airs, with an Appendix on the Nature of Blood. By Tiberitjs Cavallo, F. jR. S. Octavo, 256 pages, price 4s. Di lly, London, •..1798. . ;
I:T is not quite forty years fince the artificial aerial fluids began to be adminiffered as remedies to the human body. The uncertainty, and the errors of the eany applications, rendered the progrefs of the prac~ tice how and doubtful ; nor ha> the experience or the fuccefs of recent and more numerous praffitioners been, fufficient to determine the precife power of the aerial fluids,; or to diffipate the doubts which are fHh entertained concerning their ufe. A defire of extri¬ cating the fubjeff from the conflux of contrary opi- pions,:reftabliHied prejudices, and oppofite interefts, induced the author to publifh the prefent work. To exhibit, a concife. view of afeertained faffs, to fepa- rete them from fuppofitions and hypothefes, and to P uiit out the ways of inveftigating tne farther ufes of iaefitious airs, has been his principal aim in the com¬ pilation of the prefent effay.
i he full chapter treats of the principal properties of tlipfe airs, or permanently elaftic fluids, which have been applied as remedies to the human body, and of the beft; means of obtaining them for praffical ufe.
In
Cavallo’s Medicinal Properties of Factitious Ai rs. 4 1
In the fecond, the author relates "the generally-known eircumftances refpe£ling the refpiration of co nmon, and of oxygen air. The exhilarating effefts attri¬ buted to diluted oxygen air, or, as it has been termed, improved atmofpherical air, which has been fa id to produce a florid colour in the face, to conciliate Jleep, to ftrengthen the organs of digeftion, to pro¬ mote circulation, to ftrengthen the pulfe, &c. are fuppofed to admit of explanation, on a comparifoa with the effects experienced by a fhort excurfion out of a town, or of a houfe, after confinement: yet it may be doubted whether there be any clofe analogy in this cafe ; for the fuperior purity of the country air, above that of the town, is fo fmali, as not to equal that which is produced by mixing common air with even- one-twentieth of its bulk of oxygen air; whilffc it is manifeft that there are many other circum^ ifances to which the effe&s may be afcribed.
The third chapter treats of the phenomena arifing from breathing other aerial fluids, befides the common and the oxygen airs. The fubje&s of this and the preceding chapters have already been amply difcuffed in different parts of our Review.
Chap. 4. Phenomena arifing from the application of the elaftic fluids to other parts of the animal body beiides the lungs. It has been found that the pores of the fkin imbibe and expel a fmali quantity of air, and it is faid that in equal times they will abforb a much greater quantity of oxygen, than of common, or of any other, air. Different forts of elaftic fluid were feparately injefted into the cellular membrane of animals, through incifions made in the fkin, and the apertures were clofed immediately after. The appearances obferved were in general as follow :
Common air fwelled or puffed the animal, render¬ ed it uneafy for a day or two, after which the fwell- ing began to decreafe, and vanilhed entirely at the end of about three weeks.
tmi&tde Oxygen
42 Cavalkfts Medicinal P roper ties. of F petitions Airs.
Oxygen air fw.elled the animal, and rendered if fornewhat uneafy for a ihort time ; the uneafmefs, however, foon vaniflied, the animal became unufu- ally lively, and the fwdling difappeared much fooner than in the cafe where common air had been ufed.
Azotic gas fwelled the animal, and rendered it dull, by fuperinducing a fort of ftupor, which in a few days time degenerated into convulfions, and at laft killed the animal.
Carbonic acid gas was rapidly abforbed, and fel- dom produced any flight and temporary uneafmefs.
Hydrogen gas fwelled the animal, produced heavb nets and fbiverings; but the fwelling difappeared fooner than in the cafe of common air.
Mr. Girtanner is faid to have injected azotic gas into the jugular vein of a dog, in confequence of which the animal died at the end of twenty feconds. On opening the thorax, the pericardium, and the heart, the right auricle and right ventricle, were filled with black blood ; the left ventricle was of its ordi¬ nary dark colour; the heart had loft its irritability almoft entirely. A fimilar experiment being made with carbonic acid gas, inftead of azotic gas, nearly the fame phenomena took place.
In the fifth chapter, the author gives the modem Theory of Refpiration, and the Nature of Aerial Fluids. c It is entertaining to perufe the works of authors previous to the late difeoveries, and to ob- ferve how near the ideas of fome of them approached the modern theory of refpiration. Hippocrates con- ftdered air as one of the aliments of the body. Dr. Mayow afferts, that fome nitre, or aerial fpkit of nitre, enters the body through the lungs, and fur- nifties the animal fpirits at the fame time that it conn nmnicates heat to the blood.*
^ ‘ 'C'e.e his work, printed at Oxford in the year 1674, under the title of 'Tract at us qumqu-e Medico-PhyJiclC
Cavallo’ s Medicinal Properties of Factitious Airs . 43
‘ Dr. White fuppofed that the Simulating quality of the air is neceffary to keep the heart in motion. Mr. Hewfon, obferving that the blood has a more florid red appearance in the left, than in the right, auricle of the heart, concludes with faying, that as the change of colour in blood out of the body is oc- cafioned by the contact of air, fo it may be prefumed that the fame change within the body is occafioned by air alio, and that the change takes place in the lungs.’
Chap. 6. A general idea of the application of aerial fluids in different diforders incident to the hu¬ man body.
Chap. 7. Of the particular adminiftration of aerial fluids in different diforders. The difeafes in which the aerial remedies have been ufefully applied are here arranged in alphabetical order.
The next contains an account of Several cafes in which thefe fluids were administered. Thefe cafes have been either extracted from other publications, or have been communicated by the author’s intel¬ ligent friends. Of moll of the former we have al¬ ready taken notice on different oecafions. This is a part of his talk which we cannot deem the author by any means competent to fulfil. To enable a perfon to judge of the effects of applications to the living body, with any degree of certainty or precifion, an acquaintance with the fubjeCt in all its various rela¬ tions, is required. This can be expeCted from pro- feffional men alone ; and experience thews us, that of thefe even the number is few on which any great re¬ liance can be placed. The various nature of indivi¬ duals, the imperfeCt and contradictory accounts which have, been given, and the frequent adminiflration of other remedies, in conjunction with the aerial fluids, render our knowledge of their powers in a high de¬ gree precarious and unfafisfaCtory. For thefe reafons we decline following the author in the ftrifitly medical parts of his work.
The
44 Cavalkfs Medicinal Properties of Factitious Airs*
The ninth and laft chapter contains practical re¬ marks concerning the production of factitious airs, and the means of preferring them. c In particular fituations,’ the author obferves, 4 the difficulty of pro¬ curing proper materials and proper tools may prevent the poffibility of adopting the molt expeditious, or, upon the whole, the molt advantageous, methods of procuring the aerial fluids ; and when that is the cafe, the praCtitioner mult confult the firlt chapter of this effay, for the method which may be more fuitable to the circumiiances of his fituation. But when there is the opportunity of procuring both materials and inltruments, it is then proper to follow7 the plan which may appear lefs exceptionable.
4 The cheapcft article for the production of oxygen air is the mineral called manganefe , which is found plentifully in many parts of this ifland, and elfewhere. A very good fort of it is found near Exeter. It ought to be free from extraneous, and particularly noxious, minerals; but it frequently contains a confiderable proportion of calcareous matter, which may be de¬ tected by powdering a little of the mineral, and pour¬ ing fome nitrous acid upon the powder ; for this will produce an effervefcence proportionate to the quan¬ tity of calcareous matter. It muft not, however, be expeCted to find manganefe perfectly free from it ; for though this may be the cafe with filial! pieces of that mineral, yet in confiderably large quantities of it, fuch as are required for the production of oxygen air, fome calcareous earth is almoft alw7ays contained ; but the only ejteCt which arifes from it, is the production of carbonic acid gas, together with the oxygen air, the former of wffiich is eafily feparated from the latter by the wTell-knowm method of wTaffiing in lime-water.
< The greateft quantity of oxygen air is extricated from manganefe merely by the aCtion of a full red heat ; it is, therefore, neceffiary to put that mineral in a veffel ca pable of refitting the aCtion of fuch a de¬ gree of heat. Earthen-ware, and certain metals, are
the
Cavallo’s Medicinal Properties of Factitious Ain . 45
the materials fit for the conftruftion of fuch veffels. The former is certainly unexceptionable in point of purity ; but it is not managed very eafily for this pur- pofe, and befides, the ufe of it is attended with com liderable expence, for a velfel of that fort will hardly ever ferve more than once, as on cooling after the firft experiment it generally breaks; and indeed it fre¬ quently breaks in the courfe of the experiment. ^ Of the metals, gold or platina vefiels would be the fitted: for the purpofe, did not their value offer a material objection. Thofe metals excepted, iron is the bell ; for though the ufe of a velfel of this metal he attend- ed with evident objedtions, yet, when managed with care and attention, the oxygen air may be produced of fuch a degree of purity, as to be more than jfuffici- ently ufeful for medicinal purpofes.
‘ It is neceffary to remark, that in all cafes, but efpecially wThen an iron velfel is ufed, the manganefe, as well as the velfel in which it is contained, and the pipe or tube which conveys the air from it to the re¬ ceiver, mull be quite free from animal or vegetable matter, and perfectly dry, otherwife the el. attic fluid, which is produced, may be injured in point of purity, and it may even degenerate into a noxious fluid.
6 When thofe particulars are attended to, the oxy¬ gen air will principally contain a certain proportion of carbolic acid gas, and fome light powder of man¬ ganefe, the former of which is to be feparated by means of lime, and the latter will be depofited by Handing, in about ten or fourteen hours time.
6 The fpecies of inflammable gas moldy in ufe are extrafted by means of diluted vitriolic acid from zinc or iron, and by palling the fleam of water over the furface of red hot zinc, or iron, or charcoal,
c The gas, extracted by means of diluted acid, holds in fufpenfion fmall particles of the metals con¬ cerned, viz. of the zinc or irhn, the latter of which in particular may be rendered marufeft by burning the gas in a bottle full of it, in which yafe fome fmall par¬ ticles
2
/
46 Cavallo’s Medicinal Properties of Factitious Airs*
tides of a dark red light will be difcerned within the pale flame of the gas, which are the ferrugineous par¬ ticles ; for thofe minute red fparks are not to be feen in the inflammable gas which is obtained from pond water, or putrid matter, or, in fhort, from fuch fub- ftances as do not contain any metallic fubftance.
c The gas obtained by pafling the fleam of water over red hot zinc, holds in fufpenflon a confiderable quantity of the flowers of zinc, which it depofits in about a day’s time.
£ The gas obtained in a fmiilar manner from iron is the rnoft abundant, and of courfe the cheapeft.
s For the produflion of the heavy inflammable gas, or hydrocarbonate, Mr. Watt recommends to ufe “ charcoal made of the twigs of fofter woods, fuch as willow, poplar, hazle, birch, or fycamore, avoiding fuch as have reflnous or aftringent juices. Prepare £C the charcoal by heating it to full ignition in an open “ fire, arid quenching it in clean water, or by filling a “ crucible with it, covering it with clean fand, and expofing it to a ftrong heat in an air furnace, and “ then buffering it to cool. In either of thefe cafes it will be found free from any bituminous matter, “ which might contaminate the air, as generally tc happens with common charcoal.”
* Mr. Watt likewife mentions, amongft other forts of inflammable gas, that which is extracted from a. mixture of charcoal powder and flaked lime, which, on account of its peculiar properties feems likely to prove very ufeful : cc In refpetl,” fays he, to the <c medicinal properties, all I know is, that the in- cc flammable air from charcoal and lime contained no fixed air feparable by waffling with quick lime and water,, and that it did hot caufe the vertigo when u inhaled pure.”
‘ One or other of thofe fpecies of inflammable gas may be preferred in particular cafes, and it is not only likely, but in great meafure proved by a final expe¬ riment, that the particles of iron, or other matter, 4 which
Cavallo’s Medicinal 'Properties of Facti tious Ai r’s: 47
which are fufpended in a particular fort of gas, may be peculiarly ufeful in certain difeafes.
c In the production of inflammable gas. the intro¬ duction ot any extraneous matter, and efpecially of vegetable or animal fubftances, and of minerals that contain acids, fhould be carefully guarded again!!.— It is like wife advifabie, for a very obvious reafon, not to conduCt this procefs by candle light.
‘ The carbonic acid gas may be extracted from chalk in Mr. Watt’s apparatus, according to the di¬ rections given with the laid apparatus ; but when no extraordinary large quantity of it is required, it is far more commodious to extraCt it from chalk or marble powder, and diluted vitriolic acid, in a gl-afs veflel. The difference between chalk and marble in this refpeCt is, that the former gives out the gas quicker, but is foon exhaufted ; whereas the latter gives it out more gradually, and for a greater length of time ; hence, in fome cafes, the former, and in others, the latter, may be preferred.
4 Concerning the Preferyalim of Aerial Fluids. Oxygen air is not contaminated by keeping in glafs receivers, or in fuch veffels as do not communicate
any thing to it, nor does the contaCt of pure water injure it ; but in wooden veffels, or veffels painted with oil paint; and when a confiderable quantity of common river water is in contaCl with it, the oxygen air will be contaminated more or lefs.
4 The various ipeeies of inflammable gas are apt to degenerate in procefs of time, efpecially if they be kept mixed with common or with oxygen air. The hydrocarbonate, in particular, is vaftly more powerful when frefli made, than two or three days after. Due allowance, therefore, mu ft be made for the lofs of power in the adminiftration of thofe airs.
W hen- oxygen air, or inflammable gas, is to be taken out of an air-holder or bottle, &c. by putting water in the veflel after the ufua] manner, it is ad- vifable -to ufe lime-water .5 for the’ Jirtje will not only
abforb
48 Cavallo’s Medicinal Properties ofF actitiousAirs <
abforb any carbonic acid gas that may be mixed with thofe airs, but will alfo prevent the putrefaction of the water.
* For this purpofe there is no occafion to filtrate the lime-water, as is practifed in the ufual manner of preparing it ; but it will be fufficient to mix the quick lime with the water, and after leaving it at reft for an hour or two, to feparate the fluid and ufeful part from the fediment, by decanting it gently.
‘ The carbonic acid gas is not contaminated by keeping ; but as it is abforbed by moft fluids, it fhould not be kept in contaft with much water. In moft cafes it will be better to produce it afrefh every time it is wanted.’
An Appendix is fubjoined to the volume on the Nature of Blood. The intimate connection between refpiration, and the ftate of the blood, the neceftary dependence of animal life on the oxygen part of the atmofphere, through the intermediation of that fluid, undoubtedly render an account of its nature highly neceftary, in a general inveftigation of the adtion of aerial fluids on the human body. The account of the chemical properties of the blood here given, is chiefly extracted from Fourcroy’s late chemical works, and contains nothing that is not known to the genera* lily of our readers.
The configuration of the red particles of the blood, as determinable by the microfcope, has given rife to much controverfy. ‘ Luenhoeck thought that each red particle confifted of, and was refolvible into, fix fmaller globules, and that every one of thefe fecon- dary globules confifted of other fmaller particles. — Hewfon took them for bladders which contained a nucleus or central body that feemed to roll from one fide of the bag to the other. Torre faw them like rings 5 viz. confifting of an internal and an external circle, and this ring appeared to be divided, or to confift of parts joined together like the rim of a com¬ mon coach wheel. Falconer confidered them as flat
or
- V'T V
- -
s
<Lgt "
Cavallo’s Medicinal Properties of Factitious Air s . 49
> 1 P ® ^ > > :'V s
•5 ry y- p> r o c*
i JE* ,
V- "
or fphcroidicai bodies; for he thought he tome times faw them Tideways. “ The red globules^’ fays the late Mr. J. Hunter, “ are always nearly of the fame tf fize in the fame animal, and when in the ferum do <c not run into one another as oil does when divided “ into fmall globules in water. This form, therefore, “ does not arife limply from their not uniting with the 4C ferum, but they have really a determined lhape £c and fize. This is fimilar to what is obferved of
“ the globules in milk ; for milk being oily, its glp- cc bules are not foluble in water ; neither do they cqn- ¥ fill of fuch pure oil as to run into each other ; nor
wrill they diffolve in oil. I lufpeft, therefore, that £‘ they are regular bodies, fo that two of them could ££ not unite and form one Dr. Wells is of opi¬ nion, that the red globules confift of two parts, one within the other, and that the outer, being in foluble in ferum or dilute folutions of neutral falts, defends the inner from the aft ion of thofe fluids fd
By employing the minute glafs globules invented by the Abbe Torre, the author thinks he has in many points confirmed the Abbe's obfervations. £ I have repeatedly meafured,’ fays he, £ the diameters of the red particles, both by means of my mother-of-pearl * micrometer in a compound microfcope, and likewife by looking at them with one eye through a Angle lens, and referring their image to a fcale properly divided, and viewed with the other eye out of the microfcope.
£ In perfons of nearly the fame age the mean fize of the particles differs very little indeed. In the fame perfon they differ a little, and their figure is not very circular. This deviation from the circle is not fuch as a fiat circular furface would affume in its different inclinations to the axis of vifion ; for, according to the rules of orthographic projeftion, the flat circular furface muft appear either circular, or elliptical, or as
_ ■ < ■: ... v. ... .
* Treatife on the Blood, p. 41. f Phil. Tranf. P. II. for 1797. vol. v . E a ilraight
50 Cavallo’s Medicinal Properties of Factitious Airs,
a ftraight line ; whereas I never faw the particles of blood as ftraight lines, viz. edge wife, and the elliptical figure, which they fometimes affume, is by no means regular.
c In an adult of the human fpecies, the diameters of the red particles run from about 0,0003 to about 0,0004 parts of an inch, and I very feldom faw one fmaller or larger than thofe limits. If, therefore, we take the fmalleft particles and fet them in a row, we fhall find that about 3334 of them will equal one inch, and if we take the largeft, about 2500 of them will meafure one inch.
c When the particles are magnified more than 40 or 50 times, and lefs than 80 (meaning always in diameter), they appear like colourlefs transparent fpots inclofed within dark circles.
4 When magnified more than 80 times, and lefs than about 160, a dark fpot, like a dot made with ink on paper, appears in the middle of each particle.
c If the reflector which illumines the particles, in- ftead of being fituated ftraight before the objeft, be fet on one fide of the axis of vifion, fo as to throw the light obliquely on the objedt, then the half of the dark circle of each particle difappears, viz. that half which is on the fide oppofite to the refleftor. The central fpot does at the fame time appear to change its place.
£ When the particles are magnified above 200 times, the central fpot appears converted into a cir¬ cle inclofing a tranfparent fpace. The diameter of this inner circle is about the half of that of the ex¬ ternal one ; but the proportion of thefe diameters, or the fize of the internal circle, may be caufed to in- creafe or decreafe by the leaft alteration of the dis¬ tance between the objeft and the microfcopical lens , and by the fame, means the fpace within the inner cir¬ cle may be rendered clearer or darker than that be¬ tween the two circles. The pofition of the inner circle is changed by the direftion of the light ; for if the particle of blood be viewed through a microfco- 4 pical
Oavallo’s Medicinal Properties ofF actitiousAirs . 5 1
pical globule, directly facing the flame of a candle, without the intermediation of any lens or reflector, the inner circle will appear concentric with the outer one ; but if the candle be moved a little to one fide, fo that the light may fall obliquely on the particle of blood, then the inner circle will be obferved to move towards the oppofite fide, and to acquire an elliptical fhape.
c When the particles of blood are magnified above 400 times, an imperfect image of the candle, which is placed before the microfcope, may be feen within the inner circle of each particle.
‘ Through a glafs globule of 0,018 of an inch in diameter, I have feen the red particles of blood mag¬ nified about 900 limes* in which cafe the image of the flame of the candle could be feen within the inner circle of each particle very clearly, at leaf! fo as to fhew to which fide the motion of the air in the * room inclined it.
f Notwithftanding this great magnifying power, the annulus or fpace between the two circles did not appear to be divided, excepting fome accidental fraftures, which now and then could be feen in a few of the particles.
‘ Thefe obfervations feem to prove, that the red particles of blood are not perforated, but that they are globular, and of fome uniform fubftance much lefs tranfparent than glafs. They likewife fhew that Mr. Hewfon’s idea of their containing a central body or nucleus, moveable within the external fliell, arofe from the apparent change of place which the various direction of the light produces on the central fpot or inner circle of each particle.’ — — -
Where fuch contradictory ftatements appear, and where the difficulty of making microfcopical obferva¬ tions is confefledly fo great, and the refult liable to iuch uncertainty, it is impoffible to have any reliance on the accounts which have been given refpecling the ultimate ftrufture of the red globules of the blood :
52 Duncans'' Annals of Medicine for 1797.
and we lliall probably remain in our prefent date of ignorance, on this fubjeft at lead, till we have better means of increafing our power of vifion than we are yet acquainted with.
Art. V. Annals of Medicine for the Year 1191 ; exhibiting a concife View of the lateft and moji important Difcoveries in Medicine and Medical Philofopny . 1 By Andrew Duncan, Sen. and
Andrew Duncan, Jun. M. D. D . &c. Vol. 2,
Oftavo, 470 pages, price 7s. Edinburgh, Mudie! 1798. b
^T^HE prefent volume is not lefs interefting, either in reipefct to the fele£lions, or to the original matter which it contains, than any of the preceding ones from the pen of Dr. Duncan. It commences, as ufual, with an analyfis of books. The firft re¬ view is of Dr. Ruffel’s valuable and fplendid treatife on the ferpents of India, with experiments and re¬ marks on their feveral poifons. We fhall pafs this over for the prefent, in the hope of thortly gratifying
our readers with a full and particular account from the original work.
The fecond article contains an account of fome newly-difcovered fads in the ltrufture of the retina of the eye, by Profeffor Reil, of Halle, in Germany. * lhe firft difeovery is attributable to Dr. Soemmering, In the bottom of the eye, clofe by the entrance of tne optic nerve, towards the outfide, and exaHly in the axis of the eye, there is a yellow fpot in the re- tma, of an oval flrape, about one line and a half, or two lines in horizontal diameter, and one perpendi¬ cular. Fhe colour is molt faturated in the center. I owards the edges it is paler and unequal. A plait,
Arcbiv fur die Phyfidogie. II Band. 1797.
which
Duncans’ Annals of Medicine for 1797. 53
\ *
which is in the middle, gives it there a cloudy ap¬ pearance. This yellow fpot may be obferved in the eye of every healthy perfon after birth. It has many varieties with refpebt to fize and depth of colour, but its fituation is always the fame.
f At this place there is alfo a plait of the retina, which is folded in towards the cavity of the eye. It lies horizontally between the optic nerve and the ex¬ ternal angle. It commences at the nerve with a fine point, becomes gradually broader, extends in length about a line and a halt, and terminates abruptly. It is fubjedt, however, to many varieties. Sometimes it is a fingle fimple plait, which entirely conceals the tranfparent portion of the retina ; fome'times it is di¬ vided, and at other times entirely wanting.
‘ There is, befides, exactly in the axis of the eye, about two lines on the outficle of the optic nerve, a thin, tranfparent, oval portion of the retina, whofe diameter is nearly one fourth of a line, and greatefl horizontally. Its edges are not ragged, but it ap¬ pears as if cut wdth a lharp inftrument. It lies in the plait, which conceals it more or lefs, and is furround- ed wdth the above-mentioned yellow fpot. Soem¬ mering takes it to be a real hole; Buzzi, on the contrary, thinks that it is merely a tranfparent and thin portion of the retina.' Michaelis feems to agree with him ; and our author admits that they may be right, although his own obfervations, as wTell as MeckeTs, are rather in favour of the exigence of an adfual hole.
c Michaelis faw the plait more diflincfly in foetufes of feven or eight months than in adults, and the tranf- parent portion lay concealed within it ; but the yel¬ low fpot wras wanting. Nor is it to be obferved in the eyes of newdy-born children. After the firft year, it becomes fomewhat yellow, and the depth of the co¬ lour increafes with the age of the fubjeft. Soem¬ mering fays, that this fpot is pale in children, bright yellow in young people, and becomes again pale in
E % " old
54 Duncan's Annals of Medicine for 1797.
old age. Its degree of faturation feems to be inti¬ mately connected with the hate of vifion. It con- ftantly diminifhes in proportion as vifion is obftrudted. Where one eye only is difeafed, in it the yellow fpot is wanting, and the plait is frnall and wrinkled; while in the found one they are rather more diftindt than ufualf— -Thefe are the appearances ; but they have not as yet led to any improvement in phyfiological fcience.
Art. 3* Allgemeine Gefchichte der Natnr und Artz Artzneikunde Erzaehlt. i. e. IJniverfal Hiflory of Me¬ dicine and Phyfics. By An gull us Frederick Hecker, Vol. 1, Odfavo. Leipfic. I his is too copious a fub~ jedl to be brought within the limits of analyfis.
Art . 4. Ideen fur Diagnoftick , &c. i. e. Hints for a Syftem of Diagnoftics , communicated to reflect¬ ing Phyjicians. By J. E. Wichmann, Phyfician in Ordinary to the King of Great Britain , and F. JR. A
• Gottingen , & c. Vol. 1, Odtavo. Hanover, 1794ft _
The importance of a juft and accurate diagnofis in the practice of medicine can hardly be rated too high : yet it is perhaps the moil difficult part of the art, and the one therefore that is the moil imperfedt. Defini¬ tions in medicine are of little ufe : the charadter of difeafes can only be underftood by a thorough invef- tigation of all the phenomena. It is the intention of the learned author of the prefent effay, to enable us to become acquainted with the marks which conftitute the diftinguifhing charadter of difeafes, by comparing and examining thofe which are fimilar in many of their appearances. The difeafes which are thus brought together and compared with each other, in the pre¬ fent volume, are ; the crufla lacfea , and another erup¬ tion, fomewhat fimilar, which the author terms crnfla ferpiginofa . Zona , eryflpelas veficulofum, eryfipelas a veneno , pemphigus , and fehris bullojd , are next com¬ pared and diftinguifhed from each other. In the next effay, Dr. Wichmann endeavours to eftablifh a juft diagnofis between the different dwellings off the neck,
Duncan's Annals of Medicine for 1797. 55
as frunuiy fcrofula, bronchocele , and mumps: chorea , and raphania , are then compared ; and, laftly, the author concludes this firft volume with remarks on fome caufes of chronic vomiting, and the means of
diftinguifhing them.
• • • ; ✓ - - ' <
The three next articles give an account of Dr. Monro’s Treatife on the Brain, Eye, and Ear j Dr. Rollo’s on Diabetes ; and Mr. Cruickfhank’s on the Ufe of Acids and other Subftances in Lues Venerea. For a full account of each of thefe, we refer to the laft volume of our review.
Art . 8. Obfervations on the Medical Effects of Com- prejjion by the Tourniquet. By George Kellie, Sur¬ geon in the Navy. 061avo. Edinburgh, 1797. The obfervations of the author on the fubje6t of compref- fion by the Tourniquet, were firft prefented to the public in the year 1794, and appeared in the Medical Commentaries for that year. * The prefent volume contains thefe, and likewife many new obfervations, the refult of fubfequent experience. Mr. Kellie firft: relates fome experiments tending more exactly (:o afcertain the influence of compreffion on the human body in a healthful ftate. ‘ If,’ he obfervesc 6 we ob»
Aru 61 the circulation in two or more extremities, by
*•
the tourniquet, the pulfe at firft increafes in frequency, and becomes at the fame time fuller and ftronger ; but foon after, the frequency diminifhes, fo as even to be lefs than before the comprefiion was made. Some increafe of heat is foon difcovered, efpecially in the face and bread. Anxiety, and a fenfe of fullnefs about the prascordia, are perceived, which gradually increafe till the perfon becomes faint and vertiginous. The countenance appears tuigid, and, in fome expe¬ riments, the temporal and jugular veins were obferv- ed fuller, and more diftended, than they were before the compreffion was made.
* See alfo an account of other experiments on the fame fubjeft. — •
ivied. Rev. Vol. p« 12.
1
56 Duncan’s Annals of Medicine for 1767.
c If the compreffion he continued for twenty minutes, or half an hour, the viiion becomes fome- what confufed, objects appear double or clouded, and imall black fpedtra are feen floating paft the eyes. Drops of fweat now Hand on the face, neck, and break, and the increaflng vertigo, fleknefs, and ten¬ dency to deliquium, demand the removal of the tour¬ niquets.
f On reftoring the circulation, thefe fymptoms al- moft immediately vanilh, a coldnefs about the prae- cordia, and chilnefs of the whole body, is then per¬ ceived, attended fometimes with lhudderings and yawnings ; the blood flows with a painful heat through the veffels which had been comprefled ; the whole limb is fuftufed with a glow ; and this is fucceed- ed by a fenfation of prickling. The pulfe continues flow, and generally becomes flower than it was before the compreflions were removed, beating, at the fame time, full and foft.
c If the circulation be obftrudted in one arm for fifteen minutes, or half an hour, the pulfe, after the removal of the corn predion, will, Mr. K ellie obferves, be found fuller and ftronger in this than in the other
arm.
s If the tourniquets be properly applied, fo as in- ftantly and completely to comprefs the artery, the veins of the comprefled limb do not fwell, and the limb itfelf feels foft and flaccid, rather than hard. But if the artery be not completely comprefled, or if any time be loft in ferewing the tourniquet, the veins are firft comprefled, and allowed to fill, before the communi¬ cation between the heart and arties is deftroyed.- — Hence they appear turgid, and thfe limb feels hard and painful from diftenfion.
* When the circulation is completely obftru&ed in an extremity, if a vein be opened below the tourni¬ quet, the blood will flow, and the comprefled veffels may be thus entirely drained of their contents.
Duncans’ Annals of Medicine for 1797* 57
* If, after compreffion has been continued for fome time, a vein be opened below the tourniquet, by gently preffing the arm, it will discharge to the ex¬ tent of two or three ounces of blood, of an uncom¬ monly dark colour. When the blood-veffels have thus been emptied, if the compreffion be removed from the artery, and continued on the vein, blood will again flow from the orifice, but very different in ap¬ pearance, being now thinner and more florid. With refpeCt: to coagulation, that which was drawn from the vein while the arteries were compreffed, coagu¬ lates fooner than the other, and never fliews any buffy coat ; although in that which was drawn from the fame orifice, after the reftoration of the circula¬ tion, it may be very confpicuous.
‘ After thefe general obfervations on the effefts of compreffion, confirmed by different experiments, of which Mr. Kellie has here given a diftmCt relation, he next proceeds to give an account of the effects of compreffion in fome difeafes.
‘ In intermittents, to which Mr. Kellie’s obferva¬ tions in his former letters principally referred, he has found, that if the two iliacs, or one iliac, and one fubclavian, be compreffed, about the time of an ex¬ pected paroxyfm, and the compreffion continued till the ufual period of attack be fully elapfed, the fit will be prevented or poftponed. If the cold ftage have taken place before the compreffion be made, in three or four minutes the fenfations of cold and the rigors will ceafe ; the pulfe from being frequent, fmall, and weak, will become fuller and ftronger, and, after fome time, lefs frequent. The pain of the loins, and afterwards the head-ach, will go off ; the naufea, anxiety, and third, will be relieved, and the hot fit will thus be induced, with milder fymptoms than before.
c The compreffion, Mr. Kellie tells us, ought ge¬ nerally to be continued ten or fifteen minutes, for the fymptoms of the hot ftage will thus be moderated ;
but
58 Duncans" Annals of Medicine for 1797.
but ought feldom, he thinks, to be continued much longer ; for he has obferved, that when this has been done, the pulfe, which had become fuller, ftronger, and flower, has again been rendered fmaller and more frequent, and when the tourniquets were removed, the rigors and fuccuffions returned.
c In confirmation of thefe affertions, we are here prefented with a particular detail of three cafes of in- termittents, which have occurred to Mr. Kellie fince his former letter.
c From obferving the effects of compreflion in inter- mittents, Mr. Kellie wras induced to make trial of it in other febrile difeafes. In the incipient ffages of thefe, he has found compreflion by the tourniquet very ferviceable. The pulfe has become fuller, ftrong¬ er, and flower ; and if the patient was affedfed with coldnefs and rigor, he became warmer, the pain of the loins and head-ach vanifhed, anxiety, naufea, and third, were relieved, and, in fome cafes, the fymp- toms thus carried off never returned. And from thir¬ teen different cafes, which are here particularly relat¬ ed, he concludes, 1//, That compreflion by the tour¬ niquet, in the incipient ftages of pyrexia, will forne- times, like emetics, prevent the farther prbgrefs of the difeafe, 2 dly, That in other and more advanced ffages of pyrexia, compreflion may be employed to moderate the fymptoms, and reduce the frequency of of the pulfe. 3 dly, That when employed in acute rheumatifins, the vigour of the circulation, heat and pains, are for a few minutes increafed. 4 thly> That in from five to fifteeti minutes, the pains are totally removed 5 in fifteen or twenty minutes, the heat di- mini flies, and the pulfe decreafes in velocity. 5 thly> That, on reftoring the circulation, the pulfe becomes flower, and the temperature lefs. 6 th ty, That thefe fymptoms, thus relieved or removed, feldom return for fever at hours after, fometimes not for a whole day, and that the following attacks are lefs fevere than the preceding ones. 7 lhty9 That if the compref-
fion
59
Duncans' Annals of Medicine for 1797.
fion be continued for half an hour, or longer, drew- fmefs, vertigo, anxiety, and tendency to deliquium, are induced ; but that, though thefe effefts are to be avoided in the cold ftage of intermittents, in the incipient ftage of pyrexia, and in all cafes of arterial debility, they yet appear ferviceabie in acute rheuma- tifms, and in all cafes where inflammatory diathefts exifts. §thly , That in acute rheumatifms, the tour¬ niquets fliould be applied on the affedted extremities. And, lafhjy That rheumatic pains, without fever, may be thus certainly removed or relieved.
c To thefe obfervations, deduced from aflual prac¬ tice, and careful experiment, Mr. Kellie has fubjoin- ed, in the third fedtion, home conjectures refpeCting the manner in which compreftion may be fuppofed to operate. It is, he obferves, well known to phyfto- logifts, that the proportions of circulating fluids differ very conftderably in the fame veffels at different times, and that fuch changes in the diftribution of the blood are often occafioned by flight caufes, while at the fame time they produce very conftderable effects* It is however certain, that the compreffton of one or more large arterial trunks, muft occaiion, in every other part of the fyftem, what has been termed by phyftologifts Plethora ad fpatium. This plethora will take place in a greater degree in fome parts of the fyftem than others, according to the parts which are comprefled. Thus, by compreftion of the fubclavian, a greater quantity of blood will be circulated through the head. Hence the patient then fooner complains of drowfinefs and vertigo ; and hence different fpecies of head-achs are foon removed by this compreftion, thofe efpecially which depend on defeft of ftimula- tion. On the contrary, when the compreftion is made on the external iliacs, the plethora will exift chiefly in the branches of the internal iliacs, the cceliac, me* lenteric, and emulgent arteries ; and hence lumbago and pain of the loins, in the cold ftage of fever, are
60 Duncans’ Annals- of Medicine for 1797.
moft eflfedtually and fpeedily removed when tourni¬ quets are applied to the lower extremities.
4 As by compreffion plethora is induced, Mr. Kel¬ lie infers, that a greater quantity of blood muft pafs through the heart and lungs in a given time, and a larger fupply muft be lent to the brain and other vif- cera. Thefe organs, therefore, muft, he thinks, be ftimulated into greater exertions ; and hence the ef¬ fects of compreflion are, increafed vigour of circula¬ tion, and th,e removal of atony.
c But as the long- continued operation of any fti- mulus, at length produces an inert or quiefcent ftate of the fyftem ; fo, if compreflion be too long conti¬ nued, the pulfe, which was at ftrft excited into more energetic adiion, becomes again flower. and fofter. — - And on this principle Mr. Kellie thinks we are able to explain the feemingly oppofite eftedts of compref¬ fion, in intermittents and acute rhenmaiifm. In the cold ftage of intermittents, the compreflion fliould not be continued any longer than is fufficient to cftablifh an increafed excitement, and ten or fifteen minutes will commonly be found long enough. But where the phlogiftic diathefis exifts, the compreflion, Mi. Kellie thinks, fliould be continued till vertigo and tendency to deliquium be induced, and the violence of the adiion of the heart and arteries will then be found much dimmiftied. For ail ftimulants, by their violent and continued operation, produce firft increaf¬ ed, then decreafed exertion, and, finally, quiefcence of the moving fibre. And fuch appear to be the ef~ fedls of compreflion.
4 There is, Mr. Kellie thinks, ftill another way in which the fyftem may be a tie died by compreflion. — - Though the energy of the brain would feem to de¬ pend much on a certain fullnefs of its blood-veflels, yet, where the fulnefs is increafed beyond this, inftead of an increafe of excitement, that vifcus will in fome degree be itfelf compreffed, and a kind of apopledlic ftate induced. Dr. Darwin, in his Zoonomia, has
propofed
I-
Duncans5 Annals of Medicine for 1797. 61
propofed to ftill the violent aftion of the heart and arteries in inflammatory fever, by gently compreffing the brain ; and this he thinks might ealily be done, by fufpending a bed, fo as to whirl the patient round, with his head mod diflant from the centre of motion, as if he lay acrofs a millftone. But in all cafes where compreffion of the brain may feem to be indicated, Mr. Kellie propofes, that the two fubclavian arteries ihould be comprefled, as they pafs over the firft rib. While fuch compreflion is without danger, of eafy execution, and can at all times be effected without the removal or difturbance of the patient, it will, Mr. Kellie affiires us, if continued from fifteen minutes to half an hour, have the defired effects.
‘ In the laft place, Mr. Kellie obferves, that when the circulation is obftruffed in any extremity, the parts below the tourniquet become quiefeent, the arteries ceafe to a£t, and the blood accumulates in the veins. The blood, thus detained in the compreff- ed extremity, would feem, by its differing farther dif- oxygenation, to become lefs ftimulating. And if, while the arteries are comprefled, a vein be opened below the ligature, and the blood be drawn off, the vafcular fyflem of the limb will be lefs ftimulated. On this principle he explains the effects of compref¬ fion, in thofe pains of the joints and limbs which are caufed by the increafed exertion or activity of the veffels of the inflamed ligament. Thefe pains ceafe, when, by compreflion, the inflamed veffels are render¬ ed quiefeent ; and the tumefaction of an inflamed part is reduced, when the comprefled veffels are drained of their contents, by opening a vein below the tourni¬ quet. And Mr. Kellie is difpofed to think, that inflammations of the extremities might be fpeedily cured, by compreffing the arteries, fupplying the af- fefted parts, and then emptying the inflamed veffels, by opening a correfpondent vein, or by fcarifying the inflamed furface. Such a practice might,, he imagines,
62 Duncans" Annals of Medicine for 1797.
be very ufeful in the incipient flate of white fwellings, and in acute inflammations of the joints.
c After giving a diftinct account of the fuccefsful effefts of compreffion, Mr. Keflie concludes the pre- fent treat ife by candidly acknowledging, that he has fometimes been difappointed, and that compreffion, as a remedy, is, like all others, precarious and va¬ riable in its effects. Thus, in a cafe of intermittent, though the rigors were fufpended, they returned, after feveral trials, on removing the compreffion ; nor was the pulfe ever altered. In a cafe of incipient py¬ rexia, on the application of a tourniquet to an arm and thigh, the patient alnioft immediately became vertiginous, and vomited ; and in a cafe of pain of the loins, he found the affection much aggravated by compreffion of the iliacs. Such variety of effefts, however, will, he thinks, rather be expe£ted by every one acquainted with the animal economy, than be matter of furprife to him. And we cannot help thinking, that from Mr. Kellie’s experiments and ob- fervations, unqueftionable evidence is afforded, that compreffion by the tourniquet affords us a very pow¬ erful agent in the practice of medicine.’
The other publications reviewed in this part of the Annals are, Dr. J. Hamilton’s on the Seats arid Caufes of Difeafes ; Drs. Clark and M’Lean’s on the Yellow Fever; and Dr. Beddoes’s Reports on the Nitrous Acid ; all of which have been fully noticed by us.
This brings; .us to the fecond part of the work, or that containing Medical Obfervations. The firfl: of thefe is a hiftory of a lingular cafe of petechiae line febre, accompanied with exceffive haemorrhages, ter¬ minating favourably under the ufe of the vitriolic acid : related by Mr. John Walker, Surgeon, in Edinburgh. The fubject of this cafe was a boy five years of age. The complaint came on during the
hooping
Duncans’ Annals of Medicine for 179’
63
hooping cough, and fee. ms to us to have been a very aggravated cafe of fcurvy ; produced very probably by a free indulgence in the ufe of fugar. We ob- ferve, like wife, that the author exhibited within the lpace of a very few days, about three bottles of Port wine , and many pounds of fugar, probably as antifep- tics. Under this treatment it does not feem very furprifing that the difeafe fhould gain ground ; that the whole infide of the lips and fauces fhould be co- covered with petechias, with a profufe difcharge of blood from the centre of the larged: ones : and that there fhould be a fucceffion of livid blotches and petechias on the fkin. The cure was fpeedily effeCt- ed by five drops of the diluted vitriolic acid given every hour or two,
2. The Iliftory of a Cafe of Venereal Ulcer , effec¬ tually cure a l by the topical Ufe of an Arfenical Cor - rofive Application : by Mr. Thomas Morifon, Surgeon, Dublin. The cafe was a recent chancre, and the ap¬ plication confided of equal parts of arfenic and red precipitate, continued till a hough took place, fol¬ lowed by a healthy ulcer. We obferve nothing very Uncommon in this practice.
3. Hijtory of an inveterate Cafe of Tinea Capitis , fiiccefsfully treated by the Application of an adheftve Pafte : by the fame. In this cafe, which had re¬ filled various attempts to relieve it, 6 the whole fcalp was entirely covered with that honey-comb appear-' ance, not unfrequently met with by practitioners* and it emitted, at the fame time, a very offenfivc fetor. His habit of body was evidently difpofed to fcrophula ; and there were certain marks of approach¬ ing debility, attended with a fufpenfion of the ufual aCtions of the ftomach and inteftinal canal. I ordered his head to be carefully fhaved, and an emollient poultice to be applied over the whole affeCted parts, with directions that he fhould call upon me. the fol¬ lowing morning..
c He
64 Duncans* Annals of Medicine for 1797.
4 He accordingly paid me a vifit. I faw that the poultice had effected the purpofe, fo far as to render foft this remarkable incruftation. I alfo perceived fmall and indolent tumours on the pofterior part of the head, near to the origin of the occipital mufcle. The cervical glands were enlarged, and fhewed a fcrophulous diathefis. He was ordered the Peruvian bark in fmall and repeated dofes, with an increafed quantity of nutriment ; and I alfo direfted that a little wine fhould be given. As an external application, I direfted the following adhefive pafte to be prepared.
c Take two pounds of common ale, and fix ounces of the fineft flour ; mix them intimately ; and having fet them over a very brilk fire, add four ounces of yellow refin, ftirring them conflantly until they be perfeftly incorporated, and take on a fmooth gela¬ tinous appearance.
c On the 23d of March, 1795, I applied this pafte, fpread lightly on ftrips of linen, and deflred the lad to attend me regularly every morning, until recovered from his deplorable difeafe. I accordingly removed, next morning, the pafte, ftrip by ftrip, which gave him fome degree of pain and uneafmefs. It was alfo attended with a temporary effufton of blood. But he told me his head was much ealier after its removal, than he had remembered it for four years, which was nearly the date of the commencement of the difeafe. I cautioufly and regularly, for fifteen fucceflive morn¬ ings, removed and applied the pafte, obferving that my patient gradually became lefs concerned about the pain of its removal. I alfo, with a pair of fciflars, cut off the hair which began to grow, and fuch fcabs as might prevent the application of the pafte.
s From the firft application to that period when I could prognofticate a perfect cure, there was a gra¬ dual diminution of the effufion of blood, which had at firft iffued from the fores, on the removal of the pafte ; and all other appearances proceeded equally favour¬ ably.
< The
/
Duncans' Annals of Medicine for 1797, 65
The fubjeft of this important cafe continues now perfeftly free from the difagreeable complaint to which he was before fubjefted, and has acquired a copious crop of fine hair. I have treated feveral other cafes in the fame manner, with fimilar fuccefs*
< 4. Hiftory of a Cafe , in which a Wound of the Head , with confiderahle Deprejjion of the Cranium , terminated in complete Recovery , without any Opera¬ tion : by Mr. John Mackie, Surgeon in Antigua. A negro boy, aged fourteen, received a kick on the fore¬ head from a mule on the 2d of June, 1795, and was carried home in a ftate of infenfibility. On vifiting him foon after the accident, I found an extenfive la¬ cerated wound on his forehead. The bone was com¬ pletely denuded, and a confiderable portion of it de- preffed, immediately above the longitudinal finus. I wifhed to have been able to elevate the deprefted part immediately, but the danger attending an operation for that purpofe induced me to delay it, till I fliould fee the (ituation of the patient next morning. I di¬ re ft ed, therefore, a poultice to be applied over the wound. I adminiftered an opiate to the patient, and ordered that his regimen ihould be ftriftly antiphlo- gillie. On the night after the accident, he was faid to have had fome delirium, and to have fpoken fre¬ quently incoherently. But in the morning I found his pulfe at feventy-two, and of moderate ftrength* His appetite was good, and he had no giddinefs or uneafinefs whatever. The wound difeharged a lim¬ pid fanies, the quantity of which was but inconfider- able. I did not, after this, again examine the wound till the feventh, when I found matters nearly as be¬ fore, his pulfe continuing at feventy-two, and foft, the depreffion remaining in the fame ftate as when it was firft examined.
c On the 10th he was vifited by Dr. Emmert ; and as we both agreed on the impropriety of having re- courfe to a very dangerous operation, when no urgent appearance required it, all thoughts of performing vol. v. F the
#
/
66 Duncans’ Annals of Medicine for 1797.
the operation of the trepan were for the prefent laid alide ; and nothing farther was done than dref- ling the wound, which now difcharged purulent mat¬ ter, with digeftive ointment.
c On the 20th, I found that the palpebral were af- fefted with a confiderable fwelling, but without pain. Other circumftanees continued nearly the fame as be¬ fore ; his pulfe was feventy, and full, but not hard. On the 30th, a frnall portion of bone was thrown off, which however did not weigh more than half a grain. The wound now difcharged laudable pus ; the depref- lion continued as before.
c On the 6th of July, as the edges of the wound had affiumed rather a fungous appearance, diredfions were given for their being walked three or four times a-day with a folution of blue vitriol. On the 12th, I found the wound looking much better, and the fun¬ gous excrefcences greatly diminifhed. By the 16th the wound was nearly healed. The depreffion continued as before ; but he was able to walk about, and had no complaint.
c On the 26th, I found him at work, in good health, the wound being completely healed, though there was dill a very confiderable obvious depreffion, as well as a large cicatrix. And as he has now con¬ tinued to the prefent day, July 13, 1796, free from any complaint, 1 think there is every reafon to con¬ clude, that the depreffion will not be productive of any bad confequencesd
The remainder of the volume will be noticed in our next number.
Art.
V
'
Art. VI. R cm arks on the Fijlula La chry malts ; with the Description of an Operation confiderably different from that commonly ufed ; and Cafes annexed in Proof of its Utility: to which are added , Obf creations on Hemorrhoids ; and Addi¬ tional Bemarks on the Opthalmy. By James Ware, Surgeon . Octavo, 150 pages* price 3s 6cL
THE difeafe termed Fiftula Lachrymalis, though trifling in its apparent magnitude, acquires no fmall degree of importance from the deformity it often occafions, and from the trouble and uneafinefs to which it generally gives rife. It is, therefore* an object defervedly of conflderable attention amongft practitioners, although it has not hitherto been treat¬ ed with that fuccefs which might have been wifhed. The operations which have been employed for its cure have fometimes fucceeded, but are attended wdth much pain and inconvenience, and, which is worfe* have very frequently failed altogether. A mode of treatment, more Ample in execution, and more fuc- cefsful in its termination, than thofe which have* hitherto been employed, muff doubtlefs be highly definable : and fuch, there is reafon to hope, promifes to be that, winch is now recommended, by the inge¬ nious author of the prefent ellay.
The method of treatment which has of late gene¬ rally prevailed, has been that of inferting a tube, either in the natural duft leading from the lachrymal fac to the cavity of the noftril, or in an artificial open¬ ing made through the os unguis into the fame part. From different caufes thefe have frequently failed of giving permanent relief. Sometimes the failure has been owing to the tube having been improperly placed, or from its having made its way out at the corner of the eye, or through into the nofe : fome¬ times the cavity of the tube has become entirely ob~ firucted by infpiffated mucus. The operation which
F 2 Mr.
( 67 )
N
68 Ware on the Fijiula Lachrymalis , Kc.
Mr. Ware has adopted in place of this is, in general, fo eafy to be performed, and has in many inftances fo fpeedily and effectually accomplifhed a cure of the diforder, that its defcription will no doubt be highly acceptable. The following is the mode in which it
is directed to be performed.
‘ If the difeafe has not occafioned an aperture in the lachrymal fac, or if this aperture be not fituated in a right line with the longitudinal direftion of the nafal duff, a puncture fhould be made into the fac, at a fmall diftance from the internal juncture of the palpebrse, nearly in a line drawn horizontally from this juncture towards the nofe. The blunt end of a filve;* probe, of a fize rather fmaller than the probes that are commonly ufed by furgeons, fhould then be intro¬ duced through the wound, and gently, but fteadily, be pufhed on in the direction of the nafal duct, with a force fufficient to overcome the obftru£tion in this canal, and until there is reafon to believe that it has freely entered into the cavity of the nofe. The polition or the probe, when thus introduced, will be nearly per¬ pendicular ; its fide will touch the upper edge of the orbit ; and the fpace betwen its bulbous end in the nofe and the wound in the fkin, will ufually be found, in a full grown perfon, to be about an inch and a quarter, or an inch and three eighths. The probe is then to be withdrawn, and a filver ftyle of a fize nearly fimilar to that of the probe, but rather fmaller, about an inch and three eighths in length, with a flat head like that of a nail, but placed obliquely, that it may fit clofe on the fkin, is to be introduced through the du£t, in place of the probe, and to be left con- ftantly in it. For the firffc day or two after the ftyle has been introduced, it is fometimes advifable to wafli the eye with a weak faturnine lotion, in order to obviate any tendency to inflammation which may have been excited by the operation : but this in ge¬ neral is fo flight, that I have rarely had occafion to ufe any application to remove it. The ftyle fhould be withdrawn once every day for about a week, and
after
69
Ware on the Fifiula Lachrymalis, & (c.
afterwards every fecond or third day, fome warm water fhould each time be injefted through the duft into the nofe, and the inftrument be afterwards replaced in the fame manner as before. I formerly ufed to cover the head of the ftyle with a piece of diachylon plafter fpread on black filk : but have of late obviat¬ ed the necefiity for applying any plafter, by blacken¬ ing the head of the ftyle with fealing-wax.
* The effeft: produced by the ftyle, when intro¬ duced in the way above-mentioned, at firft gave me much furprife. It was employed with a view fimilar to that with which Mr. Pott recommends the intro¬ duction of a bougie ; viz. to open and dilate the nafal du£t, and thus to eftablifti a paftage, through which the tears might afterwards be conveyed from the eye to the nofe. I expected, however, that whilft the ftyle continued in the duff, the obftruction would re¬ main ; and of courfe that the watering of the eve, and the weaknefs of the fight, would prove as trou- blefome as they had been before the inftrument was introduced. I did not imagine that any effential be¬ nefit could refult from the operation until the ftyle wras removed, and the paftage thereby opened. It was an agreeable difappointment to me to find, that the amendment was much more expeditious. The water¬ ing of the eye almoft wholly ceafed as foon as the ftyle was introduced ; and in proportion as the pa¬ tient amended in this refpeef, his fight alfo became more ftrong and ufeful. The ftyle, therefore, feems to a£t in a two-fold capacity ; firft, it dilates the ob- ftrufted paftage ; and then, by an attraction, forne- what fimilar to that of a capillary tube, it guides the tears through the du£t into the nofe.
c The wound that I ufually make into the fac, if the fuppurative procefs has not formed a fuitable aperture in this part, is no longer than is juft fuf- ficient to admit the end of the probe or ftyle ; and this in general, in a little time, becomes a fiftulous orifice, through which the ftyle is paffed, without occafioning 4 . F 3 the
70
Ware on the Fijtula Lachrymalis , Stc.
the fmalleft degree of pain. The accumulation of matter in the lachrymal fac, which, previous to the operation, is often copious, ufuallv abates foon after the operation has been performed, and, in about a week or ten days, the treatment of the cafe becomes fo eafy, that the patient himfelf, or fome friend or fprVfint who is conftantly with him, is fully competent to do the whole that is neceffary. It confifts folely in withdrawing the ftyle two or three times in the week, occafionally injefting fome warm water, and then re¬ placing the inftrument in the fame way in which it was done before.
‘ It is not eafy to afcertain the exact length of time that the ftyle fhould be continued in the du£t. Some have worn it many years, and, not finding any incon¬ venience from the inftrument, are ftill afraid and un¬ willing to part from it. Others, on the contrary, have difufed it at the end of about a month or fix weeks, and have not had the fmalleft return of the obftruclion afterwards.
‘ The troublefome ulcerations, which are fometimes formed over the lachrymal fac, heal, in general, as foon as an opening is eftablifked through which the tears may pafs into the nofe. But in two inftances which lately came under my care, in which the pa¬ tients had occafionally been fubject to cutaneous erup¬ tions, thefe wounds did not heal fo foon as I expect¬ ed ; and a conftderable quantity of purulent matter was difeharged through the aperture that had been fnacle to admit the ftyle, feveral days after the opera¬ tion was performed. Both thefe cafes were evidently relieved by adminiftering internally a weak folution of the hydrargyrus muriatus, together with a light preparation of the Peruvian bark ; and by purfuing the ufe of thefe medicines, the wounds in a fhort time clofed ; the aperture which had been made with the lancet contracted into a fiftulous orifice, juft large enough to admit the end of the ftyle, and the purulent difeharge wholly ceafed.
‘ The
\
Ware on the Fiftula JLachry mails , &V. 71
f The pofition, both of the probe and ftyle, is very nearly the fame, whether they be palled through the natural nafal duel, or through a perforation in the thin part of the os unguis ; and 1 have reafon to believe, that it does not effentially fignify in which of thefe ways the operation is performed. It may be proper, however, to point out a few circumllances in which the two operations appear to differ. One is, that in confequence of the nafal duel being lined with a frnooth membrane, the i n fir u merit ufually paffes through it with facility ; and its paffage is unac¬ companied with that fenfation of a forcible breach, which is perceived by the operator when it makes its way for the firft time through the fubftance of the os unguis. Another is, that when the inlf rumen t has palled through the nafal duff, it has nearly a perpen¬ dicular pofition with refpecl to the ufual pofture of the body ; whereas, when it has palled through the os unguis, it has an oblique direction downward and inward. A third difference is, that in the former in- ftance, the inllrument is more firmly fixed than it is in the latter, in which it often has an unfteadv motion when touched with the linger. By an attention to thefe hints, I think it may be difeovered with tolera¬ ble certainty, in which of the two ways the inllru¬ ment has paffed ; and, i believe, 1 may venture to add, that whether the ftyle be introduced in the former or latter of thefe directions, it is equally able to condufl the tears into the nofe, and to accomplilh a cure of the d iforder.
c In thofe cafes where the nafal du61 is fo com¬ pletely obfir acted that the blunt end of a probe can¬ not be made to pafs through it, there does not appear to me to be any way of obtaining a paffage for the tears from the eye to the nofe, fo ealy, or fo effectual, as that of making a perforation through the thin part of the os unguis. When this part of the operation is accompliilied, the perforating inllrument fhould be withdrawn, and a nail-headed ftyle, about an inch
F 4 long,
72 Ware on the Fijtula Lachrymalis , 8(c.
long, be introduced through the aperture in the fame way in which it is introduced through the nafal dufit in thofe cafes where the obflrufilion is not fo great as to prevent its pafling in this direftion ; and it may remain here with as much fafety as in this laft-men- tioned inftance, for as long a time as its continuance may be thought neceffary to eftablifh the freedom of the communication. It may be proper to obferve, that when the ftyle is carried through a perforation in the os unguis, the length of an inch is fufficient to allow its end to reach the open fpace that lies between the os fpongiofum fuperius, and the os fpongiofum infe- rius. But when it is carried through the natural nafal du£I, its length mull not be lefs in an adult perfon than an inch and a quarter, or an inch and three eighths, in order to allow it to pafs completely through the du6l into the nofed
Ten cafes are added, feledted from a confiderable number, in proof of the advantage arifing from this mode of operating. One or two of thefe will give our readers a fufiicient idea of its nature and utility.
4 Cafe 1. An Obf ruction in the Lachrymal Canal , of feveral years' continuance , perfectly and f pee dily cured by the introduction of a nail-headed Style through the Nafal Duct. A young lady of Oxford, who, for upwards of three years, had been fubje£l to an almoft continual watering of one of her eyes, ac¬ companied at different times with a trouhlefome in¬ flammation of the tunica conjunffiva, was introduced to me on the 8th of July, 1796, by Mr. Curtis, Sur¬ geon, at Iflington. Prior to my being confulted, the tears had frequently been mixed with a fmall portion of infpiffated mucus, which at thofe times made the eye feel ftiff and uneafy ; and the eyelids were ufually gummed together when fhe awoke in the morning. On examining the eye, an excoriation was perceived on the edges, both of the upper and lower lids, and on gently preffing my finger on the lachrymal fac, which appeared fuller than in its natural ftate, a few
fmall
73
Ware on the Fijlula Lachry malls, Kc.
fxnall particles of infpiffated mucus were difcharged through the punfta lachrymalia, and fpread over the eye. I endeavoured to injeft fome warm water through the inferior punftum into the nofe ; but the obftru£tion in the nafal duft was fo great, that none would pafs, the whole of the liquor returning immediately through the fuperior punffum. A little of the unguentum hydrergyri nitrati was applied with a camel’s hair pencil to the excoriated edges of the eyelids, and a weak vitriolic collyrium was directed to be ufed three or four times in the courfe of the day. The injedtion of warm water, together with the application of the ointment, were repeated feveral days in fucceffion. On the 1 1th, the watering of the eye was lefs troublefome. On the 15th, a part of the injefted liquor evidently paffed both into the nofe and throat, as it did alfo on the three following days ; the flow of tears over the cheek being conflderably dimi- nifhed. On the 19th, the patient caught cold at the Opera; in confequence of which, the epiphora imme¬ diately returned, and was accompanied with a fmall degree of inflammation on the ball of the eye. The next day no part of the injedled liquor would pafs through the duct. 1 fcarified the fchneiderian mem¬ brane, on the infide of the nofe, writh the point of a lancet, and took away two or three tea-fpoonfuls of blood ; an opening medicine was adminiftered ; and a faturnine lotion applied to the eyes. On the 2 iff, the inflammation of the eye was removed ; but ft ill none of the injected liquor would go down. I intro¬ duced the end of a fmall gold probe through the fu¬ perior punftum lachrymale, and gently pulhed it on, in the direction of the du£t, but it would not pafs. On the 22d, I repeated the attempt, and it now went freely into the nofe ; after which fome warm water, injected through the inferior punftum, alfo paffed. — - The watering of the eye gave very little trouble for feveral days after this time : but in about a week the obftruftion to the tears returned, together with an
inflammation
74 Ware on f he Fift ula 'Lachfijma Us, Sc.
inflammation on the ball of the eve, and a fmall tumefaction in the lachrymal fac. Both the patient and myfelf were much difcouraged by this relapfe ; and I now propofed to her to allow me to make a punfture into the fac, and to introduce a ftyle, in the way that has been defcribed in the preceding pages. Agreeably to this advice the operation was performed on the 7th of Auguft ; and, with very little pain or difficulty, a probe was flrft introduced, and aftem wards a nail-headed ftyle, an inch and three-eighths in length, through the nafal duft into themofe. Au¬ guft 8th, the young lady had not experienced any pain, and the inflammation of the eye was abated. Auguft 9th, I withdrew the ftyle, and injected fome warm water through the wound. It paffed freely into the nofe ; alter which the ftyle was replaced with as much eafe as it had been at flrft introduced. Auguft 10th, the watering of the eye, in every refpedt, much more ealy than it had been for many months before the operation. The ftyle was withdrawn, and re¬ placed every day for about a week, and afterwards every fecond or third day, until the 30th of the fame month, when the patient left London, being perfefllly able to manage the operation ; which the repeated every four or flve days, in order to keep the ftyle clean and the paffage clear.
‘On the 16th of Auguft, 1797, fhe informed me, by a letter, “ That her eye had been effeCfually re¬ lieved by the introduClion of the ftvle ; that (lie had then worn it without the fmalleft inconvenience above a year ; and that fhe fhould certainly continue it until fhe had an opportunity of feeing me.”
‘ Cafe 2. An Epiphora, produced by an old oh - ftruction in the l achrymal Canal , which , like the former , was fpeedily cured by the introduction of a nail headed Style through the Nafal Duel. The daughter of L P., thirteen years of age, was recom¬ mended to me Auguft 14-th, 1797, by Mr. Moore, apothecary, in Norfolk- ftreet. Strand, on account of
a com
75
Ware on the Fijlula Lachrpmalis ,
\
a conftant watering of the right eye. It had been troublefome to her ten years, and began during the time flie had the fmall pox 3 which diforder had pro¬ duced a violent inflammation in both her eyes. When I firft faw her, the edges of the lids of both eyes, and particularly of the right, were conliderably ex¬ coriated ; and her fight was fo extremely weak, that flie had long been unable either to react, or to work with her needle. The right lachrymal fac was dif- tended with a confiderable quantity of thick mucus, which oftened returned through the pun ft a lachry- nialia over the eye ; and not unfrequently flie was obliged to difcharge it by the preffure of her finger. I injeQed fome warm water through the inferior punc¬ tual, but could not obferve that any of it paffed into the nofe. The obftruffion was fo compleat, and it had continued fo long, that it appeared to me in vain to attempt to clear the duff by a continuance of this mode of treatment. I, therefore, propofed to the mother of the girl, to permit me to punflure the fac WTith a fpear-pointed lancet, as had been done in the preceding cafe, and to introduce a nail-headed flyle. The mother and daughter acceding to the propofal, the operation w as performed the fame day, and a flyle was introduced without any difficulty, through the duff into the nofe. The head of the inftrument be¬ ing b acked with fealing wax, no dreffimg was ne- ceffary over it; and the eye was no othenvife defended from the light than by the ufe of a common (bade. Auguft 15th, the eye was not in the leaft inflamed, and the patient had not fuffered any pain fince the time of the operation. A little ot the Unguentum Hydrargyri Nitrati Rubri was applied with my finger to the excoriated edges of the eyelids, and was wip¬ ed off immediately afterwards. Auguft 16, I with¬ drew the flyle, and injeffed fome warm water through the aperture ; the whole of which paffed at once either into the nofe or throat ; after which the flyle was introduced again as before. This operation was
repeated
76 Ware on the Fijiula Lachrymalis , Kc.
repeated daily, until Auguft 23d, when the water! ing of the eye had wholly ceafed, and the fight of the patient was become as flrong as that of other per- fons. The ftvle was continued in the du£l until the 2d of Oftober, being retrafted only once or twice in the week, in order to inje£t fome water through the paffage. At this time it appeared to me that the lachrymal paffage was fufficiently eftablifhed to allow the indrument to be withdrawn entirely. This was accordingly now done, and the wound fuffered to clofe ; after which the Epiphora did not return, and the fight continued perfectly flrong and ufeful.’
The fubje6t which next engages the author's at¬ tention is, Haemorrhoidal AAe6tions. The nature of thefe, their effects on the general health of the body, and the ordinary means of relief, are fuff fieiently known. In general, the difeafe is of fo little importance, and fo fleeting in its duration, as to render unneceffary any particular interference of art. Occafionally, however, the pain and irritation are fo great as to produce an inability to perform the com¬ mon offices of life. In fuch cafes, it becomes indiff penfably neceflary to have recourfe to extraordinary modes of abidance, fuch as extirpation of the offend¬ ing parts, either by cutting them off with a fcalpel or fciffars ; or by tying a tight ligature round their bads, in order to deprive them of nourilhment, and thus to caufe them to die and fall off.
Mr. Ware obferves, that though the number of haemorrhoidal tumours protruded through the anus is often conflderable, yet the pain which the patient fuffers is not produced equally by all of thefe. If an accurate inquiry be made, it will often be found, that the patient will point to one, or at mod to two, of the tumours, from whence all his pain proceeds. When thefe are examined, it will be difcovered, that they are much harder and more inflamed than the red ; and generally they are alfo fmailer and lefs promi¬ nent £
77
w are on the Fifiula Lacrhymalis , <Su\
nent ; protruding but juft low enough to be compreff- ed be the fphyncfter ani.
If this be a juft defcription of the ftate of the dis¬ order, it follows that the operation of cutting off the whole number of haemorrhoids with a Scalpel or SciS- Sars, and that of tying a ligature round them, are alike unneceffary. Inftead of having recourfe to thefe Severe remedies, we have only to direft our attention to the hard inflamed tumour, which is the caufe of the pain, and which is not unfrequently Situated in the center of the reft. This is often no larger than the end of the little finger, and the removal of it almoft inftantly abates the pain, and, in a ihort time, caufes the reft of the tumors to collapfe and disap¬ pear. The mode which Mr. Ware has purfued, con- fiftently with thefe principles, is, to take hold of the moft painful of the tumours with a differing hook or forceps, and fnip it off as clofe to its bafts as poffible, with a (harp pair of curved fciffars. Several cafes are adduced in Support of this mode of treatment.
€ Cafe 1 . A gentleman in Birchin Lane applied to me, about three years ago, on account of an hemor¬ rhoidal diforder to which he had been Subject many years. For the laft twelve months Several large tu¬ mours were protruded through the fphyn&er ani whenever he had a ftool, and afterwards they not only bled, but he was often for hours in fo much pain, that he was unable to attend to any bufinefs. Many medi¬ cines had been given him, and different applications employed, but without affording him any afliftance. On an examination I found a confiderable number of haemorrhoids protruded through the anus, all of which appeared to be in a ftate of inflammation ; but one in particular was exceffively tender, and felt quite hard when touched with the finger.* I ftated to the
patient
* It has been obferved above, that hemorrhoidal tumours are not unfrequently occafioned by a thickning of one or more of the plicae or folds in the membrane which lines the inferior part of the inteftine rec¬ tum.
2
78
Ware on the Fijtula Lackrymalis 5 <Sfc.
patient my opinion, that this hard pile was the caufe of the pain he endured, and that the removal of it was a highly probable means of giving him eafe, and caufmg the other tumours to collapfe. On the fubfe- quent day I performed the operation in the following manner. Having fecured the hard haemorrhoid with a differing hook, and drawing it forward, I cut it off, with a curved pair of fciffars, as clofe to its bafis as I was able. The remainder of the tumours inflantly collapfed, and withdrew within the fphyndter ; and, as they were quite foft, I did not think it neceffary to fearch further for them. The pain the operation oc- cauoned was much lefs than the patient had. experi¬ enced for a long time after every motion. No haemor¬ rhage followed. I applied a comprefs dipped in a faturnine lotion over the anus, and bound it on with the ufual T bandage. An uneafy fenfation was ex- perienced in the redtum during the whole of the firft day, but the patient flept well in the night, and the following day was perfectly eafy. On the third day he took a gently opening medicine, which procured him two loofe motions. Thefe were mixed with a fmall quantity of blood \ but gave him very little pain as they came away, and were followed with a very flight protrufion of the gut, which went back, imme¬ diately on the application of the finger. He had not any occafion to take medicines afterwards. The bowels in a fhort time performed their proper office without pain or protrufion, and he became quite well in every refpeft. For a year and a half he continued free from any uneafmefs of the haemorrhoid al kind , but then the gut began to have a flight tendency to protrude whenever he had a coftive Fool. He took particular care to avoid this by an attention to his diet, and by the ufe of gently purgative medicines.
turn. I have reafon to believe that this is much more frequently the Caufe of thefe tumours, than a varicous enlargement of any large blood veffel that is htuated in this part.
As
79
Ware on the Fiji id a Lachrymalis > Kc,
As this, however, did not hinder the gut from occa- fionally coming down, he was advifed to take the fize of a nutmeg of Ward’s Paile every morning and even¬ ing. Fie had not taken this medicine long before the tendency to a prolapfus entirely went off, and for the lafl two years he has not had the lead unealinefs in this part.
c Cafe 6. Mrs. FL, about four years ago, had occa- fion to take a purgative medicine, which unexpect¬ edly operated with great violence. In confequehce of this, whenever die had a llool afterwards, a part of the internal membrane of the refilum was protruded through the fphynfiler ani, requiring the application of the fingers to return it to its proper pofition ; and in a fhort time the gut became fo weak, that it came down whenever the walked the diflance of a hundred yards. She was not unfrequently alfo troubled with a confiderable haemorrhage from this part, which fometimes came on fuddenly, and occafioned her great diflrefs. Many remedies, both external and internal, had been made ufe of, but without afford¬ ing her any relief. I at fir 11 fufpe filed that this was one of the common cafes of haemorrhoids ; and, as the patient was conilituiionally colli ve, I direfiled her to take the fize of a nutmeg of an electuary compofed of fulphur and cream of tartar mixed with lenitive elefituary, once or twice every day, according as the Hate of her bowels made it neceffary. An ointment compofed of equal parts of the powder of pak galls and elder ointment was alfo prefcribed to be applied, morning and evening, to the protruded gut. Thefe remedies, however, did not produce any good effefit. She was then advifed to introduce up the gut the end of a fmall candle, about two inches long, and as thick as the little finger, once or twice every day,, in order by its preffure to hinder the protrufion, and, in this way, to give ltrength to the weakened part. A thick comprefs at the fame time was confined on the anus by a T bandage, which was bound on the part as
tight
BO Ware on the Fijlula Lachryvtatis , t('c.
tight as it could be borne, without giving pain, Thefe applications feemed at firft to have a good effect in keeping up the gut ; but in a fhort time, the benefit they afforded ceafed, and the introduction of the candle, and wearing the bandage, became a work of fo much fatigue, that the patient could not be pre¬ vailed on to continue the ufe of them. 1 was now permitted to examine the feat of the difeafe, and I found the pofterior and inferior part of the reftum protruded through the fphyn&er ani, about the fize of the firft joint of the little finger. There did not ap¬ pear to be any diftinft tumor in the part, that could properly be denominated an haemorrhoid j but the re- femblance between the two diforders wTas fo ftrong, and the diftrefs of the patient fo great, that l thought myfelf fully juftified in recommending the excifion of the protruded part, in the fame way in which I would remove an inflamed haemorrhoid. The patient giving her confent, I performed the operation on the follow¬ ing day. Having fecured the moil prominent part of the tumor wuth a hook, I cut it off in the ufual way with a curved pair of fciffars. The haemorrhage that enfued was very inconfiderable and the gut imme¬ diately returned to its proper pofition, I covered the part wuth a cold faturnine lotion, and bound it on wuth a T bandage. About two hours after the ope¬ ration, the patient felt an uneafinefs in the reftum, as if Die fhould have a ftool ; and fhortly afterwards a large quantity of thick blood was brought away. — This much alarmed both the patient and her friends*, and occafioned them to fend in hafte for me ; their alarm being increafed by a return of the haemorrhage before I arrived. I immediately applied a doflil of lint dipped in a ftrong vitriolic lotion to the wound, and repeated the ufe of a thick comprefs dipped in a cold faturnine lotion to the external part ot the anus. A bolus containing five grains of dragon’s blood, and an equal quantity of alum was given every tw7o hours ; the weight of the bed cloaths was leffened ; and hot
drinks
Lagrange’s C'oitrs IP Etude Phcirmaceutique. 81
drinks of every kind were carefully avoided. No haemorrhage of any conlequence took place after this plan was adopted It was fteadily continued for twenty-four hours ; the comprefs being frequently dipped, during this time, in the cold faturnine lotion. The boluffes were afterwards given every four hours for another day. On the third the patient took lome caftor oil, which brought away a loofe itool with a fmall mixture of blood, but without any protruflon of the gut. She had a flight fenfe of forenefs in the wound lor about a month ; but then the pain wholly went off ; and from that rime to the prefent, which is Upwards of three years, fhe has enjoyed her health perfectly in every refpefl.’
The laft part of the volume contains additional re¬ marks on the Ophthalmy : but they are of too mifceh laneous a nature to allow of abridgement here : one of the chief purpofesy however, is to enforce the ule of the tinctura thebaica , as an external application, in the manner recommended in the author’s treatife on this fubject ; and to diffuade from the ufe of the tinct. opii of the new pharmacopoeia ; the effefls of which are very different. A ftribt compliance with the mode of application pointed out is likewife en¬ joined.
Art. VII. Co urs D'Elude Fharmciceutique. Par B. Lagrange, Pharmacien de Paris, &c. In 4 Vols. Offavo, price 20s. Imported by Booset.5 London, 1798.
THIS work is divided into four parts ; the firft contains the elements of phyflcs, the general laws of nature, the properties of bodies, their mo¬ tion, gravity, the theory of mechanics, hydroftatics^
Q w and
\
82 Foot's Cafes of V efiae Lotnra , & (c.
and capillary tubes ; the nature of aerial fluids ; op¬ tics in general ; the laws of light, eleCtricity, mag- netifm, acouftics, &c. ; thefe form the fubjeCt of the fir ft volume.
The fecond contains the materia medica , or the lift of Ample medicines; divided into the three kingdoms, vegetable, animal, and mineral.
The third part contains botany, and commences with the principles of that fcience, followed by the fyftems of Linnaeus and Tournefort ; laftly, the bo¬ tanical demonftration of a conflderable number of plants, according to the method of Tournefort.
The fourth volume contains pharmacy, or phar¬ maceutic chemiftry.
The general nature of the work may hence be un~ derftood. It profefles to have nothing original, but the arrangement. The vaft number of Amples in¬ troduced, the multiform compounds, and the almoft indifcriminate aflignment of virtues, give it a cha¬ racter that ill accords with the prefent advanced ftate of medical fcience.
1====^=== - _ . — . — - — .
Art. VIII. Cafes of the Succefsful Practice of VefiCiC Lotura in the Cure of Difeafed Bladders. By Jesse Foot, Surgeon. OCtavo, 42 pages, price Is 6d. Becket, London, 1798.
rTpHE author profefles himfelf indebted to a cafe £ related by Le Dran, for the firft hint of the praCtice he here recommends. He thinks it not a little extraordinary, that a praCtice fuccefsfully pur- fued by a man of fuch eminence, fhould have been hitherto wholly difcontinued, and attributes it to the want of an inftrument fo well adapted to the purpofe as the elaftic catheter*. Four cafes only are related
* See a cafe of this kind, Med. Rev Vol. 3, p. 1.
of
J
83
Foot's Cafes of Vcfcce Lot ufa, 8£c.t
of this mode of practice. By trariferibing one of thefe* our readers will be enabled to judge of the reft.
‘ Cafe 3. A gentleman, of the Excife Office, went down to Harrowgate, for the benefit of its water, but was compleatly difappointed. He there met a friend of mine, and it was in confequence of his recom¬ mendation, that he applied to me, in the fpring of the year 1796.
* He was about 56 years of age, tall, but not cor¬ pulent, of a ruddy complexion, not that fort indica¬ tive of high health, but fuch a one as thofe have, who have been at fea, and have lived freely • when the hands and the face have a tendency to a livid ap¬ pearance ; a fort of weather-beaten face. I queftion- ed him as to his manner of living, and though, as I fufpedted, fpirituous liquors did make a portion in his drink, yet I am inclined to believe, that he did not take it to a degree of intoxication ; and that he did not abufe his conftitution more, by that privileged poifon, than other moderate fubjefts do, who have yielded to the fpontaneous habit of conftantly taking it, or who have been driven to it, as a fubftitute for wine, fince fuch a duty has been exafted upon that moft neceffary article of life ; and lince not even a drawback upon it, has been allowed for the poor in a work-houfe. Nothing is more common, and no¬ thing can be more prejudicial, than for perfons af¬ flicted with bladder complaints, to take to gin ; and nothing is more common, when once they have taken to it, than for them to like the difeafe for the fake of the remedy.
£ This patient's complaint, when I firft faw him, was a frequent difcharge of his urine, over which he rarely had any command. Sometimes it flowed from him as he walked about, involuntarily ; and fome- times, when he knew his bladder was charged with a largifli portion, he could not urine at all. At other
C 2 times.
f
84
Foot’s Cafes of Vejicce Lotura, 8C c.
times, his urine would fuddenly ceafe to flow,. during the aft of urining 3 and upon thefe laid occalions, his efforts would be encreafed, and his pain acute 3 pro- Fufe fweats would build forth 3 and if he was then taking his walk, as he was confdantly in the habit of doing from the office to his houfe at Iflington, he was forced to lean tor fome time, where he could find a place, and by drifting his pofdure, he generally fuc- ceeded in obtaining an evacuation, and confequently procuring eafe.
c The fymptoms of his cafe pointed out fo plainly the nature of his complaint, that it did not require much confideralion to determine it to be, either gra¬ vel or ldone, but mold probably the former. Upon introducing a bougie of a middling lize, I found the capacity of the urethra extremely narrow, towards the neck of the bladder 3 and the patient then informed me, that he frequently found clots of blood come forth with his urine. I afcertained another faft by enquiry, namely, that the capacity of his bladder was not leffened, or at leafd to no great degree. Thinking that the fiid thing to be done was to diftend the urethra, I began the cafe wdth palling bougies for that intention, wdth recommending a fomentation of the decoftion of poppies to be applied in the direc¬ tion of the urethra, and with prelcribing then, a de¬ co cdi on of bark with elixir of vitriol, to be taken fre¬ quently in the ufual dofes, but foon changed it for lim e -water.
‘ My patient went on thus till the month of Auguft, without the fmalleft abatement of fymp¬ toms. Having about this time experienced the ad¬ vantage of the veficae lotura, I concluded that it was expedient at leafl, to throw lime-water directly into the bladder, in Head of fending it circuitoufl'y there, through the conftitution 3 and more expedient than by the fliort paffage even, invented and defigned by Dr. Darwin.' In order to be able to effeft this, i pafled the largeft bougie I could get, to procure a paffage
85
Foot's Cafes of Vefica Lotiira, Cc.
for the catheter, as I had hitherto been foiled when- ever I attempted topafs it.
c This idea opened to me a very enlarged train of refleftion ; and my reading an excellent paper by Dr. Whytt, in the Medical Obfervations of a Society at Edinburgh, encouraged and enhanced the value of it to that degree, that it was impoffible for me to refill the defign. Nothing b elides the want of proper in¬ ftruments was the obftacle, at the time Dr. Whytt Wrote his> paper, to the practice then; and this has been the obftacle ever fince, to this felf-evident pro- cefs. A furgeon ought always, in order to reafon fairly upon what has been done by former furgeons, to afeertain what inftruments were known at the time they puhlifhed their cafes, and bv that deter¬ mine the degree of improvement at leaft; fo far as inftruments have a concern in the advancement ot the art. Dr. Langrifh has encouraged the fame idea, but to his fuccefs alfo, the want or proper inftruments was the obftacle that rendered the practice imprac¬ ticable, at leaft upon the human bladder of a male fubjedl.
I fucceeded in palling the elaftick catheter, but not on the firft attempt, injedted lime water diluted with warm water, and found what f was not at all fur- prifed at, that the bladder would contain and retain more than eight ounces. I went on thus not every day for a month ; the bladder was able to hold the i.njefted fluid, and the patient departed with it.
‘ During the praftice of the veficae lotura upon
, © . 1 .... . r •
him, the patient regained his continence ot urine, and fcarcely ever called without bringing with him fragments of gravel which he had difeharged, and fome with the greateft difficulty, of an irregular figure. I recommended him kill to keep his urethra open with the largeft bougies that the urethra would admit, during the procefs of injection. Whilft he was in- jefiting, it very frequently happened, after the bladder had been fully difiended by the repetition of the in-
G 3 jedlion
86
Foot's Cafes ofVefae Lotura , -8Ce,
je&ion, that the water would Hop all of a hidden; but then palling a bougie to diflodge the piece of gra*» vel from the neck of the bladder, it would flow out again, until the bladder was empty. It was con¬ cluded upon the ceflation of this fymptom, that there was no more gravel to come awray ; and this was judged to be a proper criterion to decide upon, when the procefs ought to be difcontinued, For as the bladder could be completely filled, and repeatedly filled, the preffure of the full bladder in the expulfon of its contents, eonftantly brought the gravel within, to the neck of the bladder, when it either fuck fall, and thereby flopped the current of the fluid, or came forth through the urethra with the current.
4 dhefe equivocal fymptoms having totally ceafed, I difcontinued the injection, leaving it to the patient to keep the urethra open with bpugies. For as I could not take upon me to fay, that more gravel may or may not hereafter be formed, I thought it right for him to be prepared, with the only poihble power of procuring the difcharge out of the bladder, of what¬ ever extraneous fubftance might haye been hereaf¬ ter collefted within it. And as this gentleman left me perfectly fatisfied and at cafe, l rely upon it, that if he had ever fince experienced any return of his complaint, I muft have heard from him, or have feen him again.
c I fhall not take upon me to affirm which of the three remedies I applied was the caufe of diflodging the gravel, rcfloring the continence of urine, and giv¬ ing eafe to the patient, If enlarging the paflage of the urethra could have flngly done it, an opportunity for that was given for months, without any viflbje alteration, and whilft at the fame time the patient was drinking lime water. Whereas the fact is, that it was not until the application of the veficre lotura had been repeated, that the patient either regained his continence of urine, or evacuated the grayel from the bladder, or found eafed
It
Wallis’s EJfay on the Gold . 87
It is proper to obferve, that tne other were cafes of difeafed bladder, not depending on calcu¬ lous concretion ; and the author feems to attribute the good effects of the injection to its power of di¬ lating the bladder, as well as to its diluent and de- fenlive properties. But there appears to be a (iudied obfcurity in the author’s manner of writing, which leads one to imagine he thinks himfelf the molt ^pro¬ per to direct and fuperintend the operation. I his may, perhaps, be a neceffary hint to patients.
We confefs our expectations of relief from this plan of treatment fall tar ffiort of thofe of Mr. Foot.
Art. IX. An Efay on the Gout , in which is intro¬ duced a Candid Examination , and a Refutation attempted , of Dr. Latham's Principles, lately pub- lifted on this Subject , and others advanced, deduced from Facts occurring in the Author's own Cafe , and from his Practical Experience of many years. By George Wallis, M. I) . 8vo. 203 pages, price 4s, Robinson, London, 1798.
FEW difeafes have more frequently been the fub- ject of medical writings, than the one which we are now to notice : but with how little fuccefs, both in theory and practice, may be gathered from the various and contradictory hypothefes which have prevailed from the earlieft ages of medicine to the prefent day, and from the glarfng inefficacy of every mode of treatment which has been hitherto adopted. How far the author has fucceeded in removing any of the difficulties which encompafs the fubjeft, will appear as we proceed in our account ot his effay.
In the firft feCtion, the author exhibits the opi¬ nions of different authors reipefting the caufe and feat of the gout. In the fecond, that of Dr. La¬ tham is examined, and its refutation attempted : a
G 4 talk
38
Wallis’s Effdy on the Gout.
'talk of no great difficulty, as will appear, we pre~ fume, from ,the account we have already given of this hypothecs.*
Dr. Wallis next narrates his own cafe, from whence he deduces his opinion of the nature of this -difeafe : which is, that it is a nervous affec¬ tion : but as this is a term of very extensive im¬ port, it is neceffary that we ffiould follow him in his elucidation of the matter.
c And fir ft/ he fays, c the fymptoms which mani- fefted themfelves before the pain of my foot became violent, as enumerated in pages 35, 36, and 37, are evidently of the nervous kind ; which, on ex¬ amination, we (hall find fimilar to thofe by which people are oppreffed who labour under a flow fever, and brought on in the following manner. We muff, however, previoufly obferve, that the nerves them¬ felves are univer tally allowed to be the inftruments of all fenfation, by whofe influence many parts are put into, and all parts continued in motion ; which motion is quick, or flow, ftrong, weak, &c. accord¬ ing to the energy, or debility of that fyftem by which it is created. It is certain, alfo, that flow fevers will arife from any caufe which can debilitate the addon of the nervous fyftem, fuch as great fa¬ tigue, mental or corporeal; excefs of venery ; fevere fiudy ; uneqfinefs of mind long continued ; great eva¬ cuations , whether of blood or other fluids of the machine ; morbid matter received into, or generated in the habit, & c. &c. &c. We know, likewife, that the fymptoms which are the confequences of tbefe caufes, arife from a torpor of the nervous fyflem ; by which means the excretions of the whole habit are made in too fmall quantities, and feme of the excretories almoft entirely clofed ; on which ac¬ count a very large proportion of excrementiticus matter, that fliould be conftantly palling out of the
* See Med. Rev. vol. 4, page 40.
habit,
Wallis’s EJfay on the Gout . 8 9
habit, is retained, and acrimony of different natures generated within.
‘ Now, by this acrimony, a different train of fymp- toms occurs, according to the different parts affeCted, till nature, or the powers of the conftitution, are roufed to free themfelves from thefe oppreflive af¬ fections, and either corrects, affimilates, ejeCts, or other wile conquers the primary offending caufe ; which done, the nerves begin to affume their pro¬ per and natural actions, all the different parts depend¬ ant thereon perform their ufual functions, and the whole machine reaffumes its wonted regularity in aCtion and accuftomed vigour.
c Thele faCts being indifputable, allowed by au¬ thorities of the fuff eminence, and obvious to any difcriminating practitioner, it will be fome fat is fac¬ tion to fee how they quadrate with thofe fvmptoms, confidered as precurfors of the gouty paroxyfm.
f The firft appearances manifefiing themfelves, I have faid were, general languor and lajji tilde, fatigue from trifling exercife , debility of the whole fyjiem , load and heavinejs at my jtomach after eating , cof- tivenefs, pallid urine , dulnefs of hearing, founds in my ears now and then, fimilar to the found of a Jiroke from a bell ; dimnefs of fight , as if objects at a finall dif- tance were enveloped in a miff, &c. &c. &c.
‘ Now, it muff be allowed, that where any parts depend upon another for the promotion or continu¬ ance of their aCtion, any defeCt in that aCtion may naturally be attributed to fomething defective in the -moving caufe ; and that moving caufe re tides in the nerves : tor if the branch of a nerve ferving any part be divided, that part will lofe its power, and become paralytic in a given time, if not inliantaneoufly ; nor can the total iofs be attributed to any other caufe. J hat the defeCt relides in the nervous fyftem, 1 hold certainly to be the cafe, when the motions of the va¬ rious parts ot the fyltem are confidered in general : for 1 am well aware, where a particular part is only
affected
90
Wallis’s Eflcnj on the Gout.
affefcled in the manner here defcribed, that defeft may be, and often is, owing to fome derangement or other in the organic ftru&ure of the part, or incapa¬ bility of the part, from fome accidental caufe, feeling the influence of the nerves, though they themfelves retain their full power.
‘ The fymptoms above enumerated appear evi¬ dently to arife from want of power in the parts af- fefted to perform their offices in a manner confident with a date of health. Hence the mufcles of the machine perform their motions weakly ; the circula¬ tion of the blood becomes languid ; the domach and intedines are fluggifh and torpid in their adtion ; the or¬ gans ofhearing imperfeft in their feeling ; as well as the eyes lofing, in fome degree, the clearnefs and acute- nefs of their vifion ; and all this from fome caufe af- fedling thofe inftruments of aftion or motion, upon which the perceptive and moving powers of thefe parts depend. And that this mud be the cafe, is obvious ; becaufe, previous to the attack of this difi- eafe, thefe organs experienced in themfelves no de- feft, but were performing their functions with eafe and freedom.
‘Now, this caufe I take to be, the aril untie or gouty matter exercifnvg a fedative power upon the nervous fyjlem in the flrfl injtance ; whence a torpor in the action of all the parts /abject to their influence is occa~ floned , by which means the fluids, which ought to circulate freely to the external parts of the machine, are conveyed too fparingly, and hence the larger veffels of the habit experience an oppreffive pleni¬ tude, till, by their increafed action, acquired by the natural Airnulus of the habit, that is, the matter of heat inherent in the blood being there collefted, in- creafes their power, and occafions the blood to be puflied forward more freely; by which increafe of power the morbid offending matter is thrown from the more internal parts of the fydem, feparated by a law of nature from the circulating fluids, and depo-
fited
Wallis’s EJfay on the Gout . 9 1
fited by the fame law on the extremities, and thofe chiefly of the fmall joints moft diftantly removed from the heart and larger arteries, where the moft forcible circulatory powers refide, and to which the fmaller veflels of the fame order are fubfervient ; the offend¬ ing matter fo depoftted, then, from its acrimony, begins to irritate the minute fibrous expanjions of the nervous fyftem , creating acute pain, and that very often inftantaneoufly $ by this means the fluids are folicited to the parts, fpafms in the cutaneous veflels take place, tenfion and fwelling fucceed, with in¬ flammation externally, till the arthritic matter, fepa- rated from the habit, lofes its power, and is partly thrown out of the conftitution by the cutaneous pores, partly re.-abforbed and eliminated by feme of the other excretories, particularly the kidneys and urinary paflages 5 and this appears to be the mode of which nature makes ufe to free the machine from matters fo offenfive. Nor does it feem improbable, that nature employs this pain as her inftrument of relief to the conftitution in general ; for we find, upon its acceffion, which forms the fecond ftage of the gout, the various affections under which the confti¬ tution previouflv laboured, vanifli, and fymptoms of an oppofite nature fucceed : the febrile affections be¬ gin to put on a difference appearance; the pulfe grows ftrong and full, though lefs frequent ; the coun¬ tenance affumes a florid hue ; general heat is diffufed over the body ; there comes on a greater thirft, and a ftronger defire for diluting and fub-acid drinks • the urine grows^ higher coloured ; and other fymptoms, more indicative of continued inflammatory fever, take place, with exacerbations in the evening ; and things continue in this ftate till the abatement of the pain ; and then the violence gradually decreafes, and at laft goes off, leaving the part affeCted, fwelled, red, and extremely weak : which are only mere effeCfs brought on by the preceding gouty irritation/
92 Wallis’s EJfay on the Gout, ,
Upon tbs whole, the author concludes, that the caufe of the regular gout is ftimulus in the firft in- ftance, independent or fpafm or diftenfion, inducing immediate pain, fixing, by a law' of the animal oeco- nomy, on the fmall joints and ligaments furrounding them, of the extremities, having fpafm and diftenfion for its affociates, which produce fwelling, inflamma¬ tion, and pain as their confequences:
c That all this depends upon an acrimonious hu¬ mour, called arthritic from its eflfedts, firft exercifing a fedative power on the nervous fyftem whilft circu¬ lating in the mafs of fluids ; when feparated, a ftirnu- lating power on the fibrillous expanfion of the nervous fyftem, in conftitutions previously difpofed to favour fuch a depofition, and feel its effedts :
c That the gout, when mifplaced , depends upon predifpofition of the parts affedled to receive the arthritic acrimony, and feel its power ; when retroce¬ dent , upon conftitutional debility, incapable of retain¬ ing the arthritic acrimony in the fituation where it firft fixes ; or it arifes from accident or mifmanage- ment ; then it frequently puts on the appearance of mifplaced gout ; all which diversified appearances originate from the fame caufe as thofe of the regular gout, placed under different conftitutional or acci¬ dental circumflances.,
When gouty people are attacked fuddenly by apo¬ plexy, it is accounted for, by the gouty acrimony producing a highly fedative effedt, like the eledtric matter upon the nervous fyftem, by which its power is totally deftroyed.
Thus it appears that the author has loft fight of his firft principle. Inftead of being a nervous affedlion, as we were informed, it turns out to be an acrimoni¬ ous ftate of the fluids, capable, it would feem, of exerting very oppofite effe&s. Firft, the arthritic or gouty matter exercifes a fedative power upon the ner¬ vous fyftem, whence a torpor in the larger veffels of
the
Curry on Apparent Death from Drowning , 8(c. 93
the habit ; thefe being oppreffed by plenitude, are roufed to increafed action, and the fluids are thrown forwards to the extremities, where the morbid offend¬ ing matter, by fome law of nature beft known to the author, is feparated from the circulating fluids, and depolited on the minute fibrous expanfions of the nervous fyftem. Inflead of acting with a fedative power here, producing torpor, &c. it irritates violently, creating acute pain, and that very often inftantane- oufly, followed by tenfion and fwelling, and inflam¬ mation. Such are the inconfiftencies which hypothefis gives rife to. The nature and progrefs, entrance and exit, of this arthritic acrimony are as clearly and pre- cifely marked, as if it had been a matter cognizable by the fenfes, and its exiftence fliewn by ocular proof. But we have not room for all the remarks which offer themfelves on this occafion. We trufl, however, that a formal refutation of fuch arguments is altogether uhneceffary.
Art. X. Obferoations on Apparent Death from D 7 ’ owning , Suffocation , Ate. with an Account of the Means to he employed for Recovery ; drawn up at the Defire of the No rth amptonjh ire Prefervative Society . By James Curry, M. D. Phyjkian at Ketterton. Odtavo, 113 pages, price 2s. 6d. Johnson, London.
THE time is within the recollection of many now living, the author obferves, when it was almoft univerfally believed, that life quitted the body in a very few minutes after the perfon had oeafed to breathe. Remarkable examples to the contrary were indeed upon record ; but thefe, befides being ex¬ tremely rare, were generally cafes wherein the fuf- penfion, as well as the recovery of life, had occurred fpontaneoufly \ they were therefore beheld with alto-
niikment.
£
§ 4 Curry on Apparent Death from Drowning,
niffunent, as particular inftances of divine interpofition* and afforded no ground to hope, that human means could prove at all ufeful under timilar circumftances. Such a view of the matter neceffarily checked any rational and premeditated attempt to recovery, even in thofe cafes where the appearance of death was evidently occafioned by the operation of external and alh gn able caufes.
That there is an effential difference between abfo« lute and apparent death, is, however, fufficiently aff certained j and it is one part of Dr. Curry’s plan to point out the marks by which thofe two hates may be diftinguifhed : on the one hand, that ufelefs efforts may not be made ; and, on the other, that no means may be left untried as long as there is a poffibility, or a hope, of effecting recovery.
Although medical men are, from the nature of their ffudies and profeffion, particularly qualified for being ufeful on fuch occafions, it by no means fob lows that they are exclufively fo. Intelligent perfons of every defcription, may readily acquire fufficient information on the fubjeft, to enable them to a 61 with propriety and fuccefs ; and it is chiefly with a view to the inffruftion of fuch perfons, that the ob- fervations before us have been drawn up. Technical words and phrafes, therefore, are properly rejefted, as far as poffible.
Although there is nothing new in the fa61s or fpe- culations which calls for particular notice, we cannot difmifs the prefent article without exprefifing our opinion, that it is exceedingly well calculated to am* fwer the purpofes intended by its author.
Art-.
i
Saumarez’s New Syftem of Phyfiology .
95
A r t. XI. A New Syftem of Phyjiology. By Richard
Saumarez, Su rgeo n .
(Continued from Vol. 4, page 568.)
/
WE concluded our former account of Mr. Sauma¬ rez’s work with his remarks on the Brunonian Dodtrine of Medicine. That of Dr. Darwin he pro- feiies not to comprehend, and, of courfe, naffes it by without a comment. 1
The author next gives a view of the proceffion of living beings, and endeavours to prove, from their greater prefervative and procreative powers, their longevity, &c. that vegetables are more perfedi in their frame than brutes— brutes more perfeft than the human fpecies. The reafon of this he fuppofes to arife from the difference in the final caufe of their exigence, which in vegetables is dated to be the pro¬ pagation of the fpecies merely, as means of affording fupport to beings of a higher clafs : in brutes, the gratification of the appetite , and the propagation of the fpecies ; whilft in man, the final caufe of his exig¬ ence is, befides thofe which belongto him in common with inferior beings, and which are only fecondarv the perfection of his mind. '
Author, in the next place, treats of the means by which the final caufe of human exiffence is at¬ tained ; and this leads him to fpeak of univerfities in general, and of the College of Phyficians, and the Corporation of Surgeons. The neceffity of fuch effa- bhfhments, he obferves,ffs not fo great in arts and fciences, as it is in theology. In theology, the ob- )eti is to preferve, not to improve the doctrine f it is to make men learn wrhat has already been proclaimed and not to .invent a new fyftem. On the contrary, in arts and fciences, the objedf is not only to learn what zs already known, but to improve upon that know*
ledge.
\
96 Saumarezx New Syftem of Phyfiotogy.
ledge, to explore new branches of fcience, and bring the whole to a hate of perfection. At the time when thefe colleges were founded, the hate of fci¬ ence was totally different from what it is now ; they poffeffea a perfect monopoly of knowledge, and there were no ehablifhments formed in London, or other parts of England. At this prefent time the cafe is completely reverted ; there is a monopoly of know¬ ledge in London, and a perfect hate of herility in the colleges, efpecially with refpeCt to our profehion. Notwithftanding this condition of things, the fellows who have the controul over the affairs of the college, inhead of admitting the meritorious to participate in the dignity attached to the eftabliihment to which they belong, monopolize the whole advantages to themfelves, and damp the ardour of purfuit, by ex¬ cluding men from attaining profeffional honours by means of profeffional merit.
c The College of Phyhcians, by virtue of its charter, has not only the privilege of examining medical men, members of the different univerhties of Oxford and Cambridge, with refpeCf to their qualification in their profehion ; but they have a right alfo to fummon any members of foreign univerhties, and prevent them from pra&ifing in London, or within the bills of mortality, if upon examination they are found defi¬ cient, in profeffional knowledge. The charter that granted the college thefe important privileges, had for its objeft, the prevention of empyrics from the praCfice of medicine, and the laudable defife, that every one ffiould give proper tehs of his acquirements before he was allowed to praftife.
* At this period the art of medicine was in the moft ■barbarous hate that can be conceived , but after the college was eftabliffied, and certain tehs made requi- iite to enable phyhcians to pradfife, an inducement was held out for men of dignity and abilities to en¬ gage in the hudy of it ; the hoh of empyrics coiife* qmently dimimfhed, and almoft difappeared, and the
advantages
2
Saumarez’s New Syftem of Phyfiology * ; 97
advantages were very foon felt and acknowledged. It was about this time that the immortal Harvey dis¬ covered that the blood was in a conftant ftate of cir¬ culation, in the living fyftem. Inftead of Englifh fludents emigrating to foreign univerfities for the pur- pofe of being taught firft principles that were falfe, viz. that the blood was dead and ftagnant ; foreign fludents came to England with a view of learning principles that were true.
4 The increafe of practitioners foon began to excite fome degree of jealoufy in the fellows of the college • they not only found a competition, but a diminution, of revenue ; they therefore applied to, and obtained from, parliament* the power of making certain bye¬ laws, not in oppofition to the Spirit of the original charter, but with a view of extending its operation. So far, however, from adhering to this principle, the fellows have multiplied the bye-laws of the college in fuch a manner, that, inftead of profeffional merit be¬ ing the road to profeffional honour, profeffional honours are now the real and true attributes of pro¬ feffional ignorance,
c After feeing what knowledge it is that disqualifies a man to become either a fellow or a licentiate of the college, it remains to fay, what are the eflentiai attri¬ butes by which that exalted and diftinguifhed honour is to be obtained. A man muft have ftudied, or at leaft palled, two years at one of the foreign univer¬ sities, Edinburgh, Glafgow, &c. (London is not con- fidered an univerfity) before he can be permitted to offer himfelf for examination as a licentiate ; ‘and finally, it is neceflary that he ffiould have regularly matriculated at either of thofe fountains of medical wifdom, Oxford or Cambridge, for the nominal pe¬ riod of fourteen years, before he can be admitted within the pale of a fellowlhip, in the Royal College of Phyficians in London It is very true, that with the exception of young gentlemen who are natives of thofe cities, ftudents occalionally refort there only for
H the
98 Saumarez’s New Syjlem of Phyfiology
the purpofe of keeping terms ; and many abridge their period of fervitude from fourteen nominal years, to three of abfolute attendance. Keeping terms in this way is called term-trotting , and the graduates themfelves have received the appellation of term- trotters. This is the period thought neceffary before apprentices to furgeons and apothecaries are deemed qualified either to bleed, or adminifter an enema to a patient ; whilft, on the contrary, the matriculated ftudents of Oxford and Cambridge, who have learnt anatomy without diffe&ion, ftudied medicine by fee¬ ing the healthy, and the practice of it without vifiting the lick, are deemed bona fide alone qualified to be at the head of our profeffion. is jt then furprifing that the College of Phyficians is dwindled to nothing, and the only dignity attached to the fellows of it but a name ; that whilft they are flattering and compli¬ menting each other in their orations, they are abuling the licentiates, and holding at a diftance men of fu- perior medical knowledge to themfelves ?
‘ Motives of perfonal regard prevent me from dif- cufling the abilities of the different fellows. It has been thought that the publication in France of the Lime Rouge y zvith Notes , was very inftrumental in exciting the contempt of the nation againft the Haute Noblefle. If the profeflional abilities of the fellows of the college were fcrutinized, it is very probable that a fimilar lot would befall them.
‘The great leviathan of the college, ********5 before his death, is reported to have declared, that there was no good in phyfic, although he realized eight or ten thoufand guineas annually by the admi- niftration of it. But here I jjpp for the prefent. J (hall merely conclude by applying to thefe gentlemen the memorable word* (hat came from the elegant pen of Junius, upon a former occafion : 66 The feathers that adorn the college bird fupport his flight : ftrip him of his plumage, and you fix him to the earth/
2
Some
Saumarez’s New Syfiem of Phyfology, 99r
Some obfervations, equally fevere and juft, follow, on the conduit of the Corporation of Surgeons: but this is a fubjeft that we have repeatedly handled.
'• > * •> i »
c As to the Apothecaries Company, it muft be con- fidered as a company deligned for traffic and mer- chandife, rather than for fcience. The good it does (and that good is certainly great) extends to the im¬ portation of the belt medicines, which it vends to the public at an equitable price. It does not however appear that the exertions of this company have con¬ tributed in any confiderable degree either to the per¬ fection of the practical part of chemiftry, or to meli¬ orating the pharmaceutic department ; it may rather be confidered as a difpenfary to the fellows of the College of Phyficians, and as more immediately under their controul.
f After having expofed the errors of thefe different eftabliffiments, it may perhaps be expeCted that I fhould point out the means by which they can be amended. The eftabliffiments of themfelves are good, and it is the conduCt of thofe only who fuperintend them which is bad. Inftead of afting conformably to the principles of the inftitutions, they live in conftant violation of their precepts. It is not new laws that are wanted, fo much as the proper execution of the old. The evils that exift are evils of omiffion more perhaps than of commiffion. Let thofe who have the management of the Surgeons’ Company aft with diligence and zeal ; and notwithftanding the impaired and impoveriffied ftate of its finances, we Humid foon fee it have leftures without a theatre, books without a library, committee-rooms without dining- parlours, and a full purfe for the indigent and needy, inftead of an empty one.
‘ When men are animated with a laudable fpirit to further the end of the inftitution to which they be¬ long, we frequently behold great objefts attained by means apparently inadequate and infufficient : on the
contrary
I' ' " __ <H
10D 6atimarez5sArac Syjiem of Phyfiology*
contrary, inftead of looking forward to the attainment of the final caufe, they do not think of it ; they ge¬ nerally employ the means to perfonai purpofes inftead of general ones ; to private advantage inftead of pub¬ lic good. x .
< Animated as I feel myfelf to be with the love of my profeffion, and deeply interefted in its welfare, I fincerely hope to fee the government of it placed on a refpe&able eftabliftiment, and the governors of it refpeftable men : it is then, and then only that we may hope to fee it attain the end for which it was defigned.
< It is however vain to hope that public adminiftra- lions can be well managed whilft the conduft of in¬ dividuals of which they are compofed is bad. If the parts of a building are defeftive, it is impoflible that the whole can be good ; it is therefore a reformation in private morals that mnft be firft attempted, before we can expe£t to fee large maffes of men a£ting and co-operating together in the acquifition of knowledge, and in the general diffufion of it. The means how¬ ever are evidently the fame in both, and confift in education and iriftru&ion/
; : .•*p • «•>*-. . ' , ■’ t!t
(To be continued
A
I
No. XXVI.
I
MS
THE
MEDICAL and CHIRURGICAL
REVIEW.
SEPTEMBER, 1798.
Art. XII, Duncan's Annals of Medicine, Vol. IL
for the Year 1797.
(Continued from page 66.)
»
The next paper in the prefent colle&ion which we are to notice, is by Mr. George Kellie* Surgeon in the Navy, on the EffeQs of the Nitrous Acid in the cure of Syphilis. Mr. Kellie employed this fubftance in five inftances. The firft was a cafe of chancre, cured by the acid, after fourteen days ufe. This patient continued well three months af¬ terwards. The quantity of the acid was gradually increafed to half an ounce daily.
The fecond was alfo a cafe of recent chancre, which got well within ten days ; the quantity of acid employed, half a drachm daily.
The third a cafe of bubo, cured in about eight 'Wreeks : acid from one to two drachms daily.
The next was a cafe of fecondary fymptoms, with heftic, and general health much impaired. The ef¬ fects of the acid not remarkable in this cafe, though continued for fix weeks. vol. v.
I
Cafe
102 Duncans’ Annals of Medicine for 1191 <
Cafe 5, was of a boy, who had a phagedenic ulcer of the leg. After refilling various means, it gave way to the nitric acid.
The fenfible effects of the acid in the cafes above mentioned were, increafed flow of faliva, without foe- tor of the breath, or forenefs of the mouth ; and in¬ creafed perfpi ration.
I v V
Art . 6. The Hijlory of a Cafe , in which , after a complete Inverjioii of the Uterus , a. favourable ter mi - nation took place . By Mr. Thomas Brown, Surgeon in Muf el burgh.
Art . 7. Hijlory of a Cafe terminating fuccef fully, after Amputation at the Shoulder Joint. By Mr. William Rurd, Surgeon in the Navy. — Thefe cafes afford nothing remarkably new in practice.
Art. 8. The Hijlory of a Cafe in which a Tape Worm zvas difcharged from the Stomach, upon the ufe of an Emetic. By Mr. William White, Surgeon in Donaghadee. — The fymptoms attributed to worms in the alimentary canal are very equivocal. In the fol¬ lowing cafe, however, by Mr. White, they feem to have been pretty clearly afcertained.
f Hugh Smith, a glover here, aged about thirty-fix years, applied to me lately for advice with refpedt to his health. He laid that he had, been in a bad (late " of health for twenty ve-ars pail; that when he was young, he had a very large belly ; that of late years he had a very fevere ftomach complaint, and a molt offenfive breath ; and that his appetite could never be fatisfled with food. He had frequent pains of his ftomach, and a very peculiar feeling, as he faid, about the top of bis throat, as if lorn e thing were coming up ^ fometimes tickling, with a fenfe of full- nefs, and fometimes like to choke him. He had alfo frequent headach.
‘ He was of a very dull and melancholic clifpofi- fion ; lean, and a very bad colour. He had applied,
for
Duncans* Annals of Medicine for 1797. 10 $
for medical advice • and had taken many medicines* without any effect.
‘ He fufpefted he had worms* as he paffed fome fliort worms, of a fiat form, a number of years ago.
< From the above fymptoms I was led to fuppofe; that there were worms in his ftomach. But the chief fymptom which induced me to think fo, was the pe¬ culiar feeling and fenfation in the upper part of the
throat. f1
c I remember the cafe of a lady, who had been long under a ftomach-complaint, had been long under the care of a phyfician, and had taken many medb cines without benefit. With her* the mod: trouble^ fome fymptom was a tickling, and the fenfe of fome- thing, as it were, twifting about the top of the gullet. In this cafe, I recommended an emetic, referring the fenfation to fomething offenfive in the flomach. But my advice was not taken. Some time afterwards, the lady vomited a worm, fpontaneoufly, ox the lumbri- cous kind, and was immediately relieved from the fenfation; and never had any return of her ftomach- complaint afterwards.
< Smith’s cafe was exactly fimilar to the lady’s* with refpeft to the peculiar fenfation in his throat. And there were other undoubted proofs of the exift- ence of worms, viz. his having tome years ago paffed fome joints of taenia ; and alio, the voracious appe¬ tite ; which, I think, is diagnoftic of the tape worm, as, on account of its prodigious length, it requires proportionate nourifhment, and, probably, abforbs at every joint the chyle, and digefted part of our aliment. There can fcarcely be any doubt but that it is nourifh- ed in this way, as it exifts after it is broken into fe» parate portions in the human body.
c Having formed this opinion of Smith’s cafe, I gave him a very ftrong emetic of tartarifed antimony ; and, as foon as he began to vomit, he threw up the end of a tape worm, which his wife took hold of, and coiled away, wThen it broke. But new efforts of vo-
I 2 uniting
104 Duncans’ Annals of Medicine for 1797.
rniting brought away the reft ; and his wife, being greatly alarmed (as the thought that he had vomited fome of his bowels), fent for me. And, to my afto- niftnnent, I found he had vomited a tape worm, which meafured eighteen yards in length. The end laft vomited was: alive when difcharged, as his wife informed me.
5 It was very narrow at both ends, and the joints very fhort; but it was about half an inch broad about its middle, and the joints rather more than an inch long.
4 The worm is preferved, and in my poffeffion ; and the man is now in perfe£t health.’
Art. 9. The Hiftory of a remarkable Cafe of Ty¬ phus Fever , immediately fucceeded by Meajles , ter nil nating fuccefsf, Lilly . By Dr. George Mo Oman, Brad¬ ford, Yorkjhire . — The fubject of this cafe was a boy twelve years of age: The plan of treatment adopted during the fever wTas ftimulant in the higheft degree. Tinffure of opium, caftor, and ferpentaria, were given every hour in Port wine ; and equal parts of brandy and water for common drink. A bottle and a half of old Port, and half a bottle of brandy, were confumed in twenty-four hours ! Who of our readers will wonder, at being informed, that at the end of a week from the commencement of this treatment, no advantage fhould have been gained : that the pulfe lhould have been at 144 in the minute, the tongue black, and the ftupor fo great, that the pupils were infenfible of the approach of a lighted candle, and the noftrils of volatile falts ? It was not till the frequent application of cold water to the extremities had been made, that the pulfe began to diminifti in frequency, and figns of amendment to take place. The author feems, however, to have purfued his fiery ordeal to the laft, and probably congratulates himlelf on the fuccefs of his praftice !
The fymptoms of the mealies fhewed themfelves a day or two after the typhus declined, and the ftimu¬ lant
i
Duncans’ Annals of Medicine for 1797. 105
lant plan was here again applied. The patient did recover.
Art . 10. Hijtory of a long-continued Cafe of Con- jtipatian , terminating fatally ; with the Appearances on Direction . By the fame. — The patient lived two months without evacuation. On diffeffion, the caufe of the difeafe was found to be a fchirrous thickening and contraction of the colon, near the beginning of the reftum. .<
Art. 11. Extraordinary Cafe of Extra-Uterine F'cetuSy voided through an Abfcefs in the Cavity of the Abomen. By Mr. J. M. Wilfon, Ho uJe-Su rgeon to the Weftminfter Hofpital.
Art . 12. Cafe of Phthifis Pulmonalis completely cured , from the Patient breathing Mephitic Air. By Mr. James Howifon, Surgeon.— There were in this cafe all the fyrnptoms characterizing pulmonary con- fumption. The following is the account of the cafe during the cure, as given by the author. After Hat¬ ing it as the opinion of all the medical gentlemen . who faw the patient, (Captain Roper) that he could not furvive a month, Mr. Howifon obferves, c A Merchantman being on the point of failing from the Prince of Wales’s liland for Bengal, on which I had taken my palfage, his going in her was notwithftand- ing recommended, as, about the expefted time of our arrival there, the healthy feafon would be felting in, fo that if then alive, he might reap the advantages of it.
6 All medicine had for fome time been laid afide, except about fixty drops of the paregoric elixir, which, he took at night, for the purpofe of affording him a temporary relief from his teazing cough. •
‘ Upon our going on board, as it was expeCted he would be moftly confined to bed, he had an apart¬ ment of about feven feet fquare allotted him, which , was lituated direCtly oppofite to the door of the great < cabin, where I was accommodated. Our cargo con-, lifted chiefly of raw fugars, the drainings of which,
1 3 mixing
106 Duncans" Annals of Medicine for 1797.
mixing with the bilge-water, produced fo intolerable a fetor, that, notwithftanding fix windows, and two large doors, opened into our apartment, I was under the neceflity of fpending a great part of my time upon deck.
‘ Captain Roper was, as I then thought, worfe fituated, having the hatchway, from whence this dis¬ agreeable effluvia ifflued, immediately under the only door he had to his cabin. In the evenings before I went to deep, I have obferved his candle to give a very dim light, and frequently to go out, which I at the time afcribed to the impurity of the air ; but as he did not complain, and as there was no other apart¬ ment vacant, I gave no notice of that circumftance to him.
c The two firft nights wre were on board, he thought he had Spent with more comfort than any for Some time preceding. During the third, fourth, and fifth days and nights, he evidently coughed lets, and kept bet¬ ter. By the 10th he had got a tolerable appetite, and fcarcely awakened during the whole night, while his cough and Spitting were much decreaied, and the pain of the fide a! molt gone.
‘ His health continued improving rapidly, until our arrival in Bengal, which was in twenty -five days, from our leaving Prince of Wales’s ifiand. A little of his cough Sill remained, but there was no Spit mg of blood, and the fetid breath, and pain of the fide were entirely gone.
* For Some time previous to our arrival, he Sept fo very found, that the difficulty we had in awaking him, when called to breakfaft, was remarked by every per- fon, as Something extraordinary, his pulfe at the time being uncommonly foft and flow.
e In the courfe of eight days after our arrival, the remainder of his complaint entirely left him, and I had the pleafure of feeing him fourteen months after in perfedt health/
Art,
Duncans5 Annals of Medicine for 1797. 107
. Art. 13. Hiftory of a Cafe of imperforate llymen% fuccefsfully removed by Operation. By Mr. John Lucie Smith, Surgeon , Barbadoes.
Art. 14. Obfiervations on Mr. Baynton' s Method of treating Ulcers of the Legs. By Mr. W. Sim¬ mons, Surgeon to the Manchejter Infirmary . — Mr. Simmons approves highly of the employment of ad- hefive plafters, as recommended by Mr. Raynton, in his ingenious treatife on the fubjeft ; though he differs fomewhat from Mr. Baynton as to the modus operandi of the remedy.
c It not uncommonly happens,’ Mr. Wilfon ob- ferves, c that a combination of the different kinds of ulcer takes place, and that the callous is attended with a fpecific morbid action. The latter may be removed, and yet the ulcer may be intractable, from affuming the former character. Whatever plan of treatment be adopted, it appears evidently the inten¬ tion to reduce it to the (late of a fimple ulcer. And in this form, or when attended with callous edges, the plan of treatment recommended by Mr. Baynton, will, I apprehend, be extremely proper. The author has not referred it to any particular fpecies of ulcer.
c For fome years i have been endeavouring to form a ground of preference, in the choice of remedies ap¬ plicable to this common kind of ulcer ; and after a trial of all of them, the plan of Wife-man, of apply¬ ing precipitate and light bandages, has gained a de¬ cided preference. When the granulations rife above the level of the fkin, the vitriol of copper has been fubflituted as reprefling them, and leaving the furface more difpofed for cicatrization. Rhubarb, fo ftrongly recommended by Mr. Home, is feeble in its powers when compared with precipitate. But the admirable plan of applying adhefive plafters, as directed by Mr. Baynton, frees the furgeon from farther difficulty in his choice of means. The principle of their opera¬ tion is exemplified in the application of fheet-lead, as
I 4 approved
■f,
108 Duncans* Annals of Medicine for 1797.
approved by the late Mr. Elfe ; which, from nicety in its application, has fallen into difufe.
c Mr. Baynton obferves, that the efficacy of this plan depends on the endeavour to bring the divided parts nearer together. But whoever attends to its effect, on an extenfive old ulcer, on the anterior part of the leg for example, will fee the impoffibility of bringing the original fkin to approximate. Admitting his facts, the benefit may be produced in two ways, firf by acting as a bandage, giving tone and remov¬ ing induration ; an d,fecondly, by keeping the ulcerat¬ ed furface level with the furrounding fkin. The uti¬ lity of bandaging is generally allowed, and it would feem that a bandage of fuch materials is preferable, by making a more fteady and uniform preffure than a common roller. The procefs of fkinning refembles the freezing of water, or the cryftallization of falts, both of which are facilitated by an even furface, which is effential to the due configuration of the cryftals. On the fame principle it is, that the adhe- five plafters are fo efficacious.
c In an old hollow ulcer, with hard callous edges, the cure is accomplifhed by the filling up of the ca¬ vity with new granulations, and the fubfidence of the neighbouring parts. Whilft the former is going on, the latter is effefted by preffure inducing the abforp- tion of the thickened and indurated integuments, oc- cafioned by interftitial depofition. Thefe two points being attained, cicatrization, or the cryftallization of fkin, will be greatly affified by keeping the furface level. This ft age of the healing procefs takes place, in a beautiful and rapid manner, under this treatment. But fliould the granulations be fuffered to rife above the level of the adjoining fkin, an immediate obftacle prefents itfelf, and the fkinning is impeded. That there is an extenfive produflion of new fkin, may be afcertained by admeafurement from day to day, c Viewing the introdu&ion of this practice, as one of the greatefl improvements in modern furgery, I
have
I
Duncans’ Annals of Medicine for 1797. 109
have thus attempted an explication of the principles on which it a£ts, in a manner fomewhat different from its inventor, hoping thereby to extend its utility. I now apply it in all cafes where there has been a de¬ finition of common integument, and I find that it does more in one week, than could be accompliihed in feveral, according to the old method. In perfons of an irritable fkin, the emplaftrum lithargyri, anfwers equally well, and is not liable to excite excoriation.’
This concludes the original articles in the volume. The third fetion is devoted, as ufual, to Medical News. The line of diftin£tion, however, is not ac¬ curately drawn between this and the former part. We have firft a paper refpefting the difeafes rnoft common among the troops in the Weft Indies, by Dr. Wright. The obfervations here furnifhed, though im¬ portant, do not materially differ from thofe given by the fame author in the feventh volume of the Me¬ dical Fa£ts and Obfervations*.
The next article is furnifhed by Dr. Withering of Birmingham, and relates to the cure and prevention of the plague, by fri6tions of the whole furface of the body with olive oil. This method is faid to have been firft propofed by George Baldwin, Efquire, his Britannic Majefty’s Agent, and Coniul-General at Alexandria, in Egypt. The dire6tions are fimplv thefe. ;
c Immediately after a perfon is perceived to be in¬ fected with the plague, he muft be taken into a clofe room, and over a brazier of hot coals, with a clean fponge dipt in warm olive-oil, his body muft be very brifkly rubbed all over, for the purpofe of producing a profufe fweat. During the friction, fugar and ju¬ niper berries muft be burnt in the fire, which raife a denfe and hot frnoke, that contributes to the effe£t.
* See Med. Rev. vol. 4, page 250.
( The
110 Duncans* Annals of Medicine for 179T.
The fri&ion ought not to be continued more than four minutes, and a pint of oil is enough to be ufed at each time.
‘ In general, the firft rubbing is followed by a very copious perfpiration 5 but lhould it fail of this effedl, the operation may be repeated, hi ft wiping the body with a warm dry cloth 5 and in order ftill farther to promote perfpiration, the patient may take any warm fudorific drink, fuch as elder-flower-tea, &c.
c It is not neceftary to touch the eyes ; and other tender parts of the body may be rubbed more gently.
‘ Every poffibie precaution rnuft be made ufe of, to prevent the patient taking cold, fuch as keeping co¬ vered thofe parts of the body not dire fitly under the operation ; nor muft the linen be changed till the per¬ fpiration has entirely fubfided. The operation lhould be repeated once a-day, until evident fymptoms of re¬ covery begin tc. appear.
c If there are already tumours on the body, they fhould be gently and more frequently rubbed, till they appear to be in a ftate of fuppuration, when they may be dreffed with the ufual plafters.
6 The operation ought to be begun on the firft ap¬ pearance ot the fymptoms of the difeafe; if negle£ied till the nerves and the mafs of blood are affefted, or a diarrhoea has commenced, little hopes can be enter¬ tained of cure ; but ftill the patient lhould not .be de- fpaired of, as, by an aftiduous application of the means propofed, fome few have recovered even after diar¬ rhoea had commenced.
c During the firft four or five days, the patient rnuft obferve a very abftemious diet; the author allows only a final] quantity of vermicelli, Amply boiled in water. Nor muft any thing be taken for the fpace of thirty or forty days, except very light food ; as, he fays, an in- digeftion in any ftage of the diforder might be ex¬ tremely dangerous. He does not alloy/ the ufe of wine till the expiration of forty days*
* There
Duncans* Annals of Medicine for 1797. Ill
c There is no inliance of the perfon rubbing a pa¬ tient having taken the infection. He fflould previ- oufly anoint himfelf all over with oil, and muff avoid receiving the breath of the infected perfon into his mouth and noftrils. The prevention to be ufed, in all circumftances, is that of carefully anointing the body, and living upon light and eafily digeftible food.
4 One of the molt ingenious obfervations made by Mr. Baldwin is, that among upwards of a million of inhabitants carried off by the plague, in Upper and Lower Egypt, during the fpace of four years, he could not difcover a tingle oilman, or dealer in oil*
It appears to us, that the evidence here adduced is more fatisfadtory as to the preventive powers of the application, than to its fanative ones, alter the difeafe has once taken place.
An intereffmg account is given by Mr. William Simmons, Surgeon at Manchefter, refpedting the ufe of arfenic in the hooping cough, a diforder that feems hitherto to have baffled all the efforts of practitioners. ‘ For upwards of three years,5 Mr. Simmons obferves, * I have given arfenic in the hooping cough, with the mo ft falutary effedt. In general, it has put a flop to the difeafe in about a fortnight ; and it has never failed to moderate it in a few davs. I have admin iff
J
tered it in one unfuccefsful cafe only, and even then it afforded considerable relief*, and had I been called in earlier, or had I been permitted to pay the atten¬ tion the cafe required, I am of opinion it would have fucceeded in that alfo. I have ufed it in the form of the mineral folution of Dr. Fowler, and in the dofes, and with the precautions recommended by him in his work on intermittents, &c. Children of a year old may take it with fafety. Previous to, and during its ufe, bleeding, blifters, and emetics, may be. employed according to the indications, particularly the latter. It fflould he continued till the difeafe be fubdued, and then leaving it off for a week, it fhould again be had
recourfe
112 Duncans' Annals of Medicine for 1797.
recourfe to for a week, to prevent a return. Should expofure to cold occafion a relapfe, it has hitherto put a flop to it, on being taken for a few days.
‘ Under thefe precautions, and with thefe regula¬ tions, I apprehend it will generally be exhibited with fuccefs 5 and I recommend it with confidence to the profeffion.’
Memoir on the Nature and Treatment of Rachitis, by Citizen Bonhomme of Paris. According to the author of this memoir, the nature of the rachitic dis¬ order arifes, on the one hand, from the developement of an acid, approaching in its properties to the vege¬ table acids, particularly the oxalic ; and, on the other, from the defeft of phofphoric acid, of which the com¬ bination with animal calcareous earth, forms the na¬ tural balis of the bones, and gives them their folidity. From this opinion he infers, that the proper treatment of rachitis muff turn on two principal points, viz. to prevent the developement of the oxalic acid, and to re-eftablith the combination of the phofphoric with the bafis of the bones. Thefe intentions may, he thinks, be often accomplifhed, by the internal ufe of phofphate of lime, and phofphate orfoda, and by the external ufe of alkaline lotions. Several cafes are re¬ corded, in which thefe pradlices were apparently at¬ tended with the belt effe&s. A powder was formed, of equal parts of phofphate of lime and phofphate of foda, and taken by infants twice a-day, to the extent of a fcruple for a dofe. The alkaline folution was made, by diffolving half an ounce of common potafh, or fait of tartar, in a pound of very pure fpring water. When this folution is to be ufed, the (kin mult firft he rubbed with a dry cloth, or a piece of fine flannel. After this precaution, the difeafed parts are to be wafhed carefully with the warm folution, and at length wiped, fo as to leave no trace of moifture. This walk¬ ing muft be repeated, at leaft, twice a-day.
He affirms, that he has feen various inftances of children cured of their difpofltion to rachitis, merely.
by
Duncans* Annals of M edicifie for 1797, 11 S
by wa filing with the alkaline liquid; but in mod; cafes he has thought it neceflary to fecure the firft fuccefs by other remedies. The alkaline lotion is a remedy the more preferable, as it is not at all difgufting, and fcarcely in any refpeft troublefome to children. But the internal remedies, he confiders as pofleffing fupe- rior efficacy.
He contends, that the calcareous phofphate, taken internally, is really tranfmitted by the lymphatic paf- fages, and contributes to oflification ; and that the internal ufe of the calcareous phofphate, whether alone or combined with the phofphate of foda, powerfully contributes to reftore the natural proportions in the fubftances of the bones, and accelerate the cure of rachitis. In proof of thefe opinions, he relates various experiments made on young fowls, fome of which took a proportion of calcareous phofphate with their food. After an exaCt comparifon, there could, he. tells us, be no doubt of the efficacy of calcareous phof¬ phate, in favouring the progrefs of offification.
Dr. j. Harnefs, Phylician to the Britifh fleet in the Mediterranean, gives an account of the good effects of the gaftric fluid of graminivorous animals in the cure of ulcers. The application of this fubftance in* fcorbutic ulcers, and thofe where there is a tendency to mortification, feems, in a great number of inftances, to have been productive of the happieft confequences, after the failure of other remedies.
A letter is given from Mr. Hammick, Jun. Affiftant Surgeon to the Royal Hofpital at Plymouth, giving an account of the benefit obtained from the external ufe of hops, in the cure of large fordid ulcers. A large handful of hops are directed to be boiled with a quart of water, till a ftrong decoction is formed. Oat-meal, with lard or oil, is then to be mixed with the hops and the deception, till the poultice becomes of a proper confidence. It is then applied to the ulcer without any intervening lint. Previoufly to this ap¬ plication, the ulcers are to be well fomented with the
decoftion.
114 Duncans* Annals of Medicine for 1191,
decoftion. The pain proceeding from the ulcers is faid to be foon alleviated, and the ulcers themfelves foon ceafe to fpread. They become clean, and in a Hate to be dreffed with lint or any foft ointment.
Dr. John Wilfon, Phyfician at Spalding in Lincoln^ ihire, gives his teftimony in favour of the argentum nitratum as a remedy in epilepfy. He employs it in dofes of two grains and a half, three times a-day.
Dr. Thomas Garnett, Profeffor of Phyfics in An-- derfon’s Inftitution, Glafgow, gives the following ac¬ count of the benefit he has obferved from the oxygen¬ ated muriate of potaih, employed as a medicine. € I have for foriie years,’ he fays, c entertained an idea which I have repeatedly mentioned in my chemical leftures, that when a deficiency of oxygen occurs in the fyftem, that principle might be better fupplied by means of the oxygenated muriate of potafh, than by any other method with which we are acquainted.
‘ For fome time I had no opportunity of fubje<fring my theory to the teft of experiment. But, during the laft fu turner, a cafe fell in my way, which feemed to offer a fair opportunity of trying it.
c A lady in the north of England, aged about thirty-three years, of a delicate habit, had for feveral years been affeSted with fymptoms of fcurvy. Her gums bled frequently, and her fkin was covered with livid blotches and petcchim, fome of which were as large as the palm of the hand, or even larger ; while others did not much exceed in fize the point of a pin, Thefe appearances were always worft during the pe¬ riod of menftruation ; and the periodical difcharge was always very profufe. She complained of great coldnefs, and was at thofe times almoft incapable of the leaf; exertion. She naufeated her food, but had a great defire for frefli vegetables. Her countenance was very fallow, and her pulfe weak and feeble. — The complaint was always wor-fe in the autumn than at any other time of the year. She had tried a va¬ riety of remedies, without any permanent relief. Ve¬ getable
Duncans’ Annals of Medicine for 1797, 115
getable acids, and the elixir of vitriol, afforded fome alleviation of the complaint, and Ihe thought Ihe re¬ ceived fo much benefit from the ufe of the cold bath, that Ihe bathed almoft conftantly, both during fummer
and winter.
c I had for fome time intended to advife her to in- hale oxygen gas ; but as an apparatus for that purpofe could not ealily be procured, I determined to try the e thefts of the oxygenated muriate of potafh. She was direfted to take" three grains of it, four times a-day, in a little water. As this produced no uneafmefs, the dole was increafed to double that quantity. She foon found the fmaller fpots difappear, and the larger ones become lefs. Her ftrength became greater than for years ; her countenance grew much clearer,^ and ihe was able to take a good deal of exercife ; betides this, the mendrual difeharge was not, by any means, fo profufe. In thort, the efFefts produced by this fait exceeded my mod tanguine expectations ; and though fome of the fymptoms returned in fome degree, when tire had one day fatigued herfeif very much with walk¬ ing, yet I really hope, that, by means of this medi¬ cine/ the may be perfeftly rfttored to health. She has now begun to try the inhalation of oxygen gas, as well as the oxygenated muriate of potafh.
It is well known, that about feventy-five cubic inches of extremely pure oxygen gas may be pro¬ cured from an hundred grain's of this fait, by means of heat. The oxygen is fo loofely attached,, that. it is difengaged even by the light of the fun. It is rapid¬ ly difengaged, and combines with combudible fub- dances, as is evident from its detonation with fulphur ; which detonation is dill more violent with phofphorus. We may therefore conclude, it would be readily de~ compofed by the carbon and hydrogen in the blood, and would diminiih the quantity of thefe principles, or increafe the proportion of oxygen.
c As the oxygenated muriate of potafh has, in this country, been "hitherto prepared as a matter of curio-
iity
116 Duncans’ Annals of Medicine for 1797.
fity only, its price was very high.. But when I began to hope that it might be ufed in medicine, I requeued Mr. Hoyle, an ingenious bleacher and dyer in Man- chefter, to try if he could form it at the fame time that he prepared the bleaching liquor. He has fuc- ceeded perfectly, and can now fupply druggifts and apothecaries at a reafonable price.’
An account has been drawn up, and printed, of the women delivered, and children bom, in the Bri- tifh Lying-in Hofpital of London ; and alfo of the twins, ftill-births, and deaths, from the time of its inftitution, in November 1749, to the end of the year 1796. This account, wrhich, we are informed, is drawn up by Dr. Combe, Phyfician to the above inftitution, contains interefting information refpefting different particulars. It appears that the whole num¬ ber of women delivered, during that period, amounted to 24,079 ; that of thefe 281 had twins, fo that the number of children born amounted to 24,360; of thefe, 12,531 were boys, and 11,828 were girls; that 978 children were ftill-born ; that 766 died foon after birth ; and that 385 women died foon after de¬ livery,
‘ The proportion of deaths, both of the women and children, appears to have been much greater during the firft periods of the inftitution, than during the latter periods ; as is manifeft from the following ab« ftraft.
|
From 1749 to |
Death of |
worn. |
Death of chil. |
|||
|
1759, |
1 in |
42, |
1 |
in |
15. |
|
|
From 1759 to |
1769, |
1 in |
50, |
1 |
in |
.20. |
|
From 1769 to |
1779, |
1 in |
53, |
1 |
in |
42. |
|
From 1779 to |
1789, |
1 in |
60, |
1 |
in |
44. |
|
From 1789 to |
1797, |
1 in 304, |
1 |
in |
84. |
The following remarks of Mr. Benjamin Bell, of Edinburgh, occur in the fecond edition, lately pub¬ lished, of his Treatife on the Gonorrhasa Virulenta, and Lues Venerea. RefpeHing the ufe of the nitrous acid in fyphilitic complaints, Mr. Bell informs us.
Duncans’ Annals of Medicine for 1797. 117
that in every trial which he has made with this acid in the cure of fyphilis, it has completely and en¬ tirely failed ; infomuch that he is now clearly of opi¬ nion, that no dependence fhould be placed on it. And whether mercury has been given or not, it ap¬ pears to him to be equally inefficacious. The favour¬ able opinion which fome have been induced to form of the nitric acid, in the cure of fyphilis, Mr. Bell fuppofes to have arifen from chancres, and other fymptoms of the difeafe, having difappeared, while this acid was the only remedy employed for them. But from frequent opportunities for observation, he af- ferts, though contrary to the generally received opi¬ nion, that chancres, as well as fome other fymptoms of 1 ues venerea, will occafionally difappear, whether any remedy be employed for them or not. In fome inftances thefe will never recur again, as he has repeat¬ edly found to happen, even with nodes. But moft commonly, venereal fymptoms afterwards again ap¬ pear with more violence in fome other form.
This being the cafe, and the moft diftrefsful confe- quences having enfued in all the inftances in which he has known this acid to be depended upon for a cure, the difeafe having rapidly gained ground in all of them, by which much blame was thrown upon the praftitioner, for advifing what at beft muft be confi- dered as a very doubtful remedy, when another, which rarely or never fails, was in his power; Mr, Bell confiders it as hazardous and improper in any degree to truft to it. He is afraid that much mifchief is likely to enfue from the frequent trials which are now making with this acid, in many inftances, per¬ haps, without any dread of the failures which are likely to occur from it.
Mr. Bell has never found, that the nitric acid, whether given internally, or applied as a walk, has proved more ufeful in the cure of niters of any de- fcription, than the acid of vitriol, or the muriatic acid ; while none of them have a£ied with fuch certainty in
vol. v. K cleanfing
1 18 Saumarez’s New Syftem of Phyjiology.
cleanfing fores, and thus reducing them to a healing flate, as the different varieties of the vegetable acid,, whether common vinegar, lemon-juice, or the acid of forreh
Some other articles of inferior moment might have been noticed, had our limits permitted, The volume concludes, as ufual, with an account of deaths of eminent practitioners, and a lift of new books.
f \
*
< j
-Art* XIII. A New Syjlem of Phyfiology. By Richard Saumarez, Surgeon.
(Concluded from page 100.^
OUR account of the prefent wrork has been car¬ ried to a confiderable length : both becaufe of the extent and variety of the fubjeCf ; and becaufe it contains* in the manner of its execution, no inconfi- derable portion of originality.
The remainder of the firft part is occupied by an inquiry into the means by which individuals attain the final caufe of their exiftence : into the relation which man bears to the Deity • and that which the Deity bears to man.
In the fecond part of the work, the author treats of the organs, as the inftruments through which animat¬ ed beings fulfil the final caufe of their exiftence. The three firft chapters are employed in explaining the anatomical ftrufture of the vegetable fyftem ; its de- compofition, and death ; and the circumftances re- fpeCling vegetable temperature.
Chap. 4, treats of the mode of propagation in dif¬ ferent animal fyftems, from the moft fimple to the more complicated. In the lower order it is obferved to be more regular, and more extenfive, than in the higher.
• • . cThe
Saumarez’s New Syfiem of Phyjio logy , 119
The experiments of Mr. Cruikfhank and Dr. Haigh- ton * are adduced to prove that corpora lutea do not conditute the ted of impregnation, as thefe have been found to exid when it cannot have taken place, as where the fallopian tube has been previoufly divided. The oedrum, or excitement of the ovafia, which is the confequence, mud therefore be fuppofed adequate to occadon an evolution of the ova to a certain degree. In the amphibia and dfh it is fhewn that fexual inter- courfe is unnecedary ; whilft in quadrupeds, fecunda¬ tion can take place by that mean alone.
In the fifth chapter the peculiarities in the mode of generation in the kanguroo are pointed out : but thefe we have before noticed f.
The dxth chapter treats of the proximate caufe of cedrum, which is fuppofed to depend on a fenfe of Want in the generating organs* and does not take place till thefe are fully evolved. (Edrum exids in thofe fydems that have generative organs, but are def- titute of fexual, in a higher degree than in thofe fyf- tems that poflefs both.
The following chapters treat of the mode of pro¬ pagation in the human fpecies, of mendruation, and of the generating organs of the male. — This concludes the drd volume.
The fecond volume commences with an account of the procefs of evolution in the human foetus.- — Chap* 2. Of predifpqfition in general . The difference be¬ tween the foetal date and the adult confifts in this, that the diderent organs in the former are in a padive date, podeding only a capacity to act , and requiring proper fubjecfs on which that capacity may be ex¬ erted, and difplayed in the production of addion. It is this capacity of action, of the eye to fee, of the ear to hear, of the tongue to tafte, of the nerves to feel,
* See Med. Rev. vol. 4, pages 321, 332. f Ibid, vol. 3, page 193,
K 2
of
120 Saumarez’s New SijJiem of Phyjiology .
*
of the lungs to refpire, of the ftomach to digeft, &cf &c. which is denominated predifpojition. it is in this power which the fyftem altogether, or the different organs in particular feverally poffefs, either of operat- ing upon, or in refilling the operation of external fub- Itances, that the fyftem may be faid to poffefs a pre- difpofition to healths and fome conftitutions poffefs this in fo eminent a degree, that they pafs through the courfe of a long life in the undifturbed enjoyment of it. So long as the proper relation fubfifts, of power in the organs, and aptitude in the fubjeCt matter, health is preferved and difeafe prevented.
The power to aft therefore exifted before that power was abfolutely exerted, in the fame manner as the predifpofition to aft in the lungs, &c. exifted before action took place : it only took place when the fubjeCt matter (air) fitted for their aCtion was ap¬ plied ; and fo of the other organs. The power, •therefore, or capacity, is refident within. The means by which that power is called forth into energy comes from without s the refult of which is the production of organic action ,
The aCtion produced is not the "caufe of life, as has been erroneoufly fuppofed, but merely an effect of it. Life may and does fubfift. without organic aCtion, although organic aflion cannot fubfift without the exiftence of life. 4 Life had a prior exiftence to the organization, and organization itfelf to the action pro¬ duced. Life is the primary and efficient caufe, of which organization is the fecondary or inftrumental caufe ; and organic aCtion itfelf is the final caufe, which proceeds from the living power of the organs a Cling upon fubftances foreign to themfelves, when they poffefs a proper aptitude to be afted upon. So long as this relation continues to fubfift, of power in the organ, and aptitude in . the fubjeCt matter, the fyftem receives the fupply it perpetually demands ; the fenfation of health and of ftrength, fo delightful and agreeable, may be then faid to ex ill ; on the con¬ trary,
121
Saumarez’s New Syjtern of Phyfology.
trarv, when there Is a mal-conformation of the organs, or the fubjeft matter applied to them is either im¬ proper from excefs or defeft, or from the nature of its fenfible qualities, difeafe takes place/
On the lubje£I of predifpolition to difeafe, the author obferves, that fuch is the conltrudlion of all generated beings, that whilft their powers of prefer- vation and refiftance are limited, the celeterious caufes by which they may be affailed, are aim oil infinite both in number and power; fo that in the lull enjoyment of health and of ftrength, all are eonftantiv predihoof- ed to the operation of morbid caufes, by which difeafe is produced.
The fyftem is predifpofed to difeafe from accidents, becaufe the organization is not diffidently drong to refill the operation of the mechanical powers to which it is expofed, and by which it is often affailed. it is predifpofed to difeafe, from the operation of fubllances whofe powers do not refide fo much in their me¬ chanical as in their fpecific or chemical qualities, as the different fpecies of poifon, natural and morbid.— Finally, it is predifpofed to difeafe from the operation of the fenfible qualities of chemical bodies — of fire in a fenfible form, of lightning, of various caufdcs of an acid and of an alkaline nature.
The following obfervations occur on the Rrunonian doftrine of predifpolition. c It appears that Dr. John Brown’s ideas ot predifpofition were very different from thofe I have endeavoured to explain. Predif¬ pofition he defines to be tc a ft ate intermediate betwixt health and difeafe : the powers producing it are the fame with thofe that produce difeafe p. 59. This nonfenfe would be of itfelf perfectly, unintelligible, were it not for the imperfect explanation which the context affords. The context fays, that cc predifpo¬ fition arifes from the fame exciting powers ailing upon the fame excitability from which both health and difeafe arife, and is an intermediate Hate between both.” So far from this opinion being true, that a
K 2 llatt
122 Saumarez’s New Syflem of Phyjiology .
ftate of prfedifpofition arifes from the fame exciting powers addng upon the fame excitability from whence both health and difeafe arife, and is an intermediate Hate between both, that a date of predifpofition, pro¬ perly defined, can only exift before the exciting pow¬ ers have been applied, or before they have produced any addon upon the excitability. Predifpofition, as we have feen, really and truly exifts in the fetal ftate altogether ; it exifts in the collapfed lungs ; in the fetal ftomach before it has received any food ; in the organs of generation, and in various other parts. On the contrary, according to him (and, I may add, molt others alfo), at ftate of predifpofition is a ftate of pof - difpofition : it is predifpofition ended, and addon be¬ gun ; it is the origin of difeafe before the morbid ac¬ tions of the fyftem have had their full fwing. It evi¬ dently appears, that Dr. Brown had no knowledge whatever of the condition of the fetal ftate, of the ftate of predifpofition in which it then exifts 3 of the capacity of addng which it pofl'efies, and of the power by which addon is ultimately produced.
* In every fyftem whatever there is a tendency to evolution and health, before the tendency to difeafe and death. There is a period allotted to both : when perfeddon is attained, it ends, and the tendency to dififolution begins. It would be far otherwife, if life were the forced ftate he fuppofes 3 if it were true, “ that the tendency of animals every moment is to diffolution 3 that they are kept from it not by any powers in themf elves , but by foreign powers, and even by thefe with difficulty, and only for a time 3 and then, from the neceffity of their fate, they yield to death.” If life were the forced ftate he fuppofes it to be, the proper application of his exciting powers would perpetuate animal life ad infinitum : inftead of animals being forced to die, they would be forced to live 3 and he might as eafily refufcitate a dead animal by means of his ftimuli, as excite motion in a paffive top by the addon of a whip. The whip may be com¬ pared
Saumarez’s New Syftem of Phyjiology. 123
pared to his exciting powers ; the top to the fub fiance in which excitability refides ; and the motion pro¬ duced by the combined agency of the whip and top together, is exaftly analogous to excitement or life, which is forced and whipped out by the opera¬ tion of his exciting powers aCting on his excitability. It is very obvious indeed, that Dr. Brown grounded his fyftem upon the phenomena be beheld common matter difplay ; he faw excitement produced in the fyftem by the introduction of different fubftances of brandy, wine, &c. he therefore referred excitement to the brandy as its caufe, in the fame manner as the motion produced in the top by the action of the whip. Both cafes, however, are totally oppofite and diftinCt : in the one cafe, the top is totally paffive, and yields to the moving power which the whip communicates : in the other cafe, the animated fyftem conftitutes the power which acts upon the brandy ; the fyftem is the caufe exciting, the brandy, the thing excited upon ; and in this effort it is by which aCtion is produced.
* A neceffity evidently fubfifts, that the food intro¬ duced ftiould correfpond to the ftrength or weaknefH of the fyftem. In atonic difeafes, where the fpecific power of the aftimilating organs is extremely weak, the ordinary kinds of aliment become unfit to be in¬ troduced ; and we are obliged to refort to food that poffeffes the ftrongeft poffible aptitude to be aCted upon, in order that it may be digefted : inftead, there¬ fore, of giving folid, liquid food is preferred ; and we are taught by experience that fermented liquors and animal juices poffefs a ftronger aptitude to be afted upon by the ftomach than cold water, or acid or other fubftances of the fame clafs. In proportion, therefore, as the ftrength of the fyftem decreafes, the aptitude in the aliment ought to increafe : hence arifes the necef¬ fity of giving in the latter periods of low fevers wine and brandy, when every other fpecies of aliment is rejefted unaltered and undigefted.
K 4 ‘ It
/
124 Saumarez’s New Syflem of Fhyjiology .
c It is owing to the total confufion of ideas, to the total ignorance of phyfiological knowledge, that Dr, Brown, in the very onfet of his book, chap. i. art. 1. under the title of what he calls Explanations, but which are really and truly axioms, (hews himfelf ig¬ norant alfo of the difinftion that fubfiffs between medicine and diet. Expl. 1. “ Medicine is the fcience ofpreferving the good, and preventing and curing the ill health of animals.” This proportion, I maintain it, is falfe : the means by which the good health of animals is preferved, is not a fcience, neither does it belong to any branch of medical knowledge : it be¬ longs to the dietetic branch, arifing from experience alone, and in which men totally ignorant of medicine are perfectly converfant. This knowledge extends to the whole range of the brute and even vegetable creation, amongf which the fcience of medicine does not yet appear to have made any progrefs. On the contrary, the praftice of medicine is the art (not the fcience : our knowledge of its operation, and the fub- jeft on which it operates, is as yet too imperfect to bring it to any fcientific rule) by which difeafe is cured, and health refored ; and medicine itfelf is the mean bv which the end is attained,
j
c Although it is the fyfEm which in general pof- feffes the power by which health is preferved, and difeaie prevented, or difeafe cured after it aftually fubfiffs, there are various complaints which arife from the application of fpecific poifons, and which can only be cured by fuch remedies as have the fpecific power of uniting with and defraying the fenfible properties which thofe poifons po fiefs : — mercury for the lues, fulphur for the itch, & c. &c. Thefe remedies, like thofe poifons, are taken up into the blood, or aft upon the poifon in the part, and produce their bene¬ ficial effefts by eliminating and defraying the fenfible qualities thofe poifons contain. So totally defeftive, however, is the Brunonian fyfem, that it does not provide at all for the fpecific aftion of fpecific poifons :
the *
Saumarez’s New Syftem of Phyjio logy. 125
the author, therefore, gets rid of the fubjeft thus, p. 63. “ The only cure for poifons is their early difcharge from the fyftem ; and if, as often happens, others, by wounding an organ neceffary to lire, are fatal, the effefts of both are foreign from our prefent purpofe, and ought to be referred to local difeafes.” Aware of the deleterious effects which poifons produce, he confequently recommends their early difcharge from the fyftem : he, notwithftanding this acknowledgment, fays, <c that it is excitement atone through its varying degrees , that produces either health , difeafe , or reco¬ very ; it alone governs both univerfal arid local difeafes , neither of which ever arife from faults in the fo lids or fluids , but always either from increafed or diminijhtd excitement : hence the cure is never to be directed to the fate of the fo lids or fluids, but only to the dimi¬ nution or the increaje of excitement” p. 50.
c Thus, then, has Dr. Brown, with one ftroke of his pen, deftroyed the diftindtion that the wifeft and bell Phyfiologifts have ever made, of difeafes that were merely accompanied by an increafe or decreafe of the action, either of particular parts, or of the fyf¬ tem altogether, from thofe that were accompanied, not merely by an adtion too high or too low, but where the action was totally altered from the healthy ftate, conftituting a certain peculiarity in the nature of the difeafe itfelf, known by the appellation of 'fpecific. Thefe fpecific difeafes evidently arife from the fpecific quality and adtive powers of the poifon, and the weak- nefs of the fyftem in refifting their operation. When thefe poifons therefore produce their effects upon the fyftem, fometimes deftroying its adtion in a few hours, or in a few moments, they ought, in fuch cafes, to be called fedatives. Shall it be denied, when the ftrongeft men are fuddenly deftroyed by the inhalation of a few draughts of mephitic gas, that the operation of it is not diredtly fedative ? When the poifon of the ti~ cunas, of lauro-cerafus, and efpecially of different ferpents, which Dr. Ruffel, in his late molt fplendid
work.
3 26 Saumarez's New Syfiem of Phyfiology.
work, has decidedly proved, deftroy different animals in twenty or thirty minutes, without producing, in many inftances, any fenfible aft ion from the time the poifon is received, to the diffolution of the animal,- — Shall it be pretended that death is not produced by a fedative effeft upon the fyftem ? It required the ar¬ rogance of Dr. Brown himfelf to deny the'exiftence of fe datives,' — to deny the fpecific mode of their ope¬ ration, — to deny the fpecific nature of the difeafe they produce, or that the matter which is in confequence evolved, is capable of producing the fame poifon upon another fubjeft. Thus it is we have the poifon of plague producing plague, but not fmall-pox ; the poifon of final! pox producing fmall-pox, but not mealies-; the poifon of the itch producing the itch, but not Syphilis. But, according to the Brunonian Syfiem, all thefe fubffances are one and the fame in their nature : the only difference there is between them, confifts in the different degrees of flimulant properties they poffefs, and in the different proportion of excitement they produce ; fo that the pox and the itch, typhus fever, and the plague, &c. &c. may be cured by the fame means, the nature of the ftimulus alone varying in degree. It might indeed be further Hated, that the caufe producing the difeafe, and the medicine effecting the cure, are, according to him, in their nature, one and the feme ; the only difference between them confining in the degree of ftimulating power they Severally poffefs. Hence he fays, that “ whether the matter of contagion act by a flimulant or a debilitating operation, its operation is the fame with that of the ordinary power , that is to fay, the caufe of difeafe is the fame ; and if, as Sometimes happens, no general affeftion follows the application of contagion ; if no undue excefs or defect: of excite¬ ment is the confequence, the affeftion is altogether local, and foreign to this place.” So far from the affertion being true, that the operation of morbid poifons on the fyftem arifes from the ftimulus they
produce.
Saumarez’s New Syjlem of Phyjiology. 127
produce, being merely in excels or clefeft ; and that the effeCt produced on the fyftem is the fame in kind as the nature of the caufe, whether it be above or below par $ fo that an high ftimulus (hall produce in- creafed excitement, and a low ftimulus a weak degree of it, it is often totally otherwife.
‘ If this were the cafe, the atonic fymptoms, in atonic difeafes, ought to manifeft themfelves more eminently after the poifon has been applied * at the time when it was in the plenitude of its power, adting upon the excitability in the aggregate, without abate¬ ment or divifion, than it is found to do at the latter period of the difeafe. If this were true, the fymp¬ toms of debility, of putrefadiion, and of death itfelf, ought to manifeft themfelves as foon as this imperfect ftimulus is received. Thefe atonic fymptoms ought progreffively to go off, in proportion as the effefts are abated by the introduction of adequate ftimuli, and the poifon itfelf weakened by divifion and feparation. If this were the cafe, typhus fever would invariably begin with fymptoms of putrefaction, and terminate with thofe of inflammation ; inftead of the difeafe be¬ ginning, as it frequently does, with fymptoms of in¬ flammation, and terminating with thofe of putrefac¬ tion. It certainly is within tile knowledge of raoft practitioners, that fome of the worft fpecies of typhus frequently qpme on with fymptoms of ftrong and in- creafed aCtion, which demand a ftrift antiphlogiftic diet : any other regimen only tends to hurry on the fymptoms of inflammation, to induce local determina¬ tions, either to the head, in producing phrenitis ; to the lungs, in producing peripneumonia ; or to the in- teftines efpecially, in producing enteritis. It is only at the latter period of the fever, that the real fymp¬ toms manifeft themfelves, when one and the fame poifon which produced inflammation at flrfr, is the remote caufe of inducing at laft the ftate of putrefac¬ tion.
< The
128 Saumarez's New Sijftem of Phyjiology. *
c The beft praflitioners that have written on the plague, recommend bleeding and early evacuation as the moil effectual means of cure ; and it is now found, by the general teftimony of the French phylicians who have long refided in the Well Indies, and by our own furgeons at this time, that if bleeding and evacuations are immediately employed on the very firft onfet of the yellow fever, the patient generally recovers; and it is found that the admimftration of mercury itfelf, fo as to produce ptyalifm, feerns to have almoft a fpecific ef- left in operating a cure. To expatiate oil the cala¬ mities which this pernicious Brunonian do&rine has produced in its application to practice, will not fatisfy the humanity it has offended : it will not reftore the children to the parent, the parent to his children, and a multitude of brave and deferving fubjefts to their country ; thoufands, and tens of thoufands, have fallen victims to it. The yellow fever, in the Weft Indies, amongft the Englilh, was called bv the native French furgeons the brandy and madeira fever, from the quantity of fpirituous liquors that were adminis¬ tered. W hi I ft our brave foldiers uniformly died by this mode, the French, by adopting the antiphlogiftic plan in the ftriCteft poffible degree, generally reco~ vexed.
‘ Equally falfe are his opinions with refpeft to the different dates of excitement that often exift in dif¬ ferent parts of the fame fydem : it is notorious to every man of common obfervation, that enteritis and phrenitis frequently come on, and are attendant on typhus fever; and the author of thefe pages can fay with confidence and truth, that he has been the means of faving the life of feveral patients, by taking blood from the temporal artery, at a time when there was a brown tongue, a quick pulfe, and the other fymp- toms of low fever. On the contrary. Dr. Brown thought, p. 44, “ that every a flection of a part, that occurs in general difeafes, however formidable, is to be confidered only as a part of the affection inherent
in
r ' *
1
Saumarez’s New Syfiem oj Phyfiology . V2S
■ in the whole body, and the remedies are not to be direfted to a part, as if the whole d if cafe lurked there, and was only to be removed thence ; but to the whole body, all which it affefts.”
The next chapter is on the fubjeft of the blood. Inftead of acceding to the opinion of Mr. Hunter, that the coagulation of the blood arofe from an exer¬ tion of the living power which it contained, fmiilar to the contraftion of a mufcle, the author fuppofes it to proceed from a diminution or deprivation of life ; that it is an aft of dying, or of death itfelf.
Chap. 4. On infpiration. Before parturition, the different organs of fenfe and fenfation are in a paf* five ftate, owin£ to the harmony that fubhfts between
O m ft
them and the medium in which they are placed. After parturition, the irritation they fufiain from ex¬ ternal caufes excites them to aft. Thus, the mufcles of refpiration are thrown into aftion, the internal ca¬ pacity of the chefl is enlarged, the mouth is opened by the mufcles of the face, and the air rufhes into the lungs through the medium of the trachea. And thus infpiration is firfl performed. The effefts of air on the blood are next inveftigated.
Chap . 5, treats of the means by which the blood is diflributed from the lungs to the different parts of the fyffem ; of the arterial fyftem 5 of the brain and nerves ; and of mufcular motion.
Chap. 6, of the Linnzean claffification of the animal kingdom.
Chap. 7, and following ones, treat of the means by which the blood is fupplied from the wafte it fuflains: the different fpecies of aliment that are employed by different animated fyftems pointed out; the organs of rnanducation and digeftion defcribed.
Refpefting the ufe of the fpleen, a point which has hitherto puzzled all anatomifts, the author has a pe¬ culiar notion. He fuppofes it to be fubfervient to di- gefiion in this way. When the ftomach becomes dis¬ tended
/
ISO Saumarez’s New Syjlem of Pho/io login
tended by a full meal, the left or great curvature be* comes approximated to the fpleen, on which it pro¬ duces a confiderable degree of compreffion, although it is too remote to produce fuch an effeft when empty. This preflfure on the fpleen tends to diminifh the ca¬ pacity of the vefiels with which it is fupplied, and an accumulation takes place in the fplenic trunks. The blood confequently flows into other channels through which it can obtain admiffion. Tbefe channels con- fill: in the larger branches which the fplenic trunk gives to the ftomach, called gaftrica finiftra, through the five fmaller branches called vafa brevia, and through the feveral branches which the fplenic artery diftributes to the pancreas.
The increafed quantity of blood which thefe organs in confequence receive, enables them to fecrete a larger proportion of the gaftric and pancreatic juice, at a time when the diftenfion which the ftomach fuf- tains from the plenitude of food renders the fupply of gaftric juice more effentially necefiary, or when the accumulation of chyme in the duodenum demands a more abundant quantity of pancreatic.— Such is the hypothefis of the author on this obfcure queftion. To us, we confefs, it appears too mechanical.
Mr. Saumarez next treats of the powers by which chyle is abforbed, and blood fupplied : viz. the lac¬ teal and lymphatic abforbent vefiels. A criticifm here occurs on the late Mr. Hunter, which is cer¬ tainly ill-founded. From the changes in magnitude and form in many parts, which are taking place dur¬ ing the growth of the fyftem, and which changes are e fiddled by the power of the abforbing vefiels, Mr. Hunter called thefe the modellers of the fyftem. — But Mr. Saumarez, from finding them deftined to remove dead and fuperfluous parts, will not allow them any fhare in perfecting the form of the body. Mr. Hunter certainly did not fuppofe, as Mr. Sau¬ marez imagines, that the abforbents laid the enamell¬ ed
Saumarez’s New Syfiem of Phyfiology . 181
td far face of the teeth ; it is diffident that they ffiould be able to remove irregularities, to produce ultimately the fame effeft. A model may furely be perfected as well by fubtradion, as by addition of parts : whence otherwise the art of the fculptor r
Refpe&ing the produdion of animal heat, the au¬ thor obferves, that in proportion as the blood changes from a pure and healthy Hate, to an impure and a difeafed one ; in proportion as the florid colour of the blood decreafes, and the black colour increafes, it appears from experiment there is a progreiiive in- creafe of fenfible heat, fo that the blood in the right fide of the heart is much hotter than the blood on the left. ‘ If the caufe of animal heat depended, as is generally fuppofed, on the quantity of caloric that is abforbed, the temperature of the fyftem at the period of manhood, would be far lower than it is found to be - during the period of infancy ; becaufe the compara¬ tive magnitude of the lungs in particular, with refped to the lize of the fyftem altogether, is much lefs in the one than it is in the other. In infancy, the lungs have attained their fqlnefs of growth, when the fyf¬ tem is not half evolved. Great therefore muft be the quantity of caloric feparated and abforbed. How immenfely high then ought to be the temperature of the infant frame ! And finally, that animal heat does not altogether depend on the quantity of caloric which is abforbed by the lungs, is further proved by fafts which every praftitioner muft often have beheld —of the continued and exceffive quantities of fenfible heat which are evolved from different patients labour¬ ing under phthifis pulmonalis, at thole times, when the difeafe of the lungs muft weaken, or altogether bereave them of the powrer of .aft-in g. I have feen a fcorching and a burning heat iffue from the furface of the (kin of thofe, whofe lungs,, after death, I have found eroded and alrnoft totally wafted, the bronchia jffienffelves plugged up and abounding with purulent
matter.
132 Saumarez’s New Syjlem of Phyfiology.
*
matter, and when the quantity of caloric abforbed mu ft confequently have been very fmall. So far in¬ deed is the abforption of caloric from producing heat in the part by which it is received, that it tends to abate the temperature of the blood. It produces, it is true, an increafe of fluidity and a melioration of colour. It changes blood from a coagulating or ropy confidence to a fluid one, — from a black to a florid colour, and from a higher degree of heat to a lower one.
4 If the lungs were the immediate agents by which animal heat was produced, and the production of animal zvarmth the final caufe of their aftion, the effefts would be immediately rendered fenfible by the temperature of the blood by which that warmth was received ; fo that the blood of the pulmonary veins* inftead of being cooler, would be much hotter than the blood in the pulmonary artery. We may there¬ fore conclude, that the atmofpheric matter which the* blood immediately receives through the medium of the lungs* does not aft by the production of fenfible heat (or warmth), but by meliorating the quality of the blood, efpecially with refpeft to fluidity and colour, — conditions of the blood which are known to be molt favourable for its ufe.
f That the lungs are not the immediate fources of animal heat, is further proved from the low tempera¬ ture of the blood of thofe who infpired air of a de¬ gree of temperature far exceeding the heat of the blood/
Animal heat, therefore, arifes, in the author’s opi¬ nion, from a ftate of decompofition which takes place between the dying parts of a living animal; and the decompofition which the blood has fuftained, is the caufe why there are two degrees of difference in the temperature of the good and of the bad blopd, — between that which proceeds from the lungs, and that which returns to them ; between that which is
florid!
Saumarez’s New Syjlem of Phyjio logy « 133
florid and fluid, and that which is black and has a tendency to coagulate.
The author is next led to conflder the means by which this carbonaceous and other matter, the pro du£t of the animal combuftion, are expelled the fyl tern ; viz. the different excretory organs of the body as the kidneys, the exhalant veffels of the fkin, and thofe of the lungs.
It is almofi: univerfally fuppofed, that the diaphragm is a principal organ of infpiration. Mr. Saumarez, however, maintains a very different opinion. e The natural condition of the diaphragm,’ he obferves, c is to be convex towards the lungs, and concave towards the abdomen, as it is found to be in the foetal date.
c On the contrary, in the adult date, when infpira¬ tion has taken place, it is forced from this relaxed condition, by the didendon which the lungs fudain from the air they receive ; fo that its mufcular fibres contraft, and by thefe means it becomes altered from a curve upwards to a plane. As foon, however, as this air becomes diminilhed, either from abforption, or from the lofs of its elafticity, the didenfion which the bronchice had fudained progreffively goes off, the diaphragm returns into its original date, and, in this a£t, the internal capacity of the thorax is diminifned in a longitudinal direction.
c The action which the diaphragm performs feems to be independent of the will, and goes on during deep as perfeSily as during a date of watchfulnefs. The diaphragm appears to be an organ not neceffary to the procefs of infpiration, but of expiration only* In its natural date it mud ever impede the procefs of infpiration ; and it is only by the impetus of the air when it ruflies into the bronchiae from without, that this natural condition of the diaphragm is overcome^ a contraction of its mufcular fibres produced, and the longitudinal direction of the thorax confequently en¬ larged.’
If this were the faCt, we may afk, of what ufe is the drong mufcular druCture of the diaphragm? Does vol. v, L it
r
134 Fordyce’s Third Differ tation on Fever .
it ever, in the deeped inspiration, attain a plane fur- face ? It appears evident, even to demonilration, that its contraction can have no other effeCt, than that of ipcreafing the diameter of the thorax longitudinally,
\ i
The living fyftem has now been traced from its cm- bryon date to that of its final termination, or death. The means by which this is naturally produced con- fid in the action of the excretory organs being dronger than that of the incretory. The mode of the bodies’ fubfidence on things from without, continues for the moft part the fame. The aCtions of the different or¬ gans which are more immediately fubfervient to the evolution and prefervation of the fyffem, lofe the energy they poffeffed : whild, on the contrary, the actions of the excretory organs in general continue in full force. It is by the weaknefs of the one, and power of the other, that natural death is produced.
Three chapters are added, which conclude the work, and in which the author treats of matter, and its different combinations and arrangements, as forming the various fpecies which we behold around us. But we cannot follow him here.
Art. XIV. A Third Differtation on Fever. Part I. Containing the lliftory and Method of Treatment of a regular continued Fever , Juppofing it is left to purfue its ordinary courfe. By George For- dyce, M D. F R S. Senior Phyfician to St. Tho¬ mas's Hofpital , &c. OCtavo, 260 pages, price 4s. London, 1798. Johnson.
A CONSIDERABLE interval has elapfed fince the appearance of the author's Fird and Second Diilertations on Fever,* and we fhould be difpofed to augur ill of the continuation and conclufion of the
* See Med. Rev. vol. 2, page 426.
work,
Fordyce*s Third Dijertation on Fever . 135
work, had we not reafon to know, that the matter* of which they will be competed, is in much forward- nefs, wanting little more than arrangement to prepare it for the prefs. We fhould deem it a ferious iofs to the public, to be deprived of any part of the valuable obfervations of Dr. Fordyce, on a fubje£t which, for a great number of years, has engaged his clofe and unremitting attention. Theories of fever are daily fhooting forth from the hot-beds of imagination. And they betray all the luxuriancy and all the weaknefs of fuch produ£tions. Whilfl the obfervations before us* founded as they are on nature and experience alone* mud, and will, hand the tell of ages.
The author’s firft object in the prefent differtation is, to diftinguilh a regular continued fever from other difeafes with which it has frequently been confound¬ ed. A fever which continues for three, four, five weeks, or even longer, without any marked crifis, and afterwards goes off by degrees, one critical fymptom happening after another, is only, in the author’s opi¬ nion, a repetition of ephemerae or fingle paroxyfms of fever, where the fubfequent paroxyfm begins before the crifis of the former has begun to take place.
One criterion of a regular continued fever is, that it encreafes for a certain time from its beginning, re¬ mains for fome time in its greateft degree or acme, then, without any apparent caufe, gradually dimi- niffies and terminates in health. Or otherwife, a crifis takes place during its progrefs, and carries off the difeafe ; or the crifis converts it into an inter¬ mittent ; or in its progrefs it produces topical inflam¬ mation ; or kills the patient. Any difeafe, not having thefe properties, is not a regular continued fever.
The tendency to go off fpontaneoufly, though not peculiar to fever, yet ferves to diftinguifh it from heftic fever, and fome other affections. HeCtic agrees with regular continued fever, in fometimes arifing without apparent caufe ; but it commonly arifes from, and is kept up by the conffant application of an ap-
L 2 parent
]S 6 Forclyce's 'Third Dijfertation on Fever .
parent caufe. It wants tills effential property of re* gular fever, that where it does not arife from an ap¬ parent caufe, and often when its caufe is removed, it has no difpofition to go off’ of itfelf, but remains until it deftroys the patient.
That affeftion of the fyftem which attends phleg¬ monous inflammation has commonly been termed
J
fever, but improperly, in the author’s opinion. It differs from fever in being kept up by a conffant ap¬ parent caufe, with which it like wife goes off. Similar appearances take place in rheumatifm, and gout, but depend entirely upon their apparent caufe.
Should eryffpelatous inflammation arife on the lkin,_it often happens, after the inflammation has taken place, that the pujfe becomes frequent to 120 ffrokes in a minute or upwards ; the ftrength of the patient is univerfally depreffed, there is head-ach, foulnefs of the tongue, lofs of appetite, naufea ; the fenfe of heat is very much increafed, as alfo the de¬ gree of heat to 100°, or 103°, or 104°; there is dry- nefs of the fkin, and obftruftion of the pulfe. Thefe fymptoms are all very much increafed in the evening; and there is fome degree of relaxation of them in the morning. This difeafe is extremely ffinilar to fever, yet it is to be excluded from that difeafe by its total dependance upon its caufe, the eryfipelatous inflam¬ mation of the fkin ; for if that be removed by applb * cation of alkohol, diluted with water, to the inflamed part only, all thefe affections of the fyftem generally go off.
Should an eryfipelatous inflammation arife in the., throat, producing whitiffi Houghs in it, limilar fympr- toms appear in the fyftem ; but if the inflammation be carried off by the exhibition of large quantities of the bark of the cinchona, and the whitiffi Houghs be made to fall off, fo that all difeafe fliall be removed from the mucous membrane of the throat, the affedlion offthe fyftem generally ceafes. This affection of the fyftem, therefore, cannot be ranked among fevers, according
to
Fordyce’s Third Differtation on Fever . 137
to the rule, which excludes from fevers diieafes de¬ pending on the conftant application of their came.
Should phlegmonous inflammation take^ place in any part of the duodenum, jejunum or ilium ; and after the inflammation has taken place, as [hewn ny the pain, if the ftreng.th be greatly depreifed, if the pulfe fhould become hard, frequent to 120 ftrokes in a minute or. upwards, and much contracted ; if there fhould be a thick brown fur upon the tongue, great fenfe of heat, head-ach, palenefs, and contraction of the Ik in, naulea and vomiting ; if there fhould even be delirium ; let the inflammation of the inteftines be^ cured by copious bleeding from the arm and fkin of the abdomen, by the application of fedative and re¬ laxing fomentations to the abdomen ; all thefe fymp- toms 'in the fyftem generally will fubfide and go oh, and therefore cannot form a difeafe which ought to be included in the clafs of fevers.
One objedl in view, the author obferves, in laying down the above diflindtions, is to difcriminate be¬ tween difeafe s where it is only neceflaiy to remove their caufe to cure the patient, and thofe where other circumftances of the dueate are of moment. Thus in phlegmonous inflammation it is fufficient in general to attend to the local difeafe. The affedtion of the fyftem, indeed, or general inflammation, is fometimes fo great as to endanger the patient, and in this cafe requires attention; but the means of relief are for the molt part the fame as for the topical difeafe, and to¬ tally different from thofe that fhould be employed to take off fever.
An important remark occurs here on the fubjedl of rheumatifm. When it was the pradlice to bleed largely in acute rheumatifm, metaftafis frequently took place to the interior parts of the body, and deftroyed the patient. This accident in the author’s pra&ice during the laft fifteen years has rarely hap¬ pened. In this period he has entirely left off bleed¬ ing in acute rheumatifm, and has not loit above two
L 3 or
138
Fordyce’s Third Dijfertaiion on 'Fever .
or three patients, although he has treated feveral hundreds in this difeafe.
Continued fevers fometimes begin at once exa£t- ly with the fame fymptoms as an ephemera. At times, however, there arifes immediately upon applh cation of the caufe of difeafe, particularly if it fhould be expofure to cold, putrefaction, or infection, fome derangement of the fyftem, but no complete paroxyfm of fever. Thefe derangements confift of languor, the patient’s feeling himfelf not perfectly well, and being unable to exert the powers of his body or his mind, whether for bufmefs or amufement, lb perfectly as when in abfolute health. Sometimes his deep is dif- turbed ; he does not go to deep readily ; his deep during the night is broken, and he is not refrefhed fo much as ufuab It happens fometimes that thefe fymptoms go off in a few days ; fometimes they all at once increafe very confiderably, and form a paroxyfm, which is the beginning of the fever.
When a continued fever is produced, fometimes when the caufe of the difeafe is applied, there is not the lead appearance of fever, or any apparent altera¬ tion from health for many days, until all at once a complete paroxyfm of fever comes on. Sometimes, when the caufe of lever is applied, fome dight febrile appearances take place, and continue till a perfeCt at¬ tack of fever arifes, which comes on at once, and its fird paroxyfm is eafily afcertained ; now and then they gradually diminidr and go off, without any permanent fever arifing, When fuch dighter febrile fymptoms take place, they do not increafe gradually, fo as to conditute a fever, but the patient goes on with his ordinary occupations ; not well indeed, but not fo as to be confined, until all at once a paroxyfm, fuch as has been defcribed in the diflertation on the ephemera fimplex, takes place, fo that the patient can almoft always mark the very hour in which the attack comes on, Sometimes a complete paroxyfm of fever is pro* duced immediately upon application of the caufe*
If
Fordyce’s Third DiJJertation on Fever . 139
If none of the fymptoms of fever happen between the time of the application of the caufe and that of the firft paroxyfm, a itrong attack takes place at once, and begins often with a fenfe of coldnefs, horror, and rigour; the cold is followed by a fenfation of heat, which is fucceeded again by a fenfe of coldnefs, and fo alternately for the firft twenty-four hours. Some¬ times there is no fenfe of coldnefs, but the patient feels from the beginning very hot. Whether there be a fenfe of coldnefs or a fenfe of heat, the thermo¬ meter under the tongue rifes to about one hundred, or from that to one hundred and five degrees of Fah¬ renheit’s fcale, excepting at the very firft beginning of the attack. Whether there be fenfe of cold or of heat, there is always great depreffion of ftrength, both in the powers of the body and the mind, which is generally according to the degree of fever, fometimes fo great as to render the patient unable to fupport himfelf in an ereft pofture ; fometimes not fo con- liderable as to prevent him from doing his ordinary bufinefs, if he makes extraordinary exertions.
It has unluckily often happened, that phyficians have been too apt to go on attending their patients for a day or two after a paroxyfm has adlually taken place, and unfortunately have been by that means fo exhaufted, as not to be able to go through the remain¬ ing part of the difeafe, but have been cut off.
The depreffion of ftrength is in all degrees, be¬ tween thefe extremes. The pulfe, during the firft twenty-four hours, beats feldom lefs than ninety times in a minute, and very feldom more than one hundred and five in a minute ; whereas in an ephe¬ mera, or in the firft paroxyfm of an intermittent, it very often rifes to one hundred and twenty or thirty pulfations. It is fometimes full and ftrong, always obftrufted, fometimes fmall and particularly foft, fome¬ times of the natural fulnefs, but with a particular de¬ gree of foftnefs ; when this is the cafe, it indicates a
L 4 ' fever
140 Fordyce’s Third Differtation on Fever .
fever which will be very violent, efpecially in refpeSt to the depreffion of ftrength.
The author gives the following explanation of his terms with regard, to the pulfe. 4 Great numbers of practitioners/ he obferves, 4 have called obftruftion hardnefs, freedom foftnefs of the pulfe.
4 The feelings of the organs of the fenfes are often different in different men. The ear, for example, of one perfon, can diftinguifh accurately the different notes on the mufical fcale ; the ear of another can diftinguifh nothing but that the found is louder or lefs loud. In like manner, the fingers of fome are only capable of diftinguifhing whether the pulfe is more or lefs frequent, and that by comparing it w7ith fome other meafure of time. It is neceffary, therefore, that we fhould have fome other criterion of the differences of pulfation than the feel of the practitioner, in order to be able to teach young practitioners how to dis¬ cover if they have any power of feeling different fen- fations, and diftinguifhing them.
4 When the pulfe is hard, whether it be ftrong or not, the blood is long in coagulating ; the confequence of which is, that if the blood flow from a vein in a large ftrearn through the air, into a veftel nearly the feCfion of a fphere, the red particles will fall down towards the bottom of the blood, and leave the upper furface of the coagulum colourlefs after the blood has coagulated ; whereas if the pulfe be ftrong, without any hardnefs, the blood will coagulate much fooner under the fame circumftances, fo as not to give time for the red particles to fall clown from the upper fur- face of the coagulum, which will therefore be red.
4 In like manner, if the pulfe be obftruCfed and not hard, the coagulum will be red on the upper furface.
4 This then is a criterion by which ftrength and obftruCfion may be diftinguifhed from hardnefs, viz. when the pulfe ms hard, the upper furface of the coagulum is not red,
4 It
Fordyce’s Third Differ tuition on Fever. 141
c It is neceffary that the praftitioner thould make himfelf mafter of the feel of the pulfation under thefe different circumftances. r. This may be done by feeling the pulfe of a patient affe&ed with an intermittent, in which there is often ftrength, fulnefs, and obftruflion, but no hardnefs, and in which cafe a quantity of blood may be taken away without any detriment to the patient ; and again, in a pleurify, where there is ftrength and hardnefs, and in which blood is taken away with great propriety,
‘ By thefe means any man with the faculty of feel¬ ing, fo as to diftinguifh the different fenfations arifing from pulfations, may make himfelf mafter of the dif¬ ference between hardnefs and ftrength, or obftru&ion, which, as will be fhewn afterwards, is very effential in the management of fever, obftruftion being an ef- fential fymptom of fever. Hardnefs is an irregularity, and confequently is to be referred to that treatife, in which irregular fevers are to be confideredd
The caufes which reproduce fever are apparently two, one that reproduces a remittent and intermittent fever at the expiration of a certain period of time 5 1 the other the natural evening paroxyfm, or that change in the fyflem which may be obferved in health to take place between five and fix o’clock in the evening, as quicknefs of pulfe and deprefhon of ftrength : it is this which reproduces a continued fever : both of thefe, as far as the fcience of medicine has hitherto been inveftigated, are perfeftly incompre- ■henfible.
Thefe different caufes ferve to diftinguifh between an intermittent and remittent on the one hand, and a continued fever on the other. For if we find, in the fir ft days of a fever, when there is no perfetf in- termiftion, that the exacerbation takes place between five and fix o’clock in the evening, or a little later, we may conclude that the difeafe is a continued fever; but if the exacerbations take place at any other time
in
142 Fordyee’s Third Differ tail on on Fever.
in the twenty four hours, that it will terminate in an intermittent or remittent fever.
The firft paroxyfrn of a continued fever is irregular, with a greater or lefs degree of violence, feldom, how¬ ever, fo violent as the fubfequent paroxyfrn. The fecond paroxyfrn is generally regular. The third pa- roxyfm is more fevere than the fecond, and fo every evening the difeafe continues to increafe for the firft week.
Sir John Pringle and many other practitioners, being attracted by the appearance of putrefaction which takes place in fevers where the ftrength is greatly depreflfed, have fuppofed that the difeafe de¬ pends on putrefaCtion of the fluids, and not the pu¬ trefaCtion of the fluids upon the difeafe. It appears to the author in a very different light. If the putre¬ faction of the fluids is fubfequent to the depreflion of ftrength, and if a certain degree of depreflion of ftrength takes place in all fevers, in that cafe certainly the putrefaftion of the fluids cannot be confidered either as the eifeCt of putrefaCtion, but as the effeCts of depreflion of ftrength.
The following are given by the author as figns denoting what has been called putrid fever. c The fymptoms of putrefaCtion, when they firft take place* are alterations in the appearance ol the fecretions. The urine firft has a more vifeid appearance than common; is frothy, browner, and not abfolutely tranf- parent, although there is no cloud or fediment. If the putrefaCtion is (till greater, it becomes of a dark brown, and lofes its tranfparency, and fometimes a dark brown fediment falls to the bottom of the vefFel, after it has flood an hour or twTo. The faeces begin to be foetid, and at laft have a very putrid fee tor, which, however, is to be diftinguilhed from the foe- tor of the inflammable air, which is often difeharged, and is very foetid, although there be no putrefac¬ tion. The foeces are alfo not uncommonly black and liquid. The fweafc, if there fhould be any, tinges the
s linen
143
Fordyce’s Third Differtation on Fever .
linen with a dilute ichorous appearance. The cruft which forms upon the tongue appears browner and more clammy • as the fever goes on it grows browner and browner, until at laft it is quite black; the teeth* rubbing it off from the tongue, become as it were buried in a black ffime ; this hardly takes place be¬ fore the end of the firft week of the difeafe; the breath alfo becomes foetid.
There fometimes appears upon the fkin, but not excepting the putrefaction has arifen to a confiderable degree, a kind of difcoiouration, fimilar to the ap¬ pearances which we find in polifhed marble, not purely white, which are called bluffi veins. When the degree of putrefaction is more confiderable, dark purple fpots, of various fizes, are formed in the fkin j if the putrefaftion be ftill more confiderable, the fkin becomes all over of a dark purple colour.
€ At the beginning, when the putretaCtion has not gone to any great length, if blood fhould have hap¬ pened to hate been taken from the arm, the coagu- lum is loofe and eafily broken, the ferum being hardly of a browner colour than common. Sometimes when the depreffion of ftrength is not very great, the blood retains this appearance during the whole courfe of the difeafe. Should the patient become fo weak, as to be carried off by the weaknefs, this appearance is not altered, for it is depreffion of ftrength, not weaknefs, which produces putrefaftion.
c If there is greater depreffion of ftrength, and by confequence putrefaftion is in a greater degree, the ferum becomes of a browner colour. In a ftill fur¬ ther degree it is red : in this cafe, on examining the red particles with a microfcope, many of them are found diminiffied in fize, and not regular fpheres, or oblate fpheroids; fome have the appearance of being broken in two, and look like half moons : but moft of them retain their healthy appearance. If the putrefaftion goes on ftill further, there is hardly any diftinftion between ferum and coagulum,; if ftill fur¬ ther, the coagulable lymph forms a kind of bag,
leaving
144 Fordyce’s Third Difleriation on Fever.
leaving the ferum on the outfide diftinCt. In the fubftance oi the bag itfelf, there is no intermixture of red particles, fo that it looks like the buff, which is on the furface of the coaguhim in cafes of general inflammation; but within this bag a red fluid is con¬ tained, which,’ upon being examined with a micro- fcope, fhew s the red particles of a variety of forms.
e All thefe appearances the author has feen. There are feme cafes upon record in which it is ftated, that the blood was abfolutely foetid ; and a practitioner of perfect credit, who praCtffied a confiderable time in hot climates, told me he had feen feveral cafes, where the blood taken from the arm was actually foetid.
c As depreffion of ftrength produces putrefaCtion of the fluids, fo, on the other hand, putrefaCtion of the fluids. occafions greater depreffion of flrength, fome- times in a degree that proves fatal : in this cafe the pulfe often towards the end beats tatter than can be counted.
4 It happens more frequently that hemorrhage arifes, almoft indiferiminately, from any of the cavi¬ ties which open externally: thefe hemorrhages are very dangerous, and often fatal.’
c At particular times it is very rare that any great mark of putrefaCtion takes place ; at other times it is more frequent. It was common enough in Lon¬ don, from one thoufand feven hundred and fifty, to one thoufand feven hundred and lixty-five; from that time the feverer fymptoms of putrefaCtion have been feldomer feen ; and from one thoufand feven hundred and feventy-five to this period, one thoufand feven hundred and ninety-feven, they have been very rarely feen indeed in fevers,’
Among the fymptoms of the difeafe, which gra- dually encreafe from the fecond exacerbation to the
j
end of the firft week, or fometimes a little longer, is delirium. Ot this there are two fpecies obfervable, one without any material afleCtion of the brain, the
other
Fordyce’s Third Dijfertation on Fever . 145
other with fulnefs of the veffels of the brain. The Appearances dharatterifing theie different fpecies are pointed out at considerable length.
Whether it be that the fever is gradually incieafing, and delirium along with it, or that^ delirium is the occahon or the increafe of it, the lever goes on in proportion With the delirium. If, the deiiiium con¬ tinuing confiderable, the patient refpires witn mi- iiculty, or hardly at all, or if the deglutition be almoft totally prevented, or if in attempting it, it throws the patient into con vulfive contractions, he larely re¬ covers. On the other hand, although the other Symp¬ toms of the difeafe abate, it the delirium continues, without Itupor or deafnefs, and the other marks of fulnefs of the veffels ot the brain, in fuch cafe, not¬ withstanding the practitioner and the by-dander are flattered, the patient is frequently cut off.
Thus the fever continues to increafe from the^ be¬ ginning of the fir ft, Sometimes to the middle or the fecond week of the difeafe, and continues in tfle fame degree, unlefs it fhould be carried off in a crifis. Crifis much feldomer takes place in cold than in hot climates. In London, the author obierves, not above one third part of the fevers which happen, terminate in this way.
c The appearances, then, in the fecond week are fome, times frequency of the pulfe, to perhaps an hundred, or an hundred and five, in the evening; and in the morning from ninety-five to an hundred, in many cafes of fever the pulfe is much more frequent, but this will be defcribed as an irregularity in a future differtation.
‘ The tongue is covered with a brownifh fur, which is not Hi my, excepting when putrefaction takes place, as has already been defcribed. When the difeafe is Se¬ vere, it is not uncommon for the middle or the tongue efpeeially to lofe this fur, and appear, when moift, cleaner and rawer than it is in its natural ftate, and,
when
146 Fordyce’s Third Differ tat ion on Fever .
when dry, with a degree of polifh, as if it were gkzed over.
c The eyes have always, provided the fever be regular, a degree of confufion ; but it is greater or lefs as there is more delirium, as has already been defcribed. The fkin is of a dirty dulky colour; this fymptom is in a greater or lefs degree, according to the violence of the difeafe.
« The head-ach is often lefs complained of by the patient, but this appears rather to depend upon the confufion of the mind than on the head's being ac¬ tually relieved.
c The appetite is often totally loft. The patient frequently complains lefs of thirft during the fecond than during the firft week ; but this want of thirft feems rather to be from the confufion of the mind ; for fometimes, efpecially when the fever is very vio¬ lent, he will drink a great quantity at once, and at other times, in the fame circumftances, will hardly drink an ounce. The fkin continues very dry and parched, that is, feels very hot and dry to the bv- ftander.
‘ The urine continues perfeftly tranfparent, as has been defcribed.
4 There are flatulencies in the inteftines, generally with coftivenefs ; but now and then there are one or two thin and very foetid evacuations in twenty-four hours, even when there is no other appearance of pu¬ trefaction .
c The deep, when the patient gets any, is more or lefs quiet, partly according to the delirium, and partly according to the general reftlefsnefs.
c If the fever fhould be flight, and perfectly regular; if the practitioner has patience, and does not prefs the patient with improper remedies, nor the by-ftanders with improper nourifhment, this ftage of the difeafe pafles over with tolerable tranquillity. On the other hand, if the delirium, and other fymptoms of fever, be very violent, it proceeds with the utmoft anxiety to the praftitiouer and danger to the patient. This
happens
Fordyce’s Third Dijertation on Fever , 14*!
happens in all gradations, from the moil fevere and fatal to the flighteft.
c Provided there has not been fuch a depreffion of ffrength as to occalion putrefadtion of the fluids, and by that means to deftroy the patient, and that nei- ther of the kinds of delirium which have been de~ fcribed fhould prove fatal; or provided the patient fhould not be deftroyed, by ftrong fymptoms of fever taking place at the beginning of a critical paroxyfm ; and the delirium, if of the firft fpecies defcribed, keeps pace with the other fymptoms of the firft ftage ; or provided it be of the fecond fpecies, if it begins to be converted into deafnefs and ftupor; and provided, that the fever was of itfelf perfectly regular, and, laftly, that it has not been rendered irregular by im¬ proper treatment, it rarely happens that it is danger¬ ous after the fecond week/
c On the fifteenth day, and often fooner, the fymp¬ toms of the difeafe begin to abate. The firft ap¬ pearance of this abatement is not uncommonly a cleannefs and healthy look about the edges of the tongue ; or fometimes the fkin becomes of a more natural colour; fometimes, although not very gene¬ rally, a fweating takes place all over the body, and the fkin afterwards continues moift. The delirium, if it be of the firft kind, abates in the day-time, and re¬ turns at night ; if of the fecond kind, the patient is deaf and ftupid, with little difference in the twenty- four hours; and this deafnefs and ftupor remain until the whole of the difeafe has difappeared/
The eruptions which take place at this period, as petechiae and marbling of the fkin, are faid not to influence the progrefs of the difeafe.
c In the third week, the urine depofits fometimes a copious lateritious fediment for a day or two, and af¬ terwards returns to its natural appearance. Sometimes there is a copious lateritious fediment in the urine made in the night time, and a mucous one in that made in the day time. The coftivenefs goes off, and the foeces return to their ordinary appearance. The eyes, unlefs
when
148 Blair’s Effays on the Venereal Difeafe .
when the delirium has ended in ftupor, begin to have a more healthy appearance, are more compofed, and exprefs a greater attention to the objects around them. All the fecretions become gradually increafed, notf equally, but fometimes one more and fometimes ano¬ ther. The fleep returns, but not equally, the patient fometimes palling a tolerable, at others, a reftlefs night. There is fometimes a greater degree of thirft than was exprelfed in the fecond week. The appe¬ tite returns, although feldom regularly ; fometimes it is voracious, but the patient is notwithstanding fatis- fled with a very fmall quantity of food ; in other cafes it returns very flow ly. The depreflion of ftrengthi fometimes goes off almoft at once, and what is lin¬ gular, leaves the patient with a greater feel of w7eak- nefs. Thus the difeafe goes off, and the patient re¬ covers his ftrength very quickly.’
The author comes now' to the treatment of a regu¬ lar continued fever: but our account of this muff be referved for a future number.
Art. XV. Effays on the Venereal Difeafe , and its concomitant affections , illujirated by a variety off cafes. Effay /, Parti . On the Antivenereal Effects of Nitrous acid, oxygenated muriate of Potaffi, and fever al analogous remedies , which have been lately propofed as fubftitutes for Mercury . By William Blair, A, M. Surgeon of the Lock Hofpitaf and of the Old Finfbury Difpenfary . 8vo, 252 pages. ,i price 4s. London, 1798. Johnson.. 1
THREE centuries have elapfed,’ Mr. Blair ob- ferves, c fince the introduction of mercury for the cure of the Venereal Difeafe ; during which period, a variety of other remedies have been propofed, as fub¬ ftitutes for that mineral. Among thefe, certain vege¬ table productions have gained the greateft number of
advocates y
Blair’s EJfays on the Venereal Difeafe. 149
advocates; but, on making a fair and extenfive trial of their comparative virtues, mankind are aimed univerfab ly perfuaded, that, at prefent, we are in poffeffion of no antivenereal remedy fo efficacious as mercury. The inconveniencies, however, which fome times arife from the injudicious adminiitration of this medicine, have left room for a reafonable wiffi that we could obtain a milder antidote againft the fyphilitic virus.
‘ A new fpecific has lately been offered to the world, which (if we may believe its adherents) is not only lefs noxious to the conftitution of our patients, but even more certain and more expeditious in producing its good effefts, than mercury itfelf; and which, com fequently, is found to be in all refpefts its fuperior. In a few years’’ (fays one of thefe gentlemen) “ I think that mercury, as a remedy for lues venerea, will be banilhed by the nitric acid ; and that the 5C poifon of fyphilis may, in a great meafure, be ex- " tinguiffied over the face of the earth.”
c We have been’ continues the author, c fo fre¬ quently amufed and deceived with the cry of cc a new fpecific that, while I join heartily in the gene¬ ral wiffi for one in the venereal difeafe, I cannot forbear fuggefting the probable mifehief which, a pretenfion of this kind muff occafion, before its fal¬ lacy be detected ; efpecially if men of reputation and known talents combine in extolling an uncertain re¬ medy, while we are in the actual poffeffion of an ah moft infallible one.
c The ufe of opium as a fpecific in the venereal dif¬ eafe, was much infilled on, by feveral practitioners of eminence, about eighteen years ago. Opium was then faid to have performed wonders, where mer¬ cury had never been ufed, and in various ftages of the diforder. Although its fuccefs was not abfolutely certain, the proportion of fuccefsful cafes to thofe in which this remedy did not effeCf a cure, was re¬ lated to be as three to one ; and among thofe in which it failed, there were many wherein mercury vol. v. M proved
150 Blairs EJhys on the Venereal JJifeafe .
proved equally ineffectual. Numerous inftances of reputed cures are ftill on record, and may therefore be examined in all their circumftances. Nor were thefe merely temporary effeCts ; for, after a long period of time, numbers of patients experienced no relapfe ; and, confequentlv, there was the higheft pro¬ bability of their having been perfectly cured. — What can be faid to all this ? 1 hat opium is a fpecifc ? Or, that medical men joined in propagating wilful falfe- hoods P No, furely : but, that gentlemen were not fuf- ficiently accurate in conducting their experiments, and in feleCting the fubjeCts of them ; fo that al¬ though they publifhed only what they believed to be ftriCtly true, mankind were obliged, by contrary evidence and farther examination, to rejeCt the re¬ medy, as totally inadequate in a genuine fyphilis.
The mode lately recommended, of curing the venereal difeafe by means of acids, although it com¬ monly paffes for a modern difcovery, is not fo new as is generally believed. Without infilling on a paf- fage of Fracajtorins , in the fecond book of his ele¬ gant poem/ where he ftrongly recommends the ufe of lemons, I may fugged that acids were employed externally for the cure of fyphilis, by fome of the oldeft writers on this diforder $ and they were given, internally, for the fame purpofe, about the beginning of the prefent century, if not earlier.
‘ Dr. Daniel Turner, in his tc PraCfical Differta-
tion on the Venereal Difeafe/’ mentions the following
%
44 * Sed neque carminibus negledta (ilebere noftris 5S Pleiperidum decus, & Medarmn gloria citre Sylvarum: fi forte facris cantata poetis Parte quoque hac medicam non dedignabere Mulam. u Sic tibi (it semper viridis coma, femper opaca, c" Semper flore novo redolens, (ic femper honefta a Per viridem pomis fylvam pendentibus aureis. l * '
44 Ergo, ubinitendum eft cascis te opponere morbi 44 Seminibus, m nura arbor Cithereia prajlat*
Qqippe illam Citherea, fuum dum plorat Adonirn,
44 Munere donavit multo, & virtutibus auxit.’*
cafe
Blair’s EJJays on the Venereal Difeafe . 151
cafe of a patient who had been treated by a courfe ot vegetable acids. cc Being at one time in com- pany with that excellent practitioner Mr. Charles Bernard, a gentleman came into his dudy, as I u had reafon to believe, upon fome private bulinefs * cc upon which I retired into another room, when, in a few minutes, he came to me, and defired me to <c come and fee the effeCts of a new method of curing “ the pox. The patient had been for two months “ under the care of a noted Philo-acidus , who placed <c the caufe of this (and i think moil other difeafes) *c in an alkaiy, for a light infection therefrom: in tx order to eradicate which, he was advifed to eat “ half a dozen of the larged lemons he could get, " daily, befides good ftore of verjuice at his meals, which method (after fome other preferiptions) was <c to be continued for a month ; by which time, in- dead of his cure, he found himfelf cruded over “ with inveterate fcabs and other pudules ; yet was “ told that he was well, and that thefe would fcale “ away of themfelves ; which he was ordered by the “ gentleman he now came to confult, that he would ic make trial of ; as he did a little while, till fome “ ulcers growing corrofive, and eating farther in, by “ reafon of the acrimony of the humours underneath, <c forced him to comply with a mercurial ptyalifm, “ under this artist’s care, by which his cure was foon <f completed.”
c The fame author likewife notices an oppofite feCt of practitioners, the Mifo-acidi , whofe theory led them to the ufe of alcaline remedies in the lues ve- nera : he then fuggeds, that “ by being obftinately “ wedded to fome mere hypotheds, or affeCting a “ chymical philofophic babbling, fubjeCting medi- “ cine (which is incompatible) to a mathematick “ dandard, and amufing the patient with a jargon ec of hard words, you may very probably do mif- ** chief, if not utterly dedroy him.”
M 2
* The
152 Blair’s Effays on the Venereal Difeafe .
< The illudrious Chancellor Bacon, in his maderly work De Augmentis Scientiarum, mentions it as one? of the difeafes of authors, that they “ often infe6t their fpeeulations and dodlrines with lome peculiar tc opinions they happen to be fond of, or the partic-u- “ lar fciences to which they have mod applied.” Hence, the mechanical phyhcians have had their day, and the chymids are again affuming tlm right of combating difeafe upon their own peculiar principles.
c Though the nonfenfe of Paracelfus and Van Helmont is fuperfeded by the phrafeology of modem illumination, it may be queftioned, perhaps, whether either of them have facilitated the cure of difeafes.
I am very far from mfinuating that experimental chy- midry has been ufelefs in the praftice of medicine ; but I would guard young pradlitioners againd that licentious fpirit of innovation which has bewitched fome of our fpeculative enquirers after knowledge A Nihil magis a vera morborum cognitione men tern cc retrahit, quam effrsenis ilia fpeculandi difputan- cc dique licentia, cui in ipfa praxi adeo indulfere me* " dici Arabes, et quotquot pod eos fuere Galenici.” This judicious remark of Baglivi deferves attention in the prefent inquidtive age.
Having made thefe preliminary obfervations, the author proceeds, in the drd place, to give a fum- mary view of the attedations which have hitherto been borne to the efficacy of the new remedies. This is done with much candour, but at the fame time, with occalional and jud dritfures on the evidence, and on the conclufions which have been drawn from it. This part of the work we have already prefented in fubdance to our readers at dif¬ ferent times.
In the next chapter, the author gives the unfa¬ vourable reports concerning the new remedies, with occalional animadverfions. On this occafion alfo we have, for the mod part, anticipated him. We proceed, therefore, to his own experience of the fubje£t.
The
Blair’s Effays on the Venereal Difeafe* IB%
The firft feclion contains an account of twenty-four trials of the acid of nitre, the citric acid, and the oxygenated muriate of potaili, in primary fymptoms. In the fecond feHion twenty-fix cafes of confirmed fyphilis are given, wherein the acid of nitre was ex¬ hibited. And in the third, eleven trials with the oxygenated muriate of potaih, in advanced ftages of the difeafe. — Thefe conflitute the extent of Mr. Blair’s own expedience of the new remedies. His general remarks and conciufions are referred for the fucceeding part of his effays. We (hall now prefent our readers with a few of the mod finking cafes ad¬ duced, under the different heads above enumerated.
Sect. 1. Primary fymptoms . 4 The firft cafe in
which I tried the nitrous acid was that of George Kelly, aged thirty ; who was admitted into the Lock Hofpital on the 30th of March, 1797, with a glan¬ dular fwelling in his right groin, which feemed in¬ clined to fuppurate. He contradled the venereal dif- eafe two months before ; and, at that time, had chan¬ cres : but, when he applied to me the) were healed ; his mouth was alfo affefted by mercurial medicines, which he had previoufly taken. — April the 4th. I pre- fcribed him three meafured drams of the common fuming acid, in a concentrated ftate, diluted with a quart of water. This quantity was ordered to be drank, by a cupful at a time, every twenty-four hours. — On the 6th. I encreafed the acid to four drams a day, as it agreed perfectly well. His gums, which before were rather fwelled and tender, had now re¬ turned to a natural ftate ; and the fize of his bubo was a little reduced.— 10th. The tumour had nearly dii ap¬ peared. The acid was continued in the fame propor¬ tion. He complained of a tendernefs in his cheeks,, which probably arofe from the local effects of the acid ; but he had no inclination to a ptyalifm. — 13th. His mouth in the fame ftate ; and the bubo quite gone. — 17th. The acid now gave him violent pain in his bowels : I therefore directed one grain of opium
M 3 , to
1 54 Blair’s EJjays on the Venereal Difeafe*
to be taken occafionally. — 20th. The add was Hill continued without interruption, and was not omitted till the 24th.— I difmiffed him, apparently cured, on the 27th ; and have not heard of him fince.
4 Cafe 4. George Hughes, aged twenty-two, con- traded the venereal difeafe about the middle of Sep¬ tember 1797 ; at which time he had a glandular fwell- ing in each groin. The fame tumours remained on the 12th of October, when he was admitted into the hofpital ; but, they had burft, and were covered with fcabs. A warm linfeed poultice was applied to the buboes, and the nitrous drink was adminiftered as in the former cafe. — 19th. The buboes feemed to be a little amended.: — November 2nd. No material change has taken place thefe few laft days. — 9th. Confiderably better. The acid continued as before. - — 20th. The fwellings ftill d'iminifli. The fcabs hav¬ ing fallen off, I ordered the fores underneath to be dreffed with fimple cerate.- — 27th. The fores nearly healed — December 4th. The groins ulcerating again, and do not yield good pus. The fimple cerate and acid continued. — 6th. Having made no farther pro- grefs, I left off the acid, and ordered mercurial oint- ment to be rubbed into bis thighs every night. — 1 1th. Getting much better. — 14th. The fores are fcabbed over, but indurated glands remain. — January the 8th. No hardnefs in the groins. Perfectly cicatrized.— 13 th. Difmiffed cured. • — He ufed, in the whole, fifty- nine drams of the ointment, containing a third part of mercury ; which is full as much as is commonly re¬ quired in fimilar cafes, where the acid has not been given.
* Cafe 5. W. 7B. confulted me on the 13th of 0£tober, with a chancre under the meatus urethrae, and a phymofis, of three weeks duration. At that time I relied more on the favourable reports which had been given of the nitrous acid, than upon my own experience : I was therefore tempted to prefcribe the acid mixture, with a faturnine lotion and cata-
iapfm.
Blair's EJfays on the Venereal Difeafe . 155
plafm. — -18th. Fie had diligently employed the means dire&ed, and found himfelf conliderably amended. The fame plan was purfued till the 24th , when he called upon me, and was rapidly improving.—- No¬ vember the 4th. The phymofis was quite gone, and the ulcer under the glans ftill healing : but on tetrad!- ing the prepuce, a frefh ulceration was perceived upon the corona glandis. The acid was continued; but, the daily quantity of it was now encreafed to three drams. — 11th. The phymofis has in fome meaiure re¬ turned, with an oedematous date of the prepuce, and inflammation of the glans, and a worfe appearance of the ulcers. A decoftion of poppy heads and cha¬ momile flowers was ordered to be mixed with Iin? feed meal, and applied warm twice a day. — 15th. Frefh ulcerations are breaking out on different parts of the glans, and the old fores are fpreading. I now directed the acid to be left oft, and calomel pills to be taken daily : but, the patient having by fome means difcovered that I was making trial of a new medicine, told the Apothecary to whom he had taken my prefcriptions that he was diffatisfied. Fie afterwards did not chufe to confult me any more. — I cannot tell what was the fequel of this cafe ; but there is no reafon to felicitate the philo-acidi on its progrefs, to the 15 th of November. This was the firft (and will probably be the laft) private patient with whom I have ventured to hazard my reputation, by trufting to a new-fangled fcheme.
‘ Cafe 12. John Williams, in the twentieth year of his age, was received as a patient upon the 23rd Cf laft November. Flis original complaints, which he contra&ed fix months previous to his admiffion, were chancres : he endeavoured to get rid of thefe, by fome trifling means ; but had taken nothing for three months before 1 faw him. Fie then had chancres on the middle and upper part of the penis, with indurated glands in each groin.- — I put him on the ufe of the nitrous medicine, two drams of the acid daily, and
M 4 ordered
156 Blair's EJfays on the Venereal Difeafe.
ordered his fores to be drefied with a Ample ointment. —The acid did not at all difagree with him 5 fo that he was able to continue it without any intermiffion, or diminution of the quantity, till I defired him to deftft. — No change of confequence occurred before the 10th or 11th of December, at which time his ch ancre-s were nearly healed, and the inguinal tumors diminhhed : there remained, however, a thickened fkin, and a hard bale around the cicatrized parts. — - Scarce any alteration took place in the groins, for ten days longer: at which time he complained greatly or pains in his joints.— December the 28th. The buboes not fo much tumefied, and unattended with inflamma¬ tion.— January the 1ft. They have leffened fafter than ufual thefe three days. — 4th. The acid has thrown out very fmall whitifn pimples, with black points in their centre, accompanied with an itching fenfation, all over his body.— 8th. His groins are very little fwelled now : the medicine was continued for three days more. — 1 1th. Difcharged from the holpital ; after having taken 96 meafured drams of the acid, equal to above 156 drams by weight.
- c On the 19th of February he returned to me, with numerous, broad, fyphilitic blotches, on his breaft and face ; alio a venereal farcocele, and an ill looking ulcer on one tonfil. He faid his throat became fore a month ago ; but that his eruption had appeared only a week.- — I immediately ordered the mercurial inunClion.— On the fecond day after his re -ad million, upon infpeCtmg his throat very carefully, I difcovered that both his tonfils were ulcerating, and likewife the pofterior fauces. Fie was now direCled to fumigate twice a day with factitious cinnabar, and rub in the mercurial ointment every night. — By the 5th of March all his ulcerations, and likewife the farcocele, were entirely well : moil of the fpots had alfo difappeared. —April 26. Fie left the hofpital, and promifed to re¬ turn if any relapfe fliould occur. I have not heard of him fm.ce.
* Nothing
O
157
Blair’s Ejfiays on the Venereal Difeafe.
c Nothing worthy of peculiar notice happened dur¬ ing the mercurial courfe ; nor could I perceive that the previous treatment, by nitrous acid, had occafion- ed any difference in the time or facility of his cure : but it fhould be hinted, that one dram of the oint¬ ment, containing a fcruple of mercury, was as much as he could bear in 24 hours.
Se£t. 2. Acid of Nitre in confirmed Syphilis.— * Cafe 6. Robert Chace, twenty-five years of age, was admitted under my care, October the 26th. He contrafled the venereal difeafe four months before : his firft fymptoms were chancres ; which he got rid of in a week, by taking eighteen pills. He has now loft his uvula and part of the foft palate, by an ulce¬ ration of two months continuance. — The acid mixture was adminiftered immediately : he went twice into the warm bath, without my order.- — November the 6th. He told me he had an ulceration near the verge of the anus, which had been there two months ; and likewife pains in his arms. No alteration was made in his treatment, except that a faturnine lotion wTas applied to the anus frequently. — 9th. He ufed for¬ merly to complain of a pain in his throat ; but it is
now removed : his appetite has improved lately. _ _
13th. I this day perceived an ulcer on the pofterior part of the fauces : the palate looks cleaner than be¬ fore, and the ulceration near the fundament is better.
6th. His throat is a little healed over. — 20th. Much amendment in his palate and fauces; but a fiftula lachrymals has juft appeared.— 23rd. The fif- tula gets worfe ; the fauces better. He takes three drams oi the acid daily. — 29th. Getting better in his throat daily : he begins to loath his medicine.— De¬ cember the 4th. Vefications appear on the palate and cheeks, likewife ulcerations upon his lips, from the immediate application of the acid ; his gums alfo are tender, but not fwelied, and the enamel on his teeth *s c°nfiderably eroded: I am informed that he has had a ialivation tome time. The ulcers are healed in his
. ■ r * throat ;
158
Blair’s Effays on the Venereal Difeafe .
throat ; but puftular eruptions have juft broken out on his face. I directed him in future to drink the acid mixture through a tube, to prevent its touching his teeth and cheeks, likewUe to diminifh the daily quan¬ tity of it to two drams. — -1-1 th,. Not yet better of his lips and mouth : the falivation has encreafed to three pints a day : the fpots continue on his face. — 18th. A bad ozcena has come on, with great pain, and a difcharge of purulent matter from his nofe : the fif- tula lachrv mails is going. In other refpedts, he is much the fame as on the eleventh. — 21ft. I now again ordered three drams of the acid to be taken daily : his mouth, &c. is better ; and he only fpits one pint in twenty-four hours. — 28th. His fpitting has ceafed entirely. The ozcena and puriforrn difcharge continue. The eruptions on his face are of a dubious nature ; but I begin to fufpeft they are venereal . — - January the 1ft, 1798. A Angle fcabby eruption has come upon one leg. He ftill takes three drams of the acid ; and, it agrees very well. His general health is good. — 4th. The fcab on his leg has enlarged ; and he fhews me more puftular eruptions upon his arms, like thofe which appeared nearly five weeks ago in his face. 1 he complaint in his nofe is much the fame.
- — He has already taken one hundred and Jixty-five meajured drams of the acid; zvhich are ccjmil to upwards of tzvo hundred and eighty-nine drams by weight /—Some of his recent complaints feemed to be venereal ; although the fymptoms for which he firft came under my care had entirely difappeared : J was therefore difpofed to watch the progrefs of this curious cafe, and to defift from the new mode of treat¬ ment. — January the 5th. Omit the acid, and take Pilulae ex mica panis bis in die. — 11th. The fcab on his leg encreafes in its dimenlions. The man gets fat, and has a very keen appetite : in other refpedis he remains as before. I now made him an out-patient, and defired him to continue the pills till I faw him again.— 22nd. He had no fpitting when he left the
I
Blair’s Kff'ays on the Venereal Difeafe . 159
hofpital ; but, a falivation has fince recurred : his front teeth are covered with tartar, and much in¬ jured by the acid : his gums are very painful ; but not fpongy, as if he had ufed mercury ; nor is his breath at all fetid. The other fymptoms of difeafe remain fiationary. Perftet in ufu pilularum micas panis. — 29th I difeovered a deep and foul ulcer in the lower part of his pofierior fauces. He continues to fpit very much. — February the 5th. The ulcer has become as large as half a crown. I defired to fee him again in three days. — 8th. The ulcer has not got larger ; but is very filthy in its afpeft, and clearly venereal : fome of the fpots on his face now appear to be well marked fyphilitic eruptions : I conclude that his ozasna is alfo venereal ; efpecially as it has become much worfe than before. Nothing would have juftified my continuing the new specific af¬ ter this decifive trial : mercury was the only refovree ; and it was well I had fuch an efficacious remedy to flee to.
c On the 8th of February he rubbed a dram of mercurial ointment into his thighs, morning and evening. — He repeated the fame quantity on the 10th, 12rh, 13th, and 14th ; after which he ufed it once a day till the 25th. — Fie was, by this time, ma¬ terially relieved. The mercury having caufed a co¬ pious difeharge of faliva, and his gums being now tumefied, he rubbed in only a dram every alternate evening. — March the 3rd. His throat is perfe£tly heal¬ ed : his fpots are all vanithed : the ulcer in his nofe is much better : but, the lachrymal fac has lately dif- tended and inflamed as it did before. — 8th. The fif- tula lachrymalis ruptured, and is healing again. — 15th. His nofe, &c. quite well. The mercurial friction was regularly continued till the 20th of April ; at which time he had employed about feventy drams of the ointment. I now gave him five grains of the quick- filver pill, night and morning ; and on< the 30th made him an out-patient.— May the 12th. He returned to
me.
160 Blair's EJays on the Venereal Difeafe.
me, and had more pills : they lafted him till the thirty- firft ; whem he came to the hofpjtaj and returned thanks for his cure, faying “ he was as ftrong and hearty as ever." — If there were no other cafe on record hejide this , who could he fit ate a moment in giving the preference to mercury f What can
BE MORE CONCLUSIVE?
c Cafe 17. Elizabeth Scarborough, in the twenty- fecond year of her age, contracted the lues venerea in July 1797. Four months after this, fhe became my patient; at which time die had ulcerations on the alas mad and on one dioulder. — -I ordered her the nitrous potion : it agreed very well, and afforded her a little relief by the 2nd of November.— Nothing remarkable occurred during this ftage of her treatment : fhe went on gradually mending till the 16th, when the ulcera¬ tions on her dioulder and nofe were alrdoft healed : They had been dreffed with dimple white cerate. — Four days afterwards, while the fores were ftill dimi- nifhing on the external parts of the alas nab, they fpr'ead inwards, and ulcerated the noftrils : nocturnal pains in the tibiae, at the fame time difturbedher night’s reft; but the dioulder had now quite healed. — 27th. The pains in her dims are extremely tormenting : the nofe gets worfe internally ; and an opthalmia has affected her eyes. — 30th. In addition to the other aggravations of her diforder, venereal blotches have broken out upon her face and boforn. — Experience now fuggefted the necedity ot a different plan: the acid was relin- quidied, and mercurial friction adopted. — December the 6th. All her venereal fymptoms were going awray rapidly. — 14th. Perfectly well — 29th. She eloped from the hofpital, before i propofed to difcharge her.
‘ Cafe 25. Elizabeth Turner, twenty years old, was admitted April the 28th. She contracted the lues venerea fix months before: her firft fympton was a gonorrhrea, which was fucceeded by a bubo ; after¬ wards eruptions appeared about her body. For this •complaint fhe underwent a mercurial courfe, at Guy's
Hofpital*
f
161
Blair’s Ejjays on the Venereal Dijeafe*
Hofpital, under the care of Mr. Cooper: but, in the iixth week alter her difcharge, the eruptions returned. In this ilate (he applied to me. — I gave her a dram and a half of the nitric acid, prepared by Mr. Seaton, diluted with two pints of water, and without any fy~ .rup. It occafioned pains in her flomach at firft; but, by adding fome tindhire of Opium to the drink, and giving a grain of opium at night, ihe was enabled to continue its ufe with regularity. — March the 7th. Two drams of the acid were taken daily, from this time.-— 10th. The fpots are going off, but the gonor¬ rhea is greatly encreafed. Patients with a gonorrhea have in general employed a vitriolic injection ; but
this woman did not ufe any thing for that fymptom. _ -
13th. Numerous frefli eruptions have come out on her forehead ; and the acid occafions a diftreffing op- preffion on the brain, with giddinefs, head-ach,° and paininher flomach. — She now debited from the acid^ upon which the complaint in her head went off, and the venereal fpots remained flationary till I put her upon a courfe of mercurial inundtion.— Nine drams of the ointment difperfed the eruptions. She is now continu¬ ing the treatment with mercury ; and was this day (June the 7th) going on. perfedily well.
Sect. 3. € Cafe 9. John Gibbins became my patient at the Finfbury Difpenfary, in the autumn of 1797. He had been feme time under the care of my colleague. Dr. Wells s but, a venereal eruption having broke out on his face and body, the dpetor transferred him to me, I treated him in the ordinary manner, with mercury, till the fpots had nearly difappeared ; and then, to try whether the nitrous acid was capable of effecting a complete cure, I gave him two drams (from Apothe¬ caries Hall) to be taken in a pint and a half of wrat^er daily. — This patient was one of the moft fit fubjedls poflible for a courfe of experiments: he was perfedl- ly conformable to every direct ion ; be had the fulled confidence in my judgment: he lived in a fituation where he was provided for, and where I could vifit
him
162 Blair’s Effays on the Venereal Difeafe .
him from time to time: in fhort, he was one of the molt traftable and patient beings imaginable. 1 have mentioned this, becaufe the progrefs of his cafe is ex¬ traordinary, and it may aflift in giving weight to what I fhall add of his hiftory. — He fieadily perfevered in taking the acid, without having any appearance of the lues or any unpleafant effeCt from the remedy, till the 7th of November 5 when a falivation came on.™ 17th. Frefh eruptions were difcovered upon his legs. Having now exhibited the acid forty -two days , I dif- continued it, and watched for the fubfequent fymp- toms. — 28th. Violent pains have attacked one of his arms, and a fwelling has come on the left ulna. I amufed him, and at the fame time improved his gene¬ ral health, by ordering the daily ufe of a decoftion of calcarilla. — Next day, he called to fhew me a tumor on his right tibia, which was extremely tender. I di¬ rected fifteen grains of the compound powder of ipe- cacuan to be taken at bed-time, four fuccefiive nights. - — December the 6th. His pains were better. The
;owder was repeated for fix nights more. — - anuary the 20th. Iwent on till this time, that the cafe might be in fo diftinCt and unequivocal a form as to be fit for the oxygenated muriate of potalh. In addition to the nodes, eruptions, and noClurnal pains, a lardaceous ulcer has made its appearance on the left tonfil. He began to take twenty grains of the kali in a cup of water four times a day.— 25th. The dofe is augmented to thirty grains. No good e fie 61 is pro¬ duced : his ftomach and intefiines are uneafy from the medicine. — 30th. It has agreed lately, and he has even encreafed the quantity to forty grains : but, to prevent his bowels from being affeCted, I ordered an opium pill every night at bed-time. — February the 6th. The opium is repeated, and the potafii is hereafter to be taken, /fee times a day , in the dofe of forty grains . — 10th. He ha? continued it in the fame dofe ; but the lues venerea feems fiill in progrefiion, and the tonfil is more ulcerated : his appetite fails him; his Urine diminifhes in quantity ; he has a conftant third:
and
163
Blair's EJj'ays on the Venereal Difeafe,
and dry fkin ; his bowels are griped and very hot; a cold fhivering comes over him when he takes the kali; and he has a llight falivation, with a pain in his jaws, but not fpongy gums. — February 14th. The tonfil is very deeply ulcerated, and fpreads wider; the fpots are encreafmg in number; the nodes much more painful; his gums are red and tender, but his breath is not fetid: the medicine now produces a univerfal tremor when he takes it, and has caufed a languid in¬ termitting pulfe.— 16th. He protefts he has never yet miffed taking his potaffi ; but, the third dofe to-day occafioned fuch excruciating pain on one fide of his abdomen, accompanied with a trembling motion of the heart, that tie could not move his body from the fpot where he lay, during the fpace of feven hours : at the end of that time, he was relieved by a diarrhea and vomiting. — He has had a defective fecretion by the kidneys till within the two laft days, when he voided a confiderable quantity of urine : his tongue has been furred and white, as in the former cafes. His venereal fpots are at length rather oaler than they were ; but the nodes are as large as c f>re, and pain¬ ful almoft to diflraftion : the ulcerated tonfil is ah
moil deftroved.
*
This was an experimentum crucis. He had taken the acid forty-two days, and likewife employed about
SEVENTY-SIX DRAMS OF THE OXYGENATED MU¬ RIATE OF POTASH. It was high time, after this
decifive trial, to treat the man by other means. _ On
the 17th of February, I directed him to begin with the mercurial ointment, and to gargle his throat with a weak folutionof muriated mercury. His fymptoms yielded in ten days : The eruptions, the fore throat, bus noQurnal pains, and one of the nodes, difappear- ed foon afterwards.— -This patient being often ex do fed to the cold air, and finding the ointment to be abforbed with great difficulty, was advifed to perievere in the nfe or mercury till the end of May.— He is at pre- fent in good health, and does not appear to have been much debiliated by fio tedious aprocefs/
The
164 Ferriars Medical Hijiories and Reflections .
The fuccefs of the new remedies in the cafes we have quoted above, is frnall indeed ; and the remain¬ der do not afford a more favourable refult. But we forbear at prefent to draw general conclusions, as the author promifes a further fupply of evidence.
Art. XVI. Medical Hijiories and Reflections. VoL IIL By J ohn Ferriar, M. I). Phyjician to the M anchejler Infirmary , Sic. Stic. Odtavo, 232 pages, price 4s. London, 1798. Cabell and Davies/
THE method purfued by the ingenious author in the volume at prefent before us, is fimilar to that employed in the preceding ones, of which we have heretofore given a fufficiently full account*. He does not profefs to treat fyftematically on any of the fubjefts which have engaged his attention : his aim being merely, to fupply fome deficiency in the hif- torv, or fome elucidation of the treatment of parti¬ cular difeafes.
_ The fubjeff of the firft effay is Rabies Canlna. The diffeflion of two cafes of the difeafe which fell under Dr. Ferriar’s notice, is related. On open¬ ing the head, he obferves, there was found an effii- lion of fluid between the pia mater and tunica arach- noides, which diftended the former f confiderably.— There was not more water than ufual in the ven¬ tricles. In the thorax there were fome adhefions on the right fide : the left lobe of the lungs was fo com¬ pletely filled with blood, as to have acquired confi- derable weight and folidity. This appearance is laid great ftrefs on in the fequel.
# Vide Med. Rev. vol. 2, pages 199 and 299. f A fmall miftake occurs here : the tunica arachnoides is external lo the pi a mater ; the pia mater, therefore, could not have been dif¬ tended by an efrufion between: it and the tunica arachnoides.
In
Fer bar's Medical Hiftories and Reflections . 165
In the abdomen, the liver was changed in colour, and ftreaked with white fpots. (The patient had been intemperate.) The external furface of the ftomach was much inflamed, efpecially on the great curvature. The oefophagus was completely found* The villous coat of the ftomach was found to be ge¬ nerally inflamed in irregular points, and there was an appearance of abrafion. Dr. Ferriar was led by thefe appearances to inquire, whether the dread of water, in cafes of rabies produced by the bite of mad ani¬ mals, has been accompanied by inflammation of the internal coat of the ftomach or oefophagus in other in-, fiances, and to examine how far the dread of water is effential to conftitute the exiftence of rabies ; as cafes are faid to have occurred, in which neither this fymptom during life, nor inflammation after death had been obferved.
Many cafes of rabies are mentioned by authors, in which, on diffection, inflammation of the ftomach and oefophagus was obferved. Lietaud, Hoffman, Van Swieten, and Sauvages, are adduced in proof. Some have mentioned a ftate of the lungs fimilar to that ob¬ ferved by Dr. Ferriar : and wdiilft hydrophobia, or a dread of water, has been wanting in many cafes of rabies, this fymptom has taken place in many other affections, wuthout the moft diftant fufpicion of rabid poifon.
The ufe which the author makes of the fa61s ob¬ ferved in diffeCtion will appear from the following train of reafoning. c The application of the term hy¬ drophobia he obferves, c to an acceffory fymptom, fupervening to fuch a variety of difeafes, evidently tends only to miflead, by directing the attention of. practitioners to fuppofed analogies, which have no other foundation than the abufe of a word. To be correct, we muft preferve the diftinftion between rabies, and difeafes wffich are effentially different from it in their ufual appearance, and which only ac¬ quire an adventitious refemblance to it under uncom-
vol. v, N moiii
166 Ferriar’s Medical Hijlories and Reflections.
mon circumftances. Several cafes have been defcrib- ed, of late years, under the title of, Spontaneous hydro¬ phobia. I think it very evident, from the view I have Exhibited, that no fuch difeafe ever exifts. If t-hofe: cafes be analyzed, they will be found to belong to the clafs of hyfterical, febrile, mental, or fpafmodic diforders, and by ranking them under their proper titles, we fhali at once clear this fubjedl from a great and accumulating mafs of error. By confidering the matter in this point of view, we are alfo enabled to explain the contradiftory reports, hitherto fo perplex¬ ing, on the eflfedts of remedies in rabies. It is eafy to perceive, that evacuant and antifpafmodic remedies would remove a difficulty in fwallowing, occafioned by inflammation or fpafm in the ftomach or oefopha- gws ; that bark and wine would cure it in cafes of typhus, or of low mania ; and that opium and the cold bath would be fuccefsful, when it accompanied tetanus.
‘ When thefe falfe cafes are fet afide, perhaps we gain fomething refpedting the ratio fymptomatum , and the pradlice, in rabies. The difficulty of fwal¬ lowing, in this difeafe, is probably almoft always at¬ tended with inflammation of the flomach or oefopha- gus : we cannot, therefore, hefltate to bleed, and to apply rubefacients of the mo ft active kind to the Ik in, as near the feat of inflammation as poffible, whenever this fymptom appears in a clearly-marked cafe of ra¬ bies. It is of fome advantage, that wre can nearly afcertain the duration of the difeafe ; for, if the prac¬ titioner be confulted early, he can determine with precifton, whether a fucceffion of blifters, or of ftimu- lants quicker in their operation, be better adapted to the remaining portion of time. But the mode of ap¬ plying thefe remedies may alfo be varied, by atten¬ tion to the view of the difeafe next to be mentioned.
‘ It has been remarked in many of the difledlions, that the lungs have been loaded with blood, to fuch a degree, that fome part of them has appeared almoft
a folid
Ferriar’s Medical Hiflories and Reflections. 167
a folid maf$, exactly refembling the phenomena which occur, when blood has been effufed into the fubftance of the lungs in pneumonic inflamma¬ tion. The only queftion upon this point is, whether this happens fo frequently as to conftitute an effential part of the difeafe, I am inclined to fufpeCf that it does. It is true, that in my firft patient, Johnfon, there was no particular difeafe viflble in the lungs, which furprifed me more, as he had fathered repeated attacks of pain in the breaft and tides, and of cough, previous to the acceffion of the rabies. But the ap¬ pearance of effuflon in my fecond patient was fo ftrik> ing, and the phenomenon is mentioned fo frequently, without reference to theory, by authors, that it is allowable to direct the attention of practitioners to this circumftance.
c This ftate of the lungs is obvioufly a fufficient caufe of death, and when it is detected, affords a folution of our doubts on that head. If it be fup- pofed, that congeftion of the lungs takes place in the firft inftance, the affeCtion of the brain, and the ap¬ pearances of effuflon or congeftion difeovered in it, receive alio a full explanation. And that this fuppo- lition is not improbable, appears from the great anxiety and oppreftion at the breaft, of which the fick fo generally complain, which Dr. J. Hunter fuppofes to depend on an affection of the heart, but which the review of diffeCtions inclines me to refer to the lungs. Symptoms of compreffion of the brain are fufficiently remarkable, in the ordinary courfe of the difeafe, fuch as the delirium, and the convulfions, which are frequently of the epileptic type ; but, in fome cafes, the appearances have been ftill more de- cifive. In a patient of Dr. Mead’s, a paralytic af- fe&ion of the right arm fupervened, and the patient complained of mift before his eyes. A patient of Dr. Howman’s, who was feized with rabies in con- fequence of a recent bite, was affefted, at the very commencement of the difeafe, with palfy of the right
N 2, arm,
168 Ferriar’s Medical Hifiories and Reflections .
arm, and intermiffion of the pulfe at the wrift of that arm. The difficulty of fwallowing did not take place till the third night; and the paralytic complaint com tinued to encreafe till death.
‘ If future diffedtions fhould prove, that congeftion in the lungs generally appears in thofe who die of rabies, I confefs that I fhould be difpofed to confider this difeafe as dependent on the obftrudiion of circu¬ lation in that important organ. Accumulation of blood in the head, and compreffion of the brain, muft be the confequence of fuch an obftrudlion, rapidly formed. The quick, panting refpiration, anxiety and fudden debility, may be referred to the. fame caufe. In fadl, we find a fimilar degree of tremor attendant on the croup, which confifts in in¬ flammation of the trachea, and deftroys by fuffocation. That degree of inflammation in the ftomach or oefo- phagus, which produces the difficulty of fwallowing liquids, may not only arife from fympathy, but the fymptom itfelf may occ'ur in confequence of the ftate of the lungs alone. This will appear from the fol¬ lowing cafe, given by Ronetus.
“ Quidam voraciffimus enteroceles moleftias decli- naturus, caftrationi fe fubmifit, feliciter peradtae. Om¬ nia rite fe habebant, cum poft tres feptimanas diffl -■ cult ate deglutiendi et difilcili refpiratione prehenditur, , Tertia die lingua erat carbone nigrior, urgebat deglu-- tiendi et refpirandi difficultas. Nil in hac anginas: fpecie, nec intus nec extra apparebat, fi linguae ni- grorem exceperis.
<c Mortui aperto corpore, falva reperta eft trachea' arteria, et omnis phlegmonis expers. Thymus intu- muerat, et atro fanguine fcatens tracheam premebat. Pulmones fe praebent inflammati, et creberrimis ma- culis nigris confpersi cum gangrsenae fignis eviden- tibus.,,
4 It will appear, on reference to Lietaud, under the title, Lcejiones Pectoris , how frequently inflammation
of
Ferriar’s Medical Hiflories and Reflections. 169
of the higher part of the abdominal vifcera, accom¬ panies pneumonic inflammation.
c To all thefe confederations we muft add, the fud- dennefs with which death takes place, and the re¬ markable fluidity of the blood, fo commonly obferved in diffedtions ; circumflances which cannot be fatis- fadtorily explained, without attending4 to. the date of the lungs, which I fuppofe to exift.
c Thefe conclufions, it muft be owned, are uncer¬ tain, becaufe the facts from which they are drawn are incomplete. I offer them only as conjectures, which may give a new direction to farther enquiries, on a fubjedt equally important and obfcure.
c In the mean time, it cannot be uninterefting to conftder, what mode of pradtice this view of the dif- eafe would determine us to adopt. Repeated blifter- ing would certainly be advifeable, if the period of the difeafe fhould admit this remedy ; and the application fhould be made to the head, as well as to the cheft and fpine. Blood fhould be drawn from the jugular veins, and perhaps the head and lungs would be beft relieved by the repetition of bleedings. The ftate of the pulfe, and the apparent degree of debility, fhould not deter the practitioner from ufing this remedy, on my fuppofition. Thofe fymptoms may be confidered as the neceffary confequence of impeded circulation in the lungs. Dr. Nugent’s cafe of rabies was cured by large, and repeated general bleedings. In the prefent ftate of knowledge, little will be attributed to the mufk which he exhibited. Great attention fhould, undoubtedly be paid to the ftate of the pulfe, while the blood flows from the vein, efpecially after the firfl bleeding. The fame cautions apply here, which have been given by pradtical writers, on the fubjedl of re¬ peated bleeding in peripneumony. In fadf, there is no difeafe which is accompanied by more ftriking marks of debility, at its firfl appearance, than peri¬ pneumony. If, however, the pradfitioner fhould be alarmed at the idea of frequent general bleeding,
N % leeches
170 Ferriar’s Medical Hiftories and Reflections,
leeches may be applied to the temples. With the view of relieving the lungs from congeftion, by ftimu- lating the exhalents, and of exftinguiffiing the exifting difeafe, by producing another lefs dangerous, the fuc- cefs faid to have attended the free ufe of mercury is perfectly reconcileable. 1 fhould join opium, in pretty large dofes, with this procefs. Calomel with opium may be given internally, while the mercurial friCtion is applied to the limbs : I believe that the mouth w ill be fooner affected in this manner ; and, confide ring the fhort duration of the difeafe, it is of the higheft importance to excite a ptyalifm early.
c So greatly would this hypotheiis alter my views of the indications ot cure, from opinions which I have formerly expreffed, that it wmuld induce me to pro¬ hibit entirely the ufe of the cold ba h, and of bark, during the exigence of the fymptoms,
c Refpetring the ufe of oil, I ffiould be more un¬ certain. Dr. Shadwell’s cafe appears to favour it* yet there was fomething very ur.uf il in that cafe, both m the mode of attack, wffiich refembled phrenzy more than rabies, and in the duration of the difeafe ; for eleven days elapfed from the firft fymptoms of ill- nefs, and nine from the phrenitic attack, before the difficulty of fwallowing, and dread of cold air left the patient. If oil were given, i fhould not allow it to fuperfede the mercurial courfe.
c As it is abfolutelv neceffary to choofe among the contradictory methods of treatment, recommended in rabies, I have thus ventured to ftate the plan upon which I fhall proceed, if any other cafes occur to me ; but with a deep conviction, that the grounds of pre¬ ference are not yet Efficiently afcertained. This is a fubjeCt, concerning wffiich the mind of the medical philofopher cannot remain at reft. It is allowable to hope, that careful diffeCtions, and accurate difcrimi- nation of fymptoms, will at fome future period, afford the power of removing this hitherto intractable difeafe/
It
Ferriar's Medical Hifiories and Reflections . 171
It appears to us that objedtions of no inconfiderable weight might be darted againd much of this reafon- ing. The inflamed ftate of the ftomach and oefopha- gus has not always been obferved, where the hydro¬ phobia veas prefect, nor, if it had, would it explain the peculiar date of mind which accompanies this fymptom. The condition of the lungs obferved by the author has a (till lefs claim to confideration, as explanatory of the fymptom s of the difeafe ; for it has been yet more rarely obferved to accompany it. We may obferve ot this alfo, that it would be wholly infufflcient to account for the fymptoms ; for who has obferved peripneumony attended with the date of mind peculiar to rabies ? or has the mode of dying been at all flmilar ? In fadt, it is in vain to compare the phenomena excited by peculiar poifons in the fydem, with thofe which arife from other caufes. There is neither analogy in the fymptoms, nor in the method of cure. Obfervation mud point out the one, and experience alone can fugged the other.
The fecond efiay contains an account of the Edab- lifhment of Fever Wards in Mancheder. In the twro preceding volumes, the author pointed out the mifery and havock, produced by the prevalence of infedtious fevers, among the poor in manufadturing towns. The object of the prefent efl'ay is of a more agreeable na¬ ture $ it is, to explain the meafures which have been adopted, for remedying thofe evils, and the fuccefs attending them, which has exceeded all expedtation. A board, or committee, was formed for the purpofe of fuperintending the health of the poor in Mancheder and Salford, whofe objedt was to inquire into the caufes of the rapid fpreading of infedtion, and the means by which it might be bed obviated. The principal fources of fever among the poor appear to be, lodging-houfes, cellars, cotton-mills, and the in¬ cautious intercourle of the poor with each other, in places infected.
N 4
The
172 Ferriar’s Medical Iliftorks and Reflections .
The moll eligible mode of remedying thefe evils appeared to be, the appropriation of a building, to the particular reception of patients ill of fever ; and a houfe was accordingly provided, and named I he Houfe of Recovery. The following are the regu¬ lations which were adopted in its management.
< 1. Every patient on admiihon, fhall change his infeflious, for clehn linen ; the face and hands fhall be wafhed clean with lukewarm water, and the lower extremities fomented.
‘ 2. The clothes brought into the houfe by pa¬ tients, fhall be properly purified and aired.
• ‘ 3. Ail linen and bed-clothes, immediately on being removed from the bodies of the patients, fhall be immerfed in cold water, before they are carried down flairs.
‘ 4. All difcharges from the patients fhall be re¬ moved from the wards, without delay.
c 5. The floors of the wards fhall be carefully wafh¬ ed twice a week, and near the beds every day.
c 6. Fumigations with nitre and concentrated vi¬ triolic acid, which have been lately employed with fuch fuccefs in his Majefly’s military and navy hos¬ pitals, as an antidote to contagion, fhall be ufed, ac¬ cording to the directions of Dr. Smyth, twice daily in all the wards of the Houfe of Recovery. The walls fhall be frequently wafhed with quick-lime, frefh flaked in water, and whilfl it continues bubbling and hot.
6 7. No relation or acquaintance fhall be permitted to vifit the wards, without a written order from one - of the phyficians.
c 8. No flrangers {hall be admitted into the wards ; and the nurfes fhall be itri&dy enjoined not to receive unneceffary vifits.
‘ 9. No linen or clothes fhall be removed from the Houfe of Recovery, till they have been wafhed, aired, and freed from infection.
* 10. No
EerriaFs Medical Hiflories and Reflections. I7S
* 10. No convalescents {hall be difcharged from the houfe, without a confultation of the phyficians.
4 11. The nurfes and Servants of the houfe Shall have no direct communication with the Infirmary; but Shall receive the medicines, in the room already appropriated to meflengers from the home-patients.
4 12. The committee of the Strangers’ Friend So- ciety (hall be requeded to undertake the office of in¬ specting the Houfe of Recovery.
4 1 3. A weekly report of the patients admitted and difcharged, (hall be publiffied in the Manchester news¬ papers.
4 14. When a patient dies in the wards, the bodv (hall be removed as Soon as poffible, into a room ap¬ propriated to that ufe ; it Shall then be WTapt in a pitched cloth, and the friends (hall be defired to pro¬ ceed to the interment, as early as is confident with propriety.
4 15.. All provisions and attendance for the patients in the Houfe of Recovery, Shall be provided from the funds of this inftitution, without any communication with the Infirmary.
The rooms on the ground-floor wmre appropriated to the fervants, and the convalefcents. The establish¬ ment of Servants, confided of a head-nurfe, who was expeCted to Superintend the domedic concerns of the houfe, and three ordinary nurfes, a number fuppofed to be equal to the general exigencies of the institu¬ tion. On emergencies, it was propofed to hire oc¬ casional nurSes, while the temporary preflure might render their affidance neceflary. The wards were furniflied with iron beddeads, without curtains, and with ticks filled with draw, which was changed at proper periods.
The mode of removing the fick from their own dwellings, adopted by the committee, was that of conveying them in a fedan-chair, purchafed for the
ufe
174 Ferriar’s Medical Hi fi ones and Reflections.
•+ V .
life of the fever-ward, and kept in the out-building, for that foie purpofe.
f Part of a vacant piece of ground, adjoining to the houfes, was enclofed with a wall, for the purpofe of wafhing and airing the clothes of the patients’.
The fuccefs of this eftablifhment has much ex¬ ceeded expectation. An idea of it may be formed from the following comparative view of the number of patients ill of fever at different periods in certain ftreets of Manchester.
‘ From September 20, 174$, to May 20, 1794, (a period of eight months , felected on account of the ufual prevalence of fever) number of fever-patients in thefe ftreets, 400.
‘ From September 20, 1794, to May 1795, num¬ ber of fever-patients in thefe ftreets, 389.
‘ From September 20, 1795, to May 20, 1796, number of fever-patients in thefe ftreets, 267.
* From July 13, 1796, to March 13, 1797 (being a period of eight months ftnce the opening of the Houfe of Recovery), number of fever-patients in thefe ftreets, 25.
* In July la ft, five.
‘ In Auguft laft, one.
c In September laft, none.
c From the 4th to the 23d of February laft, two.
f The bills of mortality for 1796 fhew, that there has been a decreafe in the burials, amounting nearly to 400.
‘ From the opening of the Houfe of Recovery on the 19th of May, 1796, to February 3d, 1798, 623 patients have been admitted: of thefe 53 have died; 15 remain in the houfe. The number of deaths, ftnce the beginning of May, 1797, to Feb. 3, 1798, has been only 13, though the houfe has been gene¬ rally full, during the whole period. The moft itrik- ing proof of the benefit which the public derive from
this
Ferriar’s Medical Hifiories acid Reflections . 175
this inftitution, refults from obferving the diminution in the number of the home-patients of the infirmary: the number of home-patients, from June 1795, to June 1796, was 2880; from June 1796, (immediately after the opening of the Houfe of Recovery,) to June 1797, the number of home-patients was 1759; that is, the illnefs of 1121 perfons has probably been pre¬ vented by this inftitution, in one year; for the home- patient’s lift has generally encreafed every year.’
The number of cures effected in the Houfe of Re¬ covery, it is well obferved, muft be principally af- cribed to the attendance, and the comforts experi¬ enced by the patients. A clean bed, a quiet ward, an attentive nurfe, and the frequent vilxts of the phy- fician, are fo many medicines to a poor creature, who has been languilhing in a cold, damp cellar, or in a garret expofed to the injuries of the weather, a- midft the neglecl and confufion of a wretched family, clamorous from hunger, or brutal from de¬ bauchery.
£ In the practice of the Houfe,’ Dr. Ferriar ob~ ferves, c there is nothing peculiar, excepting the ufe of cold bathing, which I introduced among the home- patients in 1791, and which I have employed very fuccefsfully in the fever wards. I h^ve not ufed it in the firft days of fever, as danger is frequently to be apprehended from the tendency to congeftion, particularly in the head. Perhaps the fcrophulous conftitution of a large manufaHuring town, may ren¬ der fuppuration in the brain more frequent, in fixa¬ tions refembling ours. The fevere cough, which fo often attends our fynochus and typhus, from their firft: appearance, alfo ftrongly contra-indicates this prac¬ tice with us, at the beginning of the difeafe. But when the fever runs on to a great length, without any particular affeftion of the head or lungs, when com¬ mon ftimulants lofe their effeft, and when the extreme
debility
(
17 6 Fer.riar’s Medical Ilifiories and Bejlections .
debility of the patient takes away all hope of re* florin g him by ordinary means, I find the cold bath eminently ferviceable. Among the home-patients, I was frequently under the rieceffity of employing fimple ablution with cold water, from the want of conveniencies : in the Home of Recovery we ufe the flipper-bath, and immerfe the patient. I have never known any injurious effebt produced; on the con¬ trary, patients have often declared, that they felt themfelves agreeably refreshed by it. In fome cafes* where great ftupor accompanied the other bad fyrop- toms, and where I was not without fufpicions re- fpebling the hate of the brain, I have yet ventured on the ufe of the cold bath, after applying leeches, or cupping-glades, to the temples, and I have had the fatisfaction of feeing the patient recover, from a hate little ihort of death. Immerfion generally brings on very quiet and falutary deep, in the cowrie of an hour or two. One of my patients, in whom the effebis of the bath appeared to go off towards even¬ ing, wTas bathed twice a day. The patient’s drink was commonly adrainiflered cold.
6 In cafes of typhus, which begin with diarrhoea, when the ftomach becomes fo irritable as to rejebt medicines, wine, and other kinds of fuftenance, I depend upon repeated dofes of opium in fubdance, fometimes combined with aromatics, frequently given alone. I have cured feveral cafes of this kind, when the fever run on for four or five weeks, without giv¬ ing a fmgle dofe of bark. In thefe circumflances, when there is no fixed pain in the bowels, I join the ufe of the cold bath wdth that of opium, wdth great advantage. Aflringent gliders, adminidered cold, have a powerful effebt in checking febrile diarrhoea. In one cafe, when large quantities of laudanum thrown up, combined with ftrong aflringents, were inftantly returned, and fmall loofe dools wrere dis¬ charged almoft every half hour, I direbted three
ounces
Ferriar s Medical lliftories and Reflections* 1 77
s
ounces of a flrong decoftion of galls to be injected cold ; the effect was, that the patient had no return of diarrhoea for four hours, and then parted with a fi¬ gured ftool. The naufea, which is always a formi¬ dable fymptom, may fometimes be relieved by giving, repeatedly, fmall quantities of milk and water ; in ge¬ neral, it yields to the ufe of opium, and burnt brandy. 1 find, that obftinate coftivenefs, which fometimes be¬ comes as troublefome as the oppofite date of the bowels, is belt relieved by calomel. Five or fix grains commonly operate very gently with an adult, in this (late.
* When patients are admitted into the houfie, a flannel drefs is provided for them, and their own cloaths are carried into the yard, to be wafhed, fcoured, or ventilated. During their convalefcence, they wear the drefs of thehoufe; which confifts of a jacket and trowfers for the men, and of a wrapping1 gown and petticoat for the women. At the time of /difeharging patients, their own cloaths are returned to them perfectly clean, and they rejoin their fami¬ lies, and refume their occupations, without the ha¬ zard of communicating infection to others.’
We have thus entered fully into the account of this inffitution, for the purpofe of rendering its eftab- lifhment and fuccefs as generally known as was in our power. There is not a town, as the author ob¬ serves, containing four thoiifand inhabitants, which would not be benefited by the adoption of a fimiiar plan. Abufes and errors prevail every where among the lower dalles of fociety, which require both in- druction and afliftance from the more enlightened. Much mifery, much actual differing, are unavoidable, in all dates of fociety; yet when the important inte- refts of the poor are properly watched over, their ca¬ lamities admit of great alleviation.
The title of the next efifay is, An affection of the lymphatic vej/els, hitherto mifunderjlood. It has been
long
178 Ferriar’s Medical Hiflories and Reflections*
long known, that irritation may be propagated along; a lymphatic veffel, from its extremity, to its entrance into one of the larger conglobate glands. But prac¬ titioners do not feem to have been aware, the author obferves, that all the lymphatics of a large limb may take on a difpofition to inflammation, from in¬ ternal caufes, though fuch an occurrence might have been expected a priori . The following cafe, he thinks, ferves to demonftrate this faft, and to furniffl an explanation of cafes, which have been deferibed, but not wellunderftood, by former writers,
* A gentleman of an irritable habit, fubjeft to fe^ vere bilious attacks, to hasmorrhoidal difeharges, and fometimes to a conflderable degree of rheumatifm, was affe£ted with pain, ftiflfnefs, and fwelling, in the left leg and thigh. The pain and fwelling began in the foot, and extended up to the groin. When I faw him, the fwelling was uniform, tenfe, and fhining, without difcolouration of the Ikin. Upon applying my hand, I felt great hardnefs and enlargement in the glands of the groin, and in thofe of the ham ; the patient complained mo ft of pain in the ham. The veflels could be felt much enlarged and harden¬ ed, for a little way above the ham, but the extreme tenfion of the Ikin prevented me from tracing them to any conflderable diftance.
* A bilious fit had preceded this attack, and the ftomach was ftill weak, full of flatulence, and eafily excited to vomiting. The patient had alfo been ex¬ po fed to the aftion of cold and moifture.
* About two years before, this patient had under¬ gone a variety of complaints, arifing from an accu¬ mulation of bile, and had difeharged a conflderable quantity of hasmorrhoidal blood. After this, the left arm had become fwelled and painful, but not to a degree equal to the diforder which I have defcribed. The difeafe in the arm was at that time removed, by the application of a blifter below the elbow-joint. After the difappearance of the fwelling, an acute
pain
Ferriar’s Medical Hijtories and Reflections. 179
pain in the right fide fupervened, accompanied with tenfion of the abdomen, and obftinate coftivenefs, Thefe fymptoms continued with great fe verity, during three days, and were carried off by the brifk aft ion of fenna and rochelle fait.
‘ In confidering the affeftion of the leg and thigh, I conceived that there were fufficient marks, to indi¬ cate a general inflammatory ftate of the abforbents of the limb. Thofe fymptoms from which we con¬ clude a Angle lymphatic to be inflamed, wTere diftin- guifhable in all the fuperficial lymphatics, and in the conglobate glands of the part., I determined, there¬ fore, to try the effeft of topical bleeding, and I direfted feveral leeches to be applied to the leg, juft under the knee, as the pain and ftiffnefs were moft confiderable in the ham. Almoft immediate relief was obtained from the action of the leeches, "Next day there was an evident decreafe of the fw el- ling, and I could diftinftly trace the fuperficial lym¬ phatics, entwifted like bundles of cord, through the whole courfe of the limb. The inguinal glands on the left fide were ft ill much enlarged, and very pain¬ ful, but the affeftion feemed to flop there, for no pain or diftention was felt in the abdomen.
c The difeafe gradually leffened from day to day, while the patient’s bowels were kept open by gentle cathartics, and in the courfe of a week or two little inconvenience remained.
‘ The tenfe fwelling of the limb/ the author ob~ ferves, ‘ clearly marked the diftinftion between the clafs of veffels affefted, and thofe of the fanguiferous fyftem. The abforbents were rendered incapable of performing their funftions, by the thickening of the veffels, and the obftruftion of the glands ; but the arteries being in a found ftate, the exhalents con¬ tinued to pour out their fluid, which, not being ab- forbed, muft ftagnate in the cellular membrane. The theory and the faft accord perfeftly with each other. The difference between this ftate of accumu-
. , lation
t
1 80 Ferrier’s Medical II [ft cries and Reflections,
lation, and that of common dropfy, feems to be this ; that when the lymphatics are generally inflamed, ab~ forption ceafes entirely for the time ; but that in cafes of oedema, or anasarca, abforption goes on, though imperfectly, while there is any vigour in the habit. At length, abforption is flopped, in dropfical cafes, and the integuments give way : but before this event takes place, I have generally found the fwellings af- fume the tenfe, fhining appearance, accompanying the lymphatic inflammation.’
A difeafe, refembling that which has now been defcribed, has been mentioned by feveral writers on midwifery. They have fuppofed it to be peculiar to women in the puerperal flate, and in general have attributed it to a rupture of fome lymphatic in the groin, byr the preffure of the child’s head againfl the brim of the pelvis, during labour. Dr. Ferriar, how¬ ever, explains it on the principle above mentioned, of inflammation of the abforbent veffels and glands of the limb.
* Little can be known’, the author obferves, 4 re- fpeding the remote caufes of a difeafe, which has been co'rreftly obferved in fo fewT inftances. In my patient, it was apparently produced by the aftion of cold and moifture, and it has probably been occa- iioned by fimilar caufes, in thofe cafes where it ap¬ peared feveral weeks after delivery. But there are circumflances preceding delivery, which may ope¬ rate as remote caufes, and from which the frequency of its occurrence, in the puerperal ftate, may per¬ haps be explained.
4 It is an acknowledged faft, that during the lafl months of geflation, a confiderable interruption is given to the return of blood, by the veins of the lower extremities, in confequence of the preffure of the loaded uterus, on the contained parts of the pelvis. The exigence of venous plethora, under fuch circumflances, is proved by the varicous Hate of the fuperficial veins, which repeated pregnancies fo often occafiom By the laws of the conflitution,
which
i
/
Ferriar’s Medical Hiflories and Reflections . 181
which it is unneceffary for me to repeat to patholo¬ gical readers, this ftate of plethora in the veins, muft be followed by encreafed effufion from the exhalent veffels, and the encreafe of exhalation muft produce encreafed adlion in the abforbents. In habits pre- dispofed to the difeafe, occasional caufes may rea¬ dily excite inflammation, in a clafs of veffels thus extraordinarily ftimulated. To this confideration we muft join another; that much irritability in the lower extremities is evident, in the laft months of preg¬ nancy, from the frequency of cramps in the legs, during that period. The objection to this opinion is obvious ; that the difeafe occurs after delivery . But I have fhewed that the difeafe may exift, indepen¬ dently of every circumftance regarding parturition, and I do not think it impoffible, though at prefent I cannot prove, that it may take place before deli¬ very. Future obfervations muft decide this quef- tion. But the violent preffure on the internal iliacs, and the accompanying veins and nerves, wdftch takes place during delivery, muft undoubtedly be confider- ed as a powerful occaflonal caufe of lymphatic in¬ flammation, fufticient to account for the phenomena, wdthout the fuppofition of a rupture of veffels.
c It muft alfo be conftdered, that the conftitution is much more irritable, more liable to frebrile and inflammatory complaints, after, than before delivery. The balance of the circulating fluids is fuddenly and violently changed ; there are new determinations, new fympathies produced, in a ftate of great debility, agitation, and anxiety. It cannot furprife us, that in circumftances fo peculiar, a fet of veffels, commonly exempted from inflammatory affe&ions, fliould take on an unufual difpofttion.
£ From thefe views of the diforder, the method of treatment is eafily deduced. As no inflammatory affection of the arterial fyftem exifts, and as the in¬ flammation of the lymphatics is a local difeafe, topi¬ cal bleeding is evidently beft adapted to remove the
vol. v. O fymptoms >
182 Alibert’s Confederations fur les Odours , Sic.
fymptoms; it is a remedy which proved remarkably ufeful in the cafe which I have related, and I fhould expedt great advantages from its repeated application, upon any fimilar occalion that may occur in future. A fucceffion of blitters will be a valuable addition to this courfe, and it will be proper to exhibit internally, gentle cathartics ; perhaps cream of tartar, which ap¬ pears to operate fo powerfully on the abforbent fyf- tem, in cafes of dropfy, may be better adapted to this purpofe than moft other remedies of this clafs. By this method, the difeafe will probably be removed in two or three weeks, inftead of continuing feveral months, which is the duration generally afligned to it, by writers on midwifery.5
Whether Dr. Ferriar’s view of this diforder be per- perfedlly corredl and fatisfadtory in theory, we fliall not determine. It has, however, led him to adopt a mode of pra£tice which appears to have been attend¬ ed with ftriking advantage.
(To be continued.)
Art. XVII. Confederations Philojophiques fur les Qdeurs , et fur leur Elnploi comme Medicament : i. e. Philofophicat Confederations on Odours , and on their Employment in Medicine. By J. L.
A LIBERT. Magazin Encyclopedique, 1797 .
INDEPENDENT of the importance of the fenfe of fine 11 in g, as one of the fafeguards of our ex- iftence, and the fource oi many of our pleafures, it merits ample confideration in its relation to difeafe and the healing art. Who is ignorant of the effefts of applications to this fenfe, in thofe faintings where the living principle, as it were, remains fufpe'nded for a time ? Strong odours which adt with energy on the brain, are efpecially advantageous in thofe affedtions which belong to the nervous fyflem. Aretoeus makes
mention
Alibert’s Conji derations fur les Odeitrsy fife. 183
mention of the efficacy of ammoniacal vapours on certain epileptics. Morgagni gives an inftance of the approach of epilepfy being arrefted, or prevented, by the application of the fluor volatile alkali to the noftrils. M. Pinel, Profeffor at Paris, witneffed a fimilar fa ft. We daily obferve hyfterical attacks yield to the fame remedy. Chambon makes an in- terefting remark relative to the effects of odours, on women who are frequently affailed with nervous fymptoms. Agreeable aromatic fubftances, he ob- ferves, enable us to diftinguiffi whether the affeftion proceeds from a laefion of the uterine fyftem, or from an unnatural condition of the nervous principle • they are highly falutary when the uterus is affefted ; in the other cafe they afford no relief. He adds, that hyf¬ terical women, expofed to the aftion of acrid fetid effluvia, experience relief, whilit the purely hypo¬ chondriacal are rendered worle by them.
M. Alibert fuppofes, that in a variety of cafes we might fubftitute odours, for medicines which are in¬ terdicted by particular idofyncrafies or antipathies. Haller remarks with truth, that there are many ex¬ amples of perfons being purged by merely inhaling the effluvia of hellebore, rhubarb, or coloqumtida. The odour of faffron fometimes induces deep. Might not opium be advantageoufly employed in vapour ?
Odours afford another fertile refource, but which has been much neglefted by praftitioners in medicine. The author alludes to the relief derived from fuch fweet and grateful fcents under various calamities and misfortunes. Montaigne avers, that they ope¬ rated on him the happieff effects ; and wonders that phyficians have not oftener profited by them, to calm and foothe the ills of human life. Long before him, Ariftotle obferved, that the balmy vapours which exhale from gardens and meadows, were not lefs efficacious in re-eftablifhing the health, than in the recreation afforded by them to the fenfes. The author himfelf experienced the good effects arifing from this fource.
O 2
It
184 Dumas's Syfieme Methodique.
It muft not be diffembled at the fame time that ill confcquences may enfue, from the improper ufe of thefe means. There are, in certain individuals, par¬ ticular and inherent antipathies, the caufes of which cannot be afligned, but which call for . the greateft attention. We fee perfons thrown into convul- fions from odours the moft Ample and natural — Tiffot, in his treatife on nervous difeafes, cites the example of a woman, in whom fainting was induced by the odour of Hoffman’s Anodyne Liquor : he mem tions another, on whom the perfume of lavender pro¬ duced a fimilar effeft ; and a third in whom ftcknefs and vomiting was occafioned by the fcent of the Eau de Cologne .* The books of art contain a thoufand fimilar faffs. Travellers fubjeff to epileptic attacks have been fuddenly cured or relieved, by refpiring the perfumed air of Arabia : others, it is true, have been incommoded by the fame. The influence of odours on the nervous fyllem is neverthelefs apparent.
Thefe faffs prove, inconteftibly, the relation that fubfifts between odours, and various morbid ftates of the fyftem. The ufe that may be made of this knowledge, by the praffical phyfician, is too evident to need particularly pointing out.
Art. XVIII. Syfieme Methodique de Nomenclature et de Clajjification des Mufcles du Corps Humain : i. e. A Methodical Syfiem of Nomenclature and Clajjification of the Mufcles of the Human Body . By C. L. Dumas, Prof ef or of Anatomy and Phy -
fiology, 8£c. at Montpellier . Quarto. 1797.
Magazin Encyclopedique,
✓
THE prefent work has three diftinft objeffs. As a fyftem of nomenclature, it points out the changes which have taken place in the ancient de¬ nominations of the mufcles, and explains the method
185
Dumas's Syfteme Methodique.
in which the language of anatomy has been formed. As a fyfte.m of clafiincation, it eftablithes an exact distribution of the mufcles, by arranging them under feparate and diftiridt claffes. finally, it prelents5 oy tables neatly executed, the defcription of the mufcles, placing each in the clafs to which it properly belongs.
Prole {for Chauffer has treated the fir ft object, and rendered, by his labours, a hgnal Service to anatomy. M. Dumas propofes a nomenclature, differing but little from that of M. Chauffer, but which is be¬
lieved to be more complete and exadf.
The author firft treats of the general principles of language, and afterwards gives a view of the .progref- five advances of the fciences, compared with thofe of their language, die afterwards points out the vices of anatomical language, and the means of reforming it. The objects of anatomy, little complicated in themfelves, are capable of fimple and clear deno¬ minations. Neverthelefs, the further we purfue the ftudy of this art, the more we thali be convinced, that its language is vitiated bv an innumerable multitude of infignificant and improper terms ; which, having little or no relation to the things intended to be ex- preffed by them, can afford only tulle and erroneous ideas. The method 'which M. Dumas propofes for
correcting and improving the ancient nomenclature, confifts in attaching clear and diftindt ideas to words ; in proscribing thofe which convey no particular idea ; in drawing the denominations from the bofom of ana¬ tomy itfelf ; in employing conflantly the fame terms in the fame fenfe ; in fine, in constructing a nomen¬ clature which, by the compohtion of words, by their terminations, and by their mutual correfpondence, may be fubmitted to general and invariable rules.
An hiftorical inquiry into the caufes which have impeded the progrefs of anatomy, and deformed its language : critical obfervations on the nomenclature proper to each part of anatomy, and efpecially to myology : the bafis on which his new nomenclature
O 3 is
v
186 FI ail am ’s Obfervations on Infanity, <SfC.
is founded : thefe are the principal points which en¬ gage the author's attention in the prefent eftay.
Art. XIX. Obfervations on Inf inity : with prac¬ tical Remarks on the Difeafe , and an Account of the Morbid Appearances on Hi faction. By John Has lam, late of Pembroke Hall , Cambridge , Member of the Corporation of Surgeons, and Apothecary to Bethlem Hof pit at. Octavo, ' 147 pages, price Ss. 6d. London, 1798. Riving- tons.
OF the maladies “ which flefh is heir to,” mental derangement is fureiy to be ranked among the molt deplorable. No fubjeft is more likely to have attracted the particular attention of practitioners; and it might have been expected, we fhould, by this time, have been in poffefiion of Satisfactory doCtrines re-* Speeding it, and of a method of cure, at lead certain and determinate, however fmall its fuccefs. But it is tar other wife. It has unaccountably happened, that thole, whofe Situation leads them aim oft exclusively to the treatment of mental diforders, whofe oppor¬ tunities, therefore, of acquiring knowledge is necef- farily great, have yet withheld their obfervations from the public ; fo that we have almoft wholly loft the be¬ nefit which their opportunities and experience might have afforded us. It is with peculiar Satisfaction, there¬ fore, that m the prefent, we meet with a performance, calculated, both from the filiation the author holds, and from the proofs of attentive obfervation and found judgment it difplays, to throw conliderable light on a very important, though obfeure, fubjedl.
in treating it the author confines himfelf to a fimple range ; deferibing merely what he has ob¬ served, and fug.geft.ing a treatment which is pointed out by experience alone. The Subtleties of meta-
phyfics
Haflam’s Obfervations on Infanity ,
18
l¥f
phyfics he has, with great propriety, avoided : for to what good pra£Hcal purpofe has the difquilitiou into mind and its faculties hitherto led ?
We are but little indebted, the author obferves, to thofe who have been moft capable of affording us m- ftruclion with regard to mental alienation ; foi if we except the late Dr. John Monro’s Reply to Dr. Bat- tie’s Treatife on Madnefs,. there is no work on the fubjedt which has been delivered on the authority ot
extend ve obfervation and practice. .
The firft chapter relates to the definition of infanity. Rejecting that which has been given by Dr. Mead, and alfo that of Dr. Ferriar, his own character of the difeafe is, an incorrect affociation of familiar ideas , which is independent of the prejudices of education, and is always accompanied, with implicit belief , and generally with either violent or ^ depreffing paffions *. He ftrongly oppofes the common idea, of mania and melancholy being oppofite in their nature^ In. both thefe hates of infanity, he obferves, the aUociation of ideas is equally ineorrea, and they appear to differ only, from the different pailions which accompany them. On direction, the ftate of the brain does not fhew any appearances peculiar to melancholy ; nor is the treatment which is obferved to be molt fucceinful, different from that which is employed in mania.
In the fecond chapter the fymptoms of infanity are detailed. In no two patients is tne difeafe ufhered in, or continued, with precisely the fame appearances. The different propenfities and habits of different pa¬ tients lead, of necelfity, to a difference 01 idea, and of expreffion, in each. It would oe endlefs lo enu¬ merate all the varieties. Among tne bodily particu¬ larities, however, which mark this difeafe, may be obferved, the protruded, and often gliftening eye, and a peculiar caff of countenance, which cannot be de¬ ferred. In feme, the author obferves, an appearance takes place, which has not hitherto been noticed by authors. This is a relaxation of the integuments of
O 4
the
188 HaflamV Obfervations on Infanity, Xc,
the cranium, by means of which they may be wrin¬ kled, or rather gathered up by the hand to a con- fiderable degree It is generally rnoft remarkable on the pofterior part of the fcalp ; and has frequently been accompanied with contraction of the iris. As far as the author has obferved, it does not take place in the beginning of the difeafe, but after a raving paroxyfm of fome continuance.
The author was induced to afcertain the prevailing complexion qnd colour of the hair in infane people. Out of 265 who were examined, 205 were of a fwarthy complexion, with dark, or black hair ; the remaining 60 were of a fair fkin, and light, brown, or red haired. It would be defirable to afcertain, what connexion this proportion may have with the complexion and colour of the hair of the people of this country in general.
Of the power which maniacs poffefs of refitting cold the belief is general, and the hiftories which are on record are truly wmnderful. In Bethlem Hof* pital however, the author obferves, the patients poffefs no fuch exemption from the effeCts of fevere cold. They are particularly fubjeCt to mortifications of . the feet ; and this faCt is fo well eftablifhed from former accidents, that there is an exprefs order of the houfe, that every patient under ftriCt confinement, flrall have his feet examined morning and evening by the keeper, and alfo have them conftantly wrapped in flannel. — Thofe patients who are permitted to go about, are always to be found as near to the fire as they can get, during the winter feafon.
The author next gives a hiflory of the appearances which he has noticed on opening the heads of feveral maniacs, who have died in Bethlem Hofpital. Twenty- nine cafes are given, in all of which there were marks of previous inflammation, fuch as thickening and opa¬ city of the tunica arachnoides and pia mater. In the greater number there was effufion of water into the
cavities
Haflam’s Obfervations on Inf unity , tsc. 189
cavities of the brain. Several died apoplectic and paralytic. In one inftance only was there any pre¬ ternatural hardnefs of the fubftance of the brain, an appearance which has been much infilled on by fe-
veral writers.
►
Chap. 3 inquires into the caufes of infanity. The caufes which the author has been able moll certainly to afcertain, may be divided into phyfical and moral. Under the firft are comprehended repeated intoxica¬ tion 5 blows received upon the head ; fever, particu¬ larly when accompanied with delirium ; mercury largely or nnjudicioufly employed ; the fuppreffion of periodical or occalional difcharges and fecretions ; hereditary difpofition, and paralytic affedtions.
Of the moral clafs of caufes, are the long en¬ durance of grief, ardent and ungratified defires, re¬ ligious terror, the difappointment of pride, fudden fright, fits of anger, profperity humbled by misfor¬ tunes : in a word, the frequent and uncurbed indul¬ gence of any palhon or emotion, and any fudden and violent affedtion of the mind.
Of the more immediate, or, as it is generally term¬ ed, the proximate caufe of this difeafe, the author profefifes to know nothing. Whenever the functions of the brain lhall be fully underftood, and the ufe of its different parts afcertained, we may then be enabled to judge, how far difeafe, attacking any of th'efe, parts, may increafe, diminifh, or otherwife alter its functions. But this appears a degree of knowledge which we are not likely foon to attain.
From the diffedtions of infane perfons here ad¬ duced, it may be inferred, that madnefs has always been connected with difeafe of the brain, and of its membranes. And it is much in favour of them, that they have not been feledted from a number of others, which would have rendered them liable to fufpicion, but comprize the entire number which have fallen under the author’s obfervation.
190 Haflam's Obfervations on Infanity , SCc.
- 6 It may be a matter affording much diverfity of opinion/ the author obferves, * whether thefe morbid appearances of the brain be the caufe or the effedt of raadnefs : it may be obferved, that they have been found in all dates of the difeafe. When the brain has been injured from external violence, its functions have been generally impaired, if inflammation of its fubftance, or more delicate membranes has enfuech The fame appearances have for the rnoft part been detected when patients have died of phrenitis, or in the delirium of fever : in thefe inftances the derange¬ ment of the intellectual functions appears evidently to have been caufed by the inflammation. If in ma¬ nia the fame appearances be found, there will be no neceffity of calling in the aid of other caufes to ac¬ count for the effedt ; indeed it would be difficult to difeover them. Thofe who entertain an oppoftte opi¬ nion, are obliged to fuppofe, a difeafe of the mind . Such a morbid affection, from the limited nature of my powers perhaps, I have never been able to con¬ ceive. Poflefling, however, little knowledge of me- taphyncal controverfy, I fl i all only offer a few remarks upon this part of the fubjedt, and beg pardon for having at all touched it.
‘ Perhaps it is not more difficult to fuppofe that matter peculiarly arranged may think , than to con¬ ceive the union of an immaterial being with a cor¬ poreal fubftance. It is queftioning the infinite wif- dom and power of the Deity to fay, that he does not, or cannot arrange and organize matter fo that it fhall think. When we find infanity, as far as has hitherto been obferved, uniformly accompanied with difeafe of the brain, is it not more juft to conclude, that fuch organic affedt ion has produced this incorrect affocia- tion or ideas, than that a Being, which is immaterial, incorruptible and immortal, fhould be fubjedt to the grofs and fubordinate changes which matter tieceffa- rily undergoes ? /yvffi | ’ -|rf£
( Bui
Haflam’s Obf croat Ions on Infanity, $c. 191
* But let us imagine a difeafe of ideas. In what manner are we to effeCt a cure ? To this fubtle fpijit the doctor can apply no medicines. But though fo refined as to elude the force of material remedies, fome may however think that it may be reafoned with. The good effects which have refulted from exhibiting logic as a remedy for madnefs, mud be fufficiently known to every one who has converfed with infane perfons, and muft be confidered as time very judicioufly employed : fpeaking more gravely, it will readily be acknowledged, by perfons acquainted with this difeafe, that if infanity be a difeafe of ideas, we poffefs no corporeal remedies for it : and that to endeavour to convince madmen of their errors, by reafoning, is folly in thofe who attempt it, fmce there is always in madnefs the firmed conviction of the truth of what is falfe, and which the cleared and mod cir~ cumdantial evidence cannot removed
Mr. Haflam next adverts to the prognodic In cafes of infanity. c In our own climate,5 he ob~ ferves, 4 women are more frequently affeCled with infanity than men. Several perfons who fuperintend private mad-houfes have adored me, that the number of females brought in annually confiderably exceeds that of the males. From the year 1748, to 1794, comprizing a period of forty-bx years, there have been admitted into Bethlem Hofpital 4832 women, and 4042 men. The natural proceiies which women undergo, of mendruatioh, parturition, and of pi soar¬ ing nutriment for the infant, together with the difeafes to which they are fubject at thefe periods, and which are frequently remote caufes of infanity, may, per¬ haps, ferve to explain their greater difpofition to this malady. As to the proportion in which' they recover, compared with males, it may be dated, that of 4832 women affe&ed, 1402 were difcharged cured; and that of the 4042 men, 1155 recovered. It is proper here to mention, that in general we know but little
192 Ha flam's Obfervations on Infanity , Kc.
of what becomes of thofe vcho are difcharged, a cer¬ tain number of thofe cured occafionally relapfe ; and fome of thofe who are difcharged uncured afterwards recover : perhaps in the majority of inflances, where they relapfe, they are fent back to Bethlem. To give fome idea of the number fo r'e-admitted, it may be mentioned, that, during the laft two years, there have been admitted 389 patients, 53 of whom had at fome
JL
former time been in the houfe. There are fuch a variety of circumftances, which, fuppofmg they did relapfe, might prevent them from returning, that it can only be hated, with confidence, that within twelve months (the time allowed as a trial of cure) fo many have been difcharged perfectly well.
4 To fhew how frequently infanity fupervenes on parturition, it may be remarked, that, from the year 1784 to 1794 inclufive, 80 patients have been admitt¬ ed, whofe diforder {portly followed the puerperal hate. Women affected from this caufe recover in a larger proportion than patients of any other defcription of the fame age. Of thefe 80, 50 have perfectly reco¬ vered. The frit fymptom of the approach of this difeafe, after delivery, is want of fleep ; the milk is afterwards fecreted in lefs quantity, and, when the mind becomes more violently difordered, it is totally fupp re fifed.
4 From whatever caufe this difeafe may be produced in women, it is conhdered as very unfavourable to re¬ covery, if they are worfe at the period of menftruation, or have their catamenia in very fmall or immoderate quantities.
4 At the firft attack of the difeafe, and for fome months afterwards, during its continuance, females mofl commonly labour under amenorrboea. The na¬ tural and healthy return of this difcharge generally precedes convalefcence.*
It appears, from an eftimate of feveral years, that infane perfons recover in proportion to their youth. When the difeafe attacks perfons advanced in life, . the
193
Haflam’s Ohfervntions on Inf unity , <Su\
the profpeCi of recovery is but fmall. The chance of cure, likewife, appears to be lefs, in propbrtion to the length of time which the diforder fliall have continued.
‘ When the reader contrails the preceding ftate- ment with the account recorded in the report of the committee, appointed to examine the phylicians who have attended his Majefly, &c. he will then either be inclined to deplore the unlkilfulnefs or mifmanage- ment which has prevailed among thofe medical per- fons who have directed the treatment of mania in the largell public inftitution, in this kingdom, of its kind, compared with the fuccefs which has attended the private praCtice of an individual ; or, to require fame other evidence , than the hare ajjertions of the man pretending to have performed fuch cures . It was de~ pofed by that reverend and celebrated phylician, that of patients placed under his care within three months after the attack of the difeafe, nine out of ten had re¬ covered ; and alfo, that the age was of no fignifica- tion, unlefs the patient had been affliCted before with the fame malady.
‘ How little foever I might be difpofed to doubt fuch a bold, unprecedented, and marvellous account, yet, I mull acknowledge, that my mind would have been much more fatisfied as to the truth of that affer- tion, had it been plaufibly made out, or had the cir- cumftances been otherwise than feebly recollected by that very fuccefsful pra&itioner. Medicine has gene¬ rally been elleemed a progrefiive fcience, in which its profelfors have confeiTed themfelves indebted to a great preparatory ftudy, and. long fubfequent expe¬ rience, tor the knowledge they have acquired ; but, in the cafe to wThich we are now alluding, the outfet of the doCtor’s praCtice was marked with fuch fplendid fuccefs, that time and obfervation have been unable to increafe it.
c This aftoniihing number of cures has been effect¬ ed by the vigorous agency of remedies, which others have not hitherto been fo fortunate as to difcover ; by
remedies
194 BaflanTs Obfervations on Infanity, 8(c.
remedies which, when remote caufes have been ope¬ rating for twenty-feven years, fuch as weighty bufi- nefs, fevere exercife, too great abftemioufnefs, and little reft, are poffeffed of adequate power direftly to meet and counteract fuch caufes. 4
c It will be feen by the table that a greater number of patients have been admitted between the age of thirty and forty, than during any other equal period of life. There may be fome reafons affrgned for the increafed proportion of infane perfons at this age.
4 Although I have made no exadt calculation, yet, from a great number of cafes, it appears to be the time, when the hereditary difpofition is moft frequent¬ ly called into aftion ; or, to fpeak more plainly, it is that ftage of life when perfons, whofe families have been infane, are moft liable to become mad. If it can be made to appear, that at this period people are more fubjeft to be adted upon by the remote caufes of the difeafe, or that a greater number of fuch caufes are then applied, we may be enabled fatisfaftorily to explain it. At this age people are generally efta- blifhed in their different occupations, are married, and have families ; their habits are more ftrongly formed, and the interruptions of them are, come- quently, attended with greater anxiety and regret. Under thefe circumftances, they feel the misfortunes of life more exquifttely. Adverfity does not deprefs the individual for himfelf alone, but as involving his partner and his offspring in wretchednefs and ruin. In youth, we feel defrrous only of prefent good; at the . middle age, we become more provident and anxious for the future; the mind affumes a ferious charadter, and religion, as it is juftly or improperly impreffed, imparts comfort, or excites apprehenfion and terror.
c By misfortunes the habits of intoxication are readily formed. Thofe, who in their youth have fhaken off calamity as a fuperficial incumbrance, at the middle age feel it corrode and penetrate : and
when
Haflam’s Obfermtions on Inf unity, S (c.
when fermented liquors have once difpelled the gloom ol defpondency, and taught the mind either to excite a temporary affemblage of cheerful fcenes, or to dif- dain the terror of impending mifery, it is natural to recur to the fame, though deftru&ive caufe, to re¬ produce the effeCt.
c Patients, who are in a furious (late, recover in a larger proportion than thofe who are depreffed and melancholick. An hundred violent, and the fame number of melancholick cafes wmre felected. Of the former, fixty-two were difcharged well ; of the latter, only twTenty-feven. When the furious ftate is fucceed- ed by melancholy, and after this {hall have continued a fhort time, the violent paroxyfm returns, the hope of recovery is very flight. Indeed, whenever thefe hates of the difeafe frequently change, fuch alterna- nation may be confidered as unfavourable.
c Where the complaint has been induced from re¬ mote phyiical caufes,- the proportion of thofe who re¬ cover is confiderably greater, than where it has arifen from caufes of a moral nature. In thofe inftances where infanity has been produced by a train of un¬ avoidable misfortunes, as where the father of a lar^e family, with the moft laborious exertions, ineffectually druggies to maintain it, the number who recover is very frnall indeed.
Paralytic affections are a much more frequent caufe of infanity than has been commonly fupppfed. In thofe affefted from this caufe, we are, on enquirv, enabled to trace a hidden affeCtion, or fit, tQ have preceded the difeafe. Thefe patients ufualfy bear marks of fuch affeftion, independent of their infanity ■: the fpeech is impeded, and the mouth drawn afide ; an arm,' or leg, is more or lefs deprived of its capacity of being moved by the will : and in by far the greateff number of thefe cafes the memory is particularly af¬ fected. . Very few of thefe cafes have received any benefit in the hofpital ; and from the enquiries I -have been able to make at the private houfes, where they
* have
/
196 Haflanfls Obfervations on Infanity , Sfc\
have been afterwards confined, it has appeared, that they have either died fuddenly from apoplexy, or have had repeated fits, from the efledls of which they have funk into a ftupid Hate, and have gradually dwindled
away.
‘ When the natural fmall-pox attacks infane per* fons, it moft commonly proves fatal.
6 When infanity fupervenes on epilepfy, or where the latter difeafe is induced by infanity, a cure is very feldom effedled : from my own obfervation, 1 do not recoiled! a tingle cafe of recovery.
When patients during their convalefcence be¬ come more corpulent than they were before, it is a favourable fymptom ; and, as far as I have remark¬ ed, fuch perfons have very feldom relapfedd
i . -
The method of cure is divided by the author into management , and treatment by medicine. The for¬ mer, perhaps, is of much the greater confequence. — Coercion is recommended only, for the purpofe of avoiding danger to the patient and his attendants. Mild treatment, with great regularity in all the addons performed by the patient, is particularly enforced. — ■ By gentlenefs of manner, and kindnefs of treatment, the author obferves, he has never failed to obtain the confidence, and conciliate the efteem of infane .per¬ fons ; and has fucceeded by thefe means in procuring from them refpedl and obedience. There are cer¬ tainly fome patients who are not to be trufied, and in whom malevolence forms the prominent feature in their charadter : fuch perfons fliould always be kept under a certain refrraint ; but this is not incompatible with mildriefs and humanity.
Infane patients fliould be made to rife, take exer- cife, and food, at hated times. Independently of fuch regularity contributing to health, it alfo renders them much more eafily manageable. Change of fitu- ation, and removal from friends, are amongft the riieans particularly recommended.
As
HaflanVs Qbfervations on Inf unity, <Sfc. 19?
>
As to medicines, fome remarks occur on bleeding purging, vomiting, camphor, cold-bathing, blitters,, and opium, Bleeding, the author obferves, he has found the moft beneficial remedy that has been em¬ ployed, where the patient is ftrong and of a plethoric habit, and where the diforder has not been of any long continuance. The melancholic cafes have been equal¬ ly relieved with the maniacal by this evacuation. A buffy coat has feldom been obferved on the blood.
An opinion has long prevailed, that mad people are particularly conftipated, and extremely difficult to be purged. From the author’s obfervations, however, it would appear, that infane patients are of very delicate and irritable bowels, and readily purged by the com¬ mon cathartics. The common complaints with which they are attested, are diarrhoea and dyfentery. Ca¬ thartic medicines, it -appears from very ample expe¬ rience, are of the greateft benefit in the treatment of infanity.
Vomiting is not fpoken of favourably. In many inftances, it feems to have induced paralytic affeftions by determining to the head. Camphor feems to have been ufelefs, but the author has witneffed its trial in ten cafes only. Cold-bathing appears to have done harm as frequently as fervice. Blitters and other drains have been found ineffectual.
Of opium it is obferved, that whenever it has been exhibited during a violent paroxyfm, it has hardly ever procured fleep ; but, on the contrary, has ren¬ dered thofe who have taken it much more furious and, where it has for a fhort time produced reft, the patient has, after its operation, awoke in a ftate of increafed violence.
■ • -• ‘l ' ' ' ' ■ " ’ X'" -' ""
VOL. ¥•
P
Ait.
( 198 )
Art. XX. Examen fait fur V Exigence dhin Fliiide Aqueux dans les Cavites Cerebrates , <S (c. i. e. An Inquiry into the Existence of an Aqueous Fluid in the Cavities of the Brain.
Magazin Encyclopedique, 1797*
MANY have fuppofed, that the ventricles of the brain in their natural hate contain a quantity of fluid 5 and M. Soemmering has gone fo far, as to imagine this fluid to be the organ of the foul. We fee, in this inflance, how prone the mind of man is to build hypothefes ; and on how perifhable a balls they are often ereffed, will appear from the following ftatement. A man, of the name of Kuhne, was beheaded ,at Brunfwick, on the third of January 1797 : the head was carried as fpeedily as poflible, to the anatomical theatre, and differed immediately, in prefence of Meflfs. Sommer, Roofe, Wiedman, Himly, Schoenyan, Cramer, Fricke, & c. &c. Pro- feffors of Medicine. The following were the ap¬ pearances obferved.
The membranes of the brain were frill full of blood. ~Five and twenty minutes after the execution, they began to make horizontal incifions into the fubftance of the brain, which was ftill warm and humid. Long before this, not the leaft trace of motion in the retina on expofing it to the light could be obferved, nor any other mark of fenfation. — Thirty minutes after execu¬ tion, the cavity of the left ventricle was laid open from above, but no traces of watery fluid were obfervable. It was the fame with the right ventricle.
At thirty-three minutes, they opened the cavity of the third ventricle $ and at thirty-fix minutes, that of the fourth. In none of thefe parts was the fmalleft drop of water to be obferved, nor even in the calamus fcriptorius . As the cavities of the brain have no communication with the channel of the fpine, it can¬ not be fuppofed, that by the feparation of the fourth
from
• , . H. ■ ' \
Lombard’s Lift ruction fur V Art des Panfemens, Sc. 199
from the fifth vertebra, the efcape of any fluid, before contained within the ventricles* could take place.
Thus, then, the queftion refpeCting the exiftence of an aqueous fluid in the brain, in the natural ftate, may be confidered as determined : if, indeed, any fuch proof were needed. . '
Art. XXI. Premieres Lignes de Nofo logic Infan- tile, ou EJfai fur la Diftribution des Maladies des Enfans en Clajfes , Sc. i. e. Fir ft Lines of Infantile Nofo logy ; an Ejfay on the Diftribution of the Difeafes of Children into Claftcs , Genera , and Species. By J. M* Caillau, Member of the Philanthropic Society of Health at Bourdeaux , 8s c. Twelves. Magazin Encyclopedique.
MACBRIDE, in his introduction to the theory and practice of medicine, eftablifhed four great claffes of difeafes. He divided them into 1ft. univerfal, 2d. local, Sd. fexual, and 4th. infantile, Death prevented his fulfilling more than the firft part of his talk. The laft clafs forms the fubjeCt of the prefent eflay.
The number of treatifes on infantile diforders is fufficiently great: but in none are they clafled, in- the opinion of M. Caillau, with fufficient precifion. To fupply this deficiency is the objeCt of his endeavours.
Art. XXII. Inftruction Sommaire fur V Art des P anfemens , a I'Ufage des Etudians en Chirurgie , Sc. i. e. Brief Inft ructions on the Art of Dr effing Wounds, for the Ufe of Students in the Military Hofpitals . By Lombard, Confidting-Surgeon of the Army , Sc. Sc. OCtavo. Strajbourg.
THE prefent treatife contains fummary directions, refpeCting the different circumffances relative to
P 2 wounds.
I
200 Tilrton’s Me diced Glojjary »
wounds* * and their management. Lint* and its various ufes* bolfters* tents* felons, injections, fomentations, cataplafms, plaflers * the application of different to- t4picals in the cure of wounds and ulcers ; comprefs and bandage ; thefe are the objedts of the author’s attention. The filiation of M. Lombard with the army, qualifies him in an eminent degree for the tafk he has undertaken, and his mftruSlons are the more neceffary, as the great deman \ for military bur¬ geons has introduced many into the inferior offices of hofpitals, without education and the requifite infor¬ mation. In the execution of the work, more im¬ portance, perhaps, is beflowed on minute circum- ftances, than will be thought neceffary by the gene¬ rality of Britifh furgeons.
M I Wii ■gfgrn I ■»■■ mmnm . . ji
• -• - ,-s - • • .V .
i H . * . ^
t
Art. XXIII. A Medical Glojjary , in which the Words in the Various Branches of Medicine are Deduced from their Original Languages , properly Accented and Explained . By W. Turton, M.Dl Quarto, 622 pages, price ll Is. Johnson, 1797.
OF the utility of a work of this kind, no doubt can be entertained, and it is only requifite that its execution fhould be equal to its defign. That it is fo we may venture to liate.
.••r
No. XXVII.
THE
* t
MEDICAL and CHIRURGICAL
' *'<
REVIEW.
NOVEMBER, 1798.
— ' v ~ '•» l- ^ " 4 f * -
Art. XXIV. Memoir es de la Societe Medicate U Emulation, He. : i. e. Memoirs of the Medical Society of Emulation , held at the School of Me¬ dicine of Paris. Octavo., 537 pages. Paris, 1798.
THE volume before us contains the firft fruits of a fociety, eftablifhed for the laudable purpofe of promoting and extending the different branches of medicine. Though firft inftituted by the pupils of the various claffes, the lift of members has been ho¬ noured by the names of feveral of the firft profeffors in Paris, and who have contributed their labours to¬ wards the formation of the prefent collection. We hardly need fay, therefore, that it is in many refpefts highly interefting, as containing valuable practical in¬ formation, and much found reafoning. We flia.ll pre¬ fent our readers with a general account of its contents, and a more particular one of fuch parts, as appear moft novel or important.
A *■ *. • ,i
The work is divided into the different heads of Medicine, Surgery, Materia Medina., Phyfiology, and Medical Philofophy.
vol. v. Q The
202 Memoires die la Societe Medicate Dy Emulation*
The fir ft article under the clafs of Medicine con¬ tains, Obfervations on the Danger of Cutting the Hair in fome Acute Difeafes, By P. Lanoix, M D.
Art. 2. Medical Obfervations, extracted from Authors not of the Medical Profeffion, applied to the Defcription of Fevers of the Intercurrent kind, intended as part of a larger Work. By Roufdle - Chamfer u .
3. Inquify by M. Hitffon , whether Ample Ter¬ tians fliould be left to themfelves till after the Seventh Faroxyfm, according to the Aphorifm of Hippocrates, Tertiana exquifita feptem circuitibus iitplurimum ju¬ dicature — This queftion the author determines in the affirmative, but allows, at the fame time, that parti¬ cular cafes may call for the interference of art.
The two following papers we have already noticed, in an extract from the Magazin Ency elope digue.
6. Is there a real Difference between Difeafes of the fame kind, when they arife in Armies encamped in elevated Situations, and in marfhy Grounds ? By J- Roques. — This queftion too has often been deter¬ mined affirmatively.
7. Obfervations on a fudden Suppreffion of the Menfes, occalioned by a mental Affeftion, and the confequences which enfued. By P. J. Chevalier.
8. Reflections on the Modifications which Educa¬ tion and Habit occafioned in the developement of the affeCtion termed Nqftalgia , during the late War. By R. P. Beauchamp.
9. Obfervation on a cutaneous Apoplexy. By B. A. Godefroy-Coutanceau. — There feems to us no ground for the name which the author beftows on the prefent affeCtion. It had no fymptom of apo¬ plexy, and appeared to have been merely a variety of Scarlatina. 1 he veffels of the head were found dif- tended with blood.
^ 1.0. Obfervations on certain AffeSions of the V oice. Jby M. Portal. — I he firft cafe recited by the author, is of a woman, 43 years of age, and of an irritable
, • temperament.
Memo ires de la Societe Medic ale D' Emulation \ 203
temperament. She had loft the power of fpeaking at will ; Hie made fruitlefs efforts to fpeak for fome minutes, but having once begun, found it equally difficult to reftrain herfelf. She often uttered invo- luntarily uncommon founds ; and efpecially when clofely occupied by any idea, found it impoffible to avoid expreffing it in fpeech. But in this citfe, in- ftead of the ordinary monotonous tone of converfation, ffie uttered the moft difcordant founds, p ailing rapidly from the ffiarpeft to the lowed; tone, often with an intermediate and continued found ; fo that her voice refembled at times the barking of a dog, or the howl of a wolf.
M. Portal attributed this uncommon affeftion to a convulfion of the mufcles of the voice and fpeech, and prefcribed cooling and relaxing drinks, and antifpaf- modics. After feveral months, the voice returned gradually to its natural ftate.
In another cafe of fuppreffion of the voice, the caufe was fuppofed to be a paralytic affediion of the mufcles of the larynx, and an appropriate treatment adopted with fuccefs. The remaining cafes have lefs of pecu^ liarity.
11. Memoir on periodical or intermittent Mania, By M. Pinel. — This paper contains many valuable re¬ marks, but hardly admits of abridgement. We find in it a confirmation of many of the remarks of Mr. Haflam, whofe Treatife on Infanity was noticed in our laft number.
Under the head of Surgery, the firft paper is, On the Inconveniences which the Invagination of the In- tefline prefents. By M. P. F. Ray tigers, of Holland, — By this term is underftood, the operation for uniting the two extremities of a divided inteftine. From a view of the difficulties and danger which neceffarily relult from an operation of this kind, the author thinks it ought never to be practifed in the human body. He advifes only that care fhould be taken to
Q 2 retain
I
1 J ' V •»
204 Memoircs de la Societe Medicate U Emulation,
\
retain the divided ends at the edges of the wound* which wili thus often gradually clofe, and preferve the continuity of the canal.
2. Opinion on the Signs of the Elaftic Gum Ca¬ theter having penetrated into the (Efophagus or Larynx. By J. S. F. Worbe.
3. Cafe of Luxation of the Tarfus. By M. Be an fils.
4. Obfervations on a Cancerous Ulcer. By Mb Salmade. — The ulcer was lituated on the infide of the arm, and fucceeded fome fchirrous lumps in the breaft. The appearances feem clearly to indicate the real nature of the complaint* which refilled the ordinary modes of treatment. It was afterwards cured by repeated applications of the cauftic powder ot Rouf- felot*, made into a palle with water, and laid on the furface of the ulcer for four and twenty hours at a time. It was repeated, after the interval of a few days, till the fungous dilpolition was deflroyed, and the fore put on a healthy appearance.
5. Obfervations on a Mufcle ruptured by the violence of its Contraction. — This accident happened to the pfoas mufcle, from lifting a heavy weight. It was followed by lumbar abfcefs which proved fatal. On diftection, the mufcle was found to have fufiered a. confiderahle rupture.
6. Obfervation of a voluminous Tumour of the Knee, the exa£l Nature of which could not be de-» termined, even by infpeCtion after Death. By Le- pecq de la Cloture .
\ ■ <s ’• I V
Section 3. Materia Medica. The fir ft paper in this part of the volume contains fome interefting Re-
V I ' V
* The compofition of this powder is as follows ;
R Sulphur of Mercury *,
Dragons Blood, - -
o ^ ►
Oxyd of Arfenic, - zX
(* Qu. Cinnabar.) i
marks
Memoir es de la Sociele Medicate JDy Emulation. 205
marks on the Effe£ts of Phofphorus, employed as an internal Remedy. By M. Alphonfe he hoy. This fubftance, M. Le Roy ohferves, he has very often had occafton to employ, and he thus defcribes the circum- ftance which firft led him to adopt it. Being called in the year 1778, to a woman who was nearly ex- haufted from a long previous illnefs, and apparently within a few hours of her laft, having no other remedy at hand, he took fome water from a flafk, in which pieces of phofphorus had been long kept, and gave the patient a draught of it. The next day the patient was fenfibly better, and was preferved from death, the author thinks, for a fortnight afterwards, by a continuance of the fame remedy.
He found on inquiry, that fome German praSti- tioners had given phofphorus inwardly, mixed with confections, in malignant fevers, and, as was faid, in dofes of twelve grains. On taking, however, fo fma.ll a quantity as three grains in theriaca , M. Le Roy was in danger of falling a victim to his imprudence s , for heated phofphorus needs no more air to inflame it, than the ftomach is frequently found to contain. He found himfelf exceedingly incommoded for fome hours, and drank frequent draughts of very cold water. The urine, he obferves, became exceedingly red. The next day his mufcular powers were amaz¬ ingly increafed, and he felt an almoft iniupportable venereal irritation.
He afterwards gave the fame remedy to a young man, in the laft ftage of a malignant fever, without hope of recovery ; and with the beft effects. Since this time, M. Le Roy and fome of his pupils have fo often employed it, and in luch various forms, eipe- daily in malignant fevers, that he is convinced it is .one of the greateft refources in the hands of the phy~ ftcian.
It has been given in different ways, fometimes in that of a linftus. The difficulty is to bruife it with¬ out inflaming it. To effect this, he melts it in hot
Q 3 water.
206 Memoir 6 s de la Societc Medicate £>’ Emulation .
water, and agitates the phial violently, till the phof- phorus is divided into an infinite number of globules, like oil : on adding cold water, the phofphorus is pre¬ cipitated in the form of a powder. One or two grains of this is mixed with fugar, a drop or two of oil, and the yolk of an egg, and rubbed in a glafs mortar, placed in ice or extremely cold water, till the lindtus is completed. A quarter of a grain of phofphorus taken daily, M. Le Roy obferves, is fufficient to pro¬ duce conflderable effedl.
Kunkel exhibited phofphorus, in England, in a folid form. He made luminous pills, which he gave in obftinate chronic complaints. M. Le Roy has dis¬ covered the method of forming thefe ; but has with¬ held it from the public, convinced, from his own ex¬ perience, of the danger of the remedy when not fuf- ficiently diffolved. Each pill contains an eighth of a grain of phofphorus. They poffefs, he fays, a foporific and quieting power. He has often employed them in rheumatifm, and a number of nervous affections, in pituitous difeafes, acute as well as chronic, and in rheumatic gout.
The phofphoric acid appears to the author an equal¬ ly valuable remedy. Taken as a kind of lemonade, lie fays, it is ufed by many perfons, and thought by them to contribute to the prefervation of health, and even to prolong life.
From its effects in exciting the venereal appetite, M. Le Roy thinks phoiphorus one of the moil pow¬ erful and fpeedy reftoratives in nature. Of almofl in¬ finite divifibilitv, he thinks, from its analogy to light, it bears a firong relation to the nervous fluid. Of all fubftances, perhaps, it is the moft proper to be tranfmuted in the animal oeccnomy into the eleftric vital fluid, its adtion is clearly marked on the organs of generation, and its relation to the fpermatic fluid is evident.
The body of a woman who had taken a Angle grain of phofphorus., and who had been recovered
by
Memoircs dc la Societe Medicate D' Emulation. 207
by it from a putrid fever, but who foon after died fuddenly from fome imprudence, was obferved to be entirely phofphoric, and luminous in all parts. I he hands of the anatomift who diiTe&ed the body, even after being wafhed, were ftill luminous.
M. Le Roy promifes a continuation of his remarks on this interefting fubjeft.
2. Obfervations and Experiments on certain pur¬ gative, diuretic, and febrifuge Medicines, applied ex¬ ternally. By M. Alibert.— Already noticed by us. .
3. On the utility of certain indigenous Plants in the Treatment of many fpecies of intermittent Fever* and more efpecially in thofe accompanied by Stupor* By M. J. P." J off r ion. — The obfervations on this fub- l’eft are of too general a nature to admit of abridge¬ ment here.
4. ExtraSl of a Memoir on the antivenerea! and antipforic Properties of Oxygene. By M. Alyon. — It has long been prefumed, that mercury and its pre¬ parations owe their medicinal properties in fome way to oxygene : the fimple metal may be taken in any quantities with little or no effedt. At prefent when it is known that mercury, of all the metals, is the moft oxydable ; that agitation in the air is alone fufficient to combine it with oxygene, and, on the other hand, that it readily abandons this principle : when the fa¬ cility with which oxygene unites with animal fub- ftances, and the tendency thefe have to extract it from acids and oxyds, are attentively conlidered, we may form a ready conception, the author obferves, in what way all the mercurial preparations a 61. Know¬ ing thefe fadts, he obferves, to find a powerful anti- venereal remedy, an adfive ftimulant, it is only necei- fary to take a fubllance containing a large proportion of oxygene, and which readily parts with it to animal fubffances. On thefe principles he has been able to obtain many combinations of oxygene without mer¬ cury, and which he has employed with the greateft fuccefs. Thus by axunge and the nitric acid, is
Q 4 * formed
508 Fordyce’s Third Differtation on Fever.
• \ * * •
formed an ointment fuperior to the Neapolitan ; and thus he has employed the folution of the oxygenated muriate of potafb, to cicatrize chancres and venereal ulcers, with effedt far fuperior to mercurial prepara¬ tions. By augmenting the dofes of the oxygenated ointment, and by the internal ufe of water acidulated with the nitric acid, M. Alyon obferves, he has pro¬ duced falivation, the fwelling of the amygdalae, and the other effects which refult from exceffive mercurial fridtions. The detail of his experiments are foon to be laid before the public.
Art. XXV. A Third Differtation on Fever. Part I. By George Fordyce, M. D. Sic.
( Con tinned from page 148,y
IN otir laft number, we followed the learned author through the Hiftory and Progrefs of a regular con¬ tinued Fever, and are now to notice the mode of treat¬ ment to be purfued. It has already been dated that the prefent part contains only the method of treat¬ ment, iuppofing the difeafe is left to purfue its re¬ gular courfe. The next point of inquiry will be,, whether means have been found out to fhorten the’ fever by producing a cribs, or otherwdfe, fo that the patient iliall be reftored to health. But this will form: the fubjedt of the fecond part, and which we are told! Is in much forwardnefs.
The hilt attention is to be paid to the iituation of the patient. A man afledted with fever, the author obferves, has the powers of his fyftem depreffed, and therefore cannot defend himfelf againft the cold of the atmofphere. Befides, a degree of cold greater than a man has been accuftomed to, contracts all the ex¬ ternal veffels, and therefore prevents that relaxation
which.
Fordyce's Third Differtation on Fever . 209
which ought to take place in the crifis, and of con- Fequence tends to prevent crifis from taking place. It alfo tends to render the diminution of the difeafe in the morning lefs confiderable. On thefe accounts, a man in a fever fhould not be fuffered to remain in too cold an atmofphere, or any other medium of too fmali a degree of heat.
A fmali part only of the body is expofed to the heat of the atmofphere ; this therefore may be colder than the bodies which immediately furround him. In this country, the author obferves, the heat of bodies im¬ mediately furrounding the patients fhould never be lefs than feventy-hve in winter, or eighty degrees in fummer. The different wrays of regulating the tem¬ perature are pointed out at confiderable length, bu do not require our detailing them.
In fever, a patient fhould avoid all extraordinary exertions ; he fhould be placed, therefore, in a hori¬ zontal pofition, or as nearly fo as he is accuftomed to when in health ; in this pofition he is fupported every where by the bed, and is not obliged to exert any of his mufcles, as he is when in an upright pofture, to keep the parts in equilibrium. At the fame time, great care fhould be taken that his mind be kept free from all exertions whatever, and efpecially all fuch as produce anxiety.
In regular continued fever, when fevere, the patient is not able to judge of any thing truly 3 the mind can¬ not arrange the arguments on each fide of a queftion, fo as to draw from them any perfedt conclufion, much lefs can it form a rule for any action ; nor, when it has formed an opinion of what is to be done, can it ima¬ gine the mode in which the effect is to be produced. No advantage can, therefore, be gained, by exciting, his attention to his affairs ; the force of the fyftern is only exhaufted by fruitlefs attempts. If a regular con¬ tinued fever fhould be lefs violent in its beginning, although a man might attend to his affairs with forne effcdt, yet any advantage gained by fuch attention
4 would
210 Fordyce’s Third Differtation on Fever «
would be much overbalanced by exerting the force of the fyfrem. As foon, therefore, as a patient is feiz- ed with a febrile attack, he ffiould immediately be put to bed, and left under the care of one attendant only, and every thing that can call into addon the operations of the mind is to be avoided.
The quality of the atmofphere which the patient breathes is next to be attended to : and here the author remarks, that the proportion of pure air in the atmofphere in different fituations is very nearly the fame, provided the air does not ftagnate ; in a room in a private houfe, or in the ward of an hofpital in the center of fuch a city as London. It is only neceffary, therefore, that the air fhould not ftagnate.
The queftion, whether a different proportion of pure air would be better adapted to the refpiration of a patient in a fever, than that proportion which is found commonly, is thus critically difeuffed. When¬ ever any new and feemingly important fadi has been difeovered, and efpecially if it cannot immediately be applied to any advantageous purpofe in mechanical or chemical arts, mankind in general, and very of ten even praddtioners in medicine, conceive it muff be applicable to feme medicinal purpofe. juft as an infant, allured by any thing which glitters in its eye, applies it to its mouth, fuppofing it mull be likewife exquifite food ; fo infants in medicine are dazzled with any furprifing difeovery, and immediately em¬ ploy it for the cure of difeafes, not confidering how extremely difficult an art medicine is ; how fallacious experiments made in it often are, as has been obferv- ed long ago by Hippocrates, and by what flow de¬ grees valuable medicines have had their powers in- veftigated ; how long it Avas before the effedls of the bark of the cinchona, of mercury, of antimony, were brought to light, as far as they are already known.
I he author, therefore, conceives, that in fever it certainly is not at all known, whether the fever will go through its ordinary courfe better or worfe for the
patient’s
Fordyce’s Third Di/fertation on Fever. 2 LI
patient’s breathing an atmofphere having a larger or 3efs proportion of pure air. The other vapours which conftitute the remaining three-fourths of the atmof¬ phere, may fome of them be noxious, and others of them may be breathed along with the proper propor¬ tion of pure air, without any detriment.
As the vapours which conftitute the atmofphere are extremely vifcid, they fufpend innumerable fine par¬ ticles of various folids, and alfo innumerable drops of fluids, which are principally water, the effedts of which laft have already been attended to. Many fuch fubftances may be very noxious and very im¬ proper for the patient to breathe in health, and ftil! more noxious in difeafe. That they are very noxious in many difeafes is eafily feen from what happens in hofpitals, in almoft all kinds of wounds and ulcers, inflammations and fuppurations, in all affedlions of any of the parts employed in refpiration. In all thefe difeafes the patients in hofpitals recover much more feldom than in the air even of London, a town at leaft feven miles long and three in breadth ; and in fuch a town thefe difeafes go on much worfe than they do in the country at the diftance of ten miles from it.
What are the noxious particles, or vapours, mixed with the atmofphere, which render it fo hurtful in thefe difeafes, has not been inveftigated. The breath arifmg from the lungs of animals, the vapours which ante from their bodies, the vapour ariftng from the immenfe quantity of matter which is conftantly pu¬ trefying, the vapour which has ferved for the inflam¬ mation of fuel, & c. are all improper for refpiration. The particles of foot, afhes, horfe-dung, gravel, and a vaft variety of other bodies, floating in the air of a large town, render it undoubtedly improper for ref¬ piration ; but which of all thefe fmail particles, va¬ pours, fluids, or folids, are hurtful in the difeafes which have been enumerated, has by no means been
inveftigated
y
f 12 Fordyce's Third Di/fertation on Fever .
Inveftigated by experiment* the only means of inves¬ tigation which can in the lead be depended upon.
However noxious thefe vapours* which ordinarily contaminate the atmofphere of an hofpital, or large town, are in the difeafe s which have been enumerat¬ ed, they do not feem to have very bad effefts in a regular continued fever. A patient, in a regular continued fever, goes through its courfe under ex¬ actly the fame treatment, as fafely in St. Thomas's Hofpital as he does in the country, or in an air in which no noxious particles are known to exifh It is undoubtedly true, that vapour arifmg from putrid fub- ftances depreffes the Strength, and in fo far muft be noxious in fever ; but when care is taken to avoid fuch putrefaftion, and by a proper circulation to keep a due proportion of pure air ; infectious vapour, and mod: other noxious fubftances, do not feem, from ex¬ perience, to have much effedi in regular continued fever.
The food and drink which Should be employed dur¬ ing the progrefs of the difeafe are next inquired into. The rules which have been laid down in a regular ter-
« a t O
tian are by no means applicable in a regular conti¬ nued fever, for there is no time in which the patient is free from the difeafe. In a regular continued fe¬ ver, be it ever fo flight, no Solid animal food ought ever to be employed, whether quadrupeds, birds, reptiles, or infects. Solid animal food, in a regular continued fever, during its digeftion, greatly increafes the heat to the feel of the patient. Still more to the feel of the by-ftander, and frequently, though not al¬ ways, to the thermometer. It produces great reft- leffnefs and fenle of uneafinefs, and an increafe of de- preflion of lbrength in the patient, during the time that it remains in the Stomach and inteStines. it totally deranges the fever. It often produces the ap¬ pearance of a frefh paroxyfm. If it be made ufe of about noon, or before the next evening exacerbation, this is almoft always rendered more violent. It is
true,
A
Pordyce’s Third Differlation on Fever ... 2 IS
true, indeed, that if an error be committed, and folid animal food be employed, after it Jias palled through the inteftinal canals, the fyftem generally re¬ covers itfelf, the patient only being weakened by the extraordinary exertion, and rendered lefs able to {up- port himfelf during the remainder of the difeafe. if the fame kind of food be perfifted in, it increafes the evening exacerbations extremely, brings on delirium much falter, and in a much greater degree than it would otherwife arife, and prevents the fever from being worn out by its own progrefs, as it otherwife would be. All folid animal food is therefore in every cafe to be rejected throughout the whole progrefs of the difeafe.
Even after the difeafe has been terminated by a crifis, animal food in a folid Hate fhould be rejected, there be¬ ing no caufe which has produced relapfes, as far as the author’s obfervation has gone, fo frequently, as uiing this too foon. The fame objections arife againfl the ufe of fuch animal fluids as are coagulated by the juices of the ftomach ; fuch as ferum, eggs, &c. — - Green vegetables are like wife improper, from their difpofition to run into the vinous and acetous fermen¬ tation.
The food confidered by the author as molt proper in fever is, the farinaceous part of vegetables coagu¬ lated by heat, and diffolved* wholly or partially in water ; fuch are barley water, panada, fago, and the; like. Among!! fruits, grapes, figs, and dates, are confidered the bell : apples and pears likewife, boil¬ ed, baked, or roafted. The author is inclined to think, that it is never neceffary or proper for the patient to ufe animal food of any kind in a regular continued fever. If the prejudices of the patient or the attend¬ ants require, that animal food fhould be employed, it fhould be in folution in water, but never folid. The following are the obfervations of the author refpe Cl¬ ing milk.
Milk
3514 Fordyee’s Third DijTerlation on Fever .
Milk is a fluid that always coagulates in the ftomach, but does not coagulate in the heat of boiling water. It has been generally thought, that this fluid ought not to be made ufe of in continued fevers. In one part of the works of Hippocrates, it is faid fimply, that it is bad. In another part, that it ought not to be given, unlefs the fever is very long. Sometimes the author has feen it coagulate in the ftomach fo firmly, as to render the patient fick, which ficknefs brought on vomiting, during which the coa~ gulum was thrown up refembling a tendon. In fuch cafes milk is undoubtedly a very improper food.
Milk confifts of a folution of a mucilaginous fub- fiance in water, expreffed oil, and fugar ; there is per¬ haps likewife a little of the neutral falts of the blood in it. The fugar contained in it corrects any putref- cency that might take place in the chyle, rather dif- pofing it to be acefcent ; and the expreffed oil being every where mixed with it, prevents it, when it coa¬ gulates, from forming fo firm a inafs, fo that although it be always coagulated in the ftomachs of children, it digeft$ eafier than almoft any kind of food, at the fame time that it gives them greater nourifhment. This would tempt us to employ it in fever, as an animal food of at leaft eafy digeftion ; and the author is not certain that, notwithftanding it has been con¬ demned by Hippocrates, and the few cafes he has feen where it has difagreed with the ffomach, that it is not very fit to be employed if any animal food is given.
The next object of the author’s attention is thirjl. The opinions of practitioners, he obferves, have differ¬ ed very much with regard to the quantity as well &s quality of the fluid to be made ufe of for drink. The. ancient Greek phyficians thought it improper that the patient fhould drink any thing at all during at leaft part of the difeafe, as they conceived that any kind of drink increafed the fever, and occafioned greater thirft, even water alone. Modern praftitioners, with a view •of rendering the blood thinner, have forced the pa¬ tient
Fordycc's Third Differ tat ion on Fever. 2 IS
tient to drink a much larger quantity of water, or watery fluids, than he would of his own accord.
That the blood is thick, and in confequence ob- ftruCts the fmall vedels in fever, was a doCtrine form¬ ed by authors, who were not acquainted with the fub- dances of which the blood condds. They did not know that its mod effential parts are red particles, coa- gulable lymph, and ferum; that there is befdes thefe a folutionof mucilaginous fubftance, fimilar to that which is formed where putrefaction has taken place, that there was a folution of natron muriatum, ammonia muriata, and ammonia phofphorata ; befides other neutral and earthy falts ; and that befides all thefe fubdances there is alfo water, not in a date of chemical combi¬ nation with any fubdance, but diffufed through them. There is, therefore, a larger quantity of water already in the blood-veffels than is neceffary to didolve or com¬ bine with any of them.
That it is true that there is water not chemically combined is fhewn by this, that when the blood is expofed to fome of the fine dlters in the body, fuch as the pores of the fkin or the kidneys, water is filtered off, fometimes perfectly pure ; but filtration is a procefs which never feparates two fubdances che¬ mically combined ; water then, fo filtered off, is not in combination with any of the fubdances from whence it is filtered.
If more fuperfluous matter were thrown into the , blood than is already in it, it would not render any of J the parts of the blood thinner, or capable of pading through vedels it could not pafs through before ; the only effeCf of it would be, that when blood came to a vedel fo fmall as not to let any other part of the blood pals through, the water would pafs through, and leave tire other parts of the blood behind. Throwing, there¬ fore, a larger quantity of water into the blood-veffels would not thin any part of the blood that was too vifcid, fo as to make it pafs through vedels that it could not pafs through before on account of its vif-
ciditv.
,i
216 Fordyce’s Third Differtation on Fever .
cidity. It is not neceffary, therefore, to force the patient to drink more water than he choofes for the purpofe of thinning the blood, as no fuch effedf arifes from throwing in a larger quantity.
As it is not neceffary or ufeful to give a quantity of water greater than the patient choofes to drink, fo on the other hand, the not giving a fufficient quantity, according to the third;, leems to have arifen, as far as can be judged, from that fuperftition, which has in¬ duced mankind to refrain from things agreeable, to produce fome falutary effedl ; juft as men think they will go to heaven, by not eating animal food tor two days in the week. The author conceives, therefore, that the patient fhould be allowed to drink as much as he detires ; nor does he conceive it to be of any ufe to prevent him from drinking it of the degree of heat that he likes beft.
With refpedt to quality, mucilaginous drinks are preferred to fimple water, as not running off fo quick¬ ly by the excretories.
At the attack of fever, there is ufually a quantity of indigefted food in th<? ftomach : an emetic, there¬ fore, is generally proper at the commencement of the difeafe. On the fame ground, it is neceffary to eva¬ cuate the inteftinal canal.
We pafs over feveral points relative to the choice of purgatives, and the employment of glyfters, which, though no doubt interefting to young pradfitioners, may be difpenfed with here. We come next to the important article of Jleep.
With refpedt to opium, fo ufeful in procuring a quiet, eafy, and refrelhing fleep, when a man is ex- haufted by labour, or weakened by evacuations, if exhibited, it is obferved, in the quantity of from half a grain to a grain in regular continued fever, it often produces fleep, but that fleep is difturbed : the pa¬ tient is often diftradfed with various incoherent, and frequently difagreeable dreams ; and he often wakes in the morning with a conviction that he has not flept
Fordyce’s Third Dijjhrtation on Fever. 2 If
at all. Inftead of a relaxation of the fever taking place in the morning, the head-ach is greater, he has more third, and the appetite is lefs : deep, therefore, fo procured is fo far different from that reft which gives time for the powers of the body to he recruit- ed, that they are more exhaufted during it than they would have been it the patient had not ilept at alh No fubftances which have been conjoined with the opium in fuch doles, have the e fie 61 of depriving it of thefe qualities.
About five and twenty year's ago there arofe a practice in St. Thomas’s Mofpital of exhibiting opium in a much lefs quantity, to wit, in the quantity of a quarter of a grain for a dofe, and repeating it at the end of every fix or eight hours. When given in fuch dofes it produces no immediate effect, but by degrees the patient falls into a ftupor which gradually in- cre'&fes ; and although this ftupor does not end in a complete ileep, yet it grows in a day or two into that kind of ftupor that we find, when the delirium from the fever, with apparent fulnefs of the veflels of the brain, begins to diminilh. It is true, indeed, that this dofe of opium is obtained by adding a few drops of laudanum to that mixture which is called mith- ridate, but the author has often employed the opium in his private practice, with ten grains of caftor, with equal or rather better effe£f.
Lately many practitioners have exhibited opium three or four times in the twenty-four hours in fe¬ vers, having borrowed their practice probably from that which has been purfued in St. Thomas’s Hof- pita!, the practice of the Hofpital being open to the mipectiori or many pupils. Thefe practitioners have not learned, however, that it is the fmallnefs of the dofe that produces beneficial effects ; if the dofe be increafed fo far as half a grain, the fame reftleflhefs, the fame difturbed deep, dreams, &c. as have been noticed, are brought on.
vol. Y. R The?
218 Fordyce’s Third Differtation on Fever .
The author has not ventured to employ opium in the firft week of the difeafe : after this, it considerably abates the delirium, and efpecially that increafe of it which arifes in the evening. Other remedies have been employed with the fame intentions, as muik, camphor, and aether, Hoffman’s Anodyne Liquor often has the effeft, but is very uncertain in its ope¬ ration.
When a regular continued fever is left to purfue its ordinary courfe, the efforts that take place in the fever, and the want of fufficient nourifhment and ileep, frequently weaken the patient towards the end of the difeafe to fuch a degree as to be dan¬ gerous, and even in fome cafes fatal. Weaknefs, therefore, becomes an objedl of attention to the prac¬ titioner. If fuch a degree of weaknefs fhould take place at the end of a regular continued fever, as to endanger the life of the patient, the force of the body- may in fome degree be kept up, by employing me¬ dicines which will induce the powers of the fyftem to with all their force, until the fever ihall fo far diminifh as to allow of the flomach digefting food of better nourifhment, or the powers of the body to be recruited by found and refrefhing ileep. The prac¬ tice of exciting the body to a£f with all its powers, until the fever is fo far gone off, depends upon the following principle.
Let a patient ill of a regular continued fever be ever fo weak at the time of the crifis, or at the time when the difeafe has gradually worn itfelf out ; as foon as the fever is entirely terminated, provided the patient is allowed to be perfectly at reft, and if pro¬ per nouriftiment is exhibited to him, to wit, fuch as he can digeft, the powers of the body begin inftantly to be on the increafe ; therefore the patient will be gradually reftored to his health again.
Although there may be confiderable power in the fyftem, yet there may be a want of exertion of tha power j fo that the patient may fink and die from
weaknefs.
Fordyce’s Third Dijfertation on Fever . 219
weak nefs, though there are hill in the body powers, which if they had been exerted might have kept the patient alive. By employing medicines to make the body exert thefe powers until the fever is gone off, the patient will be preferved, and afterwards gra¬ dually recover his ftrength.
If this was not the cafe, all ftimulants employed in fever would evidently be extremely hurtful, for every extraordinary exertion tends to weaken the fyftem, and to exhauft the powers that it brings into action and therefore if all the powers in the body were already in aftion, the increafmg that aftion would weaken the fyftem much more, and render the weak- nefs more fatal, inftead of preventing the patient from being deftroyed by it. The ftimulant employed muft roufe the dormant powers, in order to have good effects.
Firft, many praftitioners have endeavoured to ex¬ cite the dormant powers of the body, for it is thefe only, the author obferves, that can be excited to ad¬ vantage, by producing inflammation of the fkin by the application of various ftimulants. But both phleg¬ monous inflammation and inflammation of the Ikin have occafioned greater frequency of the pulfe, have rendered it weaker and fmaller, and, as in health, have prevented fleep, and the patient taking the fame quantity of nourilhment, and have depreffed and de¬ ranged the whole fyftem. The author therefore con¬ cludes, that producing fuch inflammation does not keep up the ftrength, or make any dormant power aft, but that on the contrary it weakens the patient.
The fpices have been much employed, but impro¬ perly in the author’s opinion, unlefs to correft flatu¬ lency, as they render the pulfe much more frequent, fmaller, and weaker.
Wine feerns to be the only remedy that is of ufe to excite the dormant ftrength of the fyftem, when weaknefs takes place towards the end of continued fevers. It tends to increafe the force of the fyftem,
R 2 without
2 20
Fordyce’s Third Dijfcriation on Fever .
without increafing the frequency of the aftion of the heard and on this ground it may be more fafely em¬ ployed than any other ftimulant. It has alfo a nar¬ cotic power.
Wine fhould be employed in moderate quantity ; when exhibited in large quantity it produces intoxi¬ cation, the effefts of which every man who has drunk it in fuck quantity very eafily perceives. The fto- mach, after the intoxication is gone off, is difordered, fpafmodic contractions take place in it, and it is not capable of digefting food, which laid effeft would render the patient weaker from want of receiving fufficient nourifnment ; it fhould be ufed, therefore, fparingly, and not in the leak to intoxicate.
It ought only to be employed, when the weaknefs has juft become confiderable, in moderate quantity ; for if we exhibit it in greater quantity than is fuffi- cient to make fuck part of the dormant ftrength of the fyftem, as is required, to be exerted, it will ex- hauft that dormant ftrength, and not leave a fufficient quantity to fupport the patient during the remaining part of the difeafe.
When wine is firft employed by perfons not accus¬ tomed to ufe it, where it becomes neceffary to em¬ ploy it from weaknefs, four ounces is a fufficient:
quantity or wine of the ftrength of Fort wine. The ftrength of wines can hardly be tranfmitted to pof- terity by any permanent mark, for the ftrength does not depend on the alcohol they contain, but like wife1 On the quantity of a vapour, which was called hr V an Helm on t gas filveftre, probably different from) that vapour which he called gas limply, and which has lince been called fixed air and carbonic acid,, although the author thinks thefe improper names p that, however, is foreign to -the purpofe of this differ- tatiom
The author has alfo to obferve, that in patients who have been accuitomed to drink wine even in
ge quant it exhibited
les, three half pints are quite fufficient ta> in twenty-four hours.'
Art
{ 221 )
Art. XXV L Medical Hiftories and Reflections .
Vol. III. % J. Ferriar, M.D . Sic.
( Continued from page IS2.J
r fubjecl next treated of by Dr. Ferriar is
jj the Croup. It is of great importance, he ob~ ferves, to form an accurate opinion refpefting the treatment of this difeafe, which is very fhort in its duration, and attended with extreme danger. It has been his lot, not only to have met with feveral iii- ftances of this difeafe in practice, but to have un¬ dergone it repeatedly in his youth, and to have feen a great deal of it in his family. From fuch opportu¬ nities, therefore, we may expect to derive much in¬ formation, and it is with much fatisfadfion we find him fpeak fo decidedly of a method of cure, which he has found invariably to fucceed, when employed fufficiently early in the diforder.
We give the author’s very accurate defcription of the fymptoms, becaufe an early detection of the dif¬ eafe is a point of the firft importance : fo much fo, that Dr. Ferriar remarks, if the alarming fymptoms are not mitigated during the firft fix hours, the dif- cafe will generally prove fatal.
c Some days before the appearance of the croup, the child is fretful, inactive, and drowfy : the eyes are fomewhat fuffufed and blood-fhot, and the complexion is muddy, or rather livid. There is fome degree of cough, which generally refembles that attending a common cold, but fometimes has the peculiar thrill found, even from the firft. This cough, in the courfe of two or three days, becomes violent and Irouble- fome, and it is then neceffary to watch the patient, with great attention. The dangerous- attack is com¬ monly made in the night, fometimes foon after the child is put to bed, but more frequently about mid¬ night. The cough, on the approach of danger, has
R 3 a thrill.
222 Ferriar’s Medical Hiflories and Reflections „
a fhrill, barking found, and returns in redoubled fits, the firft of which, though very violent, is fucceeded in a few minutes by a fecond, longer, and yet more violent. Every fit of coughing agitates the patient, to an extreme degree : the face is (welled and fiuih- ed ; the eyes are protruded ; a general tremor takes place, and there is a kind of convulfive fixuggle to renew refpiration, at the clofe of each fit. There is no expectoration, at this period of the difeafe. As the complaint encreafes, the coughing fits are fome- times more troublefome, fometimes they become lefs frequent 3 but an incefifant difficulty of breathing comes on, accompanied by fwelling cf the throat, about the place of the larynx : the head is thrown back, in the agony of attempting to efcape fuffocation, and the whole extenfors of the trunk, and of the legs, are fometimes thrown fuddenly into aftion, to ailift the effort, fo that the whole body is bent backwards, as in tetanus ; in this attitude, and in this effort, the pa¬ tient expires. I once attended the infpeCfion of a fine boy, who had died of the croup, and I obferved, his druggies had been fo violent, that the corpfe reti¬ ed, in a great meafure, on the hind head and the heels.
c There is not only an unufual found produced by the Co- gh, fomething between the yelping and bark¬ ing of a dog, which it is impoffihle to defcribe, but refpiration is performed with a hifhng noife, as if the trachea were nearly clofed up, by feme light, fpongy fubllance. The expreffion of the countenance is alto appropriate, and will alone betray the difeafe, to an experienced obferver. There is much diltenfion, the bloom of the cheeks is greatly heightened, the eyes are fwelled up, watery, and exhibit great figns of fuf- fering. The trembling, hurry, and reftleffnefs, though accompanied with heavy deep, proceed to an excef- five degree as the difeafe advances, and the heart and arteries are thrown into violent palpitations. Refpi¬ ration becomes more ilridulous, is repeated at longer
efforts,
Ferriar’s Medical Hiftories and Reflections. 22
efforts, and with greater exertion? till it ceafes en¬ tirely. Spontaneous vomiting fometimes comes on, in the ccurfe of the difeafe, and a quantity of vifcid mucus is difcharged, but without much relief. Chil¬ dren who are fubjeCI to attacks of the croup, are fometimes feized with the deep, barking cough, which will encreafe to fuch a degree as to create much alarm, about the ufual time of the dangerous exacerbation, yet it will decreafe again, and at length go entirely off, without any other remedies than com¬ mon demulcents. Cafes of this kind, I fufpeCt, have been defcribed as genuine paroxyfms of croup ; and very trifling methods of cure have been recommended, in confequence of their apparent effiacy in the fpu- rious croup, which always cures itfelf. The diagnofis of this particular cafe, is to be drawn from the follow¬ ing circumftances.
* 1. In the fpurious croup, the cough has not the fhrill, whining found, which marks it in genuine cafes . It is hoarfer, and the intervals are longer.
‘ 2. Refpiration is not fo much affeCted in the fpu¬ rious croup, even when the cough becomes alarming¬ ly violent ; and the obftru&ion does not produce the fibilation peculiar to croup, but refembles more a common dyfpnoea.
* 3. The fpurious croup is not attended with the reftleffnefs, trembling, and palpitation of the arteries, which characterize the other.
c I muff obferve, however, that thefe diftin&ions are only to be learned, from much attention fo the different cafes of the difeafe ; for the found of the cough is fo fimilar in both, as to infpire even the moil experienced with fome degree of doubt. I have fat by the child’s bedfide repeatedly, watching for the moment of danger, while the cough was encreafing m violence ; and have been only undeceived, by find¬ ing that no tremor or palpitation cajme on towards midnight, that the reftleffnefs abated, and that fleep feemed to become more com poled.
R 4 c I have
524 Fe mar’s Medical Hi dories and Rejections.
s I have feen children affefted with this difeafe^ almoft at all ages, under nine. In large families, if one child is feized with croup, mod of the others generally begin, about the fame time, to have fymp¬ toms of the fpurious croup. I have never found rea- fon to believe it infectious, and it appears very doubt¬ ful whether the difpolition to it be hereditary. 1 have known it appear in families, to whom the fymptoms were totally new.’
From the fymptoms, and from the appearances on diffeCtion, there can be no doubt, the author obferves, that the genuine croup is a difeafe highly inflamma¬ tory, and on this principle is the treatment founded. In all the cafes of croup which he has feen, he has found it neceffary to bleed immediately, and when he has feen the patient fufficiently early to entertain hopes of faving them, he has directed the evacuation to be continued, fo as nearly to produce fainting.— This is the effential point of the cure, without which no relief can be effected. Evep it the patient fhould not be feen till the day fucceeding the attack, it is proper to bleed ad deliquium , if the fuhjeet be ple¬ thoric, and the difficulty of breathing and reftleffnefs be great.
A -large bleeding generally produces an inftanta- neous abatement of the fymptoms ; hut this is not fuf- ficient for the fafety of the patient. A blifter mud at the fame time be applied to the bread, or between the (boulders, and ought to be made larger than ufuah In the cafe of very young children, we mud almoft defpair, for it is extremely difficult to procure any blood from them by the lancet, and leeches afford a very inadequate mode of depletion. Children above two years of age may have blood drawn trom the hands or feet in tolerable quantity. The operator mud not be nice, refpefting the appearance of man¬ gling, in circumftances fo dreadful.
Betides the blood-letting and binders which have juft been mentioned, the author advifes next to pro¬ duce
Ferriar’s Medical Uijiories and Reflections . 12525
dace full vomiting. Confiderable quantities of ropy mucus are thus brought off, but he has not feen the inflammatory exudation thrown up in the form of a membrane.
It the firft bleeding and emetic do not effeftually relieve the cough, and difficulty of breathing, it be¬ comes neceffary to repeat the bleeding ; and the eva¬ cuation in this cafe muff again be carried as far as the patient’s ftrength will permit. A repetition of the emetic, after the fecond bleeding, often puts an end to the difeafe ; but if this fhould fail, we have nothing to hope from medicine.
The ufe of the warm bath and demulcents may be conjoined with this plan, but they are not confidered as forming a very effential part of the treatment.
The operation of bronchotomy has been propof- ed as a laid refource, but the author thinks, from the appearances on diffedtion, it would be com¬ pletely ufelefs. The upper part of the hardened membranous fubftance might be extracted with the forceps, but the fluid portion, which fills the lower part of the trachea and the bronchia, 'and which could not be removed, would ftill occafion a powerful obftacle to respiration, and the inflammation ftill exifting, would certainly not be diminifhed by the operation.
Some remarks next occur on the Hooping-Cough. With refpeH to remedies in this complaint, bark, cicuta, tinflure of cantfcarides, the author obferves, are ail recommended by the experience of fome prac- tioners. He believes that they may all have fucceed- ed equally, for they have generally been tried about the height, or in the decline of a difeafe, which in moft cafes will cure itfelf. The only queftion is, whether it be pofftble to cut fhort the progrefs of hooping-cough, or whether it mull be left to run its eourfe,
* in
■I
\
226 Ferriars Medical Hijories and Rejections.
s In the beginning of the difeafe, when it is ac¬ companied by fymptoms of fever and inflammation, bleeding is fometimes neceffary. Blifters are more frequently neceffary, and Dr. Armftrong’s plan of ex¬ hibiting tartarized antimony, in dofes which prove gently emetic, is undoubtedly very ufeful : chiefly, perhaps, by fupplying the means of expefloration to very young children. But after thefe preliminary fteps are taken, I believe that the only remedy, which promifes to fhorten the diforder effectually, is the folution of white arfenic. I have employed this medicine, in feveral cafes of Infirmary-patients, with tolerable fuccefs 3 and I have occafionally given it in private praCtice, with fo much advantage, that I think it deferving of farther trials. The dofe with which I generally begin, is one drop daily, for an infant ; and for children under feven, two drops, re¬ peated according to the date of the fymptoms. it re¬ quires fome caution, to avoid the accumulated aCtion of this medicine. The exhibition of the folution fhouid be fufpended occafionally, for a day or more, and the bowels fhouid be gently opened, by means of a little calomel.’
Of the life of the Nitric Acid in Syphilis , and fome other Difeafes. The very contradictory accounts which have appeared with regard to the powers of this fubftance, make it defirable for us to poflfefs the teftimony of many and various practitioners on the fubjeCt. Somewhere there mult be error or ex¬ aggeration, for it is impoffible that ftatements fo very inconfiflent with each other, can be true. Dr. Fer- riar’s trials, on the whole, afford a refult favourable to the new remedies, as will appear from what follows. Eight cafes are narrated wherein the nitric acid was employed. The flrft was one of thofe obflinate cafes of the venereal difeafe, which now and then refill the aCtion of mercury, or which at leaf! are only partially removed by it. The acid was employed in this cafe,
feemingly
O 4
<
Ferriar’s Medical Hijlories and Reflections . 227
feemingly with advantage, but its good effefts were not very decided.
The fymptoms in the fecond cafe had recurred re¬ peatedly, it would appear, from too flight a ufe of mercury. The acid produced a favourable change, but the cure was completed by mercury. The third was a cafe of paralyfis of the lower extremities, from diftortion of the fpine. Iffues had been ineffectually tifed for feveral months. A recovery took place under the exhibition of the nitrous acid. A cafe of fciatica was alfo luccefsfuHy treated by the fame remedy.
In cafe 5th, an old fyphilitic affection, the pains feem to have been relieved by the acid. In the iixth cafe (fyphilis) the acid had little effect. The com¬ plaint yielded, at length, to mercury. In the feventh the pain arifing from nodes of long handing, was ap¬ parently relieved by the acid. In the eighth cafe, a venereal one, the acid produced no evident advan¬ tage, the diforder, however, feemed to yield more ra¬ pidly afterwards to the ufe of mercury.
To thefe cafes the following remarks are fubjoined. e Belides the cafes which I have thus mentioned at length, I have ufed the nitric acid in a variety of venereal complaints, in conjunction with mercury. I have not perceived, that by this combination, a fmaller quantity of mercury was fufficient to era¬ dicate the difeafe, nor have I found that the fenfible aftion of mercury on the falivary glands, was at all promoted, by the ufe of the acid.
* My obfervations would rather lead me to fup« pofe, that the acid leffens the irritability of the fyf- tem, and prevents the extent, to which the mercurial difeafe ufually proceeds. In fpeaking of immediate deductions from faCts, I fet the chemical pathology afide.
4 It appears from the faCts I have mentioned, that the fpecific power of the nitrous acid, in venereal com¬ plaints, is limited, to certain fymptoms, in the advanc¬ ed
. \ r
228 Ferriar’s Medical Hijfories and Reflections.
ed ftages. It feems to remove the pains of the long bones, and to aft on the fuperficial ulcers of the third ftage, but I fhould hardly be inclined to truft the cure of any well-afcertained venereal affeftion, to the acid alone. Mr. Simmons's trials of this remedy, which will be found in the Appendix, fhew that the acid is capable of extinguifliing the fymptoms, in a recent cafe.
c I have never been able to afcertain clearly, that the forenefs of the gums, and flight falivation, of which patients certainly complain fome times, while they are ufing the acid, depend on a general aftion on the fall vary glands. When the acid mixture is not fucked through a quill, or a glafs tube, the gums are. affefted by the direft application of the acid ; and patients have obferved to me, that even with the pre¬ caution of ufing glafs tubes, they ftill felt, that every dofe of the acid affefted the teeth and gums. I can positively after t* that I have known the acid taken in large quantities, for a considerable length of time, in conjunftion with the free ufe of mercury, without producing any ulceration of the gums, or encreafe of faliva ; yet with the effeft of defraying every ve¬ nereal appearance, in well-marked cafes.
c -I do not undertake to explain th-efe contradiftions to the principles, on which the ufe of the nitric acid has been introduced, in this diforder. Of the fafts related by Mr. Scott, whom I feel a pride in mention¬ ing, as one of my earlieft, and moil valued friends, I cannot entertain a doubt. And if my experience differs, in any refpect, from his, I hope the variation may be more owing, to the great difference between the climates, in which we have refpeftively ufed the medicine, than to inaccuracy on my part.
/ Suppofmg the efficacy of the nitric acid, in this difeafe, to be ascertained, an important queftion will remain to be decided : how far the fuiphuric, and muriatic acids are capable of afting in a fimilar man¬ ner. 1 he operation of thefe three acids has, hitherto,
beem
Ferriar's Medical Hijlories and Reflections . 229
been confidered as nearly identical. We have ufed them indifcriminately, as tonics, and they have all produced thofe effefts on the fyftern, which the chemical phyficians afcribe, at prefent, to the action of oxygen. The muriatic acid, in particular, has been much employed by me, both in private and hofpital pra&ice, for reftoring the ftrength of the moving^ fibre, in cafes of ferophula, of phthifis, of dyfpepfia, or of general debility ; and 1 have always found its effe&s to be, an acceleration of the pulfe, an agreeable, glowing fenfation in the ffomach, a feeling of encreafed vigour and alacrity, and a height¬ ening of the complexion. It has proved, in many - inlfances, an ufeful fubftitute for bark, ft eel, and bit¬ ters, by the fmallnefs of its dofe, and by its freedom from the difagreeable tafte of fome of thofe remedies.
‘ The reader muft have perceived, that in one or two of the preceding cafes, the effect of the muriatic acid was flightly tried. Perhaps, in the progrefs of this enquiry, more accurate diftinftions may be eftab- lifhed, refpefting the relative power of thefe different acids. At prefent, the nitric acid appears to be the more valuable.
4 After my fuccefs with the nitric acid, in chronic rheumatifm, I was induced to employ it in forae cafes of general debility, and great irritation of the nervous fyftern, and I have derived as much advantage from it, as could have attended the ufe of the rnoft powerful tonics. I am perfuaded, that in many irritable, bi¬ lious habits, it may be ufed with great benefit, in place of bark, and the other ufual remedies In typhus, it will probably be found an excellent tonic, mftead of bark, efpecially when the bowels are irri¬ table, and when the muriatic acid would be apt to produce, or encourage diarrhoea. From the great en- creafe in the dofe, upon which we now venture we may expefl an action, nearly adequate to all theVur- pofes of tonics, in fever, with the advantage of a re¬ medy lefs offenfive to the palate, and more effectual
in
230 Fe rriar’s Medical Hiftories and Reflections .
In relieving thirlh The only cafe of typhus, in which this medicine can be contra-indicated, is, where there Is much diarrhoea, or tendency to active inflamma¬ tion, or to haemorrhage. Yet even under thefe cir- cumftances, I conceive that the full dofe only is pro¬ hibited ; in conjun&ion with opiates, it may be mo¬ derately ufed, with advantage.
c In giving the diluted acid, with opium, it may be proper to obferve, that the opium fhould be added to it in fubflance. The addition of a drachm of laudanum, to an ounce or two of the diluted acid, will fome times produce an explofion, efpecially if the phial be agitated.
c Upon the whole, I think we may conclude, that the nitric acid has a powerful effeft in certain ftages of the venereal difeafe, but that neither the extent, nor the permanency of this effe£t is yet afcertained. That we have acquired, at lead, a valuable auxiliary to mercury, an ufeful remedy again!! chronic rheu- matifm, and, what was much wanted, a palatable tonic.’
Refpefting the oxygenated muriate of potafh, the author obferves, that he has found it efficacious in the true fcurvy. In fyphilitic complaints, he has feen no remarkable advantage derived from it. In cafes of general debility it has not fucceeded. It proved
diuretic in one only of feveral cafes.
; ■ ' ) ■ * -
Some very interefting obfervations next occur, re- fpeQing the Treatment of the Dying. The author endeavours to fhew, that the terrors which fo gene¬ rally attend the idea of death, are not founded on the aftual fufferings of the dying perfon, but are altogether the fruits of imagination. In obferving patients in this fituation, he has always been impreffi- ed with an idea, that the approach of aftual death produces a fenfation fimilar to that of falling afleep. The difturbance of refpiration is the only appareiit fource of uneafinefs to the dying, and fenfibility feems
Ferriar's Medical Hiflories and Reflections . 23 1
to be impaired, in exa£l proportion to the decreafe of that function.
Many abfurd and inhuman practices of nurfes and attendants are pointed out and judly reprobated. — - 5 It is a prevalent opinion/ Dr. Ferriar remarks,
* among nurfes and fervants, that a patient, wh'ofe death is lingering, cannot quit life while he remains on a common bed, and that it is neceflary to drag the bed away, and to place him on the mattrefs. This piece of cruelty is often praftifed, when the attend¬ ants are left to themfelves. A hill more hazardous practice has been very prevalent in France and Ger¬ many, and, I am afraid, is not unknown in this coun¬ try. When the patient is fuppofed by the nurfes to be nearly in a dying hate, they withdraw the pillows, and bolder from beneath his head ; fometimes with fitch violence, as to throw the head back, and to add greatly to the difficulty of refpiration. A full ac¬ count of this inhuman cuftom, may be feen, in a tract preferved by Valent ini, drawn up by a German lawyer, in which he afferts, that patients have been repeatedly fuffocated in this manner, when there was no reafon to expert death from the fymptoms of the difeafe. As the avowed motive for this barbarity, is a defire to put the patient out of pain, that is, to put him to death, it is incumbent on his friends to preferve him from the hands of thofe exe¬ cutioners.
‘ Another improper pra&ice, is the precipitation with which the attendants lay out the body, imme¬ diately after death appears to have taken place. I have known them drip the body, in very cold, dormy weather, wrap it in cold linen, throwing a Angle ffieet over it, and opening the doors and windows of the apartment, in little more than half an hour, after a patient had died fuddenly.
c There is, indeed, a lingular indance recorded by Sydenham, of the revival of a patient thus ufed.
232 Fernar’s Medical Hiflories and Reflections.
during the prevalence of the fiery treatment of fm all¬ pox. 3 A young man, having gone to Briftol, was feizecl with the fmall-pox, and became delirious. During the abfence of his nurfe, the attendants fuppofing him to be dead, and on account of the heat of the feafon, and the patient’s corpulency, took the body out of bed, and laid it naked on a table, merely throwing a (beet over it. The patient, thus cooled, began to revive. His nurfe, on her return, perceived ligns of life in him ; he recovered, and, feveral years afterwards, told this fiery to Dr. Syden¬ ham. But the rough treatment of the body, and the fudden alteration from the temperate warmth of the bed, to the rigorous cold of a winter’s night, have* perhaps, in fome cafes, extinguifhed the feeble re¬ mains of life, which might have been cherifhed by more gentle methods.
6 It is too certain, that the helplefs patient feels all thefe cruelties, after he has become unable to exprefs his fenfati'ons diftinftly. The teftimony of perfons* who have recovered from apparent death, leaves no doubt on this head. Perhaps a more deplorable con¬ dition can fcafcelv he conceived, than that of the expiring mailer of a family, transferred from the foo thing care of his friends, to the officious folly, or rugged indifference of fervants. This is a flate of fuffering to which we are all expofed, and if it were unavoidable, I fhould be far from deliring to unveil fo afflifting a profpeft. But the means of prevention are fo eafy, that 1 cannot forbear to folicit the public attention to them.
c When the toffing of the arms, which I have de¬ fended, the rattling noife in refpiration, and difficulty of fwallowing have come on, .all unneceffary noife and buttle about the dying perfon fhould be prohibited. The bed-curtains fhould be drawn nearly clofe, and unlefs the patient -fhould place himfelf in a pofture evidently uneafy, he fhould be left undifturbed. Ex-
4 clamations
Ferriaf s Medical Hiflories and Reflections. 233
cfamations of grief, and the crowding of the family round the bed, only ferve to harrafs him :
c The common practice, of plying him with liquors of different kinds, and of forcing them into his mouth, when he cannot fwallow, fhould be totally abftained from.
c When he no longer breathes, one perfon only fhould remain in the room, who fhould take care that no alteration be made in the hate of the bed. Every thing fhould be condufted, as if he were in a tranfitory fieep. If the weather be hot, the windows of the room may be opened, and the bed-curtains un¬ drawn, in the courfe.of two or three hours. In win* ter, it will be fufficient to withdraw the curtains within that time.
* There can be no juft reafon for the hafte, with which it is ufual to lay out the body. Seyerai hours may be very properly fuffered to elapfe, before this is done ; for the joints do not commonly become rigid for a confiderable time. At the end of that- period, the body will be completely cold, and all remains of fenfibiiity will have been extinguifhedd
In an Appendix, No. I. are contained fome ufeful rules for the prefervation of the poor from contagious fevers, drawn up for the purpofe of being diftributed by the Board of Health. The languageds very pro¬ perly accommodated to the perfons for whofe benefit it was deftgned. Much may doubtlefs be effected by the conduct of the lower claffes, and we may hope that information is only wanting to induce them to purfue their own intereft and welfare.
No. II. is a Letter to Dr. Ferriar, from Mr. Sim¬ mons, Surgeon to the Manchefter Infirmary* on dif¬ ferent profeflional fubjefls.
1. On the Ufe of the Kali Furufti, as a Cauftic in Hydrophobia & For twenty years, Mr. Simmons ob¬ serves, he has had experience of the fuccefs attendant
vol. v, i S on
234 Ferriar’s Medical Uijlories and Reflections .
on applying this cauflic, in wounds inflifted by the bite of mad animals, or of animals fuppofed to be mad ; and in no one inftance has hydrophobia follow¬ ed its ufe. It has been ufed at the Manchefter In¬ firmary ever fince its foundation, now near fifty years, with uniform fuccefs. Although the difeafe would not have appeared in many of the inftance s in which the kali purum was employed, it is highly probable that it would have fhewn itfelf in fome ot them, for it can fcarcely be conceived that the poifon fhould efcape being infufed in fuch a multiplicity of in- fiances*.
Two cafes of the Venereal Difeafe are next recited, wherein the nitric acid was employed. Without de¬ tailing thefe, it will be fufficient to give Mr. Sim¬ mons’s general obfervations on the fubjeft.
c The firft cafe fhews, that the nitric acid will cure the primary fymptoms of lues venerea, and the fecond proves, that though it is capable of relieving ulcers of the tonfils, by its direft aclion, yet it fails in perma¬ nently removing fecond ary fymptoms, whatever tem¬ porary relief it may afford, in fuch dofes as can be taken, when there are ulcers in the throat. I have given the common nitrous acid of the fhops, in this dileafe, under a variety of circumllances, and in primary and fecondary fymptoms : the refult corref- ponds with the above recited cafes.
c It requires neither confinement, particular mode of diet, nor hindrance of bufinefs. Whether the hoarfenefs, in the firft cafe, was owing to the acid, I cannot determine ; probably a much larger dofe was given than is abfolutely necelfary in primary
* In the Debate on the Dog Tax, in the Houfe of Commons, in the year 1796, Mr. Dent mentioned, that forty cafes of hydrophobia had occurred at the Manchefter Infirmary, within a fortnight. Happily* however, for the individuals, Mr. Simmons obferves, not one cafe of hydrophobia occurred at the time alluded to, but a conliderable num¬ ber applied, who had been bitten by mad dogs.
fymptoms.
Ferriai^s Medical Hiftories and Reflections . 235
fymptoms, but I was defirous to know to what ex¬ tent it might be adminiftered, as it was then meafured with precifion, and taken with the utmoft regularity. When not fufficiently diluted, it has excited vomiting, and pain in the ftomach. It would appear, that the affection of the gums, and confequent falivation, is owing folely to its direct action on them, and may be avoided by fucking it through a quill, ftraw, or glafs tube.
4 Although it has failed me in fecondary fymp- toms, when the conftitution has been much exhaust¬ ed by previous difeafe, and a long courfe of mercury, it has had a fpeedy and permanent effect in reftoring the health and ftrength, Under circumftances v/here a mercurial courfe cannot be entered on, it arreits the progrefs of the difeafe. An example of this may be taken from a perfon labouring under lues venerea, being feized with typhus— the venereal adlion is fuff pended during the fever, and is again renewred on its termination ; in this cafe, mercury mult be of doubt¬ ful propriety : the acid, however, will not only relieve the venereal affedtion, but reftore the patient’s ftrength, and coincides admirably with any tonic plan, that may be adopted.
4 In ulcers, remaining after a mercurial courfe, and which, though for a time relieved, are aggra¬ vated by the further ufe of mercury, I have derived much benefit from it.
4 Such is the refult of my experience of this re¬ medy. I am little folicitous to know how the falu- tary changes are induced, and cannot at prefent ac~ quiefce in the dodtrine of oxygenation of the fluids, either by means of the nitric acid, or of mercury ; and it muft be admitted, that opium, laurel-water, and other powerful narcotics, do not adt by any known elective attradliond
( 236 )
Art. XXVII. An Inquiry into the Caufes and Ef¬ fects of the Variola Vaccina , a Difeafe difcovered in fame of the Wejtem Counties in England , parti¬ cularly Glance fterjkire , and known by the name of the Cow Pox. By Edward Jenner, M. D F.B.S. He. Quarto, 75 pages, with Four co¬ loured Plates. Price 7s 6d. Law, &c. London, 1798.
/
■ . ' u
ideas which prevail amongfl praftitioners § and others, refpedling the very Angular difeafe which makes the fubje£l of the prefent effay, are fo vague and indeterminate, that the public are much indebted to the author for his careful and accurate inveftigation of the matter. The deviation of man, he obferves, from the ltate in which he was originally placed by nature, feems to have proved to him a pro¬ lific fource of difeafes. From the love of lplendor, from the indulgences of luxury, and from his fond- nefs for amufement, he has familiarized himfelf with a great number of animals, which may not originally have been intended for his affociates. Hence, pro¬ bably, are derived, many of the maladies, which, from time to time, fpring up in fociety, and which are not at all found in a hate of nature.
There is a difeafe to which the horfe, from his ftate of domeftication, is frequently fubjedh The farriers have termed it the greafe. It is an inflam¬ mation and (welling in the heel, from which iffues matter poffeffing properties of a very peculiar kind, which feems capable of generating a difeafe in the human body (after it has undergone the modification which I fhali presently lpeak of], which bears fo Prong a refemblance to the fm all-pox, that I think I high y probable it may be the fource of that difeafe.
‘ In this dairy country a great number of cows are kept, and the office of milking is performed indiferi- mim.tely by men and maid-fervants. One of the
former
Jenner’s Inquiry into the Variohe Vaccines, 23 7
former having been appointed to apply dreflings to the heels of a horfe affefted with the greafe, and not paying due attention to cleanlinefs, incautioufly bears his part in milking the cows, with forne particles or the infectious matter adhering to his fingers. When this is the cafe, it commonly happens that a difeafe is communicated to the cows, and trom the cows to the dairy-maids, which ipreads through the farm un¬ til moft of the cattle and domeftics feel its unpleafant confequences. This dileafe has obtained the name of the Cow Pox. It appears on the nipples of the cows in the form of irregular pullules. At their firft appearance they are commonly of a palifh blue, or rather of a colour fomewhat approaching to livid, and are furrounded by an eryfipelatous inflammation.—* Thefe puftules, unlefs a timely remedy be applied, frequently degenerate into phagedenic ulcers, which prove extremely troublefome. The animals become indifpofed, and the fecretion of milk is much leffened. Inflamed fpots now begin to appear on different parts of the hands of the domeftics employed in milking, and fometimes on the \y rifts, which quickly run on to fuppuration, firft affuming the appearance of the fmall vefications produced by a burn. Moft commonly they appear about the joints ot the fingers, and at their extremities ; but whatever parts are affefled, if the fituation will admit, thefe fuperficial fuppurations put on a circular form, with their edges more elevated than their centre, and of a colour diftantly approach¬ ing to blue. Abforption takes place,. and tumours appear in each axilla. The fyftem becomes affected, the pulfe is quickened ; and Ihiverings, with general laftitude and pains about the loins and limbs, with vomiting, come on. The head is painful, and the patient is now and then even a defied with delirium. Thefe fymptoms, varying in their degrees of violence, generally continue from one day to three or four, leaving ulcerated fores about the hands, which, from the fenfibility of the parts, are very troublefome, and
S 3 commonly
238 Jenner’s Inquiry into the Voriohs Vaccina *.
commonly heal flowly, frequently becoming phage¬ denic, like thofe from whence they fprung. The lips, noftrils, eyelids, and other parts of the body, are fometiraes affected with fores; but thefe evidently arife from their being needleffly rubbed or feratched with the patient’s infecled fingers. No eruptions of the fkin have followed the decline of the feverifh fymptoms in any infiance that has come under my infpeftion, one only excepted, and in this cafe a very few appeared on the arms : they were very minute, of a vivid red colour, and foon died away without ad¬ vancing to maturation : fo that I cannot determine whether they had any connexion with the preceding fymptoms.
c Thus the cdifeafe makes its progrefs from the horfe to the nipple of the cow, and from the cow to the human fubjeft.
c Morbid matter of various kinds, when abforbed into the fyfiem, may produce effects in feme degree fimilar f but what renders the cove pox virus fo ex~ tremely fingular, is, that the perfon who has been thus affected is for ever after fecure from the infec¬ tion of the frn all-pox ; neither expofure to the vario¬ lous effluvia, nor the infertion of the matter into the fkin, producing this clrftemper.’
A great uutpber of inftances are adduced in fup- port of this extraordinary faff:* a few of which we ihall tranferibe.
* Cafe
i # It is neceflary to obferve, that puftulous fores frequently appear fpontaneoufly on the nipples oi cows, and inftances have occurred, though very rarely, of the hands of the fervants employed in milking being affected with fores in confequence, ar..d even of their feeling an indifpofition from abforption. Thefe puftules are of a much milder nature than thofe wnich arife from that contagion whicn conftitutes the true cow pox. They are always free from the bluifh or livid tint fo confpicuous in that difeafe. No eryfipelas attends them, nor do they the w any phagedenic difpofttion as in the other cafe, but quickly terminate in afcab, without creating any apparent difdrder in the cow. "1 his complaint appears at various feafons of the year, but moft com¬ monly in the fpnng, when the cows are firft taken from their winter food and fed with grafs. It is very apt to appear alfo when they are
duckling
Jenner’s Inquiry into the Vctriohe T accuice* 239
c Cafe 2. Sarah Portlock, of this place *, was in- fefted with the cow pox, when a fervant at a far¬ mer’s in the neighbourhood, twenty-feven years ago.
« In the year 1792, conceiving herfejf, from this circumftance, fecure from the infection of the fmall- pox, the nurfed one of her own children who had accidentally caught the difeafe, but no indiipofition enfued. During the time (he remained in the in- feffled room, variolous matter was inferted into both her arms, but without any further* efte£f than local inflammation.’
c Cafe 4. Mary Barge, of Woodford, in this parifh, was inoculated with variolous matter in the year 1791. An efflorefcence of a palifh-red colour foon appeared about the parts where the matter was inferted, and fpread itfelf rather extenflvely, but died away in a few days without producing any variolous fymptoms. She has fmce been repeatedly employed as a nurfe to fmall-pox patients, without experiencing any ill con- fequences. This woman had the cow pox when file lived in the fervice of a farmer in this parifh, thirty- one years before.’
Several cafes are next given which fhew, that thole who have had the fmall-pox either efcape the cow pox, or are difpofed to have it (lightly. Some varia¬ tion, however, is found in this refpect.
The teftimony here adduced in fupport of the tail, that the cow pox protefts the human conftitution from the infection of the imall-pox, is ample and fatisfactory ; and the ftatements are confirmed by the concurring teftimony of Mr. Dolland, a Surgeon re¬ dding in a dairy country remote trom that where the prefent obfervations were made. c With refpect to
fuckling their young. But this difeafe is not to be confjde-red as fimilar m any refpeCt to that of which I am. treating, as it is incapable of producing any fpecific effects on the human conftitution. However, it is of the greatefl confequence to point it out here, left the want of difcrimination fhould occafion an idea of fecurity trom the infection of the fmall-pox, which might prove delufive.’
* Berkeley, in Gloucefterfhire,
S 4 > ' the
240 Jenner’s Inquiry into the Variola Vaccina,
the opinion adduced/ the author obferves, c that the fource of the infection is a peculiar xnotbid matter arifing in the horfe/ although I have not been able to prove it from afitual experiments conducted imme¬ diately under my own eye, yet the evidence I have ad¬ duced appears to eftablifh it.
4 They who are not in the habit of conducing ex¬ periments may not be aware of the coincidence of circumftances neceffary for their being managed, fo as to prove perfectly decilive ; nor how often men en¬ gaged in profeffional purfuits are liable to interrup¬ tions which difappoint them almolt: at the inftant of their being accomplifhed : however, I feel no room for hefitation refpefting the common origin of the dif- eafe, being well convinced that it never appears among the cows (except it can be traced to a cow introduced among the general herd w7hich has been previously infefted,) or to an infeQed fervant, unlefs they have been milked by forne one who, at the fame time, has the care of a horfe affe&ed with difeafed heels.
c The fpring of the year 1797, which I intended particularly to have devoted to the completion of this inyeftigation, proved, from its drynefs, remarkably adverfe to my withes ; for it frequently happens, while the farmers horfes are expofed to thy cold rains which fall at that feafon, that their heels become difeafed, and no cow pox then appeared in the neighbourhood.
‘ The active quality of the virus from the horfes* heels is greatly increafed after it has a£ted on the nipples of the cow, as it rarely happens that the horfe aftects his drefler with fores, and as rarely that a milk maid efcapes the infection wThen the milks infected cows. It is moil aftive at the commencement of the difeafe, even before it has acquired a pus-like ap¬ pearance ; indeed I am not confident whether this property in the matter does not entirely ceafe as foon as it is fecreted in the form of pus. I am induced to
think.
I
JenneBs Inquiry into the Variola Vaccina. \ 241
think it does ceafe*, and that it is the thin darkifti- looking fluid only, oozing from the newly-formed cracks in the heels, fimilar to what fometimes appears from eryfipelatous blifters, which gives the difeafe. Nor am I certain that the nipples of the cows are at all times in a ft ate to receive the infection . — • The appearance of the difeafe in the fpring and the early part of the fummer, when they are difpofed to be affedted with fpontaneous eruptions fo much more frequently than at other feafons, induces me to think, that the virus from the horfe muft be received upon them when they are in this Hate, in order to produce effedts : experiments, however, muft determine thefe points. But it is clear that when the cow pox virus is once generated, that the cows cannot refill the con¬ tagion, in whatever ftate their nipples may chance to be, if they are milked with an infedted hand.
‘ Whether the matter, either from the cow or the horfe, will affedt the found fkin of the human body, I cannot positively determine ; probably it will not, unlefs on thofe parts where the cuticle is extremely thin, as on the lips, for example. I have known an inftance of a poor girl who produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cow pox fore by blow¬ ing upon it. The hands of the farmers’ fervants here, from the nature of their employments, are conftantly expofed to thofe injuries which occafion abrafions of the cuticle, to punctures from thorns and fuch like accidents ; fo that they are always in a ftate to feel the confequences of expofure to infedlious matter.
e It is lingular to obferve that the cow pox virus, although it renders the conftitution unfufceptible of the variolous', ihould neverthelefs, leave it unchanged with refpedf to its own adtion. It is curious alfo to
* * It is very eafy to procure pus from old fores on the heels of horfes. This I have often inferted into fcratches made with a lancet, on the found nipples of cows, and have feen no other effect from it than fimple inflammation. *
obferve.
242 jennefes Inquiry into the VarioLe Vaccinct.
obferve, that the vims, which with refpedf to its ef¬ fects is undetermined and uncertain previoufly to its palling from the horfe through the medium of the cow, fhould then not only become more active, but fhould invariably and completely poffefs thofe fpecific properties which induce in the human conftitution fymptoms fimilar to thofe of the variolous fever, and eftedt in it that peculiar change which for ever renders it unfufceptible of the variolous contagion.
c May it not, then, be reafonably conjectured/ the author afks, f that the fource of the final 1-pox is mor¬ bid matter of a peculiar kind, generated by a difeafe in the horfe, and that accidental circumftances may have again and again arifen, {till working new changes upon it, until it has acquired the conta¬ gious and malignant form under which we now commonly fee it making its devaftations amonglt us ? And, from a consideration of the change which the infedlious matter undergoes from producing a dif¬ eafe on the cow, may w7e not conceive that many contagious difeafes, now prevalent amonglt us, may owe their prefcnt appearance not to a fimple, but to a compound origin ? For example, is it difficult to imagine that the mealies, the fcarlet fever, and the ulcerous lore throat with a fpotted fkin, have all fprung from the fame fource, affuming feme variety in their forms according- to the nature of their new combinations ? The fame queftion will apply re- fpecling the origin of many other contagious dif¬ eafes, which bear a ftrong analogy to each other/
Some obfervations next occur, but not immediately connedled with the prefent fubjedt, relative to the fmall-pox. The author mentions the inftance of a practitioner who had been accu homed to preferve the variolous matter in a warm pocket 3 a fituation favour¬ able for producing putrefadtion in it. This matter when inferted wras found to produce inflammation, dwelling's of the axillary glands, fever and fome times
eruptions $
r
Jenner’s Inquiry into the Variola Vaccina. 243
i
eruptions ; but not of the variolous kind, as patients thus inoculated were found ftill fufceptible of the fmall-pox contagion. The author further obferves, that 1 he has the ftrongeft reafons to believe, that if either the punctures or incifions in inoculation be made fo deep as to go through the fkin, and wound the adipole membrane, that the rifk of bringing on a violent difeafe is greatly increafed. Several fadts are adduced in fupport of this opinion.
Refpefting the origin of the cow pox, the following obfervations are made. c At what period the cow- pox was fir ft noticed here, is not upon record. Our oldeft farmers were not unacquainted with it in their earlieft days, when it appeared among their farms without any deviation from the phenomena which it now exhibits. Its connection with the fmall-pox feerns to have been unknown to them. Probably the general introduction of inoculation firft occalion- ed the difcovery. Its rife in this country may not have been of very remote date, as the practice of milking cow~s might formerly have been in the hands of women only ; which I believe is the cafe now in fome other dairy countries, and, confequently, that the cows might not in former times have been expof- ed to the contagious matter brought by the men fer- vants from the heels of horfes. Indeed a knowledge of the fource of the infection is new in the minds of moft of the farmers in this neighbourhood, but it has at length produced good confequences 3 and it feems probable from the precautions they are now difpofed to adopt, that the appearance of the cow pox here may either be entirely extinguished, or become ex¬ tremely rare/
The inquiry which makes the fubjedl of the prefent eiTay is undoubtedly of conftderable importance ; for notwithftanding the happy effects of inoculation, with all the improvements which the practice has
received
<
\
244 Jenner’s Inquiry into the Variola Vaccina.
received fince its firft introduftion into this country, it not very unfrequently produces deformity of the fkin, and fometimes, under the be ft management, proves fatal. But as fatal effects have not been known to arife from the cow pox, even when im- prelfed in the moft unfavourable manner, producing extenfive inflammations and ulcerations on the hands ; and as it clearly appears that this difeafe leaves the conftitution in a date of perfeft fecurity from the in- feftion of the fmall-pox, we may infer, the author thinks, that a mode of inoculation may be introduced preferable to that at prefent adopted, efpecially among thofe families, which, from previous circumftances, we may judge to be predifpofed to have the difeafe unfavourably.
Many facts concur to fhew, that the cow pox can- not be propagated by effluvia. Perfons have often flept in the fame bed with thofe aftefted with the dif¬ eafe, without themfelv.es receiving the inflexion.-— - And the following cafe renders it highly probable that not only the heels of the horfe, but other parts of the body of that animal, are capable of generating the virus which produces the cow pox.
€ An extenfive inflammation of the eryfipelatous kind appeared without any apparent caufe upon the upper part of the thigh of a fucking colt, the property of Mr. Millet, a Farmer at Rockhampton, a village near Berkeley. The inflammation conti¬ nued feveral weeks, and at length terminated in the formation of three or four fmall abfcefles. The inflamed parts were fomented, and dreflings were ap¬ plied by fome of the fame perfons who were employ¬ ed in milking the cows. The number of cows milk¬ ed was twenty-four, and the whole of them had the cow pox. The milkers, confiding of the farmer's wife, a man, and a maid fervant, were infected by the cows. The man fervant had previoufly gone through the fmall-pox, and felt but little of the cow pox. The fervant maid had fome years before been
infected
Crowther on the Difeafe of the Joints , Wc* 245
mfefted with the cow pox, and fhe alfo felt it now in a flight degree : but the farmer’s wife, who never had gone through either of thefe difeafes, felt its effedts very feverely. That the difeafe produced upon the cows by the colt, and from thence conveyed to thofe who milked them, was the true and not the fpurious cow pox, there can be fcarcely any room for fufpi- cion ; yet it would have been more completely fatis- fadtorv, had the effedts of variolous matter been afcer- tained on the farmer’s wife ; but there was a pecu¬ liarity in her fituation which prevented my making the experiment/
The plates which accompany the work are finely executed, and highly defcriptive of the appearance of the cow pox puftules.
Art. XXVIIL Practical Qbfervations on the Dif- eafe of the Joints , commonly called White-Swelling ; with fame Remarks on Scrofulous Ahfcejjes. By Bryan Crowther, Surgeon to Bridewell and Bethlem Hofpitals . Od lavo, 122 pages, price 3s, London. Robinsons, 1797.
THE author in the firft place endeavours to fhew, that the white-fwelling, as it is called, is a bru¬ mous affedtion : he is led to this opinion from having obferved, that mob of the patients affedted with this diforder were defcended from parents of a fcrophu- lous habit, and that many of their families have been deftroyed by phthifis pulmonalis.
The bones in this complaint, Mr. Crowther re¬ marks, are affedted in two ways : in the one they are affected primarily from difeafe in their interior itru&ure ; in the other they are affedted fecondarily, by their articulating furfaces becoming difeafed, in confequence of the previous affection of the internal
furface
L
246 Crowther on the Difeafe of the Joints , Kc,
' \ ' \ ')
furface of the joint. Exfoliation is a rare occurrence in fhefe difeafe s : and of courfe the practice of dilat¬ ing the wound, and the application of the adtual cautery, both of which were formerly much in ufe, are not only unneceffary but pernicious.
We need not follow the author in his remarks on the ordinary treatment of thefe diforders, for its ineffi¬ cacy is too well attefted. We proceed, therefore, to the mode of cure particularly infifted upon in the prefent work.
c It is now more than four years,’ Mr, Crowther obferves, c fince I recommended the cauffic to be applied on the integuments covering the difeafed joint, from an opinion, that i flues would prove more effectual, the nearer they were made to the feat of the difeafe.
£ I then Hated, that this opinion had fomething more than probable conje&ure to recommend itfelf, and, indeed, fubfequent experience has fully confirm¬ ed me in the belief, that the failure of the cauftic in difeafed joints, was not owing, according to Dr. Auf- tin, to the difiance of the part affefted from the trunk, but from the discharge not being procured fo near the complaint as might be effedted : however, the reader will of courfe form his own opinion from the comparative fuccefs attending the more diftant, or clofer application of the remedy.
c The mode I firft purfued in maintaining an arti¬ ficial drain in thefe cafes, was, by making a large efchar, of a circular form, on each fide of the joint, and keeping the fores open by a layer of fponge dipped in the emplqfirum certe compofitum , of the fame ffiape as the fores, but of a fize rather lefs, fo as to allow fuffi cient room for the granulations at the edges to rife above the furface of the plaftered fponge, which was further feeured in its place by crofs flips of adhefve plafter, and the affiftance of a roller.
£ f hough this method has fucceeded in the cure of confirmed white-fwellings, fome of which were at- 4 tended
v
t
Crowther on the Difeafe of the Joints , 8(c. 247
tended with caries, yet the application of the cauftic is frequently hazardous, from the thinnefs of the inte¬ guments in fome cafes ; for inftances have occurred where the cauftic has penetrated fo far as to produce a Houghing of the tendinous expansion of the mufcles ; but the furgeon may avoid injuring the ligaments of the joint, by making the efchars at a diftance fuf- ficently remote, as he can afterwards drift the fore higher or lower, more on one fide or the other, by preffing the fponge againft its edge in the direction of that part from whence he may wifh to procure a dis¬ charge. Notwithftanding the fuccefs which attended the application of the cauftic, yet thefe inconveniences as well as the very minute attention it requires, made me apprehenfive that it would never be generally- adopted. I was of courfe led to the trial of different efcharotic applications, in the form of ointment : among ft others, I was induced, from obferving the effects of powdered favine in the removal of verruca?, to try it alfo. Some of the powder was firft mixed with white cerate, and applied as a dreffing to a part that had been bliftered ; but the ointment ran off, leaving the powder dry upon the fore, and no effeft was produced. I next * infpiffated a decoQion of favine, and mixed the extraft with the ointment, which fucceeded better, for it produced a great and permanent difcharge : and at laft, after various trials, I was led to prefer a preparation analogous to the unguentum jambuci, P. L. and give the following formula, as anfwering every purpofe which my willies could have fuggeftecl :
CERATUM SABIM.
R Sabina, recentis conlujie.
Cerce fiavcz, Jingularum , libram unam .
Adipis fuilla, libras quatnor.
Adipe et cerd liquefactis incoque fabinam et cola.
f I have made many experiments refpefting this cerate, and at one time imagined, that its prepara¬ tion
248 Crowther on the Difeafe of the Joints , Kc.
tion in a copper veflel might have influenced its e£ fe£t. Its deep green colour does appear to depend upon this circumftance $ for where it is prepared in tin veflels, it is of a much paler green tinge, nearly approaching to a yellow, but its effect is the fame* The prefence of a fmall quantity of copper, in an ex¬ ternal application, cannot be of any confequence, and in this cafe, notwithftanding the modification of its colour, the quantity is fo fmall as not to be dis¬ coverable by any chemical tell.
c The ceratum fabinae has been tried very largely in the medical pradlice of a large hofpital, for the production of permanent difcharges, and it is pre¬ ferable in this view to the unguentum cantharidis, becaufe it produces no flrangury, and becaufe the quantity of difcharge is much greater. There are fome particular conftitutions where its ufe is attended with great irritation, and when fuch occur it fhould be lowered by the addition of unguentum cerae.
c It is to be underflood that a blifter is to be pre- vioufly applied over the anterior and lateral parts of the joint, and when the cuticle is removed, the fore is to be drefled with the ceratum fabinae, taking care at every dreffing, to keep the part clean.
c Simplicity attending any mode of treatment, muft certainly be confidered as a recommendation in its favour ^ and I have not known this method of main¬ taining a drain in the leak inferior to that by the cauftic, and from its fuccefs, it has feemed to me to merit a preference, particularly in thofe cafes where the difeaie in the joint is more extenlive, of courfe the pain and fwelling more diffufive, for the cauftic cannot be well applied to a furface fo large as from experience feems requifite for the accomplifhment of a cure.
c The fuccefs of this kind of treatment is always proportionate to the quantity of difcharge which is procured, and not the depth of furface from whence it is derived. The ingenuity of furgeons has been
employed*
Crowther on the Difeafe of the Joints , 8fc. 249
employed, to explain in what manner the cauftics are beneficial in complaints of this nature, one imagining it is the irritation, another the difeharge, and fome in order, as they think, to be nearer the truth, have fup~ pofed the efficacy to exift in both.
A difference of opinion, when it does not in- fluence us in the treatment of a difeafe, cannot be productive of harm, and therefore I fhould have con¬ tented myfelf, in merely bringing forward cafes to prove the efficacy of the practice I with to recom¬ mend ; but when the contrary appears, and the feel¬ ings as well as the recovery of the patient, are involved in a theoretical controversy, the difference of opinion then becomes ferious, and fhould be determined as foon as poflible ; but this can be effected only by the criterion of practical experience.
* It pay be faid in favour of the irritation which immediately attends the cauftic, that it is fometimes ef¬ fectual (for it is not uniformly fo) in reducing the fuell¬ ing and confequently mitigating the pain $ but thefe are only fymptoms of the difeafe, and not the difeafe itfelf; and we have not (as I know of) a tingle in- fiance of a confirmed whitedwelling being cured by the mere effeCt of irritation, and thofe cafes in which it feemed to me to produce any effeCt, the joint was in a ftate of a great tenfion, and further than this the complaint did not receive any amendment until an abfolute drain had been eftablifhed for fome time.
* Mr. Pott attributed the fuccefs of the cauftic to the difeharge, and I am confirmed in that opinion from fubfequent experience ; and it appears to me very doubtful that the greatest advocate for irritation, has ever known it capable of arrefting the progrefs of caries, healing fores, difperfmg abfeeffes and collec¬ tions of fluid, which are attendant on white-fwelling : but that fuch effeCts do refult from the kind of treat¬ ment we have been recommending, is beyond all doubt ; but the reader, I truft, will be able to fatisfy himfelf with refpect to this point, by a perufal of cafes
vol. v,. T which
250 Growth er on the Difeafe of the Joints,
which arc brought forward, not with a view of flip*- porting this or that particular opinion, but merely to record a plain matter of fact : viz. that white-fwellings of the joints have recovered after making a fore fur- face, and procuring from thence a confiderable per¬ manent difcharged
The author has found this method of exciting arti¬ ficial drains efficacious in difcuffing collections of fluids and even abfceffies in other parts of the body $ feverai inftances of which are adduced.
Upwards of thirty cafes of difeafed joints are brought forward in proof of the utility of the plan recommended. From thefe we iliall felect a few' of the molt linking.
« ^ * Cafe 1. I was defired to vifit a man, about twenty- feven years of age, who had been affli&ed with "a white-fwelling of his knee for more than twelve months. He differed great pain within the articula¬ tion, before the joint appeared to enlarge, and his cafe was treated as a rheumatifm ; however, inilead of re¬ ceiving benefit, he gradually grew worfe, and was ad¬ mitted into an hofpital, where he was firft falivated,- with not the fmalleft advantage. A blifier was alfo applied to the joint, and repeated every other day, for the fpace of a fortnight. He Hated, that this method procured him confiderable eafe, with feme reduction of the fwelling. When I faw him, he was in a confirmed Hate of heClic $ had been troubled with rigours ; the joint was much enlarged, and very pain¬ ful, particularly in one part, where the Ikin was thin and inflamed. Indeed, both from the appearances and the examination, I was fully fatisfied that matter had formed. . I advifed him, on account of his health,
Ao part with the limb ; but he declined the operation, telling me he quitted the hofpital, as nothing farther was propofed.
f I made a large efehar on each fide of the joint, by rubbing th t kali purum on the part, and the fores were kept difeharging, by means of prepared fponge.
6 In
Crowther on the Difeafe of the Joints , &V. 25 1
In this cafe, no eafe was derived from the Stimulus of the cauftic ; but after the fores had difcharged freely for fome time, his pains were mitigated, and his health improved.
‘ The previous painful date of the part, prevented, before, a minute examination, which would have as¬ certained that the ends of the bones were deprived of their cartilaginous covering, by the grating noife that was occafioned upon moving the joint. By the con¬ tinuance of this drain, for nearly eighteen months, his knee got perfedlly well ; its motion was unimpaired, nor was the grating found any longer perceivable upon ufing the joint,
‘ This man had alfo a Similar affe&ion of his ankle joint, attended with ulcerations and extenfive caries* on which account, he Submitted to amputation $ and though the knee had remained well a twelvemonth, and was So at the time of the operation, yet it was considered right to amputate above it 5 and I very much regret, I had not the opportunity of examining the difeafed parts.'
c Cafe 2. S. G. a child, about the age of Seven, had an indolent white-fwelling, for upwards of two years 5 the whole joint was greatly Swelled, and the inner condyle of the thigh-bone appeared enlarged.
c She appeared to be very consumptive, breathed with difficulty ; her fkin was yellow, dry, hot, and Scurfy 5 and ffie made little, and Sometimes no water in the courfe of the day 3 her belly was alfo Swollen* and the glands of the neck enlarged. In confequence of the weak flate the child was in, a Sore was made by the cauftic, only on the infide of the joint, that part being mod difeafed, and was kept open by the prepared Sponge, and when it had difcharged only a few* weeks, her fkin became cool and perfpirable ; her ap¬ petite was improved, and her breathing relieved 3 She became eafy, and her lleep was uninterrupted by thofe fpafms of the affe6led limb, with which She had been before troubled.
T 2 ‘In
$52 Crowtlier on the Difeafe of the Joints ,
* In every refpeCt fhe was mending, until, unfom tunately, fhe caught cold, by fitting at the window, to view the flames from the fire at RatclifFe, which imprudence produced a fever, and a large deep- feated abfcefs formed on the outfide of the knee, I afcertained that the fever was not fymptomatic of the abfcefs, but that the abfcefs depended on the fever, from the mother’s account, who informed me, that the child had for two days been very feverifh, before any alteration in the joint took place, or fhe had com¬ plained of any pain. It was pretty certain, that if the abfcefs had burfted, or been opened, the child would probably have been drained to death ; but the joint having been confiderably reduced in fize by the firffc: application of the cauftic, I wras tempted to apply it again, on that part of the fkin which immediately^ covered the abfcefs, taking the greateft care that it: did not penetrate into the tumour. After the efchar had feparated, and the fore had difcharged freely, the:1 child became eafier, and the abfcefs gradually difperf— ed. The iffues wrere kept open, firft by the fponge, and afterwards by the favine cerate, for upwards of: two years, at the end of which time fhe was in every refpeCt healthy, and the joint appeared free from any difeafe, though there remained a flight enlargement of the inner condyle ; however, probably fhe will be obliged to wear a lift to her fhoe, in confequence of the contracted ftate of the knee.’
* Cafe 8. l\ B. about fix years old, had been af¬ flicted with a white-fwelling of his elbow, above eight! months, and it was then ulcerated in feven places ; he had alfo a ftrumouS afleCtion of his great toe on the left foot, a fcrofulous abfcefs, and two fores on the right leg, befides a flrumous ophthalmia which had fubfifted from the fourth year of his age. On account of the inflamed Hate of the elbow, fix leeches were applied, and cloths wrung out of the fatnrnine lotion , were kept to the part, and renewed when dry.— Though this treatment in a degree relieved the in¬ flammation,
urowtner on the Difeafe of the Joints, 25$
flamrriation, yet the fores did not indicate the fmalleft difpofition to heal. A large cauftic was applied above the elbow-joint, the ulcers preventing its nearer application, the iffue was kept open for about ten months, when the ulcers formed by the difeafe had completely healed, and the joint recovered.
* This cafe affords a very ilriking iriftance of the conftitutional effect of artificial drains ; as under this treatment, he entirely got the better of all the com¬ plaints which have been enumerated. On account of his difpofition to fcrofula, before the fore made by the cauftic was healed, I cut him an iffue in the arm.
c I have aim oft daily opportunity of feeing this boy* as he lives in my neighbourhood, and he has not fmce had any complaint, though a period of nearly three years has elapfedd
4 Cafe 1 1 . A young lady felt a pain in her knee* three years before I faw her, which was exafperated by walking, long (landing, or any kind of fatigue ; the joint was contracted, much enlarged, and the in¬ teguments were in a thickened, puffy date, and of a pallid appearance, though not oedematous. She de~ fcribed her pain as particularly fevere in the inner condyle, and under the ligaments of the knee-pan, fhooting from thence into the joint. The part was at different times, cupped or leeched, and a large blifter applied. As the cafe occurred before my knowledge of the effeCts of favine, I employed the wig. cantha - ridis to keep up the difcharge, which produced great pain and ftrangury. I therefore applied the cauftic on each fide of the joint, and kept the fores open by the plaftered fponge. I with particularly to remark, that flie always expreffed herfelf relieved in propor¬ tion to the quantity of difcharge. This patient con¬ tinued under my care for two years, and nearly the whole of that time, a drain was maintained, either by the prepared fponge, or by the favine cerate, a blifter being previoufly applied. Her knee is perfectly re-
T 3 covered*
1
\ \ '
254 Crowther on the Lifeafe of the Joints, 8Cc.
' \
covered;, flie can ftraighten or bend the joint without pain, and her health, which had buffered very con- iiderably, is now completely re-eftablifhed. I cannot futficiently commend the patience with which the lady who is the fubjeft of the prefent cafe, has borne her fuherings. Indeed, the circumftances were particularly unfavourable : for a very near relation had fallen a viciim to the fame diforder, and but for a vifible improvement in her general health, I Ihould frequently have propofed amputation of the limb, as preferable to the mifery flie endured. To fecure her from a relapfe, and as fhe had been troubled with fwel lings of the glands of her neck, I cut an iffue above the knee.*
Cafe 20. A boy, aged feven years, had a difeafed knee and afikle-joint of the fame limb, which had fo impaired his health, that amputation was thought ad¬ visable, but to which the parents would not confent. The knee-joint having been firft affefted, and ad¬ vancing fail: to a date of fuppuration, it was bliftered, and the part was every day dreffed with the favine cerate, for above fix months \ this treatment produced £ reduftion of the fwelling of the foft parts, a re¬ moval of the pain occafioned by the difeafe, and a complete abforption of the fluid, with which the different parts of the joint were diftended.
Tne Knee is capable of every funftion, though the condyles of the thigh-bone remain confiderably enlarged.
‘ From the improvement of the boy’s health, and the amendment of his knee, I recommended -the ankle-joint to be treated in the fame way ; but with what advantage, I have not yet heard, as he r elides in the country.’
from the cates adduced, the author is certainly warranted in his conclufions :
1 hat long continued difcharges, artificially ex- cited, are highly beneficial in every flage of white* fwelling, and in other modifications of fcrofula.
’« That
Crowtner on the Difeafe of the Joints , Sic. 255
* That caries has been arretted, and fometimes cured $ that collections of fluid within the cavities of joints, or exterior to them, have been removed ; that fores connected with the local affeCtion have been permanently healed, and a repetition of them prevented ; that the general health of every patient has been ftrikingly improved, and that where this treatment has been adopted in confequence of the difeafed joint, other ferofulous appearances in diftant parts have alfo yielded to it.
€ That the bed method of producing fuch difcharge, is the application of a common blitter in the firft in- fiance, and when the cuticle is removed, in dreffing the part with the fa vine cerate ; and that the ufe of this preparation may be beneficially extended to a great variety of cafes, where a copious local difcharge may be thought advifable.
£ That an blue in any part of the body, may be fuccefsfully employed as a conftitutional remedy, in all cafes of fcrofula, and may probably be fufficiently powerful when it is applied in time, to prevent an attack of this difeafe, in eonftitutions predifpofed to it,
€ And finally, that we are not to be depreffed by the obftinate refinance of the complaint, or lofe the neceffary confidence in our mode of treatment, al¬ though months fhould pafs without much apparent advantage ; for it has principally been owing to a fleady perfeverance, that I have fucceeded in reftor- ing fome patients, labouring under unfortunate and almoft defperate cafes* to the full enjoyment of their health.5
The application of iffues and other drains, in the vicinity of difeafed joints, is by no means a novel praCtice ; yet it feems of late to have retained lefs confidence, than its importance and utility entitle it to. The public are therefore indebted to Mr. Crow- ther for. recalling our attention to the fubjeCl, and letting its advantages in a new and ftriking point of view,
T 4 Art,
/
( 256 )
Art. XXIX. Medical DifcipUne ; or, Rules and Regulations for the more effectual Prefervation of Health on board the Honourable E aft- India Com¬ pany s Ships . In a Letter addreffed to the Court of Directors , and publijhed with their Approbation. By Alexander Stuart, Surgeon in Southwark, and formerly of the Earl Talbot and General God¬ dard Eajt Indiamen . Twelves, 107 pages, price 2s 6dL London, 1798. Murray and Highley,,
A COURSE of four voyages, comprizing a‘ pe¬ riod of nearly ten years, in the fervice above alluded to, has enabled the author, in his fituation of furgeon, to obferve, collect, and arrange, a number of taCls on different matters relative to the important interefts of health on board fhips, in their voyages to and from India. It is a well known and melancholy truth, the author obferves, that thefe voyages, when protracted beyond the ufual length of time, from war, or other caufes, have hitherto been generally attended with great ficknefs and mortality : the fcurvy, fluxes, and malignant fevers, have frequently made dreadful ravages amongfl the crews.
1 he fuccefsful experience of the late celebrated and humane navigator. Captain Cook, has happily evinced how much it is in the power of well-direCted management to preferve the bleffmg of health, in the longeft voyage, through every variety of climate. His fuccefs, together with flmilar inftances, warrant the averting with confidence, that ficknefs and mortality, to the deplorable extent they have fo frequently oc¬ curred in voyages to hot climates, are by no means t0 J36 confidered as evils unavoidable. The means which have been employed to fo defirable an end, need only to be pointed out, it is hoped, in order to their general adoption.
1 he regulations here propofed refpeft the important articles of cleanlinefs, air, diet, .reft, exercife, and
clothing.
257
Stuart’s Medical Difcipline ,
clothing. We tranfcribe the following remarks on the pernicious ufe of fpirits, when employed unmix¬ ed ; and on the advantages of them, when given in combination with the vegetable acid.
* The only mode, it appears to me, in which liquor can be daily allowed to advantage, is in form of punch, made with either the frelh or preferved acid of vegetables, as lemon, lime, or orange-juice. When the liquor is in this manner blended with the acid and fugar, and a large proportion of water, many of its bad qualities are corrected, and the acid and fugar are given in a pleafant, palatable form, with infinite advantage. In this frate it counteracts the bad ef~ fe£ts of a fea diet, and powerfully prevents fcurvy.
c An ordinary allowance of punch daily, given at dinner, is, perhaps, among the moft effectual antif- corbutics that can be ufed at fea. We have inftances on record where this pra6tice, in a long voyage, faved whole crews, even from the flighted fymptoms of fcurvy ; whilft other fhips in the fame fleet, and expofed only to the fame caufes, were daily burying men, cut off by this dreadful malady.
c But of the virtues of this acid, (on which thofe of punch chiefly depend) both in the cure and preven¬ tion of fcurvy, I can decidedly fpeak from my own immediate obfervation and experience.
‘ On board the General Goddard, during the voyage of 1792, feveral cafes of fcurvy occurred among the foldiers, in recovering from a contagious fever that raged univerfally for a time amongft them, which were all fpeedily and effe&ually cured by the liberal ufe of preferved lime-juice. And I have every reafon to think, that the difeafe was prevented in a great many others, by the daily ufe of a fmall quan¬ tity of the acid, mixed with water, and the addition of a little wine and fugar.
c Indeed, I confider this acid, in its frefh or pre¬ ferved ftate, to be as effeftual in curing and prevent¬ ing fcurvy, as the bark and mercury are in curing the ague and fyphilis ; and a large quantity of it as necefl
fary
258 Perkin^ on the Influence of Metallic Tractors , SCc*
fary to be laid in by fhips at every place it can be procured.
* I have therefore firongly to recommend, , that a frefn quantity be always purchafed at every port a Ihip touches at on the voyage ; and alfo that a part of the (hip’s flock of liquor be made into fhrub, that is to fay, that a certain quantity of acid and fugar be mixed with a certain proportion of fpirits, to be kept and daily ferved out to the men during their contb nuance at fea,
£ It were moft truly and earneftly to be wi fired, that the Honourable Company’s fhips fliould always be fupplied, on their fitting out, with a quantity of their liquor made previouily into fhrub, which would only require a proportion of water to make punch. That the ufe of punch in a moderate degree, fliould become general ; that drams fhould never be given unlefs in fuch inftances of expofure as I have already mentioned ; and that grog fliould be ufed as feldom as poffible. In my mind the beneficial effefts that would arife from fuch praftices, would be great indeed.*
Art. XXX. The Influence of Metallic Tractors on the Human Body, in Removing various painful In - flammatory Di ('cafes, fuch as Rheumatifm , Pleurify% fame Gouty Affections , & (c. fc. lately I) if covered by Dr. Perkins, of North America ; and demon - Jirated in a femes of Experiments and Obfervations , by ProfeJfors Meigs, Woodward, Rogers, &c, &cf by which the Importance of the Dijcovery is fully Af certained. , and a new Field of Inquiry opened in the Modern Science of Galvanifm, or Animal Eleftricity. By Benjamin Douglas Perkins, A. M. Son to the Difcoverer. Ofilavo, 99 pages, price 2s 6d, London, 1798. Johnson,
THE fubjeft of the effay before us is probably new to the greater part of our readers ; but a cir- cumftance we learn from it, viz, that the Metallic
Tractors
*
!
P erkin s on the Influence of Metallic Tractors , 8Cc. 259
Tractors are vended by the author and difcoverer, at the price oi five guineas the fet, favours, at firft fight, too much of modern empiricifm, to induce us to go particularly into the contents of the work.— Yet the evidence adduced, refpeCting the powers of the remedy here recommended, is apparently fo ftrong, both in nature and extent, that no inconfider- able degree of importance attaches to the fubjeft, and we are led to give a more extended account of it, than we might otherwife, perhaps, have deemed neceffary.
The origin of the difcovery is thus defcribed.— .
Perkins, of Connecticut, m TSF orth America, for many years entertained the opinion that metals poftefled an influence on the human body, which had hitherto efcaped the fcrutinizing eyes of phyfiologifts. This opinion was the refult of fome phenomena, which in the courfe of his extend ve praCtice had accidentally arretted his attention. The firft remark¬ able incident that prefented itfelf to the notice of Dr. Perkins, was the hidden contraction of a mufcle, when he was performing a chirurgical operation. This he obferved regularly took place whenever the point of the metallic inftrument was put in contaCf with the mufcle. Struck with tne novelty or the appearance, he was induced to try the points of wood, and other fubftances ; and no contraction taking place on thefe experiments, he thence inferred that the phenomena could be afcribed only to the influence of the metal.
* About the fame time he obferved, that in one or two cafes, a ceffation of pain had enfued when a knife or lancet was applied to feparate the gum from a tooth, preparatory to extracting it ; and in the fame year he difcovered, that momentary eafe was given in a few inftances, by the accidental applica¬ tion of a metallic inftrument to inflamed and painful tumours, previous to any incifion.
While thefe and a few other cafes of a fimilar nature,^ in which the perfectly tranquil ftate of the patient s mind^ with every attending circumftance,
precluded
260 Perkins on the Influence of Metallic Tractors , 8Cc,
precluded the poffibility of a fallacy,. were engaging his attention, the news of the late important difco- very of Galvani, the celebrate-d Profeffor at Bologna, relative to the furprizing effeCts of metals on the nerve and mufcular fibre, confirmed him in his hypothefis. From this period he began to turn his attention to this his favourite purfuit, and fought with eagernefs for fubjeCts which might enable him to afcertain the power of metallic influence when applied to difeafes of the human body.
c He proceeded to make infiruments of what are call¬ ed the perfeCt metals as well as of the bafe ones, and likewife of various compound metals, and tried them all, fometimes with lefs and fometimes with more fuc- cefs, than he had ever hoped or expected. Thefe ex¬ periments he continued for feveral years ; convinced from what he had already noticed that he was right in his principle, and ardently hoping that further ex¬ periments and obfervations would enable him to ap¬ ply it to the alleviation of human affliction, and the general benefit of mankind.
c The refult corroborated and indeed exceeded his moft fanguine expectations ; for he difcovered that, by drawing over the parts affeCted in particular direc¬ tions, certain infiruments which he formed from me¬ tallic fubftances into certain fhapes, he could remove chronic rheumatifm, feme gouty affeCtions, pleurifies, inflammations in the eyes, eryfipelas, and tetters ; vio¬ lent fpafmodic convulfions, as epileptic fits ; the lock¬ ed jaw; the pain and fwelling attending contufions ; inflammatory tumours ; the violent pains occafioned by a recent fprain ; the painful effeCts of a burn or feald ; pains in the head, teeth, ears, breaft, fide, back, and limbs ; and indeed moft kinds of painful topical affeCtions, which came under his care and ob- fervation. The infiruments producing thefe effeCts are termed TRACTORS.
4 The fubjeCt by this time began to excite public attention and general curiofity. By thofe only who
had
t
Perkins on the Influence of Metallic Tractors , Xc. 26 1
had feen or experienced the effefts of the tractors were they credited, while thofe who judged only from rumour, confidered the metallic operation as a renewal of Mefmers treatment, and the fhafts of ri¬ dicule were thrown at the difcoverer, as the reviver of his exploded practice. With thefe men Dr. Per¬ kins was fuppofed to have loll his fenfes; and his hy¬ pothecs, which they have fince honourably acknow¬ ledged to be tounded on reaion, and fupported by experiment, was then efteemed the delufive dream of chimerical projection !
‘ Shortly after the adjournment of the Medical Convention, to which I have juft referred, Dr. Perkins, influenced by the advice of his friends, and delirous of being fituated in a more extenllve field for exhibiting his difcovery, repaired to Phila¬ delphia. The public hofpitals, alms-houfes, infirma¬ ries, and other inftitutions which ornament that po¬ pulous city, and do honour to its inhabitants, pre- fented excellent opportunities ‘for making experi¬ ments on a variety of new cafes, and fubjeCting his hypothefis to a feverer teft. As Congrefs was now in feftion, he performed his operations, not only in the prefence of the moft eminent phyficians, but alfo before the moft diftinguifhed perfonages of the Union. General Washington, then President of the United States, convinced of the importance of the difeovery from experiments in his own family, avail- , ed himfelf of its advantages by purchafing a fet of the tractors for their ufe.
c The Chief Justice of the United States, fe- veral of the Senators and Reprefentatives in Congrefs, and other literary characters, honoured the difcoverer with their attendance at a great variety of his expe¬ riments, as well as the medical gentlemen of Phi¬ ladelphia and its neighbourhood.
c In the prefence of fuch honourable and accom- plifhed judges. Dr. Perkins operated at the hofpitals, on patients afflicted with pains and inflammations
in
3
262 Perkins on the Influence of Metallic Tractors, SCc*
in almoft all their variety, and I believe I may fay to the general fatisfaflion and furprife of the Ypec- tators. Difeafes of the rnoft obftinate nature, which had baffled medical art, were removed by the metaltic tractors : and many perfons of an advanced age, who had been crippled for years with the chronic rheu- xnatifm, were, in feveral inftances, perfectly cured.’
The author next gives an account of the opposition which the metallic tractors met with from different quarters 5 much of this, however, it appears, gave way to a candid inveftigation of faffs, and the tefti- monies adduced" in their fupport are at lead: honour¬ able, if not decifive. Many fuppofed the tractors to a£t on the fame principle as the exploded practice of animal magnetifm, and, in faff, to be merely a re¬ vival of that impofition. But the reality of this was brought into queftion, from the following comparative observations on the two. Several members of the Medical Society of Connefticut turned their atten¬ tion to this objeft, and endeavoured to difeover, if any affinity or refemblance could be found between the operations of Dr. Perkins, and the treatment of Mefmer. •
‘ After almoft innumerable experiments, which were made on fubje&s of all descriptions, as it re- fpe&s their difeafes, ages, or ftations in life, and, in Short, diversified with every variety which occurred to them ; it was acknowledged that there could be no refemblance found, either in the modes of applica¬ tion, or in the effects which were produced, between the operation of the tractors and animal magnetifm. It was obferved, that the author of the difeovery of the metallic influence, always fought opportunities for performing his operations in the prefence of phi- lofophers and men of Science, <c who fhould be com¬ petent to deteft a fallacy, if there was one; and, on the other hand, to extend the improvement, if, in faft, a new principle is discovered.
€ It
Perkins on the Influence of Metallic Tractors, Sic. 263
c It was found that the difeafes, in which the ope- ration of the metallic influence was moft fuccefsful, are diredtly oppofed to, or very different from, thofe in which animal magnetifm had produced effefls. — Highly nervous complaints, attended with debility, in which the latter chiefly appeared effective, have rarely been relieved by the former ; alfo none of thofe dan¬ gerous or ridiculous fymptoms, which in animal mag¬ netifm were faid to be preparatory to a crifis, took place here ; nor any thing which bore the le aft refem- blance to the crifis itfelf. The pains, inftead of re¬ quiring an operation of two hours or more, as was the cafe in Mefmer’s treatment, are generally removed bv the . tractors in the courfe of twelve minutes ; and inftead 6f their being fuccefsful only among the lower daffies of mankind, who are moft fubjeft to credulity and impofition, they have hitherto been chiefly ufed among men of fcience and refpedability, who have often been difpofed, at firft, to treat them with ridi¬ cule and contempt, from a perfuafion that the opera¬ tions were all a fallacy.
c The circumftances under which the tractors pro¬ duce no eflfedt, alone fufficiently prove that a phyflcal caufe, independent of the power of imagination, is concerned in the operations ; as for inftance, relief from pain has never been procured by them, on parts of the body to which any* oily application, or where any adipofe fubflances have bepn recently employed,
* The obftacies which oil prefents in exciting mufcular motion, or the animal electricity, is particularly mentioned by Galvani, the dif» coverer of that influence. ( De Viribus El. in m . m. p. zz.)
Dr. Fowler alfo, whole ingenious experiments on the fame in- fluence have fucceeded thofe of Galvani, has the following remarks. (Exp. and ObJ', on Anim. EleEf. p . is.)
** Oils of all kinds are fo tar from conducing, that if the fingers of the perfon holding either the probe or the zinc have perlpired much, even this operates as a complete obftrudhon to the pallage of the in¬ fluence. The inftant the perfpired matter has been wiped away, and
the fingers have been dipped in water, it again excites contractions. _
When the inteftines of a frog are removed, and its abdomen is filled with oil, no contractions can be excited by placing one metal upon its fciatic nerves, and bringing another in contact with it, either above or below the furface of the oil.’*
* Indeed,
264 Perkins on the Influence of Metallic Tractors , Kc0
c Indeed, perfpiration itfelf is fo efteQual a barrier to the metallic influence, that the tractors have never been ufed to fo much advantage in the warm fummer of America, when the hands oi the operator, and the fkin of the patient, are generally covered with it. — - But if the part be thoroughly wafhed, and the oil, adipofe, or perfpirable matter be perfeftly removed, relief will be immediately obtained. Chronic pains, after an injudicious ufe of mercury, or old pains, which are the effe&s of a venereal complaint, even where no mercury has been ufed, have never been radically re¬ moved by the metallic influence.
* Another Angular phenomenon occurred, viz. That in fome inftances the metallic influence, when excited by different perfons, produced different effefls. This fa£t, however extraordinary it appeared, and however ffrenuoufly it was at firft: oppofed, is now universally acknowledged. Experiments were made to afcertain this point with fuch accuracy, as to preclude the pof- fibiiity of a fallacy ; and the refult proved, that there were perfons who might ufe the tractors for any length of time, in difeafes which were fuitable for the operation, and produce no perceptible effeft ; when by placing them in the hands of another per- fon, who fliould perform the operation precifely in the fame manner as before, the pain or inflammation would be removed diredtly. It is true, this lin¬ gular property is charafleriftic but of few, yet among the great number who have purchafed the tractors in America, there are fome who have never performed a cure. Thefe gentlemen, whenever an operation is required, put the tractors in the hands of a bye- ffander, who applies them under their direction, and the ufual falutary effefts are the immediate confe- qucnce.
c This curious fa£t has been mentioned, by the writers on the philofophy of the metallic influence,,
Perkins on the Influence of Metallic Tractors , 263
as a proof of its analogy* to the influence difcovered by Galvani.
• c I fliali next enumerate feme of the difeafes which were found to be fuitable fubjeCts for the metallic operation ; and thofe who have experienced or un- 'derftand them, will eafily judge whether the imagina¬ tion can have any influence in their cure. Can the imagination cure a gout f — remove, almoft inftanta- neouflv, the fpafms of an epileptic fit, when the pa¬ tient is diverted of every exercife of reafon ? or the contractions of a locked-jazv f — Can imagination re¬ move the pains and inflammations j* of the eyes f — - reduce tumours , as the quincy , biles , and whitlows , if applied before a fuppuration has taken place? — re¬ move the fevere inflammations , pains , and tumours of the flings and bites of poifonous infeCts ? — or of burns and fc aids, and thofe on an infant ? — or inflammations of ringworms, tetters , and eryjipelas t Or can ima¬ gination cure the lamenefs of a brute J? Thefe are fome of the afflictions which the tractors, generally cure.
4 It
* * See the experiments of profefTor Volta, relating to the various; effects of the metals when applied to the fenfe of tajie.
1 Cavallo, alfo, when fpeaking of the influence of metallic applica¬ tions, which are rendered fufceptible to the tajie and fight, has the fol¬ lowing remarks, “ Different perfons are varioufly affebted by this ex¬ periment.” [ Application of •zinc and filler to the tongue . ] *•* W ith
fome the fenfation or tajie is very (lightly or net at all perceived, whilft with others it is very flrong, and even difagreeable. Some think it a. mere pungency and not a tafte.” ** When the experiment was applied to the fenfe of fight,” he fays, “ this phenomenon is hot alike perceiv¬ ed by every perfon, fome being hardly fenfible of it, whilft otners ob~ ferve a very ft rong flafh.
“ In performing both of the above-mentioned experiments, vilz* that which produces the tafle, and the other which produces the flafh ©f light, fome perfons imagine to feel a gentle warmth diffufe itfelf over the tongue from its root to the very apex.” Can) alt o s Complete Treatife on Eleft . 'vol. Hi. page 58. , .
4 f See the effects of Galvanifm on inflammations, in Fonjjlet s Exp* & Obf. on Ani?n. EleFt . page 87 , and 1 ’,8, 129. .
‘ f; I once faw a horfe, which, in confequence of a drain in the pal- tern, had become exceedingly lame, and from the intenfe heat 01 the hoof on that foot, and the actions of the animal, was iuppofed to be in great pain, completely relieved in the courfe ot ten minutes by the
IT operation
VOL. V. W * j.
266 Perkins on the Influence of Metallic Tractors ,
* It may be naturally conceived, that the evidence exhibited muft have been powerful and conclufive, to induce the members of the Connefticut Medical Society, individually, to come forward and declare their fentiments to the world in favour of the opera¬ tion of the tractors , when they thereby openly violat¬ ed an aft of their fociety, and hazarded the ftigma of an expulfionft
The experiments are next given which ferve to authenticate the difcovery of the metallic influence. Many of the testimonies come from perfons not of the medical profeffion, but who, neverthelefs, feem com¬ petent on the prefent occafion ; for the fubjeft is, for the moft part, an appeal to the common fenfes. — * Others of the fafts are vouched for by members of the medical profeffion of high and diftinguiffied cha- rafter. A few of thefe we ffiall lay before our readers.
Experiments 4. — Doftors Baker, Hall, Lord, and Brewfter, Reprefentatives of the County of Wind¬ ham in the Connecticut Medical Convention , and Fellows of the Con . Med. Soc.
Windham County, Aug. 16, 1796.
From a variety of cafes which have occurred, not only in our own praftice but in that of our neigh¬ bouring phyficians, we ar e fully convinced of the uti¬ lity of the metallic traftors, in removing various pains, ^ • " • . ■ ■
operation of the traftors ; the hot hoof bpcoming of the fame tempera¬ ture ds that of the other. From being fcarcely able to put his foot to the ground, he became fo much better inabout twelve minutes from the time the metallic inftruments were firft applied, that a gentleman mounted him and rode away, being but juft able to perceive his lamenefs. -
( I have heard of other ftmilar inftances, but this is the only one which has come under my perfonal obfervation.
* I have frequently, however, heard of the little painful fwellings on the back, generally termed faddle biles, being cured by the operation of the metallic influence/
Jpafmodit\
Perkins on the Influence of Metallic Tractors , Sic. 267
fpafmodic , and inflammatory affections from the hu¬ man body ; and that the difcovery is of importance to the healing art.”
Experiments 8. — Dr. Rufus Johnfon , of Canterbury > Member of the Connecticut Medical Society,
w;. . - ^ Auguft 11th, 1796.
£C In the courfe of my practice a few months pall, I have made frequent experiments with the me-f tallic tractors , and have, with but very few excep¬ tions, mcceeded to my furprife in removing rheumatic pains , head-achs, pains in the face ,fpafmodic affections , and inflammatory fwellings of the throat .
“ The pains after being once eafed, have in fome infiances returned ; and then, by a repetition of the applications, have been wholly removed.
“ From my own practice , and what I know of the praftice of others, I conceive this method of remov¬ ing pains a very important and ufeful difcovery in the healing art ; and I earneftly with that the tractors may be generally difperfed, that mankind at large may have it in their power, by thefe innocent means, to eafe themfelves of many difeafes which baffle the ef¬ forts of medicine.”
Experiments 9. — Dr. Thomas Backus, of Plainfield , Member of the Connecticut Medical Society.
Auguft 9th, 1796.
“ I was called, on the 4th ult. to attend a patient, by the name of James Crawfon, who, for about five years, has been frequently troubled with a fpecies of epileptic fits . When I firft faw him he had experi¬ enced, in the courfe of the day, twelve, each of which held him about fifteen minutes. I took from him. fourteen ounces of blood ; but difcovering no happy effefts, I applied the tractors to his right leg, in which he ufually experienced the firft attack of his
D 2 fits.
268 Perkins on the Influence of Metallic Tractors, Xc.
fits. The whole limb immediately became limber and free from fpafm, and he foon revived without dif¬ fering a general convulfion.
“ About twenty minutes after, I being out of his room, was informed that the fymptoms of another fit appeared, and before I could operate on him he was univerfallv convulfed, with an entire lofs of reafon. I then drew the tractors over his right leg again, fix or eight times, when the fpafms immediately ceafed, and his reafon was inftantly redo-red.
“ In about half an hour he was feized with ano¬ ther, which w as removed very much in the manner of the lait, the indruments not being applied until a ge¬ neral convulfion had taken place. I then feated my- felf on his bed, that I might be enabled to apply the means more feafonably. Here I foon difcovered the fymptoms again, but by applying the tractors , imme¬ diately the fymptoms difappeared. Several others, at intervals, commenced with their ufual fymptoms, fo contra&ing and cramping the right leg, that the ut-
. • C it n ♦ 1 •
mod exertions ot twro men were unable to ftraighten it.
each of which were in lefs than a minute removed by five or fix lirokes of the tractors , before the fpafm had extended to the other parts of his body: the leg almod inftantaneoufly becoming perfectly lax.
By the requeft of a number of gentlemen, who by this time had convened to behold this fingular phenomenon, when the fymptoms of a fit appeared I. ceafed to ufe the tractors , that we might determine, whether the above operations had prevented the ge¬ neral convulfions, which before their application had always fucceeded the attack in his leg. Immediately he fell into a very fevere fit, which appeared in one univerfal fpafm. in this fituation I fuffered him to
Continue a few minutes, which was long enough for
the experiment, when, by applying the tractors to his leg again, in lefs— than one minute he was. entirely five from every kind of fpafm, and in- dantly regained his reafon. I dill continued by his
fide*.
Perkins on the Influence of Metallic Tractors , Site. 269
fide, and prevented feveral other general attacks, by operating at the beginning of the fymptoms.
fC About one hour and an half after the fir ft: appli¬ cation of the tractors , the fits entirely fubfided. He became very eafy, and experienced none of thofe difagreeable fenfations, which he ever had after for¬ mer attacks of this kind. He had ufuallv been af-
J
fli&ed with thefe fits, except at a few intervals, of twelve or fifteen minutes each, about twenty-four hours from the time they firft commenced. It is therefore evident, that the influence of the tractors not only fhortened the fits, but leffened their number, as at this time they continued not more than nine or ten hours from their firft commencement, and about an hour and an half after the firft experiment. He has difeovered none of that debility which has ufually fucceeded his former attacks, and continues to this day enjoying better health than ufual.”
Experiments 13. — James Gofs, M. 1). of Gloucefler ■,
MaJJ'achufets .
{C I this day faw your tractors applied with fuc- cefs on a child of Mr. James Smith, fifteen months old, which had been, about an hour before the ap¬ plication, very feverely fc aided , by falling into boil¬ ing fat with one hand and arm, on which large blis¬ ters were raifed. After a few minutes operation, the rednefs and inflammation was almofi wholly removed, and the child appeared to be eafed of pain.”
Experiment 17. — Communicated bp James Burrill, Efq.
Attorney General for the State of Ilk ode //land.
“ My fon had for nine years been afflicted with the rheumatifm to fuch a degree, that he could not walk without crutches, nor at many times drefs or undrefs himfelf. Dr. Perkins, by applying his tractors* gave him immediate relief, fo that he walked with eafe
U 3 unaflifte
270 Perkins on the Influence of Metallic Tractors 8(c.
unaffifted by any fupport. For nine years preceding this period, the diforder was fo violent that he was almoft conftantly in pain, which at night was fo fevere as often to prevent deep. Soon after the ope¬ ration of the metallic influence, he was wholly freed from pain, and the dwelling of his joints fubfided. Since that time, when the fame fort of pains recurred, of which there have been but few inflances, they have always been eafily removed by the fame application.
“ Jofeph Bradford.’ 1
<<r Mr. Bradford is a neighbour of mine, and I have knowledge of his fon’s having been for a great nura- bet of years feverely afflicted with the rheumatifm to fuch a degree that he always appeared to walk with great difficulty ; and that, fince your metallic appli¬ cation, to which I was an eye-witnefs, he has walked with apparent eafe, and in every appearance is much amended. 1 have had knowledge of the fuccefs of your tractors in many other inllances, and have the firmed belief in their general efficacy.”
Experiment 20. — James Glover, Efq. County of Tioga ,
State of New York ,
<c Your tractors , which I lately purchafed to ufe in my family, I have applied with great fuccefs, upon a perfon fcalded with boiling lye. A man by the name of Welch , who was at work in my pot-afhery, when boiling down the lye fome of it flew into one of his eyes, which foon became very much inflamed, and fwelled to fuch a degree that he could not open it, and remained in that fituation for the fpace of three days. After the tractors had been ufed a few minutes, he was able to open it, and with two ap¬ plications only, his eye was entirely free from pain and inflammation, and in a fhort time was perfectly well, although fo badly fcalded, that he had defpaired of its ever recovering.”
Experiment
Perkins on the Influence of Metallic Tractors , & u\ 27 1
Experiment 23. — Rev. Samuel Spring, D. D, of New¬ bury Port , S'/u/e of M a ffachufe its, Author of“ Re¬ ligious Tracts 9” Sic. 8(c.
February 24th, 1797.
C€ Give me leave to congratulate you in the view of the ample fuccefs with which your difcovery has been crowned. To afcertain its. utility in any new cafe, will, to you no doubt, be particularly grateful. Let me then remark, that they have proved fuccefsful in removing the rickets . In my congregation at New¬ bury Port, there is a young gentleman, who, previous to the application of the' tractors, had not, for fixteen years, been able to bend his body fufficiently to reach the floor with his hand ; but whofe pains," in a few minutes afterwards, were not only removed, but he was alfo able to reach the floor with facility. I have not the lead doubt but many affiidled children, and young perfons, might in a fliort time be relieved from the burden of fuch complaints, by a feafonable and proper ufe of the metallic tractors ..
“ In confequence of your invaluable difcovery for removing many pains of the human body, I with you, dear Sir, the mod ample fuccefs, and the grateful notice and encouragement of your fellow-citizens.”
Experiment 26. — Communicated by the Rev. Samuel Hopkins, D. D . of Newport, Rhode Ifland , Author of“ The Sy Jl em of Divinity fl Sic. Ec.
Auguft 17th, 1796.
For twelve or fourteen years Captain William Land, of Newport, had been frequently afflifled with fevere paroxyfms of the gout. In the fall of 1795 he had a violent attack of this diforder, which had con¬ fined him to his room for five or fix days. At this time, when his foot was very much fwelled, inflamed, and in fuch extreme pain, efpecially his great toe, that he could not walk, nor fet his foot on the floor,
C 4 I called
272 Perkins on the Influence of Metallic Tractors , 8(c.
I called upon him, and operated on his foot with the metallic tractors according to Dr. Perkins's direc¬ tions. Within five minutes the pain and inflammar tion ceafed, fo that he walked with eafe. The fwell- ing within twenty-four hours fubfided, fo that he put on his fhoe ; and this foot in two davs became as well as the other. The pain has twice returned fince, but has been foon removed by the fame application. I have information of other perfons being cured of pain, by the fame paeans, in this city."
.. * p
Experiments 28. — Rev. Thomas Barnard, D. D. of Salem , State of Mqjfaclnifetts.
December 6th, 1796,
u A p ad y of between fixty and fe veuty years of age had one of her fingers contracted for feven years, which the was unable to open without the affirmance of the other hand. About the firfl of November lafifc I applied your metallic tractors. The difficulty was removed, fo that the opened it as her other fingers. I have had direct information from her three weeks imce the operation, and her finger continued well. At the fame time I cured a whitlow on one of her thumbs with one trial. From what I have done, feen, and heard, I am fully fatisfied that the difcovery is important to the healing art."
^ With refpeCt to the theory which is to explain the fads above fpecified, we are informed, that Dr. Per¬ kins has not yet brought any forwards. Dr. V aughan, an ingenious friend of the difcoverer, in a differtation on the fubjeCt of Animal Electricity, lately publifhed, attempts to account for the effeCt of the trafilors on the principle of the newly-difcovered influence of Gal van b f [ have frequently,’ he obferves, c taken out the hearts of frogs, turtles, &c. and obferved at¬ tentively their actions. They will contrafit and dilate fua fponte for fome time, and then ceafe, when they may be again excited to contract by lacerating them
with
i
Perkins on the Influence of Metallic Tractors , &rc. 273
with a wooden or other pointed inftrument But when they become no longer excitable by thefe means, they may be re-excited to contrafl by the irritation of a metallic inftrument. I once obferved a fmgular phenomenon in an amputated limb. One of the crural mufcles contracted upon being irritated with the point of a fcalpel. The experiment was then tried with a pointed wooden inftrument, but to no effe£t ; yet on irritating it a fecond time with the fcalpel, it contracted once or twice. Hence the appli¬ cation of metals is one of the belt and moft delicate tefts for afcertaining the ieaft poffible degree of muf- cular irritability. After having been wholly infenfible to the impreffions of all other flimuli , they may be re-excited, on the application of their native ftimulus.
“ Although we cannot with precifion fay why hominal eleftricity fliould be fufceptible of metals only, yet the faff is inconteftible, and fanClioned by the experiments of thofe gentlemen afore-mentioned, whofe veracity is unqueftionable. It is alfo further fubftantiated by the difcovery of Dr. Perkins’s me¬ tallic tractors for removing pains and topical affec¬ tions. The DoCtor obferved to me that he had made trial of ail the various metals, but none are fo effec¬ tual as thofe of which his tractors are competed.™ This difcovery is as important in the healing art, as it is novel in the fcience of phyfiology, and all that re¬ mains, to illuftrate its efficacy, is a rational and phi- lofophical demonftration of the principle itfelf, and an explanation of the modus eperandi on the eftabliflied laws of the animal oeconomy. This, however, is con- fidered problematical by tome, and by others it is pofitively difearded. Yet to ceafe from enquiry be- caufe we are fometimes miftaken, is no greater proof of wifdom than to defift from walking becaufe we fometimes ftumble.
<£ And if we only take an impartial view of the operations of nature herfelf, and attend diligently to the analytical inveftigations of the afore-mentioned
experimen-
274 Perkins on the Influence of Metallic Tractors , <$V.
experimentalifls on this fublime fubjeft, I think the fceptic himfelf muft admit, that the principle of ner¬ vous energy, is a modification of electricity. As fen- fation is dependent upon this energy, a pleafurable fenfation, or what may be termed a natural or healthy degree thereof ; then certainly pain, or fuperfenfation, can only depend on an accumulation of the electroid fluid, or extra degree of energy in the part affeCfed. On this principle the problem admits of an eafy fo- lution ; namely, that the metals being fufceptible of this fluid, condudt the extra degree of energy to parts where it is diminifhed, or out of the fyftem altogether* reltoring the native law of eleCtric equilibrium.
The particular affeCtions in which this operation is the molt effectual are, chronic rheumatifms, as lum¬ bago, fciatica, &c. odontalgia, otalgia cephalalgia, phlegmons, cynanchies, opthalmias, pleuritic pains, fpafmodic cholics, burns and fcalds, paronychia?, con- tulions, atonic gout, fpontaneous hcemorrhages, herpes, eryfipelas, &c. with many other topical affeCtions which might be enumerated if neceffary. The trac¬ tors fhouid be carried to feme diftance from the part affected, along the courfe of the larger nerves ; and in obftinate and fixed pains of long Handing, the opera¬ tion fhouid be continued until a flight inflammation is excited ; but in eryfipelas, and other fuperficial in¬ flammations, the operation fhouid be very light on the inflamed part, and principally confined to the edges of the tumour. In removing pains from the head, the hair fhouid be perfectly free from pomatum, or other adipofe fubftances ; and all parts on which the trac¬ tors are ufed fhouid be free from fweat, oils, &c. In pleurifies, cholics, . &c. a diaphorefis not unfre- quently fucceeds their operation, and fometimes faintnefs is produced, by the fudden abftraCfion of nervous energy. In a cafe of cephalalgia, if the pain is confined to the fore part of the head, it is imma¬ terial whether the hair is pomatumed or not. A few days fmee I awoke with a moft rending head-ach,
unaecom-
Perkins on the Influence of Metallic Tractors , 275
unaccompanied with fever ; I delayed the operation fome hours, on account of my hair being pomatumed, but the pain became fo infupportable (and the ufual applications failing) that I refolved to make trial of the tractors , as the pain was for the moil part in my forehead. After the operation had been continued a few minutes on my forehead, and the back of my neck, I was perfectly relieved from pain, and have re¬ mained fo ever fince.
“ It is argued by fome (who are oppofed to the metallic operation) that the efficacy of the tractors depends merely on a counter irritation produced by friction. I would afk thofe dogmatics how metallic friftion cures burns or topical inflammations ? Does not the leaf! impreffion on an inflamed part produce pain, and wTould not friction augment the evil ? — Phlegmons, and fome other topical inflammations, may often be removed by exciting a counter irrita- tation with bliffers, 8cc. which reftore the equilibrium of the nervous fluid. But blifters feldom anfwer any valuable purpofe in local inflammations, accompanied with exceflive a£tion of the arterial fyftem, until the fever is previoufly diminifhed. Neither will the me¬ tallic procefs fucceed fo well in the acute as in the chronic rheumatifm, while the febrile action remains inordinate. This fliews a correfponden.ee in efteCt, but the modes of operation are diametrically oppo- lite. The former is by an indirect organic procefs i the latter by a dire£t and fpecific operation ; and all pretenfions towards identity are precluded by the di- verfity of their effe£ts on burns and phlegmons, as before mentioned. Phlegmons, and other topical af¬ fections, are owing to an internal or external irritation on the nerves of a particular part, by means of which the veflels of the part are alfo brought into action, and not unfrequently the whole vafcular fyftem a£ts in concert, from a fympathetic harmony prinrawally eftahiifhed.
“ Spoilt a-
276 Perkins on the Influence of Metallic Tractors y Sic,
“ Spontaneous Hemorrhages are thofe which de¬ pend on a local excefs of tone or eleffricity, deno¬ minated (by the illuftrious Cullen) a Hemorrhagic effort.
Herpes are the produff of a morbid or exceffive excitement in the veffels of the cutis ; the incruftation is formed by exceffive aftion. The metals remove this inordinate a&ion by abftradling the extra degree of electricity ; corrohve lotions deffroy the morbid ac¬ tion by corrofion, and induce or reftore the condition for healthy a ft ion.
Burns . — The ftimulus of heat produces inflam¬ mation, by exciting and accumulating the eleftric fluid.
&c Epilepfij is owing to an irregular; diftribution of the nervous fluid, and an accumulation thereof in the muffles affected with fpafm. That this is the faff, is obvious from the preternatural ftrength of epileptics.
“ Pain is merely an accumulation of eleffricity, in a particular part ; and the fubfequent ftate of eafe is obtained by abftrafting the extra degree of fenfibility. Hence the frequent faintings in parturition, cholics, &c. are to be imputed to a diminution of nervous energy. In chronic pains, conneffed with idiofyn- crafy, or dependant on habit, fo that the orgafm of the part is injured, or a mal-conformation induced by nature or accident, the metallic procefs cannot be ex- peffed to fucceed.
t6 When fuppuration has taken place, the tractors -mu ft be confldered as mere palliatives. They fhould never be ufed on the back, during the exigence of the catamenia. Befldes thofe cafes in which they have already been found fuccefsful, future experience will probably develope many others, in which they will prove equally efficacious.
<£ The tractors will alfo, in all probability, fucceed better in the hands of fome perfons than others. For example : — Many people are remarkable for an ex¬ treme luftre in their eyes 5 fome are fo much eleff rifled
4 naturally
Perkins on the Influence of Metallic Tractors, Sfc. 21 v.
naturally as to (hew evident figns of it when a fenfible electrometer has been applied to them ; and others have manifefted an extreme fenlibility of even the fmalleft degree of eledricity, infomuch that they would be affeded by a hath of lightning, though fo remote that the thunder could not be heard. All this evinces that eledricity, fo far from being noxious, bears a very aCtive and falutary part in the animal ceconomy, which will probably lead to more im¬ portant refearches on this interefting fubjed, and incite future travellers to explore the remaining terra incognita
We have thus thought it our duty to go much at large into the evidence which has been brought for¬ ward, in fupport of the alledged power of the me¬ tallic traders; for, unquellionabfy, if there be no er¬ ror or mifconception of fads, the importance of the difeovery is great indeed. There is, certainly, much in the reports that will ftartle the cautious and feep* tical inquirer, who does not, on flight and trivial grounds, admit fads which fo far outrun his ordinary experience and comprehenfion. Yet where the proofs are fo many and fo ftrong, it would be unrea- fonable to queftion them on any other grounds, than cautious and fair experiment. To this tell, the mat¬ ter will, no doubt, foon be brought. Not having wrtneffed the application of the metallic traders, we can of eourfe offer no opinion on the fubjed. We may date, however, on report, that a few trials which have been made in one of the London hofpk tals, have not added to the confidence which the prefent pamphlet is well calculated to infpire.
Arx.
( 278 )
Art. XXXI. A Lecture introductory to a Courfe of popular Infractions on the Confiitution and Ma¬ nagement of the Human Body. By Thomas Beddoes, M. D. O cl a vo, 72 pages, price Is. 6cL Johnson. London, 1797.
WE have, on many occafions, declared our- felves advocates for the diffufion of medical knowledge amongfl the public at large, convinced that it would contribute no lefs to the benefit of fo- ciety, than to the honour and refpefl ability of the members of the medical profeffion. It is with plea- Lire, therefore, that we find the fubjecl taken up by fo able a hand.
The origin of the defign here announced is thus defcribed. c A practitioner in furgery accidentally informed me many months ago, that he was defirous of giving a courfe of anatomical ledtures in BriftoL To furnifh individuals with fo much knowledge of themfelves as fhould enable them to guard againft habitual licknefs, and a variety of ferious diforders, had been long an objedt of contemplation with me.
I therefore propofed that the courfe fhould be mo¬ delled according to this idea. I remarked, that a dif- tindt exhibition of the larger lines of anatomy and phyliology would be alfo the mode of infirudfion bed adapted to young Undents in medicine ; much ob- fervation of ledtures having convinced me that ex¬ treme minutenefs is only perplexing to beginners.
I bis, joined to fome other confiderations, prevailed. 'The perfon in queftion has devoted much of his fpare time to the providing of proper preparations, and he has affociated in the undertaking a fellow pradfi- tjoner, who poffefles a valuable anatomical collec¬ tion. For my own part, I fhall contribute my ut- moft a ili fiance to the defign, in whatever way that afliftance fliall, upon refledfion, appear moft likely to be effeffual. The purpofe of the courfe will be
. to
Beddoes" Lecture, Sc. on the Human Body. 279
to exhibit the ftrufture of the human body, in a man- ner neither fuperficial nor tedious, to explain the furidlions of the parts as far as they have hitherto been inveftigated, to illuftrate by fpecimens the principal deviations of thefe parts from their healthy conformation, and to interfperfe fuch reflections as may be ufeful in phyfical education, and the whole conduft of life/
It is added, that MeiTrs. Bowles and Smith, who undertook the courfe, were more ntmieroufly at¬ tended than they expected. As fuccefs, therefore, has crowned the tirft attempt, it is a natural with that its publication may produce fimilar undertakings elfewhere. — A few extrafls will convey an idea of the ftyle and manner of execution of the prefent lec¬ ture.
‘ You are already/ Dr. Beddoes obferves, f in ge¬ neral apprized of the object of thefe leisures. The principle by which they are to be regulated, was ex¬ plicitly fet forth to the public ; and you muff be prepared for a courfe eiTentially different from fuch as are ufually delivered in the fchools of medicine. Difregarding the profeffion in which you may be adlually engaged, or may hereafter defign to engage, we purpoie, in the firft place, to lay open to you, your own phyfical conftitution. We are aware that, before a mixed affembly, fuch a fubjedf can alone be properly treated, according to a meafure and me¬ thod, difficult at once to feize. At thefe, however, we fh all aim. If we ftiould attain to be perfpicuous, it does not follow that we mult be inaccurate or flight.
/ Oar explanation of the great doftrines of anatomy will, it wre can realize our own ideas, anfwer every demand of liberal curiofity upon the flock of in¬ formation hitherto accumulated. With me, how¬ ever, immediate gratification is a very fubordinate confideration. Many detached points of moment will, no doubt, be elucidated, while the parts are before
vqu
0
r ' |
3
280 Beddoes* Lecture , Sic. on the Human Body. vou, becaufe the elucidation can then be mod dlf-
m J
tindlly underftood. But I lay principal ftrefs upon the demonftrations, as neceflary for furnifhing data to¬ wards that fpecies of knowledge to which the con¬ cluding lectures will be dedicated. On this head I fhall, in a few moments, freely enlarge. An effay on the means of fecuring health can be indifferent to no man, who has feared for himfelf, or pitied in another, thofe evils, by which daily life is mod cru¬ elly infefted.
‘ Beyond the limits which I have thus loofely af- figned, it is prefumed that the majority of this au¬ dience will not ftretch their expectations. But we have, among us, fome of the medical pupils of the city : and before I difmifs the little i have to fay on the firft part of the courfe, it may be proper to add a word for their fatisfaction. I take it for granted that they have not overlooked an intimation in the profpedtus, defigned for them ; and I hope they are difpofed to admit its juftnefs, till the contrary fhall appear. It requires, indeed, but little fagacity to difcover that individuals, whatever be their difference in other refpecis, are pretty nearly on an equal foot¬ ing in relation to our defign, if the/e have fcarce en¬ tered upon the circle ot medical feience, and thofe have devoted themfelves to different purfuits. A plan calculated effectually to inftrudl the one, bids fair to prefent to the other as much information as moft perfons may be capable of receiving: at one time.
Some of your number may painfully anticipate the details of anatomy, I can enter into the tremors of the moft apprehenfive. I have had them in full force myfelr. But thofe who have courage to rifque the firft encounter, may be fure of conquering the principal portion of their falfe alarm, which will very foon fubftde and be altogether forgotten. By help of the difcoveries of modern chemiftry, the uuifance of putrid fmells may, I believe, be abated;
and
)
Beddoes* Lecture, &c. on the Human Body. 2$1
imd were the ingenious called upon by the public voice, models fufficient for every purpofe of popm lar demonftration might be contrived. Thefe models would imperceptibly fubdue the averfion of the de¬ licate, and prepare them for witn effing an exhibit tion of the parts themfelves without difguft. By con¬ ciliating the mind to images which it is worfe than Folly to confider as loathfome, more would be ef¬ fected. than the bare removal of a great impediment to the moft important and moft curious of all hu¬ man ftudies. For it is a well-known obftruftion to eveiy branch of the healing art, and by confequence a public misfortune, that we are all, in early youth, made or fuffered to acquire this abhorrence towards the objects of anatomy. Ffence, I fuppofe, in part originates that frequent, (and according to my expe¬ rience, aim oft condant) refufal of permiffion to exa¬ mine the bodies o! the dead. It is alio, I am aware, in great part to be afcribed to falfe tendernefs. However it may originate, I reckon, among the probable advantages of our undertaking, the "dimi¬ nution of an evil that daily leaves in uncertainty, points of the higheft confequence to the living. I trud that even though you may have previoufly fuc- ceeded in breaking thefe pernicious affociations in yourfelves, you will hereafter be more in earned to foften the cruelty your acquaintances may unthink¬ ingly harbour. For cruelty is the proper name of every fentiment which oppofes the good of fome, by
enjoining or impeding what would not be injurious to any.
‘ Deeming it important that you ffiouid fully com¬ prehend how the diffemination of medical knowledge is to enrich medicine, I fhall a little unfold what has- been already intimated. Since the immortal Syden¬ ham, the region of human maladies has been more accurately explored. Many landmarks have been fixed j and what is termed the hijlory of difeafes has been compofed witn infinitely fuperior fidelity.
VOL. V. x -But
282 Beddoes' Lecture, $V. cw th& Human Body.
But much is yet wanting in cafes of very gradual de¬ viation, to fill up the fpace between the ftate of per¬ fect health, and the ftate regarded as full-formed dift eafe. If you corifider how rarely medical men are called upon to examine the various intervening con¬ ditions, and how unfavourable their fugitive vifits rauft be to examination, you will not deem it ah- furd to fuppofe that the interval will long remain a blank, unlefs dorp'eftic come in aid to profeffional ob- fervers. Important circumftances or fymptoms arife without notice, and pafs away without leaving any certain trace. They are often loft to the fcience : they are loft, with their poffibly beneficial indications, to the patient. And wherefore, but becaufe the eye of the fpedfator has not been taught to fee ? Hence the phyfician, who is to determine on the evidence, cannot confide in the report of the witnefs 3 nor can the witnefs confide in himfelf.
* I fhall truft to your fagacity for the detection of fome inferior benefits, which would be enfured by rendering thefe purfuits popular 3 and but point out the moft remote perhaps, though certainly the greateft of all 3 indeed the refult and confummation towards which whatever elfe we gain is but preparatory.-— By the joint efforts of the intelligent in the profeffion and out of it, the genuine preventive or prophy¬ lactic medicine would be at length eftablifhed. I am aware that medicine is ufually defined the art of preventing and curing difeafes. Both thefe preten¬ tions it often realifes. But preventive medicine , the deftined guardian of infancy, youth, manhood, and old age, adapted to the interior of families, has yet no exiftence,
c I do not conceive-that you can defire a more de¬ tailed account of the fupplemental lectures, tor which the hope of being ufeful has induced me to engage. There is, indeed, another head which I fhould not like to leave unndticed. You will find that there^ are grounds for improvement in medicine, upon
which
Beddoes* Lecture , Kc. on the Human Body, 28 S
which the graduated and non-graduated regulars have feldom had the courage to proceed. In truth, not- withftanding the hourly failure of all our ufual re- fources, in the moft reputable hands, upon youthful fuhjefts, utter inattention to felf-knowledge has here¬ tofore maintained a public feeling, favouring the triumph of intrigue over ability, and by every fort of indirect menace, deterring the ordinary prafti- tioner of medicine from aiming at great difcoveries. But there exifts a fraternity , which, by boafting of remedies for our word maladies, and by holding them at the fame time concealed, becomes the fpon- taneous outcaft from humanity. If you afk why its members, whom no concern for character reftrains, do not ftrike out ufeful inventions, I (hall readily own my inability to anfwer fatisfadlorily, unlefs I may fuppofe them deftitute of information and of genius* not lefs than of Hi a me.
‘ That you may be able to refolve the queftion for vourfelves, I could wifli to introduce you into the bufy recedes of quackery, where pharmaceutical compofitions, new and old, are firft disfigured, like children kidnapped by gypfies, and then baptized by the moft ludicrous names. But they impofe ; and the difgraceful tribute levied by the proprietors, is a handing premium for fraud. What is fingular, it does not avail you to fee through the artifice. You may as well pay with the good grace of a dupe* The felicitation of feme friend of the family is fure to extort your fhare of the general contribution. I have fcarcely known a confumptive perfon upon whom, whether willing or unwilling, a certain public medicine , not lefs contemptible than the meaneft of its fellows, has not at feme period been forced/
/
( 284 )
■ \ " ' '
Art, XXXII. A few general Rules and Infractions ^ very necejfary to be attended to by thofe of both Sexes who are afflicted with Ruptures. By Wil¬ liam Turnbull, A. M. Surgeon to the Eajlern Difpenfary and the Society for the Relief of the ruptured Poor . Twelves, 46 pages, price Is, London, 1798. Boosey, &c.
IN the courfe of his attendance on the ruptured patients committed to his care, the author found many inconveniences had arifen from the want of feme general rules and inftruclions, which might enable them, in molt cafes, to manage the trufs, and conduct themfelves during their abfence from the practitioner. To remedy an evil which fre¬ quently retarded and fometimes prevented a cure, he has now printed what he conceives will anfwer this falutary purpofe.
A general outline of the difeafe is fir ft given, di~ veiled as much as poffible of technical phrafeology. By this an idea may be formed of the nature and caufes of ruptures in general, as well as of the prin¬ ciples on which the cure is founded. The different kinds of rupture are next deferibed, with the marks and fymptoms peculiar to each ; and, laffly, the treatment, efpecially the ufe of the trufs, is explain¬ ed, with fome general cautions and inltruCtions, ne¬ ed! ary to be attended to by thofe who are afflicted with this malady.
In a work like the prefent, nothing will be ex¬ pected that is novel to the profeffional reader. In this age of patents and difeoveries, however, it may be well to give the author’s tellimony refpefting the patent elajiic trufs , the merits of which, he mull be- fuppofed well qualified to determine. 4 Much,’ he obferves, c has been lately faid refpeCting the advan¬ tages that would arife from the ufe of patent Elastic trusses j and the inventors of this trilling
novelty
I
WeikarcTs Medicine Amplified , Sc. 285
novelty have not fpared either trouble or expence in promulgating their utility. But, as I am convinced that any trufs of this defcription, made without the circular fteel band, can never anfwer any beneficial purpofe, but, on the contrary, may prove, in many infrances, extremely injurious, I think it neceffary to deliver a decided negative as to their general ufe.
My chief reafons are, that they do not prefs fuffi- ciently on the aperture through which the gut paffes ; and, likewife, that they have no fixed point of fup- port, as they bear irregularly on the parts, and con- fequently their compreffion muft be always unequal and uncertain. In cafes of flight and recent hernia, they may occafionally fucceed ; but no trufs can be depended on, unlefs it is made with the circular fteel fpring, which, from its producing an equal preffure, and bearing directly on the opening, renders it more eafy and convenient to the patient, and effectual in v * its operation.’
Art. XXXIII. Methode medicate Jimplifiee cVapres les Principe s de Brown , Sc. i. e. Medicine Am¬ plified on the Principles of the Brunonian Syjiem, illufi rated and confirmed by M. Weikard. Twelves, 3s. 6d. Imported by Boo set. London, 1798.
HiHHE advocates of the Element a Medicine, there 1 is reafon to believe, have confiderably dimi- niihed in number in this country, fince the death of their celebrated author. Time has, in a great mea- fure, reduced the enthufiafm which this performance once infpired, and given to it its proper eftimation. To deny its claim to genius and originality, would be to do it injuftice ; but its infufficiency, as a ge¬ neral balis of theoretical and practical knowledge,
X 3 has
28 6 Soemmering's Be Corporis humani Fabric a.
has, we trull, on many occafions in our work, been amply and fatisfaClorily expofed.
The firm hold which the humoral pathology has obtained, and indeed ’{till obtains, in the fchools on the continent, mull have occafioned tfie work of Dr. Brown to have been received with' avidity, eh peciaily by the younger part of the profeffion, from its novel and bold attack on eltablifhed principles : and we are not furprized at being informed, that it is ftudied at prefent with all the ardour, which its originality, and mode of execution, are well calcu¬ lated to excite. Its merits will not probably foon be fairly appreciated!
Art. XXXIV. S. T. H. Soemmering Be corpo¬ ris hujnani fabric a. Ofitavo, vol. 4, 366 pages, price, 5s. Imported by T. Boosey.
IN feme former numbers of our review,* we had occafion to notice the firft, fecond, and third vo¬ lumes of this refpecfable writer on the anatomy of the human body. The opinion we then entertained of the merits of the performance, has fuffered no di¬ minution by our perufa! of the prefent part. The author commences, as ufual, with a catalogue of the bell writers, on the fobiefii of which he treats, viz. the brain and nerves , he then proceeds to the ana¬ tomy of the dead human brain* and with his ufual arrangement and perfpicuity, invefligates this very important vifeus. The volume is replete with inte- refling phyfiological reafoning, and minute anatomi¬ cal defeription, worthy the attention both of the practitioner and fludent : and we are happy to find the profeffor invefligating chemically, the nature and properties of an organ, whofe compofitioii and ana^
* See Med„ Rev, v. ii. p. *50, and v. iv. p. 276,
- 1 J ty
Soemmering’s De Corporis humani Fabric a « 287
fyfis have been, hitherto, little attended to by anato- mifts in general.
The Brain examined by the Micro/cope .
The cineritious and medullary portions of the brain, he obferves, appear to be compofed, according to the teftimony of many obfervers, of tenacious, glutinous, and feme what pellucid globules, cohering together : nevertheless
1. It is not yet determined, whether the cineri-
tious portion be com poled of larger and the medul¬ lary portion of fmaller globules ; the medulla of the fpinal marrow of fmaller globules, than that of the brain ; and the nerves of the leaft of all ; nor, whe¬ ther the more remote the globules are from the ci¬ neritious portion, the more fubtle they become; nor whether there is any difference between the cineri¬ tious portion and the medulla; nor, whether the globules are of different fizes, one with regard to another. v a
2. Nor is it clear, whether thefe globules float in a pellucid fluid; which becomes more denfe the farther it recedes from the cineritious portion, fo that the globules move freely one amongft another, or whether they are united together by a peculiar ilender and appropriate cellular ftru&ure, or only by ; veffels.
3. Nor is it afeertained, that the globules are placed in right lines along the nerves, for they can¬ not be fufficiently cleanfed, fo as to be diffinftly feen by the microfcope.
4. Nor is the fize of the globules clearly dem.o.h- ftrated ; for fome authors affert, that they are lefs than the globules of the blood.
The chemical Analyfts of l he Brain .
A pound of human brain, expofed to the chemical analyfis, yielded, befides a great quantity of water,
X 4 two
•T5
'288 $oemniering*s De Corporis humani Fabrica .
two drams of fpirit of ammoniac, one ounce and a half of rancid oil, and forty grains of a volatile oil.
Sixteen ounces pf well wafhed brain, entirely freed from blood, and reduced by degrees into allies, ex¬ hibited not the leaf! mark of iron. The remaining part immerfed in vitriolic acid, and mixed with the fait of Turldfh galls, produced a purple or reddiih colour, not in the leaf; tending to black.
Nor was the leaf; appearance of iron detected by phlogifticated alkali.
A great quantity of the acid of fugar was, how¬ ever, obtained ; four ounces of which, mixed gradu¬ ally with a fufficient quantity of dephlogifticated acid of nitre, produced three drams and ten grains of ex¬ cellent cryftals.
The brain is diffolved into a milky mafs by the fpirit of fait or of urine,
Pyrophorus can be procured from the human brain, when expofed to the adtion of fire with alum.
Befides a kind of animal matter, more like the al¬ bumen of eggs than foap, the acid of phofphorus, terra calcis, foda, and ammoniac, may be obtained.
The greater part of the contents of the fcull , and the fpinal canal , does not appear to be effential to life and the energy of the nerves i For
1. There are many inftances of infants, born al- mofl; without brain, and likewife without the fpinal marrow, who neverthelefs have lived and become
fat
The calvaria, efpecially of foetufes, is often filled with a pure water and no brain,* Infants without my fpinal marrow have been feen to live.f Some-
.tr , _ . Element, ruyjiciog. torn. iy. p. 353, a fimilar example l -fol xviT1 ' by Remnia m the racdical commeptaries of ^ipburgh,
t Memof?5 de Dijon, tom. ii. p. 22 5.
** 1 . * ■ 7 . ; .<
times
Soemmering's De Corpoi'is humani Fabric a. 289
times a foetus is brought into the world without any head. *
2. Animals with fmall brains, poflfefs neverthelefs great vigour, of which fiih are examples. There is no animal of the fame fize as man which has a brain of nearly the fame bulk : yet the nerves in man are often as fmall or fmaller in proportion, than thofe of other animals. If, therefore, fo fmall a portion of cerebrum be fufficient to fuftain life and the energy of the nerves in thefe animals, why not in man alfo ?
3. There have been inftances both of adult men and beafts, whofe brain has been almoft wholly de¬ ft royed, or converted into pus, or abforbed, in com frequence of the preffure of bony tumours ; and where feveral ounces have been loft bv a blow or other caufe • but who have neverthelefs continued in per* feft vigour.
4. The foetus grows quickly in ntero , although the brain be inert.
5. Life continues during fleep, when the natural power of the brain is deprefled.
6. The vigour of life has continued perfe£t in ma« ni’acs, notwithftanding the brain has been found al- moft wholly corrupted.
The author next proceeds to the confideration of the Tving human brain, in which the reader will find every thing which has been hitherto faid on the fub- jeft, with many pertinent and original obfervations of the writer.
Under the head of organic vitia of the nerves is cpnfidered their chemical analyfis.
Chemiftrv, the author obferves, extrafls from the nerves a great quantity of water, impregnated with ammoniacal fait* a little oil, and volatile alkali ; but a greater quantity of inflammable air, which, expofed
* Banner's AnaiQmtJcbe Wahrnehmungen, Konifberg, 1769. Obf.
p.
to
290 Soemmering’s De Corporis humani Fabrica.
to fire, fuftains a more vigorous and longer continued flame, than that which is obtained from the other parts of the body; and, laftly, a greater quantity of oil than can be extracted from the mufcles.
The funfitions of the nerves are next in order: arguments are employed to prove, that the nerves are the inftruments of fenfe : — that the medullary por¬ tion of the nerves is fenfible, although their involuera are not fo that the more the nerves are excited, the greater the fenfation : — that an increafed commo¬ tion in a nerve induces pain : — that from a continued Himulus the nerve becomes lefs fenfible : — and, that a greater fenfation deftroys a lefier one.
The power which the nerves poffefs of inducing mufcular contraction is a phenomenon well known. It is inherent in the nerves of the mufcles only. The motion which is requifite for that purpofe originates in the brain, and is conveyed to the rnufcle through the medium of the nerve. Senfation is firft carried to the brain, then the power is exerted which in¬ duces the mufcles to contraCt. The tonic powder of the nerves may be deftroyed, while the fentient powder remains, and vice verfa. Is there then, the writer afks, more than one kind of nerve ?
From the confent of the nerves, their power upon the blood-vefiels and abforbents, and upon the dif¬ ferent fecretions, a very important queftion arifes, viz. Whether the nerves contribute to the nourifh- ment of the body, and whether they are concerned in the production of animal heat ?
The ftruCture of the organs of fenfe, the author oh- ferves, explains the reafon why the optic nerve ferves for vifion, and the auditory nerves for hearing ; yet, neverthelefs, nerves in other parts of the body, under certain circumftances, have a peculiar mode of aftion ; for tartar emetic produces vomiting, but does not dif- turb the fenfe of tafte ; the crocus metallorum vomits, but does not injure the eye ; pepper is agreeable to the fiomach, but is hurtful to the eye ; the manner m
which
Fearfon on Inflammatory Diathejis in Hydrophobia. 29 i
*
which thefe different aftions are induced is not yet known.
The next queltion, which is difcuffed, is. Whether the nerves are hollow canals ? which leads the author to the mode of aftion of the nerves, and the long difputed do&rine of the exiftence of the nervous fluid. The volume is then concluded with a very excellent defcription of each nerve of the human bodv.
A r t . X XXV. The Arguments in favour of an Inflam¬ matory Diathejis in Hydrophobia confidered ; with fame. Reflections on the Nature and Treatment of this Difeafe. By Richard Pearson, M. D. Phyfi ~ cian to the General Hofpital near Birmingham , Odtavo, 59 pages, price Is 6d. London, 1798'. Seeley.
*
THE inflammatory nature of the hydrophobia or rabies has been maintained by many refpedtable writers on the difeafe, who have enjoined a plan of treatment founded on this principle, confiding in large and repeated blood-lettings, and other parts of what is termed the antiphlogiftic plan. Diffatis- fled with the arguments which lead to this hypo- thefis, and ftill more, perhaps, from its infufficiency as a guide to practice. Dr. Pearfon has been induced to inquire into their validity, and' to attempt their refutation.
The arguments which have been urged in fupport of the inflammatory nature of hydrophobia from the bite of a mad dog, are founded, 1ft. upon certain fymptoms which attend the difeafe : 2d. upon ana¬ logy, or the occurrence of flmilar fymptoms in feme other difeafes of a known inflammatory nature : 3d. upon the appearances on diffeftion : and, laftly, upon the, fuccefsful employment of venefe ftion in home
fuppofed
292 Pearfon on Inflammatory Diathefls in Hydrophobia *
fuppofed cafes of rabies.— Each of thefe is examin¬ ed in order.
Among the fymptoms which are faid to denote in¬ flammatory aftion in this diforder, the following are the principal ; pain in the epigaftric region, and ardor and oppreffion about the preecordia ; vomiting ; re fi¬ le ffnefs, third:, heat, and fever ; difficulty of fwallow- ing liquids ; difficulty of breathing ; priapifm ; watch- fulnefs, and furor. — Of thefe the author obferves, that fame of them are merely accidental, others fcarcely perceptible, and fome, even if prefent, would not denote the difeafe to be of a nature requiring the ufe of the lancet. The pain in the region of the ftomach, not being conflant, is referred by the author to a fpafmodic origin. The vomiting he fuppofes to depend on a peculiar fympathy of the flomach with the heart. The oppreffion about the praecordia is probably owing to an affeftion of the heart, drongly marked by the palpitations and irregular pulfe. The difficulty of breathing comes on by fits, and is accom¬ panied with fighing, and is fuppofed to arife from eonvulfive movements of the diaphragm and abdo¬ minal mufc'les. The difficulty of fwallowing liquids is alfo referred to eonvulfive efforts. The re file fine fs proves only an exquifite degree of fenfibility ; whilfl the thirl! is the natural confequence of the abflinence from liquids. The watchfulnefs and furor admit of explanation on the fame principle.
2. Symptoms refembling thofe which occur in hy¬ drophobia have been faid to arife occafionally in quinzy, gaftritis, and peripneumony ; but while their appearance in thefe difeafes, is confelfed to be only occafional, and whilft it is doubtful whether fome of the cafes quoted were really inflammatory, there feems no ground, for confidering them otherwife than as ac¬ cidental.
3. Great ftrefs has been laid, by thofe who contend for the inflammatory nature of hydrophobia, on the appearances on diffe&ion : thefe are, an unufual ari¬ dity oi the yifeera and other parts ; marks of inflam¬ mation
[
\
Pearfon on Inflammatory Dia thefts in Hydrophobia. 293
• i i
mation in the fauces, gula, and larynx 3 inflammatory appearances in the flomach ; and accumulation or eff fulion of blood in the lungs. The firft of thefe is not a conllant occurrence, and therefore not effentiah— The rednefs which has been often obferved in the flomach and oefophagus, Dr. Pearfon fuppofes to arife from an erythematous inflammation of the mem¬ branes, and not requiring the ufe of the lancet and debilitating means. The accumulation or effuflon of blood in the lungs has not been always obferved, and appears to the author to be the termination of the difeafe, and bv no means the difeafe itfelf. It feems to have been moil confpicuous where the furious pa- roxyfms were moil frequent and moil violent ; and. on the other hand, to have been altogether wanting where the patients (as has fome times happened) died in a gradual, placid manner.
The fall argument in favour of the inflammatory nature of the, difeafe refts on the fuccefsful employ¬ ment of venefeftion in fuppofed cafes of hydrophobia. ’But many of thefe cafes, the author obferves, are doubtful and unfatisfaftory in their nature ; whilft there are many, in which the progrefs of the difeafe was not at all arreiled by the ufe of the lancet, and are unexceptionable and decifive in the higheft de¬ gree. Blood-letting, too, has been equally ineffec¬ tual as a prophylactic.
The failure of blood-letting, added to the flight de¬ gree of febrile adlion, and the want of the buffy or fizy appearance of the blood, together with the found ffate in which the vifcera and other parts have been frequently found, on opening the bodies after death — all thefe fadls. Dr. Pearfon thinks, fully authorize the conclusion, that the difeafe produced by the bite of a mad dog, or other rabid animal, does not belong to the clafs phlegmafise , in other words, that it is not an inflammatory difeafe.
Having now gone over the ground of the author’s arguments againft the inflammatory nature of the dif¬ eafe.
I
994 Pear fon on Inflammatory jJiatheJis in Hydrophobia 0
\
cafe, we come next to his own view of the fubjeQ, and to the treatment which it fuggefts.
After the failure of blood-letting, the warm bath, and the reft of the antiphlogiftic method, the tranft- tlon was natural, the author obferves, to the tonic plan. Dr. Ruffi, however, feems to have been led to this, not fo much by a confideration of the unfuc- cefsful employment of the remedies above mentioned, as by a fancied analogy between tetanus and rabies. * In tetanus from wounds, fractures, amputations, and cold after expofure to heat, there is no poifon acting upon the fyftern ; the mufcles are affected with fpafms, and are not alternately convulfed and relaxed, as in hydrophobia ; and in the former diforder there is none of that preternatural fenftbility — none of that intolerance of fluids, when applied to the furface of the body — nor any of that irritability of mind, which we obferve in rabies canina. I do not fee much ana¬ logy between them.
4 But, although the fymptoms are unlike, it does not neceffarily follow that the fame, or nearly the fame treatment may not be applicable to both. I am inclined to think that one of the remedies recom¬ mended by Dr. Rnjh , may be given with good effeSl in cafes of hydrophobia ; I mean wine ; and the more fo, as we find from Dr. Ruffe! s account, that wine in large quantities has been adminiftered with fuccefs againit the bite of a venomous ferpent, between which diforder and rabies there is, in feveral re- fpefts, a much greater affinity than between rabies and tetanus.
c As for the other remedy propofed by Dr. Rujh , viz. the cold bath, experience is againft it. In one of Dr. Vaughan's patients it had a full trial, as well as in a patient who died at the Birmingham Hofpital fome years ago. The application of water, hot or cold, feldom fails to excite convulfions, and only ferves to aggravate the difeafe. It is time that bath¬ ing, which has been fo generally and fo unfuccefs-
fully'
4
Pearfon on Inflammatory Hiathefis in Hydrophobia. 295
fully employed in hydrophobia from the days of Cel- jus to the prefent moment-, fhould be laid afidm
‘ I hope the confidence which molt praftitioners have in mercury as a cure for rabies, is not mifplaced. The progrefs of this difeafe, after its unequivocal fyrnp- toms have appeared, is generally fo rapid, that there is not fufiicient time for mercury to take effect ; and I with I could not add that in fome well-authenticated inftances, after this remedy had taken effeft and pro¬ duced a falivation, the difeafe terminated in the ulual fatal manner. If it has ever been cured by mercury, it has been in confequence of a coimter-imprejjiori communicated to the whole fyftem, and not in con¬ fequence of the falivation ; for a falivation is a con- ftant fymptom of the difeafe, fo that if it were curable by a flow of fpittle, it would cure itfelf,
’ « If arfenic or lead have ever been of fervice in hy¬ drophobia, it mull have been by producing a fimilar counter-impreflion.
‘ Confidering that the poifon of a rabid animal pro¬ duces an excejjwe increafe , or morbid alteration , of the natural fenjibility — that (as Mead has remarked) it is common to all who are bitten by a mad dog, that they can ill bear the impreffion of objefts upon the fenfes— that all feeling is painful— that the flighteft touch or rubbing of the limbs hurts — that the lead noife is offenfive ^ and the opening or fhutting of a door affrights, as if the houfe was falling —that the eyes fo ill bear the light, that even the light of any thing white is intolerable — that in like manner, the inward membranes are fo tender, that they cannot fuffer their natural fenfation — that the common cool- jnefs of frefh air is difagreeable to the lungs — that the making of water gives uneafmefs in the urinary paf- fages — and laftly, that there is a perpetual reftleffnefs
from the beginning of the attack to the end ; - con-
fidering that the poifon produces thefe effects, w q thould, a priori, have pronounced opium to be the remedy ; but experience has lhewn that it has here
no
/
298 Pearfon on Inflammatory Diathefls in Hydrophobia *
1
no curative power. It failed in Dr. Vaughan's trials ; it failed in the inftance of the French woman under the late Mr. John Hunter's care ; and it failed in the cafes lately publifhed in the Medical Records and Refearches. In fome of the firft mentioned trials, it might be objeded that it was not adminiftered in dofes fufficiently large, but this objedion will not apply to the laft mentioned cafes, in one of which (William Yates) it was given to the quantity of 180 grains in the fpace of 14 or 15 hours/
‘ From the failure of opium both in moderate and in large dofes in this difeafe, it may be prefumed that other narcotics, fuch as ftramonium, belladonna, nUx vomica, or tobacco, will have no better effed. When* ever they are given in hydrophobic cafes, it would feem advifeable to combine them with powerful aro¬ matics ; indeed it may be doubted whether the aro¬ matics, given without the narcotics, might not anfwer De(I > fo oppofite does the nature of this difeaie appear to be to that of an inflammatory afFedion.
6 Dr. liiifk has fhewn that the provoking of fome degree of inflammatory adion is necefiary to the cure of tetanus. Now, although I do not fee with him the dole analogy between this difeafe and rabies ; yet I think it probable that the exciting of fome degree of fever and inflammation may have a falutary eifeft in cafes of hydrophobia. Indeed there is no example of a perfon recovering from an animal poifon introduced into the fyftem, without more or iefs inflammatory adion. The poifon which produces the plague, is often moft fatal when it is accompanied with the leafl: degree of fever; and fwelling and inflammation of the bitten part, together with encreafed heat over the whole body, are the ufual forerunners of recovery in cafes of viper-bites.
On thefe grounds, there is a reafonable prefumption, that wine and aromatics may have a beneficial effed in rabies, provided the averfion to liquids is not fo ftrong as to render the exhibition of wine impradicable.
Perhaps
Pearfon on Inflammatory Diathefis in Hydrophobia, 297
Perhaps the nitrous acid , or other mineral acids, or vinegar (as mentioned by Dr Ferriar) might be ad- vantageoufly mixed with the wine.. The ace turn aromaticum, Ph. Ed. feems preferable to common vinegar. At the fame time, wine and vinegar may be inje&ed up the return. Thefe things are to be adminiftered on the ftrfl appearance of the fymp- toms chara&eriftic of rabies; for as the difeafe ad¬ vances, neither wine nor any other liquid can be got down the patient, in quantities fufficient to produce a powerful effect ; and there is fometimes an equal impediment to the adminiftration of clyfters. Yet even in this ftate of things, we are not without re- fource. Some of the concrete acids (fuch as the ef- iential fait of tartar, the eflential fait of lemons, or even the flores benzoes) may be given, joined with about half as much powdered capficum or other ftrong aromatic, and divided into fmall portions, to be in- veloped in thick pafte made of flour and water, and formed into fmall bolufles. Not lefs than 20 or 30 grains of the concrete acids, nor lefs than 8 or 10 grains of the capficum, fhould be given for a dofe. In adminiftering remedies againfl: a difeafe fo rapid in its progrefs, we muft exceed, and that confider- ably, the ordinary meafured
‘ As ipecacuanha, in fmall dofes, proves fo fer- viceable in fome fpafmodic diforders, it might per¬ haps be ad vantageoufly joined with the acids and aromatics above-mentioned, in hydrophobia. Four or five grains of the powdered root might be a fuffi¬ cient dofe. Some degree of naufea, and the confe- quent perfpiration, would probably be of ufe ; but it does not feem definable to provoke vomiting in the beginning of the difeafe, as that would inter¬ fere with the operation of the other medicines.
' While thefe things are adminiflered int&rnally, to¬ pical applications are not to be neglefted. Where the bite is in a part that will admit of it, a ligature, as proDofed by Dr. Percivaf fhould be applied above the cicatrized wound. This will prevent far- v, ■ % Y ther
298 Pearfon on Inflammatory Diathejis in Hydrophobia .
ther abforption. At the fame time the bitten part may be opened or deftroyed by the application of the lunar cauftic, or concentrated mineral acids. In-
. . . Aft**
$ fiammation and ulceration excited in this manner promife, from what we obferve in the inflance of
viper-bites, to be productive of the belt effefts Af¬ ter the corrofion of the cicatrized wTound, by the means juft mentioned, the ligature which had been paffed round the limb, fhouid be removed.’
c It would alfo be ufeful to excite inflammation and ulceration in other places befides the bitten part. With this intention, cauftics might be applied to the arms, and perhaps the thighs. When the ur¬ gent fymptoms abate, and medicines and food can be more eafily fwallowed, it will be no difficult matter to fupport the ftrength of the patient under the difcharge from the fores occasioned by the cau¬ ftics. In this ftage of the diforder, the Peruvian bark may be given freely ; and to allay irritation, opium occafionally in moderate dofes.*
In the pamphlet before us. Dr. Pearfon has cer¬ tainly fucceeded in proving, that the affeClion of the fyftem in Hydrophobia is not the fame as that which takes place in pleurify, or peripneumony, or the other ftates of Ample inflammation, and of courfe that a mode of treatment adapted to thefe is not ne~ ceflarily indicated in the former. It does not, how¬ ever, feem to follow, that the contrary ftate of the fyftem muft be fuppofed, and debility furnifh the in¬ dications for its treatment. Stimulants may be ufe¬ ful, and may be the moft powerful remedies we are in pofleffion of ; but whether they are fo, or not, can only be determined on trial, and not on any previous view of the nature of the difeafe which theory may fuggeft. In fa£t, ther$ are no two poi- fons which operate precifely the fame changes in the fyftem, nor are they, probably, to be combated in the. fame way. Experience is the only guide on which we can rely.
CORRESPONDENCE.
THE Editors have to acknowledge the receipt of a Letter from Mr*,1 Boag of Stockport, containing i'ome remarks on their review of Dr. Wallis’s Treatife on Gout *. Were it confident with the plan of this work, the Editors would gladly infert the whole of Mr. Boag’s Letter* but controverfy is not their object.
Mr. Boag obferves, that the theory which Dr. Wallis has employed is by no means original, but that in its eflential parts it is derived from Sydenham and the older phyficians: we cannot allow, however, that this adds greatly to its probability. Though Sydenham will ever ftand high, as an accurate obferver and good practitioner, his theories add nothing to his fame, and are now indeed nearly and defervedly for¬ gotten. It is enough to fay of the gouty acrimony, that its exiftence has never been proved. The inconfiftency of the hypothefis, as de¬ veloped and explained by Dr. Wallis, is allowed by Mr. Boag. It has in no refpeCt illuftrated or improved the practice.
In anfwer to J. S. the Editors obferve, that all analytical accounts pi new’ publications are thankfully received.
* See Med. Key. page 87, of th iprefent volume.
\
No. XXVIII.
THE
MEDICAL and CHIRURGICAL
REVIE W.
JANUARY, 1799.
Art, XXXVI. Philofophical Tran] actions of the Royal Society of London. Part L for the Year 1798. Elmsley. London,
ART. 2. Experiments and Obfervatio?is, tending to Jkezv the Compofition and Properties of Uri¬ nary Concretions. By George Pearson, M. D. F. R. S. — Dr. Pearfon obferves, that urinary concre¬ tions have obtained their denominations, like other things, from their obvious properties. Accordingly, in our language, they are popularly known by the names of Hone and gravel, or fand, from their refem- blance to the Hates of earth fo named : and we find names of the fame import in other lan gai ages, fuch as (Aretams ;) XzQiaeig, (Coelius Aurelianus ipappos, (Aretaeus ;) (various authors *) Calcuhis>
(Celfus and Pliny ;) Sahulum , (various authors.) In. other languages, and efpecially in thofe now fpoken, it is unneceffary to notice names which have the fame meaning.
The notion very generally entertained of the na¬ ture ot urinary concretions, confifted with tjie terms,
vol, v. z till
502 PhHofophical Tranf actions of the Royal Society,
till the laft twenty years ; although the experiments of Slare, Frederic Hoffman, and Hales, long before fhewed, that thefe fubftances commonly confift of animal matter. Galen indeed imagined that Cpfoy/xao or vifeid animal matter, is the bafts of animal con¬ cretions ; but in his days, earth was believed to be the bafis of animal matter. Alkaline medicines were, however, employed by the Greek phyficians, in difeafes from calculi.
c The experiments of the akhemifts alfo made it appear, that earth was only a part of the matter of concretions. It was probably the obfervation of the difpofition and cryffallization of faline bodies, which 1'uggelted the notion of urinary calculi being of the nature of tartar. Such was the opinion of Bafif Valentine, and after him of Hochener, better known by the name of Paracelfus ; but whether the latter adopted the denomination Duelech from its import, ©r from caprice, has not been explained. Van Heb mont, a century after his prototype Paracelfus, being kruck with the experiment in which he difeovered the concretion of falts in diftilled urine by alcohol, was led to depart from his adored mailer’s opinion, with refpedt to the nature of calculi; although he acknowledges the merit of Paracelfus, in. having dif¬ eovered the folvent Indus, (a calcareous done alfo called Jcptarium) which Van Helraont fays is pre¬ ferable to alkaline lixivium. He alfo fays, that when the archeus fpirit of urine meets with a volatile earthy fpirjh, and does not a£l in a due manner, a concretion will be formed ; but,, in a healthy ftate, although all urine contains the matter of urinary calculi, no con¬ cretion can take place, beeaufe the archeus, or vital power of the bladder, counteracts its formation.
* As to the kind of earth composing calculi, the only diftindtion of earths, till about the laft half cen¬ tury, was, into abforbent and non-abforbent ; but, < fip.ee the abforbent earths were diftinguifhed into calcareous, magnefia, and alumine or clay, the cab
(
. v it • 4 , * ■'V
Philofophical Tranfactions of the Royal Society, 303
careous was confidered to be the earth of urinary concretions; apparently, however, for no other rea- fon, but its obvious properties, and its extenfive dif- fufion through the whole animal kingdom.
c At length, viz. in 1776, the experiments of the wonderful Scheele were publifhed in Sweden, but were fcarcely known in this country till 1785. Thefe experiments exploded the opinion of the earthy na¬ ture of calculi, and fubftituted that of their confiding of a peculiar acid, refembling the fuccinic, and of a gelatinous matter, without any earth. Afterwards about of their weights of lime wras found by Bergman ; which, for a caufe now well known, had eluded the acutenefs of Scheele. Although the ex¬ periments of Scheele were confeffedly unqueftionable, and were ably fupported by the learned Bergman, fome very eminent chemifts having obtained different refults by their own experiments, adopted a different opinion of the compolition of thefe concretions, he immortal, and ever to be deplored, Lavoifier fup- pofed thefe fubftances to confift of acidulous phof- phate of lime and animal matter, many of them being partially fufible ; but ftill it was the unrivalled Scheele who difcovered, that the urine of healthy perfons contains fuperphofphate, or acidulous phof phate of lime ; and who alfo indicated the experiment which verified his opinion, that pholphate of lime is the bafis of bone.
f Experiments have been likewife made, for the moft part in a rather defultory way, and moft of them by perfons but little pra&iced in chemical inquiries, which at lead afford evidence, that urinary concre¬ tions are very different, with refpeti to the proportion of the ingredients in their compofition, and perhaps alfo in kind. Mr. Fourcroy, who however muff not be claffed with inexperienced chemifts, i believe firft obtained pruffic acid by fire, and by nitric acid, from thefe concretions : and (hewed that they fometimes contain phofphate of ammoniac and of foda ; which.
Z 2 may
304 Philofophical Tran/actions of the Royal Society *
may be diffolved out of them by water. Mr. Four- croy alfo fays, he found magnefia in the intedinal calculus of a, horfe ; which calculus was a triple combination of one part of phofphate of ammoniac, of two parts of magnefia, and one of wafer, befides traces of animal and vegetable matter.
; Dr. Link, in a very elaborate differtation, pub- blifhed at Gottingen, in 1788, on urine and calculi, concludes, that urinary concretions confift of phof- phoric acid, lime, ammoniac, oil, the bafis of dif¬ ferent kinds of gaffes, together with the acid fub- Innate of Scheele, although he did not fucceed in obtaining it.
4 It is a proof of Dr. Black’s fagacity, that he fliould have been able to perceive, from a few ex¬ periments, that urinary concretions confided of ani¬ mal matter and the earth of bone, before the com- petition of this earth was demondrated by Gahn.
c In this hidorical (ketch it fhould be noticed, that alkaline fubdances though ufed by the Greek phy¬ sicians, and afterwards by the alchemical phyficiaiis, appear to have been laid afide by the regular prac¬ titioners, for a century or two preceding their revival, by the famous Mrs, Stephens, in 1720. Her pre- feription brought into vogue the theory of thefe medicines operating by their caudicity. The fuccefs- ful ufe, by Mr. Colborne, of potadi faturated with carbonic acid, according to the difeovery of Bewly and Bergman, and the dill further improvement in practice, from the ufe of foda, as well as potadi fuper- fat mated with carbonic acid, by the difeovery of a peculiar method by Mr. Schweppe, have completely refuted the theory of the agency of alkalies on the principle of caudicity. ’
^ The obfervations of the learned author relate prin¬ cipally to a fubdance, which appears to be very ge¬ nerally a condituent of both urinary aad arthritic concretions. It is obtained by diffolving it out of
thefe-
Philofophical Trarif actions of the Royal Society. 305
thefe concretions by lye of cauflic fixed alkali, and precipitating it from the folution by acids. It ap¬ pears, likewife, to oe altogether a different fubflance from the dcid fublimate of Scheele, and which in the new fyflem of chemiflry, is termed lit hie acid.
It would carry us to much too great a length, were we to follow the author in the detail of his exoeri- rnents: we fliall content ourfelves, therefore, with the conclusions wThich refult from them.
1. li appears, that at leafl one halt of the matter of the urinary concretions fubjefted to the above ex¬ periments, united to cauflic foda, and was precipitat¬ ed from it by acids.
c 2. This precipitate does not indicate acidity to the inoft delicate tefts : and, as it is inodorous, tafle- leis, scarcely foluble in cold wrater, does not unite to the alkali of carbonate of potafh, of foda, or of am¬ moniac, nor to oxide of mercury, nor to the lime of lime water, nor decompofed foap, or pruffiate of iron, and, as its combination with cauflic foda refembles foap, more than any double fait known to confift of an acid and alkali, this precipitate does not belong to the genus acids. °
/ 3- As this precipitate could not be fuhlimed, without being decompounded, like animal matter^ and alfo for the reafons mentioned in the lafl para¬ graph, it cannot be the fame thing as the acid fub¬ limate of Scheele, or the fuccinic acid.
c 4- As it does not appear to be putrefcible, nor form a vifeid folution with water, it cannot be refer¬ red to the animal mucilages.
f 5. On account of its manner of burning in the air, under the blowpipe, and its yielding on expofure to fire in clofe veffels, the diftinguifhing products of animal matter, (efpecially ammoniac and pruflic acid,') as well as on account of its affording a foap-like matter with cauflic foda, this precipitate may be confidered as a fpecies of animal matter ; and, from its compofition being analogous to that of the fui>
fiances
506 Fhilof&phical Tranfactions of the Royal Society.
fiances called, in the new fyftem of chemiftry, animal oxides, it belongs to that genus. Its peculiar and fpecific diftinguifhing properties are, imputrefcihility , facility of cryftallizatwn , hi fallibility in cold water, and, that moft remarkable property of all others, producing a pink or red matter , on evaporation of its folution in nitric acid*'
Having found the precipitate above alluded to, to be an oxide, and not, as is commonly fuppofed, an acid, the author thought it probable that, like other analogous oxides, it was acidifiable. In his endea¬ vours, however, to effect this, he was not fuccefsfuh The part of the urinary concretions which remain¬ ed infoluble in the lye of cauftic foda, appeared, by experiment, to confift of phofphate of lime. Three hundred grains of calculus examined, appeared to contain as follows.
Grains.
Peculiar animal oxide, - - - - - - 175
Phofphate of lime, ------- 96
Ammoniac (and moft probably phofpboric acid united to the ammoniac,) water, and common mucilage of urine, which were not collefted, by eftimation - - - - 29
300
c If it be allowed/ Dr. Pearfon remarks, c that this urinary animal oxide is totally different from the acid fublimate of Scheele, it will be neceffary to give it an appropriate name. Agreeably to the principles of the new chemical nomenclature, the name fhould be hthic oxide. But the term lit hie, is a grofs iblecifm ; and I truft that philological critics will find the name ounc or uric oxide perfectly appro¬ priate ; for, if it be thought objeftionable, on account of the exiftence of the matter in arthritic as well as
urinary
Philofophical Tranf actions of the Royal Society . 307
urinary concretions, (till philology will allow its ad- million, as in other limilar cafes, Kar ; it being
found in greater abundance, by far, in the urinary p adages than in other fituations, and therefore fall¬ ing under common obfervation, as an ingredient of the urine. If, however, the term lithic oxide, or any other denomination, (hall obtain acceptance, I fhall very willingly adopt it.
/ It requires no fagacity, in a perfon acquainted with the tadts of the preceding experiments, to per¬ ceive that they are applicable to a variety of ufes in chemical invedigation, and in the practice of phyfic. The latter I of courfe take no notice of in this place : but, relative to the former ufes, I fhall particularly point out, that we are now able not only to deteft, in the eafied manner, the prefence of the minuted proportion of the above animal oxide in urinary con¬ cretions, and alfo in other fubftances, but even to de¬ termine its proportion to the other conftituent parts, in the fpace of a few minutes, in mod cafes, and in all in a very little time, without any other apparatus than nitric acid, a round-bottomed mattrafs, or glafs difh, and a lamp. By this method, I have, in a ge¬ neral way, examined above three hundred fpecimens of concretions, of the human fubjeft and other ani¬ mals, principally urinary ones ; and alfo many from other parts, particularly thofe from the joints/'
Out of two hundred fpecimens examined by the author, not more than fix did not contain the animal oxide above defcribed. The proportion of this oxide was very different in the different fpecimens ; varying from (exclufive of water) to .£§£ ; but, for" the mod part, varying between and The
common animal mucilage of urine is frequently found in concretions, in very different proportions ; but is perhaps never a principal condituent part of them. It appears alfo, that the animal oxide was not found in the urinary, or any other, concretions, of any ani¬ mal but the human kind : ladly, that it was alfo
2 4 found
SOB Philofophical Tranfactions of the Royal Society .
found in human arthritic calculi, but not in thofe pf the teeth, ftomach, inteftines, lungs, brain, &c.
The urinary concretion of a dog being examined, appeared to confift principally of phofphate of lime, phofphate of ammoniac, and animal matter. A like concretion from the urinary bladder of a rabbit con- lifted of carbonate of lime, with common animal matter, with, perhaps, a very final 1 proportion of phofphoric acid. A concretion, la; i to be from the ftomach pf a monkey, afforded the fame refuits — - Different fpecimens of renal calculus in the horfe, afforded carbonate of lime and common animal mat¬ ter. One fpecimen, however, was found to contain phofphate of lime, phofphate of ammoniac, and comb xnon animal matter.
The difference in the conftitution of urinary con¬ cretions may depend on the difference of the urinary- organs of different animals, on the food and drink, and on the various difeafed and healthy Hates of the urinary organs.
The author has not found the uric oxide in the urinary concretions of any phytivorous animal ; but whether it would be formed in the human animal when nourifhed merely by vegetable matter, muff be determined by future obfervations. In the mean time, it is warrantable' to conclude, from analogy, that it would not, and the application of this fadf to prac¬ tice is obvious. — We lhall be happy to fee Dr. Fear- ion profecute this interefting fubjeff, with a view to medical pradfice.
The next article which we are now to notice in the prefent volume, contains an Inquiry concerning the Source of the Heat which is excited by Fric¬ tion: by Benjamin Count Rumford, F. R. S. &c.— This fubjedt is perhaps not, in ftridtnefs, applicable to our purpofe. Yet. it is altogether fo important,
and
Philofophical Tranf actions of the Royal Society. 309
and the theory of heat has fo often been introduced in medical fpeculations, that we have no doubt of Handing excuted tor the notice here bellowed on it.
It frequently happens, Count Rmnford obferves, that in the ordinary aifairs and occupations of life, opportunities prefent themfelves of contemplating fome of the mod curious operations of nature; and yerv interefling philofophical experiments might often De made aim oft without trouble or expence, by means or machinery contrived tor the mere mechanical pur- pofes of arts and manufactures. It was by accident that the author was led to make the experiments which form the fubjeCl of the prefent paper.
Being engaged in fuperintending "the boring of cannon,, in the workfhops of the Military Arfenal at Munich, he was ftruck with the very confiderable degree of heat which a brafs gun acquires, in a lliort time, in being bored ; and with the Hill more intenfe heat (much greater than that of boiling water, as was found by experiment) of the metallic chips feparated from it by the borer. An inveftigation of thefe phe¬ nomena feemed to bid fair to give a farther inlight into the hidden nature of heat; and to enable us to form fome reafonahle conjectures refpecfing the ex¬ igence, or non-exiftence, of an igneous fluid : a fub- jeSt on which the opinions of philofophers have, in all ages, been much divided.
The particular points of inquiry, which fuggeHed themfelves to the ingenious author, were : whence comes the heat actually produced in the mechanical operation above mentioned ? — Is it furniflied by the metallic chips which are feparated by the borer from the folid mafs of metal ? that is, according to the mo¬ dern do&rines of latent heat, and of caloric, is the capacity for heat of the parts of the metal, fo re¬ duced to chips, fo changed as to account for the heat produced? — On repeated trials it was found that the capacities of the metallic chips, and of the folid block of metal, were in no refpeft different.
It
310 Philofophical Trarif actions of the Royal Society.
It was next endeavoured to afcertain the quantity of heat produced, and the rapidity of its produCtiom In thirty minutes, the 113 pounds of gun-metal was found to be heated to 130 degrees of Fahrenheit’s fcale, by means of the friCtion occafioned by the revolution of the cannon on the extremity of a blunt borer.
If the heat, or any confiderable part of it, were produced in confequence of a change in the capa¬ city for heat of a part of the metal, as fuch change could be only fuperftciaU the metal would by degrees be exhaiifled. But in fucceffive experiments, not the fmalleft fign of exhaustion appeared, notwithstanding the large quantities of heat actually given off.
The author next endeavoured to find out whether the air contributes any thing in the generation of the heat excited by friftion : and for this purpofe the ex¬ periment was made under water, where, therefore, no air could have accefs. The generation of heat was here equally great and rapid as before. In two hours and a half, the water furrounding the apparatus was actually made to boil. When the water was Inhered to have free accefs to the metallic furfaces where the heat was generated, the production of heat was as great and as rapid as before.
The author concludes his experiments with the fol¬ lowing general remarks :
4 What is heat? — Is there any fuch thing as an igneous fluid ? — Is there any thing that can with propriety be called caloric ?
c We have feen that a very confiderable quantity of heat may be excited in the friction of two me¬ tallic furfaces, and given off in a conftant ftream or flux, in all directions , without interruption or inter- miffion, and without any figns of diminution, or ex¬ hauftion.
c From whence came the heat which was con¬ tinually given off in this manner, in the foregoing 3 expert-
Philofophical Tranf actions of the Pioyal Society . 31i
experiments? — Was it furnifhed by the fmall par¬ ticles of metal, detached from the larger folid maffes, on their being rubbed together ? — This, as we have already feen, could not poffibly have been the cafe.
c Was it furnifhed by the air? — This could not have been the cafe ; for, in three of thefe experiments, the machinery being kept immerfed in water, the ac- cefs of the air of the atmofphere was completely pre¬ vented.
c Was it furnifhed by the water which furrounded the machinery ? — That this could not have been the cafe is evident ; firji , becaufe this water was conti¬ nually receiving heat from the machinery, and could not, at the fame time, be giving to , and receiving heat from , the fame body; and Jecondly , becaufe there was no chemical decompofition of any part of this water. Had any fuch decompofition taken place, (which indeed could not reafonably have been ex¬ pected,) one of its component elaftic fluids (moft pro¬ bably inflammable air) muff, at the fame time, have been fet at liberty, and, in making its efcape into the atmofphere, would have been detefted ; but though I frequently examined the water, to fee if any air bubbles rofe up through it, and had even made pre¬ parations for catching them, in order to examine them, if any fhould appear, I could perceive none ; nor was there any fign of decompofition of any kind whatfoever, or other chemical procefs, going on in the water.
‘ Is it poffible that the heat could have been fup- plied by means of the iron bar to the end of which the blunt fteel borer was fixed ? or by the fmall neck of gun-metal by which the hollow cylinder was unit¬ ed to the cannon ? — Thefe fuppofitions appear more improbable even than either of thofe before men¬ tioned : for heat was continually going off, or out of the machinery , by both thefe paffagcs, during the whole time the experiments lafled.
‘ And,
$12 PhUofophical Tranf actions of the Hoped Society .
< And, in reafoning on this fubjeft, we mu ft not forget to coniider that moil remarkable circumftance, that the fource cf the heat generated by fri&ion, in thefe experiments, appeared evidently to be inex-
hauftible. m T
« It is hardly neceffary to add, that any thing which any infulated body, or fyftem of bodies, can continue to furnifh without limitation , cannot pof- fibly be a material Jub fiance, and it appears to me to be extremely difficult, if not quite i-mpoffible,. to form any diftindf idea of any thing, capable or being excited, and communicated in the manner the heat was excited, and communicated in thefe experiments, except it be motion.
* I am very far from pretending to know how, or by what means, or mechanical contrivances, that par¬ ticular kind of motion in bodies which have been fuppofed to conftitute heat, is excited, continued, and propagated, and I (hall not prefume to trouble the Society with mere conjectures ; particularly on a fubjecl which, during fo many thoufand years, the moil enlightened philosophers have endeavoured, but in vain, to. comprehend.
6 But, although the mechanifm of heat fhould, in fact, be one of thofe myfteries of nature which are beyond the reach of human intelligence, this ought by no means to difeourage us, or even leffen our ardour, in our attempt to mveftigate the laws of its operations. How far can we advance in any of the paths which fcience has opened to us, before we find ourfelves enveloped in thofe thick mills which, on every fide, bound the horizon of the human intellect ? But how ample, and how interefting, is the field that is given us to explore 1
4 Nobody, furely, in his fober fenfes, has ever pre¬ tended to underhand the mechanifm of gravitation ; and yet what fublime difeoveries was our immortal Newton enabled to make, merely by the inveftigation of the laws of its adtion 1
1 The
Phiiofophical Tran/ actions of the Royal Society . 313
c The effefts produced in the world by the agency of heat, are probably juft as extenfive , and quite as important, as thofe which are owing to the tendency of the particles of matter towards each other ; and there is no doubt but its operations are, in all cafes.* determined by laws equally immutable/
Art. 5. Obfervations on the Foramina Thebefti of the Heart : by Mr. John Abernethy. — There is a re¬ markable contrivance, Mr. Abernethy obferves, in the blood-veffels which fupply the heart, not to be met with in any other part of the body, and which is of great ufe in the healthy functions of that organ, but which is particularly ferviceable in preventing difeafe of a part fo effential to life.
A diften.ded date of the blood-veffels muft always impede their functions, and confequently be very de¬ trimental to the health of the part which they fup¬ ply ; but, as the cavities of the heart are naturally receptacles of blood, a Angular opportunity is afford¬ ed to its nutrient veffels, to relieve themfelves when furcharged, by pouring a part of their contents into thofe cavities. Such appears to be the ufe of the foramina, by which injections, thrown into the blood- veffels of the heart, efcape into the cavities of that organ ; and which were firft noticed by Yieuffens, but, being more expreffly defcribed by Thebefius, generally bear the name of the latter author.
Anatomifts appear to have been much perplexed concerning the foramina Thebefti ; even Haller, Se- nac, and Zinn, were fometirnes unable to difcover them 5 which fuggefted an idea, that when an injec¬ tion was effufed into the cavities of the heart, the veffels were torn, and that it did not efcape through natural openings. When thefe foramina were in¬ jected, they were found under various circumftances, as to their iize and fituation ; and Haller obferved, that the injection, for the molt part, efcaped into the cavities of the heart, it alfo remains unde¬ termined.
right
SI 4 Philofopkicat TrafiJ actions of the Royal Society ,
termined, whether thefe foramina belong to the arte¬ ries and veins, or re fp entirely to each fet of veffels.
, It is from an examination of thefe openings in dif- eafed fubjef/ts, the author obferves, that a folution of fuch difficulties may probably be obtained. Who¬ ever reflects on the circumftances under which the principal coronary vein terminates in the right auricle ot the heart, will perceive that an impediment to the flow of blood through that veffiel mult occafionally take place ; but the difficulty will be much increafech when the right fide of the heart is more than ordi¬ narily diftended, in confequence of obftruflion to the pulmonary circulation. Indeed it Teems probable, that fuch an obftruflion, by occafioning a difiend- ed Hate of the right fide of the heart, and thus im¬ peding the circulation in the nutrient veffels of that organ, would as neceffarily occafion correfponding dileafe in it, as an obftruflion to the circulation in the liver, occalions difeafes in the other abdominal vifcera, were it not for fome preventing circumftances.
Having been attentive to fome very bad cafes of pulmonary confumption, from a defire to witnefs th® effefls of breathing medicated air in that complaint, the author was led to a more particular examination of the heart of thofe patients who died. In thefe cafes he found, 'that by throwing common coarfe waxen injection into the arteries and veins of the heart, it readily flowed into the cavities of that organ; and that the left ventricle was in je fled in the firff place, and moll completely. When the ventricle was opened, and the eflufed injection removed, the foramina Thebelii appeared both numerous and large, and diftended with the different coloured wax which had been impelled into the coronary arteries and veins. Upon eight comparative trials, made by in- je fling the veffels of hearts taken from fubjefls whofe lungs were either much difeafed, or in a perfeftly found flat e, it was found, that in the former, com¬ mon injection' readily flowed, in the manner which v has
I
Pkilofop final Fran factions of the Royal Society, 315
has been defcribed, into all the cavities of the 'heart; but principally into the left ventricle - whilft, in many of the latter, he could not impel the leaft quantity of fuch coarfe injection into that cavity.
I n is difference in the facility with which the ca- \ities of the neart can be injected from its nutrient veLels, was obferved by moft an a to mills- though thev did not advert to^ the circumllances on which it de¬ pended. Haller’s teftimony on this head is here adduced.
As it feems right, Mr. Abernethy obferves, that the blood which had been diilributed by the coro¬ nary arteries, and which mull have loll, in a Greater or lefs degree, the properties of arterial blood, fliould npj- niixed with the arterial blood which is to be diilributed to every part of the body, but ought rather to be font again to the- lungs, in order that it may re-acquire thofe properties ; we therefore per¬ ceive why, in a natural Hate of the heart, the prin¬ cipal foramina Fhebelii are to be found in the right cavity of that organ. However, as even in a ftate’of health, thofe cavities are liable to be uncommonly amended, in confequence of mufcular exertion fome- fomes forcing the venous blood into the heart falter than it can be tranfmitted through the lungs, there feems to arife a neceffity for fimilar openings on the left fide; but thefe, in their natural Hate, though capable of emitting blood, and of relieving the ple¬ thora of the coronary veffels, are not of fufficient ffze to give paffage to common waxen injections. Yet, when there is a diftended Hate of the right cavities of the heart, which is almoH certainly nccafioned bv a- difeafed Hate of the lungs, thefe foramina leading into the left cavities then become enlarged, in the manner that has been already defcribed ; and thus :he plethoric Hate of the nutrient veffels of the heart,
ind the confequent difeafe of that important organ are prevented. . o *
Ihe preceding remarks Efficiently explain, in the tuth or s opinion, the caufe of the variety in the Hze
i * and
SI 6 Philofophical Tran/ actions of the Royal Society .
and fituation of thefe foramina, which alfo appear to belong both to the arteries and veins ; becaufe, the injeChon which was employed was too coarfe to pafs from one fet of veffels to the other, and yet the dif¬ ferent coloured injeftions patfed into the cavities of the heart un mixed.
There is yet another mode, Mr. Abernethy ob- ferves, by which difeafes of the heart, that would otherwife fo inevitably fucceed to obftruCiion in the pulmonary veffels, are avoided. Having formerly been much furprized to find the heart fo little af¬ fected, when the lungs were greatly difeafed, and obferving in one or two inftances, that the foramen ovale was open, he was led to pay more attention to the (late of that part ; and he has found this to be a! moil a conftant occurrence in thofe fubjeCt's where pulmonary confumption had for feme time exifted previous to the perfon’s difeafe. It was obfervecj thirteen times in the courfe of one year : and, in feveral inftances, the aperture was fufficiently large to allow of a finger being paffed through it. As the feptum auricularum is almoft conftantly perfect in fubje&s whofe lungs are healthy, the author concludes that the renewal of the foramen ovale is the effeCl of difeafe : nor will the opinion appear, on reflection, improbable.; for the opening becomes clofed by the membranous fold growing from one edge of it, till it overlaps the other, and their fmooth furfaces being kept in clofe contaCi,, by the preffure of the blood in the left auricle, they gradually grow together. But fhould there be a -deficiency of blood in the left auricle, and a redundance in the right, the preffure of the latter on this membranous partition, will fo ftretch and irritate the uniting medium, as to occafion its removal ; and thus a renewal of the communication between the auricles will again take place.
From thefe obfervations it is natural to fuppofe, that in thofe men, or animals, who are accuftomed to remain long under water, this opening will either
be
4
Philofophical Tmnf actions of the Royal Society . SIT
be maintained or renewed ; yet on this circumftance alone the continuance of their life does not depend ; for, we now have fufficient proof* that if the b^ood is not oxygenated in the lungs* it is unlit to /Support the animal powers. There is an experiment lelated by Buffon, Mr. Abernethy obferves, which has not been publicly controverted, * and which tends greatly to milreprefent this fubject. He fays, that he caufed a bitch to bring forth her puppies under warm water * that he fuddenly removed them into a pail of warm milk; that he kept them immerfed in milk for more than half an hour ; and that when they were taken out of it all the three were alive. He then allowed them to .refpire about half an hour, and again immerfed them in the warm milk* where they remained ano¬ ther half hour ; and, when taken out, two were vigorous, but the third feemed to languifh : this fubmerfion was again repeated, without apparent injury to the animals.
This experiment is fo directly contrary, Mr. Aber¬ nethy obferves, to what we are led to believe from all others, and alfo to the information derived from cafes which frequently occur in the practice of midwifery, (in which, an interruption to the circulation through the umbilical chord occalions the death of the fetus) ^as to make us fufpecft its truth : he was therefore in¬ duced to examine what would happen in a fimilar experiment. He did not indeed caufe the bitch to bring forth her puppies in water * but immerfed a puppy, ftiortly after its birth, under water which was of the animal temperature. It loft all power of flip- porting itfelf in about fixty feconds, and would fhorfc- ly have perifhed, had it not been removed into the air. Neither could he, by repeating this experiment, fo accuftom the animal to the circulation of unoxy-
* The fact related by Buffon was called in queftion by Mr. John Bell, in the fecond volume of his Anatomy of the Human Body. See Med. Rev. vol, 4, page 381.
yob. v. A a
seriated
o
SIB Cullen's Clinical Lectures .
genated bicod, as to lengthen the term of its exig¬ ence in fuch an unnatural fituation.
Ypung animals, indeed, retain their irritability for a con/iderable time, fo that they move long after they have been plunged beneath water; and may even, on this account, recover after they are taken out But the manner in which BufFon has related his experiment, feems to imply, that the circulation of the blood and other functions of life, were continued after the animals had been excluded from the air; but the author is convinced, that the doe* which was the fubject of his experiment, would have been be¬ yond recovery in a few minutes.
Thofe animals which are accuftomed to remain long under water, probably firft fill their lungs with air, which may, in a partial manner, oxygenate their blood during their fubinerfion. The true fiatement of this fubjeft may probably be, that the circulation of venous blood will deftroy moll animals in a very fnort ipace ot time ; but that cut tom may enable others to endure it, with very little change, for a longer period.
Art. XXXVII. Clinical Lectures delivered in the Years 1765 and 1766. By William Cullen, ■ • Y ' late P rofeffbr of the Practice of Phvjic in
the Uniyerjjty of Edinburgh, &c. Me. Taken in ‘ Short-nand by a Gentleman who attended. Oc¬ tavo, 338 pages, price 6s. Lee and Hurst. London. 17.97.
I jl is tiuly obferved by the isditor oi the pages be¬ fore us, that the pofthumous works of the late celebrated i lofcftor Cullen need no encomium j but L any part deferves more attention than the reft, it is thofe Clinical Leftures he read to his pupils, as il- luftrations of his own practice ; compofed while his
m ind.
Cullen’s Clinical Lectures .
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mind, matured by experience, retained all its native vigour, and delivered where his doctrines were to be confirmed or confuted by actual cafes, they muff be invaluable. The correffnefs of this publication, it is obferved, does not reft upon detached feraps, whole defeats are fupplied from memory, being printed from the manuscript of an eminent pbyftcian, who attended thefe leftures, and took them down in fhort-hand.
The fubjefts treated of in the prefent lectures are. Nervous Diforders, and the Nervous Syftem, Tenfton and Laxity, Sympathy, Hyfteria*, Hypochondriafis, Falfy, Head-ach, Hydrophobia, the Acceleration of the Puife, Rheumatifm, Eledricity as applicable to the practice of medicine, Jaundice, Scrophula, Dy- fentery, the Venereal Difeafe, and Intermittent Fe¬ vers.
On each of thefe topics many excellent remarks will be found. It is greatly to be wiftied that a complete copy of the lectures given by this celebrat¬ ed practitioner could be compiled from the notes of his different hearers. An acquifttion of this kind would be invaluable. We (hail prefent our readers with fuch parts of the prefent volume, not as are moft important, for they are all fo in a high degree, but fuch as have been leaft noticed in the courfe of our work, and which do not enter into the plan of the author’s Firjl Lines.
Of Sympathy. c We have now fpoken in a brief manner upon the tenfton and laxity of the animal fyftem, and endeavoured to explain it by confidering the tenfton of the mufcular and fanguiferous fyftems. We have conftdered a particular part of the body, which is upon a different footing from the reft, the alimentary canal. We have fhewn that the great varieties it undergoes in point of tenfton, are owing to its unequal diftenftons, from the want of conftant counterpoife ; in confequence of which, it is more irritable, and depends more on the tonic power, than
A a 2 media-
S20
Cullen’s Clinical Lectures .
mechanical tenfion.' Still, however, that it has a connexion with the tenfion of the whole fyftem, we made apparent, from the e fife 61s of flatulency in the primce vice, and the method taken to difperfe it. This connexion, we obferved, was called fympathy. As long as we have no idea on wdiat this conneftion depends, the term may be ufed ; but if we can find out its foundation, and the means of 'communication, (which ought to be attempted), it will be no longer proper. Thus it would be abfurd to talk of a fym¬ pathy between the pendulum of a clock, and a finger that points the time ; becaufe here we underhand the means of communication between them. In the fame manner here, if a fentient principle is interpofed, if the motions follow not indeed by a mechanical power, as in a clock, but by a phyiical neceffity, all occafion for fuppofing occult qualities, and conlequently ufmg this term, immediately ceafes. A general fympathy is now univerfally difclaimed : as to particular fym- pathies, there is ftill fome doubt. With regard to this, the very idea of fympathy fuppofes two corref- ponding parts. If in confequence of an imprefifion being made on any one part, and conveyed from it to the fenforium commune , a motion is excited in the moving powers, this motion muff either be general, or determined to fome particular part.
c In the fir It cafe, no one thinks at all of a fym¬ pathy, as has beep juft faid ; but when a motion is. excited by it in any particular part, this is commonly called fympathy : but many of thefe feemingly parti¬ cular fympathies, are in reality general ones, and con- fequently not to be looked upon at all as fympathies. Dr. Whytt has, in his laft treatife, deftroyed the very foundation of particular fympathies, by fhewing that they are not owing to any communication of parti¬ cular nerves with one another, but that they come through the intervention of the fenforium commune. This defiroys the notion of particular fympathies, and confequently of fympathies in general.
If
Cullen’s Clinical Lectures. 321
c If a blufh is excited at the fight of any thing in¬ decent, this is called a fympathy between the eye and the cheek: but the idea, of which this blufh is the effedf, might be received by the ear, the touch, &c. So that the blufh on the cheek is not owing to any particular confent between the eyes and it, and confequently is not a particular fympathy. In the fame manner, fear excites forne effects, which are not produced by any particular fympathy between thofe parts which receive the impreffion, and thofe that are irritated. The motion of particular parts, in confequence of thefe impreffions, depends only on the intervention of the fenforium commune , and the par¬ ticular irritability of thofe parts. Thus, a perfon, on looking from a precipice, had always a contraction of the ere matter mufcles produced. This could not be owing to any confent between the eye and the cremaiters, but to the irritability of thefe mufcles, and might have been produced by the fame idea ex¬ cited any other way. In this view fhoujd the fym¬ pathy between the ftomach and other parts of the fyftem be conftdered. It is not owing to any com¬ munication between the nerves of thefe parts, but to this circumftance.
4 Any affedtion of the ftomach will aftfedi the fen - forium commune ; and this has a power of exciting a motion in thofe parts, not in confequence of any con¬ fent of the ftomach with them, but of fome particular irritability which they poftefs. This propofition is convertible from thofe other parts of the fyftem to the ftomach. We may now apply this general prin¬ ciple to the feveral confents obferved between the ftomach and other parts : and firft of all, between it and the head. This is not any particular confent, but fuch as fubfifts between the fenforium commune , and every fentient part. What effect the ftate ot the tenfton of the ftomach has on the ftate of the mind, appears from hence ; that when it is in due tenfton, the mind is poffeffed of vivacity, courage, clearnefs,
A a 3 and
522" Cullen’s C Tmical Lectured
ancl confiftency of thought : when it is otherwife, the Hate of the mind is quite the reverfe. This might moil probably be beft explained from the tendon of the parts ; but leaving this, we fhall obferve that the particular confent between the ftomach and head is owing to this circumftance. When the fenforium is afffedted by this or any other organ, the effedts are firft felt in the parts neared: to the fenforium, as in the eyes and ears. No wonder, then, that a vertigo, affedtion of the eyes, & c. are gradual precedes to a complete animi deliquium. In the fame manner, if an impreffion on the ftomach has a tendency to pro¬ duce convulfions, it will probably firlt appear in the mufcles of the eyes and vifage. To illuftrate this by an example, if a nerve is pricked, it will fometimes produce a tetanus ; or if in a lefs degree, a locked jaw, this part being near to the fenforium commune . This cannot be owing to any confent between the pricked nerve and the nerve of the jaw, becaufe it has the fame effedt whatever nerve is pricked. This may be owing too, in fome meafure, to the number of the levator mufcles there in proportion to the de- preffors; and. in other parts too, the flexor mufcles are more apt to be aftedted by it. On the whole, then, this is not to be looked upon as a particular confent between the head and ftomach 5 but it is to be attributed to the ftomach having a great effedt upon the fenforium commune , and the parts of the head, as being neareft to the fenforium commune , being moil likely to be affedled by it.
c Another remarkable confent is obferved between the ftomach and furface of the body. This is perhaps owing to the furface of the body being the iargeft organ of fenfe, having the greateft number of nerves, and thefe too now ftripped of their covering mem¬ branes, which muft make it extremely fenftble. It is therefore very likely to be affedled on any affedtion of the fenforium commune. If then the ftomach af¬ fects the fenforium commune (as it was fhewn above
to
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to do In a threat decree) this wftl affedt the furface of the body, and vice ver/d : lo that here too there is no particular confent between the parts, but it is to be referred to the great fenftbihty of each. — Another reafon why the furface ot the body is more liable to be aftedted is, that it has a great number of blood* veffels , and thefe are liable to be varied by any change in the fyftem, as being far! hell from the heart. But any variation in the ftate of the veffels will alfo affect the nerves, which run over them ; and thefe a min being aftedted, will in like manner affedt the circulation*. A third reafon is, that this is a part in oft fubjedt to the vicifti tudes of heat and cold, which will affedt both the nervous and fanguiferous fyftems. It muft therefore have a great effedt on the fenforium commune, and, through it, on every fen- fible part, and particularly the ftomach ; for every confiderable change of the blood is particularly de¬ termined, either to the furface of the body or the vifcera ; and thefe will mutually affedt each other.
‘ It is of great confequence to (hew how thefe are mutually affedted by each other. Some of thefe phe¬ nomena may perhaps occur again, in fpeaking on the circulation ; but either in that place or this, it avails little to refer them to fympathy. It is worth while to obferve in Sandtorius’s Aphorifms, how greatly the ftate of the mind, and all the internal functions, depend on the furface of the body. Ano¬ ther remarkable confent of the ftomach is with the extremities, not confidered Amply as a furface ; but as the parts moft remote from the heart and the fen¬ forium commune. It is eafy to ftiew how parts may be affedted in confequence of this diftance ; but our time doth not allow us. It particularly appears in the gout. Whether there is any peculiar morbid matter in this diforder, is not eafy to determine : but it is evident that many of the phenomena attending it muft be referred to the confent between the ftomach and extremities, in confequence of their
A a 4 mutual
324 Cullen’s Clinical Lectures.
mutual degree of tenfion, and not to any tranflation of morbid matter, On this principle if will be eafy to explain, how a dram may drive the gout from the ftomach to the extremities. Thefe are the confents of the ftomach with the other parts of the fyftem, which more particularly belong to our purpofe. The alimentary canal itfelf was find mentioned with a view to nervous diiorders , but there are other parts liable to be affedted, which communicate their own hate of tenfion to receive it from other parts of the fyftem. Such are the- lungs and heart : the lungs are liable to inequalities in diftending powers, though not fo much as the ftomach ; and the heart, too, though one or the moft adtive parts of the body, has a diftending power, liable to fome irregularity ; confequently they are both liable to various degrees of tenfion, which may produce various effedts on thcmfelves, and upon other parts. Thus a cafe is mentioned by Dr. XX hytt, in his Treatife, page 21 6, of a nervous pa¬ tient, who had a cough, in confequence of changing her pofture, or of a change of heat or cold : this can only be explained from the ftate of tenfion in the lungs being affedted by that in fome other part. The eftecls of a change of pofture, in particular, can be explained only from this variety of tenfion, and not from any circumftance in the fanguiferous fyftem. The ftomach, then, and alimentary canal, the heart, lungs, and mufcular fyftem are, with the fenlorium commune, moft liable to fpafmodic affedtions, and in thefe parts do they generally appear. But there are fome other paris, alfo, which have a great variety of tenfion, and by that means may affedt thefe. Such are the feminal veffels in men. This may be faid to depend on a particular irritable matter produced there • but its nature will perhaps he better ex¬ plained, from the different degrees of tenfion in them. This opinion will be better fupported by ana¬ logy, if we confider fome of the particular effedts of this affedtion, with regard to the ftate of the mind.
Cullen’s Clinical Lectures .
32 5
and the fenfation of pleafure it excites. The genitals of women have alfo a conflderable influence this way : thefe are varioufly affedted by a feries of conditions they pafs through, as conception, geltation, bringing forth, &c. But thefe affections can fcarcely be ac¬ counted for from any irritable matter, but rather from the variety of tendons they are fubjedt to. Hence there is a great difference in this refpedt between men and women. In men, venery is chiefly to be confidered ; but in the female organs, fomething very different is neceffary to produce thefe changes. Thus women who indulge themfelves mo ft in venery, if they are barren, are not liable to the fame diforders with thofe that bear children : the uterus has alfo a great effect this way, as being fubjedt to periodical hemorrhages, and thereby liable to a variety of ten¬ dons, fo as to influence the fyftem very much every month. Some men too have periodical difcharges, and thefe are liable to the fame affediions as women with their menfes.
‘ Upon the wffiole, it appears, on a general view, that many of thefe affediions may be explained from -a general tenfion, every one part ferving as a balance in this refpedt to another.’
The only other fubjedt we fhall extradt from this valuable colledtion, is that of Head-ach ; a fubjedt of great importance, both from its occaflonal feverity and the frequency of its occurrence. It is one, at the fame time, that has feldom been fatisfadlorily treated of by authors.
‘ We fhail next fpeak of Ann Hood, labouring under a violent head-ach. This is one of the molt frequent fymptoms in pathology, and is of very dif¬ ferent natures. It may be diftinguiihed as being either idiopathic or fympathic, that is, a diforder or a fymptom. When it is to be looked upon as the one, and wffien the other, is uncertain. We fhail at prefent fpeak of it only as idiopathic. This is a very
difficult
326
Cullen's Clinical Lee lares.
difficult fubjeft, owing to the frequency of the dif¬ order, and the various circumftances and different forms it appears in. Boerhaave has not given it a place in his fyftem, nor mentioned it in his treatife de nervorum mortis.
i In the firft place, we muff enquire what cafes of the head-ach are properly idiopathic. Galen, Are- tarns, and the followers of the ancients, and among the moderns, particularly Stahl and his difciples, have diftinguifbed thefe into four kinds, the cepha¬ lalgia, cephahva , clavus , and hemicrania . But they have not made any ffieady diftindlion : fometimes dif- tiriguifhing them merely by the degrees of violence or duration, oftentimes by the place they occupy, and often by the modification of the pain. But thefe we fhall find to be no proper diftinctions. We could in¬ deed expeft them to be confidered in this light, only iince phylicians began to examine more accurately the various genera and fpecies of diforders, as has been done particularly by Sauvages. He excludes one of the genera eftablifhed by Galen, the clavUs, and conftitutes only the other three. The great fault of his works is, that he conftaritly enumerates fymp- toms as fpecies ; and no where perhaps more impro¬ perly than in this diforder, of which he has made no lefs than thirty different fpecies. Of thefe we muff
a y X
rejeft all tliofe that depend on feme primary diforder, as the cephalalgia in fl animator ia, whether it be an inflammation of the brain itfelf, or of its membranes. On the fame footing we reject all thofe depending on a fever, whether continual or intermittent, as the ce¬ phalalgia febrilis and inlermittens , ccphahea febri- cq/d, and hemicrania lunatica. But we muft ob- ferve here, that every exactly periodical head-ach is not to be referred to the cephalalgia intermittens, and doth not always depend on the fame caufe. It is therefore doubtful whether Sauvages is right, in af- figning the hemicrania lunatica to the general inter¬ mittent fevers.
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c We like wife reject all thole arifing from a topical inflammation of the contiguous parts, as the cephalal¬ gia catarrhalis, the hemicrania , odontalgica, Jinus , cory zee , purulent a , and a 6 infeeds . It is much that he did not add, the otalgia to all thefe, as being of the fame nature. Of this other fpecies, the cephahta polonica or head-ach depending on the plica polonica being improperly cut, is not to be admitted as he ex¬ plains it. We reject alfo all thofe which depend on caufes not more peculiarly affecting the head than any other part : this is the cafe in the cephakea fy~ phi Utica, which is no more a difeafe, than an affec¬ tion of the fkin from the fame caufe is ; as alfo in the cephalzea ah acrimonid , proceeding from the feurvy. Neither of thefe give any particular difeafe, much lefs an idiopathic primary one.
c Under the cephalalgia inflammatoria , Sauvages obferves, that this is of the fame nature with thofe arifing ab ictu , mdnere , or any other external injury. He has not made any diftinCt fpecies of thofe ; but if he had, we muff: have rejected them ; perhaps, how¬ ever, thefe may occafion fuch a ftate of the brain as may produce proper idiopathic head-achs. We have now rejected about one half of the fpecies he eftab- lifhes, but muft ftill proceed to rejeCt others, as the cephalalgia pulfatilis , depending on a flight variation in fymptoms only, and anemotropka , on a flight varia¬ tion in the caufe.
c It is not eafy to determine, how far we may eftablifh fpecies from external or remote caufes ; but if we admit this fpecies from a change of wind, we muft alfo admit feveral others, as from the heat of the fun, & c. Laftly, the cephaleca forafa is to be reject¬ ed, as being founded on internal, and not very evi¬ dent caufes. In the next place we muft obferve, that it is yery doubtful how tar forne of his fpecies are to be looked upon as diftinct from each other: thus the cephalalgia plethorica , catamenialis , hccmor - rhoidalis , feem to be all the fame fpecies ; and, per¬ haps.
3
S2S Cullen's Clinical Lectures.
haps, the cephalalgia gravidarum too is to be refers red to the plethcrica . The hemicrania Jucmorrhoi- dalis and cephalalgia hcemorrhoidalis are certainly one fpecies only.
c It may be difputed too, whether the hemicrania claims is a diftinct fpecies. Again, there is the fame doubt with reipetf to another clafs, as the cephalalgia hijft erica, cephahea arthritic a, hemicrania nephralgica , &c. Whether thefe and the others are diftinct fpe¬ cies, or whether they are all the fame fpecies, we ihall confider hereafter.
£ At prefent we fliall fuppofe a fpecies properly idiopathic, and one that feems moft general, and give its hiflory, or at lead its general date. We ihall be liable here to the fame inaccuracy which moft phyficians are guilty of in defending genera rather than fpecies ; and it is very difficult to avoid this.
c We ihall begin with obferving, the particular temperament it is apt to affeft : this is the fanguine, or rather the fanguineo-melancholic temperament.— This may be diftinguilhed by the following marks; as black hair; a more lean and firm habit; a ruddy, but withal a brown complexion, with large veins, and abftrafting from the ruddinefs of the cheeks ; with a {kin pale, but frnooth and foft. This is diftinft both bom the fanguineous and melancholic tempe¬ rament. The diforder frequently attacks the purely fanguineous, and no lefs frequently the purely me¬ lancholic temperament; it affetls young perfons more than old, but oftener about the acme than any other time of life.
c It often continues a long time after, but feldom arifes in elderly perfons : it is more frequent in. women than men, in the proportion, perhaps, of ten to one. As to the time of its attack, it is a diforder of all feafons ; if it is more general in any one feafon than the other, it is in the fpring. Such are the preaif- pofing caufes of this diforder. As to its oceafional caufes; it arifes in many perfons without any oh-
' . fervable
Cullen’s Clinical Lectures .
329
fervable ones ; and where it is exactly periodical, we can fcarcely fuppofe any occafional caufe conftantly recurring ; though, in the hemicrania lunatic a , the ilate of the moon feems to be fuch a caufe. There, are, perhaps, few diforders which aft by paroxyfms, that do not depend on occafional caufes ; and though the patient may not obferve thefe, they may be found out by diligent inquiry. To find thefe out, is one of the mo ft important things in prafiice ; and they really exift always, though fometimes very difficult to be difcovered. This is very obfervable in the head- ach, where the flighted changes in diet, exereife, temperature of the air, &c. are fufficient to bring on the diforder. We can mark a great number of thefe occafional caufes ; but it is difficult to enumerate them, and frill more to arrange them in proper order. The firfl: we (hall mention is the plethora This is a frequent caufe, and fhould, indeed, have been marked as a predifpofing caufe, as it was in fact, when it was obferved that the diforder frequent¬ ly prevailed in a fanguine habit.
We mention it here, becaufe whatever increafes it, may be an occafional caufe of the head-ach ; fuch ; as the fulnefs of diet, an obftruftion in any evacua¬ tion, either natural, as menftruation, &c. or fpon- ! taneousj as haemorrhages at the nofe, &c. Thus the \ head-ach generally prevails at the beginning of meii- :ftruation. To this article of increafed fulnefs in the i body, we may add coflivenefs, which often accom- ! panies this diforder, and when extended to a great ( degree may produce it.
c Perhaps we may join here, cold applied to the extremities, whereby perfpiration being obflrufted, will excite fulnefs in the veffels, and particularly in thofe of the head. Again, there are other caufes which aft in producing a temporary turgefcence and .rarefaftion, fuch as being kept in any great degree of heat, and particularly, being expofed to a hot fun, &c. or a change of weather from cold to hot, from
s heavy
330
Cullen’s Clinical Lectures .
heavy to light, and dry to mold ; alfo whatever dn- creates the impetus of the blood, and quickens the circulation, will have the fame effect as a diltenfion of the veffels, and may be an occafional caufe, Such is violent exercife, and fome of the paffions, particu¬ larly anger. Thofe exercifes too may be occafional caufes, which do not excite an impetus of the blood over the whole fyftem, but flop the reflux of the blood from the head, by preventing its free paffage through the lungs, and thereby cauling a regurgita¬ tion ; as much and loud fpeaking, violent laughter, coughing, vomiting, &c. On the fame caufe, per¬ haps, but with a greater degree of obftru£lion, de¬ pends the head-ach, which commonly proceeds from fits of the fpafmodic afthma.
c To thefe we may add another fet of occafional caufes, quite different from the former, and, per¬ haps, direftly opposite. Of this kind are fudden fear, fudden grief, and particularly any fubjeft of anxiety. To thefe we may add excels of ftudy, not only fuch as is keen and intenfe, but that which is long protraQed and accompanied with watchings. This laft is a frequent caufe ; and yet not lefs fre¬ quently the head-ach is occafioned by too much lleep, and, in fome people, even by the ordinary deep : fleeping at unufual hours, as in the afternoon, is very apt to bring it on ; an abftemious way of life is another caufe ; and we have known feveral in- fiances of perfons cured of the head-ach by ufing a fuller diet : it may alfo be occafioned by evacuations, if too large and too long continued.
' c We mentioned above, that the head-ach fre¬ quently proceeded from obftru£lions of fome ufual evacuations ; yet it arifes no lefs frequently from too copious evacuations, and none are more fubje£t to it than women with too copious a menftrual flux, or men with an hemorrhoidal flux : in this cafe it at¬ tacks women at the going off of menftr nation, as in the other it did in the beginning. In fliort, there
are
Cullen’s Clinical Lectures.
831
are inftances of its being occafioned by every thing that weakens the body. One of the mod frequent caufes is the application of cold, particularly to the head, and this is relieved by warmth : to this we muft add, riding in the wind 3 but whether this is merely from the fame caufe is uncertain. Again, various odours, whether fragrant or foetid, will forn.e times produce the head-ach 3 wine too will have this ef¬ fect, either when taken in fuch a quantity only as to heat the body, or after intoxication ; opium will, in fome perfons, produce fimilar effects, and probably other narcotics, and among thefe the metallic. This is more evident in arfenic and mercury than any other. All ftrong impreffions on any of the fenfes, as violent noifes, ftrong light and odours, may alfo be occalional caufes. There are fome other clrcum- ftances more difficult to be explained. Thus, what¬ ever produces vertigo, as looking upon a ftream of water, or from a great height, will often oecafion the head-ach. Whether thefe oecafion flight temporary head-achs only, or the proper idiopathic ones, is not certain 3 but we fhould imagine, that the laft is the cafe. We are next to (peak of the proper form, in the feries and combination of its fymptoms. This is commonly called the hiftory of the difeafe, though that comprehends the predifpofing caufes, as alfo the occalional and the remote, the fymptoms and effects of them. The head-ach fometimes feizes fuddenly and with great violence, but more commonly comes on in a more gradual manner. In this laft cafe, it often begins with a fenfe of weight, as if there was a leaden cap on the patient’s head 3 oftentimes with a fenfe of turgefcence and fullnefs 3 often too with a ftiffnefs and conftriction about the head 3 frequently there is a fenfe of cold about the head, or perhaps, an affection of the ikin and hairs, which become more or lefs briftly. The diforder beginning gene¬ rally with one or other of thefe fymptoms, changes to a more formal and fixed pain : this, again, is°of
various
532 Cullen's Clinical Lectures *
various kinds ; frequently a kind of forenefs is felt over the fkin of the head, fuch as is ufual after any great fatigue, and what is called, by feme authors, la [Jit u dp ulcer of a ; fometimes there is a fenfe of bli¬ nds, as if fomething was conftringing the head, or violently diftending it. Thefe two are often con¬ founded together, as they fomewhat imitate each other. Oftentimes there is a more piercing pain or tenebrus, as if a nail was thru ft into fome parti¬ cular part. All thefe are attended with a ftrong pub fation in the temporal arteries, and in the other parts, and which is even perceptible by the eye. Thefe different feelings of pain are again diftinguifhed as they are more diffufed or definite ; generally they are limited fo as to affeft one fide more than the other; they are often fituated over one eyelid, as alfo upon the fummit of the head, but more towards its ante- terior part ; frequently they are confined to die tem¬ ples, or perhaps to the temporal mufcles ; wherever they fix, they are more gentle at firft, but gradually become very violent. This is commonly attended with a fenfe of heat; often the face becomes turgid and ruddy, but not with an uniform rednels, but difcoloured with red fpots ; fometimes, however, it is without any of this turgefcence, rednefs, or bloat- ednefs, and the whole countenance is pale and cold. When thefe pains are very fevere, and continue for a long time, the eyelids fall, tears flow involuntarily, the eye is fuffufed, and the albuginea more or lefs in¬ flamed, and vifion becomes obfeure, or is entirely deftroyed. Commonly, there is more or lefs ver¬ tigo added to thefe fymptoms. The ears are alfo affefted, as they have a fenfation of various noifes, as of ftorms of wind, ruffling of waters, tinnitus, & c.
‘ Oftentimes too the fmell and tafte are affefted, and almoft deftroyed. But wre muft obferve, that, inftead of thefe fymptonts, there is frequently an in- creafe of fenfibility, fo that the fmalleft light, or gent- left noife, difturbs them. The internal fenfes are alfo
affedled.
Cullen’s Clinical Lectures . 333
affefted, the memory is impaired, the imagination incoherent, and, from a want of attention, the judg¬ ment is difturbed. Sometimes it produces a deliquium animi, though not very frequently. It often is at¬ tended with bilious vomitings, and commonly with a coftive belly, and palenefs of urine. After all thefe have continued for fome time, a ftupor and Deep come on, which terminate the fit*
4 AS to the ftate of the pulfe, oftentimes, even in violent and long-continued head-achs, it is not fen- fibly altered from its ordinary ftate. In other cafes' it is altered, and very varioufly, becoming not uncom¬ monly lefs frequent than before. In other cafes it is not changed in its frequency, but becomes fuller dur¬ ing the paroxyfm, efpecially in the parts affected, whence arifes the throbbing and perceptible pulfa- tion, accompanying this diforder. But fometimes this fulnefs is alfo accompanied with an increafe of fre¬ quency.
4 We mentioned the different ftates of the tempe¬ rature of the parts ; and the connexion between this and the ftate of the pulfe is very difcernible. Thus, where there is a fenfe of cold with a pale fkin, the pulfe is either lefs frequent, or, at leaft, is not in- creafed in that reipeft. Where there is a heat in the part, frequently accompanied with fwelling, and with more or lefs rednefs, the pulfe is more full and frequent. We have now fpoken of the form of the difeafe, and fhal.l only add a few general remarks upon this form. The paroxyfms vary in the degrees or violence, duration, and period. They come on at different times of the day; as, in fome, in waking in the morning ; in others, at noon, or foon after meals ; frequently in the evening ; and in fome perfons, after going to bed, and towards midnight. They differ alfo greatly in their duration, continuing for fome hours, fometimes for days. They have alrnoft always a remiffion, and return at a certain interval, which in
vol. v. Bb fome
Cullen’s Clinical Lecturer
feme are exaft, in others very irregular. Of the exatF intervals there is alfo a great variety, fome returning daily, others in a tertian form-, fome monthly 5 others- again, annually.
‘ The consequences of thefe head-achs, are fre¬ quently one or other of the various diforders of the head, as oblivion, fatuity, and mania. Oftentimes they end in the epiiepfy, .palfy, or apoplexy: fome- iirnes they fall upon the exterior parts of the head, affefting the lenfes and their peculiar organs, as the eyes, with more or lefs fuffudori, and often with an amaurojis or guild ferena ; and alfo the ears, impair¬ ing or de droving the fenfe of hearing. A common effeCt, where the pain is htuated over one eyebrow, is to leave that eyelid paralytic. Frequently the temporal mufeles are affeCted with a palfy or atro¬ phy. Such are the chief effects of an idiopathic head-ach. v ,
* The date of the body under this diforder, would be bed learnt from examining it after death. But it rarely happens that a perfon, dies after the head-ach, without fome other diforder of the head fupervening, as the palfy, epilepfy, ike, and then, upon examina¬ tion, we find the fame date of the parts as after thole diforders. Thus we meet with topical affections, as tumours, abfeeffes, various er olio ns, maj*ks of accu¬ mulation, dagnation and e fib don ot blood, and ferum in the brain. It is not certain, whether thefe are eaufes or effefls, exiding previoufly before the head- ach, or both thefe ; and tho-fe fu p erven in g diforders feeing the effects of the head-ach frequently recurring:. Either of thefe is fufiiciently probable; and fome- times one, fometim.es the other feems to take place.
c In head-achs of very long duration,, it is difficult ■to conceive any primary topical affeflion of the brain, ib that thefe mud often be the effects of the head-ach : yet inftances of fuch topical affections have been found after accidental deaths, and fuch as were -not immediately connected with the head-ach 3 which
feems
Cullen’s Clinical Lectures . 335
jfeenis to fhew; that they fometlmes exift before the head-ach.
c In order to judge here what are the proximate caufes of the head-ach, and how it may operate in producing thefe topical affections* or the diforders attending it, wTe mull; enter into the theory of the difeafe.
f In the hr ft place, the head-ach may proceed from fimple fulriefs, and the diftenfion occasioned thereby, which gives the cephalalgia pletlionca. Thus we lee it manifeftly arifing from all the caufes which pro¬ duce or encreafe a fulriefs of the blood-veffiels* which occalion a temporary rarefaction, or which determine the blood in a greater force, or in a large quantity to the velfels of the head. This is fufficiently explained by the occafional caufes of the diforder, which wre have already mentioned : we fhall only illuftrate it by a fingle inftance of a perfon wrno laboured under an. afcitess founded on fteatomatous tumours, occupying a large portion of the abdomen; this compreffing the bloodweffels, produced many varicous fwelJings in the velfels of the lower extremities, and a con- ftant fulnefs in the veins of the head, fo as to oc ca¬ ll on violent head-achs ; in particular, any Hooping brought on head-ach, dimnefs of fight, giddinefs, flupor, partial paralytic afFeCtions, and fometimes formal fits of the apoplexy, lading feveral hours. This (hews how the head-ach may frequently be produced by various inclinations of the head. This is the mofl fimple view of the head-ach, as depend¬ ing on plethora, which is often flight and traniitory, though there is a variety in this refpeCl according to the caufe. Thus, even in this plethoric Hate, when there is a greater tendency to heemorrhages, there are more formal paroxyfms of the head-ach. Haemor¬ rhages are commonly faid to depend, on a fulnefs, and increafed impetus of the blood in the fyftem, and, perhaps, on a particular debility in thofe veffbls In which the rupture takes place. But this notion
Bb 2 of
336
Cullen's Clinical Lectures .
of fpontaneous haemorrhages, is not cor re ft ; and to explain the nature of them, we mult have recourfe to Hoffman, who, in his chapter upon the haemor¬ rhages of the nofe, tells us, that they are begun by a fpafm, or ftrifture of the veffels of the extremities, whereby the impetus being inereafed in thefe vef¬ fels in the head, the blood burfts. But this will not be underftood, without being acquainted with his doftrine of fevers.
4 There is another cafe depending on a rheumatic affection, or the fame with that occurring in rheu¬ matic affedtions of other parts. Here there is an inereafed impetus in veffels not fuited to haemor¬ rhages, as being inclofed in the membrane of the mufcles. To underhand this, we muft look into the writings of the Stahlians, who tell us, that they are conge ft a c ample la et incompleta , the former of which anfwer to the proper haemorrhages, and the latter to the rheumatic ; fo that in both they fuppofe there to be the molimina hemorrhagica, and an inereafed impetus.
4 This doftrine, with a little improvement, would be very juft. What the difference in the liate of the veffels is, we iliall not explain at prefent. B elides this, there is, perhaps, fome difference alfo in the caufes of each. But however this may be, it is cer¬ tain that there is a paroxyfm of the head-ach. of the rheumatic kind : there is likewife another of the arth¬ ritic kind, which is alfo another of the congefta.— How far this differs from the rheumatic in topical affections-, is difficult to explain. It differs however in this, that arthritic arifes from an interruption of the ufuai determination of fuch arthritic affections, and is. relieved by their return. There is a fourth cafe depending on a topical fever.
c Intermittent fevers, during an epidemic period, often operate folely in producing, head-achs. Per¬ haps then we have head-achs precifely in the fit na¬ tion of intermittent^ with this difference only, that they are topical inflead of general. Whether there
are
337
Blizard on the large Blood-veJJels , Sc.
are not topical fevers of other kinds, which are the foundations of various head-achs, is not determined, but feems probable. Thefe four fpecies appearing in paroxyfms, are all analogous ; and in proportion as a perfon is acquainted with the doctrine of fevers, will he underhand the hate of thefe head-achs, and their proximate caufes. They begin with a cold fit, or with fymptoms analogous to it ; fuch as, a general horripilatio , and a fenfe of coklnefs in the part, which is frequently fucceeded by a hot fit, firewing at leaft an increafed impetus in the part itlelf. Sometimes this is communicated to the reft of the fyftem, and produces a more frequent pulfe. They terminate alfo like levers, with hcemorrhages, fweatings either in the part itfelf, or more generally ; and oftentimes tumours of a particular part, as in the rheumatifm. Frequent¬ ly they are without any fenfible refolution ; but this alfo happens in many fevers.’
We muft referve the conclufion of this intereftmg fubject for our next number.
Art. XXXVIII. A Lecture on the Situation of the large Blood-vejfels of the Extremities ; and the Methods of making effectual Pre (jure on the Ar¬ teries , in Cafes of dangerous Effufions of Blood from Wounds : delivered to the Scholars of the late Maritime School at Chelfea ; and firft printed for their life. Third Edition : to which is now added a brief Explanation of the Nature of Wounds , more particularly thofe received from Fire-arms. By William Blizard , F. B. S. Twelves, 8 4 pages* price 3s, London, 1798, Dilly,
LITTLE argument is wanting to prove the bene¬ ficial confequences which might refult to foci- ety, were the knowledge of the lituation of the large blood-veffels of the extremities, fo far as is necelfary
B b 3 fox
33S B lizard on the large Blood-vejels , &c.
for checking dangerous effufions of blood, and the ufe of the tourniquet, more general % not confined to the navy and army, but extended to colleges and fchools, particularly to military and nautical aca¬ demies, manufactories, fipfpitals of every defcrip- tion, prifons, plantations, fire-offices, the clergymen pf parifhes in which no furgeons are refident, com¬ manders of merchantmen, miners, &c. The expe¬ rience of moll perfons, the author remarks, could af¬ ford inflances of danger or death through defeft of this knowledge.
The defcriptions and inftruftions here given, are fo clear and explicit, as to be readily comprehended by any ordinary capacity 3 and though intended for the ufe of the public only, are yet well calculated to form a manual for the younger and more inexpe¬ rienced part of the profefliom A neat plate, which is prefixed to the work, reprefenting the coupfe of the principal veflels of the limbs, will no doubt add great¬ ly to the effefl and utility of the verbal defcriptiqn.
I he remarks on wounds contain every thing which could be reafonably expefled within fo narrow a com- pafs. Ihe moft prominent features are felefted, and thofe^ only which have an immediate reference to practice. Ihe following obfervations on amputation, and the fecuring of veffels, will give our readers* a favourable idea df the execution of this little tra6t.
Amputation is to be performed only under cir- cumftances, unequivocally expreffing it to be pecef- fary for the prefervation of life.
€ Events, in gun-fhpt wounds and compound frac¬ tures,^ feem tp juftify the aflertion, that fuccefs oftener attends amputation after fuppuratipn, than when per¬ formed before that period.
Ihere are, however, occurrences in thefe and Other ^ defcriptions of cafes that at once determine their judgement as to the propriety of immediate am¬ putation 5 and, independently of the hurt, abftraftedly
confidered.
Blizard on the large Blood-vejfels, Me. ' 339
confidered, there are many things that will have great weight in deciding upon the operation as the belt expedient* even when* prima facie , the nature of the injury may be fuch as, under more favourable circumftances, might juftify a lefs fevere decifion, — * The fituations of wounded people, in a crowded hof- pital, in an airy plain, in the field of battle, in a chamber of convenience and fecurity, in the anxious moment of engagement, when in quiet poffeffion of the field or the fea, during the hurry of a purfuit, the alarm of a retreat, &c. are very different, and will prefent reafons for afting differently in fimilar in¬ juries,
c General chirurgical principles, confirmed by ex¬ perience, mud, however, be adverted to, and fhould be the guide upon every occafion.
c The more topical or limited the hurt, the more proper, generally, will be immediate amputation ; and, vice verfa, A wound, by a mufket-ball, in the ancle-joint, and one in the thigh, with fracture, from a cannon-ball, are cafes that illustrate this po¬ rtion. — It is the more neceffary that an inexperienced perfon fhould well confider this rule, as the figns of the greater extent and degree of violence might other- wife be very likely to miflead his judgement.
* The operation ftiodld be done completely beyond the feat of cmitnfion , as well as of fratture, &c. This plain rule, alfo, is of great importance : the utmoft care, therefore, is neceffary in determining upon the nature and boundary of the injury.
‘ Gun-fhot wounds in the joints generally require
imputation.
< In every cafe of wound of a large artery, it is fiafer to make a ligature upon each divided extremity, than to truft to one only : branches may fupply the lower portion, and continue or renew' haemorrhage.
‘ The period of feparation of contufed and dead parts muff be religioufly watched. ihe alarm oi bleeding may happen when not expected from any
B b 4 ftgn
340 Blizard on the large Blood-vejels, 8Cc.
fign of coDtiiiion ; and life will confequently depend upon immediate affiftance. The retracing of a veffel, or fainting, may fufpend hemorrhage, that may after- wards occur, and prove fatal.
‘ Whenever ligature can be made in the cafe of an opened artery, it ought to be done. Nothin o- tluTi. bears the title or styptic is to be depended upon. r
6 Men ^ould be wary how they give their fanaion to dependence upon styptics in preference to cer¬ tain means of flopping haemorrhage. A little matter will fom e times fuffice to reftrain a bleeding In an amputation of the leg, below the knee, of a boy eleven years of age, at the London Hofpital, all the arteiies retradled fo much that not a ligature was rnaae, and he was foon well. If any thin0" called flyptic had been employed in this cafe, it would have acquired unmerited reputation, and the lofs of many valuable lives might have been the confeouence .* Refiftance to a flow of blood may be made by divers means, that may prove effeaual in bleedings from fin all arteries; but are always to be regarded as fallacious in divifions of large veffels. *
Mealy, and tender fibrous, fubftances, united with the blood, may form a, relifting pafte. Acids, iptrit of wine, &c. may coagulate the blood, and fo occalion refiftance. Stimulating things may excite the extremities of divided veflels to contract, and retract, and thence refiftance may be caufed. Coagu¬ lation of the blood in the coats of a divided arteryf as well asm the tube ltfelf, and, confequently, death of the veil el, may happen from heat, and various things < a.led caufhcs. Solutions of refins may be decom¬ pounded by the blood in the part, and' the 'refinous coagulum may obftrua the divided velfels, as with the compound tincture of gum-benjamin, tinaure of myrrh, tcc. ; and fome of thefe properties may be united m the fame article: but experience has de- monftiated the fallibility of all fuch means.
'* Unhappily
Rlizard on the large Blood-veffels , Kc. 341
* Unhappily, however, there are occafions where ligature cannot be made ; and it fometimes happens, that the trial of a ftyptic may be admiffible, even in cafes where ligature can be performed. Oil of tur¬ pentine, applied by buttons of lint, will generally prove the mod: effectual article of the clafs of ftyptics : being made hot, its ftyptical property becomes con* fiderably augmented.
c Rut, molt of all, next to ligature, compression is to be depended upon. This may be made by means of compreffes of linen, lint, &c. either againit the ends of the veffels, upon their Tides, or in both ways. Sponge is admirably adapted for preffure $ but, when it is employed, the rationale of its ufe fhould be remembered. The end purpofed will de¬ pend upon its elaflicity. It is, therefore, to be fo preifed into, or upon, the part, as, when expanded, to maintain a proper degree of preffure againft the open veffels.
‘ Ligature may be made with the greateft proba¬ bility of fuccefs upon any artery of the upper extre¬ mity; and upon any artery, below the ham, of the lower extremity : arid there is forne probability that ligature may be fuccefsful below the large artery, called arteria profunda , that goes off from the artery in the groin: but no perfon is to be buffered to die by haemorrhage that can be reftrained, from any vef- jfel. What may pojlbly happen cannot be foretold. The very order of things, in the diftribution of the veffels in the part wounded, may be reverfed ; and it fhould be remembered, that the nourifhment of the parts below may be effectuated through the gradual dilatation of myriads of communicating fmall veffels, in the ratio of their diameters, where no large artery, that can itfelf carry on the circulation, exifts.
c The difficulty of effectually fecuring bleeding vef¬ fels increafes much by the lofs of time ; efpccially, if irritating ftyptics have been employed. The adhe¬ sions, thickening of cellular fubftance, & c. that fol¬ low.
$42 BJizard on the large Blood-vej}ehp
low, render it oftentimes no eaiy matter to afcertain^ and properly bring to view, the injured veffel : nor is fuch a date fo favourable for the event of a ligature as the condition before inflammation. Experience has proved it a fafer general practice, in the cafe of pun&ure or divifion of a large blood we fie!* at once fo far to extend the wound as to allow of tying the artery with eafe and proper effeft.
c The elaftic forceps are convenient for holding veffels while ligatures are made upon them ; but, in precarious fituations, it is fafer to ufe the needle and ligature ; taking great care, however, to leave out diftinguifhable nerves. The many-tailed flannel bandage is the bed for the thigh after amputation. By cutting oft one of the portions of a ligature, the bulk of extraneous matter in a wound is favourably Idfened. 1
c There is fometimes a date of dreadful apprehen¬ sion, concerning operations, even in perfons of urn doubted courage. An occurrences fojne years fmces at the London Hofpital, will exprefs this in a Striking manner, and may convey* feme inftruflion. A fo¬ reigner was to have his leg amputated, on account of a difeafe in it through which he was finking. He was fo reduced, that it was determined to perform the operation on his bed. At the moment of pro* ceeding to the incifion, he fuddenly raifed himfelf, fainted, and fell backwards. He thus continued feme minutes, with a pulfe barely perceptible. He then recovered a little, again darted up, afked, “ Is my leg off?” and, upon being told it was not, faint* ed again. It was judged, that he would inevitably die without amputation ; that he would probably die from repeated fainting ; that the operation, performed with due care as to lofs of blood, would tend to roufe, indead of weakening, the aft ion of the heart and veffels ; and that, therefore, it ought to be per* formed. It was done, with as much expedition as% poffible.— 1 The operation was entirely finished, when
he
Crichton on Mental Derangement f fc 343
" %-j j •}'$ \ i* • i
J ** ft
he again raifed himfelf, and pot the queftion as be¬ fore. Being affured that his leg was removed, he inftantly became cheerful, and fainted no more. He left the hofpital perfectly well ; and always declared, that he had not the lead painful fenfation from, or confcioufnefs of, the operation.'
Art. XXXIX. An Inquiry into the Nature and Origin of Mental Derangement ; comprehending a concife Sijjiem of the Phyjiology and Pathology of the Human Mind , and a Hijtory of the Paffions and their Effects , By Alexander Crichton, M,D. Phyfician to the Weftminjler Hofpital , and Public Lecturer on the Theory and Practice of JPhyJic , and on Chemijlry . 2 Vols. Oftavo, price 12s. boards. London, 1798, Cadell and Davies.
r^pHE work, the author obferves in his preface, I which is at prefent fubmitted to the judgment oftlie public, is an attempt to reduce, under certain fixed principles, a number of loofe faffs, which abound in the writings of medical men, metaphy- ficians, and philofophers of different ages and of various countries. Many of thefe faffs have been Jong known ; others, from the late period and foreign languages in which they have been communicated, it is prefumed, are only partially lo ; but although they all relate to diforders which are common in civilized nations, and are daily becoming more fre¬ quent, and are univerfally lamented, as conftituting the greateft calamity to which mankind is fubjeft; yet it is generally confeffed, that the attempts to throw light on their real nature have been very few, and thefe few have not been fuceefsfuh
If we except, Dr. Crichton remarks, Dr. Arnold of Leicefter, no other author in this country has written fully qn the fubjecf of mental derangement.
Monfieur
344 Crichton on Mental Derangement , 8Cc.
Monfieur Dufour is the only author, fince the time of Sauvages, who has written on them fyltematically in France ; and although the German prefs has fent forth a vaft number of publications which relate to difeafes of the human mind, yet they are only collec¬ tions of cafes, hiftories of individual difeafes, or ac- * counts of new remedies ; for no author of that learned nation has written either fully or fyltematically on Vefanice ,
The method which the author has adopted through¬ out the whole of the work, is that of analyhs. This, v he obferves, is the genuine touchftone of truth, not only in matters of external fenfe, but alfo in obje&s of abftraCt reafon ; for, as in conducting this mode of inquiry, every conftituent or elementary part mult be feparately examined, it is the fureft way of detecting error j and as all complex ideas become clear, in proportion as the individual parts of which they are compofed are diftinCtly reprefented in the mind, io it is the beft mode ot eftablifliing well-founded refill ts.
When the work of analyfis is completed, the molt ufetul and difficult part remains ; that of applying the re full, or general principle, to explain and arrange the individual faftsf It is this, indeed, which dif- tinguithes the man of fcience from the mere fcholar. It is, of all mental employments, the molt difficult, the moft liable to. error, and yet the moft valuable when w7ell accomplifhed. It is the abridgement of faCts. and fimplification of all knowledge. Experience and obfervation teach us a vaft crowd of fafts. We mul¬ tiply thefe by analyzing them ; in analyzing them we generally obtain a knowledge of the caufes of a num¬ ber of their properties, and often of the caufe of their production ; and we are thus enabled to reduce a number of effeCts under a few general principles. Hence the utility of this procets. But that it is a procefs which is often dangerous, and even hurtful to fcience, mult alio be admitted. It is dangerous when
WG
Crichton on Mental Derangement , Sfc. 345
we try to reduce general principles under principles {fill more general ; or, as it were, to find out the ulti¬ mate fource of all our knowledge ; for where are the faffs to' guide us in fuch a refearch ? The ultimate principles are excluded from human refearch, but, unfortunately, not from human curiofity. It is hurt¬ ful to fcience when a man of genius attempts to re¬ duce the faffs of any branch of fcience under general principles, while the faffs themfelves are too fcanty to admit of juft conclufions being drawn, for then wild hypothelis muff neceftarily arife.
The work is divided into three parts or books. In the firft, the phyfical or corporeal caufes of delirium and other derangements of mind— in the fecond, the various morbid changes which each faculty of the human mind is fubjeff to, either from an over- ftraining, or from an original or acquired difpropor- tionate activity, are inveftigated. In the laft book, the Paffions are treated of.
Such is the general outline, and which leads to a detail of vaft extent. It is not, however, to be fup- pofed, that the fubjeff has here been purfued through all its windings, and in all its minute ramifications* Neither the life, nor- -the faculties of an individual, would fuffice for this. As far as it goes, however, the prefent work evinces long and laborious invef- tigation in its author. We could have wifhed it had been lefs defaced by verbal and typographical errors : errors, which a little more attention, and a little lefs hafte, might furely have prevented.
In the firft book, as has been already ftated, the phyfical caufes of Delirium are inveftigated. The firft chapter, here, is occupied on the iubjeff of the principle of Irritability and its laws. Thefe are com¬ prized in the following axioms, which are partly new, partly modifications of thofe of Fontana and Gir- Xanner.
Axiom
346 Crichton on Menial Derangefnent , Sic*,
Axiom I. After every adrion in an irritable part, a ftate of reft, or ceftation from motion, muft take place betore the irritable part can be again incited to action.
Axiom 2. Each irritable part has a certain portion or quantity of the principle of irritability, which is natural to it, part of which it lofes during addon, or from the application of ftimuli.
Axiom 3. By a procefs wholly unknown to us, it regains this loft quantity during its repofe or ftate of reft.
Axiom 4. Each irritable part has ftimuli which are peculiar to it, and which are intended to fup- port its natural addon.
Axiom 5. Each irritable part differs from the reft in regard 'to the quantity of irritability which it poft feffes.
Axiom 6. All ftimuli produce addon in propor¬ tion to their irritating powers.
Axiom 7. The addon of every ftimultis is an in-- verfe ratio to the frequency of its application.
Axiom 8. The more the irritability of a part is accumulated, the more that part is difpofed to be adted upon.
Axiom 9. If the ftimuli which keep up the adtion or any irritable body be withdrawn tor too great a length of time, that procefs on which the formation of the principle depends is gradually diminifhed, and at laft entirely deftroyech
Thefe are the general laws agreeable, to which irri¬ tability feems to be regulated in producing its various phenomena.^ The next queftion is, what is the nature of this principle ?
Of late/ Dr. Crichton obferves, c a newr dodlrine has arifen, which has been dignified with the refpedl- able title of a theory. The proofs of its truth, however, are fo fcanty, and fo many fadls remain unexplained by it, that it cannot be allowed fuch an honour. Dr.
Girtanner
3
Crichton oil Mental Derangement , Kc. 347
Girtanner is the firft: who confiders irritability to be nothing elfe than oxygene, the bails of pure air. — - This opinion has been adopted by Dr. Beddoes, and a few other pneumatic doCfors.
* In examining this hypothecs, it is impoffible for any one who has a juft fenfe of the value of candour in another, not to be hurt by the manner in which Dr. Girtanner conceals difcoveries that have been made, and conjectures that have been offered to the public long before he wrote. There is a fpecies of egotifm in fome authors which is fo powerful as to make them hide not only the fources from which they borrow their ideas, but often to afcribe to them* ielves the merit of difcoveries to which they have no kind of claim. The opinions of their opponents, when eafily combated, are all brought forward, be- caufe the refutation of thefe adds to their glory ; but the combats of others who have fought fuceefsfully before them in the fame field are not mentioned, for fear that their fame fhould fuller diminution. Such a conduct mull neceffarily occafion difguft, a fentb ment always unfavourable to a wTriter, however great his talents may be, for it prevents our doing him that juftice to which he is other wife juftly entitled/
The faCt that oxygene combines with the venous blood during refpiration, which is mentioned by Dr, Girtanner as a difcovery of his own, is (hewn to be¬ long to Dr. Goodwin, who publifhed his experiments long before the wrork of Dr. Girtanner made its ap¬ pearance. . *
The author contends with Dr. Beddoes that fcurvy, fo far from being a difeafe of fuper-oxygenation, is one in which the blood is not fufficiently oxygenated. After bating, with great fairnefs, the arguments ufed in fupport of this and the other branches of the pneu¬ matic hypothefis, Dr. Crichton goes on to obferve — c In regard to this theory, (as it is called) I have to obferve in the firft place, that the whole phenomena of mechanical and mental ftimuli on the irritable
parts
/
348 Crichton on Mental Derangement, $Y.
parts of animals are not only left unexplained, but really hand in direft contradiction to it. Does a piece of rock-cryftal, a particle of fand, a thorn, or the point of a pin, all of which ftimulate, draw oxy- gene from a mufcle ? Can any proof whatever be given of their having fuff'ered any chemical change upon being applied to an irritable part ? Yet they are all of them capable ol exciting inflammation, when applied to naked veffels, or mufcles. The fame queftions may be alked concerning our thoughts, confidered as ftimuli. We choofe to walk, and ac¬ cordingly we get up and walk. In what manner can the oxygene in our limbs be aflefted by Ample volition ? The brain mu ft be fuppofed to be a che¬ mical laboratory, and the foul an operative chemift who prepares agents which have a more powerful attraction for oxygene than the mufcular fibre. — * Thefe, it is to be imagined, are fent along the nerves quickly or flowly, in large or fmall dofes, according as a man choofes to dance, or to walk, to lift a load, or to lift a feather.
It is a curious circumftance in regard to this theory, that oxygene is confidered, not only as the principle oi irritability, but alio as the agent that a£ts on it. Dr. Girtanner, indeed, denies this, and fays, that oxygene, and bodies which contain it in great abundance, are only negative ffimuli, that is, they yield it to the mufcular parts, and predifpofe them to greater action. Cold, which is a negative ftimu- lus, and hunger, it too long continued, gradually de» Itroy life ltfelf, in the way in which all negative ftimuli are fuppofed to produce their effect, that is, by not fupporting adtion. If bodies which yield oxy¬ gene are to be confidered as negative ftimuli, they ought,- therefore, to do the fame; but I appeal to facts if this is the cafe. Does not red precipitate, when applied to a fore, inftantly excite a violent action in* the part? Do not corrolive fublimate (oxy¬ genated muriate of mercury,) and white arfenic (white
oxyde
>
Crichton on Mental Derangement, SCc. 349
oxyde of arfenic) aft in the fame manner? If thefe fub (lances produce their effefts in no other way than by cdufing an accumulation of the principle of irri¬ tability, where is the ftimulus which produces the inflammation ? The oxygene which thefe bodies are fuppofed to yield cannot be at the fame time the principle of aftion, and the exciting caufe of aftion. If a negative ftimulus of this kind were taken into the ftomach, one would naturally imagine it would caufe an accumulation of irritability in the whole of that organ, and if any ftimulus were to aft on the part, a general inflammation of that organ would enfue. But how is this to be reconciled to the faft ? When a perfon dies who has been poifoned bv ar- ienic, is not the inflamed part limited to thefe places with which the arfenic has been in contaft ? A highly inflamed, and fometimes gangrenous fpot, not larger than a (hilling, or a half-crown piece, is dis¬ covered. All the reft of the ftomach, except it be thofe places immediately furrounding the fpot, are in general but (lightly inflamed.
c The manner in which ftimuli aft, and produce the contraftion of mufcular and other irritable parts of the body, are phenomena which muft awaken the fpirit of inquiry in every man who has the flighted tinfture of it in his mental corapofition ; but it is not by crude and baity conjeftures that wre can arrive at a knowledge of thefe myfterious intri¬ cacies of nature. It is for this reafon, that the invef- tigation of thefe fubjefts (hall be delayed until a number of other phenomena have been examined. The deeply learned Bacon, and Boyle, modeftly con¬ ceived, that, previous to the formation of general principles, it was firft abfolutely necefiary to examine with much caution, patience, and impartiality, every faft connefted with the branch of fcience, to which the general conclufi on related ; but this flow, yet neceflary procefs, does not well fuit the temper of the prefent times, Syftems are formed in a trice, vol. v . C c an4
350 Crichton on Mental Derangement , gc.
and conftituted theories by the authority of one or two individuals. We Amplify every thing in a moft wonderful manner, and endeavour to approach the facred fountain of truth by leaps and bounds, as if we were fuddenly endowed with powers totally un¬ known to the philofophers of former ages. Man is a fibre which bends itfelf into a ring, then becomes a tube, and then an animal *. The principle of his motions is oxygenef : ideas are motions of fibres J: vegetables have ideas || : children may be begotten of any fex, fhape, or feature, at the will of the male parent §. The whole of living bodies are made up of a few airs; and the great globe itfelf is only a fplinter of a fradiured fun.^]7
*
In the fecond chapter the author treats on Senfa- tion. After examining the opinions of different au¬ thors on the nature of this faculty. Dr. Crichton gives the following, hypothefis on the fubjeft. c That the particles of which bodies are compofed are not in a ftate of perfect contaft, is a truth eftablifhed in phy- iics ; for, independently of the repellent power with which they are endowed, and which prevents their complete union, a certain portion of heat is conftantly prefent, which alfo keeps them feparate from each other. A convincing proof of this pofition is, that the moft folid body we know may be made to con- trad! in all dimenfions by withdrawing heat from it, and may be made to re-expand by giving it its former temperature. The heat either combines itfelf with the particles of the body, increafing their natural re¬ pellent power, or it infinuates itfelf between them, forming atmofpheres for each particle ; and owing to the great repulfive power which the particles of heat have for each other, they keep thofe of the body
* Zoonomia, vol. i, fe£t. xxxix. f Girtanner on Irritability. X Zoonomia, fe£t. iii. j| Same book, fe£l, xiii, $ Same book, leCt. jfcxxix. J3ufFon’$ Theory of the Earth,
afunder*
Crichton on Mental Derangement, Xc. SSI
afunder. When it is afferted, then, that the me¬ dullary particles which compote our nerves are by no means in a ftate of perfeft contaft, it is only at ferting that they are poffeffed of a certain quality which is common to all bodies. The vafcularity of the cineritious part of the brain, and of the nerves themfelves, their ioftnefs, pulpinefs, and natural hu¬ mid appearance, give reafon to believe, that between the medullary particles of which they are principally compofed, a fine fluid is conttantly fecreted, which may be fitted to receive and tranfmit, even more rea¬ dily than other fluids do, all impreflions which are made on it. I do not conceive that there is any ne- ceffity for fuppofing it to be of a fupernatural degree of fieenefs, fuch as the conje&ural sether of authors; nor is it necefiary to confider the nerves as tubes in which it circulates. It is a conftituent part of their texture, lying between and furrounding the medullary particles. The particles of this fluid, as well as the medullary part ot the nerves, mull, in common with ail matter, "have each of them their atmofpheres of heat, which probably increafes their natural repel¬ lent powers. When any of the particles, then, of this fluid are forcibly deranged from their natural fituation, thofe which have been compreffed aft on thofe neareft them, and thus the figure of impreffion is tranfmitted to the brain or to other parts of the nervous fyftem. Hence it follows as a necefiary de¬ duction, that what we confider to be the properties of external bodies, are more properly fpeakmg, only alterations of our own nerves. Thefe aie caufed, indeed, by certain phyfical properties in the oodles ; but our knowledge of theie properties is combined with the affeftion oi our nerves. It is on this, that is founded, in a great degree, the diverfity of tafies, or judgments, which different people entertain about the fame external objeffs. But trns view of the fub- jefl will be more enlarged on in another part of the
Cc 2-
$52 Crichton on Mental Derangement, Ke«
* As the fluid, which conveys the impreffions of
external bodies to the brain, appears to be fecreted
from the fine veffels which fupply the nerves with
nouriftiment, fo it neceilarily follows, that they muft
be varioufly affefted by every thing which alters the
action of thefe veffels, & c.’
y »
Of this hypothecs, as the author modeftly and juftly terms it, little need be faid. We fear it will go a very little way in explaining the mode in which im¬ preffions are communicated to the brain. The veil has not yet been withdrawn from this myfferious fubjeft.
In the third and fourth chapters, the fubjeQ of Senfation is continued, together with that of the or-, gans which contribute to this faculty.
Chap. 5 leads more immediately to the main ob» je£l of the work : it is entitled. Methodical Inquiry into the Nature and Phyfical Caufes of Delirium, par¬ ticularly the Delirium of Lunatics.
The general exciting caufes of delirium are reduced under the three following heads :
iff. Phyfical, or corporeal caufes ; fueh as too great determination of blood to the head, as in fevers, or intoxication, difeafed vifcera of the abdomen, poi- fons, exceffive difcharges, &c.
2dly. Too great, or too long-continued exertion of the mental faculties, as in the delirium which often fucceeds long-continued and abftradt calculation ; and the deliria to which men of genius are peculiarly fubjech
3dly. Strong paffions, fuch as anger, grief, pride, love, & c.
Of thefe different caufes, the modus operand i is inveftigated at length. The following are the au¬ thor’s general deduftions from the different faffs brought forward. *
* 1ft. We
Crichton on Mental Derangement, He. $5$
* 1ft. We obferve that a mere increafed determi¬ nation of blood to the head, provided the circulation be fo free that a great congeftion does not arife, is not the caufe of delirium, fmee in the cafes of fevere exercife, and in many fevers, where the pulfe beats 120 in a minute, and the face is fluflied and full, no fuch phenomenon takes place,
c 2dly. That an increafed quantity of blood fent to the head, or the quicknefs with which it circulates there, are not the immediate caufes of delirium, is further evinced by this faff, that the delirium of fevers, and many cafes of phrenzy, begin when there is very little quicknefs of pulfe, and often continue after that fymptom is greatly fubfided.
‘ 3dly. Diffedtions demonftrate in the cleared man¬ ner, that although a vaft variety of morbid appear¬ ances have been detedfed within the heads of deli¬ rious people, efpecially phrenitic patients, yet there is no one which has been uniformly prefent in all analogous cafes ; and therefore there is no reafon to believe, that any one of them is to be conlidered as the immediate caufe of the alienation of mind, but rather as accidental effedts, arifmg from various caufes 'tMiich have occurred either previous to the com¬ mencement of the diforder, or during its attack.' Tumors of various kinds, edifications of arteries and the membranes envelloping the brain, hydatids, ftony concretions, increafed vafcularity, diminifhed vafeu- larity, coloured fpots, increafed denfity, increafed fpecific gravity ; preternatural laxity, ulceration, rtq> tured vefiels, extravafations of blood, lymph, and fe~ rum, not only on the furface, but in the cavities and in the lubftance of the brain ; and independent of all thefe appearances, a vaft variety in the form of the fkull, have been detedled in various cafes. The chief circumftance, however, which proves that they are rather confequences than caufes of any particular dif- eafe, is, that they have been found not only in phre-
C c 3 nitic
$5* Crichton on Mental Derangement, &c.
nltic patients, but alfo in idiots, melancholic patients, hyfterical ones, paralytic ones, and epileptic people.
< 4thly. In all cafes of that peculiar kind of deli¬ rium called phrenzy, the firft phenomenon of difeafe appears to be a difordered hate of fenforial feeling, if the expreffion be permitted. All impreffions on the brain are powerfully felt there. Thofe derived from the external fenfes, if they are calculated to excite any defire, or paffion, do fo in a moft uncom¬ mon degree ; and the reaftion of thefe mental impref¬ fions diforder the whole frame. The perfon acts as if from an involuntary impulfe, which does not ad¬ mit of the operations of reafon. Hurry, uncommon ftrength, buttle, and violence, characterize all the actions and expreffions of the patient; every thing creates an uncommon excitement of nervous energy in him,
* We have had reafon to believe that the medium, by means of which all impreffions, ah externa , are conveyed to the mind, and ail thofe arifing in the mind are communicated to the various parts of the body, is a peculiar fluid fecreted, or at leaft formed in the medullary fubtianee of the nerves. This re- ' fleftion, and the previous conclufions drawn from the prernifes already laid down, naturally give rife to the conjecture, that the principal caufe of fuch phrenzy and deliria as have been defcribed, mult be a pecu¬ liar morbid action of the veifels which fecrete nervous matter, efpecially the fluid in q'ueftion. . It may be altered not only in quantity but quality. This idea is much ftrengthened by the confideratfon that the natural and healthy phenomena not only of the whole body, but of Angle parts, and efpecially all fecreting organs, are much affefled by difeafed vafcular afiion. One fet of fymptoms proceed from the mere phyfical derangement which the uncommon aftion of the vef- fels produces on the folid particles in their neigh¬ bourhood. Another arifes from the changes in the
, fluids
Crichton on Mental Derangement , $c. 35*5
fields which circulate through them, and confequent- Iy in the fecretions they perform.
c Although the force and quicknefs with which the heart and arteries aft is extremely different in different individuals, and probably alfo in different parts of the fame individual, it is a fair conclusion to fay that there is a peculiar one which fupports the healthy aftion of each individual. The expreffion difeafed , or morbid action , is one by which is meant, in a general fenfe, all deviations from this healthy aftion.
c It is impoffible for us to afcertain either the pe¬ culiar nature or number of all the difeafed aftions of which the vafcular fyflem is fufceptible ; far lefs thofe which happen to the veffels of particular parts in various difeafes. The difference that.exifls in the natural aftion of various parts, is by no means un¬ derflood. Of morbidly increafed arterial aftion, one kind is peculiar to gout, another to acute rheumatifm, another to venereal inflammation, another to fcrophu- lous inflammation, another to eryfipelas, &c. Now, although it is natural to fuppofe that in general the adlion of the remote branches of the arterial fyflem may be fuppofed to correfpond with that of the larger arteries, yet we have undoubted proof that this is not always the cafe. Their aclion is often altered in many very remarkable degrees, without any corref- ponding change of action in the heart, or fyflem of larger blood-veffels. This is proved by cafes of to¬ pical inflammation of all kinds, in which the healthy appearances of the part affefled are all changed, and yet the circulation in general goes on as ufuaf. It is alfo proved by many difeafes of the fkin, by fecon- dary venereal fores, fcrophulous tumours, &c. In many cafes, indeed, of topical difeafed arterial aftion, the fyflem at large is deranged, but in fuch cafes it is not owing to the difeafed acSlion becoming general, but to a number of fecondary caufes ; that is to fay, the topical difeafe, produces a certain number of
C c 4 events *
556 Crichton on Mental Derangement , 8Cc.
events; thefe become the caufe of others, and thefe others of a third feries, and fo on. Thus, cer¬ tain difeafed actions of the veffels of the liver not only produce uneafinefs there, but alfo caufe the bile to be much changed from its healthy ftate, both in quantity and quality; and hence a certain number of morbid effefits, pain in the ftomach, naufea, vomit¬ ing, faulty digeftion, and lofs of appetite, colic pains, and violent purging. Thefe, if they continue for any length of time, produce head-ach, heat of fkin, third, great languor, and reftleffnefs, and at laft, cramps in the extremities, and convulfions, &c. So the difeafed adb’on of the veffels of the brain, which give rife to phrenzy, operate in a fimUar manner, An altered date of feeling in the brain is evident in the quicknefs and vividnefs of the eyes, the irafeibi- lity and the difordered date of the mental faculties ; the patient’s infenfibility to cold, and alfo his deprav¬ ed appetite, 8rc. Thefe, if they continue, produce want of deep, flight febrile paroxyfms, a furious and ungovernable conduft, wild and incoherent expref- fions, and fo on.
c But if the aftion of the veffels which fecrete the fentient principle, be greatly altered from their healthy ftate, the fine fluid which is fecreted muft undergo proportionate morbid changes. in order to prove the effect which any unufual change of the fluids has on the mental operations, I fliall infert a Angular fatly mentioned by Dionis in the 498th page of his Conrs (TOpet 'ations de Chirurgie , He fpeaks of a practice which was at one time attempted to be introduced, with a view not only of preventing, but curing many difeafes.
ihe fadf he fpeaks of is the transfufion of blood, from certain animals into man. The event, however, was terrible ; for a great number of thofe on whom the experiments were made became furioufly mad, and loon died. The parliament of Paris having gain- £d intelligence of thefe experiments, iflued a decree.
/
m :
Crichton on Mental Derangement , SCc. 357
by which it was forbidden, under the molt fevere penalties, to repeat fuch experiments. His words are thefe : “ Ils firent plufieurs de ces operations qui <c devoient felon eux, avoir un fuccefs furprenant; “ maix la fin funefte de ces malheureufes viftimes (e de la nouveaute detruifit en un jour les hautes “ idees quids avoient concues ; ils devinrent faux,
furieux et moururent enfuite. Le parlement in- ce forme de ce que s’etoit pafle interpofa fon autorite, €C et donna un arret par lequel il etoit defend u -foils “ des rigoureufes peines de faire cette operation.”
f This fa ft is brought forward, not with a view of infpiring the idea that the delirium of maniacs arifes primarily from a vitiated ftate of the fluids, but merely to prove that when the fluids are altered, no matter what the caufe be, they ahvays change the aftion of the vafcular fyflem,
* Upon the whole, I conclude that the delirium of maniacs, when it has the peculiar charafter of that which has been deferibed, always arifes from a fpe- cific difeafed aftion of thofe fine veflels which fecrete the nervous fluid in the brain. This difeafed aftion appears to be one which, independent of its fpecific nature, by w7hich it is diftinguifhed from common in¬ flammation, or fcrophula, is a preternaturally increaf- ed one ; and this 1 think is proved by the quicknefs of the external fenfes, the irafeibility of mind, the heat of the fkin, the flufhed countenance, and un¬ common energy of body which maniacs evince. This hypothefls explains the reafon alfo why it often has periodical exacerbations, and remiffions. They who believe that tumors, ulcers, and ofliflcations of the brain, or increafed fpecific gravity, or increafed hard- nefs of the fame, give birth to mania, mull necefiarily be at a lofs to explain why the delirium ever ceafes while fuch caufes exifl ; but if it arifes from difeafed aftion, it mull ceafe, and may, or may not return, ac¬ cording as a variety of other circumfcances confpire to its re-excitement/
The
358 Rumball on the Nature and Caufe of the Pulfe , $(c.
i
The fixth chapter, which concludes the firft book, treats of Deliria from Morbid Nervous Impreffions.— The hiftory of Hypochondriacs forms the principal fubje£t of this chapter.
(To be continued.)
Art. XL. An Attempt to afcertain the Nature and Caufe of the Pulfe , in a State of Health ; as far as it depends on the contractile Power of the Heart and Arteries , and the Mechanical Effect of the Blood , by Diftenfion. By J . Rumball, Surgeon , Abingdon , Berks. Twelves, 49 pages, price Is. 6d. London. 1797. Johnson.
WE have perufed thefe remarks, without having been able very certainly to difeover, what it was the author meant to inculcate. His chief poll- lion feems to be, that the velocity of the pulfe is in an inverfe ratio to its ftrength ; adopting the common law in mechanics, cc that whatever is gained in power is loft in timed' c As is the quantity or column of the blood, fo will be its velocity, in an inverfe pro¬ portion to the momentum thereof ; that is, the greater the quantity, the lefs the velocity, and vice verfa ihus the force of circulation is fuppofed to be regu¬ lated in nearly the fame degree, both in a bate of fulnefs, and depletion. In the flow pulfe, a power of three is conceived to be operating with a motion of one, for a given time ; in the other cafe, a power of one adfing with a celerity of motion as three to one, in the fame fpace of time ; thereby compenfating for its moderation in degree, and producing ultimately the fame effect.
# -All this appears to us too mechanical, and ineffi¬ cient to explain the different phenomena. The bates of infancy and age, indeed, are mentioned as afford-
Rumball on the Nature and Canfe of the Pulfe, & c. 359
ing exceptions to the rule ; but there are others innumerable.
The power of cold in exciting difeafe is thought, by the author, to be in fome inftances analogous to its operation on inanimate bodies. ‘ I have feen,* he obferves, c an old wine decanter (previoufly heat¬ ed before the lire) fuddenly fiy to pieces only upon pouring in the cold wine ; and the fame things hap¬ pens every day from the fad den application of heat to a cold glafs ; but this is not owing to the degree of heat, but to the fuddennefs of its application, or the vivid tranlition from one extreme to the other, bee a ufe the fame glafs, if gradually heated, would bear heat enough to boil any fluid. To thefe hidden changes, then, from one extreme to thfe other, fhould I look for the common caufe of moil of the coughs, colds, catarrhs, &c. in this variable climate of ours.’ —The fact is perhaps true, but the illuftration is but a lame one.
\
Appended to thefe remarks, are two Cafes of Small-pox during Pregnancy, which deferve to be recorded.
‘ Cafe 1. On the 28th of April, 1796, Mary Beckenham, of Sutton Courtney, in the County of Berks, was attacked with thofe fymptoms which ufually precede an eruptive fever ; and the natural fmalf pox being then in the village, it was juftly fuf- pedted that fhe was infedted with that difeafe ; and accordingly in the ipace of a few days, an eruption made its appearance, which from the attendant lymp- toms during the progrefs of the difeafe, the regular fuppuration of the puftules, the fubfequent infedtion of the reft of the family, and the marks remaining after her recovery, there could be no doubt of its being the confluent fmall-pox.
< When firft taken ill, fhe was fuppofed to be about four months advanced in pregnancy ; and from the great confluence of the puftules, and the violence
of
3
%
$60 Rumball on the Nature and Caufe of the Pulfe, & (c.
of the fymptoms, it was hardly expecfted that fhe could efcape with her life : however* fhe happily recovered* and on the 26th of July following, was fafely delivered, with very little of my affiftance, of a live male child, bearing very diftinfl marks of its having been affedted with the fame difeafe as that of the mother. Now from the ulcerated fpots being compleatly cicatrized, as well as the diftance of time from the firft infection of the mother, I think I may venture to conclude, that this patient had palled through the difeafe in utero, and furvived it, fo far at leaft : however, from the lize of the child, which was rather below mediocrity, the diftance of time from a certain affeftion of the mother, and the death of the child in lefs than half an hour after its birth *.
I did alio conclude, that the mother could not be much more than feven months gone, and that at any rate the child could not be faid to have paffed through the difeafe with impunity.’
c Cafe 2. Ann Pufey, of Abingdon, Berks, was advanced in pregnancy about four months, when a general inoculation took place through the town ; fhe was accordingly advifed to remove till after her deli¬ very; but from the preffmg necefiities of her own family, who were alfo under inoculation, and many more very urgent reafons, fhe was obliged to remain, and chofe to run all rilk, rather than be inoculated ; lire was, however, prepared as for inoculation, and caught the difeafe, which (he paffed through very favourably, having but a moderate fprinkling, and at the period of cuftomary calculation, was fafely de- . livered of a daughter, without the leaft appearance of the child ever having been infefted with the dif¬ eafe of the mother. — The child is now feven years of age,, and I hope foon to have the pleafure of inocu¬ lating her, for the fatisfaftion of all concerned f.’
* This child is preferred by Dr. Pegge in the Anatomical Mufeum at Oxford.
f When this trial has been made, we hope the author will find fome means of communicating the refult. ,
Art.
v . . - i
c
( 361
f
Art. XLL Defcription and Treatment of Cutaneous* Difeafes. Order I. Papulous Eruptions on the Skin , By Robert Willan, M. D. F. A S . Quarto, 110 pages, with Seven coloured Plates, price 15s. London. 1798. Johnson.
THERE are few fuhjeCts relating to the fciencc of medicine, of wriiich our knowledge is fo limited, or which have been fo imperfeCtly handled, as that of Cutaneous Affections. Thefe are alike im- perfeft, in their hiftory, their diagnosis, and their method of cure. Every attempt, therefore, to il~ luftrate fo obfcure, and, at the fame time, fo impor¬ tant a fubjeCt, merits a favourable reception from the public. The prefent, however, has a higher claim on public favour, from the induflry and attention, which have evidently been bellowed on it, by its ingenious author ; and from the very accurate repre- fentations afforded by the plates ; a matter of the greater import, as it promifes to afford a ftandard of companion to future labourers in the fame field, the deficiency of which has rendered much that has been hitherto written on the fubjeCt in a great meafure ufelels to us.
Little improvement. Dr. Willan remarks, has been made in the fubjeCt at large, fmce the time of Avi¬ cenna. Later authors who profefs to treat of it ex- preflly, do not always furnifh additional materials from their own obfervation and experience. Their principal objeCt has been to reconcile the defcription of cutaneous complaints, given by the Greek and Arabian phyficians, with each other, and alfo with the forms of them obferved in this and the neigh¬ bouring countries ; an attempt which can fearcely be deemed either rational or practicable. AffeCtions of the fkin rnuft be fuppofed, as well as others, to vary much in different climates. Is it therefore improper to apply the fame names, or to eftablifh the identity
362 Willan on Cutaneous Difeafes ,
of difeafes, where the refemblance perhaps confifts in only one or two circumftances of fmall importance ; more efpecially, fince the obfcurity and want of pre- cifion in the descriptions left us by the ancients fome- times render it difficult to afcertain their meaning.
The Greek writers, the author obferves, afford a tolerably diftinft account of phlegmone, eryfipelas, herpes, and their varieties ; as alfo of feveral local tumours, under the name of phyma, anthrax, phy- gethlon, dothien, epinyftis, terminthus, jonthos, &c. Of the formidable difeafe termed elephantiafis, they have given a minute and elaborate defcription. Some more ftriftly cutaneous affeftions they denote by the terms cnefmos, lichenes, pfora, and lepra : which though diffimilar in their form and progrefs, are arranged under the fame genus, from a theoretical notion refpefting their caufes. In like manner the alphos, leuce, and melas, are defcribed as having a clofe affinity with each other, whilft they really differ in their principal charafteriftics.
The Greeks have been moil particular in defcribing external affections of the head ; but miflead us, by applying new names to the fame difeafe, in different fituations, or in different ftages of its progrefs. This will appear from comparing their accounts of pty- riafis, ceria, achores, meliceris, melitagra; exanthe¬ mata, helcydria, and pfydracia capitis; fycofe, and lichenofe tubercles of the chin ; madarofis, milphofis, ptilofis, alopecia, and ophiafis. Of the difeafes^ of the eyes, teeth, and gums ; alfo of apthai and. other affedtions of the tongue; of polypi, oezena, &c, their defcriptions are minutely accurate. Several external blemifhes, not ranking as difeafes, are alfo mentioned by them, as ephelides, phaci, chalazia, thymia, pe- iiomata, celides, rhagades, tyli, myrmeeiac, acroch- ordones, &c.
Many deficiences are, however, to be noted in thefe authors : firft, they do not fufficiently defcribe puftular difeafes, which are the moft numerous and
molt
i
\
\Villan on Cutaneous Difeajes , S63
mod important of all cutaneous complaints; nor do they always diftinguifh puftules from papula and exanthemata.
2. They give us no regular hiftory of proper ex-, anthematous diieafes, or rallies : but are falls fed with a loofe comparifon of their appearances to the efFefts produced upon the Ok in by nettles and other ftinginy plants, or by the bites of ideas, gnats, bugs, &c.\p- plying feveral terms to denote them, as exanthif- mata, blaftemata, eczefmata, &c. but without any diftindtive characters, Their only material obferva- tions are, that fome forms of the exanthemata are permanent, while others appear and disappear irre¬ gularly . and fin the i, that tnofe or a purple or blade colour are highly dangerous.
3* T hey fomctim.es employ the fame term to ex- prefs different difeafes. This is particularly obfer- vable in the ufe of the word pfora, which they apply to a difeafe whofe charaCteriftic appearance is a dif- tribution of fcales in various figures; to a puftular complaint terminating in extenfive fuperficial ulcera¬ tions ; and alfo to a ciifeafe of the eyes or eyelids.
. 4- charades, or ftruma, their account is very flight and partial.
Celfus, Pliny, Marcellas, and other Roman au¬ thors. have copied the Greek accounts of cutaneous diforders, only changing fome of their terms, without materially improving the fubjeet.
Under Impetigo, as a generic title, Celfus feems to comprehend the ulcerated pfora, the fcaly pfora, and perhaps the lepra ot the Greeks, along with fome o tlier diflimilar affedlions. He conftitutes a genus vitiligo, including the alphas, leuce, and melas : under the titles of papula and ignis facer, he has described the lichenes and herpes of the Greek writers ; and he includes their alopecia and ophiafis under the general term area. Celfus, however, is the. firft who has given a particular account of the
fcabies.
$64 Willaft on Cutaneous Difeafes ,
fcabies, a difeafe mentioned indeed by the Greeks,, but no where defcribed by them.
The Arabian phyficians are, on the whole, more diftindt in their account of cutaneous difeafes than either the Greeks or Latins ; but their fenfe has been obfcured by very erroneous tranflations. They accu¬ rately defcribe external affedtions of the head ; dif- tingui thing them into alraba (crufta ladiea), alavirati (pityriafis), alfahera or the dry fahafati (porrigo), 'and refrengi, the moift or ulcerated fahafati (cerion), of infants. Balkiati and alvatin they reprefen t as obffinate forms of the fahafati extending to other parts of the body. They have alfo particularly men¬ tioned the difeafes of the hair, and feveral fpecies of baldnefs. Some difeafes affedting the tkin more ge¬ nerally are defcribed by them under the names of black morphea, white morphea, alguada, black and white albaras, ufagro, herifiati, and alcharifi, fee.
This multiplicity of terms has been produftive of confufion ; and is the lefs neceffary, as many of them do not exprefs different kinds of difeafe, but rather apply to different degrees of the fame afieaion. Thus the alguada and white morphea are defcribed merely as luperficial and flight forms of the white baras, which anfwers to the leuce ©f the Greeks. The blacx baras feems to be the impetigo nigra of Celfus : it is faid to be of the fame nature, and re¬ ferable to the fame caufes as the black morphea, but to affedt the fiefh and even the bones, whereas the morphea is confined to the fkin. The ufagro is like- wife confounded with the black morphea and baras ; and all of them are fometimes reprefented as appear¬ ances of a more general difeafe, the leprofy or ele- phantiafis.
In the order of exanthemata, the Arabian writers have defcribed the effera, and benat, or the plant of night : tney diftinguifh the miliary rafli under the title of hafef; and are the fuff authors who have ac¬ curately defcribed the mealies (alhalba). Among the
puffular
Willan on Cutaneous Difeafes, &C. 365 v
puftular difeafes they have alfo given the firft account of the fmall-pox (algridi); and have defcribed an af- feftion fimilar to the fcabies of Celfus, which, how¬ ever, is not properly diftinguifhed from the fahafati and ufagro.
Their ufe of the term bothor renders this laft order of difeafes very indefinite; lince bothor does not with them fimply denote puftules, but alfo papula*, wheals, warts, corns, and every fpecies of tubercle on the fkin.
The Arabians have exactly copied the Greek ac¬ counts of the anthrax, herpes, and eryfipelas. They term the laft almefire, and diftinguifh it with great accuracy from phlegmonous inflammation. They de- fcribe one form of herpes under the denomination of Perfian fire ; and comprehend the phyma, phygeth- Ion, bubon, and terminthus, of the Greeks under a general term, althoin. The affe&ion denominated fare feems to be the epiny&is. Their abdemenui is the Greek dothien, or boil. Of the fcrofula they have given a more accurate account than the Greek writers ; and they mention the fwelling of the throat, which arifes from an enlargement of the thyroid gland, under the term botium.
Laftly, they have noticed a variety of local affec¬ tions, which it will be fufficient at prefent to men¬ tion ; baraffen (lentigines), alguaffem (livores) ; al- cola (aphthae), alefirati (rhagades), alhafaph (inter¬ trigo), afec (tubera), alcoalib and iutefula (verruca) mifmar (clavus), alcahas (paronychia), afalha (lupia), and albedfanem, which comprehends red fpots of the face, and ulcerations, from cold, on the extremities.
Of the modern authors on the fubjeft of cutaneous difeafes, it is obferved, that they not only give va¬ rious interpretations of the accounts left us by the ancients, but have perverted the fenfe of many paf- • fages, in the Greek writers more particularly. They "alfo make artificial arrangements by no means con¬ fident with each other ; feme reducing all the difeafes
vol. v. D d under
366 Willan on Cutaneous Difeafes, Kce
under two or three genera ; whilft others* too ftudious of amplification, apply new names to different ftages or appearances of the fame complaint. Thofe who attempt to give theoretical views of the fubjeft at large, are feldom clear and fatisfatfory : and there feems a peculiar impropriety in clafhng the difeafes, as fome have done, from hypothetical principles, rather than from their obvious charafteriftic appear¬ ances.
Having given this hiftorical fiketcfi, Dr. Willan pro- ceeds to affign the limits and natural divifion of his fubjeft. The firfl point, therefore, is to fix the fenfe of the terms employed, by proper definitions—: to conftitute general divifions or orders of the difeafes, from leading and peculiar circumfiances in their ap¬ pearance : to arrange them into diftinft genera: and to defcribe at large their fpecific forms, or varieties— : to claflify and give names to fuch as have not been hitherto fufficiently diftinguifhed— : and laftly to fpe- cify the mode of treatment for each difeafe.
Every genus is illuftrated by coloured engravings, reprefenting fome of its molt finking varieties.
The prefent volume contains only, as is exprefled in the title, the Order Papula * ; and of this the au¬ thor has conftituted three genera : viz. Strophulus, Lichen, and Prurigo.
The Strophulus includes in it the Red, and White Gum, the Tooth-rafh, and other eruptions peculiar to Infancy. They are, for the moft part, mild affe&ions, requiring little peculiarity of treatment.
The fecond genus is that of Lichen, a word which has feldom been employed twice in the fame fenfe. The following, however, is the definition affixed to it
* Definition . A very fmsll and acuminated elevation of the cuticle, with an inflamed bate, not containing a fluid; not tending to fiippura- ti«m : terminating, for the moft part, in fcurf.
' 4 v by
Willan on Cutaneous Difeafes , <Sfc. 367
by the author. “ An extenfive eruption of papufe affeQing adults, connected with internal diforder, ufually terminating in fcurf, recurrent, not conta¬ gious. v
The fpecies and varieties here are, lichen fimplex, agrius, pilaris, lividus, and tropicus. The firft feems to be what is in common language termed a critical rath. It is often, at its commencement, miftaken for meafles, fcarlatina, & c. and is fometimes confounded with fcabies.
The lichen agrius appears to be an aggravated cafe of the former. The following is an inftance of this affeftion. The fubje£t of it was a lady 36 years of age, with dark complexion, and coarfe fkin. * Dur¬ ing the year 1793, the had often complained of pains in the head and ftomach, with a fenfe of depreflion and faintnefs. Thefe fymptoms were occafionally troublefome to her till the fpring of 1794, when they were fuddenly relieved by an appearance of numerous red, tingling papulae on the arms, and wrifts. A fimilar eruption appeared about fix weeks afterwards on the upper part of the breaft, and on the back, extending to the loins. In all thefe fixa¬ tions, if any of the papulae fubfided, and became fcurfy, frefh ones appeared : they were always mo ft vivid, and tingling at night; in the morning itchy, and lefs inflamed. The rednefs or inflammation round the papulae was greateft, and moft diflufe in the flexures of the elbows, where the fkin was alib interfered with rhagades, or chops. After taking powders compofed of cinnabar and nitre, with an infufion of the tops of juniper, for twTo or three weeks, the eruption wholly difappeared. It returned however on the arms, within a month ; and in autumn fome perfon perfuaded her to undergo a mercurial courfe, which kept her in a ftate of falivation for a confiderable time. During this procefs, her fkin was free from the eruption ; but as foon as the effedls of the mercury had fubfided, her arm was again covered
D d 2 with
$68 Willan on Cutaneous Difeafes> &V.
with numerous red papula?, more painful and tingling than before. At the beginning of the year 1795, in the fevere frofl, the eruption aflumed a puftular form ; the puihiles were fm all, hard, inflamed, and in many places confluent ; the ulcerations fucceedingthem were partially covered with blackiih fcabs, but continued to difcharge a watery fluid for feveral months, and did not wholly heal till the end of the year. Since that time the has been much affe&ed with pains of the limbs, head-ach, languor, and indigeftion. Thefe complaints are occafionally removed, in confequence of the appearance of papula? on the arms, and other parts of the body : but the eruption does not return at any flated times, nor is fo permanent as formerly.
‘ It may be obferved, that women are much more liable than men to the lichen agrius, and that the complaint ufually affeCls thofe who have undergone long continued fatigue, watching, and anxiety/
a
The peculiarity of the lichen pilaris is, that the fmall tubercles or afperities appear only at the roots of the hairs of the Ikin.
Lichen lividus. The puftules characterizing this eruption are of a dark red, or livid hue, and more, permanent than the foregoing. They appear chiefly on the arms and legs ; and are not attended, nor pre¬ ceded by febrile fymptoms. It principally affeCfs per- fons of a weak conflitution, who live on a poor diet, and are engaged in laborious occupations. The caufes fufflciently point out the cure.
By the lichen tropicus is meant the affection term¬ ed prickly heat , a papulous eruption almolf univer- fally affefling Europeans fettled in tropical climates. An account of the appearances in this difeafe, as found on the Coaft of Africa, is here furnifhed by Dr. T. M. Winterbottom, Phyfician to the Settle- . nient at Sierra Leone. A vivid eruption of papulae fomewhat analogous to the prickly heat, the author #bferves, appears in our own climate, on the arms,
hands.
Willan on Cutaneous Difeafes , 8fc» 369
hands, face, and neck of labourers, and other perfons - who ufe violent exercife during the hot months of fummer. It produces a fenffition of tingling and fmarting, more than of itching, and difappears in a fhort time without any particular confluences.
The laft genus of this order, is Prurigo (gratelle or univerfal itching of the fkim)
The fymptom of itching is common in a greater or lefs degree to moll difeafes of the Ikin : but there are fome cafes in which it occurs as the leading circum- ftance, and is at the fame time accompanied with an eruption of papular, the colour of which fcarcely ex¬ ceeds that of the adjoining cuticle, and with other appearances fufficiently particular to conftitute a diP tincf and independent genus of difeafe.
This difeafe, from its fuppofed affinities, has been ranked with fcabies, lepra, or impetigo. Not being, however, characterized, during its firft ftages, by an eruption of puftules, nor by fcaiy crufts, it muft be fe- parated from the above affeCtions, in an arrangement made according to external appearances.
The prurigo, as it arifes from different caufes, or at different periods of life, exhibits fome varieties in its form, which are defcribed under the titles of pru¬ rigo mitis, formic ans, and fenilis. The prurigo mitis appears generally in the fpring or beginning of fum¬ mer, and is characterized by foft and fmooth eleva¬ tions of the cuticle, retaining the ufual colour of the ikin, unlefs irritated by fcratching. If cleanlinefs is negleaed, it often changes to the itch; the acarus fcabiei beginning to breed in the furrows of the cuticle, the diforder becomes contagious. Frequent wallring with tepid water is faid to be all that is neceffary in the treatment.
The next fpecies is important, from its being often accompanied with general affeCtion of the fyftem : tor the purpofes of diagnolis we ffiall follow the
Dd 3 author
)
370 Willan on Cutaneous Difeafes , &c.
author in his defcription of the appearances and ac¬ companying fymptorns.
4 The prurigo forrnic.ans is a much more obftinate apd troublefome difeafe than the foregoing. It ufually affe6ts perfons of adult age ; commencing at all feafons of the year indifferently; and its duration is from four months to two or three years* with occafional lhort intermiffions. hey are diftufed over the whole body, except the face, feet, and palms of the hands ; they appear, however, in greateft number on thofe parts whicn from the ordinary mode of drefs are fubjeffed to tight ligatures, as about the neck, loins, and thighs.
y The itching is complicated with other fenfations, which are varioufly defcribed by patients. They fome times feel as if fmail mfefts were creepin°r on the fkin; fometimes as if flung all over by ants** fometimes as if hot needles were piercing the fkin in divers places. On handing before a fire, on un- dreffmg, and more particularly on getting into bed, thefe fenfations become mod violent; and ufually preclude all reft during the greateft part of the night. When any part of the fkin is ftrongly rubbed, it be¬ comes red ; and large tubercles or wheals are ex¬ cited, which however fubfide as foon as the irritation ceafes. The cuticle being abraded by the repeated application of the nails to allay the troublefome fen¬ fations of itching, the furface of the body is every where fpotted with fmail thin fcabs. This is in many cafes the only appearance which the difeafe exhibits to the eye, the papul<e being nearly ot the fame colour with the fkin, and often indiftina from their minutenefs.
Where the papula? are of the larger fize above rne^.ioned, their eruption is preceded by head-ach, fick ivTs, and pains of the ftomach ; and if they be fuddenly repelled from the furface, the fame fymp- tmns return in a violent degree. In other cafes, the i-ffeaion of the fkin is not fo obvioufly conneaed
with
Wiflan on Cutaneous Difeafes, S(c. S7:I
with a diforder of the ftomach : neverthelefs it may in general be faid, that this, fpeciefe of prurigo is at¬ tended with a ftate of ill health in the constitution ; for thofe perfons are molt liable to Suffer frequently from it, who are of a fallow complexion, who are weak and fomewhat emaciated, or who labour under obftruttions of the vifcera. The fame concluiion may be deduced from the nature of the caufes, which ufu- ally precede the difeafe : thefe, I have often had occafion to obferve, are grief, watching, fatigue, and a poor diet. However, as all perfons are not equally affefted in the fame circumftances, fomething mud neceftarily be referred to the original texture of the {kin, or ftate of the cutaneous ' glands. With re- fpe£t to this predifpofition, I have only been able to remark, that the greater number of patients had a more than ufual coarfenefs or roughnefs of the fkin, which feemed often to have been communicated hereditarily: and that when the itching and papulae difappear at the termination of' the difeafe, the cu¬ ticle is left dry, fcaly, and thickened. This obfer- v at ion is alfo made by Galen,
‘ To the occaftonal caufes above recited, I may add the want of proper cleanlinefs, to which the ap¬ pearance of this diforder in the lower clafs of people is often referable. Certain modes of diet have like- wife a confiderable efteft in aggravating or exciting the prurigo formic an s. Many perfons are affedted with it, who in the fummer feafon live much upon fifti, and other ftimulant animal food, at the fame time drinking freely of wine or fpirituous liquors. Some of the white Spanifh wines excite in particular habits an eruption of itching papulae, which is excef- iivelv rroublefome for many hours afterwards,, but does not become permanent if the beverage be dis¬ continued^ I have feen the fame effeft produced by wine made of the Mufcadine raifins ; a few giaffes of it has occaftoned an univerfal itching of the fkin, and precluded reft for twenty-four hours, or upwards,
D d 4 ‘ The
$72 Willan on Cutaneous Difeafes 5 6fc.
* The prurigo formicans is by m oft praQitioners deemed contagious, and confounded with the itch: in endeavouring' to afcertain the juftnefs of this opi¬ nion, i have been led to make the following remarks : I ft. The eruption is, for the moft part, connected with internal diforder, and arifes where no fource of infec¬ tion can be traced. 2dly. Perfons affefted may have conftant intercourfe with feverai others, and yet never communicate the difeafe to any of them 3dly. Se¬ veral perfons of one family may have the prurigo for¬ micans about the fame time : but I think this fhould be referred rather to a common predifpofition than to contagion : having obferved that individuals of a fa¬ mily are often fo affected at certain feafons of the year, even wh^n they refide at a diftance from each other.
c It is extremely difficult to relieve the prurigo formicans, either by internal or external remedies. Where it appears to be connected with general de¬ bility, or forne diforder of the abdominal vifeera, thefe circumftances require a prior confideration, and ffiould be removed by proper diet, exercife, or me¬ dicines adapted to the nature of the cafe. If the af¬ fection ot the fkin ftili continue after the patient’s ftrength and appetite have been re-eftablifhed, which is not unufual, it becomes neceffary to do fomething further for his relief. In this attempt I have expe¬ rienced many difappointments, from the inefficacy of medicines recommended on the heft authority. An- timcnials and preparations of mercury, given fepa- rately, or combined, produced no beneficial effetft: the former indeed very generally aggravated the com¬ plaint. Neutral falts and other remedies adminifter- cd as diaphoretics, were attended with as little fuc- C^fs. T he diet-drinks ufually employed in cutaneous difeafes contributed to allay the troublefome fenfation of itching : as little difference was perceptible in their refpehtive effefls, perhaps more may be attributed to the watery vehicle than to the virtues of the impreg¬ nating
273
Will^n on Cutaneous Difectfes , 8tc,
nating ingredients. Vitriolic acid, fulphur, cCthiops mineral, and cinnabar, I tried in a variety of cafes, for a ccnliderable length of time, -without obferving any permanent advantage from them.
6 Fixed alkali feemed to anfwer better than any of the above remedies : I employed the natron preparatum of the London Difpenfatory, fometimes alone, fome- times in combination with fulphur : at the fame time an infulion of fafafras or the tops of juniper was drunk freely. Under this courfe the difagreeable fymptoms were gradually alleviated, and the complaint difap- peared in a month or fix weeks. The oleum tartar! per deliquium, with a fmall proportion of the tindlure of opium added to it, was equally efficacious.
c Moft of the writers on this fubjedt, recommend itrong purgatives, adong with alterative medicines, in order to expel from the blood and cutaneous glan ds the vitiated humours, from which, as they fuppofe, the complaint originates. Their theory is probably erroneous; and the pradtice founded upon it, though very ancient, will not bear the teft of experience. I have, in general, found that purgatives frequently repeated are injurious; as might indeed be expedted from a previous confideration of the occafional caufes inducing this complaint.
‘ With regard to external applications, it may be obferved, that mercurial and lulphureous ointments proved of little fervice : that decoctions of white hel¬ lebore, fo much commended by the ancients, were without effect ; as alfo lime-water, or folutions of white vitriol, and corrofive fublimate. It is neceffary to keep the Ikin free from fordes, by frequent waffl¬ ing with warm water. The itching, however, is not always allayed by this means, whence I was induced to employ fome of the medicated baths recommended by authors, and obferved confiderable advantage from thole prepared with alkalized fulphur. Sea-bathing, alfo, in fome cafes, entirely removed the complaint/
The
3-7 4 Willan on Cutaneous Difeafes, $*c.
The prurigo fenilis is not thought to differ effen- tially, from the fpecies laft defcribed. It attacks ef- pecially. perfons in advanced life, and is- exceedingly Hard of removal.
*
The author next mentions feme pruriginous affec¬ tions which are merely local ; as thofe feated in the podex, praeputium, urethra, pubes, fcrotum, and pu¬ dendum muliebre. The laft of thefe is often the fource of great diftrefs : we Khali, therefore, tranfcribe the author’s obfervations on the fubjeft.
I be prurigo pudendi muliebris is fomewhat ana¬ logous to the prurigo fcroti in men. It is often a fymptomatic complaint in the lichen and lepra: it like wife originates from afcarides irritating the rec¬ tum ; and is, in foine cafes, connected with a dis¬ charge of the floor albus.
€ A fimilar affecfion arifes in confequence of the change of ftate in the genital organs at the time of puberty, attended with a feries of moil diftrefling fil¬ iations. I (hall, however, confine my attention to one cafe of this diforder, which may be confidered as idio¬ pathic, and which uiually affefts women foon after the ceffation of the catamenia. - It chiefly occurs in thofe who are of the phlegmatic temperament, and inclined to corpulency. Its feat is the labia pudendi and entrance of the vagina ; it is often accompanied •“with an appearance of tenflon, or fulnefs in thofe parts, and fometimes with inflamed itching papuke on the labia and mons veneris. The diftrefs arifing from a flrong and almoft perpetual itching in the above fltuation, may be ealily imagined. In order to allay it in feme degree, the fufterers have frequent recourfe to friction, and to cooling applications ; whence they are neceflitated to forego the enjoy¬ ment of tociety. An. excitement of venereal fenfa- tions alfo takes place from the conftant direction of the mind to the parts affedted, as well as from the means employed to procure alleviation. The com¬ plicated
Willan on Cutaneous Difeafes,. 8(c. 375
plicated diftrefs thus arifing, renders exiftence almofl infupportable ; and often produces a date of mind bordering on phrenzy.
‘ Deep ulceration of the parts feldom takes place in the prurigo pudendi ; but the appearance of apthae on the labia and nymphae, is by no means unufuah From intercourfe with females under thefe circum- fiances, men are liable to be affefted with aphthous ulcerations on the glans, and infide of the praepu- tium, which prove troublefome for a length of time, and often excite an alarm, being miftaken for chan¬ cres. They may however be removed by frequently wafhing the parts with milk and water, and by ap¬ plying at bed time the unguent-urn ceruffe acetate.
f Women, after the fourth month of pregnancy, often fuffer greatly from the prurigo pudendi, attend¬ ed with apthae. Thefe, in a few cafes, have been fucceeded by extenfive ulcerations, which deftroyed the nymphae, and produced a fatal hettic : fuch in- ftances are however extremely rare. The complaint has, in general, fome intervals or re millions ; and the apthae ufually difappear foon after delivery, whether at the full time, or by a mifcarriage. Saturnine lo¬ tions afford relief in {lighter degrees of the prurigo pudendi, but cannot generally be depended upon. Saline folutions, lime-water, vinegar, and oily emul- fions prepared with fixed alkali, have aifo a tempo¬ rary good effeft. The mo ft certain remedy is a fo- lution of corrofive fublimate in lime-water, half a fcruple of the former being added to eight ounces of the latter. The repeated application of it every day has in fome cafes wholly removed the complaint. Its ufe muff however be poftponed, if there are rhagades, or painful fiffures of the. ikin, which often occur, and require fome immediate palliation.
‘ Profeffor Lorry thinks the prurigo pudendi may be moll effedlually relieved by the warm bath, or by the application of the fleam of boiling water. He adds fome proper cautions againft: the ufe of wine
or
376
Hamilton on Hydrophobia .
or flrong condiments ; as alfo again!! foft feats and down beds, which are the means of exciting too great a heat in the part affedled.
‘ I have employed for this complaint the regimen and internal medicines formerly mentioned under the heads of prurigo formicans, and prurigo podicis, with various fuccefs ; and am forry to add, that the difeafe has proved in feveral inftances fo inveterate, as to refill; every plan hitherto recommended for it by medical authors/
This, then, concludes our analyfis of the firft order of cutaneous difeafes, as arranged by Dr. Willan. The remaining orders, as defignated by Scales, Rallies, Vehicles, Fuftules, Tubercles, and Macula?, will form the fubjedt of the future volumes of this work.
Art. XLI. Remarks on Hydrophobia , or the Dif- edfe produced by the Bite of a Mad Dog or other Rabid Animat. By Robert Hamilton, M. D. Member of the Royal College of Phyjicians , Lon¬ don y Sc. and late Phyjician to the Army. Gdhivo, 2 vols. Second Edition , with additions and correc - - lions. Price 12s. London. 1798. Longman.
ORE than ten years have elapfed fince the former edition of Dr. Hamilton’s work made its appearance : fo many corrections and additions have been made to it in this interval, that it deferves rather the title of a new treatife, than that of a fecond edition. Circumftances have of late befallen the au¬ thor which will doubtlefs forcibly call forth the fym* pathy of the reader ; yet the pro fen t work needs no foreign aid to excite an intereft in its perufal : its merits amply entitle it to an attentive confideration. Great pains have been taken to bring forward the whole mafs of our knowledge on the important fub-
jea
‘II
$77
Hamilton on Hydrophobia .
ject of Hydrophobia, and to examine narrowly into its nature and mode of cure. The refult of the in¬ quiry is, to withdraw our attention from frivolous ap¬ plications, under the aflumed name of fpecifics, and to fix it on the preventive plan, the only one which can at ail at prefent be relied on.
c The fhort time,5 fays the author, ‘ which I en¬ joyed the rank of Phyfician to the Army, fcarcely warrants me to notice it in my title-page, two months being its limits. A calamity into which I fell about the time of my appointment, was the means of depriving me of this rank. After a fevere- and tedious fever I totally loft my fight, and was on that account fuperfeded. It has not hitherro been thought expedient to compenfate me for this mis¬ fortune, by any other appointment, either civil or military. A few years of my life were formerly fpent in the army, in a medical capacity, where the duties of my humbler ftation were fcrupulo'ufly and confci- entioufty difeharged ; but the fituation did not, on leaving the army, entitle me to half-pay, and cuftom, it feems, does not fanftion fuch a recompence for that of phyfician, where the fervices have been fo limited, whatever the circumftances of the cafe may be. In the retirement, therefore, from bulinefs which followed, I turned my attention to the revifal of a Treatife formerly comppfed on Hydrophobia. 5
In the introduftion the author argues the poffibility ■ of the difeafe ariling in dogs from internal caufes, in¬ dependent of infection from the bite of another. — That heat of weather is not a fufficient exciting caufe is (hewn, from the infrequency of the difeafe in Ja¬ maica and other places in a hot climate. The fymp- ; toms are next deferibed as they take place in the dog ; a point of material importance, as we are thereby enabled to guard agamft accidents that might other wife happen. In the early ltage, however, the difference between this and other difeafes is not fo
obvious,
STS Hamilton on Hydrophobia .
obvious* for it has feveral fymptoms in common with them.
The following fymptoms are mentioned as pecu¬ liar to and forming this malady in dogs.
‘ 1- A difinclination for his food. He does not* it is true* refufe it ; but he takes it with an evident indifference and liftleffnefs ; this indeed is not pecu¬ liar. F
‘ 2. He is melancholy. It is as eafy to mark this fymptom in the dog as in the human fpecies. In health he is frolickfome and playful; but now he hangs his tail* and at the approach of his mailer or any^other of the family* ffiews lefs of that joy with
which he was wont to welcome them on their" return home.
c 3. His eyes appear mixed and dull. This may be called the firll llage; yet there is fcarcelv any thing pathognomonic here. It Ihould be obferved* that in this llage he will Hill obey the call of his mailer, and follow mm, nay* he will even fawn on him when he approaches ; but his memory is lefs ac¬ curate and he occafionally forgets him. His irregular peeviilmefs at this time points out he is greatly in- difpofed. It becomes now highly proper to regard our fafety, and not to truft him if he fnarls : nor oimhf we to attempt to carefs him. §
As the firft llage of the difeafe is indiflincl and marks nothing peculiar, we may be in danger from want of fufpicion of the nature of the malady ; but let the indifpofition of a dog be ever fo flight, pru¬ dence ought to direft us to treat it as of importance.
The fecond is more cliflinftly marked ; for in a day or two he feeds with lefs avidity, though he does not refufe, as has been faid, his vidluals ; authors have affirmed, but erroneoufly, that at this tirme he refhfes drink. He now ffiuns other dogs, and is equally lhunned by them. Obfervation, I think, does not confirm that the healthy limn the infe&ed in other
difeafes.
Hamilton on Hydrophobia . St#
difeafes, to which in common with other animals they are liable.
< Now comes the laft ftage ; he lofes altogether his recollection, quits his mailer’s houfe, runs forwards he knows not where, and without any particular de¬ li gn, rufhes in his fury, and without barking, at every animal that comes in his way, but turns not a fide to bite any, and in the fpace of two days after, or left, dies convulfed. If he is tied up he bites at his chain in this ftage of the malady, and is furious when approached.
c The fymptom of a drooping tail is more remark¬ able in this than in the former ftage ; another is like- wife evident, viz. a convexity of the back, formed by drawing his hinder towards his fore legs, an indica¬ tion of great uneaftnefs in the bowels. This is like- wife accompanied by an extreme drynefs of the nofe* c In all the different animals under hydrophobia (the dog included) the difeafe attacks by exacerbation and interval. — I can inftance this from good authority and ocular infpeCtion.
* One thing is remarkable ; and in which among others he materially differs from man under the fame difeafe ; he never avoids water, having no fear of it ; and as it would feem, feeling no inconvenience either from drinking or touching it. I know from expe¬ rience, he laps whatever liquid food is let before him, long after the poifen can be communicated by his bite. Previous to his death fame fwellings about his throat are f aid to have been obferved, and even the tongue has been affeCted in the fame manner, and dripping with flaver: fometimes it has been feeii to loll out of his mouth. Such is the common pro- grefs of the fufferings of a rabid dog, and fuch are the chief fymptoms that diftinguifti it.’
s It is a fortunate cireumftance for man, that he is not fo liable to be infedfed as the dog ; not more than one, perphaps, in fixteen of the human fpecies, who &tq bitten, take the difeafe. The fufceptibility of the
dog
380
Hamilton on Hydrophobia .
dog after a bite is difcovered to be much greater. Four men and twelve dogs were bitten by the fame rabid dog; all’the men efcaped, but every one of the dogs died mad. In comparing inftances of this kind in authors, many proofs corroborating this remark, will be found. The men here ufed no other means of prevention than what we every day fee fail. To what can we attribute this? Scarcely, I think, to the greater fen ability of the canine fyftem, rendering it more eaiily inf Tied. It mull be to fome other law in the ceconomy of his framed
The queftionrefpe&ing the mode of aftion of the canine poifon is next difcuffed ; whether it afts by abforption, or nervous irritation. The former opi¬ nion is that adopted by the author; but a detail of arguments here, would carry us to much too great a length. The queflion, however, is not likely to be loon fettled fatisfadtorily.
Abforption, the author thinks, is proved by thofe cafes of the difeafe where no wround has been infliS- ed, but the poifon has been limply applied to the found Ikin'. Of this feveral inftances are recorded, both antient and modern, One of this kind is ad¬ duced by Dr. Bardlley, on the authority of Dr. Per-
• cival. A man living at Worral in Chefhire, having
• fallen alleep on the ground, while he was . in this fituation, a mad dog accidentally came pall, licked him about the mouth, then ran away, without doing him farther injury. He was feized with the difeale about the ufual time, and died in confequcnee.
Another inftance is afforded by the author on the ' authority of a competent witnefs. A young woman hid her apron torn,; and Havered by a mad dog leap¬ ing on her and attempting to bite. Fortunately Hie received no other injury from him, by the timely af~ fillance offered, and by the loofe part of her cloathing which he laid hold of. But imprudently and without proper refleftion, fhe began to mend the rent in her
apron
SB 1
Hamilton on Hydrophobia.
apron before the part was either wafhed or well dried 3 and as imprudently, or through habit, inftead of cut¬ ting the thread with fciffars, bit it off with her teeth. In a few weeks fhe was feized with hydrophobia, which proved fatal *.
Leaving, however, the opinions of local irritation , and abforption , to be further difcuffed by fuch patho¬ logies, as may conceive the arguments here adduced inconclulive on either fide, the author proceeds to confider the queftion, In what manner is the prac¬ titioner to conduct himfelf, in order to obviate the' impending danger from rabid virus, either inferted in a wound by the animal’s tuffs, or befmeared over fome naked part of the body, thinly and delicately covered with cuticle. Whatever may be the iffue of the opinions refpefting primary irritation and abforp¬ tion, .the method proper to be purfued will be pre- cifely the fame.
The author combats the opinion which has been inculcated by fome, that the difeafe may commence at any time, from the fir ft hour rill years after the bite. The cafes of difeafe which have been given as fuc- ceeding the bites of enraged animals, as cocks and* other domeftic fowls, horfes, cows, apes, fwine, &c. and which have often been called hydrophobia, are confidered as cafes of tetanus, and not at all allied to hydrophobia, -which, the author believes, feldom, if ever, commences before the nineteenth day, or af¬ ter the eighteenth month.
The firft mode of prevention noticed is that by fuftion of the wound. Some authors have recom¬ mended fucking the wounded part, and affirm that no danger can attend the perfon who performs this humane office, as the poifon muff be eje&ed with the faliva by which the internal parts of the mouth are conftantly bedewed, and which, as a further fecurity,
* For other inftances of the like kind fee Ephem. N. C. ann, 7. obs. 1 21. — Coel. Aurel. De Morb. Acut. lib. 3. cap. 9. — Joh. Ma- thaei Conful. No. 82.— Matthiola Opera.— Hildani Cent. j. obs. 86. — Phil. Tranf. No. 277*
VOL. V.
ji. e
may
-382 Hamilton on Hydrophobia,
I
may be waflied out afterwards with water; Exam¬ ples are adduced in proof of the fuccefs of this me¬ thod in the bites of other poifonous animals and rep¬ tiles, fuch as the viper, &c. But from the trials of Dr. Mead on the viper, it is evident, that on touch¬ ing the tongue and lips with this reptile’s poifon, there is danger. This eminent phyfician and fome other friends, in order to afcertain its nature, ventured to tafte it diluted with water, and their tongues were inftantly affefted with a fharp burning heat. One, bolder than the reft, tafted it undiluted, and fuffered for his temerity. The inflammation induced thereby
did not fubfide for two days.
It is not reafonable to fuppofe, therefore, that fuftion would fucceed better where the poifon of a rabid animal is introduced. In many cafes the teeth penetrate deep, and in various directions, over which the fuperincumbent parts form valves, preventing its return to the furface. There is, likewife, no proper evidence of its having been fuccefsfully employed. That it could not be done with fafety to the operator would appear from the exiftence of the difeafe from the mere application of the poifon without a wound, as above mentioned.
Of Extirpation, Ablution, and Cauftic. It would be highly defirable to know the length of time the poifon remains in the part bitten, before it begins to exert its effe&s on the fyftem. A rule might hence be formed, to guide us in our local treatment. The following faffs are adduced on this head.
< Firft, Mr. Loftie had a patient who received the bite twenty hours before the part was extirpated, which is the operation under confideration. I he difeafe did not take place.
£ Second, Of two cafes related by Mr. Foot * ex- cifion was not performed in the one till near twenty- three hours, and in the other not till fixty-eight had elapfed. Both did well.
* * Vide Foot on Hydrophobia.
* Third,
Hamilton on Hydrophobia. 5 85
* Third, It was thirty hours in the cafe mentioned by Doctor Shore*, before any thing was done to the wound. The patient efcaped.
f Fourth, It was not till after twenty-eight days, from the bite, in the cafe of the young lady at Ipfwich'f, when extirpation was performed. She is now, at the diftance of three years, in perfefl: health.
c Fifth, In fpring 1792, and the preceding winter, the county of Suffolk was greatly infefted with mad dogs, efpecially round Saint Edmund’s Bury. Several accidents happened from them to men and other ani¬ mals. This afforded opportunities for exciffon at dif¬ ferent diftances from the bite. Some of them fell under the care of Doctor White of that place J. In one cafe he cut out the part three days after the accident. The perfon has ever ftnce remained well. Seven were bitten by rabid dogs about the fame time in the neighbourhood. Three of them did not apply till the third day: two came to him on the fecond day ; the other two not till fame time (the period not fpecified) after the accident. The parts were then extirpated, and they all did well.
< Sixth, A foal was treated in the fame manner, bitten five days before. The animal continued well long after.
« On the other hand, the fame dog bit a horfe, a cow, and two pigs on the fame day; no excifion was ufed; and though internal remedies were adminifter- ed, the animals were all dead within the month ; a preemptive proof of the fuperiority of extirpation,
c Seventh, I ordered two of my patients, Field and fon^f near this town, who had been bitten about forty
4 * Vide Meafe’s EfFay on the Bite of a Mad Dog, p. 12.5 .
4 f Vide page 23, note.
4 X The Do6tor was not inattentive to the advantages that might re- fult from this mode. Vide his oblervations on the fuhjec.t, in an ap» pendixto Meafe’s Eflay on the Bite of a Mad Dog, London, 1793.
4 qy Thefe are the two perfons mentioned in my firft edition. The cafes were then too recent for a decided opinion as to the efficacy of
the
E c 2 hours,
584
Hamilton on Hydrophobia .
hours,, to fubmit to the extirpation of the wounded parts, which was done. At the fame time i directed them to chain up the dog, to determine refpedting his diforder. The dog died mad on the third day, after
owing marks of a moft violent difeafe by fits of the higheft exacerbation, and fury, exerted againit the chain that bound him, and the rails of the cage wherein he was confined, ihe men remain tree from the difeafe at this day.
< From thefe examples we may hope favourably even from late excifion. But have we reafon to hope the fame at the commencement of the difeafe ; at the re-inflammatlon of the wound, the harbinger of this awful period ? Is the poifon latent in the part where firft infer ted till this time ? From all parts of the evi¬ dence carefully weighed and taken together, I think, there is reafon to conclude, that an operation, even at this late period, may be fuccefsful in preventing the approaching malady.5
The following inftance feems to fhew that preven¬ tion may take place at the very commencement of the fymptoms. Hr. Guthrie had a patient at Peterf- burgh, who was bitten by a dog. This was a boy, fer- vant at that time to the Britifh minifter then refident at the Ruffian Court. This animal bit two other dogs on the fame day, both of which died mad in the {pace of a month. This was evidence of the exiftence of the difeafe in the animal. The wound was in the foot. The Doctor fcarified it till it bled freely. After
tire operation, Twelve years and upwards have elapfed, and I may
now fpeak with pofitivenefs. ‘
< This dog had left home a day or two before, and remained abient about two days; the family miffed him, but knew not the caufe of his abfence. Soon after his return he committed the accident. He not only ate and drank that day, but likewife after being chained. He ap¬ peared, on his return, as if fatigued and famifhed by abtlinence and negleft, and knew the family as formerly; followed his mailer, who went to labour at his farm, and flept contiguous as ufual, unfufpefted of difeafe. "It was on his mailer’s walking abruptly up to him that he flew on him, and bit him. The fon was bitten afterwards, in another exacerbation ; a farther proof of fits, and intervals in the malady. y
385
Hamilton on Hydrophobia .
this it was dreffed with ftrong mercurial ointment for fourteen days 3 and the fore was kept open by apply¬ ing, oceafionally, a fmall blifter over the part.
Farther, the wound was dreffed with Hill’s Ormf- kirk medicine. By this means the fore was kept dif- charging for five weeks. It was then differed to heal, and remained fo tor ten days, which comprehended a period of feven weeks from the accident. Ine boy then felt {hooting pains in the cicatrix ; thefe lafted for feveral days, and one of the cicatrices began to inflame, and aflame the appearance which the incifion of inoculation prefents before the eruption of the fmall- pox. The Doctor immediately ordered the wounds to be re-opened, and ftrong mercurial ointment again to be applied. During its ufe the fhooting pains ceafed, and the eruptive appearances fubfided; the boy remained well long after.
On the whole, therefore, the author is of opinion, that excifion ought not be omitted at any period, from the infliftion of the wound by the rabid animal, to the firft fymptoms of the approaching difeafe.
6 In removing the bitten part, much care and judg¬ ment are requifite. It cannot be doubted but a few failures, of which we read,- arofe from want of atten¬ tion to the minuter circumftances in the operation. On removing the piece, the under furface fhould be carefully examined to find whether the wound pene¬ trated through. If this be difcovered, a deeper piece ftill fhould be taken out, fo that no mark whatever of the tooth be perceived, but the under fide be pure and found. For fhould the lealt fpeck be left, which had been touched by the poifoned tooth, there will be no certainty of fafety 3 the operation will prove nuga¬ tory. I fpeak of recent injuries ; but it days have elapfed, the enfuing inflammation, in the progrefs towards cicatrization, will alter the appearance, and render other cautions neceffary.
c Mr. Hunter, on cutting out the piece, in one cafe, examined the under furface ; no marks of a tooth were
E e 3 perceptible.
386
Hamilton on Hydrophobia.
perceptible. But on examining the fuperftcies of the wound from which the piece was removed, he oh- ferved a part in the middle hollow underneath. This was proot of his not having cut fufficiently deep, and nothing but this nice examination could have con¬ vinced him to the contrary.
j
‘ l fhall, without hefitation, then, recommend, and would enforce it, were I able, a piece to be cut out round the part wounded, making the incifion at the fame time pretty deep, to prevent accidents, from leaving any of the animal’s faliva behind. I can fee little cruelty in this, when we compare fhort tempo¬ rary pain to the dire fcene that we have reafon to expend
The adlual cautery, befides its being often imprac¬ ticable, is lefs to be relied on than excifion. c Some¬ times it happens that the part bitten is unfavourable for extirpation. This is the cafe when large vcounds are received either in the lips, or about the face. In thefe parts a fpeedy cicatrization is defirable to pre¬ vent the deformity, which muft fucceed fores long kept open, where the bafes are enlarged, and the lofs of fubftance becomes greater ; and, if with the pre¬ cautions already delivered, the wounded furfaces be removed, there can be little room for future appre- henfion.
c Extirpation either in the upper or under , lip, has likewife inconveniencies : a fear from a large wound muft remain altogether unfeemly, disfiguring the coun¬ tenance.
/ This was the part bitten in the unfortunate cafe of Mailer Rowley. Cauftics, however, were applied, foon after it was received. That they did not fuc¬ ceed might in part arife from the cauftic not having touched every part of the wound ; but with as much probability trom fome of the clog’s faliva adhering about the gums or inlide of the lip, from whence it was afterwards abforbed ; for, “ the lip was torn a
good
Hamilton on Hydrophobia * 387
good deal. The teeth” (of the dog) a had ^gone through and through, and had torn out a piece.”
c In fuck cafes the phyfician hgs a molt difficult part to aft. If he pays too great attention to appearances* he may fall into' the oppofite extreme, and lofe his patient from lenity and regard to his looks. If he boldly advifes extirpation, and his patient ffiould fur- vive, he may not efcape cenfure, but incur his dif- pleafure through life for disfiguring him.
c The moft unfavourable places are about the face ; and of thefe, the cheeks* nofe, and lips are moft lo. The fore part of the neck alfo, is not without incon¬ veniences, yet it is better to ufe the knife on fuch occafions, than to fuffer the patient to fall a facrifice without attempting fo rational a prophylaftic* Should the worft take place, we have discharged our duty without trailing to chance for an efcape/
With refpeft to cauftics, in thefe cafes, the author obferves, one general remark may be made, viz. That the ftronger, not the weaker, ffiould be had recourfe to. Whatever diffolves animal fubftances moft per¬ fectly and fpeedily, penetrating deep* is the fitted: for the prefent purpofe. The kali purum is of this kind. It forms immediately an efchar to fome depth, which may be immediately removed by a fpatula ; and by re-application of the cauftic, another be taken off; and this being repeated, removing ftratum after ftratum, we proceed to the depth intended. In this mode of ufing cauftic it would feem equally fafe and equally fuccefsful with excifion by the knife,
Specifics are next fpoken of. In all ages, from almoft the firft appearance of the difeafe, men, as it was natural, began to turn their thoughts not only towards its prevention, but its cure. Various were the fubftances which ignorance and fuperftition* in condufting this refearch, led them to propofe. That their inveftigations were not crowned with fuccefs* is
E e 4 too
388
Hamilton on Hydrophobia.
too well known: and although the darknefs of former ages, with refpecl to fcience, might be an apology for introducing the numerous train of inert trifles* termed fpecifics, which their practice prefents ; yet later times enjoying the advantages of more enlight¬ ened inveftigation, ainidft the various and luminous difcoveries which patient labourers have produced, can boaft of having penetrated but little farther than the fages of 2050 years ago,* into the abftrufe nature of this dreadful malady.
Specifics have abounded from their days, down to the pyefgii t. The word has fomething fafcinating in it ; and when pronounced, reafon feems to defert her abode. The underftandings of the great dl men of the refpeelive ages in which they ilourifhed, became clouded, howfoever penetrating in other inveftiga- tions, when this idea took pofteffion of their minds. No illuftration is neceffary to prove this. The variety of fpecifics, their ever-changing competitions, arid their conflant failures, ftand forth as the monuments of their infignificancy, and the truth of this obferva- tion. Much mifehief have they produced ; while a iingle inftance of advantage, howfoever loud their in¬ ventors may have proclaimed the contrary, cannot be fairly and openly brought forth in their favour to fatisfy rational invefligation.
W ith jiftliee, therefore, the author warns us againft placing any reliance on fpecifics. The greater part of them, indeed, have gone into merited oblivion ; but two or three hill retain a fhare of the public confidence. One of thefe is the Onnjkirk medicine, which is ftill held infallible by many, especially in the northern and weftera .parts of England, though its infufficiency has been many times proved in the molt decifive manner. From the analyfis of Dr. Blackr- and that of his pupil Dr. Eleyfham, the
j
* The time, according to fome, when the difeafe firft appeared.
<■ - com po fit ion
Hamilton on Hydrophobia .
compofition of this medicine appears to he as fol¬ lows : / -
Half an ounce of powdered chalk.
Ten grains of alum.
,, o „ .
Three drams ot Armenian bole.
One dram of the powder of elecampane-root.
And fix drops of the oil of anifeed.
The Tonquin remedy, introduced by Sir George Cobb, is well known to confift only of cinnabar and mull : whilft that of Dr. Mead is a powder confiding of afh-coloured ground liver-wort, and black pepper. From the nature of the ingredients of which thefe medicines are compounded, no one will now expedt from them any adlive properties ; nor does their uti¬ lity reft on any degree of fatisfacfory proof; at the fame time that their inefficacy has been repeatedly and moft clearly eftablifhed.
Vinegar has of late been recommended as another preventative, by Dr. Moneta, Phyfician to the King of Poland, who has lately written on the fubjedf . The fol¬ lowing obfervations of the author, together with the facts adduced, (hew clearly how little the recommen¬ dation of writers in favour of new remedies can be confided in, in this as well as in other cafes. c Dr, Moneta aflerts his having prevented the difeafe by it (vinegar) in more than fixty cafes, when ufed as he dired'is, immediately after the bite, and for nine fuc- ceeding days, as an external application to the wound, which is to be previoully w allied with warm water, cupped, and fcarified. He mixes it with a fourth part of melted butter, and dipping therein compreffes, binds them over the part, renewing them frequently. While this procefs goes on, an ounce and a half at a dofe is frequently adminiftered internally ; and this is continued till about the fifteenth day, not thinking it neceftkry, however, to keep the wounds open longer
than
5 §6 Hamilton on Hydrophobia .
than the' ninth day. The difeafe, he allures us, has been ftopt at its commencement by the fame means. Did experience in the hands of other men furnilh fimilar events, the difcovefy would be as valuable as the method is Ample.
c Vinegar has alfo been applied in Italy, and equally extolled ' but fmce that, we are informed it has failed there in one inftance * and I am appre- henfive, the inference to be drawn is* that in thofe cafes wherein its fuceefs was announced, there exifted no rabid infeftion ; and that in this cafe, where rabid infection operated and proved fatal, the infallibility of the remedy was put to the teft.
‘ At Warfaw it had like wife a tolerably fair trial in two inftances.
£ Eleven perfons out of feventeen were committed to the care of Dr. Wolf. He did not negleft this opportunity of putting to the teft the moft noted fpe- cifics which were recorded, or were fafhionable at that time. It was the ninth day after the accident when they applied. He made deep fcarifications in their wounds ; ufed careful ablution, warm fomenta¬ tions, with vinegar, fait, and theriaca ; and kept open the wounds for eighty days, in thofe who lived fo long. Every fourteen days copious V. S. was ufed ; and every feventh day a ftrong cathartic of falts and jalap adminiftered. Their diet was chiefly vegetable ; their drink only whey and water. The herb matri- iylva, in as large a quantity as could be procured, was recommended, which they daily ate. They like- wife ate plentifully of the herb anagalis (flore puniceo) another noted fpecific ; and at the fame time did not omit the famous compofition of Palmerius. Befldes this, which was the general treatment, two were daily rubbed with a dram of mercurial ointment, and were purged with calomel. To two others were daily prefcribed four ounces of vinegar, three drams of the tinfture of poppies ; and at night they were ordered half an ounce of rob fambuci. Another took
every
1291
Hamilton on Hydrophobia .
every day fifteen grains of camphor, four fcruples of nitre ; and at night half an ounce of the fame rob. Two others took twenty-four grains of mufk, vfith fifty grains of cinnabar; other two took from forty to fixty drops of fpirit of fal ammoniac, prepared with quick lime; and the laft took a fcruple of chryftal- lifed fait of tartar prepared by the mixture of a little fpirit of fal amnion, with a folution of that fait.
c An officer, one of the number bitten, came into the city on the day after the accident, and had the beft advice the place afforded ; befides which, as a’ preventative, he took the bark and camphor very co- piouily ; yet, in the feventh week, he was feized with the difeafe, and died. One of thofe under the vinegar courfe fell ill on the thirty-third, and died hydrophobic on the thirty-fixth day. They vomited and bled him copioufly, but without effefit. The other, an old man, is faid to have recovered after an indifpofition which they attributed to the difeafe. He was purged and bled, and took befides morfulm balfami Peru- viani, and drank lemonade. After his recovery 100 drops of fp. fal arnmon. were daily taken. A curious remark is added rcfp effing this man. It is affirmed, that the blood drawn during this illnefs, which was certainly not hydrophobic, had a very foetid firiell. This, perhaps, might be attributed to the balfam, and other medicines ufed.
4 The man to whom the camphor, nitre, & c. were given, fell ill on the thirty-third day: he underwent a very powerful treatment, but ineffectually. cc He was thrice copioufly blooded ; was plunged forcibly into the coldeft water, for the fpace of two hours, and was nearly drowned. He was clyftered with effect. He himfelf forced down, with incredible aver¬ sion and labour, a great quantity of drink ; by which he vomited more than fifty times abundance of frothy flime. He took feveral ounces of oil, and feveral bolufes of caftor and opium, of each four grains, without effeCt * and died the fourth day.”
4 A girl.
L
f92 Hamilton on Hydrophobia .
c A girl, who ufed the mulk with cinnabar, was attacked with hydrophobia on the fixty-fecond day, and died on the flxty-fifth. Her companion, a preg¬ nant woman, had taken, till this, the fame medicine, which the now exchanged for fp. fal ammon. Nothing further being faid, it is prefumed that fhe continued uninfeCfed ; but a third woman, who had taken nothing, fell ill on the fortieth day. She is defcribed, as fuffering under the ufual fymptoms, wdth the ad¬ dition of excruciating pains in the bowels. She took, in two days, no lefs than two bottles of brandy, re- filling every other liquor. To this the doctor ordered daily twm bolufes of caftor and opium, and advifed her likewife to add to her brandy an equal portion of oil. She recovered. This woman certainly never had the hydrophobia. Apprehenfion of the fate of her companions, bitten at the fame time, might have alarmed her.
c The furvivors continued their prophylactic treat¬ ment to the hundredth day. How far the remaining number would efcape, could not then be known, be- caufe the time of danger w7as not over. He mentions four of them, who took nothing, being in as good health as anv of thofe under his care: and the con-
j
clufion from the whole is, that had his furviving pa¬ tients taken nothing, they would have been equally in health/
With refpecf to the cold-bath, Dr. Hamilton is certainly warranted in his conclution, that it never at any time prevented the operation of rabid in fe 61 ion from coming into action at the time of its proper lawr, nor cured the difeafe when it had once taken place.
Of mercury too the eftimate is little more favour¬ able. It has failed in fo many inifances on record, that we have great reafon to fulpeCt its virtues, and might be juftified in configning it to the fame obli- vkf with other noted fpecifics. From the following
cafes.
/
393
Hamilton on Hydrophobia.
cafes, afforded by authors of obfervation and expe¬ rience *, every doubt on the fubjeCl mull vanifh.
* Etienne Champion was treated with mercury, and a ftrong falivation produced.
c Briquet in vain ufed mercury three or four weeks to a falivation.
c The Sieur Gravan was falivated a confiderable time, with the fame unfortunate event.
f Meffrs. Rebiere falivated no lefs than ten, and unfuccefs fully.
‘ M. Theiffet treated feven hy prophobics with mer¬ cury, yet they all died.
c Dr. Oudot had a female patient who died alfo, though it was largely exhibited.
* Three of Laffon’s patients died, though treated in the fame manner.
c A woman under Revolot’s care ufed it unfuc- cefsfully.
‘ Dr. Francis had three patients to whom mer¬ cury was likewife ineffectually exhibited.
c Roux has collected feveral cafes to prove its inutility.’
To thefe the author adds two more. In the one. Dr. Gray of Bengal exhibited it, keeping up ptyalifm a confiderable time : and Dr. Raymond of Marfeilles in the other, ufed it for forty days, railing a falivation alfo : yet both thefe patients died hydrophobic.
The author next defcribes the Symptoms of the Difeafe, as they appear in the Human Species. But thefe, with the remaining parts of the work, mu ft be referved for a future number.
* Mem. de la Soc. Roy. de Med. Anno 3783.
Art.
( 39f )
Art. XLII. Recherches Phyfiologiques , et Experi¬ ences Jur la Vitalite. i. e. Phyfolqgital Refearchesy and Experiments on Vitality. By j. J. Sue,
M. D. and prof ef or of Anatomy.
Magazin Kncyclopedique. 1797.
fT^HE fcience of anatomy, or the defcription of Jj^ the fituation and UruEture of the different parts of the human body, has been carried in the prefent age, to a confiderabie degree of perfection. The moft celebrated an ate miffs and phyfiologifts perceived that it was time to dire ft their inquiries towards the caufes of the motive faculty of animals, and the hid¬ den fource of their fenfations : but as the nerves here perform the principal part, the neceflity of an exaft defcription of thefe parts became apparent. It was with thefe views, M. Sue obferves, that Meckel em¬ ployed himfelr m defending the nerves of the face, where are reprefented all the fentiments of the foul : that Walker deferibed at confiderabie length, thefe of the cheft and abdomen, the knowledge of which is fo effential in a number. of difeafes : that Girardi gave us an excellent defcription on the origin and ramifications of the intercoftal nerve : that other ana¬ tomies, jn fine, have applied themfelves to the dif* covery of the nature and ftrufture of ganglions and plexufes, the knowledge of which, particularly the former, the author confiders as calculated to throw great light on the phenomena of animal motion and fenfation. From the obfervalions he has made on ganglions, he thinks they may be confidered as fo many magazines, where the vital power and fenfibility are united, to be carried at length to the nerves which arife from, or which have commu¬ nication with them, and thus to increafe their aftive force.
It has been fought to difeover, whether the nerv¬ ous fluid, or the fubfiance which ; appears to perme¬ ate
395
Sue fur la V Halite,
ate the nerves, has a circulatory motion ; but we have gained nothing by the attempts which have been hi¬ therto made. Although, according to the older phy- fiologifts, the brain was confidered as the foie feat of feeling, and was regarded as the origin of all mo¬ tion and fenfation, this opinion appears at prefent, after much obfervation, liable to great and numerous difficulties. It has been remarked by feveral anato¬ mies, M. Sue obferves, that in many animals, and even in man, appearing to enjoy the belt health, that the brain has been almoft of a ftony hardnefs. M. Le Roy informed the author, of a cafe he had wit- neffed, of a man who died fuddenly, and in whom he found a confiderable part of the brain offified, although he appeared to enjoy perfect health to the time of his death, and to poffefs the entire ufe of his mental faculties.
If it be alked, how the vital functions, and the powrer of fenfation, could exift under fuch a hate of the brain, while the fmalleft injuries of this vifcus are often fufficient to induce palfy ? the anfwer is, that we are hill fo totally ignorant of the nature of the brain and nerves, that we know not in what degree thefe contribute to the produff ion of this affeffiom For what can be oppofed to thefe faffs ? It is ini- poffible not to conclude, that in the individuals fur- nifhing the obfervations, the feat of fenfation muff exift eifewdiere than in the offified portions of the brain. There have been numerous inftances of foe- tufes born at full time, or nearly fo, without a brain, and even without a head, although ivell formed in other parts. Many obfervations 'of this kind are ad¬ duced, from different authorities*. Two years ago, the author diffecfed a foetus at full time, in which there exifted neither cerebrum, cerebellum, medulla oblongata, nor fpinal marrow, not even the rnedul-
* Comment, de Leipfic. tom. 17. — Hidoire de 1’Acad. de Scien. 3711, &c.
lary
396
Sue fur la Vitalite.
lary canal ; yet there were found the firft ten pair of nerves, the cervical pairs, the ctorfal, lumbar, and facral, with their diyifions and fubdivifions in the extremities ; likewife the great fympathetics, the vif- ceral, add the eighth pairs The child lived and moved for feven hours. The author examined ano¬ ther foetus at five months, which had neither head, bread, ftomach, nor final! inteftines.
From all tbefe facts one may conclude, that the fource of fenfation and of organic life, which, in tbefe individuals, conduced to the developement of their' organs, could not be the brain.
The independence of the vital functions on the
brain, appears further from an experiment made on the tortoife, which lived fix months after its brain was removed, and performed all its ordinary move¬ ments. In the fame animal, the circulation of the blood continued more than twelve hours after its head was cut off.
It appears, therefore, from thefe observations, that the feat of fenfation, which has been -attributed ex- clufively to the brain, may exift in other parts, and really does exift in the fpinal marrow; ftnce it is im- poffible, without this fuppolition, to explain the pre¬ fence oi vitality and fenfation in beings deprived of a brain.
The fpinal marrow, then, feerns, in a certain de¬ gree, to fupply the place of brain, and to fulfil its functions. The real nature of nerves, and the man¬ ner in which they produce fenfation, is wholly un¬ known to us. Many phenomena feem to ihew, that they poffefs properties of which we are ignorant ; they poffefs powers which exift long after the parts to which they belong are feparated from the boclv. This property renders organized beings altogether different from machines, with which they have fo often been compared. In the latter, all movement ceafes the inftant the parts ceafe to communicate with the moving power; whilft the parts of an ani¬ mated
3
I
Sue fur la Vita Hie. 397
mated being, preferve, for a considerable time, their movement or vitality.
In one of the author's experiments, the head of a young turkey was feparated from the body by a tingle ftroke : the animal fell down motionlefs, and appa¬ rently without life, but in a Short time raifed itfelf on its feet, and clapped its wings, with great acti¬ vity. In this cafe it is difficult to conceive whence, in the body of an animal deprived of its head, and confequently where the fpinal marrow can no longer communicate direftly with the heart, the nerves can acquire their power of reproducing fuch diftindt and powerful movements. If this vitality of animals, or rather of their parts after Separation from the whole, afford fuch finking phenomena in quadrupeds, birds, fiffies, the amphibia, See. it is ftill more remarkable in infefts and other Similar beings, although the dura¬ tion of their exiftence be ffiort : but thefe phenomena Should the lefs excite our wonder, as they belong ef- fentially to the nature of the organization of thefe beings, which we are ftill So little acquainted with. We perceive, in faff, that thefe phenomena are al¬ ways dependent on this organization ; and when, for inftance, animals are fo conftituted as to Suffer the divifion or removal of certain parts without deftruc- tion to that harmony which fubfifts between the reft, life, in fuch, may be preferved for a confiderable Space of time : but we find it difficult to admit this, from our habits of deducing too general laws from individual observations ; and thus we are aftonifhed at meeting with facts which appear to contradict them.
(To be continued.)
Art.
VOL, V.
Ff
/
( 398 )
Art. XL! II. * Report of the Commijf oners appoint¬ ed by the National Inftitute to repeat the Experi¬ ments which have been made on Galvanifm: read in the Name of the Commi/fion, by Cit . Halle. From the Bulletin des Sciences, par la Societe Philomath ique, Thermidor, An VI.
rT^HE commiffion was not fatisfied with repeating JL a great part of the experiments already madel they claffed them, and rendered them complete by the addition of others which were wanting.
I. The phenomenon of Galvanifm, taken in gene¬ ral, is as follows : A communication is elfablilhed be¬ tween two points of a feries of nervous or mufcular organs by means of certain determined fubftances. At the moment when this communication is made, them take place m the Hate of the organs changes, the nature oi which is Hill unknown 3 but wrhich are xnanifelied by fenfations more or lefs lively, or con¬ tractions more or lefs violent, ffhefe mufcular con- ti aCtions take place even in feparated parts of the body, and with as much force as when produced by the molt effectual means of irritation, the” feries of mufculai 01 nervous organs is called the animal arc j the other fubftances form the exciting arc. The com- polition of both may be varied many different ways..
II. Among the effects refultmg from the different compontions of the animal arc, the following are the molt remarkable : A ligature made on a nerve does not intercept Galvanifm, unlefs it be made in the part fm rounded with He Hi. If the nerve be cut, and its two ends be in contaft, Galvanifm takes place. ; but
if they are only brought near to each other, without contaCt, it is intercepted.
* We are indebted for this article to a very ufeful monthly pub- MagaziJ, No f ^ Y “de “S aPPearance> th= Vhilojogcal
III. Among
S99
Report on Galvanifm.
III. Among the effefts refulting from the different competitions of the exciting arc we fhall remark the following : The moll favourable compotition is when it contifts of three pieces, each of which is a different metal. One muff touch the nerve, and the other the mufcle : thefe are called the fupports , or armatures . The third forms the communication. This is called the communicator. But one or two of thefe maybe omitted. Animal bodies, or water, may be placed between them 3 or other fubftances, either metallic combinations, or all other metals, 8c c. may be fub- ftituted in their ftead. It has not yet been poftible to determine exactly what are the moil ineffectual com- binations ; but they have been already claffed to a certain point, according to the degree of their effica¬ cy. Gold, tilver, zinc and tin, are the metals moft favourable to Galvanifm, when introduced into the exciting arc.
In general a tingle metal does not aft, except when all other circumftances are favourable 3 but in that cafe it has been often feen to aft. Error, however, may readily here arife 3 for, if one of the ends of the arc be alloyed, in a proportion ever fo little different, the arc afts as if there were two metals. By rubbing one end with a different metal, fometimes even with the fingers, or by breathing upon it, efficacy may be communicated to it, under circumftances where it would not otherwise have poffeffed any.
Oxydes aft lefs efficacioufty, ejeteris paribus , than their metals. Dry carbon afts as an actual metal. It is not intercepted by water and moift fubtiances, nor by the fingers if wet ; but this is not the cafe if the fin¬ gers be dry. The energy of Galvanifm is not inter¬ cepted or diminiflied by pieces of dead fiefh. The effects of it are fenfibly checked by the epidermis ; and they are incomparably greater in flayed animals, or in parts of the human body from which the epidermis has been removed.
It cannot be faid that Galvanifm is intercepted by all idie-eleftric bodies 3 but, on the other hand, it is
3 inter-
400 ' Report on Galvanifm .
intercepted by all fubftances which are ftrong con¬ ductors of eledhicity. Such are dame, very dry ani¬ mal hones* the fteam of water, glafs brought to a red heat, &c. •
IV. Galvanifm is influenced alfo by feveral circum- fiances foreign to the compofition of the two arcs. Such as, 1. The date of the parts which are fubjecied to the operation : the frefher they are, the ftronger are the effects. 2. The longer or fliorter exercife of Gab vanifm : fufceptibility of Galvanifm is in general ex¬ cited by exercifing it ; is exhaufted by continuance, and renewed by repofe. 3. The fucceflion of various experiments. A difpofition of metals which at firfl had been ineflfe£tual, has become effectual after a dif¬ ferent difpofition* Two uncertain experiments are hurtful4 to each other, and become ftill more fo if made in fucceflion. 4. The Hate of the atmofphere. The atmofphere electric ; the animal on which the - operation is performed charged and infulated, the ef- fe£t is the fame. The wdiole apparatus placed under water, the effect remains the fame.
V. There are various artificial means to weaken or revive the fufceptibility of Galvanifm. Thus, a frog exhaufted and brought near to a charged elebtropho- rus refumed its fufceptibility. Alcohol, on the other hand, weakens and even extinguifhes it fo as never to return. Potafh produces the fame effeft, only llowly. According to M. de Humboldt, this fuf¬ ceptibility is in many cafes reftored by oxygenated muriatic acid gas. The commiflioners did not ob- ferve this circumftance ; but they propofe to refume the fubject, and to repeat feveral other experiments of that learned philofopher.
They have already repeated thofe oii the action of Galvanifm on the heart, and have obferved, as he did, that its action is the fame as on the voluntary
mufcles, and that it accelerates their movement.
\ * .
No. XXIX.
THE
M EDICAL and CHIRURGICAL
R E V I E W.
, - . .. ■ v \ . ., ✓ ' ■ ' /. \
MARC H, 1799.
Art; XLIV. Philo fophical Tranf actions of the Royal Society of London. Part II. for the Year 1798. Elmsley. London.
THE fir ft paper in the prefent cohesion, relative to medicine, is furniihed by Mr. Home, and is entitled, * An Account of the Orifice in the Retina of the human Eye, difcovered by Profeffor Soem¬ mering: to which are added. Proofs of this Ap¬ pearance being extended to the Eyes of other Ani¬ mals.’
The following account of Mr. Soemmering’s difco- very was communicated to the author by Mr. Mau- noir, an eminent Surgeon at Geneva. “ The war being an obftacle to a free communication between England and the Continent, you are not, perhaps, ac¬ quainted with a new difcovery in the anatomy of the human eye, made by a profefior ot Mentz, Mr. Soem¬ mering; permit me, therefore, to fay fomething on the fubjeH. He was diffe6ting, in the bottom of a vefiel filled with a tranfparent liquid, the eyes of a yol. v. N G g young
402 Philofophical Tranfactions of the Royal Society .
young man who had been drowned, and was (truck on feeing, near the infertion of the optic nerve on the retina, a yellow round fpot, and a (mall hole in the middle, through which he could fee the dark cho- roides , (looking at the furface of the retina which covers the vitreous humour.) Fie differed other hu¬ man eyes, and conitantly, when the diffecfion was carefully made, found the hole of the retina feemingly at the pofterior end of the vifual radius, nearly two lines on the temporal fide of the optic nerve, and the hole (urrounded by the yellow zone, of above three lines in diameter. The hole of the retina is not diftin&ly feen, being covered with a fold of the retina itfelf. An anatomift of Paris differed many eyes of quadrupeds and birds, and found the yellow fpot and hole in no animal but the human kind.
Should you think that nature has intended this hole to grow large when the eye is oppofed to a (Irong light, and thereby caufe a great part of the rays to fall on the choroid, and vice verfa , w7hen the eye is in darknefs ? And the want of fuch a conftruftion in animals, is it owing to a greater powTer of augmenting or diminifhing the pupil, than in men ? If Meffrs. Mariotte and Le Cat (hould come to life again, they would find, in that hole, the explanation of the phe¬ nomenon ot the twTo cards, one difappearing at a cer¬ tain diftanee from one eye, &c. which may be ex¬ plained by faying, that where the optic nerve enters the ball, thebe is no choroid, and fo no vifion.
1 diffeeied fome human eyes a (hort time after I had read the discovery, and found the fpot, the ruga concealing it, and the yellow zone. The beft way,
A think, to fee' them, is to take oft' the half pof¬ terior part ol the fclerotica, then the correfpond- ent part of the choroid ; both mu ft be cut round the infertion ot the optic nerve. I he retina is to remain bare and untouched, fuftaining alone the vitreous hu¬ mour • then you may lee the round fpot, wrhich reaches the optic nerve, and a fold of the retina, marking a
diameter
i
/
Phihfophical Tranfactioris of the Royal Society * 403
diameter of the fpot. Then, if you prefs the ball a little with your finger* fo as to pufh the vitreous hu¬ mour rather near the bottom of the eye* the ruga is unfolded, and you will fee the hole perfefldy round, of ~ of a line in diameter, and its edges very thin.
“ All this can be feen on the inflde of the eye* but not fo perfectly ; and, in that cafe* you muft make your obfervations in water ”
To obferve the appearances here pointed out, is not always an eafy matter, and requires that the dif- feftion be made with caution, and in a particular manner. Some anatomifts, indeed* have altogether denied their exiftence * on no other ground, as it would feern, than becaufe they had themfelves failed in endeavouring to deteft them. We fhall, therefore* give the procefs followed by Mr. Home, together with his remarks, in his own words.
c The mode I adopted*’ Mr. Home obfe’rves, c for examining the retina, was that of removing the tranf- - parent cornea ; then taking away the iris, and wound¬ ing the capfuie of the cryftalline lens, fo as to difen- gage the lens, without removing that part of the capfuie which adheres to the vitreous humour; by which means, the retina remained undifturbed, and could be accurately examined, when a ftrong light was thrown into the eye. '
* The aperture in the retina, furrounded by a zone with a radiated appearance; was diftinttly feen, on the temporal fide of the infertion of the o|)tic nerve* and about \ of an inch diftant from it, apparently a little below the pofterior end of the vifual radius. The aperture itfelf* in this view* was very fmall. After having viewed it in two different eyes* I took an op¬ portunity of {hewing it to Sir Jofeph Banks and Sir Charles Blagden, who both faw it with the fame de- gree of diftinftnefs* 1
* At firft, I believed it neceffary to have a very frefh eye for demonftrating this aperture, but I have fmce found, that it is more readily feen in an eye two
G g 2 days
404 phtloji ophical Tran factions of the Royal Society .
days after death ; the zone, which is the moft confpi- cuous part, being of a lighter colour the firft day, than it is upon the fecond.
I have alfo fucceeded in preferving the pofterior part of the eye in fpirits, without deftroying the ap-% pearance of this aperture. This preparation I am un¬ willing to bring to a public meeting of the Society, fmce it may be liable to be injured by being much fliaken; but I hope my having (hewn it to Sir Jofeph Banks and Sir Charles Blagden, will be fufficient evidence, both to the Society and others, that fuch a preparation can be made.
c I am induced to make this remark, by recoiled- ing that a celebrated anatom iff of Edinburgh denied, in his iafl publication, that the anterior lamina of the cornea can be Separated from the others, as a conti¬ nuation of the tendons of the four ftraight mufcles of the eye, for no other reafon than becaufe he could not fucceed in the demonftration of it 3 the failure, pro¬ bably, ariftng from the eye not being fufficiently frefh to admit of fuch a feparation. Had it been mention¬ ed in my former paper, that the preparation, from which the engraving was made, had been fhewn to this learned Society, or to any members of it, mv af~ fertion would probably have had more weight.
c In feparating the vitreous humour from the re¬ tina, l found a greater adhefion at this particular part ; and, when the vitreous humour was removed, the retina was^ulled forward, forming a final! fold, in the centre on which was this aperture. This doub¬ ling was fometimes produced by endeavouring to cut through the vitreous humour, to difengage the cry- iiailine and its capfule.
^ £ I have been the more particular in defending the appearance of this aperture in the retina of the human eye, that, while I announce this curious difcovery of Mr. Soemmering to this learned Society, I may give the molt complete confirmation of it. To have this in my power affords me a particular pleafure, as it gives
f
/
Philofophical Trarif actions of the Royal Society. 405
me an opportunity of doing juriice to the merit of a foreign anatomih, who deferves fo highly of our art ; and who has demonhrated to his cotemporaries, that thofe who labour patiently, and follow their purfuits with ardour, may hill hope to make difcoveries, in the anatomy even of thofe parts of the body which are confidered as the bell underhood ; fince the hujnan eye, fo long the favourite objed of the moh eminent anatomifts and philofophers, is hill but imperfedly inveftigated.
€ After having made the preceding obfervatiops upon this lingular appearance in the human eye, I found, in Dr. Duncan’s Annals of Medicine for 1797, an account of a publication concerning it by Profelfor Reil, entitled, The plait, the yellow fpot, and the tranfparent portion of the retina of the eye.
c After thefe are defcribed feparately, the following circumhances are mentioned. “ Soemmering takes this appearance to be a real hole. Buzzi, on the con¬ trary, thinks tlpat it is merely a tranfparent and thin portion of the retina. Michaelis feems to agree with him. Reil and Meckel are rather in favour of the exihence of an aflual hole.
<c Michaelis faw the plait more di hi nelly in foetufes of feven or eight months, than in adults and the tranfparent portion lay concealed within it, but the yellow fpot was wanting: nor is it to be obferved in the eyes of newly-born children. After the firft year, it becomes fo me what yellow, and the depth of the colour increafes with the age of the fybjed. Soem¬ mering fa)S that this fpot is pale in children, bright yellow in young people, and becomes again pale in old age. Its degree of faturation feems to be inti¬ mately connected with the hate of vijfion : it conilaiit- ly diminiihes, in proportion as virion is o b ft ru cried. Where one eye only is difeafed, in it the yellow fpot is wanting, and the plait is fmall and wrinkled ; while, in the found one, they are rather .more dis¬ tinct than ufual.
rig 3 “ Michaelis
i
406 Pkilofopkical Tranfactions of the Royal Society ,
<c Michaelis difcovered no veflige of thefe appear¬ ances in the eyes of dogs, fwine, or calves.
* Profeffor Reil’s mode of differing the eye, to (hew the aperture and plait, is exactly fimilar to that men¬ tioned in Mr, Maunoir’s letter.
It will appear, from the account of this orifice in the retina, which precedes thefe obfervations of Pro- feffor Reil, that the plait fo particularly mentioned is an artificial appearance, which takes place in the clif- fedlion of the eye, and arifes from the circumftance of the vitreous humour adhering more firmly to the edge of this orifice, than to any other part of the retina ; fo that the fmalleft motion of the vitreous humour, in confequence of dividing it, or removing the choroid coat, produces a plait, by pulling forwards this portion of the retina. What is faid of the colour of the yellow fpot, and of the difference of opinion, whether it is a hole or a tranfparent portion of the retina, I fhall confider more fully in another part of this Paper.
* After having afcertained the appearance of this aperture in the human eye, and found what appeared the bell, mode of feeing it, I determined to invelfigate this fubjedf in the eyes of other animals.
4 The monkey was the firft animal which I pro¬ cured for obfervation ; being led, from previous know¬ ledge in comparative anatomy, to believe that the ttrudture of its eye muff bear a very clofe refemblance to that of the human fubjedt.
* The eye was examined immediately after the death of the animal, and wa§ prepared in the fame way that I have already defcribed the human eye to have been for this pupofe ; fo that the concave furface of the retina appeared in its moft natural tlate, and the vitreous humour, being entire, kept it expanded, and free from ruga. On the firfl view, nothing was t<*be feen but one dark furface, furroundi >g the en¬ trance of the optic nerve. Two hours after death, the retina became fuf&ciently opaque to be difti'nguifh-
ed,
Philofophical Tran factions of the Royal Society. 407
ed, and, immediately after, the orifice was vifible, ap¬ pearing to be an extremely fmail circular aperture, without any margin ; but, in half an hour more, the zone had formed, which, when very accurately exa¬ mined in a bright light, had an appearance of four rays, at right angles, its fituation, refp effing the op¬ tic nerve, was precifely the fame as in the human eye. As I confidered this to be a fa£t of fome importance, fince it proved the aperture in the retina to be a part of the flruflure of the eve, generally, and not a oecu-
m J J O J J i.
liarity in the human eye, I requeued Sir Jofeph Banks, Sir Charles Blagden, and Dr. Baillie, to examine it : to all of them it appeared very diftinfl. After having (hewn it to thofe gentlemen, and having an accurate drawing made of it, i preferved that portion of the eye in fpirits ; where the aperture in the retina can (till be diftindtly feen, but the radiated appearance is
loft.
c In the eye of a bullock, prepared in the fame manner, i looked in vain for a fimilar appearance : if it exifted, and bore any proportion to the fize of the eye-ball, as it appears to do in the human eye and that of the monkey, it mult have been very vifible. The concave furface of the retina was examined in different lights, under a variety of circumftances, and by magnifying glades of different powers, but ftili no aperture could be difcovered. I was, however, very much (truck, while looking at the optic nerve, to fee fomething in the vitreous humour, (in confequence of a perfon accidentally ihaking the table,) that had not been before obferved.
c This proved to be a femi-tranfparent tube, re- fembling in its coats a lymphatic veiTei, rifing from the retina, clofc to the optic nerve, on the temporal fide of its infertion, and coming directly forwards into the vitreous humour, in which it was loll, after being diflinffly feen for ~yks of an inch of its courfe.
‘ This tube is not lb xlifii nelly feen in the eye im* mediately upon the animal’s death, as fome hours'
C g 4 alter 5
40S Philofophical Trmf actions of the Royal Society 3
after; and is much more obvious in fotne eyes than in others. As the coats of the tube mull be nearly the fame in all eyes, this difference probably arifes from its contents not always having the fame degree of tranfparency.
* When the eye has been kept 24 hours after the animal’s death, there is an appearance of a zone of a circular form, a (hade darker than the reft of the eye, in which the optic nerve is included : when this zone, which is nearly ~c*ths of an inch in diameter, is atten¬ tively examined, the tube 1 have described is exadlly in the centre of it. The tube feems to be confined by the vitreous humour, (while that humour is entire,) and only to move along with the central part of it ; and, in fome inftances, when the vitreous humour is divided, the tube falls down. Its attachment at the retina appears ftrong'er than its lateral connection with the vitreous humour ; for, when I coagulated the vitreous humour in fpirits, and feparated it from the retina, I found the tube was left with the retina, but upon being touched was eafily torn.
c In the fheep’s eye there is a fimilar tube, in exactly the fame fituation, refpefting the optic nerve, but much fhorter, and much lefs eafily detected. It does not appear to be more than of an inch in length, before it is loft in the vitreous humour. After having feen the tube diftindtly in two different eves, and having had a drawing made of it, I looked for it in feveral others, without finding it : but, examining an eye from which the cryftalline lens had not been re¬ moved, only an aperture made into the vitreous hu¬ mour, by removing a portion of the ciliary proceffes along with the iris, the tube was diftinctly feen. The weight of the lens probably pulled forward the vi¬ treous humojLir, and kept the lhort tube ereft, in its natural fituation.
c I mention this circumftance, to prevent, as much as I am able, other anatomifts from being difappoint-
Philojhphical Tranfoctions of the Royal Society. 409
eel in not finding it; which may readily happen, if the fearch be not made with confiderable attention.
4 In the fheep, there is no appearance of a zone furrounding the tube.
c Thefe faffs, although few in number, are fuffi- cient to prove, that this orifice is not peculiar to the retina of the human eye ; and that its fituation in man and in the monkey is the fame : in them, it is placed at feme diftance from the optic 'nerve; but, in fome other animals, its fituation is clofe to that nerve, and it puts on the appearance of a tube, inftead of an orifice.
4 There is one circumftance which is curious, and which it will require further information upon this fubjeff to explain; the yellow zone, found in the human eye and that of the monkey, is not met with in any other animal which I have examined.
‘ Having ftated the faffs, and alfo the opinions of other anatomifts, that have come to my knowledge, as well as my own obfervations, upon this orifice in the retina of the human eye, difeovered by Mr. Soem¬ mering, and having added to thefe, feveral new faffs refpeffing it in other animals, I (hall draw fome ge¬ neral conclufions from the whole, with a view to fhew that the conjeffures which have been made, refpefl- ing its ufe, are probably erroneous. I fhall after¬ wards point out feveral reafons for confidering it as the orifice of a lymphatic veffel, intended to carry off the vitiated parts of the vitreous humour and cryftal- line lens.
4 In the human fubject, as no examination, can be made for fome confiderable time after death, it is ira~ poffible to afeertain what is the real ftate of this orince in the living eye, and what changes take place in it after death ; we only learn, that the tinge of yellow furrounding the orifice is very flight, when the eye is examined recently, and that the next day it becomes much deeper.
4 Thefe
410 Philof optical Tranf actions of the Royal Society .
c Thefe points appear to be fatisfa&orily cleared up, by the examination that was made of the monkey's eye, as it was begun before the parts had loft the ap¬ pearance belonging to them as living parts. In that ft ate, the retina was tranfparent, and no orifice could be feen ; fo that the orifice is rendered vifible, by re¬ maining tranfparent, while the furrounding retina be¬ comes opaque. This appears to decide the difpute between Meffrs. Soemmering and Buzzi ; for, if this part does not undergo the change peculiar to the retina, we muff confider the retina as wanting there. After the orifice is thus rendered vifible, the yellow tinge is wanting, and does not take place for feveral hours, and even then is fainter than it becomes after¬ wards ; which appears to be fufficient evidence, that this tinge is the effedt of fome change after death, and cannot, therefore, have any effect upon vifion.
c The orifice has been fuppofed to account for a fmall objeft becoming invifible, when placed at a certain diftance from the eye, and brought oppofite a particular part of the retina. This, however, can¬ not be the cafe, as its fituation in the retina does not cor re fpond with the part oppofed to the objeft, when rendered invifible.
c The orifice itfelf is probably too fmall to produce any defeat in vifion, as the trunks of the blood- veffels which ramify upon the retina cover a larger fpace than this orifice, for a confiderable extent, without obflru&ing the fight of any part of the object.
c While my obfervations were confined to the hu¬ man eye, I was led to confider this orifice as a lym¬ phatic veffel, paffmgfrom the vitreous humour through the retina, but could bring no abfolute proof of its being fo. This opinion was ftrengthened by finding, that in the monkey, the orifice was only rendered vifible when the retina became opaque ; and it has fmce been corroborated, by a diflinT tube being met with in the eyes of iheep and bullocks.
c That
Philofophical Tranf actions of the Royal Society . 41 1
c That a change mull; be conftantly taking place in the cryftalline and vitreous humours, to preferve to them the neceffary degree of tranfparency, can hardly be doubted ; and that the abforbent veffels which per¬ form that office fhould have one common trunk, which follows the courfe of the artery and vein, perfeftly agrees with what takes place in other parts of the bodv.
4 In the human eye, and that of the monkey, the ' artery is in the centre of the optic nerve ; but that would have been too circuitous a courfe for the lym¬ phatic veffel to follow, and, by going through the retina, at fome diftance from the nerve, it can pafs out of the orbit with the blood-veffels that go through the foramen laeerum orbitale inferins. In the bul¬ lock and fheep, there is a plexus of veffels furround¬ ing the optic nerve, and the tube dips down, clofe by the optic nerve, probably to accompany them.
4 From the obfervations made by Michaelis, of the yellow fpot not being vifible in feetufes, or in infants under a year old, or in eyes that are blind, alfo of its being brighter in young people, and paler in old, it would appear, that it is only when the eye is capable of performing its functions, that there is any (lain communicated to the retina/
The next paper contains an interefting Defcription of a very unufual Formation of the human Heart : by Mr. James Wilfon, Surgeon.
The heart, Mr. Wilfon obferves, is an organ of fo much importance in the animal oeconomy, and is fo immediately concerned in the fupport of life, that any unufual deviation from its natural form and fitua- tion in the human body, has always been con fide red as a fubjefi of fome intereft by the phyfiologift. Many circumftances refpefifing the circulation of the blood and refpiration, wholly unknown to our anceftors, have lately been afeertained : but we are not yet arrived at a perfect knowledge of thefe important actions. Dif¬ ficulties
412 Phitofophical Tran factions of the Royal Society .
fieulties yet remain $ more information may ftill be acquired ; and the reafoning upon thefe fubjefts will be lefs liable to fallacy, in proportion to the number of fafts which have been obferved, and the accuracy of the obfervations- On this ground, the author has been induced to lay before the public, a description of a monftrofitv in the human heart, very Singular in its nature, and hitherto undefcribed..
£ It is well known,’ Mr. Wilfon remarks, ‘ that the circulation of the blood throughout the body, and ex- pofure of it to the atmofpheric air in refpiration, feem, in mod animals, to be neceffarily connefted ; but are not equally fo in all. They are fo much connected in the human fubjeft, and in moft quadrupeds, that after birth there is a double heart ; viz. one for the circula¬ tion of the blood throughout the body, to be fubfer- vient to the various purpofes of life and growth ; the other for its circulation through the lungs, where it undergoes a change which is effential to its general circulation through the body: tbefe two circulations, in the natural (kite, bear an ex aft proportion to each other. In fiances, however, have occurred, even in the human fuhjeft, where this exaft proportion has not been prefer ved ; yet life has been prolonged for home years, but in a feeble and imperfeft hate. In Some of thefe inftances, the pulmonary artery has been f inaller than ufu.al, fo that much lefs than the natural quantity of blood was expofed to the influence of the air in the lungs ; in others, the foramen ovale has not been clofed, but a confiderable communica¬ tion has remained between the two auricles ; and, in others, there has been a communication between the two ventricles, from a deficiency in the feptum.. The effect, of all thefe deviations- is the* fame, upon the blood in the general circulation, viz. that a part of the blood is not expofed to the air in the lungs ; fo that if is lefs pure as it circulates over the body. A more remarkable deviation in the ftrufture of the heart, than any to which I have juft alluded, has been lately
publifhed
Philofophical Transactions of the Royal Society , 41 S
publifhed by Dr. Raillie, in his Morbid Anatomy, In this heart, the aorta arofe from the right ventricle, and the pulmonary artery from the left ; the reverfe of what ought, in the regular oourfe of circulation, to have taken place ; (the veins were as ufual ;) and no communication w7as found between the one veffel and the other, except through the remains of the dubtus arteriofus, which was not larger than a crow quill, and a final 1 part of the foramen ovale, which dill continued open; yet this child lived for two months. In the following cafe of mo nitrous forma¬ tion of the heart, there is this very great fingularity, that nature feems to have fubftituted, very exabily, the circulation which takes place in lome amphibious animals, for that which is natural to the human fpecies.
c The infant had arrived at its full time, and lived feven days after its birth. Indead of the ufual inte¬ guments, mufcles, &c. a membranous bag appeared to protrude on the upper and fore part of the ab¬ domen, extending from the lad bone of the dernum fome way below the middle of the belly, and out¬ wards, fo as to be nearly circular: the navebftring Teemed to enter this membrane near its middle, and to wind fuperficiallv, for fome little way, towards the left fide ; it then dipped into the abdomen, at the place where this membrane joined the ufual cover¬ ings. Within this bag, the appearance of which was very nearly fimilar to that of the chorion and amnios which envelop the foetus at birth, but thicker in con¬ fidence, a tumour was perceived, poffeffing confider- able motion, from the nature of which, no doubt was entertained that it was the heart.
4 During the fhort period of the child’s life, it was, feen and examined by a number of profefllonal men. Upon its death, the tumour was carefully opened by Mr. Morel], in the prefence of Dr. Poignand; when the heart, as was previoufly fufpebled, appeared to be fituated in the epigadric region of the abdomen, and
to
I
414 Philofophical Tranj actions of the Royal Society >
to be Imbedded, as it were, in a cavity formed on the fuperior furfaee of the liver. In this (late, the child was fent to Dr. Baillle, by whofe deiire I injected the heart, and laid its principal veffeis bare, fo as to bring their uncommon difiriBution and courfe into view : a preparation of them hill remains in Dr. Bailiie’s pof~ feffion.
c A confiderable part of the tendinous portion of the diaphragm appeared to be wanting, as likewife the lower part oi the pericardium, which is ufually affixed to it. The thorax being laid open on each fide of the fterhum, the two pleurae were feen palling from that bone to the fpine, and covering the lungs* as ufual. The lungs appeared perfe£tly natural in colour, and nearly fo in fhape ; but were larger and fuller than ufual, in confequence of more room being afforded for them in the thorax, from the peculiar fituation of the heart. In the fpace correfponding to the anterior mediadinuiru was the thymus gland, con- fiderably longer than in other children, and extending downwards the whole length of the dernum ; behind this, was a peculiar arrangement of blood-veffels.
c The heart, indead of confiding of four cavities* as in the natural dru&ure, confided of a dngle auricle and ventricle, which were each of them large in their iize. A large arterial trunk arofe from the ventricle, and afcended into the thorax, between the pleurae, immediately behind the thymus gland : it foon divided into two large branches, one of which continued to afcend, forming the aorta: the other paffied back¬ wards, and proved, upon examination, to be the pulmonary artery.
4 The aorta, having reached the common place of its curvature, formed it in the fame manner as it tilually does ; fent off the veffeis belonging to the head and upper extremities; defcended before the vertebrae, and paffed into the abdomen between the crura of the diaphragm. From the place where it began to form the arch, it was in no refpeft different
from
/
Phitofophicai Transactions of the Royal Society. 415
from the aorta of any other infant, except that no bronchial artery was lent to the lungs, from it, or any of its ramifications.
‘ The veffel which proved to be the pulmonary artery, almoft immediately divided into two branches ; one going to the lungs of the left, the other to the lungs of the right tide. Upon meafuring accurately the circumference of the aorta, where it feparated from the original trunk, it was found to be exactly one inch and a quarter. Upon meafuring the circum¬ ference of the pulmonary artery, in the fame manner, it was found to be fifteen fixteenths of an inch ; fo that it was five fixteenths of an inch lefs than the aorta.
The vena cava inferior, having been partly fur- rounded by the fubftance of the liver, entered the lower and back part of the auricle. The fubclavian vein of the right fide eroded over to the left of the mediaf- tinum, where it joined the left fubclavian, and form¬ ed the vena cava fuperior. This puffed down on the left ot the afeending, and before the defcencling, part of the aorta ; it was then joined by a trunk formed by two large veins, which came out of the lungs, and which were fituated immediately behind the pulmo¬ nary arteries : the union of this trunk with the vena cava fuperior was continued into a large veffel, which gradually expanded itfelf into the auricle. The vena azygos afeended on the left fide ; received fome branches which palled under the aorta from the right, and then entered the upper and back part of the vena cava fuperior : there were no bronchial veins. From there being neither bronchial arteries nor veins, it would appear that the pulmonary arteries and veins, in addition to their ufual offices, performed thole of the bronchial veffels.
c The liver was not divided on its upper furface by the fufpenfory ligament, but had a confiderable ca¬ vity fcooped, as it were, out of its fubftance; which, in fnape, was adapted to, and contained, the heart ; it was alfo, in fome other particulars, rather different
from
416 Philofophical Tr infections of the Royal Society .
from its natural fliape, but not fufficiently fo to require being minutely deferibed. The reft o*f the infant was examined, but was not found to be diffimilar to any other*
< It is a well afeertained fadt, that the blood receives a florid hue from the influence of the air on it in the lungs; and this change is fuppofed to be effected by the combination of a certain quantity of oxygen gas with it. In pafling from the arteries to the veins, in every part of the body except the lungs, it lofes the florid hue, and becomes darker: the florid blood is that which is employed for the purpofes of fupporting life. In the natural circulation, it is well known, that the whole of the blood conveyed to, and circulating in, the pulmonary artery, is of a dark colour ; and the whole of it, when returned by the pulmonary veins, is florid.
6 It is obvious, in the cafe which I have deferibed, that there always mutt have been florid and dark- coloured blood mixed, and circulating in the arteries* It would feem alfo, upon the firft reflexion, that the quantity of dark-coloured blood would be the greateft, in the fame proportion as the capacity of the aorta was larger than that of the pulmonary artery. It is therefore neceffary to recoiled!, that a confiderable proportion of the blood carried to the lungs was already florid or oxygenated ; and alfo, that the lungs In this infant were larger in proportion, than in chil¬ dren of the fame age : a fmaller quantity of blood, therefore, was to be oxygenated, and a larger furface than.ufual was appropriated for this purpofe. It ap¬ pears alfo, from experiments, (fuch as making a pe.rfon breathe air in which there is a greater proportion of oxygen, gas than in our atmofphere,) that the blood can°combine with more of it than it does in natural re fpi r&tion ; it therefore is not an improbable fuppo- fltion, that a larger quantity was combined here. A fmall drawback mull be allowed, for the quantity of oxygenated blood ufed in the fupport and fecretions
Fhilofophicat Tranf actions of the Royal Society, 417
of the lungs, and which is ufually conveyed to them by the bronchial artery ; but this quantity is too fmall to require more than this flight obfervation of it. The blood alfo which palled to the lungs, muft have been again conveyed to the heart fooner, from the fhort- nefs of its circuit ; and muft have entered the heart with a quicker or ftronger current, than that blood which paffed to, and was returned from, the more remote parts of the body ; as, in this child, the pub monary artery and aorta were filed by the contrac¬ tion of the fame ventricle. In the hearts of other children, fome time after birth, the mufcular fibres of the right fide are much fewer in number than in the left. „
.
e If them circumftances are admitted as faff, viz. that the bipod circulating through the lungs of this child was combined with a larger proportion of oxy¬ gen gas, and was returned in a quicker and ftronger current into the auricle than that returned by the venae cavae, it feems reafonable to infer, that this blood, mixing and blending with the dark or unoxy¬ genated blood, would render the whole nearly as much unoxygenated as it ufually is found in the Jeft fide of the heart, and in the aorta ; therefore, that the blood circulating in the arteries of this child would be fully equal to the fupport of life. Previous to birth, this peculiarity of ftrufture could not affect its health or growth, as the placenta then anfwers the purpofe which the lungs do afterwards ; and the fingle ven¬ tricle feemed as equal, from its fize, to propel the blood on to tfye placenta, as both ventricles in the na¬ tural ftate are, by means of their communication through the ductus arteriofus.
c The inference which has been drawn feems fur¬ ther confirmed, from the colour and heat of this child* during life, being not perceptibly different from thofe of other children. In all thofe cafes of malformation of the heart where the foramen ovale, or the duftus arteriofus, has continued open ; or where the feptura
vol. v. Hh * of
418 Philofophical Tvanf actions of the Royal Society .
of the ventricles has been perforated, and the pulmo¬ nary artery fmall, (and at the fame time two ven¬ tricles,) it has been obferved, that the body had a livid colour, and, in general, that there was a de¬ ficiency of heat.
c From the particular inquiries which I made, con¬ cerning the heat and colour of this child, of the pro- teffional gentlemen who faw it during life, and of the nurfe who attended and dreffed it, I found that the heat, fo far as could be judged by the feeling, (for it was not tried by the thermometer,) was in no refpeft different from that of other children; and that the colour of the fkin was perfectly natural, except that, on the day on which it was born, and a fhort period before its death, the lips occafionally had fomething of a livid appearance ; but that this did not fail any time, as they were generally pale. This occafional lividnefs would happen to a child in that date, fhould the heart and circulation be in no way different from what they naturally are.
* I could meet with no other remarkable circum- ilances, either in the hiftory of the mother during pregnancy, or in the child after birth. It cried occa¬ sionally, like other children, but feemed weak, and in pain ; it flept ; it lucked heartily, even a few hours before its death, and had apparently healthy evacuations of urine and fences.
c Its death can be fatisfaftorily accounted for, from another caufe than the extraordinary formation of its heart and hlood-veffels. The membranous covering, on the fore part of the abdomen, did not appear to poffefs fufficient vafcularity to retain its life after birth ; tor it immediately loft its living principle, and became putrid and mouldy in parts. Previous to the child’s death, a procefs ot reparation had begun, between it and the living parts to which it was connected, and a line of inflammation was diftinftly feen. Had this procefs been completed, and the Hough thrown off, the heart would have been expofed ; but, before this,
the
Philofophical Tranf actions of the Royal Society. 419
the heart itfelf had inflamed ; which was proved from its being found covered writh a coat of coagulable lymph recently thrown out, and from this inflamma¬ tion its death muft have arifen.
4 Had the heart been covered with the ufual pa- rieties of the abdomen, it is probable, notwithftanding its fituation, that this child might have lived in a tolerable ftate of health for years ; but muft conftantly have been expofed to have its heart injured by fome external accident, from its not being defended by the ribs and the fternum.
‘ The formation and difpofition of the heart and veflels, in the child, refemble much thofe which are found jin the frog, and fome other amphibious ani¬ mals ; but this infant could not, like them, be am¬ phibious. Thofe animals are extremely tenacious of life/fo that they live fome time, even after their heart and lungs are removed from their bodies; and, as their circulation can go on without refpiration, it is therefore not wonderful that they often live a con- * fiderable time without change of air. Life, in the human fpecies, depends equally on both thefe actions ; for death takes place, if either of them fhould flop. The circulation of the blood in this infant would have met wdth no impediment, had it been immerfed in water ; but, unlefs refpiration went on, which in that ftate it could not do, the blood could undergo no change in the lungs ; and this change is equally effential to the fupport of life, as the circulation of the blood. ’
One other paper remains to be briefly noticed, the fubjeft of which is, a Tumour found in the human Placenta, by Dr. John Clarke. — It is fufficiently known, that the principal ufe of the placenta is, to tranfmit, and apply refpedfively to each other, the blood of the fcetus, and that of its mother. No other aftion is carried on, as far as is yet known, by the veflels of the flxtal portion of the placenta, unlefs fo
H h 2 much
420 Cullen's Clinical Lectures .
much as may be neceffary far their own growth and nourifhment.
In the placenta which gave occafion to the prefent paper, was found a tumour refembling in fhape, fize, and confiftency, the human kidney. On being cut into, feme parts were obferved to be highly vafcular, whilft others were white, and remained uninje&ed.
The exiftence of the tumor in this part thews, that the veffels of the placenta, like thofe of other parts, are capable of forming folid organized matter ; and that very confiderable deviations from the ordinary ftrufture of the placenta may exift, and be perfeftly compatible wTith the life and health of the foetus.
Art. XLV. Clinical Lectures: delivered in the years 1765 and 1766. By William Cullen, M. D. &c.
( Continued from page 337.J
IN our laft number we followed the author in his . general hiftory of Head-achs. He next proceeds to point out the diflinciions that occur, and to explain
* The principal head-achs, then, we refer to topical fever. As in other fevers, fo here is a cold and hot fit in various degrees. In fome fevers there is only a cold fit, which immediately kills the patient ; in others it is fucceeded by a hot fit, and this having various
proportions to the cold lit, and with various refolu- tions.
c Thefe fevers of the head-ach are alfo of different kinds, and mark out the different prevalency of the cold and hot fits. To explain this, we muff make a few remarks upon the nature of pains. There are fome pains depending on a flimulus, or fome acrid mallei applied to the part : but as this is common to
Cullen’s Clinical Lectures. 421
every part of the fyftem, we fliall omit it here, and only take notice of thofe pains which are more im¬ mediately connected with the vafcular fyftem, and occur in the extremities of veffels.. Thefe are of two kinds, one of which proceeding from diftenfion, and which occurs in the plethoric head-ach, is well under- flood, and perhaps the only one generally thought of. The other kind of pain is analogous to an external force compreffing and conftrifting the nerves ; and perhaps of this kind is the pain arifing from fpafmodic eonftrictions. Such too is the pain arifing from cold: this condenfes all bodies, and conftringes the extremi¬ ties of nerves ; but whether it a£ts merely thus, or produces fpafmodic conftriftions, is difficult to deter¬ mine. Such conftriftions do arife from cold, and are
••
relieved by heat: thus many head-achs are accom¬ panied with a fenie of cold; and there are inftances of the fame in other parts, as in particular joints, which are only removed by reftoring the impetus of the blood to them ; and though this caufes a diftenfion, it cures them. This pain then appears to be opppfite to the diftending pain, which occurs chiefly in attacks of the head-ach and fevers, and often in chronic rheumatifms. In feveral inftances of the head-ach, thefe two points are more or lefs mixed : thus in the febrile head-ach itfelf, the pain coming before the cold fit, or accompanying it, cannot be of the diftend¬ ing kind, but muft certainly be the conftriftmg ; as there is then every proof that the blood is not impell¬ ed into the heart with the fame impetus as ufuaL Thefe pains thus differing, as they recur at different periods of the head-ach, are often connected with each other. Thus the diftending pain, as in haemor¬ rhages, by occafioning fpafms, lays the foundation for the confirming; and the conftrifting pain, when pro¬ duced, proves a ftimulus, and occafions the diftending, as in fevers, inflammation, &c. When the diftend¬ ing pain has continued in a part for any time, it leaves it in a ftate to be affected by the confirming. Thus
II h 3 acute
422
Cullen's Clinical Lectures,
acute rheumatifm is often attended by the chronic, and this by the palfy. This is often propagated to the origin of the nerves ; fo that other parts are affeffed, as being conne&ed with the fenforium commune : but thefe pains are often Separate, and the conftrifting is frequently found alone.
£ As the head ach proceeds from various caufes, either of thefe different hates may prevail: thus, on the one hand, various caufes produce paroxyfms of the dis¬ tending pain, which were marked out among the occafional caufes, ■ under the titles of fulnefs, tempo¬ rary rarefaction, and determination to the veffels of the head. On the other hand, the conftrifting pain is occaftoned by cold, and all weakening caufes; — by the paffions, as by fear and grief; by watchings, ftudy, evacuations, abftinence, and all fuch as diminifh the force of the nervous power, or, by an external appli¬ cation, bring on a conftriftion of the part. This pain thus produced, does not always prove a Stimulus, or bring on the diftending pain. What has been here faid, will explain the various caufes of the head-ach.
‘ in the febrile there is a more certain paroxyfm ; in the rheumatic, it is longer, and more uncertain. With regard to the head-ach depending on a topical fever, a queftion may ante, what fpecies of fever it might be, and when it properly partakes of the nature and genius of an intermittent. Sauvages has been fo exaff here as to diftinguifh both a cephaUa and hemi- crania^ intermittens, though there are Several oth ef periodical fpecies. This, when difcovered, leads more direffly to the method of cure, and (hews when the bark may be properly applied.
lo diftinguifh then what periodical head-achs im¬ mediately partake of the nature of an intermittent, the following considerations will be of Service, as, 1* Whether any intermittent is epidemical? then, 2. Whether the climate is fubject to thefe epidemic Intel mitten ts, though they do not actually prevail at the time ? 3. Whether it is the ufual feafon. of the
year
Cullen’s Clinical Lectures . 423
year for fuch, as fpring and autumn ? 4. If the pa¬ tient has formerly laboured under a head-ach, as con- ne£ted with an intermittent? Thus, a perfon who had before been cured by the bark of a periodical head- ach, which he had during an epidemical intermittent, on its returning, was cured of it on the footing of an intermittent. 5. At what period thefe head-achs re¬ turn ? If it be a quotidian, it is more ambiguous but if tertian, we may judge with more certainty* 6. What is the time of their coming on ? If it be in the evening, they have lets of the nature of the inter¬ mittent, which is more common at noon, or in the forenoon. 7. Whether thefe returns are ftriftly pe¬ riodical? for, in a proper intermittent, they are ufually more or lefs poftponed. By thefe means we may in forae meafure judge, how far they partake of the na¬ ture of the intermittent.
c There are fome fymptoms which exclude this in¬ termittent nature, as when we difcover the head-ach to be connefted with any particular vifcus, or other parts of the body, as with affections of the ftomach, flatulency of the bowels, arthritic fits, &c. When we difcover the head-ach to depend on occaflonal caufes, and to have its intervals varied by thefe, there is great reafon to fufpeCt that it is not of the proper in¬ termittent kind, though it is not a certain proof. For the occafional caufes do take place in intermittent fevers, yet thefe are wonderfully fleady in their pe¬ riods, independent of fuch caufes. We mutt now add, that befides the principal idiopathic head-ach, which may be looked upon as a topical fever, there are other kinds, which we know not where to refer. Such is the cephalalgia melancholic a , which is often accompanied with climnefs of fight, vertigo, &c. and fucceeded by epilepfies, apoplexies, palfles, and often too with mania. This has.a manifeft connexion with the ftagnation of the blood in the veffels of the brain, and is particularly prevalent in the melancholic temperament, and fo depending on a plethora in the
H h 4 venous
424
Cullen's Clinical Lectures .
venous fyftem. Whether it is purely plethoric, or depending on a febrile paroxyfm, has not been de¬ termined ; but it feems rather of the firftkind. It doth indeed appear fometimes in fits of a topical fever , but inch infiances are very rare. Its occafional caufes may perhaps be referred to thefe two heads. 1. fuch as hinder the reflux of the venous blood from the vefifels or the head, as ftooping, &c. 2. whatever weakens the fyftem, and diminiflies the impetus of the nervous power. Thus melancholy, hypochondri- afis, and fuch others, will excite occafional fits of this head-ach, for it is feklom periodical. What is its particular nature, has not been determined.
* Another of thefe fpecies of head-achs, which can¬ not eafily be referred to the principal idiopathic, is that connected with the menftrual or hemorrhoidal flux, and called cephalalgia catamenialis & if hcemor - rhoidahs . Ihe coming-on of the hemorrhoidal flux, is not exactly periodica], and is often foretold by this head-ach.
* The notion which would molt readily occur here-is, that the plethora is owing to fome refifiance made to the blood, as it endeavours to pafs off by thefe veffels, whereby it is made to regurgitate on the brain. But this is liable to many difficulties,* and all the argu¬ ments brought upon the queftion, whether the ple¬ thora or the menftrual flux ismmiverfal or topical, again ft a univerial plethora, will apply here.
c Still, however, the menftrual and hemorrhoidal mix are to be looked upon as topical fevers, founded on a tin gid ftate ot the veffels ot the uterus and anusa even a moderate turgefcence here, without a plethora m the other veffels, may excite a painful tenfton in oilier parts of the fyftem, and promote the impetus in them,* audit accordingly doth fo. Thus, when the menftrual flux is obftrudted, it is fometimes deter¬ mined to the lungs, fometimes to the ftomach, and
may eafily be fo to the head 3 independent of anv general plethora,
3
There
Cullen’s Clinical Led arcs. * 425
6 There is, indeed, either fomething particular in the veffels of the head, or it is in confequeuce of its com- munication with the fenforium commune , that the head is fo much affedfed in all fevers. But why it is fo, has not been yet fully folved. Taking the cat a* menial and hemorrhoidal head-achs, then, in this view, as topical fevers; we may obferve, that there is a head-ach, which often follows thefe difcharges, when they have been remarkably plentiful. This, then, cannot be of the plethoric kind, but of the con- ftridfing. Befides thefe, which are doubted concern¬ ing their being topical fevers, there is another fpecies, which has been fo fince Riverius, the cephalalgia fto~ machiea. This is explained by confent, which 'we. file wed before, not to depend on any connexion be¬ tween the nerves and the two parts, but upon an im- preffion made on one part, and communicated to the other, from a particular aptitude in the laft to receive fuch: thus the different ftates of the ftomach are found to affedt the head, and may undoubtedly be the foundation of the head-ach.
c The ftomach has a particular connexion to the nerves, all over the fyftem, whence it is fo much affedl- ed in all fevers. Crudities of the ftomach are frequent¬ ly found to bring back an intermittent fever, after it has once ceafed ; and perhaps, too, to give rife to it: we may conclude, then, that the fame ftate of it may bring on the head-ach. There is another cafe of a ftomachic head-ach, where, from a change of the determination to the uterus, the ftomach is affedled ; and this may be tranflated to the head, with this effedt, that the pains m the ftomach and head become alter¬ nate with each other. Thus they may continue in the ftomach for fome days, and then remove to the head, and the ftomach will be relieved : thus in a cafe of a head-ach, accompanied with an inflammation in the eyes, this inflammation, and the pains of the fto¬ mach, alternated with each other.
£ Befides thefe fpecies of head-achs, which, feem doubtful, there are others which are not at all of the
febrile
426
Cullen's Clinical Lectures *
febrile kind : fuch are thofe depending on more par¬ ticular topical affeftions of the brain, or ftimuli, fuch as tumours, and fo various erofions: thefe produce head-achs of a permanent kind 3 but as they are liable to be increafed by occafional caufes, they may have exacerbations, and fo appear aim oft periodical, coming on at a particular time of the day, as towards the evening.
o \
£ Thefe laid lead to a queftion, Where the pains of the head-ach are properly felt? Sometimes their feat may be internal ; but, without doubt, it is more commonly, even in this laft fpecies, in the external parts. We have fufhcient inftances of this, and onO in particular, where the patient had complained long of a pain in the crown of his head, in whom, upon diff icdlion, there was found a confiderable erofion at the bafts of the head. Thus, in an epileptic patient un¬ der our care, where there is every reafon to fufpeft a topical affection of the brain, the pain is in the verte¬ bras, which cannot bear the flighted; touch. It ap¬ pears, alfo, from the effects of compreffion, in aggra¬ vating or relieving the fymptoms. How internal af¬ fections affe& the external parts, is not known ; but certainly there is a particular connexion between the internal and external parts of the head. Thus, wounds that affect only the common teguments of the head, will often produce violent head achs. As this ihews how the external parts affeft the internal, fo the propofltion is eafily convertible.
c It may be afked, why the pain is circumfcribed in the external parts, as it generally is to the vertex, or temporal muffle, or over one eye-brow. Our anato¬ my is fcarcely carried fo far as to enable us to give a folution to this problem. We muft look upon the frontal and occipital muffles, as a digaflric, the inter¬ vening tendon of which, and that of the temporal, are the chief feat of the pain. The pain, then, here we look upon as analogous to the rheumatiffnin other parts, which doth not feem to refide in the bodies of
muffles*
Cullen’s Clinical Lectures.
427
mufcles, but their tendons. Thus, in the fciatica9 though the pains fly acrofs the mufcles, they are only violent at their extremities, as from the hip-bone to the knee, and from the knee to the ancle. Haller, in¬ deed, fuppofes thefe tendinous parts to be infenfible^ but this feems not to be the cafe.
£ When we are able to explain the above phenome¬ non, and why the electrical fhock is only felt at the joints, we fhall then, probably, underhand the rea~ ton of the head-ach, having its feat fo circumfcribed. Before we proceed to fpeak of the method of cure, we mull mention an obfervation of Lieutaud, on this diforder. He fays that he cannot lay down any diredt plan for the cure of it, but only mention what medicines have been ufed for it. What he obferves of this, is the hate of empiricifm in every difeafe.
* It is eafy to perceive, that there muft be different methods of cure here, adapted to the nature of dif¬ ferent fpecies. In the fimple plethoric head-ach, im¬ mediate relief may be given by bleeding ; but its ef¬ fects are only tranfitory ; and, if often repeated, it may be hurtful, as frequent bleeding is equally apt to bring on a return of the plethora, as the molt plenti¬ ful diet is : it fhould, therefore, be ufed with caution, and along with it may be employed abftinence, and moderate exercife, to prevent any accumulation for the future, by lupporting the ufual difcharges. But it feldom happens that head-ach, which fubfifts for a long time, is purely plethorical; it fhould therefore be treated as a topical fever, but varioufly, according to the various circumftances of it : thefe, whether exadlly periodical or not, have their intervals and re¬ turns, and to prevent thefe returns is the chief bufi- nefs of the phyfician ; thefe are often owing to a ple¬ thoric hate in the veffels of the head, either in confe- quence of an univerfal plethora, or a particular deter¬ mination to that part. Where this is very evident, and the fever produces a hot fit, attended with an increafq of heat, a frequent pulfe, or only a full one, with
throb-
416 Cullen's Clinical Lectures .
throbbings, there the cure is to be found only in blood-letting.
4 When there are only preemptions of a plethora, regard mu ft be paid to circumftances, as, if it occurs in young perfons, in the fpring feafon, &c. In gene¬ ral, bleeding fhould only be ufed, where the pletho¬ ra is evident. Topical bleeding is raoft proper, as by leeches, or cupping-glaffes. If it is thought pro¬ per to open a vein, it will be more proper to open the jugular than that of the arm : but here, too, we muft obferve, that the effects of bleeding are only temporary. A more effectual remedy is the ufe of purgatives: thefe have not fuch an immediate effect in taking off the plethora and diminifhing the heat, though they do this too ; but they may be more fafe- ly repeated, and fo are more permanent, and have a peculiar advantage, in caufing a derivation from the head. The head-ach has, accordingly, been frequent¬ ly cured by moderate, but habitual laxatives.
c If valerian ever cured this diforder, as has been af- ferted, it was by afiting as a laxative, of which we have feveral proofs now in this houfe : accordingly, there are two mftances mentioned by Dr. Fordyce and Dr. Whytt, in which valerian cured the head-ach, by being given m a large dofe, as 511 or 5111 a day. There is another remedy, which is lomewhat analogous to this, in deriving from the head, a pediluvium; for, by relaxing the lower extremities, it takes off the lenfion from the veffeis and membranes of the head.
£ But the moft effedtual remedy, either in a more general or partial plethora, efpecially in* young per¬ fons, is a low diet, confifting chiefly of vegetables : keeping up a proper perfpiration at the fame time, and equable determination of blood by moderate ex- ercife. Thefe act more generally upon the fyftem. There are others acting more topically on the head; fuch are blifters, as acting either by evacuation only, or by removing the fpafmodic affections, which are the foundations of the difeafe. Iffiies are alio of con-
iiderable
Cullen’s Clinical Lectures .
429
fiderable fervice, if we confider the nature of the matter evacuated by them, which is the coagulable lymph: thefe, then, keep the veffels more relaxed and empty 3 they are alfo ready as outlets to carry off any fuperfluo-us matter, in cafe of any unequal deter¬ mination to the part. The nearer they are to the part, the more effedt both they and the blifters mutt undoubtedly have; though they may be of fervice, too, at a greater diftance. In all cafes of congeftion and determination to the particular parts, relief may be obtained by increafmg the contiguous fecretions, as here of the mucus of the nofe: this is the founda¬ tion of the application of fternutat ories, and particu¬ larly of the alarum, which may he managed fo as to caufe a fecretron of the mucus, with the appearance of pus, and then it is often an ufeful remedy. Thefe remedies are proper where the returns depend on a particular turgefcence of the veffels of the part.
£ When there are fymptoms of a cold fit approach¬ ing, other means fiiould be ufed to prevent its return* If it comes at a conliderable interval and exadt period, the bark is moft proper. Where the head-ach has any properties of the intermittent fever, which has been already mentioned, it is aim oil the only thing to be depended on. But there are other cafes fomewhat periodica], where it may be hurtful, as in thole above depending on a turgefcence, either general or par¬ ticular: hence, it is not thought fafe to give the bark in vernal intermittents, left it fhould excite inflamma¬ tion ; for it will, peihaps, prevent the cold fit, but not the determination of the blood to the parts, and the increafed impetus occafioned thereby.
c When the bark is employed in the head-ach, it muft be given in the fame manner as in an intermittent, in large dofes, and near the approach of the fit. Where the bark is ufed, the ufe of evacuations, low diet, &c. is excluded, as in the cafe of other intermit- tents. Befides the bark, opium is a means of pre¬ venting the return of thefe fits. It has been tried
with
430
Cullen's Clinical Lectures .
with and without fuccefs, and fome times with bad effects. There is a difpute concerning its ufe in in- termittents, between Lieutaud and Storck ; and as it is proper or improper in them, fo mull it be here, A third means is, by exciting an artificial fever, by promoting a determination to the furface, or even bringing on an adlual fweat : this is done by emetics and other fudorifics, and particular flimuli. This is the foundation of the ufe of volatile alkali; thus, large doles of lab corn. cerv. have been found to prevent a return of the fit. Emetics and opium com¬ bined have often been of fervice, as in the cafe of Dover’s Powder.
c We have now fliewn the proper idiopathic head- achs to be paroxyfms of a topical fever. Thefe we have divided into two kinds ; one, where the pa- roxyims are occafioned by a more copious determi¬ nation of the fluids to the parts. This, we faid, wras to be obviated by avoiding and removing this inereaf- ed impetus, for which purpofe we recommend the ufe or various evacuations ; the other kind was, where the fit is not excited by any remote caufe ; but the plan of cure muff turn, on obviating the return of thefe fits.
4 Where they are exactly periodical, they mull be treated as other intermittents, with bark or opium : but tl^iere is alio another method, which we mention¬ ed, as often followed, either when the fit is periodical, or not exactly determinate ; and this is the ufe of emetics and fudorifics, or both combined, as in the cafe of Dover’s Powder. There is a third cafe ftill remaining, of thofe which properly appear in the paroxyfms of a topical fever, but have the cold- fit more confiderably prevailing : the method of cure mult here, too, turn on preventing the return of the fits in general; every thing is proper, that tends to invigorate the fyflem, as bark, bitters, chalybeates, exercife, &c. But, further, thefe require a particular confideration of occalional caufes, and of the means of avoiding them : thefe may be referred to two ge¬ neral
C alien’s Clinical Lectures.
43 1
neral heads, one of which is cold, one of the moft frequent occalions of the paroxyfms of this kind of head-ach. The common way of preventing this, by warm coverings, is very precarious ; for the utmoil exaCtnefs is requidte in keeping them on ; and the leaft negleft of this, expofes the patient to the effects of cold ; betides this, they are feldom effectual, fo that the patient is always wanting an addition to be made to them.
c A much more effectual method is cold-bathing, which has often proved of fervice, after warm cover¬ ings, and fuch other things, have been tried in vain, by enabling the body to refill the cold air, when ap¬ plied. The fecond general head turns on avoiding every thing which may weaken the fyftem, as ab- ftinence, evacuations, &c. In this kind of head-ach, two topical applications are more particularly admif- lible during the fit.
c In hot fits of the head-ach, warm applications rather aggravate the pain ; but cold applications have been thought ufeful in this cafe : thefe, however, are precarious, and even of dangerous effefl ; for, by pre¬ venting the increafed impetus, they often increafe the force of the determination to the part. If they fhould happen, too, to correfl the fit, they may perhaps change it to fame more dangerous affection of the brain : thus a paralytic affection of the external parts, as particularly of the eye-lid, is often the confequence of cold applications during fits of the head-ach. — None of them are proper in a hot fit; but, in a cold one, warm cloths, fomentations, warm bags, &c.. often give much relief. Their ufe feems to be con¬ fined to fuch cafes, where ftrong odours are of fer¬ vice. Thus, in a cold fit, the volatile or even cauttic alkali, as in the eau de lace , is very ufeful, or fpirits of wine, as Hungary water. There are feme other external applications peculiarly adapted to thefe fits, as sether, which is perhaps only proper here. It a£ts* not only as an antifpafmodic, buff by
exciting
/
4S2 Cullen’s Clinical Lectures .
exciting heat, and a fwelling of the part : and, if it has not this effefl, it is feldom of any great ferviee. The ufual way of applying it, is to put a little of it in the hollow of the hand, and hold it to the pained part, till the glowing heat, is removed ; but it is apt to efcape from the hollow of the hand ; fo that it is better to dip a little ball of cotton in aether, and ap¬ ply it to that part, covering it with one’s hand, or with a bladder between one’s hand and the forehead. Warm applications, ftimuli, antifpafmodics, &c. may alfo be ufed: thus, the effence of lemons, with vol. alkali, is often of equal fervice with aether, and was accordingly frequently ufed by the late Dr. Ward. All thefe are improper in the hot fit, in which topical bleedings are the mod fure method of relief. A pe- diluvium may be of fervice here, as alfo a glider, in taking off the impetus of the blood to the part, and in promoting a relaxation : thefe are the principal re- marks we had to offer, on the proper idiopathic head- ach.
€ The fympathetic head-achs, as thofe depending upon the gout, on the date of the mendrual or hemor¬ rhoidal flux, &c. mud be referred to thofe particular fubjedfs. Omitting, therefore, all thefe, we fh'all pVp- ceed to give fome account of thofe of our patients who have laboured under head-achs, beginning with Ann Hood,
e The firft account of her fymptoms, feems greatly aggravated, with regard to the fevere tacking pain, and condant head- ach ; for, from the fenfe of cold fhe felt, from her former ailment, (hewing a debilitated fydern, and from the more particular account of her fymptoms, obtained fince, it plainly appears, that her head-ach is of the lad fpecies mentioned, in which there are paroxyfms; but that of the cold fit chiedv prevails. Here, however, there appears fome little degree of the hot fit, as the cold one terminated in a fwdliiig in the eye, and that part of the head. Her complaints .firft arofe. from a fuppreffion of the menfes.
Cullen's Clinical Lectures . 433
and were relieved by their return at firft ; but they have never lince returned properly. The fuppreflion and imperfect flow afterwards, produced fome hyf- terical complaints firfl, which have fince turned out mere Ample complaints of the ftomach'. Thefe com¬ plaints have a particular connexion with the month of Auguft, having returned three years fucceflively at that period. This is difficult to be accounted for, but will admit of her conjectures : one is, that it is owing to fome particular circumftances attending that month, known from other conffderations, as of the dyfentery and cholera morbus ; the other is, that the complaints came on accidentally, at firfl:, at that period, but after¬ wards formed themfelves into an annual period. The determination to the uterus, being firfl: fuppreffed, and afterwards much diminifhed, was firfl: turned to the ftomach, and then to the head : this laft is only to be looked upon as a tranflation ; for the ftomach, then, was not fo much fubjeft to its former complaints. The conftant coftivenefs the laboured under, was a fymptom of the lefs determination to the defcending aorta, or of the weaknefs of the fyftem in the ali¬ mentary canal.
c Viewing the diforder in the light we have men¬ tioned, we propofed to treat it by blifters and iflues, at the fame time obviating the determination to the head, by keeping the belly open, and thereby deter¬ mining the fluids to the uterus. The blifters feem to have had a very good effe6t here, and to have pro¬ duced a proper refolution of the paroxyfm in the fw el- ling, as mentioned above. The common way of ap¬ plying a perpetual blifter, as it is called in England, or what we call a perpetual iffue, is to apply the em- plajlrum epifpajlicum ; and, when this has railed the fkin, to add conftantly the ung. epijpa/l. and thereby keep up a perpetual difcharge. Inftead of this, we ordered a plafter, confifting of equal parts of cm- plajlrum vejicat. Sf cereum , which we have often tried with great advantage. This doth not raife the cu-
vo l, v. Ii tide*.
434
Cullen's Clinical Lectures .
tide, or erode the parts under it, but leaves them entire, and lets the hair grow up. As thefe, in ten or twelve days, pufh off the plafter, it is neceffary to leave off the plafter, as foon as the fkin can bear the razor, to take off the hair, and apply a frefh plafter. This gives lefs pain, is free from the inconvenience dually attending the bliftering plafter, where the can- tharides is abforbed, and gets into the blood, where¬ by a ftrangury is brought on. To promote the dif- charge by the belly, we applied the aloetic pills ; and when thefe were not effectual, added 1 gr. of calomel to 3 of aloes. This is one of the beft laxatives, giv¬ ing generally one ftool in the day ; it is what is gene- rally known in thefe parts by the name of Chamber¬ lain's Pill. We made another experiment here with aloes, which fucceeded in giving a temporary relief, which is the onlything it does in general. We alfo made ufe of warm applications, which produced a fweat, and raifed a heat, but were not applied pro¬ perly in the paroxyfms : this has hindered us from em¬ ploying fome remedies, that we otherwife fhould have attempted. We fhall only fubjoin another obferva- tion here, yvhich is, that the menfes occurring, gave confiderabje relief, for fome days, as did a fponta- neous diarrhoea, which accompanied them. The next cafe we fhall mention, is that of William Mac¬ millan. His diforder, though not very diftinft, appears to be the cephalalgia rndancholica , from the fymptoms accompanying it, as dimnefs of fight, dou¬ ble vifion, vertigo, tinnitus aurium , &c. and thefe, too, occurring in a perfon of the melancholic tem¬ perament. A
5 This, then, is not to be referred to the general head of a topical fever, but to fome particular caufe, and perhaps of the veffels of the brain. There is always reafon to fufpeci a venous plethora in fuch cafes, and efpecially here, from the fymptoms being increafed by Hooping. Thus the leaft return of his diforder came on from harveft-work, in which much
ftooping
Cullen’s Clinical Lectures „
435
Hooping is requifite : add to this, that his complaints are always increafed by cold of the feet ; yet it is not certain whether this is to be looked upon as a caufe or an effeSt. There are feveral cafes of the melan¬ cholic torpor, independent of this venous plethora ; and whatever produces this torpor, may alfo occafion the plethora.
c There feems to be fome peculiar affeftion of the origin of the nerves here ; efpecially as this diforder comes on in confequence of a fever, .which often leaves affections in the origin of the nerves. In our treatment of the patient, we firft ufed moderate eva¬ cuations, as bleeding by leeches, few in number, but frequently repeated ; but we did not pufli thefe largely, as they might have proved hurtful, by weak¬ ening the fyftem and increafmg the torpor ; betides,, leeches have little effect in a venous plethora, and, in fuch a cafe, it is much better to open the jugular vein. We next attempted a derivation from the head, by laxatives, or, perhaps, purgatives : but, as his complaints feemed to be aggravated by thefe, we defifted from the ufe of them, and perhaps too foon, as this might be owing to occafional caufes only, which will often recur in fuch cafes. W e then tried a lefs ambiguous remedy, as blifters, which, at firft, feemed to have confiderable effeft, but lefs fo after¬ wards. We alfo tried perpetual ifiues, in the man¬ ner mentioned in the preceding cafe.
As the emplajlrnm calidum had no effeft, we fub- ftituted a ftronger; but this, for want of due atten- rion, has not been properly conduced. As the cu¬ ticle was but little affeCled, and the fkin under it not eroded, we have ventured on the application of a frefh plafter, immediately : as we were Hill intent on procuring a derivation from the head, we employed valerian for that purpofe. This has been always on the footing of a fpecific ; but in this, as well as in all other fpecifics, we fhall aLvays find fome operation, to which its effeCfs may be attributed. Accordingly,
I i 2 valerian
436 Crichton on Mental Derangement.
valerian has (hewn itfelf to be a laxative, in feverai other cafes now in the houfe, and particularly in the prefent patient, on whom it operated confiderably, when given to 3ii.
c We alfo tried more eflfeQual purgatives, which feern to have given relief, or, at lead, have not ag¬ gravated his fymptoms. He is now free from head- ach entirely ; and his dimnefs of fight, tinnitus an - rium , and giddinefs, are much better. A fponta- neous diarrhaea has now come on, which, if not oc~ cafioned by our medicines, might, perhaps, be look¬ ed on as a refolution of the diforder. We at firfl fuf- pefled it to be hemorrhoidal, as it came on without febrile fymptoms ; but he had fome febrile fymptoms yefterday, Jan. 27, and the night before : it is now keeping off. We only tried fuch remedies as were proper, fuppofing it to be a proper diarrhsea, or dyfenteryd
Art. XLVI. An Inquiry into the Nature and Origin of Mental Derangement , Sic. By Alex¬ ander Crichton, MAD.
(Continued from page 358 .)
■ ' • . 4^ ’
IN our lafl we followed the ingenious author through the firft divifion of his work, containing the inquiry into the phyfical caufes of delirium and other derange¬ ments of mind. In the fecond book he treats of the difeafes of each faculty of the human mind, and alfo of many kinds of diflurbance in our intellectual part, which are occafioned by peculiar faults in the facul¬ ties* The phyfiology, or natural hiftory of the mind, is here combined with its pathology or morbid hif- tory. It would be impoffible, within the narrow limits allotted to an individual article, to analyfe a fubjeft of fo wide and varied an extent. We (hall, therefore*
confine
437
Crichton on Mental Derangement .
confine ourfelves to the author’s remarks on the Dif- eafes of V olition. It will be then feen, how widely he differs from Dr. Darwin in his view of this matter.
c Between the ideas which excite bodily a£tion, and thofe which give exercife to the mental facul¬ ties alone, there feems to be this effential difference, that feveral diftin£t feries of the former may go for¬ ward at one and the fame time, each producing its peculiar bodily movements, without in any way ol> ftru&ing each other ; whereas it appears that we can¬ not admit of more than one fubjeft of thought at a time. A perfon may be impelled by one train of ideas to walk, by another to perform certain opera¬ tions with his hands, and by a third to fpeak ; and all thefe a£is, each arifing from an impulfe of this mental principle called volition, fhall go on at the fame time without impeding each other,; but no man can entertain two fubjefts which excite memory, or imagination, or judgment, at one and the fame mo¬ ment of time.
c It was neceffary to ftate thefe fa£ts in order to ex¬ plain the nature of certain very curious difeafes, which arife from an irregular adtion of this principle.
‘ When two different fhades of the fame thought arife in quick fucceffion, each of which neceffarily has a tendency to affeft the fame fet of nerves, the in¬ fluence of the one is partially deftroyed by that of the other, and an incomplete bodily a&ion takes place. If a fudden thought makes a perfon who is in the middle of a fpeech imagine that there is a better ex- preffion for his thoughts than that which he is about to employ, the aftion is immediately interrupted, and he either hops, or hammers. When this complaint is flight, it is called hejitation , when great,, ftammering.
c Every perfon is more or lefs expofed to the firft of thefe affections. It may arife from various claffes of ideas, but moft commonly it is the offspring of doubt. Doubt often arifes from great timidity ; and where this feeling is ftrong, and natural to the con-
I i 3 flitution
438 'Crichton on Mental Derangement .
flitution of fome people, hesitation becomes a very early habit In other cafes it arifes from accidental circumftances. There is one caufe which produces it accidentally in many young people, which cannot be too much reprobated : I mean the injudicious feve- rity of fome parents and teachers. The fear of pain, and the fear of offending, and the fear of being found in fault, are often predominating features in the cha¬ racters of young people, and moft commonly in thofe who are endowed with what is figuratively called great fenfibility of mind. If fuch a youth, while he is repeating his talk, be regarded wTith a look, or threatened, as if it were expe&ed he wrould fail, he commonly does fo from mere apprehend on, and this being often repeated be acquires the habit of hefitat- ing. Such a defect, although it be a real evil, is feldom confidered as a difeafe ; and, unfortunately, few parents are fufficie'ntly attentive to their children at the early periods of life to obferve its approach. Many others have it not in their power to do fo, owing to their children being feparated from them, and that up in feminaries, where the feeds of many other mental diforders are fown.
c The origin of the diftreffing habit called Stam¬ mering, generally occurs alfo in early life. It arifes either from a fpecies of doubt, or elfe from imitation, for it is in no caie to be confidered as natural to any
constitution*
c A very lingular phenomenon concerning this im¬ pediment in fpeech is, that the hefitation is generally confined to the pronunciation of a few letters,, and this is the caufe w7hy its effects are always heard and feen ; for if it concerned whole words, a total flop would be put to fpeech. The perfon begins a con¬ catenated chain ot actions, or, to fpeak in plain lan¬ guage, he begins to pronounce the words which com relpond to the thoughts that are prefent in his mind, he arrives at one of the letters alluded to, and imme¬ diately a doubt arifes in his mind how it is to be pro¬ nounced.
Crichton on Mental Derangement . 439
nounced. I am at prefent (peaking of the origin of the complaint — he then begins to pronounce in a dif¬ ferent way, and the doubt again arifes ; he then re¬ turns back to the lad pronounced fyliable of the word, and repeats it, but upon coming to the letter, the doubt again arifes, and gives a different direction to the fenforial impreffion, and he again attempts to fp eak another letter. He cannot flop, for he is in the middle of a word, the pronunciation of which he has been accuftomed to conclude, and he therefore con¬ tinues to druggie with it, till at lad, owing to fome accidental caufes, which it is not eafy to difcover, he accomplith.es its proper utterance.
c Volition, now and then, fails to produce its full corporeal effect, from various difeafed dates of the brain, or nerves, or from the influence of fome power¬ ful fenforial impreflion, counteracting thofe of voli¬ tion. In pally, and in the night-mare, a perfon is con- fcious that he makes efforts of volition to move cer¬ tain parts of his frame, and yet cannot fuceed, for the corporeal caufes which produce thefe difeafes, prevent the impulfe from being conveyed to the parts intended to be moved, and consequently they cannot be dimulated into action by that principle.
c In order that a motive of adlion (hall produce its corporeal effedl with due force and celerity, it is ne~ ceffary that the nervous fluid be fecreted in due quan¬ tity. If this is not the cafe, the impreffions which are made by the action of this principle are too much weakened before they reach the mufcular parts, and hence a feeble motion only occurs. This is the rea- fon of that didreffmg indolence which many people who have long laboured under domachic complaints, or other difeafed vifcera, or women affi idled with hyf- teria, frequently are fubject to. Such people are con- dantly agitated between the defire of accomplifhing many duties which they are confcious they ought to perform, and the painful bodily languor which op- preffes them. The nervous fluid being fecreted in
I i 4 • final]
440 Crichton on Menial Derangement.
fmall quantity, the fenfation of fatigue is foon in¬ duced, and the body therefore does not eafily obey the dilates of the will.
‘ All motives of addon which arife immediately from external agents, a£t in general more powerfully than reflex thoughts or ideas, which are merely re¬ called to the tnind. This does not require any iliuf- tration.
‘ The longer any external objeft which yields a motive of addon a£is upon us, the more forcibly, and the more eafily does it produce its effefls. There is a very remarkable cafe narrated by the learned Dr. Herz, in Vol. VIII. of the Pfychological Magazine, which may be confidered as an illuftration of this pofition.
“ In Auguft, 1785,” fays the Doftor, “ I was call¬ ed to an officer of the artillery, a man about forty years old, who, as I was informed, was feized with a pally in confequence of cold, and violent anger. His tongue, hands, and feet, were lamed by the attack.
“ He was under the care of one of our firft phy- ficians, at whofe defire I was confulted concerning the propriety of applying elearicity. From the time that this remedy was firft employed, until the follow¬ ing year, I never faw him ; but he then fent for me
again, as his own phyfician, he faid, had deferted him.
I found him fo much recovered as to have the complete ufe of his feet ; his hands alfo were ftronger , but in regard to his fpeech, the following very re¬ markable circumftance was to be obferved. He was able to articulate diftinQly any words which either oc¬ curred to him fpontaneoufly, or when they were flowly and loudly repeated to him. He ftrenuoufly exerted himfelr to fpeak, but an unintelligible kind of murmur was all that could be heard. The effort he made was violent, and terminated in a deep figh.
" On
Crichton on Mental Derangement. 441
<c On the other hand, he could read aloud with facility. If a book, or any written paper, was held before his eyes, he read fo quick and diftinflly, that it was impoffible to obferve that there was the flighteft fault in his organs of fpeech. But if the book or paper were withdrawn, he was then totally incapable of pronouncing one of the words which he had read the inflan t before. I tried this experiment with him repeatedly, not only in the prefence of his wife, but of many other people. The effeT was uniformly the fame.”
c Dr. Hefz, who juftly attributes this lingular phe¬ nomenon to the fuperior ftrength, and to the longer duration df impreffions received by the eyes, men¬ tions another cafe which fell under his obfervation, and which has a great limilarity to the one already cited. A young lady, who had fallen into a hate of melancholy in confequence of deep grief, could not be made to pronounce a word, either by means of threats, or intreaties. But if a book was prefented to her, and Are w~as requefled to read it, fhe did fo with the facility of a perfon in perfefl health. In fome cafes, the aftion of the will is totally checked by a difeafed hate of the brain and nerves, as is the cafe in that rare malady called catalepfy, of which the following is a very remarkable mftance. It is extrafl- ed from the Pfychological Magazine , V ol. V. part 3, page 15.
“ A young lady, an attendant on the princefs
of - 3 after having been confined to her bed for a
great length of time, with a violent nervous diforder, was at laft, to all appearance, deprived of life. Her lips were quite pale, her lace refembled the coun¬ tenance of a dead perfon, and her body grew cold.
“ She was removed from the room in which fhe died, was laid in a coffin, and the day of her funeral was fixed on. The day arrived, and accord/ ng to the cuflom of the country, funeral fongs and hymns were fung before the door. Juft as the people were
about
I
442 Crichton on Mental Derangement .
about ro nail on the lid of the coffin, a kind of per* fpiration was obferved to appear on the furface of her body. It grew greater every moment, and at laft a kind of convullive motion was obferved in the hands and feet of the corpfe. A few minutes after, during which time frefh figns of returning life appeared, the at once opened her eyes, and uttered a rood pitiable fhriek. Phyficians were quickly procured, and in the courfe of a few days fhe was confiderably re* ftored, and is probably alive at this day.
The defcription which fire herfelf gave of her fituation is extremely remarkable, and forms a cu¬ rious and authentic addition to Pfychology.
She faid it Teemed to her, as if in a dream, that fhe was ready dead ; yet fhe was perfectly confcious of all that happened around her in this dreadful ftate. She diftinftly heard her friends fpeaking and lament¬ ing her death at the fide of her coffin. She felt them puli on the dead-clothes, and lay her in it. This feeling produced a mental anxiety which is inde- fcribable. She tried to cry, but her foul was without power, and could not aft on her body. She had the contradiftory feeling as if (he were in her own body, and yet not in it, at one and fhe fame time. It was equally impoffible for her to ftretch out her arm, or to open her eyes, as to cry, although fhe con¬ tinually endeavoured to do fo. The internal anguifh of her mind was, hov/ever, at its utmoft height when the funeral hymns began to be Tung, and when the lid of the coffin was about to be nailed on. The thought that fire was to be buried alive was the hrft one which gave aftivity to her foul, and caufed it to operate on her corporeal frame. ”
c The relation of the above faft is faid, by the gentleman who fent the account of it to the editors of the Magazine, to have been obtained from the moft refpeftable witnefles. Independently of the re- . fleftions which rnuft naturally arife in the mind of every intelligent phyfician, from 4he Angularity of the
cafe.
I
443
Crichton on Mental Derangement .
cafe, there is an aweful warning to be drawn from it, which regards every perfon ; I mean the danger which arifes from too early burials in the cafe of hidden, or unexpected death. This is a c ire urn fiance which has been often taken notice of, and which certainly re¬ ceives additional intereft from inch cafes as throne which has been juft mentioned.
c No other difeafes can, in my opinion, be juftly deemed difeafes of volition. This declaration will probably excite furprife among the admirers of the Zoonomia, in which work all the fpafmodic and con- vulfive disorders are considered by Dr. Darwin as efforts of volition, and are ranked among the difeafes of this faculty. To me it appears that all the fpaf¬ modic difeafes arife from phyfical ftimuli, applied either to the brain itfelf, or to diftant parts of the nervous fyftern, as in themafe of worms, or acrid matters in the ftomach and inteftmes, tumours, wounds, fraftured bones, &c. ; and, that the nervous impreffion of thefe ftimuli, fo far from exciting the will, counteracts its efforts, and repreffes, as it were, its adtionf The convuifions of epilepfy, and tetanus, for inftance, are not, in my opinion, voluntary addons excited, for the purpofe of counteracting pleafure or pain, as Dr. Darwin imagines, but are involuntary a£ts of the external mufeies, produced by the tranf- million and irritation of a powerful and unufual nerv¬ ous impreffion ; and I therefore coincide with Sau- va^e, Vogel, Hoffman, and Cullen, and all former writers of repute, in confidermg thefe as difeafes which ought properly to be called involuntary ones,' It would require more time than what I deem at pre- fent confiftent with the plan of this woix, to place Dr. Darwin’s hypothefis in a proper point of view, and to fhew the impropriety of his claflif cation ; per¬ haps this may be done at a future time.
The third and laft book treats of the Paffions, con-
fidered as the caufes of mental derangement. I he
following
444 Crichton on Mental Derangement .
following are the author’s general concluding re¬ marks,
* 1. The phenomena of delirium arife when difeafed perceptions are. miilaken for realities.
c 2. Difeafed perceptions arife from phyfical or cor¬ poreal caufes, and from moral or mental caufes.
‘ 3. Corporeal caufes produce delirium, by exciting fuch a derangement in the brain as prevents external nervous imprefiions from exerciling their natural in¬ fluence on the mind; and hence delirious people either miftake external objefts, or do not attend to them.
‘ 4. Every altered hate of brain which does not amount to a certain degree of deflruftive preffure, excite, by the laws of thought, a mental perception ; but as the fenforial imprefiions of difeafed action are different from thofe which are derived from external objefts, fo the images which are excited in the re* prefentative faculty are alfo different. But nothing can be reprefented in the mind which has not formerly been received through the medium of the external fenfes, or concluded by the operations of reafoning ; and, therefore, all the ideas of delirious people, how¬ ever different they may appear to be from any thing which has formerly been heard, touched, tailed, frnelt, or concluded, are only new affemblages or combina¬ tions of prior fenfations and thoughts : the reprefen- iations of delirium, therefore, are in this refpeft, like thofe of the faculty of fiftion.
c 5, Corporeal caufes of delirium are of two kinds : the firfl aft by altering the aftion of the arteries of the brain and nerves ; the fecond by yielding morbid imprefiions, which either impair, or prevent the tranf- miifion of natural external nervous imprefiions, in their progrefs to the mind.
‘ 6. The firfl clafs of corporeal caufes produce ma¬ nia and the delirium of fevers ; the fecond, hypo- chondriafis and the delirium of nervous or hyflerical patients.
£ 7. As
Crichton on Mental Derangement . 445
e 7. As it has been proved, that in mania there is every appearance of a morbidly increafed action of the veffels of the brain, more efpecially of thofe which fecrete the nervous fluid ; and as all increafe and every alteration, in the nature of this fluid, mail increafe and alter fenflbility, and confequently caufe the fenforial imprelfions to aft with unnatural vio¬ lence, fo the moft linking features of mania may be accounted for ; as, for inftance, the want of ileep, conftant raving, and fury.
c 8. Although it happens that mania (hall appear, at times, to rife from the influence of violent paflions, or from over-ftraining the faculty of aftion, yet this feldom occurs except there be much predifpofition to the complaint ; and as in fuch cafes, and indeed in every cafe, infanity does not occur without its being accompanied by marks of difeafed aftion of the vef¬ fels of the brain ; fo it may be concluded, that the proximate caufe of mania is always to be fought for in this ftate of the brain.
£ 9. The ideas or thoughts which appear to create the mental difturbance of a perfon labouring under mania, throw no light either on the origin or nature of the complaint ; and this circumftance forms a very" remarkable diftinftion between maniacal delirium, and the delirium of hypochondriacs and melancholy ; for, in thefe laft difeafes, a perfon acquainted with the human mind, efpecially with the nature of mental perception, may often receive confidexable light from fuch fources,
£ 10. When the increafed aftion of the arteries of the brain fubfides, a morbidly weakened aftion of thefe veflels is the confequence, the nature of which it is not eafy tp afeertain, but it is the caufe of another delirium ; which delirium has a very different moral charafter from that alluded to above ; for the patient, inftead of being ferious, is gay and focial, but is ilill not governed by external objefts, or reafonable con- elutions.
c 10, Among
446 Crichton on Mental Derangement.
c 1 1. Among the moral or mental caufes which pro¬ duce delirium, grief and fear, and their modifications, are the moil frequent ; for, although every variety of pride and vanity, ambition, and feveral other paffions which belong to the modifications of joy, feem at times to produce delirium, yet they feldom do fo, ex¬ cept by ex poling a perfon to the frequent operation of mental pain, fuch as arifes from neglect, difappoint- ment, contempt, and many other kinds of painful hu¬ miliation.
€ 12. The painful thoughts produce dejeftion and defpondency in the fame way that corporeal pain acts ; namely, by exhaufting the energy of the brain and nerves, or, in other words, by inducing a torpor in thefe veflfels..
€ 13. The torpor and diminifhed fecretion of nervous fluid occaiion an inienfibility to external objects, and to the fenfations which accompany all natural wants or delires: hence the conftant engagement of the mind with ideal objects of pain, the folitude, anx¬ iety, and defpair of fuch patients.
4 14. There are, then, three diftindt kinds of de¬ lirium which belong to the order of difeafes called Vefaniae. Thefe may be denominated, lit. Mania furibunda ; 2dly. Mania mitis ; and, 3'dJy. Melan¬ cholia.
6 15. Mania furibunda caries according to the phy- fical caufes which excite it.
c 16. Mania mitis varies according to its moral character. *
17. Melancholia according to the paffions which give birth to it, or the phylical caufes which in¬ duce it.
4 18. Independently of thefe diforders which dif- iurb every faculty of the human mind, and all the external fenfes, or rather the impreffions received by the external fenfes, there are others which only de¬ range particular faculties ; the aftion of the mind be¬ ing, in other refpe&s, in a healthy Hate. Thefe, 3 * which
Crichton on Mental Derangement 447
which might be called partial difeafes of the mind, are of two kinds, iff. illufions: and, 2nd. Weak- neffes of the mental faculties.
f 19. illufions arife from corporeal caufes and from mental caufes.
* 20. Corporeal caufes and mental caufes produce illufions upon the fame general principle that the phantoms which occur in delirium produce a convic¬ tion of their reality ; namely, by occafioning fuch im- preffions as deftroyed, or greatly diminifhed the in¬ fluence of external objedls. It maybe added here, by way of a remembrancer, that the proper influence of all impreffions, ab externo, is excited on the facul¬ ty of attention ; and that when a fufficient degree of attention to any pbjedl is not given, erroneous judg¬ ment arife s.
c 21. The impreffions of corporeal caufes which pro¬ duce illufions, do not diforder the healthy adlion of the whole brain, or its arteries; and, therefore, all external objedls, aflociations of ideas, and operations of mind, the fenforiai impreffions of which do not fall on the fame part of the brain as that which re¬ ceives the difeafed impreffion, produce their natural effect, and the perfon, therefore, appears to think and adl like a reafonable man, except on fuch fubjedts as have a relation to the illufion.
c 22. Corporeal impreffions, producing, illufion, ge¬ nerally arife in parts of the nervous fyftem which are at a diftance from the brain; as, for inf ance, in the various vifcera of the abdomen or pelvis.
c 23. But all fenfations arifing from fuch caufes, whether healthy or difeafed, are generally referred,# by a fpecies of judgment, to the place where they are felt: and, therefore, hypochondriacs entertain falfe notions concerning their own frame.
c 24. The impreffions of difeafed vifcera, fuch as the ftomach, inteftines, uterus, liver, pancreas; &c. do not reach the brain until the healthy a cl ion of the nerves has been impaired.
I
4 48 Crichton on Mental Derangement .
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c 25. This injured hate of nerves is to be confidered as particularly affedting the fmall arteries, which are deftined to fecrete nervous matter ; but as the eafy tranfmiftion of nervous impreffions depends on the due proportion of folid, as well as fluid matters, which enters into the compofition of thofe organs, it follows, that the fenfations muftbe greatly difordered, and confequently we find that, in hypochondriafis, the nerves themfelves are fruitful fources of pain¬ ful feeling.
* 26. Hypochondriafis, therefore, is chiefly charafter- ized by erroneous notions relating to the patient’s own frame, and by painful corporeal feeling.
4 27. Ulufions, from moral or mental caufes, arife either from an hereditary over-adtivity of the faculty of fidlion, or from diredling attention too much to imaginary objedts, or from the influence of paffions ; by which means the fenforial impreflions of fuch ob¬ jects become ftronger than thofe of external objedts, and their exiftence, therefore, is at laft more readily believed in than that of objects of external fenfe.
4 28. In no infiance, whatever, do moral caufes feem to produce real illufion, in fuch people as have no pre- difpofition to the difeafe, until the healthy ftate of the brain has been difordered by the unequal exercife given to it by particular objedts of ftudy, or of pallion. It may therefore be reafonably imagined that the he¬ reditary difpofition itfelf, confifts in a morbid fenfibility of that part of the brain which receives the impreflions from the imagination, or faculty of fidtion ; and that the diforder, ftridtly fpeaking, does not exift in the mind.
* 29. Where the difpofition to fuch a difeafe is either born with a perfon, or artificially produced by par¬ ticular objedts of ftudy, the paflions may become ex¬ citing caufes of illufion.
* 30. As to the weaknefles of the mental faculties, thefe feem to depend entirely on a weak, or debilitated ftate of brain ; whereby the fenforial impreflions,
which
Crichton on Mental Derangement < 44.9
which arife from the operations of mind, are not of fufficient ftrength and vivacity,
30. Each faculty of the mind is fubjeft to fuch im¬ pediments, and, confequently, may appear, to be weakened.
31. Upon thefe deduftions is founded the follow-* ing arrangement of mental difeafes.
Genera and Species and their Symptoms.
Clafs Neurofes. Order Vefanias.
G. 1. Deli rium . General derangement of the men- tal faculties, in which difeafed perceptions are mif- taken 'for realities ; with incoherent language, and unruly conduct.
Species 1. Mania Furibunda. Delirium, with conftant raving, audacity, and fury.
2. Mania Mitis. Delirium, with raving, and appearance of gaiety and pleafure.
3. Melancholia . Delirium, with dejec¬ tion, defpondency, and defpair.
G. 2. Hallucination or Illujion. Error of the mind, in which ideal objects are miftaken for realities ; or, in which real objects are falfely represented, without general derangement of the mental facul¬ ties. .
Species 1. Hypochondria /is. Error re fpe Er¬
in g a perfon’s own health or form, with anx¬ iety, apprehenfion, and dread; flatulency, dyfpepfia, palpitation, tremor, and fenfe of . pain.
2. Dfcmonornania. Firm belief in the immediate communication with fpirits, or perfuaflon of the power of working mi¬ racles, without other Symptoms of ge¬ neral derangement of mind..
3. Vertigo. Apparent rotatory motion of external objects, and fenfe of undula¬ tion in the ground, with abolifhed atten¬ tion and thought.
vol. v. Kk
4. Sam-
r
*
450 Crichton on Mental Derangement .
4. Somnambulifmus ?
G. 3. Amentia. Diminifhed power of the mental faculties.
Species 1. Fatuitas. Imbecility of all the fa¬ culties of the human mind, particularly thofe concerned in aflociating and comparing ideas ; accompanied with want of language, a ftupid look, and general bodily weaknefs.
2. Memoria imminuta. Difficulty of re¬ calling thoughts, and incorredinefs as to recognizing objedts formerly perceived.
3. Perceptio imminuta. Difficulty of form¬ ing diftindt reprefentations.
4. Vis idearum ajjociandi imminuta. De¬ ficiency or incapability of arranging one's thoughts ; giving figns of confufion of in- telledt.
5. Vis fingendi imminuta. Total want of genius, or diminifhed genius.
6. Vis judicandi imminuta. Want of judg¬ ment and common fenfe.
In an appendix the author gives a tranflation of the medical aphorifms of Dr. J. E. Greding, on melan¬ choly, and various other difeafes connected with it, extradfed from his mifcellaneous writings. Very mi¬ nute defcriptions of the appearances on diffedtion in the brains of infane patients are here given, and which evince, that in almoft all cafes of this kind, corporeal changes are found to take place. Thefe remarks form a valuable addition to Dr. Crichton's elaborate work.
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Hamilton on Hydrophobia .
451
Art, XLV1I. Remarks on Hydrophobia , fife. Robert Hamilton, M. D.
(Continued from page 393.,/
THE fymptoms of the difeafe which fucceeds the
bite of a rabid animal come next to be con- - fidered. In its commencement, they differ little from thofe which are obferved to precede ordinary mala- dies. It firft threatens by the ufual warnings of fenfe of coldnefs, alternating with heat, pandiculation and yawning ; and with fometimes a higher degree of ex¬ hilaration of fpirits. Thefe continue from three, four, and even to fix or feven days, before the patient takes the alarm : a feverer train of fymptoms, but more charafteriftic, afterwards fucceeds. f
The firft fymptom is generally a pain in the part where the bite has been received, ftretching upwards towards the hip and groin, if in the lower; towards the fhoulder and axilla, if in the upper extremities; and fometimes with difcoloration : fometimes to the temples, ear, and down to the throat, if about the face or neck. Reftleffnefs, difturbed deep, convulftons, efpecially when drink is offered, occafional illufions of mind; great acutenefs of the external fenfes, irregu¬ lar pulfe, fenfe of fuffocation, copious flow of vifeid faliva, fucceed, together with a great variety of irregu¬ lar fymptoms, till death clofes the feene.
The mufcular ftrength is little impaired in this ma¬ lady, nor do the lungs partake much of the difeafe. Great irritability of the ftomach appears to be a com¬ mon fymptom. ♦
From the hiftory of the difeafe it is evident, the author obferves, that the fyniptom hydrophobia is not the commencement, but rather a middle point in the malady. An attention to this is neceffary in form¬ ing our prognoftic; for after its appearance, not an inftance is to be found of recovery ; every paroxyfm
K k 2 collefting
45£ Hamilton on Hydrophobia .
Collecting more ftrength, death hurries on apace. Death generally takes place within four days from the commencement of this fymptora.
With refpeft to the appearances obferved on diflec- tion, it is feldom that their accuracy can be relied on. It was univerfally believed, that man infefted man, and that animals, of whatever fpecies, infedted ani¬ mals ot every fpecies. Hence we need not wonder if attempts towards an inveftigation of hydrophobic cad aver a iliould be made with caution and irrefolu- tion when made at all. The diffedtions related by authors prefent many deviations from the found fub- jedf ; but in a dileafe where convulfions form fo cha~ rafteriftic a part, many of the injuries obferved muff be fecondary. Morgagni in collecting directions, for he had no experience himfelf on the fubjedf, found a variety of appearances deforibed, and no two cafes were the fame. He declines, therefore, drawing con- clufions concerning the feat of the difeafe. Speedy putrefaction, however, feeraed ' common to all; and the fame has been very generally obferved by other writers. An appearance, likewife, has in general been feen on the inner coats of the ftomach near the cardia, fimilar to what is found in the bodies of per- lons who have had flight inflammation, that is, a greater number of red veflels, with fmall breaks of red blood. I he fame was obferved in the ftomachs aiid oefophagus of dogs that died of the difeafe.
ir rom this we may conclude,’ the author obferves, s that thefe are peculiar to animals, of whatever fpe¬ cies, dying of this affedfion ; and that the exceptions noticed ^y Morgagni, Vaughan, and fome others, are too few to deftroy the force of this general obfervation.
f inattention may have overlooked them in fome in fiances, and in others, where more accuracy was uteu, the change of appearance by the diflance from death, before the inveftigation was begun, will ac- £ount for their being feldomer noticed. If, however,
we
Hamilton on Hydrophobia: 453
we view thefe anatomical obfervations in a mafs, an explanation will prefent itfelf of that diftrefling fymp- tom common to every cafe, pain, and undefcribable nneafinefs about the praecordia. The difeafed condi¬ tion however of the blood, as viewed after death, is tar different from what it prefents during the difeafe, when taken from the arm. In this hate authors con- itantly fpeak of it as healthy. I recoiled! but one ob- fervation in a large collection of examples to the con¬ trary, and in this the blood is only remarked to flow from the vein tc very thick and black.”*
c The direction which we have lately been con- fidering prefents no difeafe of the pulmonary fyftem; for the flight adhefion in part of the left lobe could only be accidental, arifing molt probably from a pre¬ vious catarrh. This would feem to confirm the ob- fervation formerly made reflecting the freedom of this organ from difeafe in hydrophobia ; but molt of the inftances enumerated in the above collection, point out the reverie. This cannot be reconciled otherwife than by prefuming a want of' diftindtion of real cafes, and attributing, at lealt in part, to this, what belongs to other complaints.
‘ I fhall referve the infertion of feveral difledtions to a future part of this work. What will be found there do not however differ in many refpedts from thefe juft confidered. Putrefadfion we find is fully eftablifhed as an early occurrence in hydrophobic cadavera ; but the appearances prefented go fome what farther; they eftablifh likewife a high degree of debility antecedent to death. In molt cafes the heart points out irregu¬ larity in its adtion, neither fyftole nor diafcole being fynchronous. One ventricle is contracted, the other at the fame time dilated : again, one is If uffed with blood, and again dilated and fluffed, if i may fo fpeak, with air only, i. e. dilated without blood. The great arteries and veins in their union with the heart, fuller
* Mead.
Kk 3
the
454 Hamilton on Hydrophobia .
the fame irregular motion. Here are evidences of powerful fpafmodic adlion which this mufcle under¬ goes.
We cannot wonder if the diftribution of the blood be equally irregular, and the circulation flopped in one part, while this vital fluid is hurried on with ce¬ lerity, and accumulated in another, whence, by ex¬ iting contractions in the courfe of the veffels, it can¬ not return to its origin in its ufual uniform and un¬ interrupted way.
6 To debility, therefore, may be afcribed all the various phenomena obfervable both in the living and the dead fubjedl ; while the variety in conflitution, flrength, fex, and age, will influence its degree, and the degree of irregularity in the fundlions of the in¬ dividual. To remove the impediment from circula¬ tion, and reftore the heart to its wonted energy, are dejiderata of the highefl importance. It is not the anxiety alone in the epigaflric region, nor oppreffion at the cartilago enfiformis, a fymptom fo diflreffmg in every cafe, which will thereby experience relief; but the (late of the brain, the inordinate adlion and ir¬ regularity in the functions of this organ, caufing oc- cafional fits of fury, the preternatural fenfibiiity of the optic nerves, the difeafed lenfibility diffufed over the furface, and other diftrefling fymptoms; even Hydro¬ phobia itfelf, with all the deliria of wild illufion, muft equally difappear.
c Much remains to be difcovered before we arrive at a knowledge of all the phenomena of this malady; but perfeverance will accomplifh much, and I defpair not of the treatment being as well underftood fome time hence as the treatment of the fmall pox. If no diffedlions were made till the prefent century, and if, till lately, miflaken notions of the infedlious nature of the complaint in the human fpecies were entertained, it cannot be furprizixrg, that anatomy has given fo little fatisfadlion. In a few' years, I truft, this defedt will be i applied, and a better pathology be afforded/ — • May thefe expeditions be realized !
The
455
Hamilton on Hydrophobia.
* * » - ■■ ^ ,
The tirffc volume concludes with fome remarks on fpontaneous Hydrophobia, which we are under the neceftity of paffing by. The fecond commences with reflections on the method of cure, as hitherto profe- cuted, and to thefe are added the author’s hints re¬ flecting fome new remedies. The particular reme¬ dies in ordinary ufe will engage little ot our notice. They have been fo uniformly unfuccefsful, that it would be a wafte of time to be diffufe. Emetics and cathartics are rejetted, as foreign to every juft inten¬ tion of cure. The cold bath, which for fo many ages has been a celebrated remedy in Hydrophobia, has, however, no proper evidence of its utility, nor does it offer any advantages to counterbalance the fufferings it occafions to the patient. The warm bath has been employed with apparent advantage at firft ; but the utility experienced has been in every inftance only temporary. Sudorifics and ftimulants have equally failed.
Venefettion has been a favourite remedy, from the earlieft accounts of the difeafe. Yet there are no marks of inflammatory diathefis, the author obferves, to warrant its ufe ; and its inutility has certainly been proved on very fufficient trial.
Much has been written in favour of mercury as a prophylactic, yet all the arguments fo fpecioufly ad¬ vanced, and the fuppofed proofs of its utility, by ne¬ gative inftances, fall to the ground, when properly ba¬ lanced with pofttive failures. It will appear from a iimilar examination unprejudiced and open, that the fame conclulion muft follow from its exhibition during the continuance of the diforder. For the laft fifteen or twenty years, from the refpeftability of the names that fypported its adminiftration, praQitioners have embraced every opportunity of putting it to the teft. From this body of evidence we muft reject it, not only as ufelefs, but even under fufpicion of its becoming injurious.
K k 4
The
456 . Hamilton on Hydrophobia .
The application of cold to the cicatrices at the time (hooting pains in thefe parts are firft felt, and li¬ gatures where they can be employed, for the purpofe of benumbing the part, and thus preventing the com¬ munication of the impreffion from the part to the fyf- tem, have been fuggefted ; but they have no fuppor- from experience. Extirpation of the cicatrix the aut thor thinks a more rational pra6li.ce. Suppofmg the difeafe to be local till the commencement of the fymp- toms, he confiders the chance of extirpating the caufe, along with the cicatrized parts, to be great. This, however, is at prefen t, a point of {peculation, though doubtlefs of great importance.
Oil as a remedy, was employed by the ancients; but it has long been neglected. A few years ago, however, its ufe was revived by Dr. Shadwell.* In one inftance it feemed to efFeflt a cure : but it is doubt¬ ful whether the cafe was truly hydrophobic. The fymptoms arofe ten days after the accident, a very un~ ufual period. The patient’s mind was highly impreffi* ed by terror. Add to this, that many fubfequent trials have proved the inefficacy of this remedy.
Vinegar. Th is had excited the attention of Eng-
• O
lifh phyficians much about the time the ufe of oil was introduced. It was exhibited in France prior to this. There is, however, no proof of its efficacy.
Antisp asmodics : under this head are included the mufk, and opium. Thefe have all been tried in the greateft extent, and have all failed.
Tonics are the clafs of remedies from which Dr. Hamilton teems to expeft the greateft advantage, both from the.abfence of inflammatory fymptoms in Hydrophobia, and from many appearances of debili¬ ty which are found to take place in it. Many of the mod powerful, however, have been exhibited without fuccefs, as zinc, and the cuprum ammoniacum. Re- fpefting arfenic as a tonic, the following obfervations
* Vide Mem. Lond. Med. Soc. Vo!. 2.
occur
Hamilton on Hydrophobia . 457
occur. ‘ Dr. Ruffel, in his account of ferpents, con¬ firms the efficacy attributed by the natives in the Eaft Indies to a compofition now known by the name of tonic pills ; the chief ingredient of which con lifts of this metallic fubftance. He affures us that it never failed in the cure of the bites of venomous ferpents ; and, le.d by fome kind of affinity, the natives ufe it alfo, with equal fuccefs, in Hydrophobia, not only in dogs, but in man.
Thefe tonic, or Tanjore pills confift of fix ingredi¬ ents : three of them we fhall call known , and three unknown . The former are white arfenic, pepper, andquickfilver ; the latter vegetable fubftances, called by the natives, vellbnavi, neri-vifham, and nervalam. The two firft of thefe lajt three would fee m to be of the cauli-form, or herbaceous kind, as the powdered roots are direfted for ufe : the other would appear to be of the fhrub, or nut-tree kind, as the kernel in powder is the part recommended. Equal parts of thefe fix articles (the arfenic firft being levigated) are beat into a mafs, with the juice of wild cotton, and formed into pills, ten or eleven of which, when weighed, were found to be a dram, which brings them fomewhat under five grains each. The quickfilver is alfo to be rubbed with the juice of wild cotton till the globules difappear.
c Swartz, a Moravian prieft, inftigated by the ce¬ lebrity thefe had obtained for the bite of the cobre de capello, and other Indian ferpents, through the nobieft motives of philanthropy, purchafed the fecret from the Brachmins, and communicated it to the Company’s furgeons. One of thefe communicated it again to Dr. Ruffe!, with feveral experiments, proving their fuccefs. The furgeon, having made farther trials feparately on the three unknown ingre¬ dients, found, that almoft without exception, chickens were killed by five grains of the velli-naVi root, in the ipace of from an hour to an hour and twenty minutes.
c The progrefs of the fymptoms were, gentle purg¬ ing, convulfions of the neck, throat, and bread ; the
former
458
Hamilton cm Hydrophobia .
former being forcibly drawn down to the latter; uni- verfal tremors over the body, paralyiis and lofs of motion of the legs, and death. v. ,
4 in the dofe of half a dram to a dog, it vomited violently, but in about fix hours he recovered. The other two ingredients had lefs activity ; they proved gently cathartic. The furgeon ufed in his experi¬ ments pills made in the fame proportion with the Brachmins, and they anfwered in every refpedi equal¬ ly with theirs. As in general the number of pills which completed a cure did not exceed fix, and fome- times fewer, the quantity of mild quickfilver is too trifling to have any fhare in it. The fame may be faid of three others ; arfenic, therefore, and the velli-
navi only form the powerful parts of the prefcription.
6 We are farther allured, that the furgeon to whom we are indebted for the communication of thefe pills, had put them to the teft in hydrophobia. He exhi¬ bited them to no fewer than fourteen different per- fons bitten by mad dogs, without any other fvmptom than purging in moft, and a flight vomiting in a few of them. This proves at leaft the fafety of thefe % pills, though it cannot be politively afferted that they cured the difeafe, unlefs the complaint was evident when they were exhibited. If they be meant, how¬ ever, as preventive, they deferve no credit; there was. no p/roof of difeafe.’
From cl i (Tech on s it appears, that hydrophobic bodies tend to a rapid putrefaction. Hence the author in¬ fers, that a defeat of vital air in the habit, is one of the effects of the difeafe. 4 If all the phenomena of the difeafe be reviewed, and we can rely on the ap¬ pearances of putrefaction after death, which have been affirmed, the vital air modified to our purpofe would feem better adapted to a cure than the other fpecies of eh flic fluids. Great exertions create proportionate debility by the expenditure of this principle. No dif- pifo, no condition of the body has been feen, where greater exertion, or greater diftrefs of the mind takes
place.
459
Hamilton on Hydrophobia.
place. The exhauftion muft be in proportion. Great temporary exertions indeed of mufcular motion have been made in hydrophobia, without apparent incon¬ venience, nay even with fome momentary relief of a diftreffing fymptom, but they were the laft efforts of expiring ftrength. This is arguing, however, from an. effeft, not from the caufe of the difeafe. The poifoned faliva may poffefs the power in itfelf, like opium, of exhaufting the frame, and creating a mor¬ bid deficiency of the vital principle, beyond what is known in other difeafes.
if it be oxygene that gives power to mufcular motion ; if its abfence be weaknefs, we cannot doubt but a condition of the body is prefent in this difeafe, containing a far lefs portion of this principle than is requifite for the ftandard of health. If this fpecula- tion be permitted, the mode of relief lies before us, and air fupercharged with oxygene affords it. We have feen that this can be done with fafety.’
c I have ventured thus to hazard a conjedfure on the probable good effects of oxygene in the cure of this diforder ; I have ventured it from a confederation of the futility of every means of relief hitherto adopt¬ ed ; I have ventured it perhaps more on the prin¬ ciples of empiricifm, than on juft induftion from the nature of the complaint ; but who is the inveftigator hitherto able fatisfactorily to arrive at it ? 1 have
hinted this opinion under the fuppofition of hydro- phobic virus entering the fyftem, and by a certain modus operandi difficult to trace in every link, creat¬ ing a certain fet of actions, and inducing changes, of which the abftra&ion of oxygene may form the prin¬ cipal. I would not, however, be underftood as ad- vifing the inhalation of factitious gafes to fuperfede the ufe of thofe fubftances denominated tonics , re¬ medies extolled by the lateft, and moft philofophic writers on this difeafe.
‘ Arfenic efpecially I would recommend as one of the moft powerful tonics perhaps yet difcovered. — ■
the
60
Hamilton on Hydrophobia .
the ufe of this, and the infpiratlon of modified airs may proceed together. They are applied to different furfaces, and in the exhibition will not interfere. If difficult deglutition (hould give an opportunity (and in many inftances we find it partially overcome/ the me¬ dicine may be exhibited, whether alone or in com¬ bination ; either in feme fubftance finely levigated, as in the Tanjore pill; or in aqueous folution, or in¬ volved in other forms, in crumbs of bread.’
The following is a recapitulation of the author’s remarks on the different remedies which have been, or which may be employed in the treatment of hy¬ drophobia. J
The difeafe, it is admitted, is feated principally in the nervous fyflem. Debility feems to form its charafleriftic.
6 Two ftages are apparent in its courfe ; a firft, or incipient ; and a fecond, commencing with hydro¬ phobia, and ending in death.
* The diforder is capable in the firft ftage perhaps of cure ; but never yet performed in the fecond.
Emetics . The firft means of relief it ha s been thought fhould be by emetics ; the reafon given is from an appearance of bile in the primae viae ; bat emetics are improper in a complaint of dire& debility. They add to irritation, leldom diminifh it, unlefs by the re¬ moval ot obftruclions in the vefiels by the force of concuffion ; or by the opening of the pores of the fur- face to give an exit to retained perforation ; but the latter is not indicated in hydrophobia.
c. Cathartics. Thefe are little better adapted to the removal of this complaint, than emetics. They are detrimental in cafes of debility, and often impro¬ perly exhibited here. ' Fcetid ftools are no teft of their utility; no guide fdr perfifting in their adminiftration. A gentle cathartic is admiftihle here, as in other dif- eaies or debility ; blit farther it would be improper to
1/4 ■4
r o fec'u fe them'.
3 d. In-
Hamilton on Hydrophobia ;
* 3tu Injections Thefe are far lefs exceptionable, nay are often neceffary, feldom debilitating ; and may be the medium for introducing medicines, or for nu¬ triment, or for both.
c 4 th. Battling. Neither the hot nor cold bath have ever been fuccefsfully ufed. The former, though it gives temporary relief in fame inftances, foon lofes its effeft. The latter, though carried almoft to drown- mg, produces no better confequences. Death has even been battened by plunging the patient into cold water. This concluflon is drawn from many trials,
4 Cavallo hints at fome cafes, faid to be cured by opium and cold bathing ; by hidden fubmerfion, ak moft to fufpenfion of life ; but he cannot remember relpedling their authenticity ; whether he read of them, or whether the communication came from the relation of fome triend. It was moft probably the former, for books tell of fuch cures ; but if cafes of hydrophobia have been removed by this means, they* were not rabid, , but tetanic inftances. They were conyulfions, and difficult deglutition, arifing from te¬ tanus, not from the poifon of a rabid animal.
4 5th. Sudorifics — Stimulants. Sudorifics are even left adapted to give relief. Volatile alkali, whether as diaphoretic, or merely ftimulant, is like wife proved deiufive. More, however, may be faid for this, than for feveral of the others, and the practitioner would do well to give it a fairer trial than what has vet been
done.
4 The ufe of the nitric acid has been fuggefted, which merits confideration.
4 6th. Venajection. None of the remedies ever propofed in this difeafe has been more abufed than venaefeEtion. ' None has proved lefs ufeful, and none fo univerfally employed, in fpite ot its conftant failure, which ought to have long ago created doubt. One man followed another in the fame beaten traEi, without inquiry; but falfe theories of the difeafe, not left than the repeated authority, ferved for its fupport. In
every
462
Hamilton on Hydrophobia .
every rabid cafe it is objectionable, nay even in te¬ tanus, or hydrophobia arifing from tetanus. None more fuddenly creates depletion ; and the difeafe now under review is marked in a peculiar manner with debility.
c 1th. Blijlers. Whether they be ufed in their capacity as fuch, or in their more partial capacity of rubefacients, they are admiffible to a certain degree ; but their limits are circumfcribed from the nature of their operation, and when they are to be applied, re¬ quire attention, that abufe may not follow, where at leaft fome ufe may be derived, under proper modi¬ fications. The abidance is found to be (lender.
£ %th. Embrocations , which are fomething of the fame nature, if fufficiently ftimulant, may be applied to the throat, the pit of the ftomach, and above all to the fpine. They will ftimulate cutaneous veffels into greater aCtion, and may meliorate the difeafed fen- fibility to cold air, by their caufing, from their ftimu¬ lant power, a change in the mode of a&ion, and con- fequently extrication of more heat.
„ « 9th . The intemperate and vexatious perfuafion of the patient to fwaliow drink, is altogether improper. Curiofity is here gratified at the expence of increafed mifery, to a moil commiferable object. Antipathies, were it nothing but antipathy, to certain fubftances, in every fpecies of diforder, are to be regarded.
c 1 Oth. Mercury. This famous remedy, on which fo much of late years has been written, may be dif* miffed, without regret, from the remedies of hydro¬ phobia. Not an inftance of fuccefs can be fairly brought forward to fupport its claims.
c llth. Running. It mult be obvious, that in run¬ ning, or violent exercife, a truly (lender folace is fet forth. If we confider its operation, it would feem to eftablifh a point in pathology of no final! magnitude ^ it is a clear indication of the patient’s general weak- nefs. It proves a deficiency of due fenfibility in the heart ; and that the ordinary ftimulus of the blood is - <7 ’ on
463
\
Hamilton on Hydrophobia .
no longer able to give a force of fyftole equal to the propullion of the contents with appropriated energy, through the arterial fyftem. Hence ft-agnation in the pulmonary fyftem, fenfe of fuffocation, &c. which running, as an increafed ftimulus, temporarily re¬ moves.
‘ 12 th. Cold. The application of cold, or more properly, hidden abftraftion of heat, to benumb the parts, and (top ofcillation and irritation, it is evident, cannot be permanently ufcful ; becaufe, if continued, the death of the part mull follow. The fame objec¬ tion may be brought againft ligatures » yet thefe will admit of application to a certain degree, till more ef¬ fectual means, for removing irritation in the part, can be prepared.
" 13 th. This is its deftru&ion, by the knife, by cautery, or by cauftic alkali. Let this be accompli (li¬ ed at the moment when fenfations ot pain, or ap¬ parent inflammation give warning of the approach¬ ing malady. I am not without hopes, that by proper attention to this fymptom, the difeafe may be check¬ ed in its commencement.
c 14th. Oil. This has been tried, with no advan¬ tage, in rabid hydrophobia. Its ufe, even in hydro*, phobia from fear, is problematical. It is not clear but that the patients, to whom it has been apparently fuccefsfully adminiftered, would have recovered from the panic under which they laboured, had it never been applied.
c 1 5th. Vinegar. Vinegar, in this country, has been equally futile.
c It is no new remedy ; the practice is of an ancient date. iEfchion, preceptor to Galen, exhibited crabV claw powder againft the difeafe ; and Galen, who fol¬ lowed his mailer’s praclice, gave the fame powder in¬ ternally, and ufed it as an application to the wound, with the addition of frankincenfe, opoponax, and gentian root, mixing them together with the Jiarpcjl vinegar. ■ ,
4 The
4
i
464
Hamilton on Hydrophobia .
i \
c The oxalic acid I have ventured to hint at, fhould an acid be thought beneficial, as better adapted, from an idea that the quantity of oxygene in a given bulk is greater, and that its coheiion with its bate is loofer, and more readily feparable, than that of the acetous acid or vinegar. But the praftice cannot be enforced on the ground of experience, as it has never been at¬ tempted.
c 1 6th. Antifpajmodics. The clafs of antifpafmo- dics, as diftinguifhed by this name, have not anfwer- ed. Opium, the molt powerful, inflead of proving lifeful, appears to have been detrimental under every management hitherto adopted. I apprehend that its ufe mud be very guarded, to prevent the mifchief attendant on its abufe. I am inclined to difcard it entirely.
c llth. Hydro-carbonate Gas. Some late writers, Mr. Barr, and Cavallo after him, have fuggefted the ufe of the hydro-carbonate gas, to remove irritation, and to induce deep. I have ventured to date objec¬ tions to it as a general remedy, though as an auxiliary, in a limited degree, it is worthy of a place ; but from its great aftivity, i. e. from its hidden effefts, and thefe of a mod powerful kind, tending almod to im¬ mediate death in an imprudent dofe, the praftitioner mud ufe the utmod caution in its adminidration. In producing temporary ceffation from pain, where pain is excedive, it appears to be powerful.
c A bath is fuggeded of this aerial fluid, with a view to obtund cuticular fenfibility, fo excruciating in hydrophobia. For this purpofe a narrow tall veflel, inch as a fmall calk, may be procured, into which the patient may be put, keeping his head above the calk. Into this the hydro-carbonate, previoufly prepared, may be introduced ; for no great difficulty will ob~ ftrubt the management, . when it may be confined in the calk by cloths, or foft chamois leather, furrourid- ing the patient’s body, and preventing its mixture with the atmofpheiic air.
Ofc •
« This
Hamilton on Hydrophobia .
465
c This, however, is an employment of fome danger to the affiftants, and to the patient, in the aft of ex¬ tricating him from the veffiel, to prevent its admixture ■with the air of the room, which may create, to fay no worfe, vertigo and head-ach. it ought to be done near a chimney, that it may be carried up by the current. A commodious contrivance, air tight and fecure, for fuch a bath, would not be difficult to invent.
c This, perhaps, is not the only fpecies of difeafe which fuch aerial immerfion may be confined. Might it not be employed with advantage in cafes of ievere burns, whether produced by explofions of gun¬ powder, or of hydrogene gas, m coal pits and other mines, or by fcalding with boiling fluids? Its pro¬ perty of deflroying fenfibility, of mitigating fevere pain, favour this fuggeftion. Burns are accompanied with moil: excruciating pain.
1 %th. Tonics . This clafs of remedies is not only unequivocally admiffible, from the pathology of the difeafe, but ftrenuoufly to be inculcated. The difeafe is ftrongly marked by debility, which tallies as throng- ly oppofe. Bitters are many of them tonics ; but vegetable bitters are bulky, and in a powdered form, at lead, the ftomach here will rejeft them: even de¬ coctions, tor the fame reafon, are objeftionable. The metallic tonics are, therefore, preferable : iron, zinc, copper.
‘ from the mineral kingdom another fubfiance has been lately recommended.
19th. Arfenic . This iubftance merits the highefl attention, and promifes no fmall advantage. It is llrange, that till lately this could not be mentioned in medicine, yvithout exciting great apprehenfion and terror; yet poifons not lefs deleterious, viz. prepara¬ tions of mercury, of antimony, and even opium itfelf, were in daily ufe with the faculty. In the form of a pill, named tonic or Tanjore pill, this mineral has been exhibited both again!! the bites of ferpents and - vol, v. LI * rabid
466
)
Hamilton on Hydrophobia .
rabid animals. From it high expe&ations are now entertained.
* 2 Oth. Oxygene Gas. Under the head ot tonic medicine 1 would clafs oxygene gas, or vital air. Its ufe I have here recommended, from the penuafion of too great a fubtr'aftion of it from the habit, created by the force of the poifon in what way foever it may operate. The mode of exhibition is ot late rnade confiderably eafy by the labours of the ingenious BeddOes. 'This" aflive fubftance is not introduced here as a catholicon, but as an affiftant to other en¬ deavours, efpecially in co-operation with tonics.
< Such are the fuggeftions which have occurred in reviewing this malady, and which the pathological reader is. earneftly requefted to re-confider. Let him feduloufly render his aid in bringing them to perfec¬ tion, or, by pointing out other means more certain, remove their ambiguity and eitablifh the fafety of mankind againft a diforder deplorable anci incut able, from its firft difcovery in remote!! antiquity, to its lateft inftance of fatality.’
Several points ot a mifcellaneous nature are {un¬ joined ; and in the appendix a confiderable number of cafes are brought forward ; which, however, it W'ouid much exceed the limits of our work to par¬ ticularize.
We mud not quit our account of the prefent ela¬ borate performance, without firft acknowledging the fatisfaftion we have received in its perufal. 1 he view we have here given of it, though it has carried us to an unufual length, is very inadequate to convey a juft idea of its merits. There is hardly a faff or opinion, relative to the difeafe in queftion, which has not been brought forward by Dr. Hamilton, and their refpedlive values fairly appreciated.
Art.
( 467 )
Art. XLVII. Obfe? nations and Experiments on the Broad-leaved Willow Bark, illaf rated with Cafes . By W. White, Apothecary to the Bath City-Infirmary and Difpenfary . Odtavo, 58 pages, price Is. 6d. London. 1798. Ver NOR'and Hood.
rpHE Bark which forms the fubject of the prefent 1 eflay, was flrongly recommended to the atten- tion ot the public in a pamphlet publhhed by Mr, James a few 'years ago. Its life, however, has not become fo general as it would feern to deferve, from the teflimonies adduced in its favour both by Mr. James, and by the author of the prefent remarks. Perhaps the reafon may be, as Mr. James fuggefts, that we are apt to overlook the merits of what is eafily procured, and coffs but little, and to be cap¬ tivated with a commodity which can only be acquir¬ ed with difficulty and expence. However this be, the willow bark feems well entitled to a candid trial ; for if it poifefs lefs than the virtues here afcribed to it, in comparifon with the Peruvian bark, it may ftill have fufficient, to render it a very valuable article of the Materia Me die a.
The broad-leaved willow is to be met with in the woods, and hedges of hilly fituations, growing to a pretty large buihy tree. Although fome botanical writers enumerate as many as thirty different fpecies and varieties of the willow, yet this fort is eafily dif- tinguifhed by the fhape of the leaves, which is re- fembled by none of the other fpecies except the bay¬ leaved ; but that again is foon diffinguifhed from the former, by the leaees being fmooth and filming, in- flead of the dowmy appearance, particularly on the under furface of the falix caprea, the fpecies here defcribed.#
* Synonma, Salix latifolia rotunda. Ran Syn. 449, — c:alix foliis ovatis rugofis fubtu* tomeotofis undatis fuperne denticulatis, Linn ,
Li &
468
Medical Records and Reft arches.
This bark difcovers to the tafte a confiderable de¬ gree of aftringency, accompanied with a flight degree of bitternefs. Its decoftion is of a bright red colour, more aftringent than the cinchona, but with lefs bit¬ ternefs. It has been generally exhibited in the form of decoftion, two ounces to two pints of water, boil¬ ed down to a quart, with a fmall quantity of pimento. Dofe, two table-fpoonfuls three or four times a day. In interm ittents it requires to be given in larger and more frequent dofes.
We do not deem it neceffary to follow the author in his chemical experiments, or in his detail of cafes .wherein this bark has been employed; as it fo much refembles, in both refpefts, the different fpecies of the cinchona. As an antifeptic, it is confide red as in¬ ferior to the Peruvian, but as atonic, greatly its fupe- rior in efficacy. The willow bark decofition has been given, the author obferves, with confiderable advan¬ tage in cafes of general debility, accompanied with lofs of appetite — in intermittents— remittents- — mild cafes of typhus- — convalefcent ftate of all febrile com¬ plaints— fluor albus— prolapfus uteri. — —In ffiort, in all cafes where the ufe of the Peruvian bark as a tonic is indicated, its exhibition has been attended with much fuccefs.
Art. XLVIII. Medical Records and Refe arches , J elected from the Papers of a private Medical Af- fociation . Oftavo, 288 pages, price 6s. London, • 1798. Cox.
MANY of our readers will doubtlefs recognife, in the prefent colleftion of obfervations, the Phyfical Society which is held weekly at Guy’s Hof- pital during the winter feafon. The obfervations here prefented to the public are not numerous ; at the fame time they are not unimportant, as will be feen by the view we are now to give of them.
The
Medical Records and Refearches. 469
The firft article is the relation of a Cafe of Strangu¬ lated Hernia, in which a part of the Abdominal Vif- cera was protruded into the left Cavity of the Cheft : by Mr. Aflley Cooper, LeElurer in Surgery at St. Thomas’s Hofpital. — The fubjeEt of this cafe was frequently attacked with fymptoms of ftrangulated in- teffine, which at length deftroyed her. On diiTeElion, the great arch of the colon, inffead of being ifretched from one kidney to the other, was found to have been pufhed into the left cavity of the cheft, through an aperture in the diaphragm. This aperture was placed in the m'ufcular part of the feptum, three inches from the oefophagus : it was of a circular figure, and two inches in diameter; and was probably an original mai-conformation. — As this cafe affords little practical inflruEdion, it is unneceflary to be more particular.
\
2. A Cafe of Tic Dolour eux, or painful Affection of the Face , fuccefsfully treated by a Divijion of the affected Nerve: by John Haighton, M.D . Lecturer on Phyfiology and Midwifery , &T- — The affe Elion here defcribed is not one of frequent occurrence, nor has it been often treated of by medical writers. In the 5th vol. of the Medical Obfervations and In¬ quiries, an accurate defcription of this complaint is given by the late Dr. Fothergi.il . The following are the leading circumftances in the cafe here narrated.
4 Mrs. hi - , of Stockwell, Surry, aged feventy-
four, a mother of children, of a fpare habit, placid difpofition, and for her age much difpofed to activity, was, about thirteen years ago, for the ijrft time, feized with pain of the face. This pain at its commence¬ ment was very moderate, but in its progrefs became violent ; at length it acquired a degree of acutenefs which neither words can defcribe, nor the imagina¬ tion eafily conceive.
c The feat of this extreme pain was fomewhat limited; being confined to the ala nafi and a fmall portion of the upper lip, on the right fide. The pain
L I S was
470
Medical Records and Rejearches ,
was not of the continued obtufe kind, like that of chronic rheumatifm ; but, on the contrary, rather tranfient, ex¬ ceedingly acute and lancinating during its attack. The periods of its recurrence were indefinite, and in the intervals of which (lie was generally in a date of per- fe£t eafe. There was a ftriking uniformity both in the origin and direction of the pain : it always began in the ala nafi and upper lip, and darted upwards towards the orbit ; but when the attack was more than commonly violent, then indeed it extended to other parts, and a fenfation of a fimilar kind, though much lefs in degree, was frequently perceived along the cheek towards the ear; the fame fenfation was alfo obferved on the fieihy and bony palate, on the gums and teeth of the upper jaw, and lometimes on the fauces. She feerned particularly difpofed to this pain in fevere, or windy weather : yet the was not altogether free from it even in the mildeft feafon. It was mod frequently excited by the more obvious oecafiona! caufes, fuch as fpeaking, coughing, taking food, blowing the nofe, &c. though fometimes it would return from caufes lefs apparent. The duration of each pain feldom exceeded half a minute ; but more fre¬ quently it was fomewhat lefs.
‘ Sometimes the had not more than five or fix of thefe pains in the fpace of a day ; at others, nearly twice that number in an hour. They varied fenfibly in their degree of violence ; fometimes fo moderate as only to fufpend the movement of the upper lip, but more commonly fo pungent as to extort fcreams ex- preffive of intenfe agony. Befides the fufpenfion of the motion of the lips, a very oppofite effeft frequent¬ ly took place, viz. a tremulous movement, during which it was fometimes drawn a little upward. Not- withdanding there were fuch intenfe pains, neither fwelling nor difcoloration could be perceived, except fuch as were occafioned from time to tirpe by ex¬ ternal applications. Thefe were the general fymp- toms.’
4 72
Medical Records and Hefearch.es .
The complaint was treated as a nervous affeftiori In the ufual wa^ though without any (hiking or per¬ manent advantage : it continued with more or lets violence for two years. At this period Dr. Haighton began to entertain juft notions of the nature of the difeafc. < While my patient/ fays he, £ was en¬ deavouring to defcribe her feelings, which (he at¬ tempted in a very inarticulate manner, Hie -flopped fuddenly, and, upon looking at the part affected, I perceived a tremulous motion of the upper lip, by which it wras drawn upwards precifely at that part where the miifcnlus levator lahu fuper ibns propriiis is inferted ; and from recoil effing a wrell known faQ, that a nerve, under irritation from ftimulating caufes, produces motion in the mufcular parts to which it is diftributed, it immediately occurred to me that the fuborbitar branches of the fifth pair of nerves, which are known to fuppiy thefe parts, mull be the feat of the prefent difeafe.
f In order, therefore, to reduce (as far as poffible) to certainty, what hitherto was only matter of furmife, I waited for the next exacerbation, which took place in a few minutes, and by making, at this time, rather a forcible preffure upon the integuments covering the fuborbitar foramen, the pain inftantly abated'.. I re¬ peated this feveral times, and uniformly with the fame effeft.
* As my conjecture relative to the feat of this dif¬ eafe feemed to" gain confiderable fupport from this experiment, I thought it effential to take a more minute furvey of the fymptoms, particularly as being feated in thofe parts which feemed affe&ed in a fecon- dary or fym pathetic way.
< Now’- it appears from the hiftory of this cafe, that the extreme pain w'as feated in the ala nafi and upper lip, on the right fide ; but when it darted with more than common violence, it affected other parts, as the ear, by extending itfelf along the courfe of the cheek, by means of communicating branches belonging to
L 1 4 the
472
Medical Records and Refearches.
the portio dura of the feventh pair, which pair begins to fpread on the fide of the face as foon as it emerges from behind t;lief condyles of the lowe*r jaw. It at-
palate, gums, and teeth of the upper jaw, but no part bf fhe lower ; fometimes the fauces but the part whicfl^feemed affefted next in degree to the original £eMt|>^was immediately behind the dentes incifiviJ H
‘ From comparing? ^&is affemblage of fymptoms with the diftribution bfthe fecond or fuperior maxillary portion of the fifth pair of nerves, I was flruck with the coincidence, and at the fame time was perfuaded, as has been already hinted, that the original difeafe was in thofe branches of the nerve tr'anfmitted by the fuborbitar foramen, and diflributed to the ala nafi and upper lip; and that the darting pains extending to the teeth, infide of the gurus and palate, arofe from communicating filaments between the fuborbitar and palatine branches. Thefe communications not only complicated the cafe, but alfo placed the profpedt of a cure at a great difiance, from the various channels by which the pain could be conveyed from the part primarily arrefted to the Senforium. But as a tempo¬ rary advantage had been frequently gained by pref- fure of the fuborbitar nerves againfi the bone, the en¬ tire divifion of them feemed eligible; and it was pro- pofed to my patient as an ultimate expedient. The propofal, however, carried with it fome difficulties. It was new to her. It could not infure fuccefs. Ex¬ perience, as far as my knowledge extended, had yet to (lamp it with its fandtion. And in this diftradlion of circumflances, the mind of my patient might have remained lufpended in doubt, had not the infupport- able urgency of pain compelled her to affent.
Having gained permiffion to operate, I began to confider the circumflances of this nerve more attentive¬ ly j and as the intention was to effeft a complete di¬ vifion of its filaments, by an incifion of a moderate length, the means conducive to that end became im¬ portant
473
Medical Records and Refe arches .
portant fubje&s of regard. It was effential therefore to acquire a knowledge concerning the precife feat of the difiribution of this branch of the fifth pair of nerves ; the mode of its tranfition and exit from the fuborbitar foramen ; together with a clear and correft idea refpefting the feat of the foramen itfelf. Be- Tides which, it was not altogether extraneous to at¬ tend to fuch contiguous parts as might, either from neceffity or accident, be wounded in the operation.
c This nerve is tranfmitted by the fuborbitar fora¬ men, in a way very different from that which the com¬ mon form of expreffion on this occafion would lead us to imagine. VVe ufually fpeak of it as one branch under the name of fuborbitar 3 but in reality it ought to be confidered as a feries of branches, for it divides before its exit, and is afterwards diftributed in a radi¬ ated manner to the circumjacent parts, viz. the levator labii fuperioris proprius, the inferior part of t\iQ orbi¬ cularis palpebrarum, to the mufcles and integuments of the nofe and upper lip.
c From this radiated diftribution, it muff neceffarily happen that the branches of this nerve are fpread over anextenfive furface at their termination, though contraffed into a fmall compals at their exit from the foramen. It was therefore confidered a matter of im¬ portance to fix upon a proper part for the operation, in order that its branches, by lying in a fmall fpace, might be more conveniently divided.
‘ In its paffage through the fuborbitar foramen, it is accompanied by a branch of the internal maxillary artery, which from its contiguity muff neceffarily be divided. Thefe are covered by the levator labii fu- perioris proprius , and the common integuments.
c As the branches of this nerve lie clofe to each other at the orifice of the foramen, that part feems the moft convenient for their divifion, becaufe an in- cifion of a moderate length will generally include them all.
4 The-
474 Medical Records and Refear dies.
* The next confideration was to determine the exa£f fituation of the foramen. This at firft feems very eafy, but in reality is not fo ; becaufe in different Ikulls the diftance of it from the orbit differs confider- ably, and there does not appear any mode of deter¬ mining this more probable than by attempting to form a ftandard from the meafurement of a confiderable number of fkulls.
c I therefore meafured the fpace between the in- ferior edge of the orbit and the Superior part ot the foramen in thirty ikulls, and found the diftance as follows.
In 2 ikulls, °f an inch.
In 16 - - |-
In 8 - -iV
In 3 — — fT
In 1 - i
* As the diftance in fixteen ikulls out of thirty, was | of an inch, I dial! confider that the medium diftance from the fuperior part of the foramen ; and if we al¬ low -f of an inch for the breadth ot the foramen, and -f. below its inferior part, we confider half an inch from the lower edge of the orbit a proper place for performing the operation.
* Having endeavoured to eftablifh a rule for deter¬ mining its diftance from the orbit, it may be proper to afcertain its fituation with refpedt to aline drawn from the inferior part of the internal angular procefs of the os frontis, obliquely acrofs the orbit, to the centre of the os malax The meafurement of this line in thirty Hulls did not vary more than •§• of an inch, and it was found that a line drawn downward, perpendicular to this oblique line, at the diftance of -J- of an inch from the internal angle of the eye, paffed acrofs the orifice of the fuborbitar foramen. By this rule I was able to form a ftandard of the fituation of this foramen in a living fubjecb
‘ Thefe
Medical Records and Ref e arches. 475
‘ Thefe preliminary circumftances being fettled, the operation becomes exceedingly Ample, and con- lifts in an incifion of -f- of an inch in length, carried obliquely downward, the center of which mu ft cor- refpond with the foramen, only -J- of an inch below it. The incifion muft be made down the bone, otherwife we cannot be certain of dividing the nerves, as they are fituated very deep. And as there are fome irregu¬ larities on the furface of the maxillary bone at this part from mufcular attachment, as well as a furrow' which is fometimes continued from the foramen down¬ wards, a fmall pointed knife will be preferable to any other, as it will enable the operator to divide with more certainty fuch nervous filaments as may be feated in thefe depreilions.
c The facial vein frequently paftes over the foramen, and conceals it; from which it is liable to be divided in the operation. If this really happens, or if any of the fuborbitar branches of the internal maxillary ar¬ tery fhould bleed with freedom, a comprefs may be made with advantage, as they are feated near the bone.
c The wound being dreffed fuperficially, will prob¬ ably heal by the firft intention.
c In the manner juft deferibed I performed the ope~ ration, and the event has amply juftified its propriety. It immediately put an end to the pain; and in a few days the incifion healed. My patient, who has now lived nine years fince the operation, contemplates that event, I fcarcely need fay, with the higheft fatis- faftion.
c It is worthy of remark, that the fenfation and ac¬ tion of that fide of the lip, though evidently diminifh- ed, were not altogether loft, as might have been pre¬ dicted. The inconvenience was only temporary; we may therefore fuppofe a reunion of the nerves had taken place, but with this fortunate effeff, that no difpofition to the return of the difeafe through the new formed part has yet appeared/
' It
476 Medical Records and Refear ches.
It is of importance to diltinguifh accurately the com¬ plaint here fpoken of from others of the fame part ; and even to diftinguifh the varieties of the fame fpecies : for the fame treatment is not applicable in all. ‘ The kind of pain/ the author remarks, 4 is very peculiar, and the courfe of it correfponds exactly with that of the nerves. The fecond branch of the fifth pair is perhaps more frequently affedted than either the firft or the third. But the portio dura of the feventh pair which isdiffributed very extenfively upon the face* un¬ der the name of pes anferinns , is more frequently the feat of this complaint than any of the branches of the fifth pair are ; and this is a matter of confiderable re¬ gret, becaufe, in fuch cafes, neither the operation propofed in this paper, nor any other with which I am acquainted, can avail. If, indeed, an operator, mi¬ nutely verfed in the fituation of thefe different ner¬ vous filaments, were by an effort of {kill and addrefs to fucceed in the undertaking, there is the higheft probability that his patient would be relieved; but by reafon of the manner in which this nerve fpreads Its branches, even where it is piercing the parotid gland, as well as the hazard of wounding contiguous parts, moil prudent pradtitioners would decline the operation. Thus we fee with how much more facili¬ ty the mind can project, than the hand can execute.
c When the feventh pair is afifedted, we can be at no lofs to know ; for the patient complains of a pain which begins in the fore part of the cheek, fometimes as high as the forehead, and extends itfelf in the di- redtion of the ear. In a cafe of this kind, no relief whatever can be obtained by dividing the fecond branch of the fifth, as fuch divjfion cannot pofiibly give any interruption to the communication between the fenforium and the feat of irritation. I find it ne~ ceffary to notice this, from having heard of a cafe in which the practitioner, from mifconceiving my mean¬ ing, performed the operation agreeably to the mode here advifed ; but the patient was not in the lead re¬ lieved by it, as might naturally be expedted.
Some
477
Medical Records and Refearches .
4 Some time ago I was requefted to attend a lady in Queen-fquare, to confult with a phyfician of dif- tinguifbed eminence, and high profeffional. refponfi- biiity, concerning the propriety ot dividing the dil- eafed nerves. This lady had the complaint feated not only in the feventh pair, but likewife in the third branch of the fifth. Here, befides the feat of the pain juft defended, one half of the tongue, and the teeth of the lower jaw on the fame fide, were affebted ; for thefe parts are topplied with nerves from the third branch of the fifth pair.
‘ In this cafe it was difficult, perhaps impoffible, to decide in which of thefe two nerves the irritation ori¬ ginated. It is not neceffary that it fhould begin in both in order to explain the fymptoms ; for it might fir ft attack thofe branches of the fifth pair which top- ply the tongue and teeth of the lower jaw, and after¬ wards affebt the feventh pair by certain well known communicating branches, one of which is feated be¬ hind the condyle of the lower jaw ; or the irritation might commence in the feventh pair, and the fifth might be affebted by communication, In either cafe, no operation was advifable, becaufe, firft, it was poffi fible that the irritation might be propagated to the fenforium in two directions ; therefore the impreffion could not be intercepted in its courfe to the brain, fo long as either channel was entire: and fecondly, be¬ caufe the deep fituation of the third branch of the fifth pair made that nerve altogether inacceffible to the knife. When the firft branch of the fifth pair is affebfed alone, it is relievable by an operation. In this cafe, the pain begins in the forehead and darts downward towards the orbit: for this nerve, in com¬ ing out of the cavity of the cranium, paffes along the upper part of the orbit, where it fends off fila¬ ments to adjacent parts, and, having paffed through the toperior orbitar foramen (frequently only a notch), is diftributed on the forehead. Here an operation is very Ample, and confifts in nothing more than a di-
vifion
t
478 Medical Records and Refear ches.
vifion of that nerve a little above the foramen. The branch of the optical artery, which accompanies it at this part, will not furniih an hemorrhage of any mo¬ ment/
In the cafe above related, the pain always originat¬ ed in one part, from which it extended itfelf to others. Whenever this happens. Dr H. obferves, we fhould confider whether the nerve or nerves can be divided between the part where the pain originated, and the parts to which it afterwards extends. When this can be done, there is a probability of operating with fuc- cefs : but when feveral parts are attacked at the fame time, or when the pain extends in feveral diredlions, from the part primarily impreffed, there is but little reafon to expedt advantage from an operation.
( to he continued. )
Art. XLIX. An Account of Indian Serpents , col¬ lected on the Co aft oft Coromandel; containing de¬ ft crip tions and drawings of each fpecies ; together with Experiments and Remarks on their fteeeral poi- fons. By Patrick Russell, M. D. F. R. . S. Folio, 91 pages, with 44 coloured plates, price 3/, ISs. 6d. London, 1796. Nicol.
FOR reafons which are fufficiently obvious, the branch of Natural Hi dory which is here treated of, has been more imperfedlly invedigated than many others. In a medical point of view, it is dill moreim- perfedk It offers, as the author judly obferves, no at¬ tractive allurements; and thofe who devote their atten¬ tion to natural hidory are more likely to prefer objedls Jefs difguding, and experiments accompanied with lefs cruelty and perfonal danger. Even the eager and refolute naturalid has to contend with many difficulties in this path of refearch, He cannot at once dived
3 ! himfelf
RuffelPs Account of Indian Serpents . 479
himfelf of the abhorrence, next to Innate, of thefe reptiles, nor can he loon acquire a dexterity in hand¬ ling them, with the calmnefs requifite tor his own fafety.
The imperfect irate in which this part of natural hiftory remains, fuggeiied to the learned author the idea of collecting and describing the Serpents found on the coaft of CoromandeL I he prefent work con¬ tains defcriptions of forty-three ferpents, illustrated with coloured engravings.
The terror occafioned by thofe numerous reptiles is immoderately aggravated by the indiscriminate ap- prehenhon of all being poifonous. lo diking uifh, therefore, thofe that are really fo, from fuch (by rar the greater number) as are harmlefs, becomes a mat¬ ter next in importance to the difcovery of a remedy again!! their poifon.
It would be vain to endeavour to convey to our readers an idea of the merely descriptive part of the work, without the affiflanee of the engravings. We fliall only, therefore, remark the differences which exift, between the poifonous, and the innocuous fpecies. The poifonous ferpents are, for . the moil: part, diftinguifhed by their fangs; which, in the Hy¬ ing animal, when held properly by tne neck, or irri¬ tated, are readily enough difcerned : though not ah ways fo eaiily m a recumbent ftate, or in *-he dead fubjefl. But the want of a row of teeth in tne upper jaw, found in that of all harmlefs ferpents, ferves alfo as a criterion, even where the fangs nave pur- pofely been eradicated, or loft by accident In fer¬ pents' not venomous, there are three rows of common teeth in the upper jaw: in the poifonous kinds, tne external row is wanting.
The defer! ption of the different fpecies having been gone through, the experiments and remaiks on their poifons follow. Of the forty-three ferpents here ex¬ amined, feven only were found furnifhed with pqifon- ous organs. The effects produced by the poiion of
480
RuiTell’s Account of Indian Serpents,
the Eaft India ferpents here defcribed feem to be near¬ ly fimilar to thofe occafioned by the bite of the rattle- fnake, and the European viper, differing only in de¬ gree, or in the rapidity of their operation. The bite of a rattfe-fnake in England, killed a dog in two mi¬ nutes; the bite of the moil pernicious fnake s here mentioned, was never obferved to kill a dog in lefs than twenty-feven minutes.
The fir ft feftion contains experiments on the poifon of the fpecies denominated by the natives the Gedi Paragoodoo: from thefe we extract the following.
‘ Experiment 1. Auguft , 1788. A fnake of this fpecies was received from Bimblipatam, after a jour¬ ney of feven hours, in fo languid a ftate, that it was with much difficulty he w^as made to bite a chicken on the breaft : a little (peek of blood was vifible on the Ikin, but without any mark of the fangs having afted ; fo that I imagined the bird had not been in¬ jured : within twenty-five minutes, however, it began to droop ; and in a few minutes more, growing rapid¬ ly worfe, it expired, without any confiderable con- vulfion, in about forty minutes from the bite.
* Experiment 3. Augnji 17 - . A gedi para¬
goodoo, which had been caught at Cafem Cottah the day before, was made to bite a ftout, large, dog, on the thigh, near the groin The animal held faft for more than twenty feconds, but the fangs feemed to have penetrated no deeper than the Ikin; there was barely an appearance of blood, and fume poifon was found about the fuppofed place of the puncture.
4 c The dog howled a good deal, when wounded ; but, on being fet at liberty, walked about without any fymptoms of poifon. In ten minutes, he urined, and the wounded thigh was a little drawn up, but he ftil! continued on his legs. In a quarter of an hour, he couched and howled ; the motion of his thigh was vifibly more impaired, though he was ftill able to raile himfelf. In twenty-five minutes, being forced to fife, both hind legs were obferved to be paralytic.
‘ In
43 1
R u ffe 1 F s Account of L n dian Serpents .
c In the courfe of the fecond hour, he grew mani- feflly more clifordered ; he did not howl much, but vomited more than once ^ became more torpid, and Jay along on one fide, panting. At the end of the fecond hour, he died, having fcarcely fuffered any convulfions.
‘ I examined the part bitten, four hours after death, and found it hardly fwelled, or difcoloured : a cir- cumflance different from what ufually is obferved in the bites of other venomous fnakes.’
The fecond faction relates to the poifon of the Cobra de Capello.
‘ Experiment 1. June , 1787. A dog, bitten on the infide of the thigh, by the comboo nagoo, howled at firft, as if in much pain. After two or three minutes, he lay down, and continued, at intervals, to moan and howl. After twenty minutes, he rofe, but flood with difficulty, and was unable to walk ; his whole frame feemed greatly clifordered. He foon lay down again, and, in a few minutes, was feized with convulfions, in which he expired, twenty-feven minutes and a half after the bite.
f Experiment 11. Auguji — — — A cobra de ca¬ pello, which had loft his two longefl fangs, but retain¬ ed two of the fecond order, was made to bite a very large, flout, dog. At firft the dog complained loudly, though the thigh neither was drawn up, nor, for a quarter of an hour, did any fymptoms of poifon appear. About this time, breaking loofe, he was purfued j and after a chace of an hour and a half, was brought back extremely heated and fatigued.
c After retting a quarter of an hour, water was offered him, but he would not drink, though he had eat fome morfels of bread thrown into the water.
c it was intended to have given him the Tanjore medicine ; but, befides that I was in doubt of his being poifoned, the time of giving the medicine had elapfed.
vol, v. Mm
‘ About
482
Ruilelf s Account of Indian Serpents.
f About a quarter of an hour after eating the bread, he grew lick, vomited, began to howl, and fhe wed much inquietude. After ten minutes, he vomited a fecond time, and became extremely out¬ rageous ; ftruggled to get loofe, fnapped defperately at the hake to which he was tied, and howled incef- fantly. Alter the fecond vomiting, he lay down, and was much agitated about the belly and liomach : the mufcles ot his face wTere alfo convulfed. Being made to rife, he walked without any feeming impediment from the hind legs.
c At the end of the third hour, he ftill continued extremely ferocious, in fo much that it became ne- ceffary to tie his legs. From this time, his howlings and ftruggling-s grew gradually weaker, and the con- vulfive motions of his face increafed ; in wdiich ftate be lingered about an hour longer, and then expired. [Nearly the circumference of half a crown was quite black, round the part bitten.
6 Objervations . The fymptoms of rage attending in this cafe, were in a degree beyond, what I had ever obferved before, or have obferved fmce. The dog teemed quite furious, and gnawed the thick with in¬ credible ferocity.
c Could this be accounted for from the agitation ex¬ cited by the violent exercife of fo long a chafe, join¬ ed to the ftrong conftitution of the dog? And may it be fuppofed, that the running retarded the mortal effects of the poifon ?*
, c That no ufual fymptoms of poifon appeared at firlh in the wounded thigh ; and that no other fymp¬ toms came on till after two hours, were remarkable circumltances.
c Experiment 17. Augujt , 1788. An attempt was made to make a cobra de capello bite a nooni para- goodoo in the tail, but that being found too fmall a
# See Transitions of a Society for the Improvement of Medical and Chirurgical Knowledge. Lond. 1793, p. 310, 321.
• ' , ' fubjefif.
Ruffeli’s Account of Indian Serpents. 483
fubjecl, the belly was bitten, a little above the anus. The fnake foon loft its former aftivity, and when put under a glafs died, coiled itfelf up. In this fituation I left him ; and on my return after one hour, found him dead : that is, in about an hour and a quarter after the bite.
4 The part bitten was a little difcoloured, and fome of the dry poifon had formed a kind of coat over it.
4 Upon opening the belly, the parts immediately beneath the bite, appeared much inflamed, but I could not difcover whether the fangs had penetrated into the cavity.
4 The lungs feerned much fluffed with blood.
4 Experiment 18. A cobra de capello received from Ganjam, under the name fatanag , was made to bite another remarkably large cobra, brought from the fame place, under the name coultiah. The poifon was Iked on the place, but no marks of the fangs could be perceived, and the coultiah remained well as before. This experiment was repeated with the like refult, though a little blood, as well as poifon, was found on the part bitten.
4 Experiment 19. Some days after the laft expe¬ riment, a coodum nagoo was made to bite the coultiah in the belly. Both fangs vifibly afled 3 blood appear¬ ed on the wound, but no other confequence followed. A tar tiitta bitten immediately alter, in the fame part, died within two hours/
In feci ion third experiments are related on the poifon of the fpecies called Katuka Rekula Poda.
4 Experiment 14. March 26. A dog A. which had been bitten three days before, and in confequence of cauftics applied to the part, had a running ulcer on the thigh, was bitten in the found thigh by a katuka rekula of a dark brown colour, which had been caught only a few hours before, and was calling his Ik in. He had fired poifon on the flick employed
* M m 2 in
484
Ruffed's Account of Indian Serpents.
in catching him ; fo that none, for the purpofe of infertion, could be procured by preffure on the dudts.
4 The bite was followed by no fymptoms of poifon > but as the dog had formerly been infected and re¬ covered, he was, after an interval of two hours, bitten a fecond time, by another katuka rekula, in order to fee how far his former recovery might render him un~ fufceptible. The ufual fymptoms appeared imme¬ diately after the bite ; but the dog, after doling for feveral hours, recovered.
4 Experiment 16. March 29. A fecond dog, B. (which had before been infedted and recovered, and kill had ulcers in confequence of cauftic,) was bitten this day, by the dark coloured katuka ; and again a fecond time, after an interval of two days > but both times without effect.
' 4 Experiment 18, April 4. The dogs A. and R. (ex¬ periments 14 and 16) were again bitten on the thigh, as alfo on the nofe, but neither of the dogs were infecled.
4 Ohfervations . The total failure in both the above inffances was imputed to fome defect in the quality of the-venomg for though the quantity emitted might not have been fufficient to kill, it might, at leaf!, have been expected to produce fome vifible effedt. A trial, therefore, was made on a fubject that feldom efcapes, however much the fnake may happen to be exhaufted by repeated exertions.
* c A chicken'' bitten on the thigh, immediatelyafter tire dug's, the wed, in lefs than three minutes, manifeft tokens' of being infedted, though the fymptoms were flight, and difappeared in the evening.
Experiment 20. April 7. The dog A. bei
ng
Sgain birten in the thigh, fhewed fymptoms imme¬ diately of the poifon having taken effect. In twenty- five minutes he was To debilitated that he could not rife ; he often moaned, and feemed to fuffer greatly. At times, he lay comatous, and before the end of the jirft hour, became fo ill as to be thought dying. To-
wards
485
Ruflelfs Account of Indian Serpents.
wards the end of the fecond hour, he appeared fome- what better. In the third hour he ceafed moaning, but refufed food, and could not be made to rife. In this ftate he continued till night. The following day, he was pretty well recovered, and began to eat.
* Objervdtious. The recovery in this cafe, con¬ sidering the formidable fymptoms which appeared fo early, and the reduced ftate of the i abject, was con¬ trary to" expedition.
" Experiment 21. The fnake being left to reft half an hour, was made to bite the dog B. (experi¬ ments 16 and 18.) The leg was immediately drawn up, but in other refpeCts the dog feemed no wife af¬ fected. After lying along for half an hour, he rofe cf himfelf, but was dull and ftupified, and foon lay down again. After two hours, he was difpofed to eat ; and at night, appeared very well.
s This was the laft experiment made on this poor animal, which had been bitten fix times; had the caultic applied twice ; and had once had the poifon inferted artificially. The ulcers from the cauffic were at this time healing fall, and the dog recovered per¬ fectly.
£ Experiment 22. April 12. The dog A. on which fo many experiments had alfo been made, being now much reduced in ftrength, while an ulcer of enormous fi?e in the thigh (partly the con- fequence of cauffic, and partly of poifon) fhewed lefs difpoiition to heal than to fpread, it was deter¬ mined to difpatch him. With this view, one of two katuka rekula podas, which had been for fome time captive, but had not bit for feveral preceding days, was made to bite the breaft of the dog; both fangs acted, yet no fymptoms of diforder followed.
‘ After waiting above an hour, another fnake was applied, to the thigh ; which owing to a fudden ftart of the dog, left a fang flicking in the wound : to make fiill more fure of liberating the dog, the fnake
M m 3 was
i
/
486 Rtiffell’s Account of Indian Serpents.
was provoked to bite him once more with the re¬ maining fang.
The dog inftantly funk, grew gradually worfe, and expired within two hours after the firft bite of the fecond brake.’
Seft. 4. contains experiments on the poifon of the Bodroo Pam.
6 Experiment 4. October 20. Six days after the above experiments, the fnake having been permitted to reft, a dog was bitten on the infide of the thigh. During the firft ten minutes, no figns whatever ap¬ peared of poifon; but at the end of fixteen minutes, the dog, who fat half couched, was feized with a trembling of the head and the fore legs. Being railed up, he walked a few paces without any ap¬ parent lamenefs. At the end of twenty minutes, the tremors increafed, and the thigh was contracted. At the ena of fifty-five minutes, the tremors became more univerfal, and the dog frequently ftretched the neck, his mouth pointing upwards, as if gafping for breath ; but he all along neither moaned, nor howl¬ ed. During the fecond hour, he lay along on one fide, either in a torpid ftate, or, at intervals, writhing his limbs: and fometimes differed a fubfultus ten - dinnm. After the third hour, he grew better, and foon recovered.
‘ Experiment 8. October 22, 1788. Two days after the three foregoing experiments, the fame dog wnich had eicaped before, (fee experiment 4.) was bitten in both thighs. The legs were almoft imme¬ diately affected, and within five minutes, the legs and breaft were, as before, feized with tremors. The dog couched, but foon rofe again ; the trembling conti¬ nued, attended with a {lighter degree of ftupor than the day before ; and in the courfe of the firft hour, the mufcles of the wounded thigh were at times tre- * ^ ^ tremors decreafed vifibly in the fecond
hour, the clog rofe of himfelf, and flood firmly on
his
RuffelFs Account of Indian Serpents . 487
his legs ; after another hour, he had pretty well re¬ covered,
c Obfervations . As the fangs adled on each thigh, and the dog was more (lightly infedfed than in the former experiment, it was probable, though the fnake appeared very alert, that the power of the poifon muff have been diminifhed. In order to try this,
c Experiment 9. A chicken was bitten in the thigh, and immediately (hewed (igns of poifon ; but, after continuing two hours in a (fate of (lupefaclion, it recovered.
c Experiment 10. After an interval of half an hour, a pigeon was bitten in the thigh. At firfl it efcaped to a rafter in the room, whither being pur- fued, it got out, and relied on the top of a rock, at a little diftance. It foon tumbled down from this lad refuge, and was brought back. In about fifteen mi¬ nutes from the bite, the bird feemed (lupified, couched on the belly, and without convuliions, ex¬ pired in that pofture, three minutes after.
e Experiment 11. When the pigeon in the above experiment fled, a fecond was immediately bitten ; and though the fnake had bitten three times before, in the fame forenoon, the fymptoms of poifon were inflantly vifible.
c After fourteen minutes, convuliions fupervened, which alternated with ftupor ^ and in forty-five minutes the bird expired ; the convuliions having ceaied (hr
ten minutes before death.
£ The appearances about the wound, were found, upon diffedlion, the fame as ufual.
< Obfervations. From the foregoing experiments, the poifon of the bodroo pam appears to be lefs dele¬ terious, and (lower in its operation, than thofe of the cobra de capello and the katuka rekula poda : the fymptoms attending it appear alfo to be in feme refpefts different.
e The firfl: chicken was convulled in an extraor¬ dinary manner, but lived eight minutes; the others
M m 4 were
488 Simmons on the Ccefarean Operation , Kc.
were {lightly convulfed, and lingered longer; fome efcaped altogether; but all fuffered fomeC degree of fhipor. The dog and the pig efcaped death, though both fuffered confiderably : efpecially the dog in Exp. 4. In Exp. 8, the ftrength of the poifon may be fuppofed to have been impaired by .captivity and falling; but its fatal efrefts on the pigeons, Exp. 10, and 1 1, '(hew¬ ed that it was not dellroyedd
The next fedlion relates to the artificial infertion of the poifon of ferpents into the bodies of living animals. Of this and the remaining parts we (hall give an ac¬ count in our next.
Art. L. Reflections on the propriety of performing the C afar e an Operation • to which are added Qbfer- vations on Cancer ; and Experiments on the fuppofed Origin of the Cow-pox. By W. Simmons, mor Surgeon to the Manchefter Infirmary . 8vo, 97 pages, price 3s. London, 1798. Vernor and Hood.
• t ' v . r C v . ■ ' ■. r
HpHE Caffarean feclion has been a fubjecl of dif- JL culfion among medical men for the two Jaft cen¬ turies. . The alledged -refult of their experience has been ftnkingly different ; tor while it is faid to have been praclifed with fuccefs in other nations on the continent of Europe, it has proved fatal in England in every inftance. From the hifiorical inquiry into the operation, which Mr. Simmons has here inftituted, there is great reafon to fufpect mifreprefentation in many of the accounts which have been given of its fuccefs. A cafe was related a fhort time ago in a newfpaper, where this operation was faid to have been fuccefsfully employed. On inquiry, however, into the circumftances, the author found it to be ef- fentially different. What was the real date of the
cafe
Simmons on the Cctfarean Operation , Sic. 489'
cafe, he does not fay. To prevent the revival of this operation, is the principal motive which led to the prefent publication. Very few, we imagine, will hefitate to join with the author in this concluiion.
Inflead, therefore, of performing an operation which is lo uniformly fatal to the mother, the author propofes, that when a cafe ill all arife in which the child cannot be delivered by the crotchet, from the brim of the pelvis being no more than one inch in di¬ ameter, the two operations of the fedtion of the fym - phi/is pubis , and that of the crotchet fhall be combin¬ ed : that is, to divide the fymphilis to make way for the crotchet. Objections, doubtlefs, may be made to this ; but they are out-weighed by the neceffity of the cafe. Whilit the Gaefarean operation is certainly fatal to the mother in this country — whilit it is agreed, that the life of the child fhall not be put in competition with that of the parent — whilit it is afeertained, that the feet ion of the fymphyjis pubis is neither fo for¬ midable nor fo fatal as the Ccefarean operation, — and y whilit the crotchet has been applied fuccefsfully in di- nienfions which wTould probably be thus acquired — the compound operation here recommended will furnifh a refource, approved by reafon, though not fandt'ioned by experience.
The next fubjedt of the author’s remark is cancer. The diltindtion, he obferves, between a well-marked cafe of cancer and other tumours, requires no great (kill or penetration ; but, to diltinguilh it from an in¬ nocent glandular enlargement, in the earlier Itage, de¬ mands greater precifion fometimes than has been yet attained. This uncertainty in the diagnofis- has been a lource of calumny to the profeffion, and an en¬ couragement to artful and defigning men, to increafe the fears, and impofe on the credulity of the public. Whatfoever the intereftea fhall alfert, it is evident, in the author’s opinion, that a remedy has not yet been difeovered, poffeffed of the power of curing cancer:
or
/
490 Simmons on the C afar e an Operation, Sic.
or it is reafonable to fuppofe, that it would be as Gene¬ rally fuccefsful as mercury is in curing the venereal
difeafe. &
The two following cafes are related, to fhew that tumours not cancerous, are fometimes consigned to all the feverity of treatment fuppofed to be adapted to cancer.
Cafe 2. c A florid healthy looking woman, of middle-age, applied to me about three years fmce, for a painful enlargement of her left breaft, of feveral months Handing. The account fhe gave was— that the difeafe came on without any evident caufe; that the whole breaft was affected from the beginning; ; that flie experienced lefs pain in the earlieft ftage; but that for fome time paft, and particularly the week be- foie, it had been fo fevere, as to induce her to apply for help. She was told by the perfon to whom the ap¬ plied, that it was a ftomach cancer, for which he could promife her no relief ; but that fhe muft attend, and undergo the ufual dreffings. Knowing, from re¬ port, the fevere pain that would be occaftoned by them ; and, receiving fo little promife of ultimate benefit ^ (lie determined to try regular profeflional ad¬ vice, and accordingly came to the infirmary.
After a careful examination of the tumour; and, having maturely weighed all the circumftances or her cafe; I had nohefitation of pronouncing it not to be cancerous. Leeches were direfted to be applied twice a week ; a iol u f ion of neutral falls was ordered to be taken every morning, fo as to procure three or - lour evacuations in the courfe of the day ; and, fhe was inftrucled to ufe the infufipn of hemlock with litharge of vinegar, as an embrocation to the part. In lefs than two months, the tumour was entirely difperf- cd; and fhe returned thanks for her cure.
idle truth of my affertion was confirmed, a year ago, from more refpeftable authority.
(.cue 3. c A lady, refident in Yorkfhire, perceiv¬ es a tumour in her left breaft, which was occaiion-
Simmons, on the Cafarean Operation , Sic. 491
ally painful, came over to Manchefter to afk my ad¬ vice. On her way hither, fhe was informed by fome celebrated cancer-dofitors, whofe opinion fhe had de¬ termined to take, that it was a cancer; and, as the dreflings neceffary to remove it would be painful, (lie muft re fide near them, for the benefit of their direc¬ tion.
c T he difeafe appearing to me not to differ eifen- tially from the former, I recommended a plan of treat¬ ment to be purfued, not materially varying from what had been fuccefsfulin that cafe; and, in a few weeks, I had the fatisfafifion to find that the tumour had en¬ tirely disappeared.’
The following is furniflied by Dr. Ferriar; and Serves to fliew that if a man is fortunate enough to make the world believe fuch cafes as this to be cancer, he may cure a thoufarid in a week, with little trouble to himfelf, and with a Single ap¬ plication of his remedy.
Cafe 4. s£ A gentleman called on me fome months ago, in great agitation, to requeft my opinion re fpe fil¬ ing a hemorrhage, which had taken place from a Small tumour near the point of his note. He inform¬ ed me, that a few days after the discharge of blood happened, he had fhewed the tumour to fome em¬ pirical prafiiitioners in this neighbourhood, who aft iured him that it was a bleeding cancer ; that he was in imminent danger from its continuance ; and that he muft put himfelf, without delay, under their care, and fubmit to a Severe courfe of cauftics. This he determined not to comply with, till he knew from me whether the tumour was of a cancerous nature. I found on examination, that it was merely a pimple, of a larger Size than ufual, which, in Suppurating, had probably opened a Small branch of an artery, and pro¬ cured a considerable difcharge of blood that was very Salutary to him, as a hemorrhoidal evacuation, to which he had been formerly Subject, was then fuppreffed. i advifed him to Stay quietly at home, with an affurance
that
492 Simmons on the Cafarean Operation , Sc.
that this dreadful cancer would difappear in the courfe of a very few days ; and indeed, in lefs than a week, no vedige of it could be traced.”
Refpecting arfenic, which has been fo long and fo generally recommended in cancerous complaints, Mr. Simmons obferves, that when externally applied to an open cancer, it leaves the parts underneath the efchar lefs difpofed to heal, than any other cauilic he has tried. The following cafe, and which we have much pleafure in communicating to our readers, gives hopes* that much advantage may be derived from its internal life.
‘ Grace Graham, aged 45 years, a widow, and mother of two children, had been fubjed to frequent attacks of acute rheumatifm, from which (he reco¬ vered in the ufual way. About Chriflmas 1795, fhe perceived a fmall indolent tumour in her left bread ; which continued incfeafing in fize for twelve months, without giving her any pain. Soon after this time, it grew painful; and increafed in fize more rapidly than before. The rheumatifm becoming troublefome again, in the fpring 1797, fhe became an in-patient of the Infirmary, under the Care of one of the phyficians. She was relieved of her rheumatic complaints, but the cancer went on increafmg. In July 1797, fhe was admitted under my care as an out-patient; at which time, the glandular part of the bread was near¬ ly confumed by the cancer ; and the lymphatics in the courfe of, and the glands in the axilla, were en¬ larged and very much indurated ; the fkin originally covering the bread was in many parts dedroyed, ex* poling a foul ulcerated furface, with here and there an interfedion of remaining fkin ; and the whole re. mainingmafs was become firmly adherent to the pec¬ toral mufcle and ribs. The lymphatic glands in the neck were alfo very much indurated: and hard knots were fcattered round the bread, towards the fternum and the clavicle on the fame fide. The pain was ai¬ med mediant, of a burning lancinating kind ; and a
filthy*
4
/
Simmons on the Carfare an Operation , Sic. 498
filthy, offenfive, famous fluid, was copioufly difcharg- ed. She enjoyed little fleep, fuffered a lofs of ap¬ petite, and had the leaden hue ftrongly marked in her countenance.
‘ Several courfes of different remedies were tried, with no more than temporary relief from pain : and the difeafe continued its ravages, affecting the whole of the lymphatics of the left arm with pain and en«- largement.
6 She was admitted an in-patient under thefe clr- cumflances; and, without any hope or profped of doing her fervice, I put her on a courfe of arfenic, on the 5th of June, 1798, by directing her to take twelve drops of the mineral folution of Doctor Fow¬ ler, three times a day. Large and repeated doles of opium had been found neceffary, to procure fome eale from her fufferings ; which were Hill continued. The folution, at firft, excited coniiderable general diforder, and great uneahnefs m her ftomach and bowels, without flie wing the leaft effe£t on the cancerous complaint. In five or fix weeks, however, the pain abated ; the difeharge was lefs fetid, and of a better confiltency ; and feveral infulated points of cicatri¬ zation appeared in different parts of the ulcerated furface. She was now fo eafy, that opium feemed to be no longer neceffary, and it was difeontinued.
£ 1 was encouraged to go on, by this favourable change ; and, as the points of fkinning increafed in number, although the parts had not yet fuffered ul¬ ceration .continued- to be flowly destroyed, 1 was dif- pofed to think that, if the conftitution could bear an increafed dofe of the folution, a cure might poifihly be effected ; and, under this idea, I ventured to give her fifteen drops, three times a day. The confe- quences foon convinced me that I was mistaken ; for not, only an alarming general indifpofition follow¬ ed; but, the ulcer became painful, foul, and fetid; and the ulceration of the cicatrized parts was ra¬ pidly renewed. Thefe threatening fy mptoms fub-
fidecj*
494 Simmons on the C afar e an Operation , 8(c.
dded, however, on leaving it off for a few days, and die then returned to the former dofe.
£ This quantity die has taken daily to the prefent time, with the exception of an interval of five or fix days, during a flight pneumonic affect ion ; and again, during an attack of cholera morbus, which laded for feveral days ; neither of which complaints feemed to have the fmalled connexion, either with the cancerous affeQion, or the taking of the arfenical folution. For feveral months pail the has been pretty eafy , to ufe her own words, the difcharge has not been at all offenfive ; the cicatrization has gone on in a manner beyond all expectation ; and the difeafed glands in the neck have di min idled in fize, and become free from pain. Many of the filial! fcattered knots have been cad out, leaving a fmall ulcer at the bottom, exquidtely tender to the touch, but foon healing ; and the chief fource of what pain die has differed for forne time. The only external application die has ufed is hemlock; firft in the form of poultice, and then by lint moidened in an infufion of the herb. The life of hemlock can throw no ambiguity on the cafe ; as die had gone through a complete courfe of it, both internally and externally, before die took the fo- lution ; with merely a temporary abatement of the fymptoms.
c Great and furprizing as the relief afforded by the arfenic has been, i am not fo fanguine as to expeft the cure of a genuine confirmed cancer ; but, the woman’s life has undoubtedly been prolonged by it ; die has been kept afmoft free from pain ; and in a condition not wholly unfit for enjoying the comforts of life; which, contrafted with the ufual fcene at¬ tending the termination of cancer, will render it a valuable acquidtion in medical praCfice. Her fpirits latterly have been diffidently good f and die has nearly loft the leaden hue in her countenance. A ge¬ nerous diet has been allowed, with four ounces of
wine
495
Sue fur la Vitalile.
wine daily. The drops have been taken in a tea-cup full of water, or in a little tea.
On the fubjefl of the Cow-Pox, our readers will recoiled!, that Dr. Jenner, in his Treatife on that affeftion, referred the origin of the difeafe in the cow, to the application of matter afforded by the heels of the horfe, when affefled by the greafe. Dr. Jenner had not himfelf, however, any experience of the faff. From feveral direct experiments, made by Mr. Simmons, with every requilite caution, it is clearly afcertained, that the cow-pox poifon does not originate in the horfe s’ heel. He has experimentally proved, likewife, that cows are not affeffed by the application of the matter of fmall-pox.
The cow-pox is a difeafe wholly unknown to farm¬ ers, both in Che hi ire and in Lancafhire ; where the experiments, here recorded, were made : fo that dif- appointment could not arife from the animals having undergone that difeafe ; and, in Chefhire, a large- dairy county, the author obferves, the men are em¬ ployed indifcriminately in cleaning the horfes, and in milking the cows* *.
Art. LI. Reckerch es Phyfto logiq lies, el Experiences fur la Vitalile , Vc. By J. J. Sue, M.l).
(Continued from page 397.^
NOT long fmce, the author obferves, it was con- fidered as an univerfal law, that the fyftem of organization adopted by nature in the vital parts of a great number of individuals, was that of all ani¬ mated beings 3 but further observation has taught 11s,
* In our next, we fhall notire the collection of FaCts, by Dr. Pear ton, refpecting the cow-pox.
4 that
496 Sue fur la V Halite.
that this concluflon was too haftily drawn, and is contradided by oppofing fads ; which, although cal¬ culated to excite our wonder, are no lefs incontef- tible. In fad, we fee beings, endowed with motion and voluntary power, polypi for in fiance, not only preferving their vitality, after being cut and divided into numerous parts, but poffe fling a faculty a thou- fand times more aftonifhing j that ot reprodudion ; each part becoming a perfed animal, by the growth of thofe parts which had been removed. And it mull be obferved here, that it is not the mere reprodudion of one part of the body, by the energy of a more impor¬ tant remaining portion, as we fee take place in lobfters and lizards, that have loft their claws and extremities : it is the parts Which we are accuftomed to confider as effential to the life of the animal, which are found to be thus, reproduced ; and this regenerative faculty ex ills not only in the part which is confidered as the head of thefe animals, but in every part without dif- tindion.
We fee, from thefe obfervations, how bounded our knowledge is, refpeding the nature of the organs neceffary to life : tor we find individuals endowed with voluntary motion, and, consequently, with life, which, though cut and divided, ftill move, and even reproduce ihemfelves ; yet without being in poffe f- fion of heart, brain, and other vifcera, which we are accuftomed to confider as indifpenfible in animal or¬ ganization.
if, from the contemplation ot the various means, which nature employs in the formation of the organs effential to animal life, we recur to the examination of thofe wvhich Are employs in the re-produdion, or in the propagation of individuals, we fhall find them not lefs varied or extraordinary. It was efteemed certain, that generation was performed in a uniform manner, by the female furni thing either eggs or a living off fpring ; but recent obfervation has fliewn,
. - . that
Su e./wr la Vitality 49t
that this mode of re-produffion does not hold good in the female of the infedt called the vine-fretter (pu- ceron) : (lie, by a fmgle copulation with the male, produces eight or nine individuals, not proceeding, as in other animals, immediately from herfelf, but the fecond from the firft ; the third from the fecond ; and fo on fucceffively to the laft. This infedt, like wife, fometimes produces eggs — fometim.es young ones^ according to the feafon $ though it has hitherto been fuppofed an invariable law of animals, to produce either eggs, or young ones, folely.
It will be feen, alfo, that the laws which refpecf the ceffation of life, or the caufes of death, andl. which have been fuppofed fo conftaht hitherto, are liable to great exceptions. When an individual ceafes to move for a certain length of time, it has been fuppofed, that this ceffation of aclion was fuf- ficient to deprive the organs effentia! to life, of all their fundtions ; in a word, to deffroy their life. But here, too, the conclusion is too general, and drawn, from what we fee take place in animals of a parti¬ cular clafs ; for many animalcules*, after being de¬ prived of motion, for feveral years, and which appear entirely dry and fhrunk ; in fhort, which prefent aff the phenomena of death ; are yet reftored to life, ana refufcitated, by means of a fmgle drop of water: The length of time that they can thus, lie dormant, has not been ascertained. But Roffredi has proved, that fome of them may be reftored to activity after feven and twenty years of this apparent death.
Another ftriking phenomenon in the hiftory of cer¬ tain animals, is the faculty they poffefs of remaining z longer or fhorter fpace of time without food. The tortoife and the crocodile can continue two months without taking nourhliment. A toad has lived eigh¬ teen months clofely fhut up in a box, without food or airf, not to mention the numerous facts, many of which feem to be well attefted, of other toads, en~ clofed for ages in the centre of trees and rocks.
* Le rotifere, 3e tardigrade, l’anguille des gouttieres, f Effais philofoph, fur les crocodiles : anon,
vql . v. N n It
498 Coindet’s Obfervations on Animal Fat , &V*
It is, therefore, evident, M- Sue obferves, from what has been faid, that we have drawn too general conclufions, relative to the mod important points re^ fpe&ing vitality. Our obfervations mull be extended, and our experiments multiplied, before we can ven¬ ture to deduce general and confident laws. ,
In a fubfequent memoir, M. Sue relates a number of experiments made by him, on this interefting fub- je£t 5 which we fhall probably notice on fome future occafiom
Art. LIL Obfervations on Animal Fat , and the Caufes of Corpulency. By !) r . Co index* Journal de Phyfique , 1798.
ANIMAL fat, examined by the microfcope^ feems to exhibit yellowidi vedcles, formed o i a very thin and transparent pellicle, which contains an oily fluid. No pores can be obferved in it, and no perfon but Malpighi has been able to difcover what are called its.adipofe duds ( diictiis adipqfi ). In cer¬ tain cafes, however, fat is abforbed , and, in gene- iral, it feems to undergo conftant changes: the Ik ins of the negrces, $ftef violent p$:ercife, exhale an oily odour.
The quantity of fat varies much, according to the different dafles. of animals ; and, if we compare the quantity of fit with the bulk of the body, it will be found that flfhes exhibit the larged proportion ; then amphibious animals^ and then the frugivorous* The carnivorous prefent the lead ; but thefe are only ge¬ neral obfervations, which are fubjed to many excep¬ tions.
All the ufes of fat are not yet known ; but we know, that in fome cafes it becomes exhaufted, and foppiies the place of aliment- Thus, animals which remain in a date of torpor for feveral months, with* out taking nourifliment, lofe their plump appear¬ ance ; from which it would feem, that this is a re¬ source provided for them by nature. May it not, perhaps* ferve to preferve animaf heat ? The circum- ’ 1 ‘ " 1 ‘ ' ' ' ' ? * ‘ fiances,
Coindet's Obfervations on Animal Fat , <9f c. 499
fiances which contribute to its formation are (till more obfcure, and have given rife to many ingenious ideas, dignified with the name of hypothefes. One of the moft probable is that of Dr. Beddoes, which appears to me to clear up many faffs hitherto inex¬ plicable, though it is fubjefl to many exceptions, a§ every hypothdis rnufl be. The foundation on which it refts is, that whenever there is a certain diminrn tion of oxygen in the animal fyftem, fat will be pro¬ duced. The following obfervations feem to fupport this affertion : The chemical analyfis of fat Ihews, that fix parts of it contain near five of carbon, and one of hydrogen, and fome febacic acid* The fat parts of animals differ from the flefhy parts only in this, that the latter contain more oxygen and azot, By this is explained the change of mufcles into a fub- fiance like fpermaceti, as profeffor Fourcroy remarked in the burying ground of the Innocents at Paris. It has been obferved alfo, that the fat augments, at the expence, of the mufcles, in the living body, and vice verfa .
The want of oxygen, confidered as a caufe of cor¬ pulency* is indicated by the analogy which- exifts be^ tween obefity and the fea fcurvy, which fee ms to be owing only to a gradual abftraciion of a part of the oxygen in the fyftem. The fea fcurvy is never am nounced by meagrenefs ; on the contrary, a fulnefs of the habit is the firft fymptom of that malady. Dr* Trotter obferves, that when a negro grows rapidly corpulent, he does not fail to be attacked by the fcurvy; from which, to make ufe of a companion of Dr. Beddoes, it appears that corpulency is to the fcurvy what cachexy is to the dropfy. All the fymp- toms of the fcurvy prove that it arifes from a priva* tion of oxygen : thus the furface of the body is cover¬ ed with livid fpots, the arterial blood is very little florid, and, after death, the left auricle is found filled with venous blood, which Dr. Goodwin found in animals that had been deprived of life by oxygen. Dr. Lind fays, that when death has been fudden, and that no effufion is found in the cavities of the body, the auricles and the ventricles are filled with blood, 3 *' and
« - ‘ „ •- . . i
566 Coindet9s Obfervations on Animal Fat , tfc*
and efpecially the left fide of the heart • which is a very remarkable circumftance, fince that fide rarely contains much blood after death.
People in the country know very well, from expe¬ rience, that when they with to fatten poultry, they muft keep them in darknefs, and mix with their food fubftances proper for prolonging their fleep, fuch as tares, or fpirituous liquors. An obfervation which appears curious is, that the age when the fecretion of fat is moft confiderable, is towards the fortieth year ; a time when the arterial fyftem ceafes to aft fuch a confpicuous part in the animal ceconomy, either becanfe it is then oiiified, or in part obli¬ terated, while the venous fyftem, becoming more and more developed, feems to acquire that influence fo confiderable in old age. Do arteries, the aftion of which is vifibly diminifhed, furnifh at that period lefs oxygen to the fyftem; and may not that be the caufe of the corpulency of middle-aged people ? .
It may be objefted that children, whofe venous fyft tern is not yet developed, have however a remarkable plumpnefs. But this difficulty has been refolved in the following manner. The venous blood when it arrives at the lungs, undergoes there chemical changes, too well known to require to be here particularized, it may happen, that according as refpiration is more or lefs perfeft, the blood may lofe a greater or lefs quantity of carbon and hydrogen. In proportion as it lofes lefs, the fecretion of the fat will be more abun¬ dant : this, then, will afford an explanation of the enormous quantity of fat found in amphibious animals* fifties, &c. in which refpiration is not fo perfefl, be-* caufe being furrounded by water, they are not in con¬ tact with fo confiderable a quantity of oxygen as ani¬ mals that breathe in the open air. They retain, then* more hydrogen and carbon, which palling into the arteries, ofecafion that confiderable^ fecretion of fat* and probably produce that voluminous fize of liver* found in fifties ; in which circulation is fuch, that alrnoft the whole blood goes to the liver, either to operate there a fecretion of fat, or of bile, the con- ftituent parts of which do not differ much from thofe of the former.
No. XXX
mssssmm
THE
MEDICAL and CHIRURGICAL
REVIEW.
M A Y, 1799.
/
Art. LIIL An Account of Indian Serpents , <5fc. By Pa trick Russell, M. D.
( Continued from page 488.)
IN our laft we felefted a number of the author’s experiments, with the view of ill e wing the effects produced on animals by the bite of different fer- pents. The fifth Seftion contains Experiments on the artificial Infertion of the Poifon. The pheno¬ mena here varied in fome degree from thofe which prefented themfelves in the former cafe. Though lome flight fymptoms in dogs were produced by the artificial infertion of the poifon, it frequently failed altogether, and in no inflance proved either mortal or formidable. With refpeft to birds, though it fre¬ quently failed there alfo, yet it often produced fome of the ufual fymptoms of poifon, in a certain degree, and often death.
Sect. 6. contains Experiments on Remedies applied to the Poifon of venomous Serpents. In many cafes, vol, v. Go Dr.
502 RuffelFs Account of Indian Serpents.
Dr. Ruffel obferves, where the poifon is applied to brute animals, its progrefs is fo extremely rapid, as hardly to leave time for the operation of a medicine, or the application of any means whatever, with a pro¬ bability of fuccefs. Where its progrefs is flower, fhould the remedy be adminiftered before unequi¬ vocal fymptoms have removed all doubt of the poifon having taken effe£t, recovery may be afcribed to the medicine given, when, in reality, no malady exifted ; and if deferred till our doubts are removed, the re¬ medy which, if applied in time, might have proved efficacious, may come to be unjuitly profcnbed as ufelefs. To this it may be added, that a bite of the moft pernicious fnake does not conifantly prove fatal; and chat e^en the tenderer animals, fometimes with¬ out the ufe of remedies, recover, in inflances where the fymptoms were very formidable.
Similar difficulties in eftimating the efficacy of me¬ dicines occur in feme degree in many difeafes ; but belong in a more peculiar manner to animal poifons. A multitude of repeated experiments, only can juftify general inferences ; and in transferring fuch inferences to the human fubjedf, analogical reafoning fhould be exercifed with the moil fcrupulous caution.
From the experiments detailed in the foregoing feftions, it Efficiently appears, that the feveral poi¬ fons mentioned, though in different degrees, are all deleterious.
That the fymptoms produced by them in the bodies of different animals are very much alike.
That the progrefs of thefe fymptoms, after they commence, is nearly the fame in order of progreff lion, though in different degrees of rapidity.
That a like variation is obferved in the commence¬ ment of the fymptoms. Sometimes it is almoft inftan- taneous ; in general from three to ten minutes, but very feldom later than half an hour.
That when the fnake is firfl caught, its bite infefts with more certainty than when kept fome time ; but
the
3
RuflelPs Account of Indian Serpents . 50S
the deleterious quality of the poifon, though impair¬ ed, is not by captivity (even where accompanied by long falling) deftroyed. When it appears to have loll the power of killing larger quadrupeds* it dill re¬ tains that of killing birds, though lefs fpeedily than at firft.
That when the fnake is made to bite feveral times fucceifively in the fame day, the frit bite, other cir- cumdances being equal, is not only more certain of infefting, but in general proves more quickly dele¬ terious.
That the poifon of brakes does not invariably kill animals ; and that they fometimes unexpectedly efcape from a concourfe of dangerous fymptoms ; though in general the danger of death is in proportion to the violence and early appearance of thefe fymptoms.
That the period of death varies considerably. Dogs* in no inftance, were killed in fo Short a time as birds ; but the variation with refpeft to both, fo far as thefe experiments go, does not feem ftriCtly correfpondent to the lize of the animal.
That the artificial infertion of poifon is lefs fee ure of taking effeCl, than the bite of the animal, but the confequent fymptoms are exaClly the fame, and the event, with refpect to the fmaller animals, not lefs fatal.
A multitude of experiments, made in Europe, on the poifon of the viper, having fufficiently confirmed the inefficacy of the mod celebrated internal remedies ufually recommended againfl venomous bites, Dr. RufTell gave the preference for trial to an Indian remedy, fanflioned by unquedionable authority, as much ufed with perfect fafety, and often with fuc- cefs. This was the Tanjore pill, one of the prin¬ cipal ingredients of which is white arfenic. The ex¬ periments here recited are few, and by no means fatisfa&ory. It appears altogether doubtful, whether this remedy produced any benefit.
C audio
504 Ruffelfs Account of Indian Serpents .
Caufiic was applied, as well as the aftual cautery* in fome indances. Thefe often failed, though ap¬ plied from four to fifteen minutes after the bite : when applied later, they almoft invariably failed. A few experiments of amputation made by the author on chickens and pigeons proved unfuccefsful. In one cafe, the limb was amputated in one minute after the bite. In a few trials, a ligature applied immediately to dogs, after being bitten in the leg by a cobra de capello, failed in preventing the progress of the poifon.
The following method of preparing the Tanjore pill was fifrnifhed to the author by Mr. Dufun, Sur¬ geon to the Garrifon of Vellore :
“ White arfenic ; roots of velli-navi*; roots of neri-vifham* ; kernels ofnervalam*; pepper ; quick- diver ; — of each an equal quantity.”
The quickdlver is to be rubbed with the juice of the wild cotton, till the globules become invifible. The arfenic being fird levigated, and the other in¬ gredients reduced to a powder, are then added, and the whole is beaten up together, with the above juice, to a fit confidence.”
One pill is directed to be given mixed in a little warm water. After a quarter of an hour, fhould the fymptoms increafe, two more are to be given, and another an hour after. — This remedy is likewife faid to be fuccefsful againft the bite of the mad dog. The author fays he gave it to fourteen perfons bitten, but does not mention the refult.
In the feventh Se&ion, the Effeffs of the Poifon of Snakes on the human Body are defcribed. It has been called in quedion, the author obferves, whether in Europe, the bite of the viper ever proves fatal to
* The two firft of thefe are poifonous roots, and the third is a draftic purge. They are all indigenous on the Malabar coaft, and ufed in compofition, by the native practitioners, in a variety of difeafes, befides thofe from animal poifons.
man.
#
Ruffell’s Account of Indian Serpents. 505
man. The Abbe Fontana, who was at pains in making enquiry, in different countries, never met with one well-attefted inftance of its occaiioning death. He found from his own experiments, that to fome, even of the domeffic brute animals, repeated, bites of more than one viper did not prove fatal ; and he conffders the variety of oppoffte and trifling re¬ medies, to which cures have often been afcribed, as a proof that the difeafe produced by the poifon of the viper, cannot be very dangerous. 44 Une maladie t<r qui cede a tous les remedes, meme a ceux qui <c font oppofes entr’eux, n’eft jamais une maladie <c dangereufe.”
The cafe is widely different in refpecf to the poi- fons of the cobra de capello, and fome other Indian ierpents. That man is fubjedted to their deleterious power, is a fadl confirmed every year by too many- fatal accidents ; and the experiments produced in the preceding fediions, put it beyond all doubt, that the ffronger animals, who refift the poifon of the viper, rapidly give up life to the fingle bite of a cobra de capello.
Of the remedies to which cures of venomous bites are often afcribed in India, fome are certainly not lefs frivolous than thofe employed in Europe for the bite of the viper ; yet to inter from thence, that the effects of the poifon cannot be very dangerous, would not be more rational, than to afcribe the recovery of a perfon bitten by a cobra de capello, to the applica¬ tion of a fnake-ftone, or to the words muttered over the patient by a Rramin.
It is eftablifhed by experiments on brute animals, that, highly deleterious as the poifon of ferpents is allowed to be, it does not to them prove conftantly, or infallibly fatal. The cafe from analogy, may be prefumed to be the fame in refpeft to man : but is with more certainty known, from the frequent reco¬ very after threatening fymptoms have come on, not only where infignificant remedies alone wrere em-
O o 3 ployed*
506 RuffelFs Account of Indian Serpents .
ployed, but where no remedy whatever had been applied.
Nine inftances are adduced of the bite of venomous ferpents in the human fubjeft, one only of which came under the immediate obfervation of the author : this we fhall tranfcribe.
Cafe 9. In the beginning of June 1788, a Gentoo man, about forty years of age, was bitten by a cobra de capello, in the fleihy part between the thumb and the fore- finger.
* He was one whom I retained in my fervice for the purpofe of procuring ferpents, and alfo, as he was very adroit in handling them, for affifting in ray experiments. He met with the accident after funfet. In attempting, at the requeH of fome neighbours, to catch a cobra de capello, juft before difcovered in one of the houfes of the village. His ufual caution feemed to have deferted him, as he pretended to have miffed his aim in the duff.
c The account he gave was, c<r that he felt inftantly ?c a iliarp pain in the part bitten, which foon fpread on the palm, and upwards on the arm. He was fenfible alfo of ffcknefs at the ftomacb, but did not vomit. In lefs than an hour, the hand and the wrift were confiderably fwelled ; the pain extended nearer the ftio aider ; he was fenfible of a confufion in his head, and a ftrong difpofition to dozed— From this time he himfelf was for feveral hours ig¬ norant of what had palled ; but from the report of thofe about him, (fo far as could be collected,) cc he “ at times (hewed much inquietude, without making any fpecifi c complaint ; at other times he lay moaning, and dozing. Towards midnight, his diforder increafed, ftartings about his throat were obferved, his breathing became laborious, lie could 45 motdpeak articulately, and feemed not to perceive , objects, though his eyes were open.” c They had applied a poultice of herbs to the arm, sod adminiftered a fecret antidote internally ; belides
which,
507
Ruffell’s Account of Indian Serpents.
♦
which, a Bramin performed his functions : but find¬ ing he grew worfe and worfe, it was determined after midnight^ by the relations, to acquaint me with what had happened.
c Between one and two in the morning, I fent back the meflengers with two dofes of the Tanjore medicine prepared in draughts. On their return they found the patient much better ; he had recovered his fenfes, and finding the meffengers had omitted to inform me of his having already fw all owed a medicine, he declined taking; the draught, left the two remedies fhould happen not: to agree together.
c In the morning, I found the hand and arm mon- ftroufly fwelled, and 1 fufpected the parts round the pundtures were livid ; but part of the poultice ad¬ hered fo clofely, and had tinged the fldn.fo deep a yellow, that I could not abfolutely determine.
4 The man had perfectly recovered his fenfes, he had no fever, complained only of confufion in his head, of languor, and of pain in the arm.
< The bark was ordered, but a few dofes only were taken. The parts about the pundtures mortified firfi: ; the gangrene then fpread over the back and palm of the hand, and part of the wrift, laying the tendons bare, and forming an ulcer of confiderabie extent ; which, however, healed favourably under the ufual treatment. Tie recovered his healih in eight or ten days ; but it was feveral months before he recovered the ufe of his hand. *
The other cafes did not all terminate fo favourably \ four of the patients fell victims to the bite ,
The eighth Section contains mifcellaneous Expe¬ riments and Remarks. ^ # .
The cobras de capellos were found to bite, each other without any confequence afcribable to their poifon, even where the fangs vifibly acted : nor was the cobra affedted by the bite of the katuka rekula
O o 4 • poda.
508 RufTeiFs Account of Indian Serpents .
poda. The bite of the former proved- fatal to the nooni paragoodoo, and to the tar tutti.
Snakes live a long time without food, but the de¬ leterious power of, their poifon is impaired by ab- ffinence.
The poifons of all the venomous ferpents which Dr. Ruffell examined, wTere, in colour and confidence, very much alike, at the moment of emiffion through the fangs. The poifon is fo me what mucilaginous when firft emitted, but becomes quickly more fo when expofed to the air ; while its colour, from pale yellowifli white changes to yellowifh ; and when dry, it refembles a yellow flafky refin. This refm, when long kept, grows much darker in colour, and is not eafily foluble ; but when recent, or in the intermediate degrees of hardening, it mixes readily enough with water, or with fpirits.
Refpedting the other fenfible qualities of the poi¬ fons, the author obferves, that the only ones he applied to his own tongue were thofe of the cobra de capello and the katuka rekula poda. One drop of the former diluted with vrater, and quite recent, was applied to the tongue, and five minutes allowed to elapfe before the mouth was rinfed. He was not fenfible of the fmalleft degree of acrimony. After an interval of half an hour, lefs than a drop of the poifon, undiluted, was applied to the tongue with repeated fridtion. The refult was the fame as before. It ap¬ peared infipid and inert as pure water. This expe¬ riment was repeated more than once, at different times, invariably with the fame refult. The poifon of the katuka rekula poda was likewife applied, in the quantity of two drops, and perfeftly recent : but without any confequence. The other poifons were not tried.
The recent poifon of fnakes applied to the eyes of chickens, caufed no vifible irritation, nor was it fol¬ lowed by inflammation.
The
V
Ruffell’s Account of Indian Serpents. 509
The recent poifons of the cobra de capello and the katuka rekula poda, under the ufual trials, gave no indication of poffeffing either an acid or alkaline quality. The other poiions were not tried.
Two drops of the recent poifon of the katuka re¬ kula poda, diluted with four drops of fpring-water, were put into a wine-glafs, No. 1.; and fix diops of water into another glafs, No. 2. : into each glafs was then permittted to fall a teafpoonful of blood from the neck of a chicken juft decapitated. Both mix¬ tures being ftirred for five minutes, with fmall fmooth flicks, were left to fettle.
The blood in No. 1. appeared of a colour confider- ably darker than that in the other, and a clot was found adhering to the point of the flick, of a darker colour, and more grumous confidence, than ordinary. To the flick belonging to No. 2., a much fmaller clot adhered, of a brighter colour, and more loofe con- texture.
After Handing three hours the difference was more remarkable; the blood in No. 1. remained uncoagu¬ lated, and much blacker, with a little livid-coloured ferum above; in No. 2. it nearly retained its pri¬ mitive colour ; the Craflamentum was formed, and a little ferum of the ufual colour remained at top.
Upon repeating this experiment the glades were more carefully warmed, and the mixtures ftirred only one minute. Very little blood was found adhering to the flicks. The fame alteration in colour was ob- ferved as before; but the blood in No. 1. was lefs fluid than in the former experiment, though ftill much more lo than in glais No. 2.
The work is concluded by an accurate anatomical Defcription of the poifoning Organs of different Snakes, illuftrated by Engravings. For this part the author is indebted to Mr. Everard Itome.
Art.
.{ 510 )
Art. LIV. Medical Records and Ref e torches , de¬ flected from the Papers of a Private Medical AJjociation .
*
( Continued from page 47 8. )
THE third Article in the collection before us, contains an Account of a ligamentous Union of the Tibia., after the removal of a carious Portion of that Bone, by Mr. Richard Smith , Surgeon of the Briflol Infirmary. — A confiderable portion of the whole fubftance of the bone was removed by the faw. The wound granulated, and the Ikinning pro- cefs advanced rapidly, and after a month had elapfed, the patient was able to walk along the ward. In another fortnight he died of the confluent fmalhpox. The fpace between the divided ends of the bone was found filled with a tough thin ligamentous band.
IV. A Cafe of a penetrating Wound by a Bayonet pajfing through the Heart , in zvhick the Patient fur - vived the Accident upwards of nine Hours : comma - moated by W. Babington, M D. Afiiflant Phyfician to Guy’s Hofpital. — This cafe occurred in the year 1778 at Haflar Hofpital, and the particulars Were drawn up bv Dr. Lind, on the examination of the body after death. This is an extraordinary cafe in every refpe£l. Not withffan ding the great extent of the injury, as will be feen below, very few of the fymptoms occurred which ufually attend wounds of parts fo eflential to life.
The colon was twice pierced, and neither the ftools were tinged with blood, nor upon diffeClion were any feces difeovered in the cavity of the belly; although both wounds were low in the intefline, in a part from whence there would have been an eafy paflage of blood fo the anus, and where the feces are fufficiently indurated to have been rendered con-
fpicuous.
Medical Records and Refear ches. 511
fpicuous, had they been difcharged into the cavity of the belly.
The ftomaeh was twice wounded, and yet there was not any vomiting, except one flight fit when coming on (bore. The naufea indeed was conftant
The wound of the liver was above half an inch in depth, yet fcarcely yielded any blood.
The wound of the diaphragm, though nearly as large as that of the (kin, produced no diftinguifhing fymptom. Neither blood nor air efcaped through it into the cavity of the abdomen, probably from its being covered by the loofened membranes of the pericardium.
The heart received two large wounds, yet its muff cular aCtion continued regular, and the circulation was afterwards fupported for above nine hours. The wounded ventricle, upon each contraction, threw part of the blood into the pulmonary artery, and part through the wounds into the cavity of the bread; refemblinsr, in feme meafure, the circulation of a foetus, where each contraction fends only part of the blood to the lungs, the reft palling by an opening immediately from the right to the left fide of the heart ; with this difference, that in a foetus all the blood is retained in circulation, whereas in this cafe that part which palled through the wounds was thrown out of its courfe, and every contraction di- miniihed the circulating mafs. The wounds of the heart did not produce any different effeCt from the wound of a blood-veffel in any diftant part of the body; the difcharge of blood from them was even not fo quickly mortal as it generally proves from wounds of equal fize in any large veffel.
The middle and upper lobes of the lungs on the right fide were both wounded : the wound of the middle lobe was above an inch and a half in depth, and of the upper lobe about hall an inch ; yet no blood was coughed up. The paffage of the air in refpiration from the wounded lungs into the cavity of
> the
I
512 Medical Records and Researches.
the breaft was productive of much difhrefs. Each di¬ latation of the bread; drew fome air through the wounds into the cavity, and, during -the fubfequent contraction, the loofe texture of the lungs on col- lapfing acted as a valve to prevent its return. The air, thus accumulated, impeded the free motion of the lungs on that fide of the breaft, and at length wholly deftroyed it'. The difficulty of breathing was alfo in part owing to the quantity of blood difcharged into the cavity from the wounds of the heart, which, when become coiffiderable, might alone have been iufficient to produce it. To the air within the cavity ot the breaft another diftreffing fymptom is alfo to be afcribed : compreffed in expiration by the contraction of the breaft, part of the air from the cavity was con¬ stantly, in breathing, forced with violence into the wound between the ribs, where, infmuating itfelf into the cellular membrane, it .produced an emphy- fema. This firft appeared upon the bread, but after¬ ward extended over the whole body, the fkin of which crackled under the finger like dry ftraw. Not only air wras forced through the wound, but alfo a condderable quantity of blood. On differing, this was found depofited between the fibres of the pec¬ toral mufcle, and in the neighbouring cellular mem¬ brane, where it formed an ecchymofis, much larger than the wTound of the mufcle itfelf could have pro¬ duced, in which neither artery nor vein, but only a few fleihy fibres, had been wounded.
V. An Account of a Rupture of the Aorta near the Heart : by Mr. Lynn, jun. Surgeon at Woodbridge.
- — The fubjeCl of this cafe was a woman. A fudden fainting dt took place in one of her labour pains, pre¬ ceded by a momentary but acute pain in the heart. She lived a fortnight after this, but the extremities continued colder than natural, the puife was finall and quick, and uneafy fenfations were experienced in
the
Medical Records and Refear dies. 5 1 3
the ched. She died fuddenly by a fecond attack of fyncope.
VI. On the Ufe of the Tinctura Ferri Mnriati in thofe SuppreJJions of Urine which arife from a fpaf modic A ffection of the Urethra. — This communication is important, as pointing out a remedy in a very dif- treffing and fometimes fatal difeafe. We are indebt¬ ed for the difcovery of its ufe to Mr. Cline.
“ A grazier, about 35 years of age, had a tincture in the urethra during feveral years, for which bougies were occafionally ufed. He was attacked with a retention of urine, which continued nearly forty-eight hours, without his obtaining any relief, although trial was made of ail the ufuai remedies. This attack WTas foon followed by another of the fame kind, and the warm bath, opiates, clyiters, &c. were as inef- fedlual as before, the urine being never evacuated until his ftrength appeared almod exhaufted by the complaint. At other times, with the aid of bougies, he voided his urine in a favourable dream, and one of moderate fize could be palled without difficulty : but during the fpafmodic date of the lfridure neither a drop of urine palfed, nor could the dualled bougie be introduced. The return of fpafm of the urethra . became afterwards more frequent, and each time the retention of urine laded fo long as to endanger the life of the patient. From the frequency of this com¬ plaint, and its fuppofed danger, he removed to Lon¬ don, and, in a few days after his arrival, was feized with a retention of urine as before. As the common methods of treatment had no effect in this cafe, it was at once determined to try an unufual remedy, and a tobacco clyder was directed. This produced languor, a cold fweat, faintnefs, and infenlibiiity ; from which he recovered in about an hour, and foon after voided his urine without difficulty. However, in a few days he had a return of the retention, and the clyder was again propofed ; but being extremely averfe to its ufe,
on
514 Medical Records and Refe arches,
on account of the very ^liftreffing fymptoms which it had before produced, it was propofed to give him ten drops of the tinflura ferri muriati every ten minutes, until it produced fome fenfible effeft. When he had taken fix dofes of it, i. e. in an hour, he had an irritation to void his urine, and it immediately flowed freely ; although in every preceding attack the complaint had continued about forty-eight hours, ex¬ cept when the tobacco clyfter was given. He had feveral relapfes of the complaint, and was each time relieved by taking the above medicine in fimilar dofes, and became fo confident that he poffeffed a fpecific for his diforder, that he no longer felt any ap- prehenlion about its confequences.
<£ This medicine has fince been given in feveral fimilar cafes with equal fuccefs ; but in all, the com¬ plaints were purely fpafmodic. Retentions of urine trom other caufes cannot be affefted bv it.”
j
VII. Three Injlances of Ohjlruction of the Thoracic Duct , with fame Experiments , Jhezving the Effects of tying that VeJJel: by Mr. Aftley Cooper.* — The tho¬ racic du£l is a veffel of fo much confequence in the animal ceconomy, from its being the medium by which the nutritious part of the food is conveyed into the blood, and the channel through wThich the greater number of the abforbents empty themfelves into the veins, that it might be reafonably expefied an obliteration of its canal would produce the mod fatal confequences. From the fafits here adduced, however, it will be found, that nature, with a kind regard to our prefervation, has provided fecurity againft this evil, fo that a confiderable degree of difeafe may exift in the principal trunk of the ab¬ forbents without any permanent interruption to the progrefs of abforption.
In the inftances of obftruclion now defer i bed, anaftomofmg veffels were found palling between the inferior and fuperior portions of the duel, and which
ferved
#-
Medical Records and Refear ches . 515
ferved to perform the fun&ions of the original veffels. Such collateral abforbents are found in many fubje&s, in whom the thoracic du£l is undifeafed.
From feveral experiments made on dogs by tying the thoracic duft, it appears, that when this is clone fuddenly, abforption is no longer continued, and the confequences are fatal to the animal. The quantity of the chyle extravafated varied according to the hate of the ftomach and intefhnes; il thefe were diftended with food, the cellular membrane was found loaded with chyle ; but very little appeared if the animal was empty at the time of the experiment.
‘ The contractile powers of the abforbents are proved by thefe experiments to be very ftrong, for it appears that their addon is fufficient to occahon a rupture of their coats. It is true that the receptaculum chyli, which was the part broken, is thinner, and lefs capable of refinance than the thoracic duct ; yet it is able to bear the prefture of a column of quickfilver, more than two feet in height; the force, therefore, exerted by the abforbents, mult be acknowledged greater than that of fuch a column of mercury ; more
o
efpecially when it is remembered that living parts will refill a force which will readily tear them when dead.
c It is not necefiary to tie the duel, to produce this effect ; if an animal is fed with milk, and after half an hour the extremity of the duft is expofed, and com- preiTed for only a few7 minutes, upon fubfequent exa¬ mination the receptaculum will be found ruptured.
c The time at which death enfued differed in dif¬ ferent animals ; thofe which were fed juft previous to the experiment died fooner than thofe whole ftomachs were at that time empty. Young dogs lived longer than the old, and the lean much longer than the fat; for thefe laft can fupport but very flight injuries. None furvived the tenth day, nor did any of them die under forty-eight hours, unlefs there was fome un¬ toward circumftance in the experiment. I am in¬ clined.
516
Medical Records and Ref ear dies.
dined, however, to believe that dogs which are very young will live a longer time.
‘ That it is the interruption to abforption, and not limply the wound, which is the caufe of death, is proved by the inftances in which I did not fucceed in tying the dud ; the animals then recovered, though the wound was equally large as in thofe in which the experiment was fuccefsful.
4 Other terminations of the abforbents in veins have been fuppofed to exift befide thofe at the lower part of the neck on the right and left fide. This opinion has not been founded upon accurate experiment, but only conjectured by thofe wTho firft oppofed the idea of this fyftem of veffels performing the office of abforption. Formerly the red veins were fuppofed to abforb ; it was next thought that abforption was in part performed by thefe veffels, and in part by the veins ; and when this idea was obliged to be relinquiffied, it was afferted that the abforbents terminated in the veins, in various parts of the body.
4 Into this miftaken opinion fome good anatomifts have fallen, from having found quickfilver efcape from the abforbents into the different branches of the vena portarum whilft they were injeCting the ftomach and mefentery of the turtle. This has feveral times happened to myfelf ; but I believe that the abforbents arife from the veins in certain parts of the body, and that the openings by which the quickfilver enters, are the beginnings, and not the terminations, of thefe veffels.
4 As proofs of this, we may obferve that the circum- ffance is only feen in thofe animals in whom the valves of the abforbents will admit of a retrograde motion of the quickfilver, and I have never obferved it, except whilft injeCting contrary to the courie of abforption.
4 The abforbent alfo always becomes fmaller as it approaches the vein with which it communicates.
6 The branches of thefe abforbents pafs into them in a direction from the vein.
4 And
Medical Records and Refear dies. 5 1 7
. 4 as a •:-lr^iCr proof, I may mention that my friend Mr. Coleman, Profelior at the Veterinary Col- 3ege, has feveral times found blood in the thoracic duct of horfes which had died without any rupture of the blood-veflels, which (hews a direff absorption of blood under certain circumftances.
\V he n q u i c k fi 1 v e r i s th ro w n into ab fo rb e n t gla n d s , it fometimes happens that the veins are .filled from them, but this, upon attentive examination, is found to a rife from previous cxtravafation. The fame may be obferved when the abforbents of the teftes are filled from the fpermatic artery or vein.
e The experiments which are here related furnifh a powerful argument againft the idea of any other ter¬ minations of thefe vefiels, excepting thofe at. the lower pare of the neck ; for when the thoracic duct was tied, the abforbents, inftead of having emptied themfelves into veins, were many of them ruptured, and thofe which remained whole continued fully diftended with their fluid,
‘ How far do thefe experiments confirm, or con¬ tradict, the opinion which fome have entertained of a retrograde motion of the abforbents ? Should we not have found, if this idea were true, that the fluids, inftead of having ruptured the duff, when interrupted, in their proper channel, would have returned into the cavities from whence they had been removed ; and how did it happen that thole abforbents which were not ruptured remained diftended ?
* c An opinion has of late years prevailed that hunger depends lefs upon an empty ftate of the ftomach, than upon a fen fat ion of general want in the fyftem. The fymptoms of tabes myfenterica have furniflied the arguments which fupport this opinion, fince the pa¬ tient, during the progrefs of that difeafe, eats more frequently, and in larger quantities, than ufual, and although the ftomach is always diftended, there is ftill a ftrong inclination for food.
vol. v. Fp
♦
‘ The
5 1 S Medical Records and Refear ekes .
* The difeafed date of the mefenteric glands, by preventing the paffage of the chyle into the blood, has been fuppofed to occafion thefe fymptoms.
« It might be expeHed that the experiments here related, as they alfo occafioned an interruption to ab~ forption, would furnifh additional arguments in fup- port of this opinion ; but the great irritation, produced by a large wound, and by the fudden dedrubtion of fo important a function, prevented any certain conclu- fions with regard to this circumftanced
VIII. Two Cafes of Rabies Canina , in which Opium was given , without Succefs , in unufually large Quan¬ tities : the one by William Babington, M.D.; the other by William Wavell, M, D. — Thefe indances af¬ ford a further addition to the large catalogue of cafes of hydrophobia redding the mod powerful remedies. The quantity of opium adminiftered was indeed enor¬ mous. In the firft cafe, the patient fwallowed, in the courfe of fifteen hours, one hundred and eighty grains of drained opium ! It is natural to afk, what quantity of this fubdance could a fydem unaccudomed to its ufe, bear, confidently with life ?
home general remarks on the difeafe are added by Dr. Babington, but the detailed account we have lately given of Dr. Hamilton’s elaborate work on the fame fubjebi, renders it unneceffary now to be more particular.
IX. A Cafe of the C ajar e an Operation performed , and the Life of the Woman prejerved , by James Barlow, Surgeon , of Chorley, Lancalhire.— In our lad number, we accompanied Mr. Simmons in his re¬ marks on this operation, who obferved, that in this country, it had proved fatal in every indance where it had been attempted. The prefent cafe, furnifhes an exception to his datement. The woman had had feveral children born alive^, before the pelvis became
diiiorted.
Medical Records and Refearches . 519
diftorted, by the wheel of a cart palling over her as the lay on the ground.
Notwithstanding the weight of the objections which have been urged againft ever performing the Csefarean operation, there is no difficulty in conceiving the exiftence of cafes, where the life of neither mother nor child can be preferved by any other means, and where of courfe, in /peculation, it would become requifite. Its great fatality to the life of the mother, not its difficulty, conftitutes the grand objection to its employment. Every initance where it has been fafe- ly performed, fhould, therefore, be publicly recorded ; tor however terrifying by the danger which attends it, it may now and then become fully juftifiable. The piefent cafe was witnefled by Mr. Hawarden, a prac¬ titioner in the village of BJackrod, and the following is the mode of proceeding which was adopted.
c The patient being taken out of bed, and placed upon a table, lying on her back with her head raifed by pillows, I began by making a longitudinal incifion, five inches and a half in length, as high as the navel, parallel to the linea alba, and about two inches to the left of that line. The integuments and the left reCius ftiufcle being cut through, a fmall opening was made through the peritoneum at the upper part, and, by means of a probe-pointed biftory, this membrane was dilated to the fame extent as the external parts. The uterus w^as now expofed to view, and an incifion, of the fame length, was continued through it. The child prefen ted with its breech, and was extracted through the artificial opening, but unfortunately was dead, yet did not fhew any material figns of putrefaction. The placenta and membranes were then extracted with the greateft eafe. The uterus was very thin, fcarcely ex¬ ceeding that of the peritoneum, and equally fo through the whole extent of the incifion. No attempt was made to examine the pelvis from the abdominal wound. The hands of an affiftant were applied on each fide of the abdomen to prevent the admiifion ot
P p 2 external
520 Medical Records and Refe arches ,
external air, and to prefs out any blood that might b<? diffufed among the inteftines ; after which, the Tides of the wound were brought together* and fecured by feven futures, over which flips of adhef ve plafter were applied, and the drefling completed by a few turns of a flannel roller around the body.
c The peritoneum was not included in the futures, and no part of the vifcera protruded during the opera- lion ; neither were there any blood-veffels divided which required to be fecured by ligature. It was a fortunate circumftance that no haemorrhage follow¬ ed the extraClion of the placenta, as ‘was to be appre¬ hended from an atonic condition of the uterus, the effeft of long diftenfion. The womb contracted pro¬ perly, the lochia were about the ufual quantity* and continued as in other cafes. The poor woman fcarce- Jy complained during the operation, fo great was her fortitude. Soon after, fhe was put into bed, , flept without taking any medicine for that purpofe, and paffed a good night. On the 29th fhe complained of afulnefs about the region of the ftomach, with an in¬ clination to vomit ; and, on laying my hand on the abdomen, a degree of tenfion was diftinguifhable. Her tongue had a whitifh appearance, and her pulfe about 120. A laxative clyfter was adminiftered with the defired effeCt, and the tenfion of the abdomen, with the pain, yielded to the ftimulating effefts of a buffering pi after. In fhort, all the fymptoms which had before indicated irritation, now fufFered a very obvious remiflion. Four days having elapfed fince the operation, it was thought eligible to remove every other future ; on the fxth the remaining ones were taken away, and the wound appeared healed.
‘ Though flie had been a nude to her other chil¬ dren, fie experienced no uneafnefs in her breads on the prefent occafion. Her. health continued in an improving condition until December 4th, when it re¬ ceived fome interruption for a few days from a diar¬ rhoea, hut which was checked by an aftringent mix¬ ture.
52 1
Medical Records and Re] ear dies.
lure. On the 10th fhe ventured out of bed; on the 17th the began to attend to her domeflic employ¬ ment ; from which time to the prefent, September 23d, 1796 (an interval of nearly three years), fhe has continued in health, menitruated with regularity, but has never been pregnant/
We fhall go out of our way to notice the 12th Article, as it relates to the fame fubjedt : the title of it is, 6 An Inquiry concerning the true and fpurious Ctefarean Operation, in which their Diftincfions are inlifted on, principally with a View of forming a more accurate Eltimate ot Succefs ; tovwhich are annexed fome Obfervations on the Caufe of the great Danger: by John Haighton. M. D/ — Many of the cafes where fuccefs attended the operation in queftion, are fup- pofed by Dr. Haighton to have been cafes of extra- uterine conception, and which he denominates fpu¬ rious. With refpedt to the caufes on which its great fatality depends, he firft notices the opinion which refers the danger to the admiffion of the air into the cavity ot the abdomen. The mifchievous effedts of air in cavities has, of late, found an opponent in Mr. John Bell. He not only doubts the entrance of air into cavities accidentally opened, by reafon of the conftant preffure exerted on the contained parts from the mufcular parietes ; but even queftions very much, whether the mere prefence of air, fuppofing it to be admitted, can produce thofe unfavourable fymptoms ufually afcribed to it.
To determine whether the admiffion of air into cavities is really injurious. Dr. Haighton inftituted the following experiment, which was repeated various times. In many brutes the cavities ot the abdomen and tunica vaginalis teftis communicate with each other during life. He took the advantage of this anatomical fadl, and from a final! pundture made at the vag
, P p 3 were
bottom of the fcrotum, penetrating the tunica inalis, feveral cubic inches of atmofphcrical air
522
Medical Records and Refear dies.
were conveyed by a fyringe into the peritonaea! cavity of a dog. From the effects which refulted, he does not hefitate to conclude, that atmofpherical air pe¬ netrating into cavities is perfectly harmlefs, and has no influence over the confequences of the Caefarean operation.
c Surely,’ adds Dr. Haighton, c no greater caufes need be looked for than the large incifion made into the uterus, the (fometimes) hidden difcharge of blood in confiderable quantity, a great part of which often efcapes into the cavity of the abdomen, where it foon lofes the properties it poffiefied while in its veflels, and confequently produces the fymptoms of an exceflive irritation. No one, I think, will prefume to fay that wounds of the uterus are not to be ranked among the mortal ones ; and the inftances where that organ, or even the vagina, has been lacerated by an injudicious degree of force, amply prove the fufliciency of the caufe to the production of the effeCt, and which efFeCt nfually takes place before the fymptoms of an inflam¬ ed cavity have come on. It is to be regretted that this part of the danger is never likely to be averted by any human contrivance : but that part of it which depends on the extravafation of blood into the ab¬ domen may fometimes be moderated by a gentle preflure of the abdominal parietes on the anterior portion of the uterus.’
We return now to the 10th Article defcribing a Ji.ngular Cafe in Lithotomy , by R. B. Chefton, M. I),. * — The difficulty in this cafe arofe from the bladder being clofely contracted around the ftone, fo that it became impoffible to introduce the blades of the for¬ ceps between the two. Dr. Chefton kept the ex¬ ternal wound open for five weeks, in hopes that the fuppuration would fo relax the coats of the bladder, as to allow of the forceps being introduced. This, however, did not anfwer his expectations. He there¬ fore endeavoured to bring it away piecemeal, and for
Medical Records and Refearches . $2%
tliis purpofe paffed his feiftars upon his finger, and in a little time made a coniiderabie impreffion on the {tone, which, though hard upon its lurface, proved to be of a loofe texture within. Proceeding with caution in this manner, he at laft fucceeded in com¬ pletely fplitting it, and with the forceps and the nail of his finger, broke the ftone into fuch pieces, that he removed the whole by the forceps, fcoop, and fyringe.
Some years afterwards, the fame patient was cut a fecond time for the ftone, and the fame circumftances occurring, the operation was finifhed in a fimilar wayy and terminated luccefsfully.
Art. 11. contains Obfervations on the Cure of the Hvdrocele by Injection: by J. R. Farre, Surgeon.— Ten cafes are here adduced, which, however, afford nothing particularly worthy of notice. They ferve to evince the uncertainty of this operation in effe&ing a radical cure of hydrocele. The event of two of the cafes remained undecided. Of the others, three fuc¬ ceeded, and four failed, under the firft injection, but of thefe, two, on being again injefted, were cured.
It yet remains to be determined, which of the modes of operating for the radical cure of hydrocele, is, on the whole, to be preferred. That by injeftion is’ recommended by its mildnefs ; but it appears more uncertain than either of the otners. In the ufe of the injeSion, it is difficult, or impoffible to apportion the ftimulus to the particular irrnabihcv of tne part or conftitution. An injection whicn gives no pain in one cafe, will occafton great uneafinefs in another j and that whicffls fcarcely felt at the time of its in- troduaion, will often afterwards excite violent in¬ flammation. Nor is the chance of cuie in proportion to the degree of pain excited.
The laft Article contains a Cafe of imperforated Hymen, attended with uncommon Circumftances :
related ’by John Sherwen, M. D. of Enfield. -r-The
p p 4 nature
524- Rollo’s Cafes of the Diabetes Mellitus , 8Cc.
nature of this cafe was npt difcovered till the woman had reached her thirty-eighth year, and had been married fourteen years. On making an incifion in the membrane with a lancet, feveral pounds of thickened menfes were evacuated, of the colour and confidence of treacle. It does not appear whether die 'afterwards menftruated. She died after two years of another complaint, and without having been pregnant.
Art. LV. Cafes of the Diabetes Mellitus ; with the Refults of the Trials of certain Acids , and other Subftances , in the Cure of the Lues Venerea. By ]ohn Rollo, M. D. Surgeon-General Royal Ar¬ tillery. Second Edition, with large Additions. Odtavo, 628 pages, price 9s. London, 1798. Dilly.
IN our laft volume *, we gave as full an account as our limits permitted of the former edition of this valuable work. Although we then felt a difficulty in coinciding with the ingenious author in his ideas re- fpedling the proximate caufe of diabetes, we endea¬ voured to do Uriel juftice to his opinions, and to place them in fuch a point of view, that our readers might be enabled to decide for themfelves. Of his fa£ts we fully admitted the importance, and their pradlical utility. In our account of the prefent edi¬ tion, we fhall purfue the fame line of condudl, con¬ fining ourfelves, however, as might be expected, to the new matter it contains, which is both extenfive and important.
Several conliderations have induced the author to comprefs the prefent edition into one volume ; the principal of which was, that the knowledge of the
* Vide Med. and Chir. Rev, No. xx, vol. 4, p. 178.
new
Rollo’s Cafes of the Diabetes Mellitus, 8V\ 525
new method o.f treating the diabetes melhtus, and the lues venerea might be more univerfally cliftufed. With the fame view, and on account of the many recent communications refpefiting the diabetes, and the ad¬ ditional trials of the new remedies in the lues, the author has confined himfelf to theie fubjects entireiy. The obfervations which were introduced on feverai difeafes apparently ariftng from ftomach altediion, and including the application oi the new doftrines of die- miftry, as well as the delcription of a morbid poftom formed on fores, have been in the prefent work pur- pofely omitted.
Of the cafes and communications which the author has received fmce the firft: edition of the work, the firft: is furni filed by Dr. Marceft containing the con¬ tinuation of a cafe, before deicrioed, under the caie of Dr. Gregory of Edinburgh, and in which a relapfe had taken place after an interval of fome months: this patient, however, continued weak for fome time. The influence of the animal diet on the quantity of urine was as apparent the fecond time, as at fir ft, and he was difcharged apparently cured.
Two cafes of the difeafe are next given by _Dr. Gerard of Liverpool. The firft was not materially relieved by the animal diet, though ^conjoined with the ufe of the hepatized ammonia. The carbonated ammonia was next tried in very large dofes, (part of the time daily) and continued for feverai months, but without effect. The patient did not aoneie pro¬ perly to the plan of diet. The fecond cafe was re¬ lieved by the animal diet, but the general health was not perfectly reftored.
Dr. C leghorn of Glafgow adduces four cafes cured according to Dr. Rollo’s plan. Thefe cafes, with fome others, feern to fnew, that a' tendency to in¬ flammation fucceeds the cure oi diabetes by animal.
food.
Dr.
526 Rollo’s Cafes of the Diabetes Meliitns , 8fe.
Dr. Storer of Nottingham has feen feven acute cafes of the difeafe, previous to the publication of the new method of treating it •> and all of them terminated fatally. He takes notice of a mild or chronic fpecies pf the complaint, which is frequently found prevail¬ ing in the different members of the fame family.-^- Several other cafes are given, by different practi¬ tioners, where the influence of the animal diet on the f ate of the urine was very evident.
Three cafes of the difeafe are next related by Dr. Pearfon. In the firft of thefe, the quantity of urine did not exceed nine pints in the twenty-four hours, and was not materially influenced by the quantity of liquids taken in. The appetite was not greater than in health. Befides the ordinary remedies, the fol¬ lowing were ufed, but without advantage. Thirty grains of carbonate of foda were given thrice daily. Twenty to thirty drops of the oil of turpentine three times a day. Two grains of calomel were given daily for two months, without affedfing the mouth or bowels. Daftly, perpetual blitters were kept on the loins. This cafe exifted prior to the difperfion of Dr. Rollo’s obfervations. On diffeftion after death, the kidneys and ureters were in a found (fate, but the bladder was much thickened, and the urethra dilated to three or four times its ufual fize. There was no mark of difeafe in the thorax or abdomen, excepting that the mefentery was much thickened, although the glands of it were not at all difeafed.
The fecond cafe likewife proved fatal, but it took place feveral years back. In the third cafe, the urine was not perceptibly fweet, but fmelt like hale beer, and took on the acetous fermentation after ftanding feme days. In other properties, the urine of this patient agreed with that of people in health, in de¬ poll ting cryflals of uric oxide*, in containing fuper-
* See an account, of the nature of this fubltance in page 304 in the prelent volume of the Med. and Chir. Rev.
phofphate
RalloVl7q/& of the Diabetes Mellitus , 8('c, 527
phofphate of lime, phofphate of ammoniac, muriate of foda, &c.
The patient was direffed to live four days entirely on vegetable food. The urine during this time proved fo irritating to the urethra and glans penis, as to in¬ flame them, and a little of it was even palled invo¬ luntarily. The urine excreted at this time contained none of the uric oxide ; but, according to Dr. Pear- fon’s obfervations, the urine voided, when the food was entirely animal, was equally acefcent, and fer- mentible into vinegar, as when it was entirely vege¬ table matter. The quantity of urine in this cafe did not exceed five or fix pints in twenty-four hours, and never was greater than the quantity drank. When vegetable fubftances were occafionally taken as food, the urine was increafed in quantity, but no effects were otherwife experienced different from thofe dur¬ ing the ufe of animal food.
Dr. Pearfon’s remarks on this and the former cafes, and on the difeafe in general, are ingenious and in- ierefting. They lead to conclulions different in many refpeffs from thofe which Dr. Rollo has deduced from his faffs. ‘ As in the malady above defcribedf Dr. Pearfon obferves, (alluding to the cafe laft re¬ cited,) c the urine was not in greater quantity than the drink ; as it was not in fo great quantity as is ex¬ pected to be difcharged in diabetes ; as it had feldom a fweet tafte, I am aware the propriety of calling the prefent dilfemper diabetes will not be acknowledged by many perfons without hefitation. The confidera- tions which induce me to conceive this to be an in- ffance of that diforder are, Iff. the great appetite for food ; the conffant thirlf for fo long a time 5 the eonftantly unputrefcible, fometimes faccharine urine, and which was frequently fufceptible of the acetous fermentation 3 the quantity of urine being much more than that of rnoft healthy perfons; and the gradual emaciation. From the great quantity of feemingly affimilable, or nutritious matter daily carried off with
•the
528 RqIJo’s Cafes of the Diabetes Mellitus , Cc.
the urine; which either contained . fugar, (although not, in general, perceivable by the take,) or matter fufceptible of the acetous fermentation ; and from other fymptoms, it feems reafonable to conjecture that the diabetes in this, and other fimilar inflances, con- fids in deficient powers of the organs of affimflatiori. According to this notion, diabetes may take place without the quantity of urine being nece hardy greater than in health, and the prefence of fugar perceptible by the take may be confidered only as cafual. Hence alfo, fuch a difeafe may probably take place much more frequently than has been hitherto noticed ; and fuch are, probably, many inflances of atrophy, or confumption, which occur without any known local affection, in which the urine may be loaded with nutritious matter, as in the prefent inftance.
‘ It is plain, from thefe remarks, that 1 feelbnclin- ed to adopt, for the prefent, the theory you have fo ingenioufly framed, and fo well fupported by faffs ; namely, that diabetes is not effentially a difeafe of the urinary organs themfelves, but of the organs of digeflion ; although you may not think as I do, that the feat is not in the flomach, but in parts lefs remote from thofe in which afiimila-tion of nutritious matter takes place.
* Saccharine matter is not the immediate caufe of diabetes, but the effeCt of this difeafe ; and if animal food is beneficial, and vegetable food is detrimental, it cannot, I think, be fhewn, that it is becaufe the former does not afford fugar and the latter does.
( In fupport of your theory, that the diabetes is not feated in the kidneys, it may be afferted, 1. That the kidneys do not appear to be fecretory . organs, or organs which compound matters of a different kind from thofe which enter into them from the blood ; for excepting, perhaps, the fe ere ted mucus from the urinary paffages, there is nothing in urine that does not exift in the fame flate of comnofition in the blood
A
itfelf. The water and faline fubftanecs are all con¬ tained
i
RqIIo’s Cafes of the Diabetes Mellitus , 8(c. 529
tained in the blood, and the mucilage of the urine teems to be the recrementitious part of the blood, mixed with fecrcted mucus of the urinary paffages. The facility, and even rapidity, with which liquids, containing various impregnating ingredients, may be tranfmitted through the fanguiferous fyitem and kid¬ neys fhew, that the kidneys are rather to be confider- ed as feparating than jeer ding organs.
c 2. From the great relief experienced on taking a large quantity of mucilage in irritations irorfi the urine, in various complaints of the urinary paffages, it has been fuppofed the mucilage paffes indigefted to thofe parts.
* It has been objected to this theory, that fugar could not be detected in the blood of patients, whole urine evidently contained it, and, confequently, that it muff have been compounded in the kidneys ; but the tell employed, namely, the take, does not appear adequate to the detection of the fubftance fought for, and that on two accounts. 1ft. Becaufe of its diffu- fion through fo large a proportion of liquid. 2dly. Becaufe the take of the fugar may be obfeured by its intimate mixture with a variety ot falts and mucilages of the blood. And for thefe reafons alfo, fugar may be prefent in the urine, and not be perceivable by the take, but yet it may prevent putrefaction, or render fuch urine fulceptible of the acetous fermentation. It is well known that ale and other malt liquors, which are vapid, and not at all fweet, by keeping in bottles, in a due temperature, will again ferment, fo as to be inebriating from the alcohol, and extremely acidulous from the great quantity of carbonic acid, compound¬ ed. Thefe vapid liquors rrmk, therefore, have con¬ tained either fugar, or matter capable of becoming fugar.
c I underhand alfo that you have made the expe¬ riment of diffolving fugar in ferurn of blood, and, as was to be expecled, found that a certain quantity mav be contained in it, and not be perceptible to the
4 , i take ;
530 Rollers Cafes of the Diabetes Mellitus, S(c,
tafte ; but, like other extraneous matters in the blood, this quantity, when feparated by the kidneys, may be infufficient to give a fweet tafte to the urine. It has been attefted by perfons whofe ftatements cannot be doubted* that the blood has, in fome inftances of dia¬ betes, tafted fweet, and that it had other properties denoting fugar. A Angle pofttive evidence of this fort ought not to be reje&ed by any number of ne¬ gative ones. But, in fhort, blood and urine to moft perfons’ tafte is commonly fomewhat fweet ; and there* fore, it feems not improbable, that there is in general, fugar both in the blood and urine of all animals at certain times. It is not doubted that the fweetnefs of chyle, and of milk, is from fugar. It feems alfo that the digeftive and affimilating organs of animals \compound fugar from merely animal, as well as ve¬ getable aliment; as appears on examining the chyle and milk of animals which live entirely on animal food ; namely, either thofe which are purpofely fed, or which are naturally carnivorous. It does not feem that the fluids of animals which feed on faccharine matters, contain more fugar than thofe which feed on animal fubftances. Vegetables manured with mere¬ ly animal matter contain as much fugar in their fluids as when manured with vegetable matter, or probably with fugar itfelf. But fugar can alfo be compounded by fermentation, without the aid of live powers, from dead animal matter and taftelefs farina. Thefe fa£fs, it may be proper to notice, feem to juftify the obfer- vation above made, that, on a theoretical ground, v/e might conclude that animal food was not likely to be either more beneficial, or lefs hurtful, than vegetable.
4 In this place it will be proper to point out, that fermentation is a more delicate criterion of the pre¬ fence of fugar in urine than the tafte ; for the urine of the above patient did not tafte fweet, but it fer¬ mented into acetous acid.
c 3. As great a variety in the appearances of urine obferved as in the alvine excrements, but in fluids
fecreted
Rollo’s Cafes of the Diabetes Mellitus, Kc. 531
fecreted by glands, fuch great differences are not ob¬ served. Hence the urine has been juftly called the feces of the blood. In diabetic diforders fome ob- fervers have attelled that the urine made a few hours after a meal had a chylous appearance.
c 4. Various other matters befides fugar may be contained in the blood of certain perfons, and not be perceived by the tafte, or other fenfes, nor even by chemical tells, but which are very evident to the fenfes, or to chemical tells, in the urine of fuch perfons. I fhall mention a few inftances.
c The odorous matter of afparagus was not per¬ ceived in the blood at the fame time that the urine fmelled lirongly of it. I have adminillered oil of tur¬ pentine to feveral patients in fuch quantities, that the urine of all of them was lirongly impregnated, but in the blood of one of thefe only could it be perceived by the fin ell. I have very often adminillered car¬ bonate of potalh, and foda, alkalies in fuch quan¬ tities, that the urine effervefced with acids 3 and I precipitated from urine, containing potalh alkali, fupertartrite of potalh, on adding tartareous acid. In one trial I adminillered 800 grains of carbonate of potalh in water, fuperfaturated with carbonic acid, between the hours of ten o'clock at night and two the following day in the afternoon. Blood was drawn at twelve on that day, and at which time urine was excreted impregnated with alkali, as juft mentioned, but not a trace of this fait could bt? detected irr fhe ferum by the tefts of violet juice, and of turmeric.
‘ Nitrate of potalh has been given in large quan¬ tities, but it could not be traced in the blood, although it was readily detefled in the urine.
‘ 5. If the diabetes be effentially an organic dif- eafe of the kidneys, one might expeft to fee always fuch a difeafed Hate on diffeflion ; which, however, could not be perceived in Laurie’s cafe above related. There are alfo diffe6tions publifned by various per¬ fons, in a few of which only was any difeafe feen in
the
532 Kollo's Cafes of the Diabetes Me Hi tus, & fc.
the kidneys ; nor are there, in general, any complaints of the loins, urinary paffages, hips, &c. in diabetic cafes. Wherefore, if organic affe&ion takes place, it fhould be confidered as an accidental attendant, or confequence ; and in this light fhould be regarded the difeafed date of the liver, fpleen, lungs, & c. obferved in fome inftances. At the mod, fuch organic difeafe can only be confidered as productive of one fpecies of diabetes, in which, on examination, it is probable the urine will be found to be very different from that in the other fpecies of this difeafe.
4 The date of the mefentery diould be more accu¬ rately attended to on diffe&ion of diabetic patients. In Laurie’s cafe above defcribed, it was obferved to be difeafed, but I was not prepared at that time for examination of this part* with a view to any theory. The urine ought alfo to be examined after the death of the patient, as well as while alive. In fome cafes, as the appetite fails, the urine diminifhes in quantity, and Jofes its fweetnefs a diort time before death.
4 The theory that diabetes is a difeafed date of the afdqailatory organs, accounts for fome of its mod cha- ra fieri die fymptoms ; namely, for the urine containing lugar and other nutritious matters, the wading of the fiefh, frequent difeharges of urine, third, hunger, weaknefs of the organs of voluntary action, &c. but it does not account tor the quantity of urine much exceeding the quantity of drink. In fome indances, the excels may be accounted for by reckoning the quantity of water contained in the folid food, and which amounts to much more than has been ufually calculated, or conceived. But in other cafes, taking the water contained in fuch food into the reckoning, is not fufficient to account for the quantity of urine ; and in inch cafes fome addition may, on reafonable grounds, be confidered to be made by the wade of the conditlition of the patient. Water may alfo be compounded in the blood- vedels, or other vedels ; the conftituent .parts of it exibing in all the fluid and
folid
Rollo’s Cafes of the Diabetes Mellitus, SCc. 533
folid parts of the animal ceconomy ; but that fuch a procefs goes forward is a mere hypothefis ; and granting that in reality there is fuch a procefs, the fupply of a large quantity of water by means of it cannot long continue, without fymptoms of difeafe appearing.
c In fome instances the quantity of urine is much sweater than can be accounted for from all thefe fources
o
united. Cafes are recorded in which twenty-five to thirty* and more pints, were difcharged in the fpace of a natural day for many fucceffive weeks, and even months; and in which the whole ingefta, as was (aid, did not amount to half the weight of the urine. The evidences for fuch cafes are fo numerous and refpeclable, that we cannot refufe to admit them j but, I confefs, it does not appear to me that the quantities of drink have been fairly, calculated ; and if they had been fo* it feems probable that the urine would not have fo greatly exceeded the quantity of liquids fwallowed, nor would birth have been given to feveral hypothetical and analogical explanations of the1 fuppofed fuperabundant quantity of water dif¬ charged to that of the drink. The explanation that water is abforbed by the Ikin from the air has been very generally accepted ; but this has no better fup- port than the analogy of the deliquefcence of certain Tilts ; and no experiments have demonfirated that water is abforbed from the air by the furface of the body. Another hypothefis,- which has great ingenuity to recommend it, is, that an extraordinary quantity of water is compounded in the lungs themfelves. I do not know the faffs which countenance fuch a con¬ jecture : nor, in the fir It place, am I able to conceive that the procefs of the compofition of water can go forward in the lungs to fo great an amount* without any fymptoms of it making their appearance in the pulmonic fyftem. 2dly. Granting that in twenty- four hours there is an augmentation of more than eight pounds of oxygen gas infpired, which there vol. v. Qq muft
534 Rollo's Cafes of the Diabetes Mellitus,
r£Liift be to compound ten pounds of water, (where that quantity is to be accounted for) and fuppofing the ingefta to be able to furnifh two ppunds of hy¬ drogen, is it confident that fo large a quantity of oxygen gas can part with its caloric wdthout a very extraordinary increafe of the temperature of the ani¬ mal oeconomy ? Or, indeed, be feparated Confiftently with life ?*
The next cafe is furnifhed by Dr, Marfhgll. It occurred feveral years ago, and is given from memory only. On difleCtion, the kidneys were found of a chocolate colour, enlarged, and flaccid.— A cafe is related by Dr. Willan, which was greatly relieved by the animal diet.
The laft cafe is given by Mr. Leigh Thomas, Sur¬ geon, of London. In this cafe, the animal diet wab found to remove entirely the fweetnefs of the urine. The urine voided in this cafe was frequently four. Different vegetable matters feemed to have very dif¬ ferent effeCts in increafing the quantity of urine.— Bread was raoft powerful in this refpeCL Parfnips, it is faid, were eaten with impunity. The blood was examined at different times. Once only the ferum had a turbid wheyifh appearance*: the nicefl tefts could not difeover any thing of a faccharine quality. The rnafs of blood, on drying in the open air, did not go into putrefaction. This cafe termi¬ nated fatally, and the body was accurately examined after death. The immediate caufe of death w7as pul¬ monic affeftion ; of courfe confiderable marks of dif- eafe were found in the thorax. The ftomach, with its coats, appeared unchanged, except upon its in¬ ternal furface, where inflamed patches were found, as well as in different parts of the alimentary canal, through its w7hole courfe. This appearance, the author obferves, may have been produced by the aftion of repeated violent cathartics, that were taken two days before, to remove an obftruciion in the
bowels
Rollo’s Cafes of the Diabetes Melliiusy & V. 535
bowels of a week’s Handing. The kidneys were rather fmaller than common, and firm as in health. Upon the under furface of the right kidney, a fmall collection of pus was found, but too trifling, Mr. Thomas thinks, to have interfered with the fecretory funClion of the gland. On cutting through the ,fub- ftance of one of the kidneys, it appeared redder than ufual, which led Mr. Cruickfhank to conclude that there was more than the common determination of blood to this organ.
Dr, Rollo next gives a concife narration of what has been hitherto advanced by authors, refpeCting the Diabetes Mellitus : the fum of which we have already given*.
The next Chapter contains a general View of the Hiflory, Nature, and appropriate Treatment of the Difeafe.
In Chapter 5th, Dr. Rollo endeavours to anfwer the objections which have been made to his doCtrine, and recapitulates the principal arguments in its fup- port.
The firft objection is, that faccharine matter has not been detected in the bloody or in the ft omach. lo this it is replied, that it is difficult to afcertain the exaCt period in the procefs of digeftion when this change may be looked for, and therefore an emetic might fail in affording the neceffary contents. With refpeCt to the blood, Dr. Dobfon affirmed the ex~ iftence of faccharine matter in diabetic blood. In feveral initances, the ferum was turbid and wheyifh, and it did not, on (landing, undergo the ufual cnanges of animal matter. Several experiments are adduced by the author, where different portions of fijgar were added to the ferum of the blood. From thefe the following inferences are deduced :
'fs
* Vol. 4, p. xS 5,
Qq 2 "iff, That;
536 Rollo’s Cafes of the Diabetes Mellitus, tfe.
e lit. That fugar, and the pureft diabetic ext raft may be contained in the ferum of the blood, without being detefted by the tafte ; that with a certain quan¬ tity of the former it goes through fermentative changes ; and that it is probable, in two or three ounces of diabetic ferum from blqod taken at a proper time after eating, the faccharine matter might be ob¬ tained.
c 2dly. That a given quantity of dried blood from which the ferum had been feparated, probably yields, when treated with nitrous acid, a larger quantity of oxalic acid, than an equal quantity of diabetic blood. This refult might have been expected; for, as fugar, or certain parts of it, forms a conftituen.t part of an animal body, and not being applied in the diabetes mellitus, there mull be a watte of it. This is further confirmed by dbferving that in Experiment N, the proportion of oxalic acid was greater than in Ex¬ periment O. In N, the blood was drawn in Sep¬ tember, whereas in O, it. was drawn in the following November; of courfe, the continuance of the difeafe
occalioned the deficiency found in O. The nitrous
*
acid not being fo pure in the one experiment as in the other, might have produced a difference in the refult ; but which could only have been trifling, as there is only a difference of 14 grains between the twro healthy refults.
c 3dly. That in diabetic blood, dried with its ferum, more oxalic acid w^as obtained, than in healthy blood, from which the ferum had been feparated ; therefore it may be fuppofed, that the excels in diabetic blood was obtained from the fugar which had been in its ferum.
c 4thly. That there is probably more iron in dia¬ betic blood than in healthy.
5thly. That the ferum of blood contains lefs of the bafe of oxalic acid than the craffamentum ; and that the ferum of blood, with the addition of fugar, will
be
Rollo's Cafes of the Diabetes Mellitus , Sic. 537
be found to contain a proportional increafe ; there¬ fore, faccharine matter may be detefted.
. c bthly. That certain fubdances, as fugar, oak bark, nitre, oxygenated muriate of potafh, &c. taken into the ftomach, may pafs off undecompofed by the kid¬ neys, and can be detefted in the urine. The domach, however, in time, feems to acquire the power of de¬ composing them, which may depend, in fome cafes, on a healthy, and in others on a morbid date. This is a fubjeft in its infancy.
f The kidneys being merely separating organs, removing excrementitious, extraneous, or unaffi'milated bodies, are very readily a£Ied upon, and Ipeedily remove the injurious matter. It is fuppofed that the renal veffels receive an eighth of the blood of the whole body at a time. If fuch be the fact, inde¬ pendently of any peculiar Stimulus, it may be con¬ ceived how very quickly the ferum may lofe any fugar, or other extraneous body, it may hold in folution, or otherwife ; efpecially when we confider that the fugar in diabetes is not conftantly fupplied, as it depends entirely on the quality and quantity of the food taken into the domacb, which mud be interruptedly. We ftiould not probably deteft bile in the ferum of the blood in jaundice, at lead not fo fenfibly, if the bile was not unceabngly applied by the fecretion of the liver. Beddes, if arterial blood contains more of the watery part than the renal, the former may lofe the greated part of the fuperabundance by the kidneys, and with it any extraneous body, as fugar, &c. It feems to be a law of the animal ceconomy, that whatever is net affimilated during the procefs of digedion, is carried off by the kidneys, or other out¬ lets, and that very quickly. This is a meafure of necedity ; for example, were the faccharine matter allowed to remain difen gaged in the blood, and to circulate in the fydem, it would foon, by the opera¬ tion of fuch a dimulus, condantly applied to the heart, &c. dedroy the animal. Thefe remarks fliew
Qq 3 the
i
538. Rollo’s Cafes of the Diabetes Mellitus , <$fc.
the great difficulty of detecting fugar in diabetic ferum.’
The fecond objection which has been made to the ’ new doctrine is : that the difeafe often Jhexos fymptoms of fyjfpepfy, or weahnefs of digeftion . To this the author anfwers, that the increafed aCtion of the ftomach is of a morbid kind, and connected with debility : being, therefore, irregular and imperfect, it does not accomplifh digeftion.
3d. Objection. That the fiomach affection may be fympathetic of difeafecl kidney , from the intimate confent fub fif ing between both*. To this Dr. Rollo replies, that the fiomach affections which exift in dia¬ betes are entirely different from thofe which take place in confequence of primary morbid conditions of the kidney. Befides, he obferves, that moil cafes of the difeafe have been preceded by ftomach de¬ rangement, or have been produced by caufes imme¬ diately operating on the fiomach.
4th. Objection. That the kidneys are capable of forming or fecreting faccharinc matter under a pe¬ culiar action , fimilar to the breafts of women . Here the author obferves, that the kidneys are not fecreting organs, but feparating only, and that a much greater change in their ftruCture than has ever been found rauft take place, before they could become capable of fecreting faccharine matter. In fome infiances of diabetes, the ftruCture of the kidneys has not been vifibly changed.
Dr. Rollo then ftates concifely the principal argu¬ ments in fupport of his doCtrine. Thefe are
111. The faCt, that a ftomach affeCtion generally precedes the urinary charaCteriftic fymptoms of the difeafe.
* This objection appeared to us of confiderable weight. Fide page
191 of our laft volume.
‘ 2dly. The
I
Rollo’s Cafes of the Diabetes Mellitus , 8 (c. 539
-dly. The fa£t, that a ilomach affeQion always attends the difeafe, which materially differs from that fympathetic of primary kidney affection.
3dly. The fa£t, that a diet of animal food, with an entire abftinence from vegetable, or other matter ca¬ pable of forming fugar in the ftomach, removes fpeed- ily the general fymptoms, the faccharine matter, the quantity of the urine, and its unnatural ftate.
4thly. The faft, that diffedfion has (hewn no mor¬ bid condition of the kidneys, but what may be re¬ ferable to a continuance of increafed aftion from the application of a limple ftimulus, and probably fym- pathy, augmenting merely the capacity of their vef- fels. The firft cafe of Dr. Pearfon, and the cafe of Mr. Thomas, exhibited no difeafe of the kidneys whatever.
The next Chapter is occupied by the ingenious Experiments of Mr. Cruickfhank on Urine and Sugar, From thefe trials there feems reafon to conclude, that different difeafes produce different changes in the ftate of the urine, and that the diagnofis may hence receive confiderable illuftration. But the fubjeft is new, and we have not room to be more particular at prefent. — • Of the experiments on the nature of fugar, mucilage, &c. we have already given a particular account*.
In addition to the number of cafes of Lues Ve¬ nerea treated by the new remedies, of which an ac¬ count was given in the former edition, feventy-eight are now brought forward ; viz. twenty-eight by the nitrous acid ; three by the oxygenated muriate of manganefe $ twenty-eight by the oxygenated muriate of potafh ; and twenty by the nitrous acid and oxy¬ genated muriate of potafh alternately, but without any particular order. Molt of thefe have entirely
* Vide Med, and Chir. Rev. vol. 4, page 189 =
Q q 4
yielded
.0
540 Rollo’s Cafes of the Diabetes Mellitus, 8Cc.
yielded to the new method of treatment, and all of them afford fufficient evidence of its powers.
The volume concludes by the following Remarks of Mr. Cruickfhank on the Effects of the new Remedies in the Lues Venerea. c Eighteen months have now e lap fed/ he obferves, 4 fince the firft cafes treated by thefe remedies have been mired; and of the firft feventeen, which were more immediately under our own management, not one has relapfed, nor have the fecondary fyrnptoms made their ap¬ pearance in a fingle initance. 1 hat the difeafe has been completely eradicated can therefore admit of no doubt.
c In our firft trials we confined ourfelves, in a great meafure, to primary affections ; but for fome time paft no diftin&ion has been made, and the fecondary as well as primary fyrnptoms have been all treated by the fame plan.
4 The total number which have now been cured, in the Hofpital, fince the beginning of March, 1797, amounts to one hundred and fifty-five, as will appear from the table ; of thefe thirteen bad the fecondary fyrnptoms of the difeafe. This fmall number of fe¬ condary cafes proves, in a great meafure, the cer¬ tainty and efficacy of this mode of treatment; for as Dr. Wittman employed thefe remedies in all venereal affections, whatever their nature might be, had the cures not been perfect, the fecondary difeafe mu ft have been very common ; befides, of the thirteen, .three only could be afcnbed to this caufe, and thefe were all afterwards cured by the oxygenated muriate ofpotafh. Of the/ remaining ten, four appeared to be the natural confequence and progrefs ot the clib eafe, and fix followed a courfe of mercury.
c The cafes of Lijhman and Chriftly are, in our opinion, particularly valuable, as neither of them, it would feem, had continued the medicines for a fuf¬ ficient length of time, and in both, the fecondary fyrnptoms made their appearance, but were afterwards
completely
1
Iloilo’s Cafes of the Diabetes Mellitus, Sic. 541
f r -
completely removed by perfevering in the fame mode of treatment. Could mercury have done more ? We would recommend thefe cafes, with thofe of Kel/t, Johnfon, Donally , and Bofworth , to the ferious con- fid era tion of all the advocates for mercury, and would alk them, at the fame time, how many cafes of fecon- dary difeafe might one hundred and fifty-five of the above defcription, treated in the ufual way, have afforded ?
£ Upon the whole, we are confident, that fewer troublelome buboes have been met with, than ufually occur under the mercurial treatment, and none of them have fpread and ulcerated in the dreadful manner, which too often happens under that remedy.
< In a few’ inftances glandular fwellings have made their appearance, but thefe have been rare, and pro¬ bably were not altogether owing to the medicines.
c There are fome fa&s refpe&ing thefe remedies, more particularly the oxygenated muriate of potafli, which deferve to be noticed anci attended to.
< In the firft place, it fometimes happens, that in certain conftitutions, the oxygenated muriate^ paffes off by urine undecompofed, and produces but little or no effedi, either on the difeafe, or conftitution, much in the fame way as mercury runs off by the bowels, in thefe cafes the patients generally complain of heat of urine, which they void frequently, and in large quantities; whenever, therefore, fuch fymptorns oc¬ cur, the urine fhould be examined by evaporating, and’ then feparating the faline from the extractive matter by fpirits of wine and repeated cryftallization. This being done, the oxygenated fait may readily be detected, °by the figure of the cryftals, and by its de¬ tonating when thrown upon red hot coals. In order to remedy this deleft, we have propofed, that cacu clofe of the fait fhould be immediately followed by ten or fifteen drops of fome acid, diluted with water; and for this purpofe the muriatic has been preferred,
although tbe nitrous might anfwer equally well, as . * either
542 Rollo’s Cafes of the Diabetes Mellitus , Sc.
either of them decompofes the oxygenated muriate a Atxi gi eat^ facility. This inconvenience is generally met with in fciophulous conflitutions, where the ex- traftive matter in the urine is naturally hut fmall, or where the medicine has been given in very la7°-e dofes,^ as thirty grains or more four times a day,°a quantity, however, which we believe to be very fel- dom neceffary. It may be remarked that, in our full cafes, we commenced with very fmall dofes, as four or five grams, but are now fatisfied that ten or fifteen
*"ipi * ^ • s-m limes a day at the very beginnin°,‘
I his quantity lhould be gradually increafed to twenty- hve, or at moil: to thirty grains, according to circum- rances; and whenever we iufpect, from the want of action on the fyftem or difeafe, that it is not decom- Poi_ed, it ought immediately to be joined with an acid,
effba ^eidom or never ms of having the delired
\ Another circumftance meriting attention, and •which not unfrequently follows the ufe of thefe re¬ medies, more particularly the oxygenated muriate of potafli, is an eruption on the flcin of a dull red colour not very unlike venereal blotches. They may, how¬ ever, be difhnguiflied from thefe by the floridnefs of die .colour, the itching with which they are accom¬ panied, and their disappearing without throwing off IciaJes, or leaving any livid or copper coloured marks, inele fpots never made their appearance but when the patients were under the full aftion of the me¬ dicine, ana generally went off in two or three weeks under a continuance of the fame treatment.
In one in fiance, where mercury had been riven horn the beginning, and very freely, alonr with the oxygenated muriate, the body was at one time co¬ hered with them, and they difappeared about the iiiual period. This in a great meafure proves that they are not venereal.
* A third obfervation which we would make re¬ jecting thefe remedies is, that they have always
4 ' aQed
Rollers Cafes of the Diabetes Mellitus , Sic. 543
a£i:ed with the greateft certainty, and quicknefs, where the fyftem has been reduced. This would feem to point out the propriety of evacuations, more especially by blood-letting, in all full and robuft ha¬ bits, previous to their exhibition. In confirmation of this, we may obferve, that in every inttance where thefe have been employed, the practice has been at¬ tended with manifefl advantage.
c Since our firft publication, in July, 1797, we have only tried one rlew preparation, viz. the black folution of manganefe in the muriatic acid. This was given in four cafes with fuccefs, but being difagreeable, and not apparently poffeffing any fuperior advantages, it has not been perfevered in.
c Of the different remedies employed, we formerly gave the preference to the oxygenated muriate of potaffi, and we are now more convinced of its fupe- riority ; for there have been many cafes where it has fucceeded much better than the nitrous acid.
‘ We were naturally led to fuppofe, that a combi¬ nation of thefe remedies with mercury would be more efficacious and certain than either alone ; or, at leaf!, that much lefs mercury might be neceffary. Accord¬ ingly, about thirteen cafes were treated in this way, but the refult did not altogether anfwer our expecta¬ tions ; for although a few of the cures were accom- pliffied in a very fhort time, the greater part proved rather tedious. There have been, indeed, a few in- ftances, where, after the conlfitution had for fome time been fully under the aCtion of the new remedies, mercury has been given ; and in thefe it appeared to have completed a cure very quickly. It is poffible that this may be the moft advantageous mode of combination.
c We do not prefume to account for the numerous failures which have been recorded, but fufpecd that they are to be aferibed either to fome irregularity, or impropriety in the adminillration of the remedies, or to a want of perfeverance and lteadinefs in the prac¬ titioner
544 Pearfon's Inquiry into the Cow-Pox .
titioner or patient. It is aEo proper to remark, that in thefe failures the remedies were too feldom varied, fo that when one did not anfvver immediately, it was dropped, and mercury had recourfe to. Now we are confident that much of our uniform fuccefs has been owing to the method which was very early adopted, of changing the preparation whenever it feemed to produce no further effeci on the difeafe or conftitu- tion. In this way a number of cures were quickly obtained by the oxygenated muriate of potafh, where the nitrous acid, &c. had not fo immediately fee- ceeded.
c We fhali conclude thefe remarks with obferving, that one of the two following pofitions mud be ad¬ mitted— Either thefe remedies cure the lues venerea, or, in ninety-nine cafes out of a hundred, the difeafe cures itfelf. Our opponents may take which fide they choofe ; for on either fuppofition, mercury rnuft be unneceffary, and this is our principal objedtf
Art. LVI. An Inquiry concerning the Ilijiory of the Cow-Pox, principally with a View to Juperfede and extinguijh the Small-Pox . By George Pear¬ son, M. I). Phyjician to St. George's Hofpital. Oftavo, 116 pages, price Ss. 6d. London, 1798, Johnson.
DR. PEARSON's object in the prefent publi¬ cation is, to examine the evidence of the prin¬ cipal faffs which Dr. Jenner has adduced in his late Treatife on the Cow-Pox*; and to hate the further information which he has derived from his own ex¬ perience, or from the communications of other pro- feffional men. ' „
Vide page 236 of the prefent volume.
V
N
545
Pearfon’s Inquiry into the Cow-Pox.
Dr. Pearfon arranges his matter under different heads, and the firft objedt of his inquiry is, c how far perfons who have undergone the fpecific Fever, and local Difeafe, occafioned by the Cow-pox In- fedtion, communicated in the accidental way, are thereby rendered unfufceptible of the Small-Pox.’ — Refpedfing this point, the author obferves, that the body of evidence is numerous and refpedtable, in proof of a perfon who has laboured under the cow- pox fever, and local eruption, not being fufceptible of the fmali-pox ; and it does not appear that a Angle well-authenticated contravening inftance has fallen under observation. Dr. Pearfon is aware, however, that this fact will not, by all, be considered as irrefra- gably eftabliffied : yet admitting it as true, its ufeful- nefs in practice, as a fubftitute for the fmall-pox, muff depend on a 'comparifon of its effedls, as to its degree of danger, its duration, and fubfequent effedls on the constitution.
No one, hitherto, has fallen a vidtim to the cow- pox : but this argument in its favour is not con¬ clusive, from the want of a Sufficient number of in- ftances to build our judgment on. With regard to the nature and degree of the Symptoms, . and their fubfequent effedls, in comparifon with the inoculated fmall-pox, the fadls refpefting cow-pox are certainly too few, to form a Satisfactory conclufion.
The cow-pox by inoculation fee ms to be little, if at all, different from the difeafe when cafually caught: nor is the former fo mild in comparifon with the latter, as we find to take place in the fmall-pox.
It appears from fome of Dr. Jenner’s cafes, that the poifon of the cow pox has the fame properties, whether it be generated by the cow, or by the human animal ; and thefe properties are the fame, however remote from the origin in the cow. But it^has not been determined by experiment, that the properties of the poifon, when taken from the human fubjeft, '
are
546 Pearfoffls Inquiry into the Cow-Fox..
1 t
are the fame with regard to the brute* as thofe of the matter from the cow.
It has been laid by feveral, that perfons having been once affefted with the fpecilic fever and local difeafe of the cow-pox, is liable to be again afte£ted as be¬ fore by the fame poifon ; and yet fuch perfon is not fufeeptible of the fmall-pox. Others have denied the truth of this pofition, but on no other grounds, than that it is not lupported by analogy. The evidence* in Dr. Pearfon’s opinion, only proves fatisfa£torily, that the local affection of the cow-pox may occur in the fame perfon more than once ; but whether the peculiar fever alfo occurs more than once, is not fo certain.
It feems fufficiently authenticated, the author ob~ ferves, that people may have the cow-pox after they have had the fmall-pox, though fome have denied this. But it is hardly determined, whether, in fuch cafes, the cow-pox affe£ts the whole conhitution, or is only a local affeftion.
The cow-pox poifon differs materially from the variolous, in not being communicated in the hate of effluvia, or gas. It does not appear that the difeafe fpreads from any infefted cow among other cows which are fed in the fame hable, like a contagious difeafe. Perfons who deep in the fame bed with one who is labouring under the cow-pox, are not, in this way, liable to be infefted. It is not even propagated from the cows to the milkers, for the moh part, unlefs the fkin of the part of the hands to which the matter is applied, be divided or abraded. This is an im¬ portant fa <h.
The local affection in the cow-pox, produced in the cafual way, is generally more fevere, and of longer duration, than ufually happens in the local affe£tion in the inoculated fmall-pox 3 but in the cow- pox, the fever is in no cafe attended with fymptoms that denote danger. Some have faid that the difeafe from the cow-pox poifon, is on the whole much more
fevere,
1
547
Pear ion’s Inquiry into the Coze-Pox.
fevere, than that from the inoculated {mall-pox. No cow has been known to die of the cow-pox.
No confequential difeafe to the cow-pox has been obferved, nor has any difeafe been excited, to which there previouily exiited a predifpofitibn ; nor has it been difcovered to produce a predifpofition to parti¬ cular difeafes. Thefe are points of great magnitude, and require ample proof. At prefent they are ren¬ dered probable only.
Laftly, there appears reafon to conclude, that the cow-pox infection may produce the peculiar local difeafe belonging to it, but without the diforder of the conftitution ; in which cafe, the confutation is liable to be infefted by the fmall-pox infe&ion. In this refpedt it refembles the fmall-pox.
Dr. Pearfon next refers to the practical concha- dons which may refult from the facts before dated. If it be true, that the fame conftitution is liable to undergo repeatedly the cow-pox, to which diftemper no one has fallen a victim, practitioners, he obferves* may avail themfelves of this mean of exciting an innocent fever, as a remedy of various diforders ; it being a truth, admitted by men of experience, that fevers are occafionally efficacious remedies, efpecially for inveterate chronic maladies ; fuch as, epilepfy 5 by fieri a ; infanity; St. Vitus’s dance; tetanus; ikin- deformities and difeafes ; &c. &c.
The cow-pox poifon, the author obferves, and the hydrophobic, are the only fpecific morbific matters to the human animal ceconomy, which are clearly proved to be derived from brute animals ; for there is only fmall probability on the fide of the opinion, that the fvphilitic poifon is from the bull* j the fmall-pox from the camel f ; and the itch from the dog. I he ceconomy then of the human kind, and of cows,, re-
J
* Bulls fo difeafed, are faid to be ping,— Sir IJaac Pennington's rotten,
t S*ee Bruce’s Travels, and Dr. Woodville’s Hillary of Inoculation.
iemble.
548 Peatfon’s Inquiry into the Cow-Poi\
femble each other, in the particular of being excitable to a difeafe, the cow-pox, by a certain fpecific poifon. Whether other animals, efpecially males of the bo¬ vine kind, can take the cow-pox, has not been de¬ termined by experiment, or accidental obfervation. Morbific poifons, which produce fpecific difeafes, adl in this way only on one fpecies of animal, except in a few inftances ; fuch as the hydrophobic, and cow- pox poifons. Camper, Ingenhoufz, and Woodville, in vain, attempted to produce the fmall-pox by ino¬ culation, in a number of different brute animals*. J. Hunter tailed in attempting to excite the fyphilis in a dog, by inoculating him with the poifon of the gonorrhoea, and of a fyphilitic ulcer. Camper attefls, that in the mod malignant epizootic murrain, which fpread mod; rapidly among oxen, yet other animals, luch as iheep, horfes, affes, dogs, &c. were not in- tefled by affociating with the didempered oxen ; nor even by feeding with them in the fame compartments of a ftable.
In the eruptive contagious difeafe among fheep in France forty years ago, other fpecies of animals which affociated with them were not infected.
The newly-obferved difeafe, which prevailed among domeftic cats in 1796, throughout great part of Europe, and even America, did not appear to affedt other animals.
Thefe obfervations may ferve to remove the fears of thofe who apprehend, that in confequence of do- medicating brute creatures, we are liable to render their difeafes endemial.
* Berrier, of Chartres, alTerts, that monkeys, dogs, Bleep, rabbits, oxen, and other brute animals, are fufceptible of the fmall-pox ; but his evidence has not the weight of a feather again It the contrary au¬ thorities.
SnvediauraTerts, that monkeys are never affected with the fyphilis, although in England they are fubjeft to the fcrofula, and that other animals are equally unfufceptible of the fyphilis, although Pau^iv af¬ firms, that in Peru, dogs are aftefted with this difeafe.
549
Pearfon’s Inquiry into the Cow-Pox .
As it appears that the cow-pox poifon, after its admiffion into the human conftitution, takes effect, or fenfibly exerts its agency upon the whole oeconomy* in feven or eight days ; the knowledge of this fa£t may enable us to anticipate, in many inftances, the agency of the fmall-pox poifon.
On account of the notion, which by fome is enter* tained, that the cow-pox infection is of the fame nature as the variolous. Dr. Pearfon points out the following diftin&ions between the two.
1. The cow-pox poifon, introduced by inoculation, affefts the whole conftitution at the fame time, in the fame degree, and manner, as when admitted in the cafual way ; and if the local affection be more fevere in the cafual, than in the inoculated way, it feems to be owing to the ftrudture of the part, namely, the thick cuticle in the palms of the hands.
2. The cow-pox poifon only affe&s the conftitution, through the intervention of the part poifoned.
3. This morbific poifon produces no eruption or inflammation, but of, and near, the part to which the poifon is applied.
4. The cow-pox poifon from the human fubjeft will, in all probability, infeft the cow with the cow* pox ; which the variolous poifon will not.
5. It is afferted that a perfon may have the cow- pox who has had the fmall-pox.
6. The local puftulous eruptions in the cow-pox are rather of the nature of veficles, or phlyftenae, than purulent eruptions •> and the ulceration is apt to be of the phagedenic kind.
7. The cow-pox infection is not propagated in the ftate of effluvia, or gas.
8. Cow-pox matter applied to the eyes, lips, and various other foft parts, or to any parts which are punctured, or wounded, in perfons who have already had the cow-pox, or are then ill of the difeafe, will excite the peculiar local affection from this poifon, and perhaps fever.
VOL. v.
Rr
To
550 Pearfon's Inquiry into the Cow-Pox .
To thofe whofe inclination and opportunities lead them to a further inveftigation of this curious fub- je£t, Dr. Pearfon Hates the following as the principal points of inquiry :
With refpect to Brutes .
1 . If a diHemper of cows has been noticed, called the cow-pox, or by any other name, in which the breafls, especially the paps, are affefted with puflulous, and generally purple, or livid eruptions and fores, by which the hands of milkers are infeCted ; what are its fymptoms ?
2. Can any connexion be traced betwixt this dif¬ eafe and the greafe of horfes’ heels ? between the dif¬ eafe and particular kinds of food, and water? be¬ tween it and any particular Hates of the atmofphere ? between it and any particular feafon ?
3. Is the fame cow liable to the difeafe more than once ?
4. Has any cow ever appeared to die of this difeafe ?
5. Is the cow fufceptible of the cow-pox by the inoculation of the breaHs, with greafe matter of horfes ?
6. Are males of the ox kind, or other different kinds of brutes, fufceptible of the difeafe by inocula¬ tion with cow-pox matter of cows ?
7. Have cows, in a Hate of pregnancy, been ob» ferved to be affeCted with this diHemper ?
8. Is the cow fufceptible of the difeafe by inocula¬ tion of other parts befide the breaHs ?
9. Is the cow-pox matter of human creatures ca¬ pable of producing the cow-pox in cows ?
With refpect to Human Creatures .
1. What parts are affefted, and what are the fymptoms of the diHemper, when contracted in the cafual way ?
2. Has any perfon been fuppofed to be in danger, or to have died of this difeafe ?
3. Is
551
Pearfonfs Inquiry into the Cow-Pox.
3. Is the whole confutation 'difordered previonjly , or only at the fame time the puftules break oat ? Does the diforder of the confutation difappear on the ap¬ pearance of the paftules ? Does the fame, or a dif¬ ferent diforder of the confutation again appear ; and under what circumflances in the courfe of the dif* eafe ?
4. If in the courfe of the difeafe, when there is no diforder of the whole confutation, the infectious matter of the cow, or of the human patient already labouring' under the cow-pox, be applied to frefh parts, does a diforder ot the whole conftittition arife, as well as a local afteftion ; and of the fame kind as thofe which have already taken place ?
5. Is the fame perfon fufceptible of the cow-pox local affection, and fever, or diforder ot the whole conilitution more than once ? or only of the local ai- fection more than once ? In the inllances in which the diforder of the whole conititution was faid to have occurred more than once, is it not probable that in one cafe only the fpecific rever of the infec¬ tion occurred, and in the others a different diforder of the whole conilitution, fuch as was merely from the
irritation of the local affeflion ?
6. Is the local affeflion of the fame nature on a fecond, or on farther attacks in the fame perfon, as
on the firft ? #
7. In the inllances of cow-pox in perfon s who had cone through the fmall-pox, were the local affeflion and diforder of the conilitution of the lame natm e, as in perfons who had not laboured under the fmall-
pox ? r .
8. Has it been obferved that a perfon has ever
taken the fmall-pox, after having gone to rough tne cow-pox? In the inllances in which the fmall-pox was faid to have taken place, was it certain tmn t le preceding cow-pox was attended with its Ipecihc fever, or was there only a local aiieition, or at
R r 2 molt
552 Pearfon^s Inquiry into the Cow-Pox.
inoft, was there only diforder fymptomatic of the local affeftion ?
9. Does the cow-pox render the human conftitu- tlon unfufceptible of any other difeafe, befide the fmall-pox; or, on the contrary, increafe its fufcep- tibility to any particular difeafes ?
10. What are the eflfe&s of the cow-pox on preg¬ nant women ?
11. , In the inoculated cow-pox, is the fever lefs confiderable than in the cafual way ?
12. In the inoculated cow-pox, is the local affec¬ tion {lighter and of Ihorter duration than in the cafual cow-pox ?
13. How long after the infertion of the matter is it before the conflitution is affe&ed ?
14. If a perfon were to be inoculated at the fame time with the cow-pox and variolous matter, which diforder would appear firft, or what other effcfts would be produced ?
15. If the cow-pox morbific matter be applied to a fecreting membrane, e. g. to the urethra, will it produce a gonorrhoea, or puftulous fores ?
16. Does this difeafe appear to injure the conftitu- tion, by producing or exciting other difeafes ?
17. Does this difeafe appear to eradicate any other difeafes already prefent }
18. Does the mildnefs or feveritv of the inoculated cow-pox depend upon the quantity of matter infert- ed, or on the wounds inflicted for inoculation ?
19. Does the cow-pox matter produce the difeafe as certainly in its dried as in its fluid ftate ; and wrhen old, as when recent ; and with equal mildnefs ?
20. Are there any particular Itates of the conftitu- tion, in which the cow-pox is particularly mild ; or, on the contrary, fevere ; as after the mealies, hooping cough, &c.?
21. Are there particular idiofyncralies in families or individuals, which influence the cow-pox, as is the cafe in the. fmall-pox ?
22. Is
Beddoes on the Venereal Dijeaje . 553
22. Is the inoculation of the cow-pox equally fuc- Cefsful in infancy, manhood, and decrepit age ?
23. Do certain epidemic Hates appear to prevail* * which influence this difeafe ?
4
Anfwers to the preceding queftions will be prin¬ cipally obtained by inoculation for the cow-pox, of which there are many opportunities in provincial fituations ; which praftice it is one of the chief ob- jefts of this publication to encourage.
Art. LVII. A Collection of Tejlimonies refpecting the Treatment of the Venereal Difeafe hy Nitrous Acicl . Puhljhed by Thomas Beddoes, M. D« Odfavo, 277 pages, price 5s. London, 1799.
Johnson.
*
SO many inftances have now been made public which prove, in a fatisfaclory manner, the in¬ fluence poffeiTed by the new remedies over the lues venerea, both in its primary and fecondary ftages, that it is no longer neceffary to enter into the detail of each individual cafe. It would perhaps be better to confine our attention in great meafure to the un~ fuccefsful cafes, for the purpofe of difcovering, as far as is poflible, the circumftances on which this dif¬ ference of refult depends, and of afcertaining the re* lative values of the new and the mercurial methods of cure.
The firfl communication in the volume before us, is from Mr. Scott, to whom we are indebted for our firft knowledge of the new remedies. He frit ob* ferves, that his theory led him to fuppofe, that oxy¬ gen, applied to the internal furface of the inteftinal canal, would anfwer the fame purpofe as the nitric acid : but he has not found it fo in practice. In two or three inftances, Mr, Scott has ieen people, when
R r 3 , taking
554
Beddoes on the Venereal D if cafe ,
taking the nitric acid, affefted with fcabs on the body which appeared to be compofed of coagulated lymph, and which difappeared, on leaving off the
acid.
With a view of procuring an agreeable fubftitute for the nitrous acid, Mr. Scott thought of uniting it with the fimple earths, and preferred the earth of alum, as the acid has the weakefl affinity with it. Though not more palatable, it produced the fame e if efts in the fyftem as the nitric acid. He like wife employed the black calx of rnanganefe, in the quan¬ tity of ieveral drachms daily ; and for the purpofe of difengaging its oxygen gas, the common drink of the patient was well acidulated with the acids of vitriol or of nitre. But no evident advantage was derived from this plan.
In one of his letters, Mr. Scott fpoke with much confidence of the good effects of nitric bathing of the lower extremities ; he even fuppofed, that this mode of applying the acid was more effectual than its in¬ ternal ufe: In a fubfequent letter much of this is retra&ed, and he (peaks with hefitation of the utility of this mode of exhibition,
C, ^ ■ v , t • 4.J? i 4 • ■■ i ■' ; / • '■ ;■ . L , v ■'
T he next communication is from Dr. Trotter. Six or feven cures by the nitrous acid, he obferves, have come to his knowledge, and molt of them of long Handing. In Tome, mercury had been ufed without efieft; in others, the acid was the firft antifyphilitic medicine. He has, however, tried it in a few with¬ out any apparent advantage. In one cafe, fevere fyrnptoms of leurvy appeared, during the ufe of the acid; fo much fo, that it was obliged to be given up for fome time, and recourfe had to the citric acid, till the fcorbutic complaints yielded : the cure was corn- pleated afterwards by the acid, nitros. This fuper- vention of fc.urvy, Dr. Trotter obferves, is a ftrong proof of fome analogy between the aftion of mercury Slid nitrous gas, for the mercury has always been ••• ‘ found
Beddoes on the Venereal Difeafe. 555
found hurtful in a fcorbutic difpofition of body. He fees no proofs of its imparting oxygene to the fyflem, unlefs the increafe of appetite may be thought fuch.
Three cafes are related by Dr. Garrick, in two of which, the good effe£ls of the acid were very ap¬ parent: but mercury had in both been ufed, fome time before. In two other cafes it was adminiftered without fuccefs ; but he acknowledges, that in one, it had not a fair trial.
Some extracts from a pamphlet of Dr. Swediaur are next brought forward, wherein he quotes the authority of M. Alyon in favour of the new remedies. M. Alyon, it feems, has obtained feveral combinations of oxygen, which he has employed with the greatefl fuccefs in fyphilis. He contrived an ointment fupe- rior to the blue ointment of mercury, and which has produced the fame effects. Oxygen he confiders as curing with greater promptitude and certainty, than mercurials. Mercury, he fuppofes to be an impe¬ diment to oxygen, which alone he affirms to be me¬ dicinal, when the treatment confifls in friftions.
Mr. Bryer of Weymouth relates one inveterate cafe, which yielded to the acid. It was likewife employed with fuccefs on another man who could not bear mercury.
Some remarks next occur on Mr. Blair’s pamphlet. This gentleman’s obfervation and experience^ having unfortunately led him to concluiions, conhderably different from, thofe deduced on the other fide, his ilatement has, of courfe, afforded occafion to many critical and petulant remarks. Many p^ges are de¬ voted to an examination of the cafes brought forward bv him, with the view of invalidating their force : but we leave this matter to Mr. Blair himfelf. Our read¬ ers may form fome opinion of the weight of his tef-
R r 4 timony.
556 Beddoes on the Venereal Difeafe .
timony, by the account we have already given of his pamphlet*.
The next article is a letter from Dr. Geach. He obferves, that mercury had been but little employed in the Plymouth Hofpital fince the nitrous acid was adopted. Two inflances are mentioned of very frnall chancres refilling the full ufe of the nitrous acid. He remarks, that the lues has yielded to the acid, though combined both with fcrophula and fcurvy.
Thirty-fix fuccefsful cafes are next brought forward from the Royal Hofpital, Plymouth, by Mr. Ham- mick, Jun. Thefe are followed by one unfuccefsful cafe. The fymptoms were chancre and gonorrhoea. Mercury was firfl employed fo as to excite copious falivation. The chancre not yielding to this, nitrous acid was employed in the ufual manner. The ulcer leffened confiderably, but did not entirely heal. The acid was continued for near three months, in which time one hundred and twenty-fix drachms were taken.' Mercury was then again reforted to, a co¬ pious ptyalifm followed, the chancre fpread under its ufe, but in about fix days, it relented and healed.
1 hree cafes of chancre are next adduced by the fame gentleman, which were cured by the fulphuric acid. The quantity given was from one drachm, to a drachm and a half daily. It feemed not to differ in its effefts from the nitrous acid.
§ix cafes of gonorrhoea follow by Dr. Geach, which were cured by the nitrous acid only, fome of them without any kind of injection. The cure was com¬ pleted ip three weeks or a month. Eight or nine in fiances in the whole, of lues venerea, are acknow¬ ledged to have refilled the new remedies, after a trial of fufficient extent. Thefe afterwards yielded to mer¬ curial friflions, but fometimes very reluctantly.
Vide page 148.
Mr.
Beddoes on the Venereal Difeafe . 557
Mr, Cuftance, of Kidderminlfer, gives an account of a fecondary cafe, which yielded to the nitrous acid, after having refilled mercury. She took the remedy for three months, for the moft part two drachms daily, and, in the whole, one pint , /even ounces^ and jive drachms of the acid .
Mention is made by Dr. Geach of the trial of phof- phoric acid in one inftance of lues venerea. Two drachms of this acid were given daily. The firlt ap¬ pearances of healing, it is obferved, were in the middle of the ulcer, the cicatrix gradually extend¬ ing to the circumference.
Several other fuccefsful cafes are furnilhed by, dif¬ ferent practitioners, in many of which the fymptoms had before refilled the effects of mercury.
Dr. Rollo obferves, c that in certain conilitutions and flates of ftomach, the oxygenated muriate of | potafh, when given in large dofes, infiead of pro¬ ducing its ufuai effedts upon the conftitution, runs off by urine undecompofed ; in fuch cafes, the patient generally complains of fharpnefs, and heat of urine, with a frequent defire to pafs it ; this fa6t was de~ tedled by the following fimple procefs. — The urine of a patient who had for fome days been taking fifty grains four times a day, and who complained much of lcalding, &c, was evaporated until it afforded, on cooling, a mats of impure cryflals mixed with animal extractive matter. — Thefe cryflals were feparated and placed on filtering paper, and walked with a little alcohol ; they were then redilfolved in hot water, and fuffered to cryflallize a fecond time by cooling ; by this means the oxygenated muriate of potalh was ob¬ tained in crylials mixed with fome ammoniacal falts, and common muriate of potalh, and when thrown upon red hot coals, detonated with its ufuai vivid flame.
* From this fa£l if would appear, that too large dofes of this medicine are not only unneceffary, but prejudicial, as by exciting the & St ion Qt the urinary
organs
558 Bed does on the Venereal Bifedfe.
organs too much, the whole, or a confiderable part may be carried off undecompofed, fomewhat in the fame manner as mercury is carried off, when it pro¬ duces purging: to avoid this inconvenience, when detected, and which it may readily be by the procefs juft described, the dofe of the medicine fliould be dirriiniflied, and a fmall quantity of fame acid, as the nitrous, muriatic, or even vinegar, given after each; by this means the fait muff unavoidably be decompofed, and confequently rendered more acdive, both on the fyftern and difeafe; as we have found from experience to be the cafe.’
The evidence of Dr. Carmichael, of Birmingham, refpefting the new remedies, is far 3efs fatisfa&ory. He has prefcribed it in numerous inftances, and m various ftages of the difeafe, but has in no inftance been able to effect a cure. He, however, allows them to poffefs feme influence over the fymptoms. The diluting medium, cliredted by Dr. Carmichael, was either water alone, or water gruel. He fufpects the large addition of fugar in Mr. Hammick’s cafes, may have been of more confequence than has hitherto been fufpe&ed : for be has given the nitrous acid in the full quantities.— This point deferves -inveftigation.
Dr. Currie’s (of Liverpool) teftimony on the fub- ject, will have much weight. We, therefore, give it in his own words. He obferves in a letter to Dr. Beddoes, c i am truly forry I have occasioned you the trouble of writing fo often to me, by neglecting to comply with your willies refpefting the nitric acid ; but the truth is, my experience of its effects in lues is not fo extenlive, or fo uniform, as to enable me to fpeak with confidence on a fubjeft, where accurate' conclufions appear to be fo difficult. Neverthelefs, fince you defire it, I will give you a fhort account of what I have obferved.
c I began to ufe the nitric acid in lues, at our Hofpital> in the beginning of 1797* In the two firff
cafes.
559
BeddoeS on the Venereal Difeafe .
cafes, there were ulcerations on the penis, and open buboes in the groin, but no decided evidence of the Syftem being affe&ed ; ahd the difeafe was in each cafe of lefs than three months handing. In the third, the difeafe had been in the habit upwards of a year ; the furface was covered with venereal eruptions ; the throat had been affedted, and the glands of the neck, on each fide, had been indurated, and were in a ftate of open ulceration. The patient had undergone a courfe of mercury in the Hofpital ; but, after puffing it as far as her fyftem would bear, ffe had been dis¬ charged, about fix weeks before, with little or no amendment in her Symptoms. The laft fix weeks. Hie had been in the country, on a milk diet, and her health was fomewhat recruited. I paid much atten¬ tion to thefe three cafes, and have minutes by me re- fpefting them, of confiderable extent. The two firffc were males.
f Each of the men took a pint of water daily, gratefully acidulated with the nitric acid ; a drachm being at firft ufed in each pint, and afterwards a drachm and a half ; but this lait proportion appearing to effect the bowels by griping, the original propor¬ tion was returned to, and the patients took a pint and a half of the acidulated water daily ; i. e. a drachm and half of the acid, as already mentioned. In the cafe of the female, we never exceeded a drachm, her bowels being very irritable.
< In five weeks, every fymptom of difeafe in the two men was gone; and I prefented them to the Board, as remarkable infiances of lues being cured without the ufe of mercury. They attended at my houfe weekly, for Some time ; but, being Sailors, they went afterwards to; Sea, and I have never heard of
them fince, „ .
< In the female, the fame happy progrefs continued
for nearly a month ; the eruption on the ficin diminifh- ed, the no&urnal pains in the head and limbs went off and the ulcerations in the neck affumed. a healing
appearance ;
I
560 Beddoes on the Venereal Dijeafe .
appearance; her general health, alfo, improved ra¬ pidly. But at this period, her progrefs towards a cure flopped; and though we perfifted in the acid fome time, it did not recommence. It was, there¬ fore, at the end of feven weeks, abandoned, and re- courfe had again to mercury, but in fmall dofes, gra¬ dually increasing them, however, till ptyalifm com¬ menced. At firit, there were indications of benefit from this new courfe of mercury ; but tbefe fpeediiy tailed ; and her general health Suffering feverely, we were once more compelled to abandon it ; the ulcera¬ tions in the neck having, during its ufe, evidently Spread and become more morbid. The nitric acid was had recourse to, as before. During this fecond courie of the acid, her health again improved, and the venereal fymptoms again appeared to give way. But, after a few weeks, thefe favourable indications tailed us; we abandoned the acid, and retorted to mercury once more. It would be tedious to par¬ ticularize farther.. With the mercury, farfaparilla, and mezereon, and opium, were fucceffively com¬ bined ; but in vain. Her health giving way, the fores enlarged, and once more we returned to the acid. At length we combined the acid with mer¬ cury, in what are called alterant dofes, and with evi¬ dent benefit. At the end of eight months, however, the ulcerations continued, though much diminished. Defpairing of any farther benefit from thefe combined powers, we abandoned them altogether, and after a proper interval, put the patient on a courfe of the mineral folution of De Valengin, (fr$m which, in obftinate venereal affections, I had before feen extra¬ ordinary effefts) and during this courfe the ulcera¬ tions fpeediiy healed, and the cure of the patient be¬ came complete, the treatment having occupied a Ipace of upwards of ten months. In obftinate cafes of this kind, it is ufual to fuppofe, that fome fcro- fulous or other taint has combined with the venereal virus, and this may have been the fact in the prefent
instance ;
Beddoes on the Venereal Difeaje . 56 i
inftance ; the refuit will, however, afford encourage¬ ment in fimilar fituations.
‘ The encouragement, arifing from the three cafes juft mentioned, led me to try the nitric acid in a va¬ riety ot otner cafes. In fome of thefe, iny fuccefs has apparently been complete ; in others, there has been evident benefit without a perfect cure ; and in others, it has feemed to fail entirely, it is not a little curious" that in fome ot the cafes in which I ha^e fucceededu the fymptoms were what are called fecondary, and the difeafe in its molt rooted and obftinate ftate. One of my patients, whole name is Elkins, has drawn out his own cafe, ^the particulars of which are Ihortly thefe: —About four years ago he wTas affehted by lues, with the ufual fymptoms, for which he underwent a courfe of mercury, and was fuppofed cured. In about nine months afterwards, however, the difeafe appeared in his throat, and in obftinate pains in his head, &c* He was again falivated, and with fimilar good effects. Twelve months after this, having been for aconfider- able time fubjeft to what wTas fuppofed to be rheu- matifrn, the difeafe appeared again, and refilled the long-continued and repeated ufe of mercury, under a praftitioner here, of the firft eminence. He was at length obliged to abandon it, having been reduced to a ftate of extreme weaknefs. About three months after this, he was admitted a patient into our Hof- pital, and under my care. At this time he had a thickening of the pericranium in two different places, the moff fevere pains, efpecially in the night, in the bones of his head, arms, and legs, and a large increaf- ing node on the right tibia. All his fymptoms were at this time increafing ; and having taken lb much mercury in vain, he was in a ftate of extreme de~ fpondence and depreffiom
c We preferihed the nitric acid, and his fufferings abated from the third day } and being continued, the thickening of the pericranium and the node of the tibia entirely difappeared, with all his other fymp¬ toms.
562 Beddoes on the Venereal Difeafe,
toms. He took the nitric acid, in all, to the quantity of eight ounces in eight gallons of water, which he drank in fixty days.
c Elkins has been nearly a year difcharged, and has never had any return of his complaints. This cafe has made feme noife, and I have endeavoured to attract the attention of feveral of my brethren to it, as decifive of the influence of the acid in this de- ftruCtive difeafe.
On the other hand, there are a fill more con- fiderable number -of cafes, in which the acid has en¬ tirely failed me, or produced only partial benefit ; and at prefen t, though I always order it internally, with mercurial inunctions on the fkin, I do not truft the cure to it alone in the fir ft injlance . Combined with mercury in this way, the conftitution feems to fupport the action of the metal better, and the cure to be accomplilhed more fafely and more fpeedily. In feveral infiances where, after a courfe of the nitric acid, it has been thought advifeable to have re courfe to mercury, a very fmall quantity of the ointment (in one cafe two drachms only,) has produced complete ptyalifm. This has occurred fo frequently, that I do not think the conjunction accidental.
* The nitric acid has never been pufhed by me to the extent, in which it has been ufed by others ; in many of the cafes, in which it has apparently failed, I cannot pretend to fay, that it would not have fuc- ceeded, if pufihed to a greater length ^ but I have not thought it proper to carry it to any extent injurious to the ftomach or bowels, while the falutary e fie 61s of mercurial inunCtion remained untried. In the quan- titles in w7hich I have preferibed it, it has been uni¬ formly falutary to the confiitution, in this refpect its aCtion contrafting very happily with that of mercury. In the cafes in which it has apparently fucceeded (in my hands) in the cure of lues, I have not known a relapfe to take place ; but as the patients have been chiefly feafaring perfons, it is not in my power to
trace
Beddoes on the Venereal Difeafe, 563
trace their hiftory fubfequent to our parting. In one caie of the primary difeafe, in the hofpital of the 20th regiment, the afliftant furgeon, who thought it had effected a complete cure, found the difeafe break out hi the throat, at the diftance of four months, and finally removed it by mercury.
I ^ave experience of the effects of the nitric acid in complaints of the ftomach, hypochondriaiis, aflhma, and fome other difeafes, as well as in hepatitis ; but a? your enquiries arediredted to its agency in a fingld difeafe- — lues— -I forbear to enter on other points.
* But you will aik whether I can mark, by any par- . ticular effedts, the circumftances attending its falutary operation in lues ?— I think I can. In the cafes in which it fucceeded, it evidently irritated the fyftem in the following refpecis :
£ The gums were always affedted with tendernefs and rednefs, and the aftion of the falivary glands in- creafed. This affection may indeed be confidered as depending on its local addon ; for it took place in one cafe, where, for the fake of the experiment, the acid was taken into the mouth, but not (wallowed. This fiate of the gums, &c. was not attended by fee tor, as during the addon of mercury, neither did it increafe as the acid was continued, hut in a little while dif- appeared. This affedtion of the gums and falivary glands did not always appear in the cafes where the acid failed.
£ 2. In every cafe in which it fucceeded or ope¬ rated beneficially, there was a confiderable increafe of urine, and this difeharge became turbid ; fometimes of a whitifh, and fometimes of a browniih hue ; it amounted to about eight pounds in the twenty-four hours. But the difeharge of urine did not go on in- creating under the continued ufe of the acid; on the contrary, it ceafed like the increafed difeharge of faliva. The affedtion of the kidneys feerned to pre¬ cede the affedtion of the falivary glands.; but both
the
564* Beddoes on the Venereal Difeafe.
the one and the other occurred by the fifth day at lateft. r
‘ 3. The patients had their appetites improved, and
felt a greater alacrity of fpirits.
c 4. In all of them the pulfe was rendered more frequent, and the animal heat towards evening in- creafed from one to two degrees, which in the night was generally carried off by more or lefs of fenfible perfpiration.
c I think that thefe fymptoms have not appeared at all, or not in combination, wffiere the acid has feemed to be inert.
But I wiili to fpeak with the diffidence becoming my imperfect experience ; and I would not willingly have fpoken at all in this ftage of the enquiry, had not there appeared a danger of the attention of medical men being wholly withdrawn from the in- veftigation of a fubjeft, which, though difficult, feem^ to me not only curious in itfelf, but likely to produce important confequences to the healing art. To affift in preventing this, I am willing to offer a teftimony, which is certainly imperfeft, and which in fome refpe&s may ultimately be found erroneous/
Mr. Hammick gives the fum of his experience in the Plymouth Hofpital, between November 1797, and March 1798. It appears that thirty-feven men were difcharged cured, by the acid alone, of different ffages of the difeafe. Fourteen of thefe had not taken any medicine previoufly; but the others had ufed different preparations of mercury, fome of them to a great extent, under which their diforders gained ground. Sixteen were cured of gonorrhoea. In all thefe, as foon as the inflammatory fymptoms went off, an injection was ufed, compofed of from four to fixteen drops of the nitrous acid, in eight ounces of water.
Mr. Hammick allows that the acid has failed in many cafes ; but this failure, he obferves, has been
in
4
565
Bell's Syft em of Directions.
in hot conquering the fymptoms at firft ; for, when once removed, they have never, to his knowledge, occurred again. The nitrous acid has never in any inltance produced the fmalleft difpofition to ptyahfm.
Subjoined to the communications which have now been noticed. Dr. Beddoes has furnifhed many re¬ marks, which it is unneceffary for us to detail. The volume furniihes abundant evidence of the power of the new remedies in the different ftages of the vene¬ real difeafe, whilft the cafes, where they have failed, are comparatively few. The caufes of this variety in their a£tion do not yet appear.
Art. LVill. A Syftem of Directions , explaining the Anatomy of the Human Body , the Manner of dif playing the Parts , and their varieties in Difeafe . With Plates. By Charles Bell. Fart L Folio, 65 pages, price 5s. 6d. Edinburgh, 1798. Cox, London.
WE have feldom feen a work better calculated, by its matter to infiruct, or by its manner to allure, the medical ftudent to the important* yet too much negledred, ftudy of anatomy, and thus to fulfil the intentions of its ingenious author, than the per- formance now before us. We can only at prefent give our readers a general idea of its nature and objects , referving a more full account of this and the remaining , parts, tor forne future opportunity. And this cannot be better done than by quoting the author's Preface,
4 For the ftudy of every faience,’ Mr. Bell obferves, £ there are required fuch general views, as may enable a ftudent to take a lively intereft in his gurfuits, to direfct his enquiries to the points of true importance, and to confirm in him a manly and heady refolution
566
Bell’s Syfiem of Directions.
to perfevere in learning the details and minutiae which, although difagreeable and tedious in them- felves, are yet abfolutely neceffary. In no cafe is this more mdifpenfable, than in the ftudy of ana¬ tomy ; tor while the general refuits or economy, con¬ sidered as a whole, are interesting and important, the details are intricate, and difficult to be acquired, and often difagreeable. There are thus two departments of this fcience ; both equally neceffary, but to be Studied in a very different manner.
c What is detailed in elementary hooks of anatomy is too often represented as comprehending the whole of the art. Yet the object of fuch books is not prac¬ tical anatomy : by which is to be underftood the real investigation and knowledge of the diffedted body. The defcriptions are not adapted to the limited and fucceffive views which, in difleftion, we muff have of the parts ; they cannot he implicitly followed as guides 5 but, on the contrary, the anatomy of any part to be differed, or of parts implicated in a great ope¬ ration, muff; be collected from many different fources — mufcles from one place, blood- veffels from another, and nerves from a third. The defcriptions, too, will be found infulated and defective in fuch views as can give a lively inter eft and knowledge of the mutual dependence of the parts. Now elementary books fhould give Simple, introductory, and conneCted/dews ; otherwise they are not only ufelefs, but become hurt¬ ful. To Study the details of anatomy without having the parts before us, is pernicious ; and a man, who has bv reading only, acquired a knowledge of names, and of the derivations of nerves and arteries, without at the fame time being able to put his finger upon the body, and tell what parts lie concealed, is more apt to be led affray, to heiitate, and be timorous, than to be prompt and decisive in bis conduft as a furgeon.
* That the common books are not fuited to be affiftants in diffeftion, every one muff allow, who has
taken the knife into his own hands, or been attentive
to
3
56 7
Bell’s Syftem of Directions.
to tile operations in a differing room. He will know, that, in diiTection, it is not the want of minute descrip¬ tion that is fo much felt, as the want of arrangement, and plans upon which to proceed. How often is it found, that young men, who have began their ana¬ tomical labours with a true convidlion of the impor¬ tance of the fubjedf, and with the molt determined refolutions to combat all difficulties which might op- pofe themfelves to their progrefs, have, for want of a plan and fyftem of proceeding, gone to work in fo difordered a manner, that they have been foon be¬ wildered, and forced, in difguft and defpair, to give up a purfuit, which, with their views better directed, would have been moft plain, and certainly moil va¬ luable to them. The convidlion of the want of fome guide to the younger Undents in their labour, has emboldened me to this attempt.
c The objedl of this work is, to ferve as an affiftant to the Undent in acquiring a knowledge of pradtical anatomy ; in gaining a local memory of the parts ; in learning to trace them upon the dead fubjedt, and to be able to reprefent them to his oven mind upon the living body. This being my objedt, the method to be purfued is obvious ; to give a fhort detail of the ana¬ tomy ; to fhew how the parts are to be laid open, and how they are to be diftinguiflied in ditfedlion, or avoided in an operation ; to explain the confequence of each part to the great functions of the body, and to mark the difeafes to which it is liable.’
The prefen t number contains the diffedlion of the abdominal mufcles, and vifcera, with the difeafes con- riedled with the anatomy of there parts.
More fpiendid, but not more ufeful, is the fol¬ lowing—
Sf 2 Art.
( 563 )
Art. LIX. Anatomia Britt annicA. A Syf tern of Anatomy , illujirated by upwards of Three Hundred Copper-plates , from the mqft celebrated Authors in Fair ope. In Six Parts . By Andrew Bell, F. S. A. S. Engraver to his Royal High- nefs the Prince of I Fates. He Work conducted by Andrew Fyfe, Ajjijlant to Dr. Monro, Pro- fejfor of Anatomy, Sc. in the Univerjity of Edin¬ burgh. Folio, Farts I. 11/ and Ill, price 71. 7s, Edinburgh, 1798. Johnson, London.
HOUGH the progrefs of improvement in ana-
torriy, the author obferves, has kept pace with
that of the other fciences, yet that knowledge, which might otherwife have been acquired, has been, in fome degree, retarded by the want of a compleat and comprehenfive fyftem, enriched with the modern difcoveries, and accompanied with proper delinea¬ tions of the numerous parts of which the human body is compofed ; for, without fuch delineations, no language is fufficient to convey juft ideas of the va¬ rious parts. Whether this defeCt has proceeded from the very great labour and expence which muft necef- farily attend the publication of a feries of plates, fo extenfive as to exhibit all the parts employed in per¬ forming the different functions of the body, or from other caufes, it is certain that no fuch fyftem has appeared fmce the commencement of this century. Many ingenious and learned men, however, both in Britain and in other countries, have, during that period, favoured the public with the refult of their labours in thofe various branches of anatomy, which accident or inclination led them more efpecially to cultivate. By collecting thefe different works, a library may indeed be formed which would con¬ tain all the anatomical knowledge that has hitherto been acquired. But, befides the enormous expence of fuch a collection, fome of the molt valuable works
are
569
Bell's Anatomia Brit tannic a.
are fcarce, and others are entirely out of print. Hence this interefting fcience is lefs underftood than its importance deferves.
To remove thefe inconveniences, by giving as com¬ plete a view as poffible of the various parts which compofe the human body, is the profeffed objedff of the prefent work. This undertaking was in con¬ templation tor feveral years before its commence¬ ment ; and it is now upwards of twenty fince it was ferioufly begun. During that period, the plan has been confiderably enlarged by the acqtiifition of new publications ; and it is prefumed, that when finiflied, it will be the molt extenfive work of the kind that was ever offered to the public, it will confift of upwards of three hundred plates, in large folio, fe- lecfed from the works of the moft eminent ana- ' tomilfs, particularly from thofe of Eufiachius, Du- verney, Zin, Albinus, Haller, Morgagni, Waltherus, Monro, Hunters, Hewfon, the Vifq, d’Azir, & c. &c. ; and from that fcarce and valuable publication of Bid loo, which appeared under the name of Cow- peps Anatomy. Such a publication, by exhibiting exadt reprefentations of the human body, as a whole, and of all the different parts of which it is compofed, and by conjoining with thefe, full explanations of the different parts, cannot fail greatly to facilitate the ftudies of thofe whofe profeflion renders a thorough knowledge of anatomy indilpenfably neceffary.
The contents of the three parts now publifhed are as follow7./
Part I. thews the front, back, and fide views of the human fkeleton. A front view of the firft, fecond, third, and fourth layers, or orders of mufcles ; the firft, fecond, third, and fourth layers of mufcles on the back parts ; and a view of the primary, or outer- moft order of mufcles on the left fide of the body ; the mufcles feated before the vcitebnc oi the neck, below
the head, with thofe of the larynx and pharynx,
S f 3 mufcles
570 Bell's Anatomia Brittannica .
mufcles of the month, bottom of the feet, infide of the fternum, &c.
Part, II. contains the mufcles of all the particular parts feparated from the body, together with the out- lines of the bones to which they are affixed, or in which they lie ; and fuch other parts belonging to them as feemed neceffary, figured twice as large as the former tables, but in the fame pofition, and in all other refpefts the fame, as far as they are re- prefented in the whole figures, excepting a few of the mufcles, which required either to be drawn in a different pofition, or in the natural magnitude, of which the reader is informed.
Part III. exhibits the proportions of the human body of both fexes in a living date ; microfcopic views of the texture and formation of the {kin, and of the hairs, on different parts of the body ; the external mufcles, {hewing their proper fituation in the fore and back views of the body, when in action, after the {kin, fat, and membranes are removed ; various pofitions and fedtions of the brain and medulla fpi- nalis ; the falx, iinuffis, and microfcopic view of part of the brain, and of a nerve ; the {kull, fhewing the paffages of the blood-veffels, the egrefs of the me¬ dulla oblongata, and nerves iffuing from the brain to the organs of the fenfes ; upwards of fifty figures of the eye, with its different parts and appendages ; near feventy figures of the ear, and of the various parts which compofe that organ ; the nofe, mouth, and tongue, with the glands which fecrete the juices, and difcharge them in mafiicating the food ; the larynx, pharynx, afpera arteria, &c. ; the mufcles of the head and neck, with their different ufes in mov¬ ing the parts. And, as there is frequent occafion to mention the bones, &c. which always ferve as an index to the parts defcribed, a familiar acquaintance with their different forms is abfolutely neceffary. It is therefore hoped, that it Will not be thought im¬ proper
Hamilton on the Duties of a Regimental Surgeon . 57 i
proper to conclude this feftion with the different bones, cartilages, and ligaments, reprefented nearly as large as the life. The bones, cartilages, and li¬ gaments, &c. of the extremities, will be given at the end of Fart VI.
Art. LX. The Duties . of a Regimental Surgeon confidered ; with Obfervations on his general Qua¬ lifications ; and Hints relative to a more reflect able Practice , and better Regulation of that Depart¬ ment. Wherein are interjperfed many Medical Anecdotes , and Subjects dif cuffed , equally Me¬ re fling to every Practitioner. By R. Hamilton, M. D. of the Royal College' of Phyficians, London, Sc. Second Edition, with Additions and Correc¬ tions. Octavo, 2 vols. 680 pages, price Igs,
London, 1797. Longman.
< ■
WE have lately had occaiion to notice, in an ample manner*, a Treatjfe on a very intereft- ing fubjeft, by the ingenious author of the prefent work. But it will not be neceffary for us to go much at length into the volumes now before us. Not that the fubject is in itfelf unimportant, but drat it is dif¬ ficult to con den fe into a fmall compafs, fuch a variety of matter as we here find. There is, perhaps, no branch of medical praftice, which has been fo ill appointed, and fo ill performed, as that which is de¬ voted to the care of military men. Yet no one, in a national point of view, can well be confidered as more important. A variety o> ufeiul and intei effing treatifes, indeed, Dr. Hamilton remarks, have been written on military medical practice, wherein both the prevention and cure of the diieafes to which troops are liable, have been amply inveftigated: but
^ )
* Hamilton on Hydrophobia. See page 376.
Sf 4
no
572 Hamilton on the Duties of a Regimental Surgeon
no author has hitherto pointed out, in a more parti¬ cular manner. The Duties of a Regimental Surgeon , or tak;en up the fubjeft in the light in which it is here fet forth.
It novelty, therefore, be any recommendation, the prefent work has this to plead in its favour: but it has more ; its objeft is utility, while it inculcates humanity towards a clafs of men, whofe fituation, at beft, is but uncomfortable, and yet to whom the com¬ munity are under great obligations at the fame time. A review is taken of the general character and con- duft of the regimental furgeon, as well with refpedt to the accompliffiment of this, as to his own more comfortable lit nation.
In drawing up the prefent work, much pains have been taken by the author to ilJjuftrate and enliven it, by the interfperfion of medical anecdotes; as well to render it, in fome degree, fit for the perufal of other pradlitioners befides thofe of the army, as to explain more fully the different fubjecls which of¬ fered themfelves to his confideration.
The fir ft volume treats of the difficulties attending a regimental furgeon’s ftation— of his qualifications,
and of his tendernefs to the fick foldiery _ of his
fpending too much time in amufements with the officers, a!nd of the impropriety of granting him double commiffions — of the greater criminality of intoxication in the furgeon than in others of the
corps, from the nature and importance of his duty _
of the neceffary medicines and their dofes — of di flec¬ tions— of the neceffity of good inftruments, of fixabie air, and of ele&icity, in regimental pradlice— of the books which ffiould form part of his library— of the utility of cultivating the acquaintance of medical men in the different quarters ; of ftudying the nature of the foil, and qualities of the water in each.
In the fecond volume, furgeons are diffuaded from thing billets, and advifed to' keep a medical regifter "the puniftiments of the foldiery, as far as the fur¬ geon
1
Hooper's Medical Dictionary , 571
geori is concerned, are difeufled— the utility of ex¬ periments pointed out, and the danger of over-hafty prognoftics — the neceflary qualifications of the Sur¬ geon's mate — this office fliewn to be unneceflary ; and the propriety of augmenting the Surgeon's pay — of extra-medicines allowed each regiment, when in camp, independent of the medicine-money; and of their unneceflary expenditure — the necefiity of a liberal education, to pra£tife medicine Successfully— - regimental pra£lice more the province of the phy¬ sician than the furgeon. - Some Remarks are Sub¬
joined on the Influenza which appeared in the year
1782.
/
From this outline, our readers may form to them- felves an idea of the fcope and tenor of the prefent performance ; a work rendered interesting, by the perfonal opportunities of information, enjoyed by the author in his Situation of army-furgeon ; and ftill more, by the exifting flate of things, when the military de¬ partment in the flate is So extenfive and So very important.
Art. LXI. A compendious Medical Dictionary , containing an Explanation of the Terms in Ana¬ tomy , Phyfiology , Surgery , Materia Medica , Che - miftry, and Practice of Phyfic . Collected from the moft approved Authors , by R Hooper, M. D. of Pembroke College , Oxford , Sc. twelves, about 300 pages, price 5s. 6d. London, 1798. Mur¬ ray and Highley.
rip LIE objeft of the author in the prefent work JL is, to deliver in a concife and perfpicuous manner, the explanation, &c. of all the terms ufed in thd whole Science ot medicine.
This
\ ) \ .
i
574
The Medical Diary for 1799 .
This little volume will be a welcome addition to the many ufeful compilations Dr. Hooper has already prefented to the public. If it have the advantage of being more eoncife and portable, than former works of the fame nature, fomething, in regard to fulnefs, it is plain, mii have been facrificed, to obtain this.
Art. LXII. An entire new Treatife on Leeches , wherein the Nature , Properties , and Ufe , of that moft Jinguiar and valuable Reptile , is moft clearly fet forth. By George Horn, Apothecary . Oc¬ tavo, 29 pages, price Is. 6d. London, 1798. Symokds,
THIS little work is divided into five Sections. In the firft, the author flievvs the different fpecies of leeches, diftinguifhing the genuine from the fpu- rious. In the fecond, he gives a; defcription of the nature and conftitution of the animal. The third ex¬ plains the manner of preferving and keeping it healthy for a conhderable length of time. In the fourth Sec¬ tion, the cafes of difeafe are pointed out, where leeches are particularly applicable. And in the la ft, the inode of applying them, and their management, are explained.
Art. LXIII. The Medical Diary for the Ye'ar 1799 : containing ruled Pages for each Day's Bu~ finefs ; a correct Lift of the London and, Edinburgh Royal Colleges of Phyftc ; an alphabetical Lift of Surgeons and Apothecaries , with the M afters. Wardens, and Courts of AJfiftants ; an Arrange¬ ment of the Anatomical, Medical, and other Lec¬ tures ; Public Hof pit als, Sic. With a Map. a f the Roads Ten Miles round London. Eighteens, price 2s. London. Boose y. &c.
Art..
(
( 575 )
Art. LXIV. A Treatife on Scrophulous Difeafes , J hewing the good Effects of Factitious Airs : illuf trated with Cafes and Ob/ervations. By Charles Brown. Octavo, 168 pages, price 3s. 6d. Lon¬ don, 1798. Glendinning,
f $
difeafe which makes the fubjeFfc of the pre- 1 fent effay, is one of acknowledged difficulty, both in its theory, and method of cure. Mr. Brown, however, flatters us with the hopes of its at length yielding to the efforts of art. He denies that it is hereditary, and afferts that the doftrine of hereditary difeafes altogether, is founded on a want of obferva- tion, and has nothing to fupport it, but obftinacy and prejudice. Yet Mr. Brown will not eafily fucceed in difproving, that certain difpofitions may be, and are frequently, tranfmitted from parents to their off- fpring, giving the latter a tendency to the peculiar difeafes of the parent. And this, we believe, is ail that is contended for at prefent.
The author’s definition of the difeafe will (hew the fchool whence his opinions are derived. Scrophula, he obferves, is a weakened action in the fyftem, ma- nifefting itfelf by the following difeafes, viz. fcrophu- lous tumours and ulcers ; phthifis pulmonalifc-; tabes fcrophulofa ; opthalmia tarfi ; hydarthrus ; broncho- cele ; hydrocephalus ; lumbar-abfcefs 5 and rachitis.
Conformably with this idea, the mode of treatment pointed out by the author, is that of giving Jone to the fibre, and reftoring the general health. For this purpofe, fteel, and the cold bath, are recommended ; but efpecially the inhalation of oxygen gas. Several cafes are recited in confirmation of the efficacy of this remedy.
As the prefent is merely an outline of a much larger work, which Mr. Brown intends fhortly to lay before the public, we forbear to be more parti¬ cular.
Ar t.
( 576: )
LXV-. Jon. Gottl. Lei den frost, M. D. et Prof. &c. Opufcula P hyfi co-C hem ica et Medica , antehac feorjim edita, nunc poji ejus obitum collecta , 1 wolves, S vols. Lemgovuc, 1797. Imported by Bqosey, London. Price 10s. 6d.
rjpPIE trafts here collected, are not all of them the immediate produftion of .Profeffor Leiden- froft, but of feveral of his pupils, as candidates for medical degrees. Written, however, under his au- fpices, and for the attainment of honours, of which he was in part the arbiter and difpenfer, they may be confidered as the opinions of the Profeffor and his fchool.
The firft volume contains eight differtations, which we fhall now notice in order.
The firft is by the Profeffor himfelf, and treats Be Hernia , vel prolapju Cordis humani. — The length and importance of this differtation require a fuller notice than we can at prefent beftow on it. Referv- Ing this, therefore, for a future confide ration, we pafs on to the fecond, Be Oleorum dale him vir lute Medica Refolvente. Auc. IV. A. Berniere , Venlonienji,— Re- folvent medicines, the author obferves, are thofe which are capable of reftoring to their former fluid¬ ity, in the living body, any infpiffated or concrete matter obftrudfing the veffels and impeding their funftions. Amongft medicines of this clafs, the mild oils hold a diflinguiffied flation. Thefe are de¬ rived either from the animal or vegetable kingdom. Of the former the author reckons the yolk of egg, freili cream, and butter, the fat of deer and goats. Of the latter, the exprefled oils of the poppy feed, of fweet almonds, and of olives.
The, firft purpofe to which thefe remedies are ap¬ plicable, is that of refolving extravafated and coagu¬ lated blood, as in coptufions, &c, That they dif-
folve
/
Leidenfrofl Opufcula Phyficv-Chemica, 8V. 57? ‘
folve coagulated blood out of the body, the author af¬ firms from experiments made to determine this point.
In bilious difeafes, the mild oils are faid to be of much feivice, from their power ot diftblving concrete bile. But it may be afked here, and in the former cafe, granting their folvent power, how are they to be made to reach, unchanged, the peculiar feat of thedifeafe? ^ '
In dyfentery the ufe of ojl is indicated by the Hate of the tongue, which becomes covered with a denfe, brown, and tenacious cruft, not to be removed by trillion or wathing, but which readily difappears, the author fays, on being fmeared over with fweet oil. He thinks it probable, that the whole of the primal vke is covered with the fame infpiffated mucus, re¬ quiring the internal ufe of the mild oils.
This^ refolvent quality of thefe fubftances, render them, in the author’s opinion, ferviceable in cafes of concreted wax in the ear, in the fcabby eruption on the heads of children, termed favus , in every cafe, in fhort, where infpiftated mucus is prefent," occa¬ sioning obftruftions, or otherwife impeding the animal functions.-— We believe the author to be under a miftake, in fuppofmg the mild oils capable of dif- folving concreted mucus.
The next diftertation is on Afthma : the author* Englebert R o nfi o rffc . — A ft h m a. , according to the au¬ thor, is diviftble into different, fpecies, according to the parts immediately atfefted, and the caufes which induce the difeafe. Thus we have the fpafmodic or convulftve afthma ot W illis. In this fpecies, the itrudture of the lungs is natural, and their functions unimpaired, excepting during the time of the pa- roxyfm, which is brought on by flight caufes, and efpecially by paflions of the mind.
The fecond fpecies is that arifmg from debility, or paralyfiSe In this cafe, the intercoftal mufcles and
diaphragm
578 Leidenfroft Opufcula P hyjico-Chem ica,
diaphragm are fuppofed to be the immediate feat of
the difeafe.
The feat of thev third fpecies is the larynx. This, the author obferves, is by far the molt frequent, though commonly afcribed to the lungs themfelvesr In this cafe a peculiar hilling found is heard on in- fp] ration 5 (hewing the rim a giottidis to be contracted, or fome how obftruCled.
The fourth fpecies of afthma is that where the lungs thernfelves are the immediate feat of the dis¬ order: fuch as, adhefion of the lungs to the pleura, the confequence of previous inflammation ; an cede- matous or emphyfematous ftate of thefe parts ; tu¬ bercles ; ulcers ; calculi ; polypous concretions, and other organic affections.
In the fifth fpecies, the thorax is the part affefted, exclufively of the lungs; fuch are a debilitated or paralytic It ate of the mufcular parts before noticed ; a gibbous ftate of the cheft ; a callous or oilified con¬ dition of the pleura in fome parts; fraCture of the fternum ; and, dropfy of the cheft.
The next head refers to thofe afthmatic cafes which arife from affeCtions of the heart, or its veffels.
Laftly, the author treats of the fpurious afthma, the c.aufe of which is feated in the abdomen : as dif- tenfion of this cavity, from various caufes.
The mode of treatment muft, of courfe, be regu¬ lated according to the different fpecies, and is, for the moft part, fufficiently obvious.
(To he continued .)
i
Art.
( 579 )
Art. LXVI. A Collection of En g ravings , repre- Jenting the moft Modern and improved Inftrnments iifed in the Practice of Surgery : with appropriate Explanations . By j. H. Savigny, Surgeons Jnftmment Maker » London. Folio, price Si. Ss6 1798.
MR. S A VIGNY obferves, that in the courfe of nearly twenty years engagement in the bu¬ ll nets of inftrument-making, he has frequently had caufe to lament, as a workman, that we were not better furnilhed with engravings ands fuitahle expla¬ nations of the numerous articles which conftitute in- difpenfable appendages to a branch of fcience, pe¬ culiarly dignified by its importance to mankind, by the talents of its profeflbrs, and by its rapid improve¬ ments : he has Hill more deeply regretted that fuck a deficiency Ihould exift in this country (juitly famed for the cultivation and encouragement of every de- fcription of ufeful arts), when, in two others, works have been publhhed, in which the accomplifhment of what he now aims at, has been very nearly attain¬ ed. He means thofe of Brambilla at Vienna, and of Peret at Paris. Without wifhing to depreciate the merit, or leffen the utility of thofe performances, he is compelled to obferve the ill-execution of the former, while the latter, whofe plates are finhhed in a ftyle altogether mafterly, has admitted fo many tedious minutiae, both in the defigns and letter-prefs, that much ufeful information is thereby excluded.
In the publication of thefe engravings, which are thirty-nine in number, the author nas lendeied an important fervice to lus fellow-workmen, in the pio- fecution of their callings, and a welcome audition to the libraries of the curious. He has not entered into a comparative biftory of old and new inftruments, nor reprefented thofe which are now obfoletc , but has ,
confined himfelf to thorn which are mod. appro\ed,
and
580 Savignys Collection of Engravings,
and generally in ufe at the London hofpitals. In the defcriptive part of the work, he has pointed out the particular inventions of diftinguilhed furgeons; and, as occaiion required, has given a detail of the altera¬ tions and improvements fuggefted by himfelf.
The engravings reprefent the exadt fize and pro¬ portion ot each inftrument ; except in fome large machines, which are reduced to a more commodious fcale. In the general arrangement, due attention has been paid to the connexion and ufes of the inftru- ments.
general
GENERAL VIEW
OF THE
PROGRESS OF MEDICINE,
THE prefent age is peculiarly characterized by
an ardent third after knowledge* and, its ge~
general concomitant, an ,eager defire of novelty.
%
In medicine, thefe have led to a driCt inveftigation of former doCtrines, and, generally, to their down¬ fall ; for fpecuiations on the fcience of medicine, have been more i&gue, and lefs fupported by faCts, than any other branch of human knowledge. — Hence, it is little to be wondered at, that fyftem has followed fyftem, and that every fucceeding profefifor has laboured to eftablifh his own hypo- thefis on the ruins of that of his predeceffor. The fame love of novelty has prompted men to an eager fearch after new remedies, though not always, there is veafon to believe, to the advantage of the art. The materia medica has fwellcd, by this means, to an enormous bulk: and an imperfeCt acquaintance with the virtues and powers of me¬ dicines has been the neceffary confequence. For the mod extenfive experience, and mod indefati¬ gable zeal, will hardly fuffice to make us thorough¬ ly acquainted with even a few of the mod aCtive
remedies in general ufe.
VOL, V,
A wider
Tt
582
Progrefs of Medicine .
A wider diffujion of knowledge, likewife, cha¬ racterizes the times we live in. Science no longer fixes her abode in the recedes of the College ; nor are fkill or fame monopolized, as heretofore, by a few. If this be an advantage to fcience in general, to medicine it is peculiarly fo. This is altogether a fcience of obfervation. Its principles are found¬ ed in experiment, and could not be inferred, a priori , by any depth of refearch. The field of medicine is of wide extent, embracing, indeed, the whole of human-. nature-. Opportunities for ob¬ fervation are never wanting to him who is ready to lay hold ot them. Every village is a fchool of medicine to the induftrious and obfervant prac¬ titioner.
Thefe truths are now generally felt, and the com fequences that might have been expected, have actually followed. Practitioners of fkill and judg¬ ment are not confined to the metropolis. Many of the lateft and molt important difcoveries take their origin from the provinces, which begin to contri¬ bute their fhare to the general flock of knowledge. The exertions of individuals have done more to¬ wards the extenfion of fcience, than has ever been accomplifhed by the collective efforts of corporate bodies, (if, indeed, any efforts have been made.)
Efiablifhments of this kind are much better fuited to prelerve, than to advance, the principles of
knowledge ; and in an art fo imperfeCt as that
of medicine is, -are much more likely to perpetuate
prejudice and error, than to foiler improvement, or
to ftimulate- to extraordinarv exertion.
„ +
v & •
a
This
Progrefs of Medicine, 583
.. " i s.t . .s . '■ f .t'. V n . *
is diffufion of knowledge and ardour for en¬
quiry, are attributable, in part, to a better mode of education, but principally, without doubt, to the circulation of compendious and periodical publica¬
tions. Fa that would other wife be confined to
the ftudious and the opulent, by the help of thefe ready vehicles, make their way with facility to the remoteft parts. Thus the number of obfervers is multiplied, the field for difcovery is enlarged, and fcience advances with rapid ftrides.
If fuch be the advantages accruing to medicine from the prefent ftate of things, it is not to be de¬ nied, that evils have at the fame time crept in. Men are prone to run into extremes. Obfervations are too haftily made. The love of novelty carries, us too rapidly along: ever in the purfuit of fome- thing beyond us. We negleft fufficiently to cultivate the objects which are immediately under our notice. No fooner are a few fafts obferved, and thofe.
perhaps, imperfe&ly, and with a prejudiced eye* than we haften to conftruct a fyftem, and torture
former obfervations to bend them to our purpofe. Faffs are no longer feen in their proper colours. They take a tint from the medium through which they pafs. Hence, the very fource of knowledge becomes polluted, and it is with he fixation and referve, that we can venture to appeal to writers for the moil fimple faffs*. The advantages of ac¬ cumulated experience, and of fucceffive obfervers are thus diminifhed, and in great meafure loft, and each inquirer has to begin the fame career. Thus
Tt 2 it
584 Progrejs of Medicine .
it is that the real advances of our art are fo flow and queftionable.
The caufe of all this, undoubtedly, is our great ignorance of the laws which regulate the animal oeconomy. If we ever attain to a clear knowledge of the operations of nature ; could we but apply the fure principles of chemiftry or mathematics, to the explanation of the fun£tions of living bodies, then might wTe, indeed, build medicine on a liable bafts. Our art would no longer merit the epithet of conjeftural, nor would it longer be made a quef- tion, whether on the whole it be a blefling or an injury to mankind.
In reviewing the progrefs which has been mad® in the different branches of our art. Pneumatic Me¬ dicine firft attrafts attention. In this, little has been done of late, and that little has by no means tended to enhance our expectations of its utility. We have hardly any teftimonies on the fubje£l, befides thofe which have been brought forward by Dr. Beddoes in his late Colleftion*. A few inftances are adduced, in favour of the infpiration of different gaffes, but they have been felefted from a mafs of a very mixed complexion. The propofal formerly made by the author, of living with cows, for the relief of pulmonary confumption, has been carried into effeft in four inftances. In two of them, no
' 'K.
* Contributions to Phyficai and Medical Knowledge, chiefly
from the Weft of England,
effe£l
585
Progre/s of Medicine,
effeCt was obferved. In the others, fome apparent relief of the fymptoms took place, though they both terminated fatally. In the greater number of inftances, where modified airs have been employed, other obvious means of relief have accompanied their exhibition, and the event has thus been left in uncertainty. Further and more elaborate re- fearches. Dr. Beddoes candidly acknowledges, are undoubtedly wanting, to determine what {hare the gaffes had in the favourable refult. On the Con¬ tinent, the matter has been taken up with much eagernefs, and practitioners are as much at variance, as in this country.
On this fubjett, the teftimony of M. Fourcroy is of the firfi: weight. He will not be fufpeCted of detracting in any degree from the juft merits of the new doCtrines. He is, however, fufficiently aware of the revolutionary fpirit which has in- feCted medicine, no lefs than politics. 4 That che¬ mical doCtrine/ he obferves, * * the moderate and prudent application of which may extend our know¬ ledge of the animal ceconomy, feems already to mif- lead minds, in other refpeCts enlightened and in¬ genious. They wifli to rear an edifice, without having collected the materials. We are yet far from pofleffing the requifite data, and that collec¬ tion of truths neceffary to form a complete doc¬ trine, a new medical fyftem. Scarcely do wTe know fome of the phenomena of certain functions in the
* Annales de Chimie, No. 34.
T t 3
animal
CSC
Prpgrefs of Medicine
economy ; Scarcely have we made any fbrtu~ pate applications of the modern pneumatic difcoye- ries 3 and already we begin to draw from them ge¬ neral induftions on the nature and caufes of difeafe $
fir ■* \ '■ •' • 4 ‘ -* f ' ‘ " ‘ • 7 ' ' ' ■■■■•- '■ i * • '-■> 4 * .»»••£.< -
fearcely have we iketched the analyfis of feme of the principal humours in a ftate of health, and al¬ ready pretend to clafs difeafes after the chemical changes of liquids, and to form a humoral nofolo- gy. We fpeak of claffing difeafes according to the excefs or defeiepey pf azote, oxygen, or carbon, before the proportion of the principal co.nftituen.tS in any particular apimal fubftance is ascertained/
Upon the whole, with refpeft to the aerial reme* dies, there is no reafon to doubt, that they are ca¬ pable of powerfully impreffing the living aft ions, and thus of becoming valuable auxiliaries in the treatment of difeafe. But there does not yet feem Sufficient ground, for concluding, that they aft che- mically, effefting a change in the composition of the folids or fluids, a point which has been much infilled on by the chief favorers of the pneumatic fyftem. Chemical changes are induced with much greater fimplicity and certainty. The aftion of modified qirs on the human body is equally uncertain and in- calculable, a priori , with that of the moft fimple exciting powers. Candour, however, mult allow, that the queftion has not yet been fully and fairly brought to the teft of experiment. The inhalatioq of modified airs for a few minutes daily, is very in¬ adequate to fhew what may be pxpefted from their
continued
Progrcjs of Medicine . 58?
continued infpiration. Nor can it be properly and effedtually tried, but by means of fome public in- flitution. On this head we are happy to announce, that the Pneumatic Infirmary, proje&ed by Dr. Bed* does, is likely to be fcon fet on foot.
The application of the acids, and other analogous fubfiances, for the cure of the venereal difeafe, may be confidered as a branch of the chemical patholo¬ gy. No one will hefitate to admit, from the extent of the evidence brought forward, that the new re¬ medies poffefs a very confiderable power over the difeafe in ail its ftages, and that they have, in nu¬ merous inftances, effected permanent cures. It ap¬ pears, likewife, fufficiently afeertained, that their operation is lefs injurious to the general health, thaii the long continued employment of mercury, many of the ill effefts of which, they obviate or remove. At the lame time, it is no lefs certain, that many re- lapfes have occurred after apparent cures by their ufe, and that they have fometimes failed altogether in affording any relief, in the hands of able and im¬ partial praftitione-rs. Sometimes, this has evidently arifen from the want of minute attention to quanti¬ ty, and other circumftances, Yet With every allow¬ ance of this fort, mercury appears to poffefs fupe- rior powers, which it has often fhown, by fpeedily removing fymptoms that had before refilled the full ap- plicatipp of the new remedies. We have yet to learn the particular circumftances which give decidedly a preference to one rather than the other.
T t 4
The
58S Progrefs of Medicine.
The Second Edition of Dr. Rollo’s valuable Treatife on Diabetes affords much additional evi¬ dence in favour of the treatment by a ftri£t animal diet. Whether it tends equally to confirm his theory, admits of queftion. The arguments adduc¬ ed againft the fuppofition of the kidneys being the primary feat of the difeafe have great weight, and detract much from the confidence we felt on the fubjech Morbid changes have often been obferved in the kidneys, in the ftomach, and in other organs $ but none of them have been conftant, and cannot, therefore, be confidered as effential. In Ihort, there are difficulties attending every hypothefis which has been hitherto offered on the fubje£t; and we are (till, probably, ignorant of the firfl and jnoft important points. The value of the praftice, however, will remain ; but, as the difeafe is founded originally in a morbid aftion fomewhere, it cannot he expefted to be uniformly fuccefsful, though it' may relieve the rooft preffing and troublefome fymp» toms,
A more curious and mterefting fubjeft of inquiry has feldom appeared, than that of the Cow-Pox. The being able to fuperfede a difagreeable and fometimes dangerous difeafe, by one of comparative mildnefs, and ultimately perhaps to exterminate a loathfome and very fatal malady, prefented advan* tages, the value of which could not eafily have been eftimated. Refpefting its origin in the cow, it be¬ came a very natural fpeculation, to refer the origin
of
569
Progrefs of Medicine .
of fmall pox, and perhaps of the other contagious difeafes, which have made their appearance in the later ages, to the fame or fimilar fources. The points of difagreement, however, are fo many, that it is impoffible, at prefent, - to admit fo general a con- clufion.
With regard to fubdituting cow-pox for variolous matter in the practice of inoculation, the fird point to be afeertained is, the eondant and certain pre¬ vention, by this means, of the fmall pox. Many di- re£l experiments have proved, that the fufceptibili- ty for the latter has been dedroyed, by inoculation w ith the cow-pox poifon; but whether permanent¬ ly, or only for a time, has not been {hewn. At the fame time, more than one indance has been adduc¬ ed* of the fmall pox taking place, and that feverely, where the cow-pox had before exifted. Should thefe turn out to be clear and well-atteded fadis, the new pradtice, we apprehend, mud drop. For the fuperior advantages of this over the variolous inoculation, though allowed by mod, are yet fo trifling, or fo equivocal, as to be altogether denied by others. The cow-pox is faid never to have proved fatal : but the number of cafes of the dif- eale on record is comparatively fmall. Out of more than feventeen hundred patients inoculated in the courfe of the lad year, at the Small-pox Hofpital, two only died. The inference is obvious— We are glad to announce, that a publication on this intend¬ ing fubjedt is Ihortly expefted from Dr. Woodville.
On
* Vide Contributions to phyfical and med. Knowledge, p.387, and medical and phyfical journal, p«
390 Progress of Medicine .
On Gal vanifm we have of late had nothing new in this country, unlefs the Metallic' Traftors- of Dr. Perkins be referred to this head. We fated fairly the pretentions which this novel praftice h&d in its favour, and left the queftion to the teft of fur¬ ther trial. Many perfons have declared that they have experienced all the benefits from the metallic traftors, which their author taught them to expect. Others, again, have doubted their efficacy, after trial. Some, we have found, imagine that they ope¬ rate by a magnetic influence of the fteel point* on the iron contained in the blood ; and thefe have found the fame effeft from the fteel point only, as from both combined, and have even fubftituted a pair of fciffars, or other inftrument of iron, fox the fame purpofe : whilft Dr. Perkins infifts on the union of the two metals, as forming the effential caufe of their effeft. Profeffor Schumaker of Copenhagen tried traftors of ebony and ivory, which are faid to have cured a pain in the knee— In this contrariety of opinion/one is apt to conclude, that too much has been attributed to the fubjeft ; and, admitting their good effefts, to impute them to more than one caufe. They may aft as conductors of eleftricity, as me* cha.nical ftimuli, and alfo by the effects of imagi¬ nation.
Dr. Crichton, in his valuable work on Mental Derangement, has done more than his title led us to expect. It is, in fact, a hiftory’of the faculties
* The tractors con fi ft of two fmall tapering pieces of metal about three inches long ; the one apparently of fteel, and the other of a yellow metaJU
and
Prog rf/s of Medicine . 591
p.QWS of the human mind. We cannot, how¬ ever, think him warranted inaffuming the exigence pf a pei^ous fluid, calculating, even, its quantity, and reafoning on its effe£ls, as if it were capable of deraonftration. The gratuitous admiflion of this, is certainly not reconcilable with thofe found princi¬ ples of philofophy which govern him in the general execution of his work.
m- • y.
Amongft the individual fuggeftions for improv¬ ing the practice of medicine, that of Mr. Ware, with regard to Fiftula Lachrymalis, merits particu¬ lar notice. The cure of this difeafe, in the hands even of the afaleft furgeons, has been painful, te¬ dious, and uncertain. The operations pra&ifed for its cure have very frequently failed to effeft it, and feeming cures have as often been followed by lelapfe. By the employment of a llyle, for the purpofe of keeping the lachrymal duft pervious, in the manner here pointed out, the treatment of a very troublefome affeflion is materially Amplified, from the known accuracy of the author, there is po room to doubt, that it will prove as fuccefsful in the hands of other prafiitoners, as it feems to have done in his own.
The effe&s of compreffing the larger arteries, by means of tourniquets, as related by Mr. Kellie, ^re highly deferving notice. Though feveral years have elapfed, fmee his Arfl: mention of the fubje£t. We Ute forry to fee it has not been purfued by other
inquirers0
1*1, ' - i
592 Progrefs of Medicine .
inquirers. Compfeffion of the extremities, indeed, by ligatures, made a part of the older materia medica ; but the rationale of its operation, and the praCtice itfelf, have both become obfolete and for¬ gotten. It is not improbable, that here, as on many other occafions, in rejecting an hypothefis, we have facrificed along with it an ufeful aid in the removal of difeafe. From Mr. Kellie's ac¬ count, compreflion of the larger arteries affords a powerful means of influencing the general (eco¬ nomy, and there is little doubt that it is applicable in the treatment of many diforders.
The remarks of Mr. Simmons on cancer afford fome grounds to hope, that this terrible fcourge of mankind may at length find a powerful opponent in arfenic. Yet when we reflect, that this fubftance has generally formed the principal bafis of the boafted panaceas of empirical practitioners ; and that it has never long together retained its fame ; we are involuntarily led to withhold our confidence. In reality, the proper diftinCtive marks of cancer are no where fatisfaCtorily laid down. Difeafes have been called cancer, which were of a very different nature ; and thus cures have been a fi¬ ler ted, and encomiums bellowed on remedies, to which further trials have fliewn them to have no fort of pretention. A character of cancer, that flball enable us to cliftinguifh it with certainty, in its different ftages, from other affections, to which it
bears
Progrefs of Medicine. S9S
bears a refemblance, is ftill a defideratum of our art.
The fame powerful remedy above-mentioned feems, in many trials, to have produced con- fiderable effects in hooping cough, a difeafe which has been little influenced by any former propofal for its relief. When we recoile£t the great and de¬ cided powers of arfenic in checking the progrefs of intermittents, analogy, no lefs than experiment, firengthen our hopes of its good effefls in the cafe under confideration.
. * i * #
Dr. Ferriar’s remarks on the Croup, fpeak with much confidence in favour of the antiphlogiftic mode of treatment in that formidable difeafe of infancy. Of late, a new practice has iprung up in America, and which is faid to have been eminently fuccefsful, confifting in keeping up a conftant fti- mulus in the throat and fauces, by gradually fwal- lowing a ftrong deco&ion of the Seneka root ; and if this fails of fpeedily affording relief, the full ufe of mercury is reforted to. Of this practice we fhall loon have occafion to fpeak more fully.
In treating of Difeafes of the Skin, Dr. Willan has undertaken a difficult and important talk. There is, perhaps, no branch of medicine which has been handled with lefs fuccefs. Writers are not at all agreed in the terms which they have adopted, and have often given different names to the fame affec¬ tion, and claffed others which are widely different
upder
594 Progrefs of Medicine*
under the lame head. It is indeed difficult to con¬ vey in language all the minute fhades which the eye perceives, without calling in the pencil's aid„ This has now been done with much fuccefs, and a ftandard been begun, to which future enquirers may With confidence refort.
The judicious 'regulations adopted at Manchefter in the inftitution of Fever Wards, as fuggefted chief¬ ly by Dr. Ferriar, niuft not pafs uniVoficed. They fhew how much the health and welfare of the com¬ munity depend on local management and {kill.— Medicine, indeed, compared with this, is but a fecondary confide ration? in as much as prevention is better than cure.
Our readers will fee that we have palled over many articles which are interefting in a cohfider- able degree. Their merits* will beft appear on perufaL
CATALOGUE
* <fe
J
CATALOGUE OF BOOKS,
IN THE
different Branches of Medicine and Surgery ,
.r .
PUBLISHED IN THE YEAR 1798.
1. A NEW Syttem of Phyfiology, comprehending the Laws by which animated Beings in ge¬ neral, and the human Species in particular, are go¬ verned, in the various States of Health and Difeafe* By R. Saumarez, Surgeon to the Magdalen HoP pital. 2 vols, .8 vo. boards, 1 4s. Cox.
2. A Treatife on Leeches, wherein the Properties, Ufe, &tc. of that valuable Reptile is clearly fef forth, B y George Horn. Is. 6d. bound. Symonds.
3. A new Edition of Dr. Wallis on the Art of preventing Difeafes and reftoring Health, with con- fiderable Alterations and Additions. 7s, 6d. bound. Robinfons.
4. Enchiridion Syphiliticum ; or Directions for the domeftic Treatment of Venereal Complaints. Byf /L P . Buchan , M. D. 2s. 6d. Callow,
5. An Effay on the Gout, with a candid ExamU
nation, &c. of Dr. Latham’s Principles. By George JValiis, M. D. &c. 4s. Robinfons.
6. A Lecture introductory to a Courfe of popular, InftruCtion, on the Conftitution and Management of the human Body. By Lhomas Beddoes , M, D. 8vo.
Is. 6d. Johnfon. . , ,
7. Nereis Britanmca; ora Botanical Delcriptiorrot
Britidi Marine Plants, in Latin and Lngiifh, with . Drawings from Nature. By /. Stdckhoufe , Efq. * F. S. L. Fafciculus Secundus, contaming/rwenty-two Specimens of f uci 12s. 6d, White.
I
496
Catalogue of Books.
8. A Philofophical and Praftical Treatife en Horfes. By John Lawrence. In 2 vols. 8vo. 15s. in boards. Longman.
9. Defcription and Treatment of Cutaneous Dif- eafes ; Order I. containing papulous Eruptions on the Skin. By Robert Willan , M. D. F. A. S. With Seven Plates, printed in Colours, 15s. Johnfon.
10. Annals of Medicine, vol. 2. for the Year 1797, exhibiting a concife View of the lateft and mold im¬ portant Difcoveries in Medicine and Medical Philo¬ sophy. By. Meffrs. A. Duncan , Sen. and Jun. M. D. 7s. boards. Robinfons.
1 1. An Appendix to the firft Edition of the Morbid Anatomy. By Matthezv Baillie , M. D. F. R. S. 2s. 6d. Johnfon.
12. An Effay on the Medicinal Properties of Fac¬ titious Airs, with an Appendix on the Nature of Blood. Bv Tiberius Cavallo , F. R. S. 5s. boards. Dilly.
13. The Soldier’s Friend; or, the Means of Pre¬ ferring the Health of the Military Men who may be called into the Service of their Country in the prefent Crifis. By Mr. Blair , A. M. Surgeon of the Lock Hofpital. 2s. 6d. Longman.
14. An Enquiry into the Nature and Caufes of the great Mortality among the Troops of St. Domingo. By Hector M‘Lean , M. D. 6s. boards. Cadell and Davies.
15. A Syftem of Dilfe&ion; explaining the Ana¬ tomy of the human Body, the Manner of difplaying the Parts, and their varieties in Difeafe. By Charles Bell. Folio, 5s. 6d. Johnfon.
16. An Enquiry into the Nature of Mental De¬ rangement ; comprehending a concife Syftem of the Philofophy and Pathology of the human Mind ; and an Hiftory of the Paffions i nd their Eifefts. By Alexander Crichton , M. D. Phyfician to the Weft- minfter Hofpital, and Public Lecturer in the Theory and Practice of Phyfic and Chemiftry. 2 vols, 12s* boards. Cadell and Davies.
• , . v V. J. I , \ f\ ■
Catalbgue of Books ; 597
' f j / . ....
17. Reflexions on the Surgeon’s Bill, in an Anfwer to three Pamphlets in Defence of that Bill. By John Ring, Member of the Corporation of Surgeons. 4s. 6d. boards. Hookham and Carpenter.
18. The Influence of Metallic TraXors on the human Body, in removing various painful inflam¬ matory Difeafes. By B. D . Perkins , M. M. Son of
Dr. Perkins of North America, the Difcoverer. 2s. 6d John fon.
19. Obfervations on Infanity, with praXical Re¬ marks on the Difeale, and an Account of the morbid Appearances on DifleXion. By John Hajlam. 3s. Rivingtdhs.
20. A Third Diflertation on Fever, Part 1ft. con¬ taining the Hiftory and Method of Treatment of a regular continued Fever, fuppdfing it is left to purfue its ordinary Courfe. By George Fordyce , M, D. F.R.S. 4s. Dilly. 1
21. Remarks on the Fiftula Lachrymalis,' with the ;
Defcription of an Operation different from that com¬ monly ilfed, and Cafes annexed. By James Ware ,7 Surgeon. 3 s. Diiiy. . . , ; -
22: Maxims of Flealth. By R. Squirrel /, M. D. Is. Mb r ray and Highley.
23. Medical Hiffories and RefleXions. Bv John
j .
Ferriar, M. D. Volume 3d. 5s. boards. Cadell , and Davies. . '
24. Medical Refearches, feleXed from the Papers of a Private Medical Affociatioii. Vol. 1. part 1.
Cox.
25. ; Defcription and Treatment of Cutaneous Dif¬ eafes, illuftrated with Plates. By Robert Willan, M. D. F. A. S. Parti. 4to. 1 5 s. John fon.
26. Obfervations on the StruXure, Economy, and Difeafes of the Foot of the Horfe, and on the Prin¬ ciples and Practice of Shoeing. By Edxvard Cole¬ man, Profeffor of the Veterinary College, Ike. 4to. 12s. boards. Johnfon.
27. Dr. Underwood on the Diforclers of Childhood.
3 vols. 12mo. 10s. 6d. fewed. Mathews.
Uu
VOL, V.
598
Catalogue of Books .
28. EfTay on the Venereal Difeafe and its conco¬ mitant Affeftions, illuftrated by a variety of Cafes. Effay 1, Part 1.
lft. On the antivenereal Effefts of Nitrous Acid, Oxygenated Muriate of Potaih, and feveral analogous Remedies, which have been lately propofed as fub- ftitutes for Mercury. By William Blair , A. M. Sur¬ geon of the Lock Hofpital and Afylum, and of the Old Finfbury Difpenfary. 4s. johnfon.
29. A comparative View of the Chemical and Me¬
dical Properties of the Briftol Hotwell Water; to which are added, diet Rules for Invalids. By Dr, Willich , Phyfician to the SaxOn Embafly, Author of the Elements of the Critical Philofophy, &x. 6d.
Longman.
SO. A J unification of the Right of every well- educated Phyfician of fair Character and mature Age, refiding within the Jurifdi£tion of the College of Phy- ficians of London, to be admitted a Member of that Corporation ; with the Opinion of the legal Judges, &c. By Chrijiopher Stanger , M. D. 8vo, 8s. Johnfon.
31. The Seaman's Medical Advocate ; an Attempt to fhew that Five Thoufand Seamen are Annually, during War, loft to the Nation in the Weft Indies, through the Yellow Fever, and other Difeafes, from Caufes which, it is conceived, are chiefly to be ob¬ viated, By Elliott Arthy , Surgeon in the Weft India Service. 5s. boards. Richardfon and Egerton.
32. A Third Difiertation on Fever, Part 1. con¬ taining the Hiftory and Method of Treatment of a regular continued Fever, fuppofing it is left to purfue its ordinary Courfe. By George Fordycey M. D. 4s. fewed. Johnfon,
S3. View of the Science of Life ; or, the Principles eftablifhed in the Elements of Medicine, of the late John Brown, M. D. : with an Attempt to correft fome important Errors in that Work ; and Cafes in Uluftration, felefted from Records of their Practice at the General Hofpital at Calcutta. To which is
599
Catalogue of Books .
added, a Ireatife on the Aft ion of Mercury upon living Bodies, and its Application for the Cure of Difeafes of indireft Debility, and a Differtation on the Source of Epidemic and Peftilential Difeafes, 8cc. By William Yeates and Charles Maclean of Calcutta. 5s. boards. Philadelphia printed. Cuthell.
34. The Arguments in favour of an inflammatory Diathefis in Hydrophobia confldered ; with Reflec¬ tions on the Nature and Treatment of the Difeafe. By Richard Pearfon , M D, Is. 6d. Seeley.
35. General Rules and Infractions, very neceflary to be attended to by thofe of both Sexes who are af-< flifted with Ruptures. By -William Turnbull, A. M. Surgeon to the Eaftern Difpenfary, and the Society for the Relief of the Ruptured Poor. Is. 6d. Johnfon.
36. A View of. the Perkinean Eleftricity; an En¬ quiry into the Influence of the Metallic Tractors, founded on a newly-difcovered Principle in Nature, and employed as a Remedy in many painful inflam¬ matory Difeafes ; as Rheumatifm, Gout, 8c c. Scalds, Burns, and a variety of other topical Complaints: with a Review of Mr. Perkins’s late Pamphlet on the Subjeft. To which are added, a variety of Expe¬ riments for ascertaining the Truth of this Doctrine. By Charles Langivorthy, Curate of Bath. Is. (> d» Johnfon.
37. Cautions to Women refpefting the State of Pregnancy, the Progrefs of Labour, and Delivery ; and on fome conftitutional Dileafes. By Sequin Henry Jackfon , M. D. Phyficiari to the Infirmary of St. George, Hanover Square, 4s, boards. Robfon.
38. An Effay to inftruft Women how to proteft themfelves from the Diforders incident to Pregnancy, or how to Cure them ; with Obfcrvations on the 1 reat- ment of Children, By Mrs. Wright , Midwife. Is. Barker.
39. A compendious Medical Dictionary. By R. Hooper, M. D. 5s. 6d. boards. Murray and Highley.
40. Cafes of the Diabetes Mellitus, with the Re- fults of the Trials of certain Acids, and other Sub-
U u 2
600
Catalogue of Books.
fiances in the Cure of the Lues Venerea. By John RollOy M. D. Surgeon-General of the Royal Artillery. Neve Edition, with large Additions, 8vo. 8s. boards. Billy.
'41. One Hour’s Advice reipeCting their Health to Perfons going out to Jamaica, with a Defcnption of the In and. By R. Wife* Is, 6d. Johnfon.
42. Lecture on Diet Regimen ; being an Enquiry into the Means of preferring Health; with Physiolo¬ gical and Chemical Explanations : calculated chiefly for the Ufe of Families, in order to banifih the >pre~ vailing Abides and Prejudices in Medicine. By A< T.M. TVillichy 1VL D. 8vo. 12s. boards. Long¬ man.
43. Obfervations and Experiments on the Broad- leaved Willow Bark. By W. White , Is. 6d. Ver- bot and Hood.
44. A Treatife on Scrophulous Difeafes, {hewing the good Effects of Factitious Airs: with Cafes and Obfervations. By Charles Brown . 8vo. 3s.- 6d. Glen dinning.
45. Efims du Sommeil, et de la Veille dans le Traitement des maladies Externes. 8vo. Paris .
. 4-6, Recherches Critiques fur la IVme Section d’un Ouvrage ayant pour litre, e£ Be la Connexion dc la vie avec la Refpiration,” par E. Goodwin. Par 7. 6. Caron. 8vp. Paris.
47. Effai fur la Nouvelle Doctrine Medicale de Brown, en forme de Lettres. Par Pvianuel Rizo , de Conftantinople, DoCteur en Medecine. Paris.
4.8. Analyfe Raifonee du Syfterae de Brown, con- cernant une M'ethode Nouvelle et Simplifiee de Trailer les Maladies en general, appuyee de diffe- rentes Obfervations. Par Rodolph Abram Schiferti , M. D. et Chir. Pams.
49. Nofographie Philofophique ; ou la Methode pl’Analalyfe appliquee a la Medecine. Par Ph . PhineU Profeffeur a l’Ecole de Medecine a Paris.
50. Sur la Dyfenterie, Par Wedekind , Medecin Enchef dTHofpital Militaire de Mayence. Paris .
Catalogue of Books .
601
51. Tabulae Anatomicae quas ad Illuftrandam Ilu- mani Corporis Fabricam, Collegit et Curavit /. C. Loder , fafc. 1 — 5 fob Vinariae. 41. 5s.
52. Ludmigii , C. id de Quarundum iEgritudinurn Humani Corporis, Sedibus et Cautis Tabulae fedecim Meditat. Nonnullis liluRratae. Fob Leipfic.
53. tickle gel> Thefaurus Materia Mediae et Artis Pharmaceutical quam Collegit atque Edidit. 3 yob Svo. Lips.
/
\
INDEX.
I
I
INDEX
TO THE
FIFTH VOLUME,
1 A*
A BERNETH Y, Mr, J. on the Foramina Thebefii of the J,. X Heart - _ - - -
Abforbents, on the retrograde Motion of -
Account of Indian Serpents — - - 47 S,
Acids, ancient Ufe of in Lues Venerea _
Adhefive Plainer, Effects of in Tinea - _
Aerial Fluids, Mode of obtaining - - - —
Airs different, Effe6fs of in Cellular Membrane — — .
Alibert, M. furies Odeurs - - — _
Alyon. M. EffeUs of Oxygen in Lues Venerea - -
Amputation at the Shoulder, Cafe of - -
Amentia, Definition of — — _ _
Animal Heat, Remarks on — — - _ _ _
Anatomia Brittannica — — — .
Annals of Medicine for 1 797 - - - -
Aorta, Account of Rupture of — — . _ _ _
Apparent Death, Obfervations on - -
Appendix to Morbid Anatomy of Dr, Baillie
Argentum Nitratum, Ufe of in Epilepfy — —
Arguments in favour of inflammatory Diathefis in Hydrophobia
Arfenic, Ufe of in Hooping Cough - - JiU
- - — Effects of in Cancer - - 204,
Afthma, Tjeatife on — — — —
- - ■ — Cafe of, effe&uaily Cured - - — _
Differtation on
3r3
$ll
501
151
6S
47
4*
182
207
102
450
*3*
568
5Z
512
93
9
114
291 2 26 492 26
34
577
35*
Attempt to afcertain the Nature of the Pulfe - —
B.
Baillie, Dr. M. Appendix to his Morbid Anatomy — . —
Bark of the Willow, Ufe of — — — — —
Bell, Mr. Benjamin, Remarks on Nitrous Acid - -
Bleeding from Wounds, Means of Stopping - - —
Babington, Dr, W. extraordinary Cafe of Wound of the Heart Ibrlw, Mr. j. Cafe of f'sefarean Se£lion fuccefsfully performed 518
9
467
1 16
337
510
Index .
Beddoes, Dr. T. Teftimomes refpe&ing Nitrous Acid * —
• s introdudlory Le6iure to a Courfe of popular Inftru&ion
Bell, Mr. Charles, Syflem of Diffe&ions
Blood, Obfervations on the Natural Hiftory of * -
- -velfels, on the Situation of the larger — -
Bladder, Difeafed, new Method of treating - - -
Blair, Mr. W. Effays on the Venereal Difeafe —
Blizard, Mr. W. on the Situation of the larger Blood-vefTels
Bonhomme, M. Memoir on Rachitis - -
Brain, difeafed Appearances in - - - -
- - - Examination of - -
does not contain a Fluid in Health
48,
Bree, Dr. Robert, Inquiry on Difordered Refpiration
Britiih Lying-in Hofpital, Account of -
Brown, Obfervations on his Syltem of Medicine Brunonian Syltem, Remarks on — — - -
603
Page.
5*3
278
129
33 7 82
148
33 7 1 12
18 287 198 2 6 11 6 121 121
C.
Caillau, M. Prern. Lignes de Nofologie Infantile ~ 199
Calculus of the Stomach — — - 1 %
— — — - — Urinary, Obfervations on * - - — — 301
Caefarean Operation, Refleftions on - - — 488, 521
- - - - fuocefsfui Performance of — - — 518
Cancer, Obfervations on — — - — 489
— — — . of the Stomach, Symptoms of — 13
Cancerous Ulcer, Cafe of 1 ■ ■ — * - • 204
Carbonic Acid Gas, Means of procuring - 47
Carmichael, Dr. Teftimony of, resetting the New Remedies 558 Cafes of the fuccefsful Practice of VeficaLotura — 82
Cauftics, good Effects of in difeafed Joints — — 245
Ceratum Sabins, good Effe&s of — — - — - — - 245
Cavallo, Mr. T. ElTay on Fa&itious Airs — 40
. — — - on the Nature of the Blood — — 48
Clarke, Dr. J. Account of a Tumour in the Placenta — * 419
Chefton, Dr. R. B. fingular Cafe of Lithomoty 522
Clinical Ledures of Dr. Cullen - — - 318
Cline, Mr. H. new Remedy for Spafm of the Urethra — 513
Colours, extraordinary Fa&s relating to ■ — — - 1
Compreflion of Arteries, Effects of • * 55
Cours d’Etude Pharmaceutique — - - & 1
College of Phyficians, Remarks on - — — 95
Conflipation, Cafe of — “7
Confumption, Cure of by Mephitic Air - - - - 105
Continued Fever, Differtation on — * 208
Confiderations Philofophiques fur les Odeurs — 182
Cooper, Mr. A. curious Cafe of ftrangulated Inteftine — 469
_ 7 _ _ Account of Obltruaion of the Thoracic Du#
Cow-Pox, Inquiry into, by Dr. Jenner — 236
U u 4
604
Index .
Cow-Pox, Remarks on _ - _ -
Coindet, Dr. Obfervations on Animal Fat Corpulency, Remarks on
Collection of Teftimonies relating to the Nitrous Acid in
Venerea - - - - - -
Compendious Medical Dictionary, by Dr. R. Hooper Collection of Engravings of Surgical Inftruments — — .
Crichton, Dr. A. Inquiry into Mental Derangement
Croup, Obfervations on . _ _ _
Crowther, Mr. Bryan, on difeafed Joints
Lues
Page. 495 4.98 49 8
Curry, Dr. James, on apparent Death from Drowning Currie, Dr. reftimony refpeCting the New Remedies
Cullen, Dr. W. Clinical I.eCtures -
Cutaneous Difeafes, Treatife on - — -
D.
Dalton, Mr. J. extraordinary Fafts relating to Vifion
Darwin, Remarks on his Syltem - — -
Depreffion of Cranium, Recovery from without1 Operation
Defcription and Treatment of Cutaneous Difeafes _ _ —
Delirium, Remarks on ~ -
Death, Remarks on Apparent — — - -
De Corporis Humani Fabrica - -
Diabetes Mellitus, Treatife on — — — .
- - — State of Kidneys in - - -
Diaphragm, Remarks on . . - _ _ _
DiffeCtions, Syltem of - — — a- -
Dictionary, compendious Medical — — — -
Diary, Medical, for 1799 - - —
Dumas, M. Syft. Methodique des Mufcles _ _ _
Duties of a R egimental Surgeon, Treatife on - - ,
Duncan’s Annals of Medicine for 1797 — -
Dying, Remarks on the Treatment of - - -
52<
E.
Entire new Treatife on Leeches — -
Epilepfy, employment of Argentum Nitratum in EfTays on the Medicinal Properties of Factitious Airs
• - on the Gout - - - _
- on the Venereal Difeafe - - —
Extra-uterine Foetus, Cafe of Examen fur l’Exiltence d’un Fluide Cerebrales —
Experiments on Urinary Concretions
queux dans les Cavites'
553
573
579
343
221
2 45 93.
558
3,s
361
445
65
361
345
93
286
524
1S
*33
565
573
574 184
57i
TOI
23O
574
114
4°
40
148
105
198
301
F.
Factitious Airs , belt Means of procuring — - - - good Effects of in Scrophula
%
Index.
Fat, Animal, Obfervations on
Farre, Mr, J. R. Remarks on Cure of Hydrocele by In]e£tion Febrile Difeafes, Effects of arterial Gompreffion in
Fever, Differtation on ■ - ■ — - — —
Fever Wards, in Manchefter, Account of — •
Ferriar, Dr. {. Medical Hiflories and Reflexions, vol. 3 164,
Few general Rules and InftruXions in Ruptures • — •
Fifher, Mr. Miers, Account of change of Colour in a Negro —
Fiflula Lachrymalis, improved Treatmept of —
Foot, Mr. JefTe, on Vejica Loiura — •
Foramina Thebefii of the Heart, Obfervations on — >
Fordyce, Dr. G. Third DifTertation on Fever — -
Fyfe, Mr. A. Anatomia Brittannica
605
Page.
49^
523
*34 171
221 284
5 67
Sz 3i3 F34 568
G.
Galvan ifm, Report on - — 119
Gattric Fluid, life of in Ulcers - - — 113
Geach, Dr. his Remarks on Nitrous Acid — —— 556
Generation, Remarks on - — - — 1 19
Greafe in Horfes, fuppofed Origin of Cow-Pox — 119
Gout, Effay on _ - . - ■— 1 - •— -f
H.
Haighton, Dr. J. Cafe of Tic Doloreux — — —
Haflam, Mr. j. Obfervations on Infanity — Hammick, Mr. Teftimony refpeXing the New Remedies Hamilton, Dr. R. Duties of a Regimental Surgeon
- - Treatife on Hydrophobia - — — •
Hallucinatio, Nature of _ — — — -
Hsemorrhoidal Affections, Obfervations on —
Heavy Inflammable Air, Means of procuring ■ -
Heat, Enquiry refpeXing -
Head-ach, Remarks on — —
/ Heart, unufual Formation of w- — —
Hermaphrodite, Inftance of — — -
Hole, newly-difcovered in the Retina •**— ”
Home, Mr. E. Remarks on the Retina Hooper, Dr. R. compendious Medical Dictionary
Hooping Cough, Remarks on '
_ _ _ — : - Ufe of Arfenic in - — —
Hops, external Ufe of in Ulcers Horn, Mr. G. Treatife on Leeches _ — —
Hydrocephalus, Appearances on DiffeXion Hydrocarbonate Air, Means of procuring
, do. —
Treatife on, by Dr. R. Pearfon —
_ _ _ _ _ by Dr. Hamilton
Hydrocele, Remarks on
Hydrogen Air Hydrophobia,
469
iM
bH 5 n 45 * 449
76
46
308
3%
4I£
1 6
S3
401
573
225
1 1 1
1 *3
574.
18'
46
45
295
45 1 523
#
l
J
606 Index .
Hymen, Imperforate, Cafe of -
Hypochondriacs, Definition of
I.
Jenner, Dr. E. Inquiry on Variolas Vaccmx
Imperforate Hymen, Cafes of - - —
Inflammable Air, Remarks on — - —
Intermitten ts, Effects of Compreflion of Arteries in Injections, Ufe of in difeafed Bladder
107, 523
449
Inquiry into the C-aufes and EfFeCts of Variolas Vaccinse
■ - into the Source of the Heat excited by Friction
• - - into the Nature and Origin of Mental Derangement
Influence of Metallic Traitors, Treatife on ■ —
Infanity, Obfervations on Infpiiation, Remarks on
InftruCtion Sommaire fur BArt des Panfemens — — —
Inftruments, Surgical, Engravings of — -
Joints, Obfervations on difeafed . - .
Irritability, Remarks on — — — -
Hues, good Effects of in difeafed Joints - - - —
k8
Kali Purum, Ufe of in Hydrophobia « — -
Kellie, Mr. G. on the Effects of Compreflion by Tourniquets
- - - - on the Nitrous Acid in Syphilis
Kidneys, State of in Diabetes - - —
L.
Lagrange, M. Cours d’Etude Pharmaceutique —
Latham, Dr. Remarks on his Hypothefis on Gout — —
Le Roy, M. on the Medicinal Effects of Phofphorus Letter introductory to a Courfe of popular InftruCtion —
- — - — on the Situation of the large Blood-velfels — —
Leeches, Treatife on
Leidenfroft, M. Opufcula Phyfico-Chemica —
Life, Obfervations on - — - —
Lithic Acid, Experiments on the Nature of -
Lichen, Obfervations on — -
Ligamentous Union of the Tibia, Cafe of -
Lithotomy, fmgular Cafe of ■»
Lombard, M. fur BArt des Panfemens — — *
Lues V enerea, Cafes of, cured by the New Remedies
*53
55
101
*5
8t
87
205
278
337
574
576
120
3°5
367
510
522
i99
539
M.
Manchefter, Memoirs of the Philofophical and Literary Society
of, vol. 5, part 1 — - — I
Ma^ckie, Mr. j. Cafe ot Deprefiion of the Cranium — 65
Index .
607
Page,
Maniacs, Account of DifleXion of — — — - j 88
Mania, Obfervations on — — 446
Memoirs of the Literary and Phiiofophical Society of Manchefler,
vol. 5, part 1 - *— — » 1
Medical Hiilories and Reflexions, vol. 3 — 164, 220
Medical Gloflary — - — — 1 200
Memoirs de la Societe Medicale d’Emulation — . — 20 f
Medical Difcipline on Ship-board, Remarks on — — 256
Metallic TraXors, Treatife on - - 258
Methode Medicale Simplifiee d’ A pres les Principes de Brown 285 Mental Derangement, Inquiry into the Nature of 343, 436
- - Difeafes, Claffification of — — . 449
Mercury, Inutility of in Hydrophobia — ■— 449
Medical Records and Refearches - — - , 468, 510
Medical Diary for 1799 - — - - 574
Morifon, Mr. T. on Tinea Capitis — •
Muriatic Acid, Medicinal EffeXs of - 2 29
Mufcles, Claihfication of 184
J
N.
Negro, extraordinary Change of Colour in — — -
Nerves, Obfervations on - - -
N erv e-fuborbitar, Divifion of, in Tic Doloreux. - -
New Remedies in Lues Venerea, Obfervations on —
New Syftem of Phyfiology -
Nitrous Acid, Remarks on 101, 116, 153, 226, 234,
o.
' 1 1 \ \.
Obfervations on apparent Death from Drowning
*53?
95>
539?
5
289
469
54a
118
553
— 93
and Experiments on the Broad-leaved Willow Bark 467
498 189
51 4
182
- on Animal Fat on Infanity
Obftruction of the Thoracic DuX, Three Inftances of
Odours, Confiderations on - — — —
Oil, Utility of in the Plague - - -
^ — Inutility of in Hydrophobia * — — - — •
Oils, on the Medicinal UTe of - -
Opium, Observations on, in Fever - -
hurtful in Infanity
Opufcula Phyfico-Chemica - -
Oxygen, EffeXs of in Lues Venerea and Pfora
_ _ _ denied to be the Caufe of irritability
- - - Air, hurtful in the Dry Afthma
_ _ beft Means of procuring
Oxygenated Muriate of Potalh, Obfervations on
93
476
576
217
*97
526
zbj
347
5o
40
115
P.
'Paify, a frequent Caufe of I dainty * -
Papula?, Obfervations on - - ‘ ~
0
•■'142
36-5
608 Index .
tw
Page.
PafTions of the Mind, Obfervations on — — — 443
Petechiae fine Febre, Cafe of - - — 62
Perkins, Mr. Treatife on Metallic TraXors — — — — 258
Pearfon, Dr. G, on Urinary Concretions - - — — 301
- - 1 - Inquiry on Cow-Pox - — — 544
• - — — Dr. R. Treatife on Hydrophobia — - 291
Phthifis Pulmonalis, Cure of by Mephitic Air — - . 105
Phofphorus, EfFe<5is of in Medicine - — - 199
Phofphoric Acid, Trial of in Lues Venerea - — 556
Philofophical TranfaXions, parts 1 and 2, for 1798 — 301, 401
Piles, Obfervations on - - - - 81
Plait of the Retina, Account of — - — * 53
Plague, Cure of by Oil - - — - 109
Placenta, Account of a Tumour in - — — — - 419
Poifon of Serpents, Treatife on — — — - 480
Practical Inquiry on Difordered Refpiration - — — — 26
Predifpofition, Remarks on - - - * 119
Premieres Lignes de Nofologie Infantile — — — 199
'PraXicaP Obfervations on Difeafes of the Joints — 245
Prurigo, Remarks on - 7— 369
Pulfe, Remarks on - - - i'40
— - - Treatife on * — - - 358
Punch, Utility of, in Scurvy -■ — - — — 257
Putridity in Fever, Remarks on 142
R*
Rachitis, Memoir on — — — 1 12
Rabies Canina, Remarks on -r— — — - 221
*- — - - — Two Cafes of - - — • 518
Red Particles of the Blood, Remarks on ~—r~ 48
Pvetina, Difcovery relating to - 52, 401
Remarks on Fillula Lachrymal is - — - — — — 67
Remarks on Hydrophobia - - - 376, 451
Refpiration, Remarks on — - — 133
Recherches Phyfiologiques - — 394, 495
Report of Commiffioners on Galvanifm - - — — ' 398
Reflexions on the Csefarean Operation - - 488
Rheumatifm, Remarks on — - 137
- - - Chronic, Ufe of Compreffion of Arteries in 38
Rollo, Dr. J. Effay on Diabetes Mellitus, 2d edition — • 524
Rouffelot’s Cauftic Powder for Cancers - - 204
Ruptures, Remarks on — - - - 284
Rumball, Mr. J. Treatife on the Pulfe — — — 358
Rumford, Count, Inquiry into the Source of the Heat excited by
FriXian * - • 308
f
s.
Savigny, Mr. ColleXion of Engravings of Surgical Inflruments 579 Saumarez, Mr. New Syftem of Pnyfiology «— 95, 1 18
Index .
Scurvy, Cure of by Oxygenated Muriate of Potaili
Scott, Mr. Remarks on Nitrous Acid - -
Scrophula, Treatife on -
Senfation, Remarks on - - ■ — •
Serpents, Indian, Account ot - -
Simmons, Mr. W. Remarks on Nitrous Acid - —
- - Reflexions on the Caefarean Operation
Sherwen, Dr. J. Cafe of Imperforate Hymen * —
Small- Pox during Pregnancy, Two Cafes of * —
Snakes, Account of Indian : -
Soemmering, Dr. Difcovery relating to the Eye
v
r78>
De Corporis Humani Fabrica Small Pox, Prevention of by Cow-Pox Spleen, Remarks on the Ufe of ~
Specifics, Inutility of in Hydrophobia Slover, Dr. Account of an Hermaphrodite Stimulants, EfFeXs of in Fever
Stomach difeafed, Appearances of on DififeXion
- - - Appearances of in Hydrophobia •
— - Calculi in - • ’
'Stuart,- Mr. A. Medical Difcipline - ■
Strophulus, Remarks on — y
Strangulated Hernia, extraordinary Cafe of - - -
Sue, M. Recherches Phyfiologiques ^ - *
Suborbitar Nerve, Divifion of in Tic Doloreux 1
Surgical Inflruments, ColleXion of Engravings of ^ - *
Symptoms conneXed with difeafed Appearances in the Stomach _ _ _ _ _ - in the Brain
Sympathy, Remarks on -
Syphilis, EfFeXs of Nitrous Acid in - - ‘
Syfteme Methodique des Mufcles — — —
Syftem of DiifeXions * - -
609
Page.
115
553 573 350 478> 5ox
233
488
523 359 5°3 52 286 242
129
387
16 218 12 12 12 256 366
469
497
469
579 12
23
3*9 101
184 S6>
T.
Taenia, Account of * - “
_ _ Difcharge of, from the Stomach - -
Tanjore Pill, Account of * —
Tape Worm, Account of '
_ Difcharge of from the Stomach *
Third Diflertation on Fever, by Dr. Fordyce - l34>
Thoracic DuX, Three Inflances of ObdruXion of Tic Doloreux, Cafe of ‘
Tinea, Cure of by Adhefive Plaifter ~
TinXura Ferri Muriati, Ufe of in Spafm of the urethra Tonics, eminently Ufe fill in Aftlima Tourniquet, EfFeXs of in Intermittents, See.
Treatife on Scrophulous Difeafes -
Tumour in Placenta, Account of -
Turnbull, Mr. W. Treatife on Ruptures
T 3
102
504
l3 1 02
207
514
469
63 51 3 34
575
419
284
6 1 0 Index,
Page,
Tu rton, Dr. W. Medical Gloffary - - — * 200
Typhus, Cafe of, fucceeded by Meades - - - 14
V.
Variolse Vaccinae, Inquiry refpe&ing — - - * 236, 549
Variolous Poifon, comparifon of, with of that Cow-Pox 549 -
V enereal Difeafe, Elfays on - - 1 48
— - Treatment of by Nitrous Acid — . . 553
Venefe£Hon, Inutility of in Hydrophobia - - — * 457
V ertigo, Remarks on - 43 7
Vitality, Experiments on ■ — - — - - - — — 497
Villon, extraordinary Fa6ts relating to — — — * f
Ulcers of the Legs, Remarks on — — — ™
- - — • Utility of the Gaftric Fluid in — - - 1 J 3
- — — — - - of Hops as an external Application — 113
Voice, uncommon Anedlion of - — - - 202
Volition, Obfervations on the Difeafes of - — - 437
Vomiting, unfavourable in Infanity — — — — — 197
Urinary Concretions, Experiments on - — - 301
Uric Oxyd, Account of - — — - 306
Urethra, Remedy for Spafm of - — 513
Uterus Inverted, Cafe of • — - — 502
w.
Walker, Mr. J. Cafe of Petechias fme Febre — — • 62
Wallis, Dr. Treatife on Gout — - - 87
Ware, Mr. J. Remarks on Fiflula Lachrymalis _ 67
Weikard, M. Mefhode Medicale Simplifiee ■ — — 285
White, Mr. W. Treatife on the Broad-leaved Willow Bark 467 Willan, Dr, R* Treatife on Cutaneous Difeafes — ' — 361
Willow Bark, Treatife on — - — 467
Wilfon, Mr. J. Cafe of unufual Formation of the Heart 41 1
W ound of the Heart, extraordinary Cafe of - - — 5 1 o
Wounds, Remarks, on - 338
y.
Y«Uow Spot in the Retina, Account of v— — — . 52
' ’ ’ * ,v . <&• sk >v
FINIS
■