THE LONDON MEDICAL AND SURGICAL SPECTATOR

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9 ■

J

. I

i

LONDON

• ■ »■

MEDICAL AND SURGICAL

SPECTATOR}

MONTHLY REGISTER OP MEDICINE

IN ITS VAEIOUS BRANCHES :

C0KTA1K1NG

ORIGIXJL COMMUXICATIOJ\rS;
CASES AND REVIEWS

IN

MEDICINE, SURGERY, MIDWIFERY, AND PHARMACY,

WITH A VARIETY OF

MISCELLANEOUS MATTER,

JJTD OTHER PR0FESSI0M4L IJ^TBLUGEJ^CE.

VOL. II.
January to Aprils 1809.

Like the induttrioui Bee,

Culling from ey*ry Flow*r.

Ronton :

PRINTID FOR S. BIOHLEY, "So. 24, FLEET-STRBET.

By Mcixier and Chenret,
Ko. 88, Little Bartholomew Close.

Ii09.

\ '■ ? .

\

- ; -. - 7 r
e • r 4.1 ■ / i

1

I

f •

4

••■ t • miai

■'. 2i

PREFACE.

fphe ISditors of the presient Work have now coar
eluded their Second Volume, and be^ to return their
aclsAOwIedgn^ents to t^heir ^pmerous and respectable
Correspondents who have favoured them with their
f:ontrib|ition9j which^ in point of practical informa-
tion^ they flatter themselves will be found equal to
other publication of the kind.

Vol. II.] January^ 1809. [Na. VI,

■» ' ■!!,

THE LONDON

iSPeMcal and fl^urgical

SPECTATOR

EMPIRICISM.

On inspecting the list of the Patent Warehouse, "what a
formidable array does it present ! How numerous are its
weapons of destruction^ compared with the forms of the
Pharmacopoeia. In one shop bill alone we have reckoned
300 specifics for the cure of different diseases. These are all
in their turns eagerly caught at in the hour of pain with the
anxious^ though too often unavailing hope of procuring re^
lief, as ^* drowning men catch at straws.'' Btit this relief, even
if by chance obtained by the use of someof them, is often pror
ductiye of a more dangerous malady. We may instance a
case lately brought to our knowledge : a constitutional ulcer
had been rashly healed with a specific by an ignorant em-
piric, which soon sent his patient to ^^ that undiscovered
country, from whose bourne no traveller returns." A few
days after this doleful event, the widow happened to meet
the Doctor. She curtesied low to him, and gratefully
thanking him, paid him this compliment on his skill : ^' God
bless you. Sir; you cured my husband^ but he died in
three weeks afterwards !"

In fashionable life the use of the nostrums of the empiric
is become part of the etiquette of the day. A dose of soumi
alterative, if the life of the gentleman has not been altogether

▼OL. II. B

3 Empiricism^ fJanuary

piite, as Velno*s Syrup, Brodum's Specific^ or Solomon's
filEhn of Gilead, is taken in preference to a forenoon luncb
before going to take a ride ; or his nerves are invigorated by
some Cordial of the same class. His dinner is next suc-
ceeded by taking an Antibilious Pill to assist digestion;
cither James's, Dixon's, or the highly-famed William Bar-
clay's. In the morning his teeth^ if he has any, are well
rubbed with some of the dentifrice powders, or washed with
a tincture of the same r description^ such as the Chevalier
Ruspini's, or others of equally fashionable notoriety. His
hands are cleaned and perfumed with medicated soaps, and
washing-cakes, as the Bandana, Sicilian Bloom, Rose Soap,
and a thousand others; and, lastly, Iiis face owes its rosy
tinge and delicate hue to some high-prized cosmetic, as the
Blodm of Venus. Should a pimple unfortunately appear, it
"shtLst be immediately removed by a careful use of Gow-
land's lotion, as a death-blow to comeliness and fashionable
Appearance.

When these circumstances are considered as attachinsj
themselves to th« conduct of men, of what is termed the
Superior sex, n^ we wonder at the encouragement given to
lerepiricism by those who are understood to be the weaker
part; and that such deceptions should have still greater in-
"fluence on their minds ? They do not perhaps take, like the
Then, their forenoon alterative, but they swallow in place of it
their nervous cordial, and anti-hysteric water, such as Silby's
ISolar Tincture, Rymcr's Cardiac, and others. Instead of the
•Antibilious, they prefer also perhaps the Female Pill of
Hooper, or the more favourite one of Widow Welch ; and,
as thoy are sometimes bad sleepers, they close the day with
thekr dose of some celebrated narcotic, as the long -used Pa-
regoric Elixir, Dalby's Carminative, &c. &c.
' Thus, while the idea of health ingrosses the chief busi-
Ififss of the day with persons of fashion, amusement, and
fof tune, th6 very means employed are the source of subvert-

1809*] - Empiricism. $

JDg it sooner, and wearing out the constitution more rapidly
than nature intended should take place. The springs of life
are thus goaded on, and, like oil poured on the fire, it burns
nore forcibly only to be sooner extinguished*

TOOTH SPECIFICS-

(Continued from Vol, /• page 424 J

Fbom this account of the teeth, it is clear that their outet
covering or enamel must be chemically acted upon by all
acids, and mechanically worn by irritation or friction. In
the composition then of all tooth-powders and tinctures^
these two evils are to be avoided, though it is never done ;
nnd to shew their injurious effects, we shall hete quote tlie
opinion of a popular physician. Dr. Nisbet, who has paid
attention to the subject,

<^ As the ie^h are so liable^ from their office, to be af-
fected by matters taken into the mouth, the first and most
natural precaution is, to remove these before they can act
against their surfitce, or any effects of heat and stagnation
take place^ The practice, therefore, of washing after meals,
cannot be too strongly inculcated,

^* Where tartar also forms, it is most observable in the
morning, adhering to the teeth and gums. This points out
the propriety of the teeth being regularly cleaned every
.morning ; and ficom the gums inclining to softness and spon-
gine^, as well as this adhesion of tartar to the enamel, a
proper tooth-bri^sb^ such as recommended by Dr. Lind,
should be,employed for the purpose. If a soft tartar is al-
ready formed ,on the teeth, before adopting this plan, the
addition of some iinely levigated charcoal should be used
, along with the brush : but if the tartar has formed a firm
solid. body adhering inseparably to the teeth, and formings
as it were, part of their substance, the best practice will be tM

*2

4 Fntpirkism* [Januarj,

separ ^f p f his by proper instruments, and then the method pro-
posed will be effectual for preserving them in a healthy state.

^^ But instead of this safe practice recommended, persons
anxious only to have their teeth cleaned, without regard to
the means employed, have had recourse to certain modes of
effecting it, which, though answering the purpose in the
mean time, have, in the end, been attended with the most
pernicious consequences. These methods, however various,
may be all reduced to two heads, being the effect of strong
mechanical friction, or chemical solution.

*^ The former depends on the use of certain powders, va-
riously coloured according to the views of their invehtors,
in the composition of which pumice stone, or some other
gtiiiy substance, forms a principal part; this prepairation,
rubbed daily witii the assistance of a brush against the ena-
Biel, produces no doubt a polish and whiteness on its surface,
but from the strong friction this effect can only be produced
at the expense of the enamel^ or by occasioning a partial de-
trition of it.

" That this is really the case, has been established by ac-
tual experiment, for if a sound human tooth be' placeid in
a vice with the convex side upwards, and rubbed with a
brush charged with any tooth powder, in less than an hour,
by continuing the rubbing, the enamel of that part exposed
to the friction will be entirely destroyed. In repeating this
experiment, with the different compositions sold under the
i(itle of tooth-powders, the same effect has been known to
follow, only varying a little in the time' required, according
to the Oneness of the powder.

^' From this fact a calculation may be formed, supposing
such powders used twice or thrice a week, and rubbed for
each time one-fourth of a minute, in what length of time
the enamel may be entirely destroyed ; by such calculation^
it will be found to require only a very few years*

<< T^ tenfler tbc f^boye eiLperimenf ^till upre ppnelusive^
it need only be observed, that the teeth never receive any
rimeliFal of the f^namel, when worn away. That it increases
^oly in growth apid fineness till the age of i^tniy ; but thaf;
after that period it receives no addition, but on the contrary
grad^mlly decay ^^ so that by the age of thirty it will fre«
quently be entirely gone. Nay, its original thickness, evei>
in fiili growth, is not more than the twenty-fourth part of
an inch, how soon then must continued friction itself against
such a thin structure p'-oduoe an abrasion.
. *^ Th^ mischief of this practice many have attributed less
to the powder than to the brush that applies if, and they
have therefore substituted a cloth in place of the latter.
To shew, however, that this idea is ill-founded, the sam^
experiment may be repeated as already related , employing
A cloth instead of the brush.. The same effect will be found
|p follow it, with this difference, tliat thQ cloth, by not en-
tering like the brush into the interstices of the teeth, do^s
opt render the polish so complete.

'< When the teeth possess a thin scale of tartar, the use^f
prepared charcoal will in time remove it.

^^ Afler a thick tartar has been removed by instruments,
it will prevent its re*accumulating.

' ^^ The teeth that are not regularly clean, should be n^ore
rubbed .with it than the others.

. ^^ Jx>timis are sold under the name of tinctures, and the
chief part of their composition consists always in a certain
proportion ofmiaer^l aqid. Hence they turn out, when
e]tai)|io^» very ppw^rfulin softening and destroying the
foeniel^ .

^ *^ They are much more easily applied than the powder,
Hie very quick in producing their effect, and are thcreforq
ffio Ofleri preferred. But in propartion to this quickness of
tiieif •pefiratio& are their bad effects produced ; and the slower

b3

Empiricism. [ January

Hhy effect is produced on the enamel, the safer is the action
of the remedy.

^^ All tinctures^ then, for the ieeth, are composed of mi<*
neral acids, diluted and concealed under various artifices :
and that this is (he case is clear,

** Ist, From their sour astringent taste, conveying to the
feeth a peculiar rough sensation.

*' 2d, From their effervescence on the addition of an aU
kali; and,

** 3d, From the known effects of mineral acids on the
i^eth, when submitted to their operation by way of expe-
riihent.

' ** From experiments made on this subject, it appears,
that a mineral acid is the only menstruum by which the ena-
nid of the teeth can be speedily cleaned ; and that, tliough
all acids are powerful solvents of the teeth, yet that the
Vitriolic is the only one which has also the singular effect
<if whitening them. Hence it becomes necessarily a prin-
ipipal ingredient in all such compositions. Nay, it may be
olbserved, that even in its most diluted state the effects of
this acid on the enamel are the same ; and though several
attempts have been made to meliorate its hurtful principle,
and yet preserve its property on the enamel, it appears that
tfao^ properties cannot be disjoined, and that such attempts
are merely a deception of their authors on the public.
' ** Thus, all acids seem to have a particular tendency to de-
stroy the structure of the teeth, and that in proportion to
ihe strength of the acid principle they possess.

* '^ By the nitrous or muriatic acid the substance of the
teeth can be entirely destroyed in one or two days. In the
vitriolic, again, this operation is slower^ and it seems to
Jake place more by acting on the cementing principle than
pn the other parts. In the vegetable acids, though this ef«
feet is proportionally weak, yet it does take place in a con-

1S09.} • Empirkisin. 7

siderable degreej which is evident from the effect of tartar,
and also from the similar known effects of sugar^ sweef^-
tnents, &;c.

" In all the countries where much vegetable acid is usea«
particularly in the West Indies and other southern climates,
the teeth of the inhabitants are seldom good. Sugared meats
and liquors again produce, while they are in the very mouthy
symptoms of roughness, tooth-edge, • and pain ; and th6
teeth of such people as use them are susceptible of pain on
the slightest impressions of cold or chewing.

^VTo these bad effects of mineral substances on the teeth
themselves, may be subjoined that of others which act upoik
the gums, and thus, in an indirect manner, have the same
hurtful tendency. The chief of these is the use of tooth-
picks. The gum is spread closely between the teeth, ^nd it
is intended by this closeness that the teeth should support
each other in their place.^ Whatever then widens the ini^
terstrces between the teeth, must tend to destroy the inten*
tion of nature; and independent of this also, the freqtient
use of the tooth-pick affords a moix) convenient lodgment fot
the food. Instead of theiooth-pick, therefore, a small baeir
brush, like a pencil, should be used, which will answer t&e
purpose, and obviate all the inconveniences that have bpen
mentioned." ,

CHEVALIER RUSPIN1*8 MEDICINES.

«

EvEUT Dentist acts as an empiric, and his medicines coUp
sist generally of a powder and tincture, the composition of
which iske.pt as a secret^ and they are vended either bjr
himself, or go into the Patent Warehouse. The first we
shall notice of this class is the Chevalier Ruspini's Denti-
frices, being operator to the Prince of Wales^ and of cpufit
the director of fashion and form in this depaiiment, 4

TOOTH POWDER. *

Take of orris-root in poivder — carmine^ or rose pink,' ^

b4

B Empiricism, [Jannarj,

niacb as wiU colour it^-^dd powder pf spi|ttIe-fish-bonej
equal parts^

The scuttle-fish-bone is a species of carbonated chalk or
whiting ; so that the whole of the box-full of the compo-
sition is not worth aboye on& peanj.

TINCTURE.

Taks red ro^ leaves, infuse in warm water, and, when
4j^ined> add to the infusion oi^e half or a thiid of common
/ipirits.

A little acid . would have made this the infusion of the
Pisyenpary» Though not a very active tincture, we consi?
4^ it as not a bad composition for the teeth. .

IJAEDNE&^S PBSPAJieD CHARCOALi*

, C^AECOAL Powder has b^eu long highly estimated as a
dentifrice, and its antiseptic qualities have been largely ex-
jpatiated upon. Mr. J^ardner's preparation, however, is net
^re ; It contains a mixture of challC) or other testaceous
j^wdcr, and the proportion of charcoal seems to serve only
ion the colouriug. This is an imposition on tbp public We
^ not object to the real charcoal as a dentifrice, if finely le?
fdgafed} but we object to the carbonate of lime mixed

mik it*

CONPEKTBATED SOl«UT|ON OF CHARCOAL.

Mr. Lardner accompanies his Powder, as is usual
with the Dentists, with a Tincture for the same purpose. A
concer)[trated solution is nonsfense in the extreme; but, in
phee of it 9 Mr. Lardner has given this appellation to an
laftision of roses impregnated with myrrh. We can see no
%9ixm ii^ this composition, if he gave it its real title.

AREKA, OR BETEL NUT.

•• The charcoal of this substance, we are told, is the great
Asi^t^ice in the east ; but we doubt this fact. We cannot
see what superior quality it can possess over^ther charcoal ;
and we suspect the latter i^ geaer^ly used under this exotic
appeUfttioiif

V809.} Medieim,

REGULAR PRACTICE,

I, MEDICINE.

* I

Medicine is, more than any other, the science of speca^
lation. Indttctton, though introduced, has not been strictly
adhered to in the deductions from facts, nor hare facts beeii
investigated on a scale sufficiently extensive, on which to
form a basis fit to reaf a permanent superstructaw. For the
truth of this, we need nci, nesoct tp tim^ of the sdence btfv
yoad tlpiepresei^t period.

TACClWATroWr

In a former unmher of this vrork we gave the Report of
iShe Jenn^rian Deputation to Cambridge for the investigation
of the supposed failures of Cow-pox: in that ixmn. Thij
Report, the production of Mr. Blair and Mir. Ringi Offered
a satisfectory explanation to the public on thi^ hea^. But
since that time a different statement has been pre^riied lo th^
Royat CoHegc of Physicians by Sir Isaac Penningfoh; 'JhtO^
lessor at Cambridge, containing^ fi5 cases of fkilfire of Cow*
pox as a preventive of Small-pox, thus leaving tl^e Cot-;
lege to exercise their judgnient upon them^ but proving i]|
a strong manner the certainty of the fact.

Sir iMac's letter is written with a coolness and candout
t^hich form a contrast to most other T^riters on the subject,
and give a fipreater interest tp his assertions. We hopie that
on this evidence an opinion will be delivered by the College,
which the* importance of the matter, as well as Sir Isaac'^
iKspectability, equally claim.

■

The introduction of Vaccination into China has beea at?
jkended with some obstacles which bav^ not occurred elfe^
where, arising from the apathy . of the natives, th^ piejo^
jdice^ thfiir mdicajL in«sD| and the m(Utpr npt b^iog^easilx

'iO 'Medicint. [January,

procured by those, who were anxious to disseminate the
practice. Some trials, however, have been made with their
usual results by Mr. Pearson, surgeon to the British Factory
at Canton ; and it is to be hoped that these will in time draw
the attention of the natives to a predilection for this preven-
tive of so fatal a disease as the Small-pox is found to be
jamongst them.

ABSTINEKCE.

, Tbb remarkable case of abstinence noticed in our last
jiuniber has undergone a farther examination by Dr. Bourne,
who, after relating the particulars of his visit to the patient^
gives the following history of it from her own recital.
^ *5 Sometime prior to the summer of 1806, she was trouMed
with occasional pains of her sides and stomach, especially
Itftei eating, but h^ food was not then rejected ; and ^he
did not consider herself so ill as to pay any particular re*
gard to:these circumstances. She had had, for a long time,
the carjC of a boy who had the evil, on whose body were a
number of very offensive sores. At the above period her
appetite began to decline, and what little food she took,
her stomach nauseated, but did not reject ; and she fancied
it had the smell and taste of the ulcers of the scrophu-
lous boy. In November following she felt herself unable
to dp her usual work, which was that of picking or beat-
ing cotton. In the. month of March 1807, she was seized
with fits, wl^ich by her description appear to have been
epileptic ; these continued about a fortnight, and were suc-
ceeded by cramps at the stomach and vomitings* She has
had no fits since. About Easter of the same year, finding
a total want of appetite, and much pain after swallowing,
•he gave up the attempt; and has never taken anything
solid since ; nor has she had any desire for food. For some
time she continued to take now and then a little tea and
w&ter, as mentioned above ; but having now no thirst at any
time, she contents herself with washing her mouth only tw»

1809.] Medidne. • 11

or three times a week. She has had no stool since the third
of August, 1807 ; but she passes from half a pint to a pint of
pale urine once in two or three days."

This statement of the patient Dr. Bourne follows by the
subsequent observations :

*' This extraordinary mode of life, as might be naturally
expected^ did not obtain general belief: and she was accord*
ingly looked upon by many of her neighbours as an im-
postor. To dissipate this notion she consented to be re-
moved to another house; where she was attended day and
night for nearly, three weeks, by persons consisting partly of
medical men, ^nd partly of such of her neighbours who
disbelieved her story. These relieved each other regularly
every four hours, and were satisfied that during the aboy^
period she took neither food nor drink, excepting once, by
desire, she swallowed a spoonful or two of water ; which
gave her much pain.

" Such are the circumstances attending this case, as coU
lected by the testimonies above described; but, forming
perhaps an unique instance of such protracted abstinence^
and so very contrary to the established habits and indispen-
sable wants of animated nature, many persons are yet ne-
vertheless disposed to disbelieve the fact. If, however, there
be any deception in the matter, it appears to be the most
complete imposture ever practised. I think we can scarcely
withhold our credit to the three weeks trial ; and if so, I see
no reason for doubting the truth of the whole. It is truf
indeed that, in many cases of disease, in fever especially^
we find an almost total cessation of appetite for solids for
three or more weeks ; but then there is usually an increased
desire for liquids ; and at the termination of the disease^
4he general appetite returns. It is owing to a want of ap-
petite entirely, I imagine, that the continuance of life here,
under the privation of food, is to be accounted for. Fcflr
j^ungcr^ if not satisfied^ is itself a stimulus, which would

/

42 . ^ Medicine. [January,

^IP tune destroy the body ; hence those unfortunate persons,
i^ho are completely deprired of tlie means of |rratifying thi^
appetite, quickly die. How then has life been sustained* i|i
«thp Case before us ? If we examine the subject philosophi*
cally, I think we may come to some rational conclusion.
*Th9 elementary principles of the human body, or those into
4rI)iiPh it Piay be reduced, by means of chemistry^ are very
Af^* Tbe food, whether solid or liquid, destiied for its nu-
Uitwtif and repsMf of the changes and waste it undergoes
dim'ing life, is al^o resolvable into the same elementary prin«
•oipks. And these principles ara moreover present in the
oitmospherd which we breathe, combined as it jalways is with
Eatery v^poiir, &e. Atid it is only by the different conw
•^in«tions and modifications of these fe\y- ^leiiientafy prin-
ciples that tfajs yariuus ariicles of food ; i^ay, the almost
4a:$iirte variety intht) prndttcts of nature, present themselves
to our view; that one thing is sweet, Qn6 is spur, and ano-
,ft€r is bitter; this is soft n^ ilmt is hard; one proves sa-
:}iibiry» ajid another poisonous,; Si^d* Ai|d according to the
^nekktive Affinities whieh those elemenis have with each olbev,
•me i^ more readily ttea another acted upon by the juices of
^e itpmach, int^itiaes^ ^c. ; or in familiar words, one is
'Of more easy digestioa tb93i another. The universal reeep--
jt9(^ for food, ia maiiki9d at least, is tho stomach ; but if
ithe body be suppliied (hroMgh this medium with nutriment,
teentaii^ing only those principles whieh exuA in the atmo-
^phers which surrounds \t^ ; and if, by the total want of
,4ppetite, this supply ke precluded by the uisual means ; }t
■ff reasonable, or it is not uophilosoi^ical at lez^t, ta sup-
pose that life may be sustained, if tb^ ^me principles can
j^i^ admission. by other aUannels. It appears that the
•irigour and strength of the body cannot be maintained in
,^his manner, a^ is the case with the subject under consi-
^ deration; yetl^e itself may thus be preserved for an iade-
^te period, The T^^fJl-toowf iilMffiiise» of hibernating

aQimals afford proofs of its continuance for months bj re-
spiration alone.

** I shall conclude with a few observations on two or three
of the particulars noted in this case. In the first place^'
the nutrition of the system is evidently introduced by the
lungs ; it is not our ptirpose to inquire here by what mehm
it is afterwards assimilated ; she lives apparcntlii/ on nit
alone ; to use her own expression ^^ she loves air," and has
the chamber window constantly open. As she almost conti-<
nually lies in bed, it is not probable that much is furnish-
ed by absorption from the general surface of the body^
But it seems that a kind of digestive process is carried
on in the intestinal canal ; and that a species of chyle is
there formed. That there is some secretion there, which
undergoes a decomposition of its elementary principles, is
apparent from the presence of air and moisture, which we
discovered by pressing the abdomen with the hand; hence
arise the frequent eructations of flatus, &c. ; but from the
tenuity of the matter imbibed, tliere are no gross particlei
to form what is usually evacuated by stool. The hardness
of pulse and dry state of the skin, seem to indicate thai
there is not a sufficiency of moisture introduced into the
system to answer the general intentions of nature ; and pro^*
bably owing to this defect, life will be gradually exhausted'.
I apprehend that a thickening, perhaps an ossification of
the arterial system, has thus commenced, and will keep in-
creasing ; having begun at the most remote points from thfe
beart, which afford the greatest resistance to the action of
that organ; thence ascending to the greater vessels and to th^
heart itself; and from thegradual obliteration of tliese, life will
become extinct in like manner to the burning but of a lamp.
How long a time may be necessary for the completion of this
(nrbcess it is impossible to say ; but from present appearances
there is ttason to believe she may continue some months
loi^r. It is probable the freqiient use of the warm bath, if
she could bear it^ woulld teftd to defer her dissolution/' '

14 Medicine^ [Januai'y^

HYDROPHOBIA

. Is still the demon of the day ; but it is kept up by contro-
Tersional reasoniog, rather than elucidated in its nature, or
ameliorated in its treatment. If we cannot cure, the object
should certainly be to prevent, j^nd, whether the disease
exists or not, to take such precautions as may give a chance
of superseding the constitutional attack. Every patient,
therefore, injured by the bite of a dog, should be treated^
whether rabid or not, as if this state were actually to be ex-
pected. The period of attack being so uncertain, as froin,
five or six weeks even to a twelvemonth, or more, no rel^«
ation should take place in any efforts directed to his safety^
One great point seems to be preventing the healing of tlni
wound ; for the wound healing so readily as it general|jr
does, impresses the patient too much with the idea that Dp
poison can exist, or be communicated by it.
. Though hydrophobia occasionally occurs, we can %^
no reason for its being considered epideinic^ or more frequepl
in its appearance now than at any preceding period of jfnfh
dical history. The leprosy, it is true, has disappeared |l)
Europe ; but this is evidently prodiiced by the change of
living and progress of civilisation. On the disappearance '
of Small-pox, nothing as yet for a series of years can b^
decisively stated*

Experiments on rabid animals would tend much to eluci*
date the subject of hydrophobia, and lead to a treatment
which might prove ultimately successful against the symp^
toms arising from it as a disease.

SEQUEL OF DR. POWEL's CASE IN REGARD TO AXN CHAND-

ler's child.

Dr. Powel's case has certainly had the effect of calling the
public attention very strongly to this subject. The. sufferings
of Ann Chandler have been minutely described; and, in
consequence of that description, aa attepipt has been since

im.2 Medicine. B

made to shew the disease, by some similaritj of symptoms^
to have been communicated to, and to have proved fatal tOy
her child.

The statement of this case of Ann Chandler's child we shall
here give, as detailed by Mr. Hodgson. The child died when
three months old ; and Mr. Hodgson prefaces the case by
observing that ** it is not yet ascertained, whether the hu-
man subject can communicate the venom Wfcich produces
hydrophobia, still less whether such communication can
a^t a child suckin^r at the breast of its mother whilst imder
the disease.

■ " On Monday, August the 8th, eight days subsequent to
ihe removal of the child from the breast, I ivas requested
by the nurse of the child's ward, in the workhouse of St.
Sepulchre, London, to see a child who had been seized with
convulsions, to which I immediately attended*

^'symptoms*

** On examining the child, there appeared spasmodic affec-
tion, especially about the eyes ; her stools were black, I
ordered medicines, which Telieved the bowels; but on the
following day, certain appearances about the head induc-
ed me' to communicate my doubts to Dr. Powel, whether the
mother's disease could be the cause of the child^s. He did me
the honour of seeing her on the Wednesday, and gave it as
his opinion, that the child's disease was not hydrophobia.

" I saw it on Thursday the 11th with Mr. Tuckwell ; it had
screamed in ,the night, there was much excitement, a quick
'pulse, and heat, but no marked appearance of the disorder
in his opinion. The bowels remained better.

*^ Friday, the symptoms increased, and the bowels were
again unwell. I had recourse to the same jnedicinos, which
relieved her, but in the evening she was seized with (ns die*
scribed by the nurse) staring and fixed eyes, difficulty of
swallowing, with a vomiting and a frothy appearance from
the motdh.

16 Medicine* fJanuaiyi

^' Saturday the symptoms about the head remained the
same ; the bowels were quiet^ and the motions nearly natural
as to colour and consistency.

^^ Sunday raorningi it screamed; the other symptoms
much the same.

*^ Monday, the symptoms of the head were much in-
creased, and the whole body put on an appearance which
prognosticated^issolution*

^^ Tuesday, when I saw her, strabismus had come on ; the
eyesj particularly the left, seemed insensible to light, and
one side was much warmer than the other.

*^ I requested Mr • Clarke to see it, and took a tea-spoon
^lled with water and poured it into its mouth. It passed the
cesophagus, but we were both of opinion that giving the
water produced spasmodic affection.

" I saw it in the evening with Mr. Wheeler, who was of
opinion, there was no distinct sign of hydrophobia, and at
eight o'clock she died.

^^ APPEARANCES ON DISSECTION.

^* On Thursday about one o'clock she was opened ; the
vessels of her head, like her mother's, were overcharged ;
there was more water than usual in the ventricles ; the whole
abdominal and thoracic viscera were perfectly healthy.

'^ It was agreed that hydropliobia was not identified in
the child, but it might be said there had been much nervous
irritability, and the only doubt is, whether such irritability
might not be occasioned by the mother's disease.

V^ In this case, we find a child in perfect health, until
•he is taken from the mother, who has suffered death from
the bite of a mad cat, which death is not produced till
thirly days after she is bitten.

^' The strabismus, a diagnostic sign of hydrocephalus^
appears on the ninth day^ but the increased actions on the
^urth. I

^^ It is also to be remarked^ that upon dissection, we find
no distant cause from the appearance of the bowels or any

1809.] Medicine. 17

etber part of the viscera, that hydrocephalus could produce,
as they were in a most healthy state.

*^ The difficulty of swallowing on Friday, and the vomit-
ing which followed, together with the observation of Mr.
Clark and myself, on giving water to the last day, arc cir-
cumstances by no means unimportant."

SYMPATHY BETWEEN THE BRAIN AND STOMACH IN CASES

OF DISEASE.

Dr. Beddoes has endeavoured by dissections to establish a
curious pathological consent between the Brain and Stomach.

** In various instances," he observes, ** an inflammation
in the upper part of the stomach shall arise, when the brain
with its appendages are turgid with blood in an extreme de-
gree, or inflamed ; and the stomach shall sometimes exhibit
no pain or other sign of inflammation. This sympathy
seems alike, whether the brain suffer from external or iu'*
ternal causes. Dr. Haen, as I have observed in my Researches
on Fever^ touched with a red hot iron the skull of a boy
affected with amaurosis, and with periodical vomiting. The
boy ate a good supper on the fourth day ; had periodical
vomiting, and died in six hours after his supper, with in*
tense inflammation of his brain, and the cardia even gan-
grenous in two spots ; prodigious adhesion of the lungs ; as
also was the case in a girl likewise cauterized, but whose
stomach shewed no inflammation.

" I mean not," he adds, ^* to present this (secondary ?)
inflammation of the stomach as a general law. But I think,
whenever the upper part of the stomach is found unex-
pectedly inflamed, the head (a circumstance so often ne«
glected) should be opened too."

YELLOW FEVER.

In our former numbers the important subject of Yellow
Fever, the scourge of the tropical regions of America, has
occasionally olaimed our attention. . In the treatment of this

VOL. II. c

I

IS Medieme, [January^

fbrndidable disease, our preference has been ckcidedlj given
to the mercurial practice, or the mode of raising and supi
|]iorting healthy inflammatory action in such a manner as
piay counteract Ihe state of asthenic debility produced by
^e operation of the morbid cause^ The superiority of this
practice, the offspring of tropical obscryationy is attested by
all the most modern writers who have seen the disease ; and
the decided sanctipn it has received in Jamaica in particular,
the subjoined testimony of the united medical e:^perience
of that island will confirm to the satisfaction of the most seep-?
tidal, as the only pertain mode of affording relief, and saving
ihe victims of this deplorable malady. This testimony has
been brought fprward inconsequence of a literary controversy
betwixt Dr. Grant and l^r. Dancer of Jamaica. '^^

On subjects of medicine we consider the disputes of pror
fessional characters as favo^rabIe to the cause of science.
Collision of opinion evpr leads to fmproyement. Like the
pint strucl^ agaiqst the steel, it gives brilliancy and acutencs$
jEothe id.asof th0 disputants. If personalifies, which is un-!
fortunately too often the cage, intervene, it is easy for the
Ipectatpr to separate the gold from the alloy. That there is
too mtich personality in the controversy of these geudemen,
yfe admit. Ut. Grant^ w^ded to the old practice, con*
tends for hieeditig and hark; while Dr. Dancer is an enthu-*
ftfcist in fayoiir of the new doctrine, in which he is joined by
the whole medical science of the island, teith one or two ex«
Options. Dr. Dancer's opinion he states to the public in
the following words :

^! There being at present but hardly one opinion amongst
tiM Medical Practitioners of this island, concerning the best
)(DOwn mode of treatment iq Yellow Fever, it is matter of
regret that any iking should hav(? appeared sp entirely out of
liate, to prpvpke irpsh discussion on the sii^ct.-^The public
Hre unhappil jr too well convinced, by experience, of tiie fa*
tiUity aljtemhog the practice f»f lartt blfed^p gB^ f ^jT

IBO».} Medkifte. Id

the betrh in Ycflow Fever, to be either imposed on by the
bold assertions of an indmdual (Dr. Grant), or to be influ*
enc^ by tbc opinion of Reyiewers in Europe, who, with
all their competencjr for general criticism, cannot be sup*
posed <;^aUfied to de/cide on a question of this nature, which
i^n only be determined by actual observation and experi-
£nee; and Mthyex parte ddienments.—- There is not a mer-
chant or head of a family in this, or any of the sea-port
(owns, who is not, by the frequent and melancholy opportu-
liities he has had of seeing cases of Yellow Fever, bettet
qualified^ in some respects^ to give an opinion concerning
the disease, than the whole College of Physiciajtis>.*^Physi*
cians will judge always from what comes under their own ob*
iftervation — and, with respect to Yellow Fever, the Medical
men in Europe know nothing ; except those who have been
in the West Indies, and have practised theie, who are al-
most unanimous in their opinion concerning the danger of
bleedings the mischief of giving bark^ and the utility qf
giving mercury^

^' It would be superfluous to q^ote authors ; but if there
be not ten, or at least five, to one, in favour of the lise of
mercurial treatmei;it in Yellow Fever, let the contrary be
$hewn.*'

In confirmation of the propriety of this opinion of Dr«
Da^cei'^ the following farther testimony has appeared by
the difierent medical characters practising in Jamaica :

** We the undersigned practitioners of pLysic in the city
of Kingston and island aforesaid, conceiving that we are
called on by the duty we owe the public, and in justifica**
tion of outselves against the ^charge of malpractice, to state
lOur opinion coiicerning the best known mode of treatment in
Yellow Fever; do, on the fullest conviction, after long ex-
perience, soTeninly declare, that in our judgment, the prac^
lice of giving* calomel and employing mercurial fricticms, so
f» to indu^ at slight salivation^ is the safest and most success*-

N

so Medicine. [Januarj^

ful ; other means are, due evacuations by stool ; affusion qf
cold water, &c, &c. not being neglected. But we are firmly
of opinion that blood-letting, except in the moment of th^
attack, is highly detrimental, and, e^en-at (his crisis, the ad-
missibility of it may in n^ost cases be jtisUy questioned.

" We are further of opinion, that the administration of
bark in this fever (of no type) is, if not in most cases im*
practicable!, highly pernicious.

'* Lastly, we beg leave to mention, that so ftr as we ar^
acquainted with the sentiments of other practitioners in dif;
ferent parts of this island, and of the other islands of th^
Wbst Indies ; and of the surgeons of tjie navy and Bucmy^
they entirely coincide with those we havq expressed.
• ** To the testimony of tjiQ undersigned might be addqd
tiiat of several eminent and respectable practitioners no\f
no more, or who have left the country.'-

KEW PRACTICE IN DIABETES, AND CEJITAIN JfERVOyS

PISEASES.

Among the new suggestions with which the science of me-
dicine teems, is the practice of copious blood-letting in Dia-
betes, attempted by Mr. Watt of Glasgow. The dangers of
this operation, either from the stite of the pulse, from its
tendency to induce dropsy, or from the decomposed state
of this fluid, are considefed by him as groundless objections,
and that tt is the effect alone of the operation, when per-
formed, we are to judge from. Though we do not wish to
call in question the veracity of Mr. Watt's success, in the
cases be has instanced, as proofs of the propriety of the
principles of treatment he contends for, yet the use of this
Herculeau remedy we deem deserving of much caution
in these enfeebled times of British constitutional vigour,
and that the vital stream, the storehouse and reservoir for all
the wants of the system, should not be rashly dissipated.
These remarks are naturally suggested by the very different

I

1809*] Medicine. 21

ideAs we have been led, from the experience of all former
practitioners, to entertain on these maladies. Evacuation,
as a primary and curative indication, has never been ac-
knowledged to constitute the basis for recovery in such states
of the system. Perhaps Mr. Watt has been led to pursue
the steps of an eminent Edinburgh practitioner, Dr. James
Hamilton, Physician to the Royal Infirmary, whose obser-
rations on the use of purgatives in a variety of diseases' are
carried as far as the subject will warrant. Purging and
blood-letting are two very different evacuations. The
former can be borne in great states of debility often with
advantage, where accumul'itions exist, seldom with very
quick fatality ; but blood-letting we have known, in a single
O|)eration^ sink the patient at once, and often irretrievably.
In cases of debility, where blood-letting is employed, the
symptoms of plethora in the sanguiferous system should be
strongly marked before the operation is resolved on. We
hope Mr. Watt's future details will be so numerous as to re-
move all scepticism in regard to the propriety of his prin-
ciples ; till then, we are sorry to give a veto against their imi-
tation.

MONTHLY REPORTS OF DISEASES.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — As your miscellany forms a medium for com-
municatingio the profession at large such proposals as greatly
interest them and the public, permit me, through its chan-
nel, to offer ray suggestions on an extended plan of Monthly
Reports of Disease, as it occurs in the great public charities
of this city, in order to form a foundation for professional
improvement, in regard to its extent j nature^ and fatality.

I am. Gentlemen,

Your obedient Servant,
London, December 14, 1808. W. NISBET.

c;3

ffl ^M^dicbfe. [Jaminjr.

Communication of Dr. Nisbett, on an improved Plan oj^

Monthly Reports of Diseases^ addressed to the Phy^

skians of the Hospitals and Dispensaries of the Metrjo*

polis.

Centlemen'^THE first object of every professional charao
ter ought to be the improvement of that science, to which
be has devoted his attention. It is one paramount to every
other in its interest with mankiad, and it is one, therefore,
to which mankind must ever look up with veneration and
platitude;, as imparting the means of suspending and remov«
in^ thpse sufferings which unfortunately ^^ flesh is heir to. ^*

The knowledge of this science is only acquired by expe-
tience and obs^vation ; and on no part of it <^Mt th^ be
Vl^re usefully employed tbftn in fonnii^g accurate reports
of dkeaaes, apdfirpm such reports drawing the proper in*
doction^. tbat establish our epinipu of their nature — of ihp
fiequency of their attack, of the constitutions most subject to
pa^icular diseases, and in the end of theix comparative
fatality.

No situation offers such an extensive field for this purpose
as the great medical charities ot the metropcdis; and to
you, Grentlemen, I beg leave to offer a few suggestions on
the importance of thi» point, as one connected with the
perfoimiice o£yonr puUic functions in yourseveirai charges,
as wc fi^qn which society in general, as well as every branch
of ike^iqt^mpui ipuM jpeap ;tb^ i^Mpst solid advantages, and
as one Of^ceBs^y |p the intelligence of the kgiislatufe itself,
Iq forming stateoieiits elf the pi^^ubtion and strength of the^
country, which cMk cmly be judged of by ascertainjjig ibp
eKtent of ^he rarages iroopi disease.

From these copsider^tiotfi^ I ca^ have uq doubt of your
zeal and philanthropy to assist. in making such arrangements
as may conyey the nec^ssnry io^sfmaiion that the executiott
•f sudijirplm»Teqaires*

1809^3 Medicine. !»

lliflicrto attempts hare been made, on a Very trifling scate
indeed^ to give such reports; but even these attempts, tr fling
as they have been, have been attended with their advantage's^
tit, Reid's Reports of the Finsbury Dispensary are connected
^ith remarks which shew acute observation, and offer useful
hints ; but they are too limited to afford the knowledge which,
from such reports, we should wish to draw. Previous to
these, Dr. Willan*s were more extended, and in his hands
they gave rise to a small treatise on the diseases of the me*
tropolis, which contains many useful practicc^l remarks
adapted to the local situation of the metropolis and its
inhabitants. Some reports also have been made of the East*
em District of London, but on the same confined scale a^
the others. The example thus set, however, has been followed
at Edinburgh, and I give it the same commendation which
all sQch attempts deserve, as leading, in the hands of men
of ability, to much useful professional information.

But in order to reap all the benefit which such a plail
must produce, on an extensive scale, a leading example should
be set by each of you, Gentlemen, to the country at large*,
I would propose, then, that a regular monthly report be
rdadebysttch persons as you think proper to appoint in your
respective charges of the patients that come under your ma*
nagement. The report should consist of five heads ; the dis*
ease; the age and constitution; the sex; the profession ; aiidl
the issue of it.

By a correct statement of the first, the proportion of
ftcttte to chronic diseases is clearly established ; and the fre-
quency also of one disease jji its attack, compared with ano-
ther. This comparispn fixes the relative importance of
particular diseasl^s in the scale of practice, and the atten-
tion they deserve, in point of forming a foundation for a se-
parate line of attendance, or claiming a more than common
attention in the duties of ordinary attendance. The adyan^
tage of this separate consideration may be instanced ift

g4

84 Medicine. [January,

consumption, gout, rheumatism, See. vhich all afford an
ample field for distinct lines of practices.

The second head, or the age and constitution of the pa-
tient, is another important subject. Bj comparison on
this head, >ve are able to observe \¥bat are the critical pe-
riods of life, bejond i¥hicli the span of existence is not to be
protracted. This period is found to vary in different con-
stitutions, and the causes of longevity have occupied the
pens of the ablest writers, without bringing the knowledge
of them to that criterion which is to be wished. Till this
is understood, every plan for the preservation of health must
be defective, as the Juvantia and Laedentia cannot in their
effect be completely determined without il^ Old age, we
know, in certain constitutions, becomes evident before tlie
thirtieth year; in others it is extended to the usual pe-
riod; but instances have^occurred by premature animalisa-
tion, that the system has been exhausted, and the springs of
life completely worn out by a natural decay before the
twentieth year.

The third bead, or the sex of the patient, is another
point equally deserving notice. The constitutions of the sexes
we become thus acquainted with in respect to their liability
to disease in general, independent of the attack of those ma-
ladies which are peculiar to each ; and a comparison caa
therefore be formed, where an epidemic exists, of the
chances of the individuals of each sex escaping, and precau-
tions taken accordingly.

The fourth circumstance, or the profession, is a great
point, in a general extended view of this subject. That
professional occupations accelerate the tendency to disease,
or aggravate its violence when taking place, cannot be
doubted. They give often a peculiar modification to thp
appearance of a malady, and they are known also to pro-
duce peculiar affections independent of any other cause.
In a commercial and manufacturing country this pircum*

1609.] Medicine. 25

stance is an' important one ; and tbe diseases of the desk, of
the artisan ' and mechanic, would deserve a more minute
attention than the general routine of ordinary practice
permits.

The last head, or the issue of disease, is the foundation on
which we are to establish the mortality of different diseases
compared with each other, and is the foundation also for
the legislator, ascertaining the strength and population of
the state, by comparing the mortality with the births of the
country. The bills of mortality vary yearly in their amount,
and new circumstances in mode of living, and a variety of
other points must always render, them fluctuating. Hence
the calculations which have been made on this head can-
not be permanently correct. They should be provisional
for the time, and by the insurance offices, or other depart-
ments connected with calculations and annuities, they
should be regularly varied in their proportion of rates, ac-
cording to the changes, in the proportions of mortality,
that annually take place. The necessity for this we draw
from the original tables of Dr. Price, not applying at pre-
sent^ or .forming the foundation of their scale of jannuities.
Another consideration which, in these cases, should be
also taken into account, is the diifferencc between a town
and country life. The other i:oints I have stated as con-
nected with the report, viz, constitution and profession,
should not be omitted any more than the age and sex,
which claim the chief investigation.

One circumstance, which renders the bills of morta-
lity at present obscure to medical men, is the absurd re-
ports often made on the causes of death : — these reports are
unfortunately in the hands of ignorant old women, who
judge from the external view of the body, arid form their
opinion according to tlieir own vulgar prejudices. To cor-
rect this, it would be only necessary, as few persons die
without some modical attendance, that tbe practitioneri who

jkff Medidmt: [Janitaryi

lias visited the patient, should send ti note on the death of
the person, stating the disease, of ivhich he died to the pa*
rish clerk, to be inserted in the register, from \¥hich tba
annual bills of mortality are made up. This would make
the general issue of all diseases clear, and faithfully establish
the proportion of their fatality to each other.

Such a report. Gentlemen, is particularly connected with
your own reputation as practitioners. The recoveries and
deaths of each hospital, with the admissions, compared
among the several charities of the metropolis, (taking tbtf
diseases in each to be much the same,) will point out
whose practice has been mo^t successful, and whose treats
. ment, therefore, claims most to be inquired into and fol«
lowed. Many other .considerations and advantages might
be here adduced in recommendation of such a plan ; but not
doubting. Gentlemen, that these few hints will excite youv
attention — ^that the execution of such a report will raise your
characters both in the eye of the public and the legis-
lature, independent of its particular benefit to the profess
sion, I now leave the whole to your own determination*
Every physician has an opportunity of joining to his report
such professional remarks, as the extensive opportunities of
the great medical charities of the metropolis enable him rea-
dily todo, and which are at present too often lost to the proit
^fession from want of such a regular channel as a monthly re*
port io convey the information. Many dislike making formal
communications to periodical works, who would be ready
to offer transient remarks connected with the other matter
of such monthly details. It certainly would be highly to
the honour of the London physicians to set the example of
such a plan. to the country at large. I flatter myself that
this slight sketch will meet your approbatibn.

In the mean time, I remain, Crentlemcn,

Your obedient Servant,
London, Dec. Ibth. WM. NI8BET.

199ft.] Medkine. S7

HEPLY TO DR. W. y/s CBITICISM ON fiK. POWELLS CASE OF

HYDBOPHOBIA.

To the Editors of The Medical and Surgical Spectator,

Gen/ZemeTi-— Hatino in a former number written in de«
fenoe of the plan a^pted by Dr. Powel, I should eon*
ceiTe U a desertion of my principles, did I not reply to the
^nimadireisions of Dr. Y. ; and as the case is one of public
importance, if I offer nothing new, I shall at least excite |»
^f{ure for iayestigatiop.

Ift the unadorned narration of Dr. Powd, I can discover
no le94i^g fact so overstrained as to induce any one to
precqnceive any partial theory. The case is a decisive proof
f^ Ih^ existence of a species of tetanus, that has acquired
th^ H^me of hydtwfphobia, rather in compliance to general
adoption, than to propriety of e:xpression ; but as the term
oi hydrophobia is properly lindearstood, a misnomen ia
bwe of Mttle impcMTtance; for, by the general acceptation of
bydraphobia, is meant a disease that arises from the saliva
^ a jrabid animal ; and as «uch a disease really exirts, by.
whatavier name \re may counter-distinguish it, from other
qpeoies-of tetanus ; hence, \vhether I proceed to consider hy»
dfpphc^ia as arising from a specific virus, secreted by the
saliva of rabid animals, or a deviation from the general va*
rieAy c^ tetanus* produced by a lacerated wound, or ityured
nerve, caa be here of little moment, since the treatment will
not he influenced by the proximate cause of the disease, so
much as by the symptoms^ as they concur and arise : and
I aoi supported in this argument by corresponding facts ;
for, in most species of tetanus, the constitutional disease is
hieaied, before any spasmodic affection comes on.

Dr. Powel has distinctly stated that his unfortunate patient,
Amk Chandler, was -wounded by a cat supposed to be mad :
two cais- were fighting, and in this moment of high irritation
she ii^erpases to separate these furious combatant$ ; in the.

9& Medicine. [Janaar/t

struggle the strange cat fixes for some minutes on her wri^t
\rith its teeth. Docs this \¥ear the face of improbability, or
carry with it a desire to bewilder the reader's judgment ? No :
it bears the marks of the furious attack of a rabid animal, re«
gardless where it fixes its vengeance ; and in the high state of
furor it then was, it is far more probable it should fix with its
teetby rather than with its claws. The cat, in the pursuit of
the mouse, fixes at the same time with its claws and teeth.
This is sufficient evidence o^ the existence of hydrophobia
in Ann Chandler, supported by the effects that followed.
Nor is it necessary that the dog should have bit the cat to
produce hydrophobia specifica, vcl. contagiosa; for in evi-
dence it appears, a dog supposed to be mad had been seen
to play with this cat ; it was only necessary to produce this
disease, that their salivas should come in contact ; which
would be ihe case, if not during the play, immediately
after, for the cat would instantly smooth its ruffled coat, by
licking it with its tongue, and of course infection followed.
Where then, even in this stacie of the business, is Dr. Powcl's
far-fetched evidence ? To analogy next your correspondent
goes with as much success, as the sequel will show : he tellt
you, with the aculeness peculiar to analogi^ts, that the heal-
ing of the wound is at variance with knc»wledge and expe-
rience ; because, on the introduction of the Vciriolous or vac«
cine matter, the wound never heals, if the virus is suffici-
ently acrid to produce the disease; but th>s opinion is
absurd even in theory. These specific poisons are distinctly
opposite to each other in their nature, their symptoms and
variety ; nay, both these diseases will go through their
course, without any admixture of each other in the same
patient. Heuce he would infer that every contagious dis«
ease must necessarily produce such a certain quantum of
acrid matter, as to fill the body with ulceration, or other*
wise he should doubt its existence. He would have ut
therefore to deny the existence of hydrophobia in. the

1809.] Medicine. ' 29

of Ana Chandler, merely because some anomalous circum-
stances were wanting. Swelling of the axilla, a point much
dwelt on, never or rarely follows the in|;roduction of the saliva
pf a rabid animal, nor dp I conceive the spelling of the axilla
to form a necessary criterion of the disease. Your corre-
spondent then demands imperiously to know a fact already
elucidated, but more particularly in the one before him:
'^ whether a disease spontapeously generated, or arising
from unknpwn causes in dogs or animals, can be communi-
cate^ to human beings ?" The case of Ann Chandler is conclu-
sive on this interesting point : a reference to the case will
substantiate this assertion. Ann Chandler, at the moment the
cats were contesting, \yas ii> full possession of health ; anxious
to rescue her own cat from the attcick of a furious strange
pne, she attempted to separate them, and in the struggle,
the strange cat fixes with its teeth on the wrist. The wound
is healed by common surgical routine; twenty-six days
after, the part inflames, and with it appear some of the first
symptoms of hydrophobia, and which, wc learn by the well-
authenticated narrative of Dr. Powel, gradually increased,
till death finally released the patient from the most miserable
of all conditions. On this case there can be but one opinion,
an opinion which every symptom of it confirms, {viz,}
that thediseaseof Anu Chandler was communicated to her by
a cat in a rabid state. Respecting the contact and contagion of
disease froni one species to another, daily experience points out
the fact : is not the manije communicUed from one dog ta
another ? &c. The case of Ann Chandler becomes decisive
on this subject, for there we see the cflfect of animal conta-
gion producing a disease, that terminates the life of the pa-
tient by symptoms as nearly corresponding to those affecting
the animal, as the system and structure of the human eco-
nomy will admit ; and this is supported by the analogy
which natural history furnishes us, in the attack which the
spider makes on the.toad. Again, the sting of a wasp and
^ bee are too well known to require particular attention here :

36 Medicine* [JsiHuaiy^

bift these analogies certainly fairour the existence of a dis-
ease, eommiiDicated to man by animah, if a rational doaht
conld be entertained on the subject : and this doctrine com*
pletely militates against the idea, that Ann Chandler's mind
'was too much absorbed by the nature of her malady, to ad-
mit of a fair inference. If a patient perusal of the taae ill
allowed, I think it will be found, in the earljr part, her
mind appears not to be so materially afibcted by the
event, and subsequently, not absolute prepossession of tho
nature of the disease vittually takes place, till it as-
aunies too decided a character to admit of hesitation*
Then indeed we see a calamitous train of events arise ;
but those, it is evident, arise more flrom the effect of the
contagion, than the prepossession of her mind lespect-^
ing her disease: the mind, amid the mighty an^
harassing conflict, appears to have combated long against
its enemy ; but its energies, ' weakened by constant exertion,
at length yield to its baneful foe, and finally we see the
patient fall a victim to rabid contagion in all its horrors.

JNText, the want of the pathognomic symptom, an increased
secretion of saliva, is also noticed ; but tliis surely admits,
in an overflow of more accurate symptoms, of no peculiar in-
ference, but can alone be regarded as an irregularity of the
disease, and does not at all invalidate the opinion of Dr*
Powel : the attempt to bite is common to hysteric affections,
it is true, but it does not follow we are to exclude it from hyi>
drophobia ; respecting the effects of sound, nothing new is
offered to justify our denial of the existence of the disease.
f n every simple disease, anomalous symptoms are constantly
urising ;' therefore, in a disease of this rare occurrence, we are
not warranted to dispute its existence, because some irregular
symptoms may not appear so decided as might be wished.
The effect of sound has no great influence in common cases
of tetanus, nor does the idea of water produce the sensation
in other species of tetanus that we are describing; finr
Die horror pf solids and liquidi^ alone belongs to this class,

ja»0 ' Medicine, 31

\xA may be cons0er^ as a distinguishing character of the
disease i therefore I have no hesitation in qiaintaining the
correct idea Dr. Powel formed of this case ; an idea sap-
ported by the termination of the disease.

We ne:^t come to the considerations of the mode Dr.Fo^el
(tdopted fi>r the safety of his patient x he judiciously chose to
\:fy the argentum nitratum, a medicine of very high import,
and one not uncertain in its operation, therefore the more cor*
rect in its application ; and though by this mode the patient
was not saved, that is no argument against its future trial : for
J am well convinced, that in all spasmodic diseases it is an
useful medicine, and conjoined with opium may be rendered
of important serrice ; in epilepsy its effects are known, and iii
the ague of low countries it acts us a specific. Thus testimo-
aies are not wanting of its efficacy, and justify its application
in this instance* In extreme debility, too, it is a medicine far
better than the sulphas ferri, sulphas zinci, or any tonic of that
plass • I ts causticity by the action of the stomach is destroyed,
for becoming saturated by a combination of new principles^
peculiar to the organ of the stomach, its corrosive action
ceases, and its medicinal one commences. Thus, Gentlemen, I
see no reason for condemning its practice in the case before us»
A bold and decisive practice is ever preferable. I shall take
raj leave of you for the present, with recommending a care*
ful perusal of Dr, PoweVs case to every medical practi*
tioner. In the interim, I remain,

Your obedient Servant,
Uwhtiy Dec. 6, 1808. THOMAS MOTT CATON.

HYDROPHOBIA.
MR. HENRY THOMSON IN REPLY TO DR. W. Y.

To the Editors of The Medical and Surgical Spectator »
Gentlemen — If ridicule were a certain test of truth, I

Aould find little inclination to interrupt your facetious cor^

irespondent Dn W. Y.

32 Medicine. [Jai^uary^

« Dazzling arc the coruscations of the Doctor's wit, and be

• has reirelied in its brilliancy, even to the total discomfiture of
•his logic. But of this hereafter —

The obscurity that hangs over the disease called Hydro-
phobia, can only be dispelled by inferences drawn from well
authenticated facts, and it was under this impression that the
case detailed in your fourth number was given to the public.
I conceived it to be a plain and faithful narrative of facts ;
but I am accused of '^ prejudice" and '^ omission of the
most important parts of inquiry." I shall therefore take
leave to make a few observations on Dr. W. Y.'s Critique.

It is unfortunate for Dr. Y. that his first assertion, one
too on which he builds so much, should be founded in error.
I never heard of Dr. Powel's case until a fortnight after my
patient had expired.

• It appears that Dr. W. Y. considers the disease in question
to have been a case of tetanus arising from the wound in the
thumb inflicted by the splinter. Some symptoms of tetanus
certainly occurred, as is usual in hydrophobia ; but is there
an instance on record of the appearance of tetanus in this
climate in so short a period as that of two days after the acci-
dent? It rarely, I believe, occurs in less than ten days, and
generally after a longer interval. If then it were tetanus, it
must have been in consequence of tlie lacerated wound
made by the dog^s teeth, not of that from the splinter. In
the attack the disease also difiered from what is usually ob-
served in tetanus ; there was no contraction or rigidity of
muscle in the neck or back, and the muscles of respiration,
which, in that disease, are seldom aifccted till towards its
termination, were here, considerably disturbed from the be-
gbning.

To Dr. W. Y.'s question concerning the redness round the
wound (which I had neglected, by some mistake, to specify
in my statement); I answer, that thesplinter penetrated so near
to the bite that both wounds were included in the redness*

1809.] Medicine. 33

. Dr. W. Y. asserts that the abseace of inflamraa(io:i in the
lymphatics is a sufficient proof of the non-absorption of
any morbid poison — but is inflammati(^n a necessary conse-
quence of absorption i

Dr. W. Y. complains that he cannot collect from my
paper ^^ whether the patient had any particular dread of
fluids." Neither from the most attentive observation could I
iiscertain that point. The sight of fluids brought on the
paroxysms ; but whether they were produced by particular
mental irritation, or by the experience of her physical in-
ability to swallow, I was not able to determine.

I cannot accede to the Doctor s substitution of the word
"shivering" for ^' great horror :" the patient certainlyevinced-
more than a common repugnance to cold applications.

I have before observed that knowledge is best obtained by
a careful notation of facts, and by the inferences thence de«
ducible« If this be granted, what will become of the fol-*
lowing position of Dr. W. Y. ? " It is totally unnecessary
to make any comments on the particular symptoms which
distinguish the progress of this disease." Does the Doctor
mean that it is useless to comment on the disease of Iiydro-
phobia in particular^ or on diseases in general? But to quote
farther, " whether they (the symptoms) were produced by a
splinter of wood, or the teeth of a dog ; whether the horror
of fluids arose from a particular state of mind incident to
the malady, or merely from the pain and difficulty of swal-
lowing, the case under consideration is conclusive that hy-
drophobia is not a contagious disease, which is capable of
being communicated, either mediately or immediately, from
dog to man." What can the Doctor mean ! ! !

Dr. W. Y.'s ratiocination is not of the common order,
but if the sentence signify any thing, it must be this ; that
in its investigation, neither the causes or the symptoms of
the. disease are worthy consideration ; and then^ without on#

VOL. II. D

3i Medicine. [January,

reason in support of hU inference, he (Concludes from tbe
case in question, that hydrophobia is not a contagious
disease.

With the same intuitive glance (for he admits not of the
Tulgar support of proofs) by ^hich the above discovery was
made, does he in the next sentence proclaim that the ^^ dog
was not mad." But if in this instance the dog was not mad,
how can it be thereby ascertained that hydrophobia is not a
contagious disease? May not the Doctor's Irishisms give
support to a certain knight-errant, who in his ^^ righte
mcrrie and cqnceilede tour," has advanced, that the only
bull he heard in all Ireland, 'if as from the n^outh of ayi Engr
lishman ?

In the written account I received froip tlie master of tl^e
dog, he states that she was carefuDy confined qf\ her return
home, on account of her diseased appearance, and from her
having snapped at the children, (a thing quite unusual wi<h
her); and that, instead of being ^^ infirm and exhausted," she
was about a fortpight befqre she died 9$ lively and playful
as ever.

Another circqmstance has lately come to my knowledgf^
that will tend much to prove that the animal was diseased.

A day or tpo preyipus to Mrs. Sharpens accident, the dc^
was known to bite another in the neighbourhood, which,
about a month afterwards^ e:p:hibited what J believe to be the
true symptoms of rabies. The heavy appearancjc of hi;
eyes, and snapping at every object during two days, first
attracted notice. He then broke out from his master^s yard^
and ran wildly al^out the country for several hours. On his
return he was closely confined, and died in fire days from th«
attack. A howling of a very unusual kind was always fol?
lowed by furious action, which continued for some time,
and was succeeded by sleep. When he awoke the same phe-
^Qfiiena were again eschibited^ On the fourth day the Uqw}

fcecame ^rradiially weaker, and durir>a^ (be trhote of the last
ft had ceased altogetlier — the first thFee dajs he ate as usual,
^at during the two last be refused every tbingf .

I remain, Gentlemen, &c.

HENRY U. THOMSON,

Member of the Rojal Coileg^e of Surgeons^ London.

^Semtngtonj JDiec. nth, 1808.

^iedical Reports f€f Cases and Experiments, with Obseroa*

tionSf chiejly derived from Hospital Practice^ S^c.

By Samuel Argent Bardsley,, M. D. M. M. S. Ed.

jand M, S. London: Physician to the Manchester In*

Jirmary^ Sfc. ^c. 8vo. pp. 336,.

(CooUnued from Yfil. I. p^e 465.)

The eirtraGts alrefidy given jfroni this interesting practical
work will have satisfied our readers that Dr. Bardslejr hM
^t written without much consideration of his subject, and
9n attention to the opinions pf preceding writers. If we
4o not always ^coincide with liim in opinion, we have siot
«€ason to find great fa^lt ; and even when he advances nothing
liewof his own, be renders^ by his rtmarksj the.opifiioni of
others more persp^QUOU^, ^n^ «VLpport3 thein by additional
fiicts*

As the s^iject of Hydropb0bia at ^present fiys so manjh
of our pages, and excites so much the public regard, ib»
following addition from Dr. Bardsley's publication, we
should conci^ive, would be found particularly curious and
Jfoperly cbqsen U> close this subject. It is called ^^ The
history of a case qf Hydrophobia occurring IS years after the
luite of a suppo^d Mad Dog." It is introduced by the au«
tboi^sremar^i^g that '^^ the folio wing case has a peculias
^im to attention, on acpoupt he great distance of time,
from .the bit# of a supposed rabid anim$d, to the appearance
.9f t)ie diie^. It is, ^nde^ a di^ult tfisk^ io a^oc^rtpip

36 Medicine* [Jajnnary,

fact of this naixije; and especially, -when inquiries are to be
inade from ignorant and prejudiced piersons. As it i3, how?
ever, a matter of the utmost importanpe to be establishedy
no pains have been spared ^o g^in every intelligence whicU
title patienj and his friend^ were capable of communicating.
The resuU of the inquiry is in favour pf the patient's re-
peated assertion : ^ That he had never suffered the least in^
jury from any animal ; except the bite, inflicted twelv^
years sincq, by an apparent mad dog.'

" John Lindsay, weaver at Fearn Gore near Bury, in the
county of Lancaster, aged thirty-six, of middling stature,
and spare habit of body, and of a temperament inclined to
the melancholic, was brought into the Manchester Lun^jtic
Hospital, on Friday May the sixteenth, J 794, about three
o'clock in the afternoon. He was immediately visited by
Dr. Le Sassier, who obligingly communicated to me the fol-
lowing particulars: The patient expressed feelingly his
sense of danger, from the persuasion that his disorder pro-
ceeded from the bite of a mad dog. He was desired to drink
a little cold water, which on being presented to him he re-
jected, with every appearance of disgust and horror. Being
again stropgly urged to drink, he made the attempt, and
with great exertion got down a small quantity of the liquid.
He was perfectly rational, but appeared apprehensive of
danger from the least noise, or approach of any person to-
wards him. He e?cpressed a desire to make water, and was
quitting the room for that purpose ; but no sooner had he
approached the door, than lie suddenly retreated, complain-
ing of an unpleasant sensation he felt from the cold ^ir, and
particularly that it produced a convulsive twitching about
his throat. To screen him from the effects of the air, whei^
conveyed from the cxamining-room into the Hospital, an
umbrella was held over his head, and his body mufSed up in
a wrapping cloak. As soon as he had got into his apartment;^
lie ate some bread and cheese^ but with difficulty : and r&«

4809.] Medicine. Sf

quested to be allowed to drink some butter-milk. He at-
tempted to swallow this liquid, and in part succeeded ; but
hot without the most violent struggling efforts, attended with
distortions of his countraiance, which remained slightly con-
tnlsecl for some time afterwards.

A consultation of the physicians of thel Hospital being
called by Dr. Le Sassier^ aiid the assistance of Dr. Perdival,
physician extraordinary to the charity, requested ; the lattei*
Gentleman, in concurrence with Dr< Le Sassier, (the rest of
the faculty being out of the way,) entertained not the least
doubt of this patient being afflicted with genuine Hydro-^
phobia. As the disorder was far advanced^ and might, in*
deed^ be considered as nearly terminating, being the third
day from the appearahce of the symptom of Hydrophobia^
little or no advantage could be expected from medicine. He
was ordered, however, about four o'clock the same afternoon,
to take a bolus composed of twelve grains of musk^ two
grains of opiuta^ and six gtains of camphor. Two drachm^
of strong mercurial ointment were also directed to be rubbed
in, upon the throdt and breast. I saw the patient, in com-
pany with the other physicians, about six o'clock the same
evening ; and w6 found him very willing, and sufficiently
composed^ to give a distinct account of the circumstanceiS
preceding the disease, and to describe his sufferings since it*
attacks The following particulars were collected : He had
been industrious, sober, and regular in his mode of living ;
but subject to low spirits from the difficulty he found, at
times, of maintaining a wife and six young children. His
txertidns, however, were in general proportionate to his
difficulties.^ ^t of late, from the depreciation of labour, he
fonnd that the most rigid oeconomy atnd indefatigable indus-
try werie not sufficient to ward off, from himself and family^
the calamities of hunger, debtj and most abject poverty;
The an jiiety of his mind now becsttne almost insupportable.
Asthcr last refuge for bis distress, he applied,* a few days

D 3

I

38 Medicine* [Jaun^f^

previofi^ to the attack of his complaint^ io the Overseers of
his Parish for their assistaoce to pay his rent, and thereby
prevent the seixure of his goods; but obtained no relief.
Overwhelmed with ^ief and disappoiatoent^ he yidded
to despair, resigning himself and family to their wretched
fate. He was soon roused from this state of iaocied apathy,-
by the piercing cries oX. bis children demanding bread .^ \vt
a paroxysm of rage and tenderness, he sat down to his loom
ta the Monday morning,, and worked night and day, seldom;
quitting his seat, till early on the ensuing Wednesday mom*'
lag. During this period, of bodily fatigue and mental aax-^
ietyi he was entirely supported by hasty draughts of cold
butter-milk, sparingly take«. Nor did he quit the loom^
until his strength was completely exhaustedr He then threw
hitnself upon his bed, and slept a few hours. On wakingyi
he complained of giddiness and confusion in his head, and a
general sense of weariness over his body. He Walked £v«
miles that morning, in order to receive his wages, for tbr
completion of bis work ; and on his return^ felt much fit*
tigued, and troubled with a pain in his head. During the
nighty his sleep was interrupted by involuntary and deep
sighs— slight twitch ings in the arjaas — and a sense of weighi
and constriction at the breast. He complained of much
uneasiness at the light of a candle, that was buitiing in tbt
room. On evacuating bis urine, he was obliged to tfim
aside his head from the vessel, as he could not bear the sight
of the fluid without great uneasiness. Being rather tiiirsty^
. he wished for balm-tea to drink ; but was unable to swallow
it from a sense of pain and tigtitoessy whkb he experienced
about the throat, when the liquid was presented to him.. H<i
suddenly exclaimed, on perceiving this last symptomi^
^ Good God ! It iis all over with me t' and immediately re*
called to his wife's recollection, the circumstance of liif
iiaving been bitten, twdve years i^o, by a large dog ap-
parently noad ; wiiich was flying from the pursuit of a nuiii-

ifiOg.] Mediewe. S9

ber of people^ on the high road between Warrington and
Manchester.

^' During the whole of Thursday, his abhorrence of fluids
iticreased ; and he now began to feel an uneasy sensation on
being exposed to theair. The slight twitchings of his arms
weie also increased to sudden starlings; attended with a
iriolent agitation of his whole body. He had suffered much
from his journey, being brought eight miles in an open cart*
I perceived at this time (half past six, Friday evening) that
his countenance expressed the utmost anxiety ; his breatliing
was laborious and interrupted ; and he complained of a duU
pain, shooting from the arms towards the praecordia and re*
gion of the stomach. A livid paleness overspread his face ;
the features were much contracted ; and the temples moist-
ened with a clammy sweat. He suffered greatly from ^«
ccssive thirst, and dryness of the mouth and fauces.

^^ An unusual flow of viscid saliva occasioned him to
spit out frequently. He complained of a remarkably fetid
taste in his mouth, and a loathsome smell in his nostrils.
He«ate some bread and butter, at his own request, but with
great difficulty, as he was obliged to throw his head back-
murd, in order to favour the descent of the morsel down the
gullet. He was requested to wash down this solid food with
some liquid ; and he expressed a readiness to make the triaL
On leceiving a bason of butter-milk, he hastily applied it,
with a determined countenance, to his lips; when he was in-
stantly seized with so severe a spasm and rigidity of th^
muscles of the neck, that he was compelled, in an agony^
to desist from drinkingp Shortly after, he raised himself
upon bis kncies in bed, took the bowl again into his hands,
and by forcibly stretching his neck forward, at the moment
he received the liquid into his mouth, and then violently
throwing his head backwards, he succeeded in swallowing
a «nudl portion. We appeared highly gratified with the sup-
of Ihiareffiui, and .the ibrtitude he had exhibited ; and

1)4

40 Medicine. [January

cxultingly demanded another draught of the batter-milk, as
he thought he could conquer the difficulty he had hitherto
ekperienced. But a violent return of the spasms in the
throat and neck checked this attempt. These convulsions
were terminated by the stomach discharging the liquid pre-
yiously swallowed, highly tinged with bile. I perceived that
he had conveyed a j^iecc of orange under the bcd-cloaths,
ivhich at intervals he applied to his mouth by stealth, and as
it were unperceived by himself; for he constantly hurried it
to his lips, when his attention appeared to be engaged on
Other objects. This stratagem did not sncceed. No sooner
had the morsel touched his mouth, than he was seized with
convulsions about the throaty and a stricture at the breast.
I saw him again, in oonsnltation, at eight o'clock this even-
ing. Fie had taken two doses of the bolus ; and the ointment
had been carefully rubbed in. He appeared rather more
composed, but expressed great anxiety at the idea of being
left alone. He courted eagerly the conversation of those
around him ; apparently from the.motive of withdrawing
his mind from the contemplation of his miserable state. The
repugnance he felt at swallowing liquids, and the uneasiness
occasioned by the attempt, he now considered as bis chief
complaints ; and was determined' to conquer the first by per-
severance, and an undaunted resolution. His spasms seemed
to be somewhat mitigated, as he got down a Kttle milk-por-
ridge with less difficulty than usual. ' A repetition of his me-
dicines every three hours was ordered during the night. At
nine o'clock the next morning; (Saturday) he was visited
again; and we learned that he *had passed the night without
a moment's rest, frequently shouting out with looks of hor-
ror, and sometimes wailing in broken and confused murmurs ;
but, on being spoken to, he always returned rational an-
swers. He was now alarmed to a degree of distraction at
being left alone. He examined every object with a timid
and suspicious eye; and, upon the least noise of a footstep

1809.] Medicine. 41

in Ibe gallery, he begged in the most pitious accents to be
protected from harm. He had never offered the least violence
to any one, since the- commencement of the disease ; and even
now, when the increased secretion of saliva occasioned him
to spit out very frequently, he apologised to thebye-standersy
and always desired them to move out of the way. I ob-
served, he frequently fixed his eyes, with horror and af-«
fright, on some ideal object ; and then, with a sudden and
violent motion, buried his head underneath the bed-cloaths^
The last time I saw him repeat this action, I was induced to
inquire into the, cause of his terror. — ^He eagerly asked, if I
had not heard bowlings and scratchings ? On being an-
swered in the negative, he suddenly threw himself upon his
knees, extending his arms in a defensive posture, and forci-
bly throwing back his head and body. The muscles of the
face were agitated by various spasmodic contortions; — his
eye balls glared, and seemed ready to start from their sock-
ets ;•— and at that moment, when crying out in an agonising
tone— ^ Do you not see that blac*k dog?' his countenance
and attitude exhibited the most dreadful picture of complin
oated horror, distress, and rage, that words can describe, or-
imagination paint !— The irritability of the whole system
was now become excessive. Hq discovered the highest de-.
gree of impatience on the least motion of the air. Every
action was accompanied with that hurry and inquietude,
which marks an apprehension of danger from surrounding
objects. The oppression of tlie praecordia was evidently en-
creased ; and, when he gasped for breath, the whole body
was writhed with convulsions. His speech was interrupted
by convulsive sobs. The pulse was tremulous and inter-
mitting; and, at some times, so hurried as not to be counted.
He had frequent retch mgs, and brought up occasionally
small quantities of a yellow liquid. Solids were now swal-
lowed with excessive difficulty ; and the attempt always pro-
duced strong spasms about the negk and breast. At tea

42 Medicine. [January^

o'clock (the same inornin;s^) we met iti consullation ; when
the medicines were ordered lo be repeated ever/ two hours,
with an increase of the dose of opium, from two lo thre©
grains. Half an ounce of strong mercurial ointment was
ordered to be rubbed in over the surface of tlie body, and
ajponge dipped in vinegar to be constantly held \o the
moutii and nostrils. At four o'clock the same day, the cdn«
fultation was renewed. We found the patient had been able
to swallow his boluses without much difficulty, and bad
dbank several times wi^ii infinitely more ease than usual ; but
fhe fluid had been immediately rejected by the stomach,
and had come up, deeply tinged with yellow. His counte-
Bance exhibited a cadaverous aspect. His voice was hoarse^
indistinct, and faultering. He complained of a fixed pain at
tfier^ion of the stomach ; which lie had felt, more or less^
duting the disease. The pulse was feeble, and scarcely per-
oeptible. He swallowed some tea with less difficulty than
had been observed since his entrance into the Hospital.
His dissolution was apparently drawing near ; yet it was
deiesied advisable io order his body to be rubbed with warm
oil ; and one ounce of that fluid to be taken every half hour,
or as often as the stomach would bear it. His mental facul-
ties at this period suffered very little derangement ; for al«
though, when not attending to external objects, he would
utter som& incoherent sentences ; yet, the moment he was
spoken to, he was perfectly .collected, and returned rational
answers. At half past four o'clock, he submitted willingly
to have his body rubbed with the oil, and for that purpose
sat down upon the side of the bed ; when he was seized with
an instantaneous convulsion, threw himself backward — and
expired without a groan ! An immediate inspection of the
body would have been a desirable circumstance : but we
were obliged, (however reluctantly,) from unavoidable impe-
diments, to defer the dissection till the following morning.
Accordingly, on Sunday morning, abqut ten o'clock, tb^

1809.] MeHcint. 43.

iKKljr :iva9 opened in tbe presence of one of tbe physicians^,
myself^ and two of the surgeons belonging to the charity*
I have to regret that the examination did not extend to tbe
brain ; and indeed^ that a more minute investigation of thm
morbid apfiearances^ accompanying this fatal malady, did
not take place* But, such was the peculiar horror inspired
by a riew of tbe progress and catastrophe of the disease^
tiikt tbe accttstoiliary dread of danger arising from arty ex-
siminafion of an hydrophobic subject was increased^ by thi»
instance, to a tenfold degree. Besides, the well-known pre-
judices entertained by the country people, against the open*
ing of dead bodies, rendered us anxiotrs to finish tbe inspec-^
tion before the arrival of the patient's friendsy who were honrly
expected. In tbe cavity of the thorax no unu»ual appear*
asces were discovered ; except, that the surface of the tuiig$>
appeared of a darker hue, and more distended with blood than
ttsoal. No inflammation appeared on an inspection of the
firaioea; nor were the mitscks of tbe larynx or pharynx ui
the least discoloured. The stomach and oesophagus were
removed from the body, and subjected to particular inspec-
tion* A longitudinal incision was made through the wholly
cavity of the oes&phtgus, but not the least marks of disease
werediscoveied. Upon opening the stomach, evident trace*
•f iniSammation were observed* It commenced at the supe-
rior orifice, and was there confined to small and irregular
spots of a dark red colour ; and might also be traced in a linear
form, and of a brighter red, along tte curvature oi the sto^
mach, terminating at the pylorus in large and irregular $pot#
of a gangrenous appearance. The contents of the stomach
did not exceed three ounces ; and consisted, chiefly, of tbe
medicines that had been swallowed, mixed with a dark oih
loured fluid* All the other viscera of the abdomen exhibited
no marks of disease."

Thi»case is fellowed by a number of scientific observations
m thediseasci which shiew much noting on tbe part of the

44* Medicint. [Jai/iua^y^

author, and arc detailed with judgment and apposite ela-
cidations.

Modern Medicine : containing a brief Exposition of the
Principal Discoxeries and Doctrines thai hate occasioned
the recent Jdvancement of Medical Philosophi/j with
Strictures on the present State of Medical Practice^ and
an Inquiry how far the Principles of the Healing jirt
may become the Subjects of unprofessional Research:
By David Uzoins^ M. D. Member of the Royal College
of Physicians^ London; and Author of the Medical
Articles in Dr. Gregory's Encyclopcedia. London^ Syo^
pp. 200.

The title-page of this work promises somewhat more than
tti?»illbcfound, ou perusal, the author perforQis. The model
of his medical style seems to be the same as that employed
Jay Dr. Rcid in his Reports, and which we by no means
consider as constitutiug the chief part of his merits ;

His work is begun by a sketch of the progress of medical
discovery, from the origin of the science to the Edinburgh
school. But this sketch is so far defective as to leave omitted
the name of Celsus, an author of so much merit ; and Gau<«
hius, the very writer who first noticed the solidttm vivum^ is to*
tally forgotten. In this detail. Dr. Uwins seems to have been
at first a well-meaning Brunonian, who has abjured his errors^
having tried tliis system, so fascinating to young men}
hut having had judgment enough to give it up, when he
found its principles did not successfully apply in practice ^
and we cannot but consider bis objections to the Brunonian
doctrine one of the best chapters of his book. We shall se*
kct a part of it for the reader's information.

*' In remarking on Brown's doctrines,*' says our author^
" it may be observed in the first place, that sliould we con-
cede to his position, that fibrous excitement is a necessarjr

180©.] Medicine. 45

^nd universal preliminary to every other change operated
upon the living body, such concession could not be made
without the qualification of difference in the kindy as -well as
in the degree of action or excitement thus produced. Who
but a determined systematic would contend for the iden-
tity of agency in opium and vitriolic aether ? Both the one
and the other stimulate or excite ; granted, but do we find
no variation /in the mode in which their exciting powers
are developed ? In f^ct, the ad absurdum extreme of infer-
ence from Brown's fundamental datum would be the re-
duction q( all uTjedicines ii?to one ; for, were there no differ-
ence but in energy between opium and aether (to go on with
our examples), the one by an increase or decrease of dose
mi^ht unquestionably be employed to the total exclusion of
the other,

" A second error, which our author's generalizing dispo-
sition led him to embrace, respects the universality of ex-
citability, or the equal distribution of this principle,
throughout the living system, for it is a fact that one organ
pan be excited while another is depressed, and that too by
the same means ; thus we find it admitted by those even who
are reluctant to question the authority of Brown, that fox-
glove, while it reduces the actions and power of the arterial,
excites and invigorates the absorbent vessels.
, ^' Thirdly, our theorist, in denying the direct agency of
e;i^ter/ial powers upon the fluids, and, but through the in-
tervention of excitability, the solids of the system, was
either ignorant of, or overlooked several facts in the obco-
nomy of animated nature, to which we shall afterwards refer.
It will be seen that some substances, which may not have
any sensible or immediate agency upon the excitability,
shall become by a species of chemical attraction, component
parts of the living frame ; this, however, by no means in
that mode nor to that extent which was formerly imagined,
mi is by some speculatists at present conceived."

*6 Surgery^ [ Janutryi

In his explanation of 4he chemical thtory of mcdicin^
we apprehend defects exist in his account of heat. But stilly
«n the whole, we are inclined to give it commendation. Hig
observations on digestion^ drawn from Mr. AbernoUiy;, avo
also worthy of perusal ;-^the remaining parts 'Of the work
we shall reserve for our next number.

II. SURiGERY,

From the variety of its subjects, Surgery opens a wide
field for observation. Its principles rest more on detailed
facts than general doctrines. Hence it is more prs^ctical than
medicine, and less subject in its application to innovation^
The value of individual cases in this departn^pt are accord-
ingly more to be appreciated.

TU9iOU|l8.

From its numerous specie^, one of the most complicated
forms of disease to which stirgical aid is applied is the class
of Tumours ; and of these, some of the chronic kind are the
most difficult in their management. A remarkable dirpnie
tumour, which he terms pendulous, is thus described .^y Mr*
Carwardinc, of Tbaxted :

" Abraham Perry, aet. 7S," he observes, ^ ^bout forty?-
two years ago^ first perceived a small tumour, situated, ao-
4H>rding to his description, upon the outer edge of the peQ«
toral muscle, where it forms the margin of the axilla. It
was like a little hard gland, without any pain in its sub-
stance ; but his attention was excited to it by a constant and
mtry troublesome itching over its -surface. This tumour ijv
^creased slowly for about twenty years, and had then acquir-
/ed the size ot a small orange, when it appeared to quit its
i)ase, or ratbei to be elongated from it by a slender peduncle,
and gradually became pendarlous ; in this «tiite it auj^ented

1809. J Surgery. 47

yR^h increased rapidity ; Ibe itching subrided, or was onljr
occasional, and less in degree. He never experienced any
thing like acute pain, but a sort of dull aching sensation^^
which might be supposed to arise from the pendulous weight
of so large a mass ; yet this sensation was rather augmented
than lessened when the tumour was suspended by a broad
band slung round the neck. Howerer, the pain or incon-
venience of any kind which he experienced was so slight^
ithat he usually worked as a husbandman till within a few
months of bis decease, though at no advanced age.

*^ The first time I saw the subject of this case was about
two months since, when I was sent for on account of an ill-
pess arising from some biliary obstruction, which in the end
proved fatal. I then obtained the foregoing account, to
which I shall now add the result of my own examination,
and a slight sketch of the tumour, which will convey a suf-
ficiently accurate idea of its form and situation.

" The neck or peduncle of the tumour was very small,
though being enveloped in a considerable quantity of loose
integument, which presented a flattened surface in front^ it
appears rather large in the drawing. After descending a few
inches, it suddenly enlarged into an irr^nlar tuberculated
mass, presenting to the touch the sensation of variously
sized, and irregular formed, portions of bones or cartilage,
loosely connected by fat and cellular substance. The inte-
guments were of the natural colour, and extr6mely loose
over the whole body of the tumour, but particularly over
its neck, where they might be gathered up into numerous
folds. The pulsation of one small artery was'perceptible in
the neck of the tumour, and a large varicose rim mean-
dered over its surface. Handling gave no pain, and its sen-
sibility was so slight, that although the skin was abraded to
some extent at the lower part of the tumour, he had not per-
ceived it till it was pointed out to him. This peculiar hard-
ness, as of portions of bone in the body of the tumour, had

48 '^^^S^^rj/* [January,

only been perceptible within Ihesefew years ; and Mr. Cribb,
a professional gentleman of Stortford, assures rae, that when
he examined it about seven or eight years ago, its texture was
perfectly like soft common adipose sarcoma. The circum-
ference of the peduncle was five inches and threc»quarters ;
l^f the largest part of the body of the tumour nineteen inches,
and its length, frpm the edge of the pectoral muscle, from
whence it appeared to arise, to its lowest extremity, was
fourteen inches.

" Ther^ was a small tuniour on his right arm, which, he
says, is precisely what he remembers the large one. It has
the feel of a common fatty tumour, and has a very trouble*
some itching on its surface.

^' On the 6th of September, 1808, the man died, and a
few hours after his decease, I proceeded, with my partner,
Mr. Clarance, to examine the tumour. On making an in-
cision through the integuments, I began where I conceived
the tumour to have originated, and continupd down to the
lowest part of it; I found that it had its rise considerably
higher up, and tracing with the knife I found a slight sheath
of condensed cellular meinbrane arising from the clavicle.
This sheath arose from the bone by a few shining tendinous
fibres, which were soon lost in the cellular substance ; it
then became gradually thinner and looser in its texture, and
over the remaining part of the tymour was nothing more
than a very slight condensation of cellular membrane. This
sheath of the peduncle contained two, nearly cylindrical,
portions of fat, loosely connected, §omewhat resembling
what Morgagni has described in Adipose Tumours (Vide
Epist. L. Art. 23, et seq.) ; they increased a little in size as
they descended, and, about six inches from their origin,
enlarged suddenly into many irregular and distinct lobes of
various sizes; these lobes were loosely connected by cellular
membrane, so that they could be easily separated by the fin-
gers ; but their chief connection was by distinct fiattish

1809.] . Stti^ers* 49

j^t^ li6HAin«ifi6 l!>tods9 mb^l ^K^curntely resi^mbliii^ b iargfef
plexus of nerves, except that they werenbt separable into:
tlistinct fasicula of fibres like -nerve. Nothing of this ten-
•dlnons substance was observed about the peduncle^ but the
9hief great plexus was situated in the middle of the tumour,^
^and sent off a branch, or branches, to each Idbe. A few of
the branches, as they approached the lobes, became ossified,
;and in ihai state entered the Ibody of the lobes, and were ac-
x;ompamed by some very trifling vessels ; indeed one small
artery^ arising from the subclavian, was :all tliat supplied
ihew^ole tumour* Some of the lobes were still in ail adi-
pose st^te^ like the neck of the tumour; others were of a
jlaadular stn^cture^ wkh numerous ^snudl cells^ ^containing
an oily ftiid^ which esca^d as soon as tiiey were cmt into ;
others had formed a thin she(ll ^r case of hard bone;, which
contained an unctuous J&iad of eai^, exactly resemibiing,
jp, colour AQd ^consistence^ fiiller''s earth ; and in these
the tendinous bands ^boye described were ossified before (jbey
filtered the lobe^ The largest of these mas3e3 of earth, sur-
irounded by its bony case, I have preserved ; and^sent to Mr*
JiLbernethy; it weighs al^out a pound and. three*quarters..
All the lobes were surrounded by more or lei^s of the original
&tty matter of the tumour ; the whole mass might wdgli
^perhaps nine or ten pounds »

" "Vyhat appears to me mpst worthy of remark in tke fore-
going case^ is the late deposition of bone, &c ., A tumpur
is formed like most adipose -tumQurs^ inthe common adipose
f ubstance of ihe body, having a very small supply of blood-
Tessels, ^d tbiese vjessels^ as far as can be judged from thel
history and appearance of the disease, took n|)Qn them thd^
pffioe of secreting fa^ ; but, after a great length of time, they
assume a new s^ction^ and deppisit bone and other earthy
inatter of an finomalous diaracter^

^* Th^rieaiypei^itpd pothing of a malignant nature in either
4>f the tumdors; they neitfaor c6mmunjicate4 tfaeir actions to

VOL. lU £

50 Surgery^ [Januarj^

the neighbouring parts, nor insinuated di&ea^ through thfsf
medium of the absorbents*

BURNS.

One of the most important subjects of this department,
which has long divided the sentiments of practitioners, is
the proper management of Burns, or accidents from fire,
and under what circumstances, either the cool or warm
regimen is to be preferred. In slight cases, the former is cer-
tainly prefer;ible; but, in those of more serious consequence|^
the stimulating terebinthinate applications have considerably
the advantage, by procuring more speedily a cessation of
pain, and giving permanent ease by reason of an earliec
secretion of pus. These are important advantages attached
to Mr. Kentish's plan ; and, as observed by Mr. Purton, of
Alceston, to use his own ords :

*' I have not been under one single instance of embarrass-
meqt, but on the contrary, have been uniformly charmed
witll the immediate ease produced ; and several of my pa-
tients, who have had opportunities of trying both methods,
voluntarily give it in favour of the new one, and that in
terms of the highest eulogy . It is surely unnecessary to add
more ; what I have stated are facts. Cessation from pain is
almost instantly produced by the terebinthinate application y
but by the cooling treatment, it is necessary often io have a
constant renewal of cold, for hours, befoire similar effects
take place. I have been in the habit of using the oh tere-
binth, cold, mixed with ol. lini, in the proportion of two
parts of the former to one of the latter; and' from mjTex*
perience, applying it cold, has been attended ii'fth morie
beneficial effects than hot, although I can readily peirceivc
that in bad cases of bums ftom metallic substances, where
deep eschars are formed,, that beating the oil miglit be at-
tended with more advantage, but I have not yet had oppor-
tunities enougli in my own practice to establish the fact.'

1809*] Surgery. 61

BLEEDTXG.

HowKTER easy and trifling the practice of Bleeding, as
commonly practised, appears, yet in many instances it is
known to be succeeded by the most serious consequences-^-eren:
death itself* These consequences are happily yery rare, and
physiologists have been puzzled in such cases to ascertain otv
whai particular i^ganic lesion induced by the operation these
symptoms so alarming could depend. The opinions on this
s^ibject may be reduced to four heads, each having its par«
ticHlar favourers, who support it by a variety of arguments.
These ar^ 1st, the pricking of a tendon ; Sdly, of a nerve ;-
Sdly, a bad constitution ; or, 4thly, peculiar inflaranu^ion*

The first of these opinions was formerly the iiu)st general,
and the situation of the vein commonly opened in this ope-
ration favoured it. But when we consider that the same
accident has follpwed bleeding in other situations, where no
tendon or aponeurotic expansion is placed, we cannot properly
refer it to this cause. Besides, even tendons themselves have
been torn and lacerated, without such consequences suc«
ceeding*

The pricking of a nerve, therefore, may be most readily
suspected,' and it explains the symptoms of this affection
more easily than by any other supposition. The first symp*
torn felt in this case \s a smarting at the orifice made, which
is succeeded by a tingling pain shooting from the orifice to
the band, and in the other direction also to the shoulder.
These syipptpms increase, affecting all the connecting musclet
of the anOf An erisipdatous inflammation, or efflorescence,
also geiieraUy appears in different parts about the orifice^
which comes to discharge an ichorous matter. Convulsive
catchings of the member at last succeed, and even a tendency
to tetanus has been known to take place; death at last
puts an eiu} to the suflbrings of the patient. From this his*
4097, then^ it aeeiku evidently a nervous affiKtion, ^r the

e2

nervous symptoms are prior to those of the inflammation ;
and what puts it beyond doubt is, that even where the symp-
toms haye already gainet} their utmost height, the enlarging
the wound, so as entirely to divide the Jtesed necye, lias im-
viediatdy celiev/ed the patieot, and soon effected a cuse.

The third opinion, or its atising £rom a bad Gon^itu(tiao«
cannot be admitted, as not accounting for the quick progress
af tiiis symptoms, >for the .efiects of a had habit a«e slow in
t^eir operation. iBesides, the same person has been a^r«
wai:^s bl^ repeatedly widiout any such accident occurring.
. The last opinion, or its depend^g on a« peculiar inflam-
9iation .of itbe vein, is very ingeniously supported by Mr.
John Hunter. Xo this l^e was led by a similar accident oc^
purring ^o horses ajGber bleeding, the neck, the part where
they are jconunonly bled in, swelling, and occasioning at last
death. On tracing the c&ct of this accident by dissection
in th£se animals, he observed Ibat the oavily of the vein was
ipflafied, and that tfao ipflammatipn had spr^ead along iU
internal surface to the chest — sometimes io the heart itseif.
From flbseryations, also, on the human body, he finds that
such inflammations of the cavities of veins frequently occur,
and be is inducied, i^erefere, tp ooosider these 'ais tl)e cause
of the various symptoips that arise.f^-rBut ^eire tfai^ the case,
tlie symptoms of inflamm^oa WiS should expect to find much
more doused than what they commonly appear. Nay, the
aymptoms of the diaease ar^ often uncommonly severe, white
thoseof jtheinflaoimation axis alight ; aadif Mr. Hunter's r^t
soiungs if^ne true, they sh.ould bear always a prpportioo to
^ state of thfiii^flammation. Besides, thaenlargemeiUof tbo
prifice should^ in this case, also be of no ifet^vice ; it ^ould
exasperate the sjnoptoms, and incretiise the inflammation : but
t^ patient is fimnd gften immediaisly relieved after its per^
formance. Mr. Hunter^s alleging, that the nerves wounded act
soaall and lUniqipoitant, if going iqp fan It is in this case nof
telkigg l^kc hi«itelf> Who is^ s^ xsadjr to attribute giaat e^J^sty

180&.J' Surgery. 56

ifo slight calisels a^he. Small, indebif, ibey may be ; biri di^'ft
tKeii' being miimportfent, tbatdo^ ndt^sdreiBlclily fbllcrw; i8t
c'irery peirsori wKo has paid (irbper atteiitian tathe pbenbth^tlS
tK the nervous* systfehi j must- know that' thesniallesft fibre 6f i
niet^i?^ vrheti injured under certain ctrcutiistances^ will cdttf«
Diuiiicat'e irritation from oiie branch to ahothei* in a lifosft'dc^
tVaordinaty mattner*. That nerves are divided in raafny of
{he common operations of surgei*y, is certain, biit afif fd
flieir Being merely pricked is doubtful. It is^ the paHittl
division of a nerve which- we'coht^d iJI atMded vfitli tKfe^
darintng effects.

Though the enlatrgeifaernt of the orifice admits of a rmdy
cure, it would be of importance if We could, without cu#<
fih^i find aiiy application equally successful, and Which*
try indiicincg a paralytic s?tat€f of the' nerve, might retnove thirf
fl^ptom^. We know that, in the celebrated case of Charlerf
tfife nittth of Frarice, treated by Ambrose Par6, wrtrm, stl*-
Ahilaiu^ ajpplicatioiis eflScted'a cure. We know, also, thaf
Oil of tiirpehtine is veiry efficacious id the punctiiTe of a teii-
dbh valid we kn(6w still further j that volat. alkali droppeff
dh'the sdatic netvi of a frog will rfender it pt^htlytic. Frbrtf
tHe^ fkcts, ihet^ some es^perimetots may be tried tb supf?rJ«f
sede the necessity of an o;^ation.

COMMTlf ItiyAtlOlf ON WHITK SWELLING OF* THE JOINT S^ A^'
ON TkifTREfATMteNT OF CATARACT j BT R; REIgtE, mI li.

To the Editors of The Medical and Sttrgidctl SpecfdfoK
Gfei^/cWe^— THEitEf is no diisease which is more to be lar-
mentbd, and to which the aid of surgery is applied with less?
sudc^ss, than the affection of the joints known by the name
ttf ' white swelling. This disease has been commented on by
Ie6fhre1r§ atid authots, as eiristSng under two species, dis^
Ufifgiifshed hf the a^ilpdlatloft of scrofulous and rheuthalic-
The propriety of this divMoh I am much -inclined to call iff
^^fioii. RheUniatfera, I affmtt, in a scrofulous habit,

54 Surgery. - f JannaryVi

may prove an exciting cause of white swelling, but as soon
as the white swelling commences, the slight redness attend*
ant on rheumatism of the skin, and in some degree the
pain, abate. The rheumatic affection of the other joints
also gradually subsides, while the white swelling increases^
The different symptoms noticed by authors, as distinguish*
ingone species from the other, arise only from the disease
commencing in different parts of the joints As. rheumatism
affects principally the ligaments of the joint, the white
swelling of course is likely to commence there, and spread
to the bone and cartilage. When the disease is brought on
by any accident or inflammatory fever, it commences on the
interior of the joint and spreads io the ligaments*

Whether it commences in the ligaments which are the seat of
rheumatism, or the interior part of the joint, the disease, in all
the cases I have examined in the latter stage, exhibits the same
morbid structure, vi%^ partial collections of scrofulous mat*
ter, &c. &c Rheumatism, therefore, has nothing more ta
do with white swelling than as an exciting cause. White swell-'
ing is often followed by small-pox, strains, and inflaminatorj
fevers, and these with equal propriety may be termed vario-
lous white swelling, &c. In the same scrofulous habit ca«
tarrh often produces phthisis pulmonalis.

From White Swelling I am induced to make some obser-
vations on another diseiise not less troublesome in its cure.

Of the Absorption of Cataract by the internal use of mer-
cury we have had the most indisputable evidence. The fol-
lowing cure, w hich 1^ occurred in my own practice, proves
that its absorption may be produced by external irritation.

Admiral* Henry having a cataract in each eye consulted
Mr. Ware, who recommended their extraction. The ad-
miral agreed to give the operation a irial on the left eye, and
if it succeeded, he promised he should shortly after operate on.
the other : unfortunately, such a degree of inflanunation and
tbJLckening of the cornea succeeded,^ as entirely todestrojc

l809i[} Surgery. 55

vision^ aiMl ill doiM^ence he i^ould not submit to any ope-
ration being performed on the other eye. The admiral haying
cored himself of many obstinate attacks of rheumatism and
gout by severe friction, and occasioualFy pounding the parts
affected ivitb a wooden hammer, resolved to make the ex-
periment on the right eye : after persevering with great for«
titude in this plan for about a month, he found that he
could discern a luminous' body, and by continuing the prac-
tice a few weeks longer, the diseased lens gradually di-
minished, and the gallant admiral is enabled to read small
print. By the same practice he has also effectually cured
himself of gout, to which he had been many years a martyr.
There is a great difference of opinion existing between surgeons
and oculists concerning the advantages of depression and
extraction of the lens. Upon a fair detail and comparison
of the advantages and disadvantages attending each, the
preference is justly due to depression, so far as the patient is
concerned, although extraction is ^lore beneficial to the
operator. The arguments adduced by Baron Wenzel, and the
objections to the operation of depression, must appear to
etery experienced surgeon invalid, and not the result of f/n-
prejudked experiencey or even of a candid regard for truth.
That able and ingenious surgeon, Mr. Hay, of Leeds, in his
invaluable publication, entitled ^* Practical Observations
on Surgery ^^^ very ably and satisfactorily confutes the ar-
gumeiitd employed by Bjaron Wenzel and Mr. Ware, in
fiivour of extraction ; and after thirty years practice in dis-
eases of the eye, states that experience has led him to prefer
the mode of depression. If the operation of couching were
performed by a pair of scissars, of the size of the usual
needle, it might be divided after the depression into the in-
ferior part of the eye, before the instrument be withdrawn,
which, in my opinion, would not preveilt its rising in the
^way of the axis of the eye, but ensure its dissolution and
absorption. I am^ Gentlemen, your obedient Servant,

RICHARD REfiCE

Ta the EdiiQrs of The Medical and: S^rgittJ, Speitta/i^^
Centlemen'^TB.EZJii are many diseaaea, appaMMAy} w»r
pie, wliicii nuicli perplej^ a siir^eoa iu/his teeatisanj^ oC
them« I kiu>w of noaemarQ so tbnaTioea'. GapitiS) or Sc^jbt-
Headl In obstinate cas«s, i have found it resist e^rerj/Iocsd'
application of. the most powerful, kind, wlictberr in. tbe fam^
of: iotion or liniiheni ; andi it. has only yielded at last to^ tiber
radical cure of esstracting moat q£ tjie hairs hy iim rp«itsi
From this, obstinacy, of the disease,. £ have long suspected ifs^-
beings ra&er a^constitutiouaithan local affi^tion r andthal^
in ali cases this circumstance should! be held, in reoolIeQtionNi
Small doses> of calomel do- not succeed: hfiX0 in Uie wo^sl?
eases; a^ proof thaLit is not (if sometimas) al^wiaysioopnec^di
with a specific cause ; and I would rather attribute it tor a«scrp^
fulousorigin) and keep the indications^mployedifai^the ttieatn
ment of this last disease . in view. $inc0 L proceeded on tlHA-
plan, and administered steel internally in liberal dosc^ along^
with the, usual local ixunedies of the stimulant: aod gently- esn
charotip kind, I have: never failed in a single instance* Iii%
clearly a disease. of debility; and whether tbifrdebiUty<i&>o€
a peculiar species, or. not, strengthening the habit^by thei
use of powerful tonics: will tend to remave the cause, ancji
allow the local remedies to have their full, influence^ If tl^i^
suggestion should lead: any of your correspondents, to iakeii
up the subject, and point out a. preferable plan &am th^it^
own experience^ they, will do a service torm^st pra^titiweiES^
and to none more than to.

Gentlemen, your obedientrServant^^
Cambridge, Dec^b, 1808. A. CONSTANT RC^DEJU
P, S. Tinea often occurs in adults^ Wh«ce it dpes^ it. 1%
generally connected with a siphylitio taint^ andtyields^ rea^
dily to small doses of calomel internally^. and> the fpll^wipg^
liniment, viz. — Equal parts of the tar ointment, the citcini^
(nitrated mercurial) ointment and th:e> sulphiur oi^tig^nt us?
gularly employed.

MOflti Surgery. St

Practical Observations on the Nature and Cure ofSiricbure$
in the Urethra. Bj/ WiUiam Waddy Member of the Roj^al
CoUege cf Surgeons in London, 8vo. pp« 88» Zs.

This Mbjigt i* om^ wfaicb^ from itii fi^quent OGcurreoee^
ffiid^ffoiH being* one of the most profitable kind ttii the pi^^cti*
Itoner, Iuib- engaged the attention of a great numbev of
89i^o^> and eyen^ fcrnaed a s^arate Une of practice^
Daran endeav^Hired'taaeoure il)by hift idlea' of a^ medieated
lK>|]^ie ; ai!^ Home and o^era by the appUcaCion of ciittfitic«.
Lessor anthers have followed' the steps- of these two iw their
^ftrent methods, and the piesent work is a bumble, iraitatioil^
of Im pi^eoesBOFSj in favour of the bougie over the oaulstici.
ia tbe. preset work we accordingly find nothing: yeryj new
#r strlhi^. It is a pamphlet written as an: advertisement^
and can claim no higher merit. Btit we shall enable our
readers to judge for themselves by a few extracts; fromi the*
m^ int^esting parts of this dissension*

One effect of the application of caustic is often io producer
»;tFOubIesome and dangerous haemorrhage, and tbe observa^
tkias of the author on this subject are thus introduced i.

^^ It has been said that the haemorrhage, which sometimes
Wisues^aft^r the application of caustic, is* move alarming^ than
leally dangerous. For: the extent, however,, to whicb it
eontinnes^ I need only refer to Mr. Home!& treatise,, and the
eommpn egcp^ience of every surgeon who has^ used: the
eau9tic.^ In the peqisal of Mr. Home's works-^^^ the part»
Wied freely ,'*—^' it continued few hours^ ;'*—** tbe quantitj^
ldrt:we supposed to be several pounds ;"-*-are- expressioins.'to
be met with in several pages.; and in one case it is deserved,
^ thebleeding and pain continued several days/^ These am
circumstances tha:t. are: not regarded as objectioiKs t6 tbe
practice 4 and the^ indifference with which they aie viewed^
fa-caBstdered. by. D)r; Andrews^ as the result ^^ of cool and
Iteidjr omdnct;'' He admits, however, *^ that if it (ba^u

% IfurgetJ/. (jsimiaTJ^i

morrbage) was, in a great proportion of castSy to termUiate
fittally, it would then ht a strong objection to the practice;
oiit this (ill ^ 'great proportion of cases) wiedd ndt find by
any means to be true." This would, indccfd, be k itty
strong argoraenf against the practice; but admitting, as
nay be fairly inferred even from this account^ that some in<«
stances have terminated fatally, surely, it is at least a strong
objection, and enough to justify Mr. Whatdy in com'<
plaining of the levity with which these objections are
treated, as well as expressing his astonishment, at the cool-"
ness with which a surgeon yiows a chamber-pot full of
blood, and the ease with which he calls for another. Mr^
Carlisle speaks of it as one of the most dangerous conse-'
quences following the application of lunar caustic, and men-
tions a case in which the hemorrhage continued seven days;
in the two first the patibnt lost four pounds of blood, and
nearly as much afterwards.

" The frequency of this occurrence, (which from the struc*
tare' of the corpus spongiosum, and the thinness of the par-
tition interposed between that, and the mucous surface of
the urethra, is accounted for,) in addition to the yariousF
circumstances already enumerated, long since determined
me to trust to milder means: and, fortunately, I have not
to lament a fatal termination in any instance from this cause;
yet I have to recollect much painful anxiety from the ap-'
prehension of it. In one case, after the eighth application
of the caustic, on withdrawing the bougie, I was instantly
covered with blood, which came out with a jet, nearly
c^ual to the 'flow of urine. I must confess, whatever those
accustomed to such accidents may think of it, that I wa»
greatly alarmed ; and as it happened in my own house, it
wa^the more embarrassing : pressure and cold applications
were used in vain ; and it was some hours before it became
sufficiently moderated, to allow the patient to be carried
home in a sedan chair. The bleeding continued^ at inter-

809.] Surgery. 5ff

' TalS) for several days ; and it was five moaths before the
patient^ who was foreman ia a mauufactory, recovered his
strength sufficiently to resume his station. In anoth^
case^ repeated haemorrhages had taken place, but had ge-
nerally ceased after a few hours. One day^ however^ it con«
tinued to flow so copiously, that I was sent for. At the same
time Mr. Heaviside was called in. Iced water was recom*
mendedi and pressure made on the part ; by these means the
bleeding was at length stopped. The man remained in a
very feeble state for a long time, nor did I think it prudent
to use the armed bougie on him afterwards. I could enu*
merate a great many instances where the haemorrhage
equalled what is related of the preceding cases^ were it ne-
cessary ; but the fact is too notorious to require it. Of ita
importance, every man can judge for himself. Thus much
I will say, that however far habit may teach a surgeoa to
regard these circumstances with indifierence, he will not
so easily succeed in making the patient, or his friends, be*
lieve there is no danger, and that extreme debility is a mat*
ter of no consequence."

The principle of the bougie being the one he contends for
in the cure of stricture, he supports it by the following rea-

soning :

^^ it is by patiently persevering in gentle means, that sue-
cess is to be secured or expected. The bougie should be
increased in size according to the facility with whicU
the stricture dilates^ and the ease with which the patient
besarsi the dilatation. If tlie parts are very firm, or very
irritable, the increase of the size of the bougie should bis
4ow, gradually stealing upon the parts, and allowing
them' to adapt their structure to the increased size. This
is well expressed by a French writer, whodescribes this gra-
dual stealing upon the parts, as effected by ^^ little and
little." ^' La mcilkure methode est d'introduire dans Isk.

0b Sufgery. [Jahte^y,

iwgc'dcsr bbt!giw qui par feur yoitimt 6t IcUY ffeitncl'4 f iiisi
KMit ^tertfei' Ji peu lb patrote de riiretfrir^, ct'ett nttbife tetn'rf rd*
ittoUlr et rflacbcr sesi fibres/^*

"• Vf itM respect to tbetimie'a Botfgle ought (o reltfaitf in thrf
ptfssage^ tbaff murt^bcr disjtermihtt! by the feelings of'thrpa*
Ifettt'; nor should it lie laid' asidfe for some niotrtbs after if
passes with facility: "' quoiqtf on uf me k pfaincJinali il n^
ftur pfeis' laisser de contiimer Fusage dfes Ikmgf e^ tbus Ite
jbUtt peildcwt qirelcjues' beurcsr, ertsuite tbutes 1^ siEfraaities, tt
diflint tonsils mois."

<* Tflcf good efifect of stitltfchitfg * Ctfrtstrfctfcd part' is fre:.
^uetttlj^ witnessed in cbYitractions of the aUjophag^s andVec-
fam. A iT^oman applied tb roe ori aeboUnt of an obstnilDtioii'
in* her throat; producing a total iifabilify of' swallowing any
^tld' sulistknce ; of which complklrit bet fithersbmeyefers
beffn^ had died; With a view of knoVvlhg in what part of
the esophagus th'e sttlcturew^s, a probang wUs introduceff.
When it arrived' at* the cfcstacle, thb Wbmatf was vfery de*
sirous it sboUld"^ be^ pushed through- by force: Sieveral at*,
tempts were, however, made in vain : at last the wbihaif
declared she ffelt the part' givier way, when shii applied* her
Hands tb tlie probe, and force* itthrb\igh. SheWa^s afteMardi'
furnished with a proper bougie, by the daily and frequent use"
of which in a f6w months she became qilite'wcll; I liave seen
several cases, of a similar nature, cbhstd^rably relieved By*
these means. Mr. Holrie record's one case of "a lady, ninfe'-i
teen years of age, who wais perfectly cured' by it; Rtr*
{Samuel Sharp was of opinioh. With' many otiiers of'eqbal*
character, that the mere stretching of a' cbiiSfrict^patt'WAi*
Aot only equal tb prbcUre all abatettfeiil of symptoifis, but'
lb effect a cure* Speaking of obstructibhs of the ufethra"i
he observes, " that it is very reni^rltable, in regard" tb liiahy*
of these strictures, that 'the syiiiptoAis arising^ fro&i them slialt'
Be extenuated'by acting against the stricture,' that is to'sayi'

V

l^r ¥^^4y^lif f^;b0)|giQ »big:fi§piigb ito>ilurti9id IfceiiKothm^
liip f^bifidqiW of tib i^toieture tibtU ^oease Aid J^ jlraoigurjf
aUaji ^t»y w^^IpisA » 9iiL» ivboiU 9$^Gii0lfi0nd tp make «raler
ef9i7 )hp^* «t¥^l), bjr vttring a bragw, f:^tain.ift (Ar«e at
^folMT bo^irs." But^ gKsrbyapsi lliie most unexcq^knaUe au*^
tliiorkj^ i» Mr. Hnoter : MVisr/ adrooate of the causaliic prae«
tJboe «9U/st 1^7 A^kst^ma^ to his opiai<Nij and jnoce iteeided
lai^9g^ ii«e4 iM>t1^.«ougbt« He lei^fMresdy states, *^ ^Aa^
(f Me ^a$^ if Buch miQ ^imU the enif>f a smattlo»gie i^
pji^sfi lejt a ie f9f^r $Q smM^ ih^ emr^ is then m our pomer.^^
Hftrieg eoiie»fyQ\n^y by all tbe n^ual aiigamento, to con*^
fimi %Jm mpsfm^y of tbf tnoatineat of eiriotiiaras by the
l^gie;, #16 paB9ph}^ ifi wpuo4 Up with itl^ ^following con*
(Am^n^ ; ^nd tit^n the finals (ates place by the felation of

^^ JfT^o^ i4ie i^r9{iie|L pait^r^ pf strii^re^^ it omst purely ha
94!witt^ by ^?«ryiiflpr^jfidipedi»ifid» tbat ev/eo preaamtiig
tbf ffitna^ion pI* ^ striotvirie tp be prepipely ascertained, eapii
different form of this disease presents difficulties thai muat^
yi\ih ^very io^prpvernQot, x^xy^ tbp direction pf the caustic
tp the a^act sp(^, ^ c»$^ttQr ^ grent uiH^rtainty • Jf then thui
^ ju9 stiU WApepmpU^^, the pbsorvatiw^ of Mrt Sharp
laq^ ip fttU f(;wr(Jfl : • • Tb« pbjectHHis," eayp he, ^^ to tha
V^e pf c^ustics^ lyer^ iUie diffipujity and alsapst impossibiUtjr
^f dir^tiAg them^ fo as \pesX tbrpugb all the diseased parts of
^ ivnotbrft) wUbPiit destxoyin^ the so^nd part ; the impraen
tlp^bUity of pratmtin^ th€ urethra frgm eontracHng v^hm
ii k^oMi m rmcht if nat more^ than it wsts at the time ot
^plpyyig the escbarptici md Ittstlyi the paip was so ex«
^ri|pii4iqg, 4^ periiaps tbp application so pdlsonousi that
immfdi^tp mpr^PiUipA pf the sprptum, penis, an^ bladder^
nvfyp spniftimes wail Jtopwn tp i^stie : upoa tbase f^ccounto^
Aq u^ pf g^hai»t>cs seem^ tp haye beea tntirply rcjeotod.'*
Ib^fP fUfi fmy I belk?e, wb^ wiU not think this was sufficiant
. trpiMii fos 9bif^(m)fig iMw ;, wd viewiag the fairttit reproi
sentations of all the improyjomPiittti sugieeBted Ida

•2 Surgery. [Januavjr^

tion ofescfaarotics to the diseases of the urethra, mast W
not still agrei^ that ^' ces r^m^dies enflaoimoient, rohgeoieat'
et ulc^roient ce conduit— 'et bien loin de procurer du soulage-
menty apr^, la cicatrice, le conduit de purine ise troattrfl^-
encore pluf ^troit." That there are circumstances in "Whieb
the application of the caustic' may be* attempted as an exp«i^-
riment^ and under certain modifications, I am ready to ad-'
mit^ but I believe those cases to be-very ftfw, and the prd-^
spect of success, as far as regards the cure of stricture, to be
very precarious. Here, as in many other Situations, where,
there is doubt as to the probability of success, aud where the
BMxde of cure proposed is both painful and hazardous, ttui
patient only ought to decide. It k for him' to make hi»
lilection, whether he will go through' the new rough road,'
instead of the smooth old one. Every young practitionel*
will do wisely to ^ act on this principle; for one unsuccessful
operation may be iri6re painful to his. feelings, and do mot^
injury to his fame and fortune, than an hundred successful
cases can repair. '

' *f Thus fyt 1 have endeavoured (o shew, that the use of
the common bougie should be considered as a leading priny
ciple in the cure of every description of stricture m (be
Qi'ethra. ^^ It requires patience, coolness, and persever-^
anoe. If the surgeon can make any progress, though
slowly, he must be contented. If, after the exertions of
many days, he once gets through, he will be compensated by
seeing Ihe ease and coipfort of the patient, and the pleas-^
ing prospect of being sooli at the end of his labour.^*
I will conclude with applying here, an observation used by
Mr. Whately on another occasion. *f If^ therefore, by tbiar
easy, safe, aud mild method of treatment, relief can 06^
casionally be given to the close of life, without the patientii
suffering mnch inconvenience or pain from the disorder, it is
certainly more advisable to pursue: this plan of treatmetti,
tiian to make use of a remedy, which has in scnne instanceg
j^podqced even &tid consequeocef.'^ .

1809,] Midwifery. 6S

Jjl aU this there is nothiDg more than what we knew Ibefore*.
It iS) in fact^ only an old song set to a new . tune. But
njrith respect to this disposition of stricture to recur, we may
remark^ that it may be considered often . as a constitutional^
di^ease^ to which every passage or Qutlet of the body lined
ifith a secreting membrane is more or less subject. Thi$
disposition ix) stricture is equally conspicuous in certain
persons, as the tendency to warts and other excrescences of
the skin. Hence it occurs in the passage to the stomach,
in tl^e intestines, and even in the passage to the lungs. It
if this constitutional nature of stricture which at all times
gives it a tendency to return, and which accordingly recom«
ipends the mesons of cure employed to remove it to be: oc-
casionally used to prevent a relapse. In every constitution,
stricture, we conceive, may be produced by the excitement
of general irritation, if. the original symptoms are in that
degree to produce a deposition of cpagulable lymph into the
cellular membrane, which is not afterwards, absorbed. But
where stricture arises, without any previous venereal excije-
ment, the constitutional disposition or tendency to it must
be strong ; and here, though a cure is effected, a relapse ii
always endangered.

ju— *,:

III. MIDWIFERY.

This department of the profession, as observed by an
ingenious correspondent in a former number, unites equally
the business of the physician and surgeon. The diseases
of the female in pregnancy, and after parturition, are often
dangerous, and demand the utmost nicety in the prognosis
respecting them as well as in their management. The
operation of labour itself is often perplexed and complicated,
and requires promptitude, decision, and manual action, in
extricating Ihe female from, her unfortunate situation. It
differs, however, from surgery so far, that, while in the
operations of surgery, you. have the. 8^4 vantage of .the eye

6* ]Midarifrry. [Jannftry^

tl> Airect tbe tise df your in^traments, inmidmiery yon. must
tmst entirely to tfiefeel, «9 that the diAcalty of operating;
is increased. This difficulty of operating has led, at
different periods, to tiie invention and rejection of a Tariefy-
of instruments. Bat in mid^mfery, the iime of typendii^
& parhaps of more consequence than Ifre form of the itislttir
itient. Hence, as this poiKt lias been more completely uiidtftv-
«itpod, the use of instruments has been lessenei), and apparent
difficulties trusted to Ibe management of nature. That liiid*
wifeiy i¥as originally practised by the illitirarate) yAxo 'irere
only acquaiiited trith the operation of labour, is dear, lerhen
we find, in all tbe authors of a prior period, ftat, tiftdcir
particular circumstances, the calling m of a pfhysiciaa 19-
^dways advised. On the contrary, at prosent the physician'
is more apt to taice the advice of the accoucheur, thani^
trust to his own opinion on fiemale diseased.

¥t7E1tPERAL CONVTJLSIOKS«

Op the diseiises which perplex the obstetrical physician,
ii<>ne is more perplexing, embarrassing, and uncertain iu iff
issue, than Puerperal Convulsion ; and the following cases
by a Derby practitioner, which have lately appeared, will
OOBfim our opinioB on tim head.

^^ In the vast and gloomy catalogue of diseases,** it is
observed, ^' to which the human frame is liable, there is
none so replete with terrors, so inconcrivably dreadfiil, as
4hb aJBectioa; and none that requires nicer management and
skill, and more boldness and promptitude in practice. 1
allude to tliose cases of it which' occur after delivery, or*
during the time of actual labour.^

** That this disease depends upon pressure of the braia
from extravasation, or from over-distention of its vessels,
produciug inflammation, and not from nercons irritation^ is,
i believe, a truth, that requires more generally to be unddt-
stood.'*

*** It is DO diffcvli matter to distinguish a disease fron its

1909.] MHioifmf. 65

fl^);^fit>nfe >Vlvcn it exists, but it is k knd^ledge of tire causes
tb&t mVlBt ilictute a (Mroper ^tid ef^i^cMral mods of treatment.
JSpilqt^sy is (I clii^eftse "Vii AVe all ^ '^ fkniilisil- with, but ifo
kno'wnothing of ill causes, at^'d,'ConfiequeAily^ afelitUe of itt
•cure. TFhis, ceiiiainly, then, cait be »n ohjQOt of no small
moment, h^ it may frequently, if not Al^vrcrys, ^naUc us, by
•dmely cate and proper management, to avrtot a disease in
its pmgre^ wbich, wheii lit <pdcuir^, 4b do fatal in its eonse*
'fences.

" Tke two folio wirtg cAscsj wbtch have lately come uhder
ray lAdpectton, m»y serve to thr#w «ome ligKt upon tikis im-
portant subject.

^^ Case I.«-*A young woman, aged 19, had a dlfficnlt
thoti^ natural labour of her first child ; the pains were
violent and prottacted, wfiich oontiiiu^ ^or e^ht « ten
ibours, when she was safelbf delivered by a respectable mid-
wife* In the latter stage of the labouc, she .complained of
paih ^nd giddiness in the head; and as soon as -the placenta
was expelled^ she sUnk timto a comatose •state; and in ten
mihtttes Was seized with convubions. She had three violent
parOxysmb, i^0(^eeded by sligbt intermissions ; abd in five
mihotes aftnr tbe la^t, she died with every symptom of apo«
pleky. Iii this case, nothing was done, as I only arrived in
time to see heir expire ; which was in about half an hour after
she was delivered.

^^ Case II.-^A ^oman^ advanced in years, was safely
delivered of hi^ second child, wlich vras many years sub-
fle^iient to lier former. She was in labour for twelve houn?^
^ht latter part of which was unusaally difficult. She ap«
peared tolerably well, but complained of pain ia the head>
%hidi grftduaUy increased, and she became delirious ; in which
state she continued ibt two hours, and was seized with con*
tnlsioiis. Before I saw her she had had thirteen fits in rapid
Mccesiiion, which left her in a state of complete torpor, and
the was to all appeiuimce on the btiak of dissolution. Her

TOIi. JI. F

66 Midwiferj^. [January,

pnlse was scarcely {lerceptible, and ber $kin \?as of a dark or
purple colour. Frpm these symptoms, I entertained no
hopes of recovery, but qrdered her a stimulant draught with
a&thcr and laudanum, &c» which seiemed to revive her, and
a second was giyen ; when her natural colour was gradually
restored, and thp convulsion^ returned with the sapie yiolence
a3 before. Her pulse now became strong and bard : and a
considerable fullness appearing about the head, I took away
a pint of blood from the arm, and applied four leeches tq
e^ch temple; after which;^ her hca^ was sbayod, s^nd a blister
applied over tuC whole. Her bowels beiqg in a coslivQ
state, a solution of soft soap was ordered as a glister, and an
opening mixture with neutral salts aud infu^, sennae. The
bleeding having r^uc^ hpr s^lmpst io a state of synpopq
she sunk into a cqmatosp slepp, in iyhich she continued for
six hoursy when she awoke, and wiisfora few minutes quitq
sensible, but again became deliripus, and uticrpd the most
incoherent expre^ions. As her pulsq did nqt waT|:ant ^
second bleeding, and the convulsions havjng entirely sub-
sided, she took draughts every t}iree Jiours with mixtur.
camph. aq. ammon. acet, et vin. ^ntim, which produced s^
most copious and general perspiration ; in wl^ich treatment
9fae persisted for two days ; during ^hicb time she gradually
recovered' her senses, and is now perfectly recovered.''

ON THE PROGNOSIS IN LABOUR.

Tq the Editors of The Medical and Surgical Spectator.

Gentlemen — A Correspondent, in one of your former
^lumbers, endeavoured to controvert the opinion delivered by
an ingenious Surgeon on the unpert^^inty of the issue of la?
bouri

Two cases lately occurred io me, which confirmed strongly
what that Surgeon asserted, aud point out the propriety of a
close attendance on the patient during the whole progress of
delivery. I was called to a lady whose labour was only com-
ine^cing, and after staying some time^ and obscrying its prp*.

IS09.3 . Midi^if^it/. 67

gress^ I deemed U unnecessaty io tontinue longer my attend-
•ance at this tiiue, returning home at four in tke mornings
About eight o^clbck I ivas again sent for in a great hurr
Ty, and found the child born before I arrived. The .«'tc*
count I then received of my patient \iras singular. From
iiie time I left her, at four in the morning, she had not had
Ihe return of a single pain, nor would it have been known
that she was «kUv0red, but that the nurse perceived by chance
iM>md.hing stir under the bed-cloaths, and, on raising them,
she fbuRd it to be Ihe child. The patient did not know
of it ; she fek ao pain, and therefore could not suppos^e
iierself delivered^

The second case was that of a lady who had been but
slightly com'plaining ; so little, indeed, that I was not sent
ftr. In this state she called for her pot de ehambre^ and
when in this situation the child was precipitated into it.

These are circumstances that speak for themselves on the
attention that is necessary to be paid by an accoucheur to his
patient in labour. Practitioners are afraid of telling all they
meet with in this way, from the danger of reflection upon
themselves ; but it is only by a communication of such acci*
dents that the younger part of the profession can be put
upon their guard,

I am. Gentlemen,

Your obedient servant,
BaihyDec 10, 1808, T. S.

OBSERVATIONS ON AUPTURE OF THE PARTURIENT UTERUS.

To the Editors of The Medical and Surgical Spectator.

Gentlemeri'^RvFTvnE of the uterus in labour is an acci«
deat which) though not frequently occurring, every accou-
cheur should be aware of. Permit me, the.i, to sta'e what re*
gards this subject ; for, rare as it is, there are few practition«i
crs of e;stensive experience who have not met with it : to the
)pt of some: it. has fallen a great number of times.

p 2

66 Miiwtftty. [Jattiiiryi

The otcSivtetktt indeed of thit accideilt ^ shall not b»
surprised at, wheb ire cdosider the tnanner in vhich the ai>
tlon of the uterus fakes place in hfbaul. B)f its eontractioHy
Isvery part of its cavit)^ Is straitened) or forms a reedstanoe im
its contents. This resiirtlamje, taowerer^ is hss «t tht iNifioe
than in^ any other part, and the action of the either parts ia
likewise assisted by the abdominal musdfSi and diaphnigib^
xvfaidi render the eflfect of their oofltractioitt isore p my eif ai
ton the orifice.--^If then the oriflee is unconmiaiily rigid^ or
^rdsternaturally confttlidted, so as to possea^ An equal itesiBt*
iance Vrith the actioh rf the other par<») the labour esther cati%
not proceed, or some part of the uterus that is Weaken thai
the orifice, from the a^iM cf Uie other parte bearing agldnst
% win gire way, and a rOpCiite of it thotl >1ar proiMbod^
^Fhe place of the utetiis, at Which tha* most oooiilonly ha|^
pens, is tbfe iAeck, — ^for the foad%fa is piMigctid froto the s«^
'peri()t tesistah^ it acquirer, by^ tb« adctttioA ^ the mbddtoi-
fiai fhnscles, and other atsfistbnt partis, oo*operating with it.

The causes of this at^iA^t atie all unknown to ha, tad we
khafll MiTy repeat them ^ enumerated by ttaihoia.
' } . The first tet of causes id> those whioh produoe dJAcatt
labodt,'*^!^ ditftortio^ ef the pelyis, and tooibid <!^oiitraetioli
of the external parts. •

But these we know oobUr in a thfOuMUld cases, without rup-
ture of the ut^os.

* 9. Violent and irregular contraction of the Mrgaaltsel^ as
in case of convulsions ; and if this symptom occur along
\irith di!(tdrtioto^ so as to prerent the te#iftihi«ti«ifi tdf dettTery^
it certainly may have a very powerful e^t*

S. The excessive bulk of the child^s bead locked in the
pelvis; and,

4. Accidenthi injury of the uterus ibelfj frbtti &tttfk^&^ Sct^

These causes then occurring where the utertts i'S prevlotis*-
1^ in a diseased state, may occasion this adcildent td happen }
but we can have very IHlte suspicion df it till it take pfoce j
And eyea admitting we have sttspictoiadf it,trfettre ttOtatktbtK

rmSU oa-ftuch sligM groumb, to attempt ia^onediate delivery^,
iridmit Qtlier etrquniiBikiQc^s in tbe o^ ifAycajm ^e propriety
^ii^ Hwo^ it is of:iw>F^ qoi^sequenqe tp be a,ble to a$cern
Ifiibsk Ihe m%v» of tbi^ aeddent^ vhro it ba^ mtUy , bappeMia
thaa to bnow it# caniBen.

TW ^igiil c^Kumoqly epupoe^ated^ are-^

T. I1l9 tiHldeii disapjHsan^ace c^ the }iQad» (>r pre^en^
ioff port) fiirmerly matly felt*,

& JBxciUftiw pain f»f Uie ajtxlomej^^ filled parti^^ul^Iy
in one place.

3. Remisftioo of the tbroea of labour, f^nncrly violctikt*

4 k Reaching and JBoodiag; aad^

.5. Wcab intermitting pube, witb tendency to del^
quium.

It is^ howevefi the s^didea disappearance of the pre-
afudng part, if once certainly felt, and the state of tbo
{Ndie, we are aoore fo trast to than any other ; for the othera
may lA occur ir the course of a^ natnral labour^ independent
of 4iit acadeatt

b the lale Dr* Yo«ng^ Leeturea of Edinburgh, there are
three coaea meotioned of tbis Occident, and ia all of them thci
Uiotir paioa weie uncomncmly trifling, so that it could not be
relckifd to any violent action of the orgasi, but was evidently
;tbr effect of disease*

Where thia aceidwt occurs fox the delivery of the
child, the Caesarian operation has been proposed ; but some
ob]0Gtioiia may be urged against it, from the state of the
patient, and more especially aa the child does not descend
compktely, ibr the most part, Into the abdomen ; so tha^
some 9i its membeii being entangled in the laceration, will
allow the intnoductioa of your band to get at the feet, when
the deliTory may be more properly completed in this way.
Bsiidea» wounda of the uterus are mentioned by authors aa
not always fataJ, and a greater chance therefore is giren to
tkfi patiafe^ if tie Mtiactioa ia made ia this way, than by a

p S

70 Uidasiiftr^^ [January

new incision through the abdotnen. The deliirery, how
ever, must be very quickly made, as, by keeping the wound
extended, the patient will sink in a few minifies from the
internal haemorrhage, and she. commonly indeeddies under
your hands. Hence it has been proposed by some authors,,
to delay any attempts at delivery till the death of the m^tlier
takes place, and that the Caesarian operation shouldMhen be
performed as quickly as possible. But however humane
this practice may be, it is not giving her finy chands of re-
covery ; and when the smallest hopes remain, however un-
fiivourable circumstances may appear, it is certainly the
duty of the practitioner to take advantage of them, and
to leave nothiiig undone which may contribute to save the
patient.

Where the rupture again occurs in the more advanced
progress of labour, or where the head is fixed in the pdvi»
as soon as this accident takes place, the forceps areto be
employed, to make the extraction as quickly as possible ;
and the hand being then introduced, to bring off the pia*
centa, you will be able to ascertain the extent of the rapture.
But the great loss is, tliat it is only by the death of the pa-
tient the accident is for the most part ascertained; for the
diagnostics arc so uncertain, as either not to strike prac**^
titioners at the time, or the patients being attended by wo-^
men, they are not sensible of the danger when the accident
occurs.

To this subject, Mr. Croatz has paid particular atten*
tion, and has endeavoured to mark those jirevious 3ymp^
terns in the course of the labour that point out this^ accident
as going to happen. He remarks,^ that in such women, the
abdomen, upon examination, feels very ])rominent, and
much distended, the vagina drawn upwards, and the orifice
of' the uterus uncommonly high. The pains at the same
tifue are extremely violent,, without any intermission, and
tii)e labour is very inconsiderably advanced by tliem*. ^ut

J809;] Midsolferyi. 71,

nil these symptoms may occnr in the course of labour, i!lrUb<»
oat any such accident taking place ; and therefore the eau**^
meratton of such symptoms Serves only to frighten "a pnicti*
tioner in his attiendance, and more especially if his patient
has been in a delicate ailing state. *

These remarks may perhaps induce some of your cor*
fesponderits to favour us with any history of cases
of ruptured uterus "which may have occurred to them.
These cases will tend to confirm or disprove what is stated
above.

I am. Gentlemen,

Your obedient Servant,

F. MELLIS.

Upper Thomhaugh Street^
Dec. 10, 1808.

The London Practice of Midwifery ; to which are added
Instructions for the Treatment of Lying'-in Women ^ and
the principal Diseases of Children^ chief y designed for
the use\ of Students and early Practitioners » 2d Edit,
12mo. pp. SOO.

The title is a popular one : what comes from the metro-
polis carries a charm with it. The present volume, we are
tpld, is a compilation from the lectures of Dr. Clarke. We
are sorry to say, it will not add to the Doctor's reputation.
What may pass in a lecture, should not come before the
piublic in a volume. It is cle^ly a publication for a raw
country-lad, who comes to attend for three months the
London Lectures, and to return at the end of that time as
a. finished accoucheur, with a diploma stating hi^ qualifi-
cations for diligence and attention, signed by his teacher,
and framed and glazed, to be huug up for the inspection of
lib custonrm, and to raise their ideas of the magnitude of his

F 4

acqvkemeniA. From the book mam Vcfiiire us, iiKd|i a ptfiscm
will learn, thai ia case of spuHoaui picgnaiicy^ ^^ i;ifemtisl
not tdf Ae patianl tl^* tratb, but tkrow a shade oiraa eaok
•ytnptQm*. We mMjf say, No doubt but she i» vidi ohiU^.
but we hare some doubt with rega^ to her feckonuig-cm bet
eoivfinement. Wa may ask,. If %\\e has been sick in the
mornings aH the iimt^ firom that «he fint reckoned ^ Ska y§iA
saj, ^' No^ certabily; but do you doabt my being wilK
cbftd ?'^— ^< O no, there it little doubt of tbajt; hoistotuck
complaints will at times arise in a very strange way. Ifwm
Have felt the motion of the child, I suppose ?"— ^^ O yes,.
yery often."— •-

** But have you ever felt a limb coming up, or a knee*
pressings as if it would come through yo^r ^uje ?"— r^^ Why
no, not so plain as that, certainly ; but ( h^vc felt it move
so often, that there can be no doubt.*' — "Aye, but are you:
sure it might not be wind">*^ — '^ Why, dear me. Sir, yoo-
never doubted it before ?"— *^ Oh, I do not doubt it nowLr
but wind will do this, and ftel a good deal like a child".
Pray are you ^ways sick in the morning;? Because 1 qnce
ko^Y a youn^ lady who was mistaken on this point, and she.
had seven children afterwards."

In case of spurious pains we are told thfet '* when a prac-
titioner is sent foe without; occasion^ )m ritQuld pzurtioularly
avoid showing that h^ is out of bumoar ;. ijkissm de no gcMdj^
and is often productive o£ harm. A geaUemaA boing sent
fi>r on one of these fruitless eaands, began ^^busii^ the auna
most unmercifiiUy ; ttie eonsej|uea€Q was^ thai thei lady so9t
to another gentl^m£| wbea seaJiy in Uboiir. ' The gieaf
objectisto remcfioe the cause; ta do iftkich wh» slwHjld P.m|yiy
the bowels, and afterwards give aa opiate^dxaiighj^.'^

Th^ advice oa tlieaccoaclfteui:*'afi(st8Qiag into the FOom>
U equally instEructive :

^* it is yefy difficult for a maa at first to Qnd his /wajr,. tvkna
it bappeaa l|« was notknowflbio the patitnti Itafime risa tbb

, 1 J^^^fi^^ T?

ligbt of him lyiU at Urn^f iod^e^ gea^c^llj^ cskose a sort
of s^Bsation irhioh frighteos awaj W^ pain for a. length of
(ini^. la the early {vpirt of labcmr tkU is of great conse-
queivae;- » pr^i^titioocir's time may be consumed, wbien itf
maji b« tbe ij^oaiaMv oa)y faoq^$ herself in lal^our j bow tbeq
is tluui to^ be discovered ? Tbc^re is ap ott^r mode than bj
dimg: away the first impression^ which,; as a stranger, Lmi
haa made^ With this view it is yery easy to ren;^8frik on het
timsty^ that; Eichai^ i» ^ piqtur^ of his p^pa,^ ^lq^
tint UttlQ ^ss Sally has the cooi^ti^nance of h^r maipat
observing that the girls are the hai^dfomest, and tu^^s^na-^
toiaJl it is to expect th^i they should be so'; that it rained
ye^jti^^y,. but h^3 a fairer prospect tp^'day ; that the mi)^
was yesterday in th« Qprth, bi^t to-day to the east ; that i\^
wefiUl|ei7 is v^y odd for the time of year, but: there is reason
to expect it will soon change for the better, jn the mid^t o$
Ibia she will get a i>ain, which will bring the conversation
iiery naturally round tp pain ; tliea we may inquire th^*
number of pains, the lengthy viol^pe, and interval of them».
4so. tilir she gets a second,, which it is right always to insi^^
iippn a& b^ipg ^ ^^y bad one,, jn^t ibr the sat;^ of urging:
tn examination^ the necessity for which sbouild be ej^plained^
#n account of giviag her satisfaction, which is necessary.
9bo will say pprbftps, >^ Bat I have not had a show y^V-^^
•* Hav^ you not, indeed!" may b^ tli^ answer: ^^ If that
WUmi it is vef y mecessai^y I should examipe if Oxt cUkjl
Ijffs ligbt^" If sh($ says she has. had a show, we can sti]^
make it an i^guiaeiit in favour of examining. If th^
watoffi are broken,, or not broken, if sl||s is strong or we^ki
n^ asay' easily make ^\m reason or o^her in favour of qi^i:
min»iniii^> for w« canpot knqw with accnracy how a womaa
lA goiilg on,rtilli we lian^ ^xan^ined her, aHer whichji we may
make up our mind aii^t^ th^ prot^le duratioi^ of the labour y
Itat im the eady stageii of lab^i^ii we aboii^lfl never aJilow th4
th«y aseia labou]^ b^ t^y>.thi|t^ w«i thixik they, ^uca goings q^

74 Miditiftty. [Jaiiiatyj

Yery far (owanls being in labour, and tbU more especially

where vre Know it is a first laboar^ If We tell them they are

in labour^ the woman will then go on fatigning herself and

get no repose, while, by another mode of conduct,* we

obtain for her a good night's rest. We should never allow

of their getting us to form a prognostic as to the doratioii of

the labour; we may generally prevent them, by telling them

that we have ascertained the child lies well, and it will be an

easy labour, or some such thing ; adding, that, as to the time

it may last, we are not able to say exactly ; or if we do hazard

an opinion, it is never till we have the child's head in our

hand, and even then we are very cautious, having been often

deceived ; we may ibcn perhaps say, the child may be born

in a pain and a half, or a pain and three quarters.'^

On early evacuation of the waters, as a cause of diflScult*
labour, it is observed :

** A patient in this situation requires a little management;
it is not just io stay with her all the time ; and yet it is neces*
sary J if we leave lier, to leave her in confidence ; therefore we
may give her the idea of making provision for whatever may
happen in our absence : we may pass our finger up the vd*
ginay and make a moderate degree of pressure for a few
seconds on any part of it, so that she may just feel it ; after
which we may say to her, " There, Ma'am, I have done
something that will be of great use (o you in your labour,'*
This she trusts to ; and if, when slie sends for usj we get
there in time, it is all well ; if later than we sliould be, we
easily satisfy her : *' Yes, you k^iow I told you I did some*
thing which would be of great service to you in labour."
If the placenta is not yet come away; *' Ah, I am quite
ill time for the afler-birth, and that you know is of the
greatest consequence in labour.*' And if the whole is come
away, *' We are glad the after-birth is all come away, in
consequence of what we did before we last left the patient,
and the labour terminated just as we intended it shoidd.'*

• The management of tvvias is thus detailed :

^' As it is necessary to wait before delivery the second time,
yre must be prepared for ii% and amuse the patient with con-^
versation: she may inquire, *^ Dear me, Sir, why does the
afler-birtit stay so long this time ?" — " Oh, they will some*
times be yery tedious »" Slie will say, ^^ But the last time I
lay in, it came away in ten minutes." — " Did it, Ma'ami aye^
I. have attended so many since I attended you last^ that I
donU recollect 4sxactly the time it took in> coming, thou^i I^
recollect all the material circumstances clearly/' We
should, therefore^ let her have an hour to cool amd to nourish;
and if, when she begkis to feel herself strong, she' should be.
agaiu uneasy about the after*birth, we may alarm her a
little, so that, after playing this piece of artifice,, she will be ,
^iet enough* Thus we may begin by explaining to her
that the after-birth is like asort of sponge, which ought to^
contract, and will not, in some cases, till after a considerable .
time ; when it does so, it will get free ; but if she is very
anxious, that wc will get every thing ready to go up and
perform the operation of separating this spongy mass.; that
we will not give her any more pain tl^in we can help, though
it is a very painful operation without a doubt.. Before we
have said so much as this, .she will feel herself less inclined to-
it, than she was, and tell us that she feels herself easier, and^
if we please^ she will wait a little^ We may then urge ^t^
for we may be sure she will be against it. The time,, haw-
ever, comes when we really see it necessary to turn and
deliver, or at least to delivef^. We have now tp undo what
we have been doing. This we do- by representing that the
sponge is separated and is kept by the uterus, which it i&
ei^y to set right without much paifi* ^Tl^us lye must amuse
the patient by talking of the after-birth till the second child
is delivered. When the last child is delivered, we may pull
gently at the cords of all the after-births at once, in order to
prevent a partial separation, which might bring on flooding;

76 Mbhoiferj/. Januarfi

pullin^^ at one cowl separates one ptaeenta ; lki« brings on
bleeding, and tho woman dies ; therefore they nHi^t all be
consklefed as one, and treated, in siyins a^iatance, as a
single fiaijsnta*.

^< It is neoessaiy ibr a young man to be prepared for a ques*
tion tkat may bo asked ^ oi)« of tke women may perhaps say ,
*^ Pray, Sir, did you erer seo a cae© of twins ?** If be wia
off Iiis giiavd, bo would be apt 1o speak tbe trulb, and say,
My bi0 BeTCff did; now if he says no, he does* an injury to tha
leoaian and himself too. She w^l reason thus : ^< Oh dieaf
me, I hope 1 have not got twins, for he wont be able to do*
lii^ef nie^ as be owns he never saw a eas^ in bis lift." Her
pains will gradually ge off fit>ni the alarm. The way is- ts^
,givoa» equivocal answer, a^, ^^ it woHid be very odd if I had
net seen ^ case of twiiis in solai^ea town as London, in thc|ft
midst of which thefoape so many advantages, such a number
of largo liospitals, that I declare a person has an opportunity
of seeing muoh, inose in London than he would hare anyi
where *lse/'

From the 4>ove extracts it will appear t])at wliat the
book wanfe in science is made up in potioy. It \s^ the system
of MaebkiveUian deception to be practised on the poor
w*onian solely for their oxvn good, and to enhance tbe
cbaracterc^ the profession. So that if the young man whp
peruses it is not made an aecoiicheup by its lessons^ he will
at least be made a cunnmg fellow.

If this work is compiled from Dr. C.'s Lectures, which
i?edoubf, he may be considered the Macbiavel of Midwifery »
fit to preside over every gossipping cliamb^ of tbe metoo-
polls; and, in the language of French official cotitume, b^
n^ay be styled Inlendunt General of the Department of the
Sex.

IV. PHARMACY> &c.

Thb tgrtvA idiproTonenl of ixtodefA pfaa«tiiac}r jg the Km-
pltficaKioii df tiie art of t)TeMnptiKMi. Tkfs sttnpKfie^oft
hai, pi^aps, been cuTired too £ir, and the activity of opera*
tion is oftett foist by study ii^ cleatnteffe of induction. Tklb
may be instanced iii many prepaintions : tbe dikir pai^go.
ricuih) or oampbv^rated tkctttf^of vypiiifn^ as orif kftUy made^
m ft more suei^^Mftil prepamtitint tkatt the mdd^n {litproU^
Ment of it, Thift cufeject hafi; beeH tery shty 4i9t^¥iUd ^
by tbe late Dr. George Fordyce ki tile case of MVemt putv-
jg;a<ivo cJiMbpfMittons, the^ing tlattbe Mmbined action ttf
certain medicines is very different from IbMr ^wen in tfaefa*
«bnpl6 slater, aft ift rhabaarb, sehna, aloes, &o. ; ^dth^ttt is
Wily firons facts and experience^ not from reasDiiiiig^ rf prSort,
M the paiticulnr properties of sepatute' dtttcte, that Mh
«naMc «^ to judge of the real qualities aifd p(ywars of sacli
oohipositiont^. In the tM6 of loetallic lremedie»^ tslich oom*
btti»ti6n IS of teM consequence, froiti tbe natutad actittty
oftlM^ir opbmlion. Thednly point is to exhibit Ifaem ih
ibeftr ftidst active oheM^ctit siMJb i ftud since << I'MlMOphers^*'^
as Mr. Ddnn obsetttes^ ^^ fattfe fls^rted, And on tbe testimony
^eKpetimefit) that the actidnf or aotivity of M^Sah depends
On the propoitioh of oxfgiin With" Mrhich they are nailed,
to this pf-i^iple i¥(s may attribute the more immediate iaflu-
tnte of tb« mariat of mercury to th\e s«ibmmiat/'

arsbnk; Actb.

I'liis acid is introduced into practice by Mr« t)unn, of
Wells in Norfolk :

<< Having/' he remarks, ^^ about six weeks back, had
cases of obstinate intermittentii, which rec^isted (he usual
4neans employed^ as the bark, canclla albe, Fowler's mi«
iieral solution, emetics, &c. I resolved upon the trial of
tbe ancnio acid« Tbe ncid was made, according to Ba*

78 Pharfnncy. [January^

cliolz's process, hy first mixing in a retort, one part of mu-
riatic acid, four parts of the white oxide of arsenic or arsc-
•mcus, ' and twelve parts of . nitric acid ; then boiling the
miictare till nitrous gas ceases to be engaged. After the
mass was evaporated to dryness, by exposing |it for a few
minutes to a lowered heat, I dissolved it, being about S%r».
]n8oz. of boiling water. Of this solution 1 gave three
drops every two liours, combined with either an equal quan«
Uty of tipctare.of opiuQi^ or cascarilla bark. The result
was particularly sucoessfQl. The foUowiag are facts which
at once prove the fiiHacy of its being injuriotis^ (at least
when giirea in small doses,) and at the same time its decided
and rem^rkaUe. efficacy.

*^ Robert Ciurle, a boy about 14 or 15 years of age, who
had lately enjoyed exceeding good health, was attacked iu
the commenoement of September with general rigour^ great
prostration of strength, and a vomiting of green bilous
matter ;:th^ symptoms were gradually superseded by the
hoi stage of fever; the i\yre:icia was considerable, tongue
.parch^, and skin excessively hot and dry; he took during
this litage, a draught with nitre, which was immediately re-
jected. He then attempted to swallow a beverage he called
ibr, made with apple-juice and water, but the irritability of
his stomach continued so great as to refuse every thing taken.
Dtiring the remission of the paroxysm, he took an emetic^
which operated perfectly well ; and after his stomach was
easier he began with three drops of Fowler's solution, which
were repeated every two hours. The secopd day following,
he was attacked as usual, and the hot fit, if any thing, was
more violent. His medicine was continued with the addition
of one, and afterwards two drops at a dose. Notwithstand-
ing, the paroxysms came on every other day equally severe
*for nearly a fortnight, when they remitted for about three
days. A relapse ensued ; the type, however, was more re?
I^lar. He then b(*gan with three drops of the arsenic acid.

1809.] • Pharmacy. 79

which was afterwarib incrieased ip four. This .dose was
taken ^very two houjs* Tbe next dajr he w^ again at«
tacked) but with much less severity* Since ^his time, the
fever returned no more^ and he }& now as hearty asd firee
f;rom dis0ase ais evjer,

^^ Encouraged by this suociess, I ne:|t-gaye it a trial in ^
case of Rheuouitismt The subject's name was Ely, of the
parish of Wighton. On her first application, «he cpm^
plained of .considerable paiq and rigidity of her arm. The
tendons at the elbow-joint were very n^upb eolarged, and
the mu^^l^ of her arm were so contracted, that she could
scarcely move it. A strong volatile liniment Vas ordered^
frequent friction with flannel, and the topical application of
tlie warm balh.

" Oa the ah of September, which was abput three days
after, slt^was much worse; her arm the same; much pain
and inflammation about the ancles; pulse quick; tongu^
white, and indeed she Iiad now every symptom of acute
rheumatism. Leeches were applied to her ancles; the in-
flamed, parts were ordered to be kept constantly wet with a
lotion compospd of spt. terebinth et aqua. The sudorific
regimen was enjoined.

^^ R. P. ipecac.Comp. si^ grains — Pulv. quaq^ quart hor.
fumend. — P. ip^cac^c. eight grains— Calomel three quarters
of a grain — G. a. q. s, ft. bol. h. s. sumend.

f * As her bowels had been rather relaxed, no aperient was
deei^ed requisite. In a fe\y days the inflammatory symp-
toms abated, but the pain and tension still continued, and
every joint was alternately aflected.

^' R. Solut. Fowler miner. — Tinct. opii. aa. two ounces,
l»umat» gtt. viij. secua^. hor.

^^ September 10. Continues much the same as to pain and
rigidity of the joints. Rep, gutfa also.

'f R. P. coft. fl. half ai^ ounce — f. canell. alb. gr. v.—
M. Pulv. sumat. ter in die,

*9 . Wimmtty. pa^uti^r,

^ ^ fTdb* Ltttle alMstidfiieAt, i^«ry^ ^vidak^ »tiffl mmh irn*
iitbiKty and d^ntraetioh iX Mie mttscI66^.

^< R. Solut; MBMlic etCfd gftt. iij. ^il^,. 4>ii^r.]

^^ Slst. The arm is reduced to itsaiatuild^iaie; bet anel^s
ibbU^b gainful, aYie «<MAklet«bIy bcdeii.

^^ f4tb. Fed9 so iMch t^^6r6d, tbartri)dMm^(rinsn<i^
Mljr of tfeaftft^s^y iiirhich, {)etbttp^) ^aa ^^ggturated by b^l:
iiddng, frdoif som^ -fl^tfolii tuifi^akt^ a (JWintity df wUlfe vU
^jiol to tbi^irmotint bf a ^drU)^.

'^^ R. Vin. ferri rfx tottncM— Sutuat. cddbli- "pW^. j. t<!¥
indie.

*^ Tbts Ibtt tf oMb l^Mdi I beaM IroAi fitir i^e^e^ AiEit sbi^
is very finely^

^ On t^e 16tb of Sefytember, GfMigfe Piarkef) itesid&i§ ia
WellSj ^^otepMhed) ^^ hiis poor boy, M^o bad %(A th^ iU«^
htes that is about, granted some medicine, as be bad bbM
iadty t^ith it off and •6A,'' l» be expl^M bimtol^ ^ ftyr
sbtoe time.'*

" R. Antim. tart. gr. y P. i^cac. gr. t^. M. Jmlr. Stat;,
irnm. Solut. arsenate acid. Tinct. opii. aa. 1 onncei BfJ
sumat. gti. y. quaq. secund. hor.

<^ Tbe Dekt day be was again attacked, hut witb a ^txy .
^transient paroxysm. Though transient, it was bis last, and
he is now quite well.

^^ A few days after. Gee. P. hiitttelf catne, and wifii the
samts complaint as bis i»oh*s'was. Tbe type of bis intenyi{f4
tent T\as a regular quotidian. His bead sulfet-ed ckcruciat"»
ing pains, and when I saw btm, bii» skin wab almo^ scorched
with heat ; pulse quick ; frequent nausea % dry tongub ;
and bowe]$ very irregular. I gave bim an emetic witii «
scruple of ipecacuanha, and afterwards ol^deircd eight dr6ps
-of the compound solution^ of equM parts of ai^etiic acid and
.tinct. of opium, to be ^kiketi ev^y two hours. The&y br
>applicd was the 2(5th of September.

. 18090 • Pharmacy. 81

*^ On the 29Ui, I found he had entirely lost his fever.
Being rather of a phthisical habitj and at that time labouring
under a troublesome cough, the following pills were pre-
scribed.

" R. For. vit. two scruples— Pil. scillae two ounces — P.
opii three grains, M. ct divid* in pilula XL — Capiet iij. ter
in die.
" His health is nOw perfectly re-established* ,

*^ On the 18th of October, a man by the name of Lake^
of the parish of Holkham, who had been labouring under a
tertian intermittent for a considerable time, applied for me-
dical assist.:*nce. He had been previously attended by a
Mr. R. and taken about thirty-two bark powders, but with-
out deriving the least benefit. On the first day of his ap«
plication, he began with the arsenic solution without aiijr
emetic, ut infra prasscripta.

^^ R. Solut* arsenic acid-^Tinct, cascarillae se three ounces
^^M . sumat gtt. vj* quaq. dua hor«

*VOnthe22d, the drops were repeated, but he informed
me the fever had attacked him only once since he took the
medicine.. I saw him again on the S6th, and with inefiable
joy in his countenance, he told me that he has suffered no-
thing from his complaint since the time above-mentioned*
J([y appetite, says he, is improved, and my strength so much
recruited, that I feel quite another man. To these might
be added no less than twenty other instances wlicre I have
given it without the least injury, but with the most decided
advantage. One patient, however, took it to the extent of
tiiae drop?j,. which brought on a great degree of vertigo ; but
another, (like the first) imagining the larger the dose the sooner
* th^ cure, took at least sixteen drops at once, and without
any bad consequence. To avoid these errors in future, the
-drops were; given in a mixture; and though the latter, a
Mrs, Norman, had taken that extraordinary dose without

VOL* II. 6

SS Pf^r^acy. [JknUlury^

uny sensible eflSjct, I found in three days after,, the diminish-
ied dose of four drojfe every two hours effected a cure. — Such^
are the tesulf^ of an add, which, I believe, has never till.
now been ventured internally*; if I am wrong in this con-
clusion^ I hope to be forgiven. To calculate on the su-
perior advantages of this Solution is useless; what has been
said of the white oxide may be said of this acid^ only that
the latter is a more active preparation. The value of a raedi-^
cine is generally ih proportion to the simplicity of its form.
Tbotkgh the bark <nay care, when taken in sufficient qpiantit^
Irny intermittent ; yet, the disgust which it creates, thetiausea
whiTch it excites,, and the "heglect oif it ^hich Cattsequentlj^
lenfscres : two-thirds of the sick^ rather than tstkt it, will leave
themsdves a *^i*ey to tteir disordrt*,. tracing to the chances*
tff fortune, or tife ai^pides of their Creator."

OPltTM.,

During the late high price atid scardMy of tWs yaltedbl»'
hAlde, tlie Ekst Iti&ih opinth lias been n^ch Used ; it lia^^
nidt, h6HveVer, been found s6 eAiclK;io«^ as the Ttiirkefy, €»•
cept When tised in hearly dodble the quantity. Opktm,.
Hhotigh tot in atfy cdnsld^rabte quantity, has ako, duti^:
the late scarcity, been imported ffdm Msideira, theprodttde
of ohefbf that 'Clu^r of islands &f Porto Santo. It is said fof
beiiiofe arornatic,.^tid more ftee ftotti iinputities^ than either-
the Bast I<idia or the Turkey 6piura : it is said also to be the-
tmttiral jaice of a species of |H>ppy growing^ there, and
yielded by e:^cissiQn. It is, in j^oint of efficacy, found equal
fo the Turkey^ arid Stfpgrlor to the East India. The price
of Turkey opiu'b Is, hfbwet^r, ^bttk tire very large ini{>orta-
tion iBLteTy raad^, hdtr r^dticed ftbHAhix gvifieirs per operand tb
thirty dr thirty^foifr t^hilling^; b«it it cannot remain ibng at
this reduced ^prk^,. as it is ktid^^O «b11 for mor&.at'thi8 fwc-^
S6nt time in Tiirkey .

Isoo.) Pkamwif* ft?

COMMpNICATBON OI^ FISfl-pO^JSpN, BY }M^. KIERNAK*
MEMBER OF THE ROYA^ COJiL^GE OP SURGEONS, IfO^r
DOX.

To the Editors of The Medical and Surgical Spectator »

Qej^Umewr^SoME ohsiervation^ weie introduced into ^
^jrmer munber of your Vi^Jtt^ble vfoija^ qu the sulxject 9^
Fbb-ppx&op. This deJjBterious ijualitjr, it vf^ jcrfj^ry^
Wfas confioed to the Ssh of Xhe tropiqal cUmates ^ aiv^^hoi)g)i
-the £ict is in general w/dl-founded, jret an exception to jjt fp
this country has coi^e withiu the sphere of my p)vn^9?9^
ledge in the following case.

Mx^ Keltoii, ,of jG^eprge Street., pay,aiidj^h S^ui^^ d,Lped
on ^ yery jftae JBarbel^ as ^s^o his wife ^v^ cluld. la ^fep
course of three hours after eating it; they were all ^e^e]^
with excessive vomiting ^d pi^rgifjgy and these symptoms
continued the whole nighj, jtill the morning when I saw
|]ftQiH. Qfk mojsLing the most minute inquiry into the source
of their malady, I could jQjftd jxo joiheir cau^ ,t9 «>y|*ic;b ^t
could be attributed, than to the eatu^g of ihe i^. I there-
fore conceive this circumstance may arise in any climate to
give the deleterious quality stated in your work to this spe-
cies of food. This quality has been particularly lipUj^
attendinsc the use of Mussels, and therefore caution is ob-
served by most people in eating them ; but the same circ.yra-
spection has not been thought necessary with White Fish of
any kiaA, ,nor ghoidd I^ve conceived it till I met wi^h the
4b^yeV^^, Wii3mim9& <5^led tp tbe p|ti<;»ts, I Jfound,
4rim ib.eif Jtft^tory pf .tj^ syaitpjt<ws, ihftt.»0/a(iPt4jQr.e.\(a^;^-
^tiW'i9(a«.i]|eQ^^y,j^ ! W«A<^i^^^iMJ'?Q«l«l:^4o.'4^i^^
fi9j|4ian,Q^ wbiflt wei?e ,«tten(},Q^ twiltji ibej|lmU^«flM^ ^atKl
vlbc rf^i9k9t9f9» ^f^ ;§PQn iicpn[^«^l * fe t fee .^H^ Si^:9tfili^9

84 . Phamiac}/. f January,

however, more obstinate than in the father and mother :
she continued long ill. That the nature of this fish may
be known, I shall extract the following account of it from
a popular writer on diet.

" The Barbel is a sea-fish that rarely weighs above two
pounds. The smallest kind are esteemed the best. It is
somewhat hard, an(( difiicult of digestion ; but it is con-
sidered as a nourishing, durable food. It was particularly
valued by the ancient Romans, with whom it formed one of
the dainties of their table, and was bought accordingly by
them at an excessive -price. The parts of the fish esteemed
most delicate are the liver and the head.^

If these observations deserve mention in your publication^
so as to put people on their guard, they are much at your
service.

I am. Gentlemen,

Your obedient Servant,

F. KIERNAN.
Charhtte'Streety Bedford-square^
Dec. 15, 1808.

COMMTTNICATION ON ELECTRICITT, IN CASES OF StTPPRES*
SION OF URINE, BY F. LOWNDES, MEDICAL ELECTRI-
CIAN.

To the Editors of The Medical and Surgical Spectator^

Gentlemen — In one of your formernumbersr a very interest*
ing case was related by Mr. Calderwood, to shew the supe-
rior powers of Electricity to those of Medicine in the cure of
obstinate suppression of urine. The truth of Mr. Calder-
wood's assertion I am satisfied of, and can support by the
strongest testimonies of the powers of this remedy in the:

1809>3 = Pharmacy: 85

same disease. But I roust remark that the tfediousnesdin the
cure rather surprised me, compared with the case by Elec*
tricity with which I have fouad it take place under my own
care. This I attribute entirety to tlie imperfection of the in*
struknent, which was incapable of giving that energy and ex-
citement to the organ by its stimulant operation, which a
larger one would have at once effected^ It is from thb circum*
stance, that, with the common machines which surgeons geoe-
rally use, Electricity^ though such an active medical agent,,
often fails, and the truth of this I can vouch by cases coming to
ine after they had been in the hands of others without success,
and then experiencing a ready and permanent cure of their
complaints. Hence it is Entirely the size of the instrument
thfat makes the certainty of a cure to be depended on.

Of late a comparison has been made by some authors, between
the powers of Electricity and Galvanism. As yet our expe-
rience of the effects of Galvanism is small. It has receirved
much praise in cases of paralysis from Dr. Bardsley, of Man-
chester ; but it seems a power that requires some caution and
nicety in its use more so than electricity ; and tliough I do
not wish to call in question its influence, where sense^ motion
and intelligence ar^ impaired without any organic fault ; yet
I think, Electricity is a power of more extensive application,
which can be better modified in morbid circumstances, and
which, on the whole, promises a more certain mode of cure«.
Perhaps, in certain affections, it might be of use to alternatiD
these two modes of treatment, orto Guhanisei\iQ patient first, and
on the succeeding day have recourse to the influence of Elec^
tricity. This experiment is certainly worthy atrial in those
dangerous and hopeless diseases, to which the nervous systeni
is subject^ and wliich so much impairs both the mental and
bodily vigour of so many unhappy individuals at the present
period. Never was a time at which nervous diseases were so
prevalent, so variously modified, and so obstinate and refrapi
(pr^ to the influence of medicine. >

B 3

86 Pharmacy. [January,

As the present cdihiniiliicatioii was catirely suggested by
the slowness of cUre in the case of sappression of urine, de-i
tailed by Mr. Calderwobd^ in order to p#ove the justice of my^
remarlL, I shall, in the next number, oflSsr the particulars of
some instances of obstinate suppression of urine, which had
resisted all the usual reihedies, yieldif^ to the application of
Electricity at oiice, and in ^o com{)lete a manner, that the
water was discharj^ed in a fnll and powerful stream before
the patieht had finished his Brst dttendanc^ on me.

I dm.

Gentlemen,

A

Your obedient Servant,

F. LOWNDES.

St. PiatVi (MViirih-y&rdy
Dee. ^ 1866.

i > t

To tJie Editors of The Medical and Surgkid SpeciaLor.

CeAtteiJitn — No disease is mole obstinate than the corfi-
iA6ti one, known by the na=i1ie <rf ^tottifach oemplaints^ htid
Iffe are in want of a remedy vAiictk ixiay be <er«ied specific,
against this train of disorders. In fa<?t, ittegularitte^ ifi
diet are top often the great source of thfe affectfon, and si
life of tchiperancc, sobriety, ^nd water-drinking, which is
the great step towards a cure, can hardly be submittM t6 hfy
most patients. Of late, a remedy against these disordMi
has been prepared by Dr. Marcet, m. the Oxid rf Bis-
muth ; and 1 give him credit for ite introduction. I have
jifepeatediy tried this remedy in tfffections of the stomacfc^
fittendc<l with indigestidn, pain, and e^pasm, <ind found It
answer eveiy intention which has been described. In some
cases the relief was very rapid; in others the vure Vi^t M

4Qore graduf^llj ; but from iqy own px^Xtnc^ I can voucb
it to be a medicine qf very aptive pqwprs^ It is highlv
fiec^ssary, however, that tbis Oxid be in a pure st^te, and
lYdl prepared. In confirmation of this opinioii, I bavc
also the authority df Dr. Bardsley, as well as Dr. JVIarceL
iq its favour. \t i§ sr>id to b£|ve ^lleyi^tefj even tb? ex-
cruciating paii^s pf a >^ai|perous Pylorus by Dr. Qdicr.
The particular aff^tion in which it seems to excite its pow?
>jBrs, as it were specifically^ is in the Pyrosis^ or Water
iBrqsh, It should be assisted in its operation by a propef
\j»^ of aperients, and it is perhaps one of the safest metallip
preparatipns tbatjcan be introduced jntotbe system. Thesp
«circumstance$ I sta^e .with the view tp attract the ^ttentioa
of the prof^pssioO) whose experience will confirm my a$r
^firtioQs or ^^Uici my er|:or, if I have carried my zeal fop

<nevelty and improvement too far.

1 am, Gentlemen,

your iDibedient Servant,

A CHEMj[CA]U PHySJCUN.
iA^rpool^ Dec^ 1% 1868.

0V TA%Ep M^piciKpa.

To the Editors of The Medical and Surgical Spectator*

Gentlemcn-^l svb^it to you the propriety of inserting i^
^Q,ur usejful publ^catiou, a thought which struck me a few
^ay^ ago, on buying a few littles of Soda 'JiVater, which I
va§ ^dyised to ta^e to T^topre my Jiealth ;— When a tax if
|ai4 on a pediciae^ SV^ff^ or not quack^ for no difference ^t
s^ms bfts l)een ma.dey it j$ not on the vender it falljs^ b\it the
Ijuy^jr : ^e unfortunately must buy^ or die ^nd be d d, if
l^^^im^ot (Jp ^p : whil^ the vender^ who frequently jxidja^ goo

o 4

88 Pharmaty. ' [Janmry,

• ' ' •• . . . ^

less than two hundred per cent, by the sale, cannot, to be sure,

afford to sink the tax out of his profits. Hence it becomes

a tax actually laid on by Quacks and Medicine Venders ;

-who, if reports speak truly of them, make a rare living by the

misfortunes and credulity of mankind •

1 am ill— Soda water, I am told, will cure me, if taken
in sufficient succession. Yet I am poor, but as I am anxious
to be cured, I muster enough money to buy a sufficient
quantity to last me for a week's trial. I find it does mend
me apace ; but as I must drink two small bottles per day,
which are 7|d. per bottle, duty includedy that is 9s. 3d. per
week, my means will not allow me to continue this expense^
I am therefore compelled to give up to chance the prospect
of my speedy recovery. Yet, Sir, I am assured by me-
dical men, that this 9s. 3d. worth of Soda water docs not
cost^ all expenses included, Ss. bottles and all! This is ft
great shame ; and, as it concerns the health and welfare of
thousands, wljp, I have no doubt^ either now do, or have
suffered from the same cause, I think it would not be amiss if
some of our great folks would lay their heads together for a
few moments to endeavour to obviate this evil— pot only in
the instance of Soda water^ but many other valuable medi*
cines.

I may be wrong ; but I do not see why the price of medi-
cines, I mean such as are essential and valuable for the cure
of certain diseases to which mankind are liable, should not
be fixed by proper persons appointed for the purpose, in the
same manner that certain necessary articles of consumption
are, — such as breads sugar, &c. Are not useful medicines

as essential to the welfare of mankind as the former ?

I • • •

Then, if Ministers thought proper to lay a tax on these, they
ji&ight always be able to do so, with justice to all parties, by
laying it on such medicines as circumstances rendered best
nble to beta: the impost, such as a fall in the price of the in^

J809.] . Pharmacy. $S

gredienls with which they are manufactured. The public,
by these m^^ns, so far from jsuficring by such ^, tax, would
be benefitted in proportion tp the sum produced by it.
Instead of wh.ich, as the taxes are now laid oh these articjies,
they are very often grievously felt, by the poor sick man,
who is not only in want of the medicine bat oftQu money tp
buy it,

I might enter more fully on the benefit likely to arise froni
the adoption of my plan, and its practicability, but I fear tp
iotn^de too much on your room.

I remain, GentleraeqL

Your obedient Servant,
London, A SIGK MAN,

Dec. 20. And formerly a Patient at Guy's*

The complaint of the above correspondent is just : he
speaks a language which every man who has felt sickness will
approve. Tlie preparation of mineral waters is certainly
rendered now both a simple and cheap process. Their pow»
ers as medicines are held in high estimation by the Faculty at
large^ but the fiict stated by our correspondent is true, they
are only to be got at a high pricey which the pocket of the
poor man cannot command. He is thus excluded from their
beaefit — for they are not remedies prepared in the public hos-
pitals, nor have they yet, however necessary they may be,
entered the list of the College Pharmacopoeia. In a fbrmer
communication by a correspondent to this work, the subject
was treated in a letter to Dr. 3abington, advising an atten-
tion on the par|; of tlie College to this, and we hope these
hints have not been thrown away, We conceive that the
mineral waters b^ing prepared at all the public hospitals and
dispensaries, both q, cheaper and more successful plan df
medicine might be adopted^ and the complaint of our popr
sick correspondent done away.

90 Medical IntelU^nce* {Jamuoy,

MEDICAL INTELLIGENCE,

TO THE ARMY MEDICAI. BOARD.
AN isgeniotts CorrespondcDt has dented fis to aoffer tlie foUoiiJag ng»
;2efition to the consideration of the Army Medical Board. In the pveieat
arduous service in which our hvsLvt troops are engaged in' Spain and Partsr
l^al, it must occ%r that the «oidiers dress of this cHaatc must be a great
iropedtmcflt to Iheir ezertions* The chief inconvenience sofered bj ng$
in these countries is from the rainj fteaspii aetiiqg in, by ^bioh thpgr f|ff
Itept constantly drenched widi wet. The moif ture ^o^tn soaks through their
hcavj great coats, and other j^ts of their dress intended to guard them
against it, so tha$ these parts of their dress thus add to their inccpve-
fiienoe by their weight as well as moisture, instead of being a prptection or
comfort. For the service on the Continent it would be fitter, as heat is
not so mtfch waiited .as dryness, that a ligh^ wax covering, perfectly wfiter-
jiroof, C9u|d be made^ which, on the itpproach of rain, could be thro|j(|i
«rer the li^st of ^ their dress* and completely defend them from the iDcIe«
lypfy 1>f the weather. It cpyld be «a9iiy carried in their knapsadi;, and
^ght be so £9nned as to gi^e 9» ^ore ^n two pounds of additional
4pei£^t. When we consider that moisture is t2ie great predisjposing causf
4p all 4vmy iliseasep, the above observations merit the serious attentian of
4lbe Vf^jf tf*! Bparjd, and all the Military Departments.

THE ESSJSX HEPORT OF VACCINATION.

If we talMEi our iOW9 e^perienc^ as tbp Xest of Yaccinalionj we are Us
<^^B(»ded friends, and shall always feel happy in the removal of doubts xm
ibis very interesting point : we are of opinioo -the following candid statement
vill materially contribute to its success, and binder a firm conviction that
Cfery friend to humanity ought to facilitate this national object, we have
j^iv.eD it at length, as it aflbxds irrefrajgable evidence of the security of vao-
CinatiQn> attested by the tirst medical characters ia the County of £ssex :

At the Anniversary Meeting of the Colchester Medical Sodetyt hoMen
<his<day, August 25, 1808,' the following Resolntions wei« entered oo Ih^
Joamals, in consequence of a motion Maade at their last Meetkig, Iwant ^^

]»}9.] Meiied Iniettigmwe. 94

Ity Dr. NevTBix, re^vestiog^ the Members of the Society, «* IMf aezt
Meeting, to Report their Obserrations on the Security of Yaocination at a
ProtectioD from Small Fox, and the ooosequcnt Effscts of it ujioa the Con-
ftitntioii.

*' Re$o1red, That the Merabem of thii Soeieiy, from % stead j, eaodid and
impartial attenttdm to the ^fleets of Vaccinatioa, doriag a period of eight
jears, io 'which time several thousand persons have been vaoeinated by them,
^hiak it their dutr to give this public testimony of its perfeet safety and se«-
curity as a preventire of Small«>Pox ; and further, that vader the fallest eoa*
Tiction of the pttwtiee, thfey hav» not only recommended it to their patieatf ^
|)ut iBtrodHCol aatd practised It it their own families, amosgst llieir nearest
and dearest relatives. That they have at different times exposed many of
^ir patients^ lon^ afterwards, to the contagion of the Small-Pox la ef<ery
l^j they could devise, with perfeet talety from its infection, and that they
have s|ever been able to trace any sabse^aeot diseases, as excited by yaoci-
nation in the eonstitution*

U They feel it the more inoumbeot upon them, at this time, to jnake sa
onblic an avowal of their sentimeots, as the SmaU-Poxhus lately beeq sa
«xtrmiely prevalent, and &tal in this town and its vicinity, and be^asj^ tfc#
ipnjndioes against vacciaatioo, partipularly among the iower order ^ thft
people, have been kept up by false and infamous reports, some of whicii
have been artfully introduced into publications of notoriety and extensive
cifculation.

** They are fully convioced,, that it is only hj the unbiassed declarations
of experienced and respectable practitioners in different districts, the |)ubUc
mind can be satisfied^^ and this most valuable discovery .and luaotioe univer-
sally adopted.

** Resolved, That this Society views with abhorrence the sublLe, artful,
and designing conduct of some practitioners, who continue indiscriminately io
recommend Inoculation for ^e Small-{>ox or ^ow^ox, m best snits their
porpQses^ and by that means frequently, when the former is iidqpted, diffuse
nad s|»read that most dreadfid and d^tructiv^ pestilence .^oifgh whole xjLU
*ages or populous districts, regardless what misery «nd distress they entail
upon others s of such shocking conduct the Membew of this Society ihavs
lately had the many prooft^ and th^j earaestly bo^ that j^roper ^nd-cA^

S8 jUtikal InleUigince. [January^

oteat fteps will crc lony be taken bjr the Legi»!alure to stop this horrii
traffic*

. **' Resoi?ed^ That Cof ies of these Resolutions be transmitted io the
different Medical Journals now in circulation, and a suficicnt number of
^em priDied and circulated io this town and its vicinity.
S. R.. If BWKU., Cokhester. Benj. Smith, Wivecboe.

Pa. GsCTWoWy ditto. Natr. Salter, Boxford. .

JoHir GoDVftET, Coggeshail. Maurice Mason, St. Osjtb.

T. C. Hahrold, Najland. H. Nunbt, Colchester.

Bem&t ,NuifN, Mannlnf^tree. F. Eaglc, Co^^eshall.

Wm. Tbafis, East Bergholt. G. Kemball, Tqlleshunt Darcej.

G. RooEHSy Manoingtree. T. Osmund, Thorp.

Wm. Susi;, ditto.

The Medical Board, we are informed, was to expire on the 24th of thU
month. We have not heard what new arrangements have taken place, an^
what medical regulations are of course io follow. When these are mad^
puUie, we shall i>e attentive io lay thehi before our readers. We hope thej
will make a material itaprovement on the old sjstem, and that we shaU have
enlj io present them with conmiendatioB and satisfaction, as applyhig to ali
tbe wants of the service^

A proposal for the improvement of Dispensaries is just now circulating by
Dr. Herdman, Physician to the Citj Dispensary, which we shall notice in oar
next number* It is addressed in the form of a letter to the Bishop of Dur^
bam, and the other Governors for bettering the condition of the Poor. - We
are afraid, however well-meant the proposal is, it is more speculative than
practicable in these times.

' We understand the Secretary of State for the Home Department bat di-
rected the Royal College of Physiciaos to inquire into the cause of the Te»
cent frequent occurrence of cases of Hydrophobia, and io consider of the
means of preventing the increase of this alarming disorder. We look for-
ward to this report with considerable anxiety, and have no doubt this learn*
f d body will gi^e every attention to this interesting subject : it cottld Wf^

1809. j MeHcid Intelligence^ dS

lia?e been committed to better hands, and we have no donbt confliderable
elncidatioD will be the result of their laboar; the well drawn case of Dh
Powell, and the recent effects that case had upon the infant of Ann Chandler^
we should conceive would fead to much important information on a subject ia
which the interests of mankind in general are at issue. That case in our
0|Hoion cannot be too widely diffused, and maj justljr be considered as the
kndrmark to future practitioners : we lament that men eminent for
tdence and liberaKtjr, should in this -instance deviate lo widely from tKe
point : 'we trust the intended report will finally settle the eontrorersy, to the
advantage of the civilized world.

A meeting of the Collega of Physicians has since been held on the
subject \ and we hope, from their united consultation, that some means
Biay be devised to ameliorate the trea^. ment in this most dreadful of all
maladies*

St. Andrew's dav Royal Society. — Dr. Wfllianr Henry this year, re-
vived the gold -medal for his varions communications. (Sir Godfrey Cross*
cj's.) Dr. W. H. WoUaston was the same day elected one of the Secre-
taries, and a Member of the Old Couocil : Dr. €. Ash was also elected af
the New Council*

The Election of a Physician of the Jurrey Dispensary, in the room of
the late Dr. Hawes, has been attended with much opposition, and has ex-
cited general interest, it is not the business of this work to enter into ttie
eontroverty to which this opposition has given rise. In the appointments t4^
all public charities, our opinion is *< delur digniori. If the merits of the two^
candidates are weighed by their profesaional experience, respectability, 9ad
miform attention to the interests of.thp charity, the Governors can have no-
hetitation in their choice; but the interests of. the charity are not always-
the bias on these occasions.

Dr. Tatersall, we just learn,, has been voted in Physieian to the Surrey
Dispensary by a majority oi new names about to be scrutmised*

Anthony Carlisle Esq. of Soho Square, Surgeon, F. R. S. ia- chosen pro-
fessor of Anatomy to the Royal Academy.

We are sorry to learn the Small Pox rages with great vioi'ence at Welliagtoo,

iM

JUsdkai Ivt%liitmiie^

[Jaaiiaiy

Keikjy iui* in St4JC>rdslMre« I« each coiwtf , th< crectioB of a ceotial y|i|
Gne statioii woukl be of ucat «i;rvice i ii i^ mOx pleaiHre ure Mmpvfioe tuo
» fcbejB^ is to agitation*

A letter from Sayaaoah* dated Oct. 6, saj*^-*< Aooouots fi'OMi 6|
Jltarjr*8 U/ i,be la«t maUf, reproseat that place as ¥erjr uabeaUlijr* hMt§i
^Tom. tbeace staXe tbe -prevalence of a disease attended vioh evierj sj;^!^
wiC yellow fevier*-*Tboiivb the faculty did not canf ider it ^oQt^ioiui, msH
4d the iababitaotfl) we undejrstwd, bad deserted the to^m^ and fled into l|i
countrj. The following is extracted from a letter leeeiv^ed b^ laat jmU
dated on Friday ;

*' The fever has raged here more violently than I ever knew it in Geor

gia. Althougl^ it was at firt conceived to be very partial, it has exteode

to at least one tbird of the inhabitants* There are now said to be forty

eight cases, of %hich nineteen are black ; and fourteen exclusive of thi

.Dumber have Jieea interred. The town is nearly deserted.

A General Bill of all the Christenings and Burials within the Billt 'O
Mortality, from December 15, 1807, to December 13, 1808. —

Christened in the 1>7 parishes within the Walls 1088.— Buried I372.

Ciiristciled^ in the i7 Parishes wUhont the -walU 4503.--^)Bur^ 3069.

Chniatened in the 23 Out-Earishes in Mi4dlee«x and Surrey ]0^1.05,««r
JBuried 97^37.

Christened in the lOF^rislafit ip the City and Liberties of Wjeatxnvwtfi

CM.tc^ .

' Males . •
Females

*

::/p:m} ^-«» "'»««•

Buried '

Males •
, Females

;;'J;f§«}i»a.U9,954

Whereof have died —

Under two years ef age

6.075

Fifty and Sixty

1^6510

(Betifeentwo mid five

2,4i&6

Shfty and Seventy

1,499

Five and toM

mi

Seveviy and eigtbty

i^aao

Ten and Twenty

QAS

£ighty and ninety

bQ5

T<weaty and thirty .

1,792

Ninety and a •hundred

64

Thirty and forty

1,2^D

A hundred

J

Forty and fift^

l,d7l

A hundred and two

1

JLncreased in the biinaU this y.fl»r J^0;^O

1809,]

MetKcal InieUigfme.

M

Never did the great cause of hnmanit; suffer more sererely hj the
#ettfa of BAjr iltao by that of Dr. William Hawes; a man ' veiierat-
«d bj humanitjr and revered bj science; the "wild Arab, tlie uapolished
Indian, and the civilized citizen, each, in their turn, maj owe to him a sei.
oond life; the acbievements of the warrior and statesman will perish in revolv-
ing; time-, bat the name of Ilawes will triumph over death, and the ntidlouded
energy of his beneficence animate posterity. VV^ere we to fondly indulj^e:
)b ehthusiacstic sonrow,. it wonld be inoompatible w<ith tb€ soleimiffty of the
occasion, and be- completely opposite to that fascinatin^f simtHicrty that
*faeds so bright a lustre on every act of his^weil spent life : the removal oC
sueh a character from the theatre of his benefice noe, w<e rasst deplore as »
national calamity,, and in the plenitnde of our sorrow, We baturatly wish fai»>
reitdeBce had for ever been prolonged among us. la the erection of the
Humane Society, the people of this country have received a legacy ftorn^
which ages to Come may derive happiness ; the improvemient of ibis legacj^
has been deposited to the care of the British Nation. Generous guardians »
continue to improve this dowvy, ^atid let the t^vid effusion of sensibility mc^
]iorsrfe hwrnAie ^liiseryv

LONDON HOSPITAL.

Or* BitttonV Ledtutes on 4be Theory and Practiee of Medtctaay and m^
Materia Medica trifl 'be eopanenced abdat the 20tb of January. For par-
ticulars apply 10 Mr. Price, Apothecary at the Hospital, or to Dr. Boxtoa.
Setieaittreh Street.

MEDICAL AND CEffiMICAL LECTUUKS-

Dr. Ciitlterbiiok ^11 begin his spring Course of Laalares^on the Theory
and Practice of Physic, Materia Medica, .and Pharmaceutic Chemistry, early
{b Xabiidfy, at i^iiie In the morning. Partictitars may be kfiownea application
•t No. 1, Criescent, New Bridge-Street.

Dr» Reid will commence his Course of Lecture on the Theory and f rac-^
"^ of ^edicrne,^t hls'bouse. No. 6,'i&re!ttvifle^treef, Br«n9WiekSNyaaT«,^n
llMiBy, JinsAly l23d, -it nlAe octoek in theiDdrotng.

Mr. Taunton will commence his Spring Course of Lectures on Anatomy t-
Pbjsiology, Pathology and Surgery, at his Theatre of Anatomy, ou Satur-
day, January the 2l8t, at eight o'clock in the evening.

66 ' Medical IrUdligefice. [Jilntiary^

Dr. Squire will, on Motidaj, January 2d, 1809, begin a Cotirse of Lec-«
tares on the Tbeorj and Practice of Midwifer^i and the Diseases of Womeo
and Children.

NEW MEDICAL PUBLICATIONS.

An inquiry iato the symptoms and treatment of Carditis^ or the iotfani'*
mation of the Heart ; illustrated by cases and dissections. By John FoM
Davis, M. D. I2mo. ds. boards.

Suggestions for the prevention of that insidious and destructive foe to the
British Troops in the West Indies, commonly termed the Yellow Fever, &o^
By Stewart Henderson, M. D. 8vo. ^s.

Observations on madness and melancholy \ including practical remarks on
those diseases ; together with cases : and an account of the morbid appear*-
ances on dissection, hj John Haslam, Member of the Royal College of
Surgeons, 8vo. 9s. boards.

Practical observations on the nature and cure of strictures in the urethra,
Svo. 3s.

Identities ascertained, or an illustration of Mr. Ware*s opinion respecting
the sameness of infection in Venereal Gonorrhea, and the Ophthalmia of Egypr^
^J0» 2s. 6d.

IN THE PRESS.

In the press, and will be published next January, a second edition of Mr*
Carmicbaers essay on the effects of Carbonate, and other preparations of Iron
upon Cancer, with an inqui/>y into the nature of that disease. This edition
n much enlarged and improved, that it may almost be considered a new
work. Among the additions, are a great number of highly interesting cases :
a disquisition on the uses of Oxide of Iron on the blood, and remarks on
inch diseases as depend on its excess or deficiency, or in any way bear a re-
lation to Cancer, with an attempt to answer the queries of the Medical So-
ciety established in London, for investigating the nature and cure of that
complaint; we anticipate mueh information from this valuable collection.

Mr. Charles Sylvester of Derby, (late of Sheffield,) has in the press an
Elementary Treatise on Chenustry ; the plan is in many respects original.

=E

We have received the prospeciusy addressed to uSy of an
Jhiended periodical publication^ to be called THE DETEC-
. TOR ; but as it is irrelevant to the plan of The Medical
and Surgical Spectator to enter into the merits or demerits
of controversial disputes^ we shall be silent on the nature of
its intended contents*

z

■ ■ ■*

Vol. II.] February, 1809. . [No. VII,

—— - . I ■ * I I ■ I ■» I I — w— — — ^p— BP— W^

THE LONDON

SPECTATOR.

r" 1 '

EMPIlllCISMi

The Royal Patent was original] j a reward to merit and a
security to ingenuity, to protect the subject in %he emolii*
ment he had a right to claim from beneficial discoveries. The
acquisition of it was a title to the philosopher and artist^
equal to the marks of honoiir conferred by universities on pro-i
fessionai characters. On this original foundation it tvas wor«
thy of praise ; and in confiding it to the hands of the Sove«
reign, as the fountain of honour, the legislature shewed the
expectations they had of this deposit, lodged in his hands,
being applied to the original intention; But this plan of ori-
ginal brightness has lost its pristine lustre; Its security is
prostituted to the tricks of imposition, rather than io con-
firm important discoveries. The establishment of the office
requires to be supported, nor is it nice in its regulations : those
to whom the department of investigation is assigned, are de-
stitute of that general knowledge which should make them
judges of the discoveries, real or pteterided^ that are siib-i
mitted to their de^sion. Every patent, before being grant-
ed, should have the claims on which it is founded, inveii-
gated by thdse who are accjuairited with the subject : and oii
their decision, its right to the title granted or otherwise,— «
Of the patents granted for medicines, we. may safely aver.

98 Empiricism, [Februarj:,

that non^ 6t tlietn are ercr submitted to the opinion of pro^
iesslbrial characters. If they were, they would find all the
compositions of those ignorant pretenders erroneous in the
principles of their prescription, or else no other than common
forms of the Pbcfrmst60pcBia, intended for a special purpose^
converted by imposition to the exalted state of an imiversal
remedy.

The degraded rank of patent privileges^ as a passport to
public confidence and reputation on the head of medicine,
cannot be better instanced than by tlie opinion entertained of »
them on the continent. When the Yellow Fever remedy wa»
introduced into Spain, the Prince of Peace expelled it by
Royal Edict, as dangerous to the lives of the community ; so
that one sovereign reprobated what another had ^ven tdyal
anthority tb use. In Russia^ British Patent Medicine tfrCr
not even allowed to be iitt^ortcd.

Of empirical ni^icines^ thos6 have been experienced ihJt
most successful to their owners which hat* been ertiplbyefl
against incurable diseases^. This we cannot instance mniti
strongly than by noticing sdme of the specifics for Pulmonikt;^
Consumption.

ANTIttlTHISICAL SPECIFICS.
The first we shall introduce is the famous remedy of Mr,
Godbold, termed hfs Vegetable Balsam.

GOPBOLP'S VEGETABLE BALSAM.

This medicine is no more than the simple oxymet of tW
shops, consequently a composition of vinegar nnd botreyi,
Such a simple remedy^ therefore, a.^ its inventor well rtbkehvefei
*' if it does no good, can certainly do no harm." In ^lighl^
colds or catarrhs, trifling remedies of this kind may I>e tiscid ;
thc^ at least amuse the patient ; but where thry arc employ^
in diseases of a formidable nature, and under the impressidA
that they Hre more than useful, nay infallible^ to the prejndite-
of proper means being resorted to, the use of such remedtti

18D9.3 Emphritism^ Of

becomes then criminal^ and cannot be too itiuch reprobated^
Godbold^s is certainly a remedy of (his kind, introduced bj
ignorance^ carried into repute by deception, and kept up b^
the same arts. The patentee of it was originally a farrier^
ignorant in the extreme, but possessing a species of cunning in
contriving to get attestations from those who knew not what
they were doing, or the consequences to which such attesta-
tions lead. That consumption of the lungs was ever cured by
Godbold's Balsam, nothing but the most consummate igno-
rance could suppose ; and if such attestations were made
equally actionable as those for giving false characters, the
titled names prostituted to such purposes wQuld soon vanish
from the posts and pillars on which they are so conspicuously
placed, to record their infirmities, and hand them to public
gaze and entertainment as uiihappy invalids. We undtlr-
stand that the original inventor, Mr. Godbold, could hardly
write his name, and the epistolary correspondence of thoso
irho addressed his patients for him, seems also to betray
strong marks of an untutored mind. This medicine has now
had its day, and is only kept up by the old testimonies*

CRAMOtt'^ BALSAM OF ICELAND LIVERWORT.

A MOttE modern antiphthisical specific is the Iceland l.i»
verWort. This is a deception, being nothing more than the
ojcymfel of squills flavoured with the essential oil of anise and
tafrawny. It is introduced to notice by a long dissertation
on the subject, in which the virtues of the Liverwort are
amply detailed, though not a particle of it enters the present
composition ; and the mode of preparation is carefully con*
tealedby the author.

** Fearful that the invaluable properties of the Iceland Li-
verwort might be much impaired^ or totally destroyed,, I
have thought proper," says the proprietor, ** to conceal iti
process and combination, upon the very careful preparation
tf which depends its efficacy, its consequent reputation^ and

H 2

'^

\

100 . Empiricism^ [February'

my veracity ; but when suck regulations take place in the
profession Chat the different departments be strictly observed^
I shall with pleasure divulge it."

REGNAULT^S SYRUP AND LOZENGES OF ICELAND I«IV£R« -

WORT.

The Iceland Liverwort is merely a mucilaginous vegetabte
with some degree of bitter. Its powers are accordingly too
trifling to be supposed capable of acting with any energetic
operation on the system ; and the idea of concentrating its
virtues are too ridiculous to be talked of. In that state it can
possess no property which does not belong to common fecula
or starch, and no higher can we rate its virtues. If any bene*
fit is to be derived from it, which can be no greater than what
is derived from other mucilaginous plants, as the mallows, &c.
the decoction is certainly the best form. But the idea of its
having any specific operation or quality on the lungs hardly
deserves notice.

Allen's pectoral balsam of liquorice.

Tins composiUon, the author informs us, " is an elegant
preparation from the simple and invaluable root from whence
it derives its name^ so remarlcably concentrated that a small
bottle contains all the specific pectoral virtues of a whole
pouiid of stick liquorice, completely divested of its gross and
superfluous parts." The declaration of this fact is attested by
the proprietor on oath. How must we be surprised, then, to
find, instead of liquorice, a harmless vegetable production^ it
contains only the Paregoric Elixir combined with the warm
essential oil of aniseeds. The essential oil seems a favourite
one in pectoral complaints with most empirics, and enters into
most of their forms, though we cannot see on what principle.
The exhibition of opiates in consumption is^ at all times a
dangerous practice, and only to be had recourse to as a palli-^
ative in certain circumstances. The indiscriminate use, there*
fore, of such remedies cannot betoo strongly inveighed against
and the opinion of a popular writer on this point deserves
milch commeildation :

•ai

I€09«] Empiricism. 101

<' Most of the nostrums advertised," be obsenres, <^ as cough
drops, &c. are preparations of opium, similar to the paregoric
elixir of the shops, but disguised and rendered more deleteri-
ous by the addition ofaromatic and healing gums ; the injury
which may be occasioned by the indiscriminate employment
of such medicines in this disease may be very considerabie, as
is well known by erery person, possessing even the smallest
share of medical knowledge/'

perrin's balsam of lungwort.

Balsam is a farourable title to every medicine where a
soothing quality is required in the idea of the vendor ; and
therefore it has been extensively appliefl to remedies for dis-
eases of the lungs. But the present medicine not only takes
advantage of this favourite title, but also adds the name of
Lungwort itself— a vegetable supposed, in former days, to
have a specific influence on the lungs; The balsam prepared
from this source is introduced to public notice by the follow-
ing observations: ^^ that it is accurately prepared on the
most approved chemical principles, contains all the essential
virtues of this celebrated and invaluable gift of nature divested
of its inert parts— is rendered perfectly pleasing to the taste,
has been found in numberless instances to produce all the
good efiects its warmest advocates can promise, or the most
afflicted deserve. As a cough medicine, it is unequalled by
any in the known world, and it is hoped will prove a blessing
to the present and future generations !1!'*

To prepare the lungwort^ and give it such concentra'tion,
is impossible. It is merely a mucilaginous vegetable, and
Mr. Perrin has taken an active preparation well known, whicli
he has newly christened with this name. This is nothing
more than the Paregoric Elixir in its usual form. On tlie
use of such opiates we have said enough in the former ar-
ticle.

pectoral balsam of honey.

This is the production of the celebrated Sir John Hill,

H 3

lot JEmpirkUm. [February^

wbo, with considerable abilitiet!| in^enuit j, and learning, de-
scended at last to the character of a Quack. The balsamic
qualities of^oney, faeknew^viras a. favourite popular idea;
fad tboug^h such a preparation, it is "wtM known, is impos-
ftble, a substitute in the fragrant smell and appearance, he
Imcw, could be bad in the tincture of Tolu and Benzoin. Thif
if therefore the true advertised Balsam of Honey; and, like
all the other balsams which are of a heating and stimulant na-«
ture, instead of alleviating the symptoms of consumption,
they tend, by increasing the quantity of pus, to aggravate the
d^ase.

The medicine is introduced by the following ^ulogium ot}
Sir John Hill, and a long detail of the merits of the prepay
ration :

^^ The Linnaeus of Britain (for such was Sir John Hill em^
phatically called) recommends this excellent preparation, as
the most salutary and effectual remedy for recent colds, obsti«
pate coughs, sore throats* difficulty of brpalhingi asthmas,^
^tarrhs, and all disorders of the breast and lungs. Congeal-
pd phlegm, acrimony in the fluids and obstructions in the
glands, are gently and safely discharged by easy expectora-
tion, wheezings, and uneasiness in breathing are speedily
lemaved by a few doses* It takes off the irritation, opens the
thoracic duct, and heals the soreness of the breast and lungs^
Thirty years experience has confirmed the recommendation
in the immediate relief and gradual cure of coughs, colds,
asthmas and consumptions, it is the greatest preserver of the
lungs ever di^cov^red^ and contains all the healing, softening
9iid soothing qualities of that salubrious es^tract of flowers,
called honey, and the richest balsams of the eastern world ;
it is as restorative as asses' milk, and never disagrees with the
stomach ; a common cold yields io its benign in^uence in a
few hours ; and when resorted to, before the complaint is far
advanced, all danger (^consumption is certainly prevented.

*^ Ob^nate cougbi^ conflrnoed asthmas, and consuniptiye

1809,3 Empiricism. ' 1<J3

coraplaiuts, yield to the influence of this great medicine ; iit-
fact, it needs only atrial to Gonvioce the most incredulous of
its unrivalled properties. Such are the faint outlines of the
merits of Sir John Hiirs Bal^iarn of Honey, the result of long
Researches into nature by that great botanist, Mfho dedicfited
his life io the discovery of tb^ true means of health in tl^
vegetable kingdom • "

The example thus set by Sir John Hill has been univer-
sally practised ;. an(} <l|e¥:e i$ silmost np v^der who does not
d^l in ti^e Pept<)r^l B(il^m of Honey dmwn from this souceo.
One person, of tbp n^rae.of CundpU, has even prietended U>
improve it; bi^t wher^ t^e improvement lies we cannot dis-
covcar.

hope's hectic, or rather anti-hecttc, pills.
This is a medicine said to be bnmght forwai^l by the
author on philanthropic principles ; and, in the idea of its
inventor, 4s a discovery of equal importance with vaccination.
It is a discovery of old times, the recipe being so antient that
the i^rriting was rendered yellow by age. On examinatioa>
it appears to be nothing more than the Pectoral Horse Balls 0f
the Farrier. It is more common to apply regular medioine
to the veterinary art, than to transfer veterinary practice to
the buman body. It has indeed been done externally in the
Black Oil of Bamet Guest ; but it has not been ventured on
before internally, especially in a disease of such a dangerous
nature as pulmonary consumption. As wf have not heard
muoh of late of Mr. Hope's specific, in spite of his boasts, and
even challenge held out, we suppose it has returned to the
senility from which his anile understanding and ignorance fir^t
drew it.

PNEUMATIC PULMONAIIV PRACTICE

To be introduced in our next number.

u 4

10^ Medicint. [febraaryj

REGULAR PRACTICE.

I. MEDICINE.

The importiint subjects which hare for some time so inncl(
occupied public attentioui still continue to proceed,

HYDROPHOBIA.

The first of these. Hydrophobia, has noif engaged the
interference of the legislature, ^ho, by a letter tp the Col?
I^e, noticed in our last, has directed a Report ixi be made^,
and eytrj information to be promulgated on the subject. The
College, YiiiXx a becoming zeal^ haye requested infpr|natio||
from the Profession at large ; and we have no doubt, that
much Yf^uable knowledge will bp brpught forward by these
means. At present, any report by the College, as far as we
can judge by those members of it whp are Physicians tq
the Public Hpspitals, could only he a recital of unsuccessful
practice, and fruitless precautions. . We .wpuld wish parti*
cularly to direct the attention of tbe CqUjege to procure iiit
formation from those concerned in veterinary medicine, and
in the cure and diseases of tbe animals* Thi$ i^iformation can
be afterwards regulate by proper views of science. Hydro-:
phobia is a subject pn which we cannot reason, bepause we
have no facts pn which tp build ^ We want here a specific^
if such can be procured, and the College should bare pro-
ceed on the saying of the npted ParacelsuS| *^ tliat he woulfl
take a remedy frpip 2).ny quarter, eyen from the DevU him*
self.'- The importapce of. this subject ba$ brought a detail
of some farther cases since our lasi before tbe public. The
first of thesp is given by Mr, Hardwick, of W^nslow, in or-
der to shew the inefficacy of the local application of artistic
at the distance of 26 h )urs aft r the accident.

*' A boy, 10 years old, was bitten in the lip by a dog, witU
which he was accustomed to play. This happened in the
evening* l(ke boy was brought to me the next night, but«

1809,] Medicine. 105

from a gross misrepresentation on the part of his parent, no
notice was lilj;en of it till the following morning. Caustic
was then applied^ and repeated for several days. It was at
last discontinued^ a^d ^Jbjs parts allowed to cicatrize. Ten
weeks from this tie^e the disease appeared, and terminated
fatally on the fifth day. I should be happy to relate the case
at full, but regular notes were not taken. The case was wit-
nessed by many professional men of the fitsC respectability.
I hope it will not be deemed presumptuous, if I h^fe object to
the practice of frequently endeavouring to make the unfortu-
nate patient swallow liquids. To be sure we sometimes suqv
feed in getting a little down, but is not the attempt attended
with worse consequences, than we can possibly deiivje benefit
^om it ? I cannot help thinking it cru^l in thee:^treme, a]94
fear that the experiment has been made more from motives of
-.curiosity on the part of the practitioner, than from any expec-
tation of serving the patient. Surely it is our duty tp
sacrifice every selfish motive, and humanity forbids the repe-
tition of this painful trial. It is a comfortable reflection that
antidotes have been fquad for many animal poisons ; this is
sufficient to inspire the hope, that accident will some daj
afford us a remedy for hydrophobia ; I say accident, because
it is chiefly to accident that we are indebted for antidotes to
.other poisons. Improved a^ the science of pliysiology is, it
does not afl^brd us one satisfa/ctory theory on the nature of this
disease. Wo see its phenomena, but cannot trace them ia
their cause. We endeavour to explain them by the rationale
of other diseases (in which by the bye we arc too often foiled),
but are lost in the very attempt. One train of thought leads
us on to another, till we find ourselves at a greater distance
from our object than when we first set out. A dark mysteri-
ous veil enwraps the subject, which our present impotent
exertions have been unable to remove. On accident therefore
J ground this hope, the most fragile footing I can find, but^

106 Medicine. [Fcbru^y,

like the drowning victim, I catch at a straw, I anticipate a
hope lyhich present facts will scarcely authorize."

The second case, from the pen of Dr. Pinckard, is detailed
in a very particular manner ; and on that account^ like Dr.
jPowel's, is worthy of being inseited, and of contrasting it
with Dr. Powel's :

CASE or HYDROPHOBIA, BY DR. PIXCKARD.

** William Waters, of Chipping Barnet, Herts, a sawyer,
aged S5 years, a strong healthy man, married, and father of
eae child, was bitten on the 14th day of September last, close
abore the upper joint of the little finger of the left hand, by a
strange dog, which he met running upon the public road
between Barnet and Whetstone. The wound was deep, and
thelaceration extensive. He applied to Mr. Lloyd, a surgeon
at Barnet; and, no suspicion of madness being entertained^
the common treatment, as in other recent wounds, was employ-
ed. The cnre proceeded without any circumstance worthy
of particular remark, leaving an eschar about an inch in
length. No provocation was given to the dog ; nor has any
opportunity occurred of ascertaining whether or not he was
affected with rabies.

*^ On Friday the 26th of November, seventy-three days
from the time of the accident, the man felt slightly indis-
posed, and returned home from work, without having eaten
bis usual dinner; but it. was observed that he drank a
draught of porter. About eight o'clock in the evening he
called upon Mr. Lloyd, complaining of a sevi^re pain in
bis left shoulder, saying he could not raise his arm to his
head. Both the surgeon and himself considered it to be
rheumatism. A bolus of pulvis ipecacuanbae compositus was
accordingly prescribed, to be taken at bed-time, and be
was directed to rub the part with a spirituous embrocation ;
but, feeling himself much worse after he went to bod, he
sent, about eleven o'clock, for Mr. lApyd to visit bf^?

18W0 Medim^. m

wben he stiU compl^tn^ pf tbe pain ia Iba ^hqulder, ad4v
ing, that he was distressed likewise wi^h ^' i\\e wiad."-Tt
Another of the boluj»ep tv'4$ administer^, "whiph ^e 3wallow-
(yi with difficulty, and he was advised to t^ltje some warn^
wide and water ; but he put it awa j, saying that be could no|t
^rink it. Mr* Lloyd felt less sati&fied r^speciicig the nature
of the disease than when he saw hiai in the eveaiiig, but i|0
{suspicion yet ^o^ that it might be hydrophobia,

^^ During the night be remained extremely rjeslless, and
groaned ^o as to dij^urb the family in Uie adjoining house;
but tbe pain of tbe shoulder subsided, leaving, as be e:|:press€4
it, ^Va tightness and phoaking about tbe thrx>at," which ii^
creased to an alarming degree. Between sev4^ and eight
o'clock the following morning Mr. Lloyd repeated his visit^
when be found him hi a state of extreme agitation, with i
s^use of constriction about the throat, and great uneasinei^
and oppression at tbe dpigaj&tric rd^ion. His respiration was
irregular and convulsive, and he had frequent eructations of
flatus. In order to obtain relief from the difficulty of breath-
\ng and sense of stiffix^ation^ he bad placed himself upon hi^
knees and elbows in bed. Some water being offered him to
drink, he suddenly started with terror and darxQ, was thrown
into violent convulsive distortions, looked pjBfended, and said
he could not take it.

'^ The nature of the disease being no longer doubtful^ Mr,
Lloy4 had immediate recourse to mercurial friction. About
three ounces of the ungujeutum hydrargyri fortius, mixed witli
campbire, were rubbed in by three persons upon the extensive
fturfape pf the neck and thorax, the patient himself assisting^
This process was continued until he felt greatly exhausted.
He then begged to be Ipfit quiet, saying that he was better.
His pulse was at this time languid and feeble. After he was
a little rested, about two ounces more of the ointment, mixed
with opiumi were rubbed into the legs and thighs ; the fric-

lOS Medicine* [Febrnarj,

tion being continued until it vfVLS interrupted by excessive
agitation, and general convulsions.

^^ The violent symptoms of this most dreadful of all hu«
man calamities 90W increased rapidly. Any liquid vas an
object of perfect horror to him ; the moving of it in a ba«
sin, pouring it from one vessel into another, splashing it
about the room, placing it before his eyes, or even speaking
of it, produced inconceivable agitation, accompanied with
a pecular expression of terror, and a dreadful distortion of
the whole frame. : Some water being presented to him, he was
instantly seized with convulsions, sprung up suddenly, and
leaped out of bed, throwing himself from the very sight of
the basin. At this period of the disease, the convulsions re*
curred in rapid succession ; a considerable quantity of frothy
saliva issued from his mouth, he uttered hideous and inde-
scribable groans, looked trembling and terrified, and a mark*
ed expression of horror settled upon his countenance. Soot^
afterwards it was observed, that his urine passed involunfav
rily; he complained more and more of the ^^ wind and
choaking ;'' the general agitation and restlessness increased t
the convulsions grew stronger and stronger j and the groans
and screams louder, and more frightfully distressing.

^^ Between ten and eleven o'clock he was quite outrage-
ous ; and tlie convulsions being so powerful that four people
were unable to hold him in bed, it was deemed expedient
to have recourse to a straight waistcoat. During the vio»
lence of the convulsions, one of the persons, who was hold"*
ing him, said that he attempted to bite him ; but he imme*
diately apologised, observing, that he did not mean to hurt
him; and Mr. Lloyd^ who witnessed this circumstance, be-
lieved it to be accidental rather than intentional.
, " The cicatrix produced by the wound upon the band
was examined, and the nature of the malady was openly
talked of by the crowd of persons who came into the room*;

1809,] - Medicine., 109

bat; instead of feeling any apprehension upon the subject,
be would not admit that the disease was in any way con-
nected with the bite he had received. He persisted in calling
it *^ the wind/' but expressed himself conscious that he could
** never recover." No change could be perceived in the part
ivhich had been bitten, except that the scar appeared slight*^
ly livid, as if it were from cold. It wajs neither swelled nor
inflamed ; nor was there any tumour, inflammation, or sore-
ness in the glands of the axilla : but, on being questioned par^*
ticularly respecting the state of the limbj he remarked that he
liad felt a sense of cold or numbness in the liand and arm, for
two or three Jays previous to his being unwell ; and that he
Lad covered the bitten part again with a ^^ thumb stall,'^
"which he had used for some time after the wound had healed.
^' The restlessness, terror, extreme agitation, and strong
convulsions continued until noon; the convulsions recurring
^ith excessive violence at intervals of only two or three
jninutes, and from the slightest irritation ; mostly from the
sight, the sound, or only hearing the name of water. About
4me o'clock he became more calm, and it was perceived that
"the horror and aversion to liquids were in some degree dimi-
nished. Soon after, he was prevailed upon to swallow two
<Lrachms of the tincture of opium.

*^ It was between seven and eight o'clock in the evening of
the S7th of November when I first saw him. Messrs. Lloyd,
Humbold, Booth, and Morrison, medical practitioners at
Bamet, were present. He was then lying in a straight waist-
coat, extended upon his back, with his hands and feet fastened
to the bedstead. He was tranquil and composed ; his coun-
tenance was natural, and his intellects undisturbed. To the
questions which were asked him, he replied in a collected and
rational' manner ; and he was sensible of all that passed in the
room. His skin was of natural warmth, and covered with a
moderate perspiration. The pulse did not exceed 90 in a
Riiaute; it was obtuse and undidating. On pressing hii|

116 JH^mii [FebtuAf^l

wrist V itti thi iSiigM, ih^ att^ ivii» p^fHHHfeA to be MghUf
treftiuToils* The totigii^ ^^ moist, and, although whitish^
dearly of a Dataral appearance ; the eye looked rather flaf knA
doudedk t'he coriTalsioiki had ceased ; the diread of liqdidto
i^^reftid^) and he frequehtly called for water to drink i
but he l^ad etill a gr^at ftource of terror and agitation from i
peculiar sensibility to currents of ^ir falling upon his skitt }
and to the irtptesion of odours upon the olfactory organic
The seti^ of feeling and smelling seemed to bepreternattiniliy
ihcreased. He had no pain, but was ettremdy distress^
frith flatuleticy. His respiration Very much resembled thai
of a female in a paroxysm of hysteria. It was accompanied
with frequent irregular Sighing, and almost constant eructa^
tions of yrlnd. On my asking him to describe his fcelingSi
hi said, ^* I am better, much better ; 1 have no complaint but
thfc Mriiid and choaklng;'* and upon my loosening one of llli
hHUds, ih order that he might accurately describe the patlt
most afibcted by constriction, he pointed distinctly to thS
throat and epigastrium;

*^ It was distressiftg to observe the anxiety and the frfc«».
quency With Which he now called for water ; yet I observed ;
that he hevet took it by deliberate drinking, so as to bring thi
organs of deglutition into any number of Successive actions*
Each time it was given to liim, he seized the cup eagerly, both
with his lips and his hand, made one convulsive swallow, theit;
hastily puilhed away the vessel, saying, if the person who held
it chanced to press it longer to his lips, that he gave him ^^ io^
much," and would ^* choak" him. Several loud erncta]ti0nl
of air usually followed the swallowing of the water, and hi
remarked, thai he drank it because it ^^ broke the wind, aifll
eased'' him. For a short time after obtaining this relief hi|
breathing was less disturbed, and he conversed with all thfe
calmness of a person in sound health ; but soon the spasmodic
feeling about the throat and stomach increased, the respiratibji
H^ttjl Oppressed, and he again called anxiously for ^< drifik tb

1809.] Medicine. Ill

move the wind/' as Jbe expressed it. On my giving hini
some ivine in the water, he said it relieved him more than the
"Water alone ; but he begged tliat it might not be made strong ;
ot)serving that if it were he could not swallow it.

*' Next to his anxiety for frequent drinking, the greatest
distress that he suffered proceeded from the opening and
shutting of the chaniber door : which, indeed, was the most
characteristic syTnptom at this stage of the disease. lie wai
liriore watchful, regarding the door, than concerning any
€)ther object. Whenever it was moved,, he started in great
agitation, looked terrified, and impatiently called oiit " the
door, the door ;" and although he neither Sviw nor heard it
€)pened, so acutely sensible was he of the slightest current
of air, that he instahtl}'^ knew from his own sensations,
"liheriany person entered or left the room. The slightest
Current of the breath falling upon his face from any person
Sjrho was speaking to him ; air bldwh from the lips upon
lis breast, and the fanning of a hat across his chest or throat
Jproduced great agitation, together with convulsive breath-
ing, and a sense of suffocation : but the same efiect was not
observed from waving a hat across his feet and legs ; nor
^rom suddenly sprinkling a few drops of cold water upon
9i is face or thorax. A candle was held near to. his eyes,
^ut he expressed no uneasiness from the light of it. He
^ad a dread of any person standing near his face; also of
^hy substance being put in motion near his mouth; and of
^iny thing strong or volatile being applied to his nose. He
deemed likewise to have a terror respecting the moving, or in
-^iny way disturbing his person. He expressed himself satis-
^ed to ti^ fastened in the waistcoat ; and when his hand was
Sieled^, said that it gave him no relief. He swallowed the
%dtelr, lying upon his back, with the head low; and refused
^o be raised, when it was proposed to lift him up to drink it ;
iie complained of the wind produced by a handkerchief^
"which was used to wipe the saliva from his lips ; and he was

1 12 Medicine. [Pebrnary,

greatly disturbed by the smell of a cloth whicb happened to
be placed upon the bed, after being used by one of the persons
who had been employed to rub in the ointment with cam-
phire. Once some wine was offered to him, instead of the
wine and water, but, when it approtiched his nose, he sud-
denly refused it, saying, impetuously, " it is too strong, I
cannot drink it." Between nine and ten oVlock he requested
to see his wife and child, when he tenderly pressed the hand
of the mother, but anxiously desired her not to put the child
near his mouth ; manifestly, not from any apprehension of
injuring the child, but from a dread of the air being disturbed
about his face.

** ITie tincture of opium was directed to be repeated every
hour, in doses of half a drachm, combined with a scruple of
the oleum succini rectificatum. He took it three times, but
it did not appear to have any influence whatever upon the
symptoms, and he complained that it was strong, and made
him worse.

^^ At midnight, upon observing a person in the room eating
roasted apples, he requested to have some, and ate nearly twa
of them, with seeming gratification. He then said that his
stomach was ^^ restored,'' and^ feeling as if he could eat some-
thing more, desired to have a ^^ beef-steak for supper." This "*
was accordingly prepared, and he chewed two or three mor^
sels, but did not swallow them.

'* About one o'clock in the morning of November SSth,
the high susceptibility, and the dread of currents of air left
him, and be desired to have the door and window set open.
He now remarked that he was much worse j requested to be
released from the confinement of the waistcoat: and said,<
impressively, that he should ^* soon be gone." His eager-
ness for water became quite insatiable, and although his sto-
mach now began to reject it by vomiting, he called for it
incessantly. On one of tlie by-standers asking him if he were
hot afraid (hat so much water might do him harm, he replied

1809.] ' • Jledicint. 118

'^ No, I feel it running off as I drink it ;" proring^ that
although his urine passed involuntarily, it i^^s not without
.consciousness. He likewise desired to have cold water ap-
plied to his nose ; and his impatience for it increased id such
« degree (hat two persons found full employment in wetting
his nostrils, and giving him water into his mouth. Before
two o'clock he expressed a similar eagerness and impatience
for air, asked those near the bed to blow upon him, and de*
sired every person to stand away from :the door, that he might
feel the cold current. He remained perfectly sensible (as he
had been throughout the whole oi the disease), and without
any return of convulsions, until nearly three o'clock, when he
expired ; his last moments being marked with calmness and
composure.

*^ Very, soon after death a number of dark red, or livid
blotches appeared about the throat and clavicles ; and the
abdomen became tense, and much enlarged.

*' APPEARANCES ON DT6SECTIOK.

** On opening the head, the dura mater adhered so strongly
to the cranium, that great force was required to separate them.
The whole sur&ce of this membrane appeared in a state of
unusual dryness, and was more free than is common from
small red points, m* exudations of blood. The vessels of the
pia maler were not overcharged with blood.

•^ The braiu was remarkably close and firm in its texture.
A peculiar dryness was observed throughout the whole of it»
substance. The cerebrum appeared beautifully while^ and
haduot 1 hose numerous red points which are usually obserT'^
ed. When cutting the cortical and medullary portions, they
both opposed a strong resistance to the knife ; they also pre->
served their form under considerable pressure from the finger.
A small quantity of colourless fluid was contained in the ven-*
tricles.

'^ On cutting through the integuments and muscles of the
thoraXy to turn them back, for the purpose of exposing the

YOU *M. I •

Hi Mtdkine. [Febmatji

ribi and sternum^ the wkole flesby substance was obsenred to
be in a sta;te of unusual drjmesi.

^^ Tbe viscera of the thorax had a healthy wpsptwwum.
The kings were fully diirf^^nded with air^ There was a gene-
ral dryness upon the sur&ce of the pleura* The pericaidium
contained about half an oitnce of fluid.

^^ The posterior part of the tongue, the outer surface of tbe
epiglottis, and tbe whole of the pharynx, exhibited strong
marks of inflammation : some degree of ledness ms also ob-
8er?able, although not so conspicuous within the larynx, and
upon tbe surface of tbe trachea and essophagus. At tbe
lower part of the cesophagus, about half an inch from tbe
cardiac orifice of the stomach, was an eroded spot, nearly tbe
size of a shilling, assuming an appearance as if the inner ooat
had been separated and shritelled up by scorching.

'^ The stomach and intestkies were much distended wiA
flatus. Their exterior coats^ also the peritonaeiAm covering
the other parts of tJie cavitjr' of tbe abdomen, and likewise the
diaphragm, were in a state of dryne^ similar to tbe pleura.
The rugs of the inner coat of the stomach were numeroug^
large, and very distinct. A few iqches below the cardia was
a fulness of the vessels of the villous coat, which caused a
spotted and eircumscubed redness aboid; three or four incbey
in diameter.

<^ Tbe liver ^md spleen were of a light or ash-coloured hue ;
in other respects of ajbealtby appearauce»

<^ The genera} dryness which prevailed in tbe fibres of H^r
muscles, within tiie substance of the brau^ and upon ti|f
membranous surfeces, exitended lili^ewuse ta Uie omfntujat,
which, whim press^ in the band^ ieU.like.a loose net o£pa(;kt

thread.

<< It is proper to cernqgrk, tbaitbestoii^aQb, theoKopbag^t^
and the trachea, were not only carefully inspected by Mr^
Lloyd, Mr. Sooll^, ai»d mysetf uffou: tb«. spot, but that; they
were taken from tJbe body apd bifQUffbA- tv l^^^y ^^^

*• rt..

I80».} Mtdieine. US

they were farther examined by Mr. Blair and Mr. Dixon,
who are much in the habit of inspecting bodies by dissection;
ahd that both thes^d gentlemen, without any communication
iath eacli othet ut)on the subject, favoured me with a WritteH'
stdX^€nt of the app^aiUnces they observed, previous to theii;
itecrfVlngany intimation that the parts were taken from a per-'
ibifi who h^d died of hydrophobia.

*^ l*hese partis Were also examined several successive days,
afiw beiiig' itoinel'sed in waiter. Thfe redness of the pharynif'
iK^'daifk^ and stronger, and assumed a livid hue, as thb'
iftl^brati'e b^b^me' corrugated ; but the redness of the meiti-'
tildes- libiAg tHe trachelai aiid oesophagus^ wcht oS^sboh aftet'
tb^'paHs werfe put into W&tisr. There was not the slight^t'
appearance of coagulum, exudation, or adventitious meni*
brane, in any part of the pharynit or larynx ; nor throughout
this Wh(ri6'e]ttent of thd oesophagus or trachea.

** ThiJ bddy WUs examined twenty-nine hours after deatb.

^^ H]^ di&)^^ cdnftintlbd about thirty-eight hours from the^
titfliel vAk^ th^ man firsit became sensible of indisposition.

** Obsfetviiftg the progress of the symptoms, as they occfir*
itfd'inlhiBca^e, the diisease might be divided, with tolersMt^
atearftey^ into several distinct periods, or stages, viz.

^ 1. A sensation of cold and numbness about the wonndy
aiifd • thrbttghout the band and arm — during two or three
dayd.

<^ S. As^v^fe p^ihdfthe shoulder, with undefined gcfnendF
didpd^tiM-^-abdut ten hours.

** 3. Hortor of liquids, with viol^rtt convulsions and dii^i
tortioliS-^fbtfrteen or fifteen hours.

** 4. Comparative tranquillity, with a desire for water, anift
a dread of currents of air-^nearly twelve hours.

** 5. An insatiable craving for air and water — ^between two
and three hours. G. PINCKARQ^

" Bloomsburi/ Square^ Nov. 30^ 1808

1 2

79

116: Medicine. [February,*

VACCINATION

Has made little progress during the last month. The fail-
ures of Sir Isaac Pennington have made no impression on the
College. Eight of his cases^ it is said> were submitted to the
Jennerian Deputation when at Cambridge, and a statement^
different from Sir Isaac's, is expected from that quarter. la
the mean time, some misunderstanding is said to prevail
among certain leading members of the Jennerian Society;
and we understand the College have it in contemplation ta
establish an institution of their own, with the view to enable
them to make a second Report, so that ail popular preju-
dices and professional doubts may be done away on the ulti-
mate merits of the discovery.

PURPURA.

Some observations of Dr. Parry, of Bath, on the treat-
mpnt of Purpura, tend to shew, that in many diseases of ac-
knowledged debility, such may be the state of certain blood-
vessels;, from an over-distension, that venesection is required,
though this over-distension arises probably from their rela-
tive want of tone, or the due contraction of their muscular
fibres ; and wherever evidence exists, from the apparent
symptoms of purpura, or even scurvy, that the case, what-
ever term or appellation it may receive, is of an active Ihb*
morrhagic nature, it matters not, he contends, in a patho-
logical view, whether febrile extravasation of blood takes
place from the rupture or gaping of an artery in the cellu-
lar membrane in the skin, or on the surface of the epithelien
in the nose, fauces, or broncbiac, bleeding is the remedy in
the first instance.

CRETINISM.

Cretinism, or that species of bodily deformily and ment-
al imbecility, >>hich marks the lower orders in certain dis-
tricts of Switzerland, more than elsewhere, has received
ifome elucidation from the late ex{jerience of Dr. Reeve, of

1809,] Medicine. IIT

Norwich ; and he has endeavoured to point out a connection
between tliis afflicting malady and rickets. " ^

" The enlargement,'* he observes, " of the thyroid gland
called goitre, is the most striking feature in the unsighfly
aspect of a cretin ; but this is not a constant attendant. His^
head also is deformed, his stature diminutive, his complexion^
sickly, his countenance vacant and destitute of meaning, hiti
lips and eye-lids coarse and prominent, his skin wrinkled
and pendulous, his muscles loose and flabby. The quali-
ties of his mind correspond to the deranged state of the body
which it inhabits ; and cretinism prevails in all the interme-
diate degrees, from excessive stupidity to complete fatu-
ity.'V

There is no necessary connection, however, between the
swelling of the thyroid gland and cretinism, though they fre-
quently exist together.

** It is probable,'* he remarks, *^ the one has been assum-
ed as the cause of the other, from the enlargement of the thy-
roid gland being a frequent occurrence in cretins ; and as it
forcibly strikes the observer from the deformity it occasions,'
this strong impression may have converted an accidental,
though frequent occurrence, into a general and necessary
cause. Cretinism is frequently observed without any affec-'
tion of the thyroid gland, and that gland is often very much
enlarged without any affection of the intellectual faculties.'
There seems to be some similarity between cretinism arid
fickets, as they both take place in infancy, are both charac-
terized by feebleness of body, and sooner or later by feebleness
of mind, and they both affect males and females equally; but
there is no sort of connection between persons afflicted with'
fcronchocele in England, and with rickets. For although it'
might be granted, that there is some delicacy of frame in f©.'
males about the period of pubescence, when bronchocele
ilisually occurs, yet neither irregular formation of the bones, nor '

1 3

118 MefUcm. [FebrusJTf

ireakness of the intellecitual powfirs; 9te C09119W syiQj^ltflBII
attending bronchocele inBritaiii*

^^ The production of cretijiism, |>y tbe bad qv^ity of the
a^^ and the food^ i)xe neglect of mor^l education, ^ndotlpi9
eyils attends^it uppn pp verty , is supported by ffsict^ fio poiql^j
that the greater number of C96es in 9ipuQtainoas di^ixi^
Inhere snow water abounds, may naMy be ascribed to thcifff
general causes. The notion of ^now- water being tb^ c^s^ of
goitre, and conseqi^ently of cretinism ) seems to have been d^
rived from Pliny (Lib. II. cap. 37), and copjued by almost
every succeeding )vriter, because it coincided with their hy?
potheses of cold and crude matters, although directly contjr;^
dieted by facts. In the first place, persons born in plageif
contiguous to the glaciers, who drink no other water than
"What flows from the melting of ice and snow, are not subject
to this disorder; and, secondly, thedi^rderis obseryedia
places where snow is unknown.

^^ The causes of cretinism b^gin to operate upon the systep"
$oon after, perhaps even beforp birth ; the want of ener^ in
the parent is communicated to the offspring ; the children
biecoine deformed and cachetic v^y early in life, th^ growtfi
9:114 developement of the body ar^ imp^ed, the abdomen hth
cpmcs enlarged, and the g)and9 swelled in various degreea;
^d the powers of the mind remain dormant, or becomf9
entirfilx obliterated, partly f^orn w^t of proper orgauizi^
tiQn, s^d partly from the total p^gl^t of every thing likp
education.

^^ It mi^ht be ^:^pected, tb^t ihci dissection of cretina
^quld ttf row some light upon theser}^ of phenomena a^sCK^-»
ated together in the origin s^nd progress of tbia Angular a^ao-r
tio9 ; but thfi^ people are so superstitious, that it is^ very diiQ«
cult to procure bodies for apatomic^l e:3(amiaation . Howayerji
fl[0^e disjs^ctiojas have h!^^ made, and the appearax^ces in th«
q^a^^ ^^ v^ery cnxiou$. F^^ thf ^^^iption qi ^ aeti^'%

ISOi.] Medicme. 119

skall bj Ackermann^ it appears that tke cayity for the i«cep>*
tioa of the pons varolii and medulla oblongata was completely
aUiterated, and that, in which the cerebellum is lodged, so
much diminished, that it scarcely exceeded one third of its
natural capacity. The return of the venous blood must have
beea coisideraUy impeded by the mal-conformation of tht
foramina.

'^ There is no fact in the natural history of man, that
nflteds an aigument so direct and so impressive, in proof of
ihe influence of physical causes on the mind, as cretinism, it
shews mofeover, that the growth of every part is essentialtfr
coimected with the conditions in which it is fit to exercise its
pecaliar functions: and in this respect, it fares with the
intellectual as with the bodily pow^s.

^^ The most decisive argument in proof of this opinion is,
that cretinism may be prevented by removing children from
the confined and dirty places where it prevails, and nursing
and educating them .in the higher parts of the mountains.
Within these last ten years, the number of cretins has ditni^
nished, the condition of the lowest class of society is some-
*what bettered, and more attention is paid towards that diseased
constitution which is the forerunner of mental imbecility. I
did not find that the poor creatures took any pride in having
any of their children idiots or bien httireux^ as some authors
assert; on the contrary, the parents were very much asham^
of acknowledging that any cretins belonged to their families ;
and it was after repeated attempts, only by declaring myself
to be a physician, that I could get access into their houses to
examine any of these wretched beings in the human form.
The burnt sponge is known as a remedy for the goitre amoi^
the people whejre it is most prevalent ; but it is i^elciom admi*
nisteted, because the disease is so common, that it does not
attract notice, nor aflfect, in general, the ordinary functions of
life. And as to cretinism, that seems to be fooked upon as be-
longing to iiidigcnpeand poverty ; i^r in ev^ry plact whe|:o 1

j4

ISO Medicine. [Febtuary,

^aw cretins, many welUIooking persons of both sexes resided,
and these were, without exception, persons of a higher class in
society, who lived in better houses, and could supply both
their moral and physical necessities.

^' I might perhaps have insisted move upon the analogy
between cretinism and rickets, for there is a remarkable coin*
cidcnccin the literary history of these two diseases, as well as
in many other points. Glisson first described rickets, as it
appeared in this country, in the middle of the seyenteenth
century, about the same time that Plater mentions cretinism.
The origin of both names is equally obscure ; and since some
of the remote causes arc now discovered, it is to be hoped the
diseases themselves will gradually disappear, and in som^
happier age be known only by description,'*

ANIMAL HEAT.

The subjeptof animal heat is one of principal importance
in all inquiries into the nature of the animal oeconomy. Som^
experipient^ have been lately made by Dr. J, A. Paris, to
prove that the quantity of it present in the secreted fluids
is less than in the blood, and that the secreted fluids being
mere chemical pompoi^nds, formed by the glands from the
principles of the blood, ii^ proportion as the capacity of the
fluids is less for calorip, q, considerable source is created for
the production of apimal heat, ai)d consequently ti;at the se-
creting pjrocejsis is a great instrupient in its production.

^^ The sums of the secretions,'' it is observed, ^^ is comr
monly the same ; for if any single secretion sufiers a change
in quantity, we sliall And the others varying so as to prer
serve the saipo general eflfect ; thus, for instaixse, if the urine
flows with greater abundance, the saliva pr perspirable mat-
ter is secreted less copiously ; if, however, a universal causf^
affects the body, so as tp diminish all its secretions, we find
the animal temperature sinks, as is exemplified by sleep^ or
4t)ip influence pf the depleting passions , ' -

18090 Medicine. ISl

The experiments on which this opinion is founded, art
thus detailed-^-

*^ EXPERIMENT I.

Temperature of the Laboratory 46° Fah.

Of urine 1 pint was heated to 65° > Arithmetic mean

Of water 113 S 89.

Temperature that resulted - 90
JBscaped during the experiment 2

True temperature - - - - 92

From the above results it appears that the water has been de*
jrived of 21* of heat, which has raised the urine 27*, from
^hich it is evident that the capacity of urine is to that of
water as 21 : 27 or as 7 : 9. Hence let x represent the capa*
city of urine, and 1*000 that of water; then

7:9: ::r:. 1.000

9 X == 7.
: a:=r|-=-7777;
whereas the capacity of arterial blood is 1,003.'*

IMPROVEMENT OF DISPENSARIES.

Nothing has tended so much to benefit the profession by
an extensive experience in the appearances and treatment of
diseases as the Medical Charities of the metropolis* They
are the proper schools for tracing the picture of the morbid
state in all its varieties, and for forming the young practitioner
for the exercise of the healing heart. Every improvement,
then, suggested for rendering the treatment there more suc-
cessful, claims the attention of the faculty, and the gratitude
of society. Dr. Herdman, Physician to the City Dispensary,
has, on this principle, addressed his suggestions to the Society
for bettering the condition of the Poor, on the present state of
the Dispensaries, or inferior charities, which he introduces
by his opinions of the principles of pathology drawn from the
^runonian source, and applies them to shew the necessity for thp

m MeHdne, [Febnuyry,

•id of diet being conjoined with tbat of medicine, in oider that
these charities may successfully answer their intended end. The
plan of effecting this forms also one part of his address. We
give Dr. Herdman every credit for his benevolent intentions.
The advantage and propriety of them cannot be disputed,
provided they could be readily put in practice ; but such a
plan, we arc afraid, will be considered as making the Dispen-
saries Hospitals ; and the sum ix) be raised would greatly cir-
cumscribe the number of these institutions by requiring
double the amount to support one that is at present requisite.
Something of a similar plan was suggested some years ago by
an ingenious surgeon^ Mr. Carlisle, in respect to convales*
oents. The regulations of the hospitals require commonly
the dismission of patients before health is so far renovated^
that the patient, generally in low circumstances, can resume
his usual occupation for his support. An establishment,
therefore, vnder the title of an Hospital for Convalescents,
was proposed for that purpose, where the patients might re«
main, and be supplied till they were able to eisLrn their own
living. This, [however, like many other philanthropic
schemes, proved abortive; and the same, we fear, will be the
firfe also of Dr. Herdman's present attempt.

INGREASB OF MORTALITY.

CoNstTMPTioN of the Luugs being the most prominent
lAalady of this climate, an attempt to trace its increase of late
years has been made by Dr. Woollcombe, and for this he
has referred to the records of the Plymouth Dispensary. In
this research he has been led into a view of the increase of
mortality in general ; and from the statements he has made, iu
consequence of a reference to the bills of mortality, the foI«
lowing facts are made out :

** From these documents it appears that two conclusions
may be drawn : 1st, that the number of deaths from con-^
sumption towards the end was greater than at the b^inning

bf the last century; and 2d^ that of the ifbo|e n^m!)er iffap

\

]909.] Medidne. m

tbe century, those from consumption bore a larger
PppaEtioa at the end than at the beginnmg. In other words
iiff^ absolute and relative mortality of consumption seems to
tli^re JMSkCreased. In vieisriog these conslusicxis however^ i¥e
^ffifit n/^t overlook two possible sources of error. In the first
pl^MEMS) acco^xling to the returns of Mr. Addington's Act to
ffti^ertain the population of this kingdom^ it appeared, that
cl|li:iPf the whole of last century the numb<^ of inhabitants
1^96 continually augmenting, and was therefore much greater
^ tl^ end than at the beginning of the century. The increas*
^ nmaber of deaths from consumption, therefore, might de»
f^d pn the in<:reased number of inhabitants, and not upon
IPjr increase in its frequency and fatality, in the same mass of
fopulatioB : consumption might devour more victims merely
||96ause there were more to be devoured . In the second place^
iFf may err, if we suppose that consumption is on the in*
crease, because, of the whole number of deaths, those from this
^l^ease form a larger proportion at the end than at the begin-
Jl^flgof the century; for the various modern improvements
4n ^e prevention and cure of diseases, have most probably
^minished the frequency and fatality of some diseases, and
1|^p proportion of deaths from consumption may seem to have
%9creased."

• T Q remove any objections to these facts from a better treat-
ipont, and les;iencd mortality from other diseases, rendering it
^W^ consumption more prominent, also to obviate any argu-^
ijH^tsi from an ^ncreas<^ population. Dr. WooUcombe thus
pf 9ceeds :

^ If, forc:^£vraple, the inhabitants of this country had, iix
-^e year 1700, been six millions, the proportion of morta^
l^ty one in forty, and tt^e proportion of consumptive morta-^
Ift;^: pne to si]i(, the total deaths would have been ]50,000»
^f$d those frox^ the disease under consideration 25,000. If
% the year ISQO, the inhabitants had been the same in num«
^31^ if^ ck^tb^ fii^Qm cQttsumptipa kid been^Iuiowa ta

124 Medicine. [February,

have increased relatively one-third, or to be in the ratio of
one to four, still might there have been no increase in theab-*
8>lute fatality of consumption ; but a reduction of the gene-
ral mortality might have taken place in the same proportion,
so as to have become as one to six<y ; in which case the total
mortality would be 100,000, and the consumptive mortality
still 25,000. This objection is therefore not without weight,
and shews that in order to establish a relative increase of mor-
tality from any disease to be a just measure of its absolute
augmentation, we must ascertain the proportion of deaths ia
the inhabitants of the country at the particular periods between
which a comparison is instituted. As this proportion is not,
and cannot be ascertained with precision, we must be satisfied
with such an approximation to the truth as can be derived
from the imperfect evidence found in those authors, who have
treated of that branch of political economy with which this
question is connected,

*^ Presuming, for the present, that in the year 1700 the
mortality in England, in proportion to its inhabitants, wasooef
to thirty-six ; and that the relative increase of consumptive
mortality has, in the course of the century, amounted to one*
third, or is become as four to six, it follows that there must:
have been an absolute increase to a certain extent, unless in-
the same period the proportion of mortality to population has
become as 1 to 54. But this supposition is too extravagant
to require refutation. It is sufficient to observe, that an«,
uncommon degree of healthiness is attributed to this island,
when it is admitted, that the mortality at present may per-L
haps amount only to 1 in 40. Admitting, however, with a
late author, that the last-mentioned proportion is just, let
us inquire what the proportion must have been in the year
1700, to account for the difference of the relative mortality of
consumption, upon the supposition of there being no absolute
increase. In that case we shall be constrained to state the
gencinl mortality in 1700 to have been 1 in 27 nearly, which

1809.1 Medicine. 125

implies a degree of unhealthiness inconsistent with the known
condition of the country at that period. It its obvious^ that
no such proportion of deaths^ as has been stated in these two
instances, could have happened without such a correspond-
ing augmentation in the population of the country^ as is
known not to have occurred, and is altogether extravagant to
suppose.''

An Inquiry into the Symptoms and Treatment of Carditis ;
or the Inflammation of the Heart; Illustrated by Cases

_ •

ond Dissections* By John Ford Davisy M.D. Member
of the College of Physicians ^ London; of the Royal Me*
dical Society J Edinburgh; and of other Medical and
Philosophical Societies. Small 8vo. pp. 190.

We are somewhat astonished that this particular disease
should be selected for the contents of a volume : a disease aU
ways undetermined in its action, its character, and termina-
tion, and not unfrequently misunderstood for inflammation
of the pericardium, and the contiguous parts : in short, a
disease so rare, so obscure, and so difficult to ascertain, was
not worth the attention Dr. Davis has bestowed upon it ;
for no practitioner can err in the treatment of this disease,
if he follows the general routine of practice in Peritonitis,
Gastritis, &c. &c. ; therefore, if Dr. Davis had not pub-
lished these observations, he certainly by us would hav«
most readily been pardoned for his negligence ; and when he
again appears in the character .of a public writer, anxious
to obtain the dignified character of a philanthropists, we
strongly recommend a reduction of price — six shillings, for
so small a volume, on an obscure disease, is too great a
privilege, even for a man of merit to make on the sense and
pocket of the purchaser. Though Dr. Davis may be Ma-
nia Carditis, yet this is no reason why the profession are at
bis shrine to sacrifice their good sense and property, which

M8 Mediate. [Febtuay,

tre conceive x^ould be t6e case, by the' pWclfas* df IfiJf
Treatise. Those who wish ijo diffuse general kiibwlbd^
should not crianap their exertions by fising to6 great a VMtitf
on their labours : this is a species of empiricisni, wKicH* it^
hold to public derision and general execration, as hiring m^
compatible with the noble principle of hundanity, and <U#
best interests of society.

Our author begins with informing us, Carditis is one of the
most obscure diseases known, and that it occurs ofteher tfaW
is suspected. After a long train of quotations, in T^ich £a*
tin, Greek, and French, swell the page, he brings us tb" a
point already in the pos^es^ion of every boy tha;t has" at-
tisiided the lecture-roonl, viz.

*^ That an inflammation of the lungs may, from coAtiguity
of parts, spread io the pericardium and heart, and 'dee vefsa ;
atnd thus, according to the particular parts aflfected, mil \^
tiiedifficulty of breathing, cough, &c."

He then proceeds to consider what the inflamittatiotf of tfeif
heart is :

** It seems proper to consider the inflammation of tite?
heart and pericardium as only one disease ; notwithstandfi^
some authors have made them distinct afl^ections. Sauvft^^,
whose definition of Carditis has been already noticed, ratikN
the inflammation of the pericardium, as a spiefdes of Pietirifiit)
tfndferthe name of Pleuritis Pericardii. Sclle preserves tfttt
distinction without any reference to the pleura. His deflhfi*^
t!on of the inflammation of the pericardium is, " Doloir pUhb^
tbrius ac gravitus in pecitoris parte prdfundiore : ahxiethsr's
palpitatio cdrdis: perpetua ad tussi^nduiti' piroclivitis;'^
He adds, " Haud raro acddit ut plurium partium irifli«f]Q[m&^
tlortes simul coexistunt, pro cujus complicatidhis divefsitatfi
cdiaatqueaKa pbertomena'adpaetent, quorum' deti^rtniilsftibfiA
diflteilis est." According to him^ tHt inJlarhfnaHchie of thU
fettft i» distlngttirfwd firom tftbt' of the pttiii(rhJt)itbii - by'tfi#

1800.] MedkiM, 1ST

absence of tke dispoditioD to cough in the former, tite defini-
tion of which is, ^^ Dolor punctorins snb sterno : palpitatfo
cordis et anxietates eontiimae : pulsus parrus incqualisi
calor exigiius."

^^ Whether these different affections dan ever be distinguished
in practice seems verj doubtful; their separate existenoe
must, however, be admitted, of which one of the cases ta be
related presently aff[>rds proof, if that were wanting. Dr.
Baillie also has seen the substance of the heart infianed, with-
out any inflammation of the pericardium; and aUhcnigh he
says, ^^ whenever the inflammation of the pericandiuin it
violent, the muscular substance of the heart is inflamed to
some depth," he does not deny that in slighter inflammation
of this membrane the heart may escape. According to hiniy
the symptoms which have been observed, are, ^^ the general
a&ction of the system known by the name of fev^ ; pain in
the r^ion of the heart, which is often, bat not always, attend-
ed with palpitations, and with an irregular pulse ; coughs
difficulty of breathing ; and sometimes syncope." Notwith-
standing the high authority from which this description pvo-
ceeds, it must be allowed to be very unsatirfactory. Neuif
all the symptoms, supposed to be present in every case, are
commou to peripncumony ; so thai there is scarcely one bj
which the inflammation of the heart can be distingiushed^
At the same time it cannot be denied, that this arises mare
from the difficulty of the subject, than from any neglect or
inabilUy of that excellent pathologist.

'^ Since then Carditis is so often connected with peripneump*
ny^ and since the symptoms which mcnre immediately arise
froo^inflammatioaof the heart, as palpitation, syncope, Suu '
are not always present ; it will, perhaps, ^be impossible to
establish a diagnosis upon solid principles. But let not the
Qbscurity,.in which the subject is involved, deter us from at*
tempting its elucidation. Let it rather call forth our greatca^t
es^rlipoa; acd if we recollect that there wns a time, when

188 MediciM. [Fcbhiaiyi

that formidable disease^ denominated Crou]^ ivas as imper*
fectly known, and as little under our control, as Carditis is at
present, we shall not want encouragement to proceed.

** CASE I.

^' Master W. act. 7. — Jan. 22, 1785. After having com*
plamed of head-ach for a month, was attacked, four days ago,
with fever. He had danced on the day preceding this attack.
Pulse 140. There is wanderipg pain affecting sometimes the
Lead, sometimes the leg, and, at others, the heel.

^^ He has taken thirteen grains of James's Pc^wder ur three
doses, and a grain of Emetic Tartar in four doses, without
vomiting.'*

^^ Capiat Pulv. Antim. Jac. gr«v. horis 2dis, teXy cum
Mist, camph. efferv.

<^ Jan. 23. P. 124, and strong. Slept now and then
during the night. Acute pain of the ankle ; scarcely any of
the head. Three stools. Neither nausea nor perspiration
from 28 grains of the powder in six doses.

** V. S. ad seven ounces, Capiat Pulv. Antim. Jac. gr. v.
horis Stiis, cum haustu ex Jul. camph. half an ounce, Sp;
Minder, two drachms.

^' Jan. 24. The blood drawn exhibits a highly inflam*
matory crust. Bowels have been twice moved by a cathar^ --
lie, and he has taken 25 grains of the powder, without naa«
sea, vomiting, or perspiration. P. 112 — 120. The pain of
the head is abated. Sleeps occasionally.

'^ Capiat haustum ex Sp. Minder. Syr. Aurant. aa two
drachms, Yin. Antim. gtt. xx. 4tis horis.

'^ Jan. 25. P. 156. Pain of the head, epigastrium, \eSL_*
side of the chest, and leg. Five stools from the same cathar- "
tic, and four ounces more of blood have been dra^vn.

" Fiat V. S. terlia ad seven ounces (antea ad' sevei^ 3
ounces et four ounces) Capiat Nitri gr. x. horis Stib* -^
Vesicatorium Epigastrio.

'< Jan. ^Q. There is a very thick and hard cmst on

jgflS.) Midicihe. IflS'

blood in botU cups* Slept quietly seyeral times in the course
of the night. P. 136. Delirium in the evening, aft^r- Ub
Awbte ; none in the mornif^g;

^^ Repr; Mist* catfaart. Y. S: et deiu Nitri gr. z. horis
*3tiis.

*^ 7. p. m. Six ounces of blood were drawo^ which near-
ly occasioned syncope. The blood has a crust one fourth of
aa inch thick. The sympfom^ are greatly relieved^ but the
pulse is now 1S6. Three stools; Sleeps frequently without
-any delirium.

** Capiat Nitri gr; ±. horis Stiis. Potus imperialism &c;
■copiose..

*« Jan. 27, h. 7ma. a. m; P. 90—108. Sleeps much.
** Capiat Hautt. efferv.

^* Jan. 98j^ h. Ota: p; m. AcUte pain in the left mamita.
Is seldom hot; Sleeps frequently, and moans while awake;
E^ts sparingly. Has taken the cathartic mixtiire without
eflfect.

^' Injr. Enema; Admoveantur Hirudines sex loco dolenti;
^apt. Nitri gr. x; horis Stiis.

** Jan; ^. Slept well during the night; A bopious
^tool from the clyster. Pain of the thorax much reliered.
*^. 120.

^^ Si dolor fixus, admoveantur Hirudines ; si vagus^ dee-
5^Qndat in Balneum. Repr. Mistr. cathart. et post dejectiones
^^piat Nitri gr. x. horis Stiis;

** Jan. 30* P. 126i Fingers cold. Wandering pain of
T^e head, side^ abdomen^ hip, and leg* Two stools. Moan-

*^ Habeat Jul. camph; two and a half drachms, Sp. Minder,
^^e and a half drachms, Yin. Antim. gtt. xrv. horis 4tis;
..^^sicatoria pone aures. Balneum;

*^ Jan. Si. Slept often during the night. P. 126. Heat
^^tural. Moaning. The Bath afforded little relief. Wan-
»Ying pain of head^ abdomen, and leg; Urine turbid .

"TgL. II. t

130 Medicine. [FeJ^nmty^

^^ Capiat lafus. Cort. Per. one ounce^ hirit Sdit. et
Rhei gr. v. bis.

^^ Jan. 31 y h. xi. p» m. Took five ounces of the InfQsije%
and food twice or three times^r Better during the d^jr, but »
moaning at present*^ P. 126. Feet and hands cold. Deluv
urn. Wandering pain of the head ^d abdomen..

^' Injr. Enema.

*< Feb. lyh. 8va. a. m. P. 126.. Heat natural; but, nol
long agO( the extremities were nearly cold. Has taken tiic
infusion twice, and some wine and water. Delirium. Mofui-^
ed and was quiet alternately dwring the night. Faee pale»
Swallows with difficulty. Urine deposits a copious wliitB
sediment.

" Capiat Infus. Cort. Per.

/* Feb* 2. A very restless nighi, but sfep^ from seven-
o'clock this morning till one in the afternoon. Symptoiaa
relieved. P. I34v Has taken batter-milk, hrqad,:and wioe
and water. At four in the nroniing he took a draught with
twenty-five drops of Antimonial Wine and five of LaiidanuBi^
and at nine o'elock ten drops of Laudanum.

** Feb. 2, h. 4i p. m. Died quietly.

" BISECTION .

*' The pericardium was very much inflamed ; its extternaf
coat much redder and thicker than natural. The internal
surface of the pericardium, and external surface of the beart,.
were much more changed by inflammation ; their smooth
shining and slippery membranes were rendered rough and
unequal ; purulent matter covered both surfaces ; they were
connected by several firm adhesions^ and some irregulat
membranous fragments lay loose in the cavity. The muscit<^
lar substance of the heart was not diseased.

^^ The arteries, veins, and sind^es of the dura and piiv
mater, were turgid with blood, but those membranes did not?
appear inflamed. The frontal veins and arteries, where tBa*
pain was chiefly seated, were less turgid than tfiese ef the yeiv

l86t^.l Medieint. lH

tex and occiputs Thore were about S dr 3 drachms of serum
in the ventricles of the brain. There was no other morbid
ftppearance in the brainy thorax, or abdomen.

^^ The history of the disorder afforded no suspicion that the
heart or pericardium wereattackedtillthe7th day ofthe fever."

For the cure of the disease he recommends blood-lettings
in conjunction with the fox-glove, mercury, tobacco, eup-
ping, &c. ; and then concludes with a

** ItECAPITULATiON.

•* It may not be improper to state briefly the principal in-
ferences, which have been drawn from the facts contained in
the foregoing pages »

** 1. Syncope and irregularity of the puUe, which a priori
might be supposed to attend Carditis invariably, and which
systematic and nosological writers have included in their
definitions of this disease, did not occur in either of the
cases*

^^ S* Palpitation happened in one case, and then only in
the advanced stdge of the complaint, after adhesion may be
supposed to have taken place between the heart and pericarp"
dium.

^^ 3. The usual marks of deep-seated inflammation, as
iigorand flushing, were not observed; nor was there so much
fever as miglit reasonably have been expected.

^^ 4. Delirium, which no author appears to have men^
tioned as a symptom of this disease, happened in two of tb^
cases,

^^ 5. Other symptoms, denoting a high degree of nervous
excitement, viz. wandering pains, and spasmodic a&ctions
of various parts, and even tetanus (not recorded by any
author, as far as 1 know,) are observed to attend the Inflam-
mation ofthe Heart*

^< 6. Vomiting, mentioned* by Dr! Darwin as a constant
symptom of Carditis, happened in one case.

*^ 7. So far £rom being always complicated with Pneumo-

K 9

132 JItdicinr. [Fdbhiarjr^

nia» as some authors have asserted, therewas' no symptom of
pneumonic inflammation in two of the cases. Ifi the other,
inflammation commenced in the Heart, and was confined to
that organ during eight days ; after which it extended to the
lungs, and the usual symptoms of Pneumonia followed.

^' 8. Inflammation may take place within the yentricles,
w hich seems not to have been observed before.

" 9. If there be any pathognomonic symptom, it is the
extreme anguish that is felt in the region of the Heart.

'^ 10. From the relief which follo\ved bloodletting in two
of the cases, it is probable, that, if it were employed more
freely than has hitherto been done, the disease might be
cured."

We think that neither science or humanity will be benefit-
ed by the elucidation of this author.

Reports on the Effects of a Peculiar Regimen on Scirrhous
Tumours and Cancerous Ulcers. By William Lamhcy
M'D. Fellow of the Roj^al College of Physicians. — pp.
190.

To the researches of this author, society and the profession
are much indebted ; indeed we give our warm applause to ever j
attempt, tliat has for its immediate object the alleviation of
human misery, the ne ptus ultra of medical investigation.
We adYnire' the perseverance Dr. Lambe has displayed amid
the strong prejudice which scientific sceptics have insinuated.^
against bis judicious practice.

Most assuredly the best interests of society are censulted
when medical men give the result of their experimental
knowledge, for it is from the observations that knowledge
gives rise to, philosophy and humanity hope for improvement
and melioration. The principal object of this aullior if
to prove the advantage vliich distilled water and a vegetable
diet has over every other mode of cure in cancer. Some wel

a$09.3 MecKcme, - 133

drawn cases elucidate thispoint, particularly t!ie first, seventh
and eight cases. We hope further trial will establish the repu-
tation of this remedy. Hb arguments are ingenious, and
many of his ideas novel: he looks upon man to have been
originally an herbivorous animal. And when we recal to our
recollection the wandering Pelasgi of Thessaly, who shook the
oak and beach for their daily food, we must confess Natural
History establishes the dck;tpne. W« recommend the adop-
tion of Dr. 'Lambe's mode of treatment in conjunction with
the medicinal one of Mr. Carmicbael. The Cancerous
Ward in the Middlesex Hospital is, we understand, to
be open for this purpose. Jn the progress of animal life
the body becomes less vascular: the vivid bloom of youth
moderates into the hue of middle life, aud this into the wrinki-
led and shrunk appearance of old ag« : corresponding changes
take place in other parts : in short, the livid hue of venous'
plethora succecdsto the vivid tints of arterial : while the body
is undergoing these material revolutions^ a niode of diet that
is completely opposite from general routine, n^ust be of essen-
tial service, even where no previous disease exi^fted ; but at
the period when menstruation is {ibout "to cease, a remotal
from an alealescent to an acescent diet, we consider of the
highest import, and strongly advise it^ universal adoption,
even where cancer or scirrhus are not suspected 4 in short we
recommend this treatise to the attentive perusal of the pro?-
fession, as a work from which much >useful information b to
bt acquired : for though the same plan is not entirely n^,
being first produced largely by the famous Friar of Malta^
aud the same mode of treatment has been put to a trial in this
country, by Mr. Pearson, as will J^ seen in his treatise (m
Cancer. Dr. Lambe has the merit of carrying it a step
. fiirther, by confining the fluid diet to distilled ^^^tead of
common water.

1S4 Medicine. [Februaryji

The following conclusion he has drawn : that —

^^ The spreading of the cancerous disease into the cotiti^t
{uous parts is completely prevented bjr the use of pure dis«
tilled water ; cancerous tumours can by the same practice lie
removed by absorption ; cancerous ulceration can be preveatv
ed ; cancerous ulceration can be completely clo^ up by Ae
basis of the ulcer becomini^ covered by the surrounding soimd
skin ; in one case, which proved fatal, a part of the ulcer lufi^
been brought to cicatrize, but the cicatrization was not perma-
i^ent ; in another, of which the event was similar, all the
parts surrounding the principal ulcer were made perfectly
90und, and ^ome ulceration ^rrnly cicatrized ; that by uniting
the use of distilled water to a vegetable diet, life may probitbly
be prolonged to an ii)deiinite extent^ even in certain cases of
i^lcerated Cancer of long standing ; and it must follow as a
direct consequence of these fact^, that if tiie disease be incline
eot| and the patient in good health, the Cancer may tie pie*
vented from ever becoming a serious disease at &11.

^^ In one sense I am indined to believe that the Cancer will
ever prove incurable. If it afibcts the mammary ^i^d, the'
di^e^sed part will ultimately perish, either by its being t%^
moved by ulceration, or by absorption, The facts are too
few to assert that this ivill be constant ; but the powers of
regeneration possessed by the human system are so feeble,
that the suppositiop is highly probable. Should ft prove fo '
be so, this circumstapce will be a proper criterion, by which
to determine, whether a case treated in an early stage by tbut
method here proposed, has or has not been a gequiue case of ■
cwcer."

^peaking of the strongest characteristic of cancer he oh?
serves:

^^ This, when the disease has become active, is unceasing,
find gradually involves every coi^tiguous part, however Amir '

1809.]- Medicine. 185

milar in tbeir tr^tare, and excites tbem to^tmilaf action.
The skin above, tbe mnsclej periosteum, and bone bene^tb,
ixsides the absorbent glaiids, all become eyentuallj a carcino*
matoos mass ; tbe bitercostal muscles, and probably even the
lungs themselveik, eve'btually suffer from the contiguity of a
cwiuxteun breast. What then is the preventing the disease
from spreading, but direct ocular evidence, that the genera^
tito of new Ganger is prevented. It is an inference then of
iOommon sense, that whatever is proved by experience tm
possess this salutary inftuence, should be adopted as soon,
at leasts as the nature of the complaint is ascertained.

^f But this is the advice of friendly exhortation, not ex-
ported from the disappointment of expectations too sanr
guine.

^' If there be any doubt that the spreading of the disease is
truly the generation of new Cancer, an examination of the
anatomical structure of the disease must put it beyond ques-
tion. I will make use of the description of Mr. Honie, whose
access to the preparations of the Hunterian Museum makes
liis authority the verj best thatt can be obtained on this queab-
tion.

^^ Mr. Home h&s described anatomically three stages of
the disease. For my own purpose I shall transcribe only the
di%(t and third. '^ ^^ When a section is made (of a canceroi}f»
tumour) in its yearly stage, it puts on the following appear^
ance :•— the centre is mare compact, harder to the feel, and haii
a more uniform textixre than the rest of the tumour, and i»
nearly of the consistence of cartilage. This middle part doea
not exceed the size of a silver penny ; and from this, in every
direction, like rays, are seen ligamentous bands, of a white
colour, and very narrow, looking, in the sectioj^, like so many
irregular Mnes, passing to the circumfearence ..of the tumour,
which is blended with the substance .of the surrounding
gland." Dr. Qaillie's description. It is well knowil, of the
'Structure of Caucer in the stomach and uterus accords precisci-

K 4

136' Medicine. ' [Februaiyi'

ly ivith this. Again, <^ when the tomour has advanced to ^
'what may be called cancerous suppuration, which, however,
does not always happen in the centre, before it has approach^ .
ed the skin, and formed an external sore ; it then exhibits an
appearance totally different from what has been described.
In the centre is a small irregular cavity, filled with a bloody *
fluid, the edges of which are ulcerated, jagged, and spongy.
Beyond these, there is a radiated appearance of ligament^
ous bands, diverging towards the circumference ; but the •
tumour, near the circumference, is more compact, and is
made up of distinct portions, each of which has a centre,
surrounded by ligamentous bands, in concentric circles."
It appears from this description, that in the advanc^ stagcf,
the circumference of the tumour is composed of a number pf
portions, exactly pf the same structure as the central part, in
the first stage. The circiimference therefore consists of n
number of Cancers in the state of scirrhus. It must foUoWf .
that whatever treatment prevents the spreading of the disease
into the contiguous parts, is the true preventive of the form^-.
tionpf Cancer.'*

** I am aware that it may be objected, that, when tb^
Cancer has become ulcerated, it does not always mate th<?
same progress as it did before ; but it will sometimes jix^cpinQ
stationary, or even make some apparent advances to a natural
cure. But in these cases, though this may happen in the part
first affected, the disease has always been making progress i^
some other, commonly in some contiguous part. Thewholq
disease is never quiescent : its activity is merely transferred.
Thus Hildanus relates a case of Cancer of the tongue, in
which a tubercle increased to the size of a chesnut ; it ulcer<r
ated, and the ulcer contracted and closed, so that the whole
eemdi almost well, except a little crack. But in the mean
time some glands, which had tumefied under the chin^
ulcerated internally, the fraenum linguae was destroyed, the
lip swelled, and the whole tongue itself so much, as nearly tj

lSjD8.j Afedicint^ 187

£11 the cavity of the mouth. Mr. Home has recorded a
similar circumstance in a case of Cancer of the penis, where
the disease in the^laiid became as it were quiescent, while
the ravages committed in the groin were yiolent in the ex«
treme. But in all the cases hitherto related, (except the
tecond> where the subject was very old) and in those still to
be reported, the quiescent state extended to the whole dis-
ease ; it included every part alike ; it began with the adop-
tion of the regimen, and continued uniformly and steadily,
as long as it was contiiiiaed.

^^ I have said enough, I think, to shew the utility of this,
regimen in cases, even where it- cannot effect a cure; it limits
the disease; it soothes the pain; and it palliates several of
the iQO$t distressful symptoms. But it is now my business to
turn to a scei^e still more pleasing ; an4 to shew, by the in(p,U
libletest of experience, that both the cancerous tumour and
the canperous ulcer are really curable. The former may be
removed from the system by spontaneous absorption ; and jthe
latter may be healed by the reparation of the diseased parts,
and the surrounding skin being drawn down, and completely
clpsing the basis of the ulcer."

(To be conUnued.)

VACCINATION.

To the Editors of The Medical and Surgical Spectator,

Gentlemen — Although my name has been introduced by .
a Gentleman as inimical io the practice of vaccination, I .
must confess I am still undetermined as to its real merits.
That it is not an uniform preventive of Small Pox, I be-
lieve is admitted* Therefore I wish to inquire of those
better acquainted with the subject than myself, and par*
ticularly of Dr. Willan, whether any new cutaneous dis*
^e»se has made its appearance coeval with the^ introduction of

13S Medicine* [Febnitrgr,

this discorery, under tfae term of the Psora Botilla 9 What in
apparently its nature, and its best mode of treatment/ I Imoyt
some strong facts have occurred in Dr. Willan's 6\¥n prtetic*
upon this point. My inquiry is one neither connected witik
opposition, nor the desire of singularity ; but to possess acon^
miction, from the judgment and experience of others, of irhal.
is really the truth respecting this. I can bare no doubt ei
Dr. WiUan's professional correctness, and tiiat I shall bq
* faroured with his opinion in answer to the above. , .

I am, Gentlemen, your obedient Servant,
Hemrietta Street, Jan. 20. R. R££G£.

VACCINATION.

To the Editors efThe Medical and Surgical Spectator.
Gentletnefi'^Ir may be expected that the discussion df
Mr. Rose's bill in the present session of parliatnent will ex-
cite the activity of the eternal enemies of vaccine inocula-
tion; and I hope that its friends to<^will be equally on the
slert in their endeavours to refiite calumny and detect misre*
presentation.

If the vaccine disease is occasionally the cause of mischief,
it is greatly to be lamented, and so far candour must allow
that the injury <be it what it may) ought, in striking a balance^
to be deducted from the good it confers on society. But the
true question with sober inquirers will be as to both the abso"
lute quantity of injury inflicted, and its relative qustntity
compared to that resulting from the old inoculation. When
every accident that happens to a child that has undergone
vaccine inoculation is ascribed by its adversaries to this
source, I think there ane two measures which might be iUktn
to set the public mind at rest on so important a subject, and,
if possible, to bring the discussion to an end.

The first measure I would propose is, that the deaths from
sman«-pox shouM be divided in the bills into twx> heads ; the

I«09.] Ii9rgtry. ^ !*•

tot to contdn those who perlih frnrm the natural contagion,
tad the second, those Who are destroycdl^j Inoculation. Thiii
ire should haVe annually authentic prooft of the direct afid
immediate injury of the old practice; and mi^ht compare
it with the allegckl nii6chic£i of vaccination. I bdi(«ve that
tiie numbers thus destroyed arc ihuch greater than iis com*
teonly imagined, and that it -would e<>ftfirm the obserration
in flie report of the College, that ^* The deaths from com-^
liion inoculation are more numerotis than the cases of im-
puted mischief from yadcination."

A second measure that mi^t be useful Would be for the
friends of vaccination, those particularly who are ccmnected
with the vaccinating societies, to collect histories of diseases
which have immediately followed the inoculated small-pox.
JThe work would be directly usefVil ; it would be fighting the
antirvaccinists with their own weapons, except that I should
hope they would use no arms but those of truth. And here
again I doubt not that for one case of injury sustained from
vaccination, a hundred might be found of far deeper and
more serious mischief from the small-pox inoculation.

As long as every sinister event, which follows vaccination,
is ascribed to it, the minds of parents will continue to be
agitated and alarmed . If it be expected, even that what obvi-
ously does so much good should be wholly unattended with
any concomitant evil or imperfection, we expect more than
has hitherto belonged to any human invention whatever,

MEDICUS.

II. SURGERY.

One of the chief improvements of Surgery that claim our
attention for this month, is, Mr.'Wardrop's new proposal for
conducting the incision of the Cornea in cases of Cataract.

CATARACT.

The in&onyenicncies that attend the usual mode of incision

140 Surgery. f February^

are first pointed out^ shewing that the incision oTthe internal
coats is not equal to those of the external. After enumerating
Tery clearly all tliedisadvantagesof theusual mode, Mr. Ward-
rop observes, they appear to him to ^^ arise chiefly from the
ivantof a sufficient portion of the cornea being. left. at the
inferior part of the wound , io support the iris, and^tP srevent ^.
the pressure of the parts contained within the eye-ball, and ;
the occasional action of the muscles, pushing forward ^be
iris toward the wound of the cornea: I therefore conceived,
that if the incision could be made in such a manner, that a
larger portion of the cornea could be left at the inferior part
of the wound, and thatj if, at the same time, it was made of
such a form as to allow the easy extraction of the lens, a con-
siderable improvement would be made in the operation.
With this view, I made the incision in the following man*
ner:

'^ The best knife for the purpose is that of Mr. Beer,
the celebrated oculist of Vienna, by whom it is employed for
the common operation. The blade is of a simple trian-
gular form, the back being one continued line from the
handle. Its point should be made firm, and the blade should
turn gradually thicker from the point towards the handle.
The back Qf it should not be left square,, but rounded off and
smooth. Having previously oiled the knife, to make it cut
more keenly, its point is to be thrust through the cornea, a
little above its transverse diameter, and one line from its mar-
gin, in a direction as if it was to pass through the pupil, pr
nearly perpendicular to the spherical surface of the cornea.
When it reaches tfie plane of the iris, the blade is to be
moved a little upon the incblon which is already made, as
a fulcrum, so that the point is elevated and turned towards
the opposite side of the cornea. It is then to be carried .
forward and a little obliquely downward, so that the cor- ,
nea is again punctured at its transverse diameter, at the
same distance from the sclerotic coat at which it had been

1809.] Surgirj/. 141

entered on thb opposite side. By these two incisions, the
blade has cut perpendicularly, or yery nearly so, to the
spherical surface of the cornea, and the gradual thickening
of the knife, by filling up the wound as fast as it is made,
prevents the aqueous humour from escaping. The eye is
now completely s^culred by the knife, and the incision is to
bt finished by turning round the blade on its axis, thus
keeping the edge turned outwards^ in such a manner, that the
remaining part of the incision is a straight line, and, tberefore,
nearly perpendicular to the lamellae of the cornea. If none
of the aqueous humour has escaped before this last step of the
incision is begun, it is sometimes necessary to withdraw the
knife a very little, to allow a drop of it to escape, before the
knife can be turned on its axis."

Thus conducted, he farther proceeds :

^^ The incision should be made so that the inferior edge of
the wound is half way between the circumference of the
cornea and edge of the pupil, supposing the pupil to be in a
moderate state of dilatation . If it be made nearer to the sclerotic
coat, then the advantage to be expected from this mode of
operating will be lost; and, on the other hand, if it be made
at too great a distance from the sclerotic coat, and, conse-
quently, too near the pupil, the iris will be apt to fall for-
wards, and a portion of it to pass through between the lips of
the wound. In one case, in which this accident happened
to me, the wotind was long of uniting, and, after it was heal-
ed, the pupil remained very irregular and contracted.

'^ In making the incision of the cornea in this manner
another circumstance also particularly deserves notice, whici
is, that on giving the knife tlie motion round its axis, aflle
kaving punctured both sides of the cornea, there is a greai
risk of the iris turning over its cutting edge, some of the
aqueous humour having by this time escaped. An operator
who meets with this for the first time, is apt to think a wound
of the iris inevitable i but if he cautiously stops the progress

ofthjo knife, and presses the iris from its edge, by gliding the
point of bis fore-finger over the cornea, the incision may be
completed vn\\k perfect safety.

^< I should not omit nentimiing, in this place, the great
advantage to be derived by having the eye-ball propeiij
fixed before attempting ta introduce the knife. I suppose tbi^
upper eye^lid firmly secured by the fingers of an assistant, ot
by Peilier's speculum, and the fore and middle finger of the
operator's left hand placed within the eye-lid, in contact ivitk
theeye»ball, pressing firmly in the comer of the eye the mid*
die finger, to prevent the ball rolling inward. When first
touched with the point of the knife, the eye generally starts ;
I have, therefeie, adopted it as a general rule, to touch the
eye gently, or give it little strokes with the baek of the kai^i^
as long as it starts or remains unsteady ;, but the moment it
appears fiUigued and fixed, I draw the back of the knife with
great caution along the surface of the cornea, till the point
arrives at the e;pcact place where it is intended to penetrate*)
and then, with some quickness and firmness, it ought to be
pushed into the anterior chamber.

** In fixing the eye, too, great advantage is derived by
making the assistant press considerably on the ball, whilst the
knife is made to pass through both sides of the cornea; but
whenever this part of the operation is completed, all pressure
ought to be carefully guarded against, and the upper eye-lid
merely supported.

^^ I have found the incision, such as has now been describe
ed, to fulfil compl^ly my expectations, after having per-
formed it in upwards of twenty cases, in order to extract the
cataract, and also in other operations, where it was nccessaiy
to make an incision into the anterior chamber. I have also
observed, in some persons who have been operated on by the
most able oculists, that the incision of the cornea was by no
means of the regular semicircular form, nor was it so near to
the qircumference of the cornea as is recommended ; not with*

1809.3 S$rgei^. 145

flitltiiding the lens in these cases was readil j extracted, and the
pupil remained perlGsctly re^^ular. This most frequently
happened in eyes which were operated on with the left
kand : I therefore did not conuder it as the aim of the opera-
tofr to make the incision of such a form, but rather as an accir
dent occasioned by the difficulty, which moat people find in
using their left hand.^'

EGTFTIAN OPHTHALMIA.

This epidemic Ophthalmia, which has created so much:
mischief in our armies, has given scope to the pens of a num-
ber of our military practitioners, and we give them credit for
their attempts to elucidate its nature and treatments Bu^
like every subject in vogue, the Egyptian Ophthalmia has
been seen where it never existeil, and obstinate cases of the
common ophthalmia of this country it is now feshionable to
refer to an Egyptian source. The Egyptian Ophthalmia is
chiefly distinguished by its enormous quantity of purulent
discharge ; but though purulency is am attendant of severe
eases in this country, it is not to be supposed the same iden*
tical disease. These hints we merely throw out to caution
practitioners against refaring to anew origifii what is a com**
mon disease of this climate.

ANEURISM.

The perfection of Surgery is now so great, that the opera-
tion for Aneurism has been performed repeatedly in the Hos-
pitals of the metropolis on large arteries; and these cases are
the following :

^* A fourth operation for aneurism of the carotid artery has
recently occurred. It was performed at St. Thomas's Hospi-
tal on the I6th instant, upon the person of a strong middle
aged man, by Mr. Cline. The tumour, which was large, had
been particularly rapid in its growth. The other circum-
stances of the case were by no means favourable. Respiration
and deglutition were affected by the pressure of the tumour,
which bad pushed the larynx from its straight course, Thift

patiait bad besides a Tcrj freqaent and tjroablesdine coij^h.
The pain was confined to the tnmonr and correspondini; side
ofthefece.

^^ All these symptoms were relieved for tbe ii^elve hoan
succeeding the operation. They then recommenced in an
increased degree, particularly the cough and dLBGiculty of
swallowing, accompanied with much irritative fever, to
remove which medicine proved inefficient* The man died oft*
Monday the 19th.

'^ The operation for carotid aneurism, performed by Mr.
Astiey Cooper in Guy's Hospital, in June lastv has been at*'
tended, we are happy to say, with perfect success. It • U
highly valuable, inasmuch as it is hitherto the only case by
which, as far as we know, the credit and character of the
operation are supported ; we mean its character in a medical
sense. The practicability of the safe application and ie<
moval of the ligature was put beyond doubt, by the event of
his first operation for the disease two years ago. Humphries^
the subject of the former, resides in Labour-in»vain-court^
Old Fish-street. He is perfectly well, and has returned to
his employ, which is that of a porter. The facial and tempo-
ral arteries of the corresponding side have no susceptible
pulsation. On the opposite side, the temporal artery is
larger than usual. The tumour has totally disappeared.
His intellect is perfect — his nervous system unafiected : and
the very severe pain which he endured upon the same side ot
the head, previous to the operation, he has never experienced
since. A hoarseness, which he had prior to the operation,
continues, though it is not now so much as it has been.

'' The subject of an operation (performed about thcf ^
came time by the same gentleman) for inguinal aneurism|
has likewise perfectly recovered ; he walks with consi-
derable ease, with the aid of a stick, and has accomplish-
ed a walk of three quarters of a mile at one time. He
mikcs no complaint of coldness in the limb. The event oi

1808.] Sargerjf. US

this case is the more gratifying, as the man did not see Mr«
Cooper until the tamour, which was very large, was actually
livid, and the operation could not have been postponed
without considerable risque. In proof of this, we may
add, that on the sixth day followiog, the sac burst and difl«
charged its contents."

^ CALCULUS.

No disease comes oftener under the care of the surgeon

than Calculus. Chemistry has tended much of late years to

elucidate its nature, and some observations upon it have been

made by Mr. Barlow, of Blackburn, which deserve attention.

*' The general opinion," he observes, ^\ that what is called

hard-water, when taken into the stomach as a common bever«

' -Bge, predisposes persons to the disease of stone or gravel, by

a specific^ mode of action and affinity with the urine, appears

to me to have little ot no foundation in truth ; nor will calculous

affections, on a minute inquiry, be more frequently discovered

in one county tbaa another.

^^ Were it possible to institute a ratio of the comparatiys
number of stone patients in the various counties in this king^
clom, according to the aggregate of inhabitants in each, it is
Onore than probable that the difference of result would scarce*
Ijr be noticed : this conclusion, then, leads me to believe that
"^ater, even when impregnated with sulphat and carbonat of
lime, possesses no inherent power in predisposing persons, to
'tills disorder. It is stated by the querist in a publication
t.1iat the county of Norfolk produces more instances of cal-
emulous affections than that of Lancaster, although the water
i n each is equally impregnated with earthy matter. Whence
Csays he) the origin of this vulgar error ?

^^ The popular opinion of this complaint being endemic^
*Tiay, I conceive, arise from the circumstance of some resident
burgeon having gained celebrity in this particular branch of
c^hirurgery, which induces those who are afBicted with thb
aiaalacly to apply for relief, when, otherwise, they would, i

146 Surgery. [February

all haman probability, have died i?i(hoat having the stone
extracted, or even the disease discovered, by those less com-
petent io undertake the operation.

^^ I am not acquainted ^ilh the relative frequency of calcu^
lous cases Mrbich any particular county produces, or the
average number of stone patients admitted into the diKrent
hospitals in tliis kingdom, nor the result of success consequent
to the operation ; nevertheless, some inference may be drawn
from the relative numlyr of cases iu this part of the county^
compared ytiih other districts, \\ hen it is kno'nrn, that during;
the period of the last seven years 1 have operated for the stone
thirteen times in this town and neighbourhood, on patients
from the n^e of two and a half years to that of fifty ^ and in
every instance (except one) with success.

i

'^ In allusion to tiie popular opinion respecting the tenden-'^
cy that water, when impregnated with earthy matter, has io '
producing stone in the bladder, I will refer the reader^ as a -
proof of the antiquity of this prevailing prejudice, to sect. Sd^
page 6S, of Hippocrates de aere locis et aqua, where lie
says, '^ The waters of rivers or lakes into which different-
streams fall, or of other places into which they have at time^
accumulated themselves, are apt to produce the stone ; for,
being composed of many different sorts, some, sweet, others
salt, or aluminous, they must deposit a sandy sediment.
Persons whose bowcis and bladders are in a soluble state, may _
escape sabulous collections; but those of a more fiery habil^
when the mouth of the bladder is attacked with inflammation^^^
cease to make water freely, and tlien the gross sandy parts of
these waters deposit themselves, whilst the more fluid particles
are let out," &c. &c. In another part of the same author's
works, he attributes the stone in children to the impure milk
cf nurses

^' 1 am aware, that the proximate cause of the production
of urinary calculi is involved in much obscurity; yet itap*
pears to me» that the disease docs not originate so much, as

■f

«

186S.J ^urgtry. 147

has been supposed, in the uriniferons vesteb of secretion in-
the kidneys, or in the nrine sedreted therefrom, as in the-
mucus produced from the inner surface of the bladder, and-
sides of those organs and cavities, through which it naturally
passes from its source in the kidneys to the termination at the
prostate gland.

^^ The peculiar construction and disposition of the prostate
gland to generate calculi, may be one cause why men arc
more subject to the disease than women, seeing they are desti-
tute of that organ; and we frequently read of calculi being
found in this appendage \o the bladder, dnd also of their
existing spontaneously in other canities of the body; such,
for instance, are the intestines, uterus, stomach, gall-bladder^
lungs, and cavities of the joints in g«nty habits;— •See Baillie'f
Morbid Anatomy, Morgagni's Epist. Lieutaud, Boerbaave's
Commentaries^ and Memoirs of the Royal Academy of Sur-
gery at Paris.

*^ These depositions of earthy concretions, J conceive,
abound more frequently in those reservoirs of the sy.^tem
where there is the greatest quantity of mucus secreted j and
where it is pent up in certain parts of the body, than in those
cavities from which there is a greater facility for the fluid to
escape from the part where it was deposited ; hence, may it
not be reasonable to infer, that the proximate cause of urinary
calculi exists ]!n an over degree of stimuli afiectiiig the urinary
organs, and thereby producing an excess of inspissated mucus
on the inner surface of the bladder, and a morbid state of
those membranous cavities, so essentially necessary for the
performance of their healthy functions. These superabund-
ant secretions may become stagnant in the excretory ducts
and ruga» df the bladder, and, by chemical affinity with the
urine, calculi may probably be generated. On the same
principle, any foreign substance accidentally lodged in the
bladder, may excite a certain degree of inflammation, and
coagillable lymph or mucus be thrown out in the cavity of

L 2

148 Surgery/. [Februarj,

this viscus, lYbicli, bj a specific attraction \¥ith the extrane*
ous body, a nucleus may be thereby formed ; hence, ive fre-
quently see the surface of a stone, recently extracted from the
bladder, covered over with mucus, which, I conceive, has in
some instances been the cause of the stone not being so dis-
tinctly ascertained by the surgeon when sounding the patient,
prior to theo^ieration of lithotomy.

^^ To conclude these remarks, I will hazard an opinion,
that as we frequently meet with children who are afflicted
with the stone in the bladder during infancy, and who have
been exempt from the causes before mentioned, and also with
foBtuses, in whose bladders much sabulous matter is deposited
in their urinary passages during their stage in theuterus^ may
they not be sometimes born with the disease ?"

ENCYSTED TUMOUR ON THE CHEEK, BT A MEMBER OP THE

ROYAL COLLEGE OF SURGEONS.

To the Editors of The Medical and Surgical Spectator*

Gentlemen — Should the account of the following case
which occurred to my notice, be deemed worthy an insertion
in The Medical and Surgical Spectator y I request that you
will have the goodness to give it a place in your journal.

A woman between 50 and 60 years of age, applied io me
to relieve her of an encysted tumour of the cheek, of the
steatoniatous kind, the skin of which was much inflamed,
and become very thin.

On account of the hazard of wounding the parotid duct,
I declined either of the two methods of removing this com*
plaint^ by dissecting out the cyst, or destroying the same
by escharotic applications. The swelling was of the size of .a
large nonpareil apple, and the state of the integuments
assured me, that if the tumour was suffered to burst, although
under such circumstances, the bag might have inflamed and

5^-^

■ t

1809,] Surgery. 149

sloughed^ jet a very unsightly cicatrice T^rould fonn, did
the patient ever get \ie1I.

I resolved to evacuate the tumour bj a puncture : its con-
tents were greater in quantity than I could have imagined to
have been collected. As soon as the cyst was emptied except
as to the integuments, the complexion had the appearance of
- • a baked apple, after its contents are squeezed out.

I determined nevertheless to trust this case to tlie result
of the original opening, and with that view I satisfied myself
^ with merely introducing as much lint into the tumour, as

'i ■ ' not painfully to distend the sac.

The second day, part of this dressing came away easily :
'* . on the fourth, the remainder of the lint dressing separated
^ itself as readily^ but the discbarge was copious and greatly of-

^ -^ • fensive. It was observable, after this period, that the exuber-
ant state of the integuments was much contracted ; I
then conceived it possible, that the sides of the cyst might
approximate and unite by adhesive inflammation, and thus
ff . prevent a renewal of a fresh secretion in the cyst.

The int^uments of the tumour, in tUe space of a month's
r. - treatment on this plan, collapsed in such a manner, as led me
not to regret the putting into practice the removal of the seem-
• ingly superfluous intcgjiments, which it was at first my intent

tion to do, and certainly from the appearance of the very pursy
' -. state of the skin, every reader will think with ipe \i might
' f have been necessary .

^ The introduction of a solution of the argentijm nitratum

in the proportion of or^e (Jrachm to one ounce of water, by
the mearis of lint dipped into the same, has certainly pre*
vented a rene»\al of the steatomatous secretion, but without
eflfecting an obliteration of the cyst. The bag remaifis
open, and although two years have elapsed, no collection of
any kind has taken place, nor does any discharge escape
from the cavity of the tumour. I shall not enlarge on this

l3

150 ^ * Surgery. [February, '

case bejond the circumstance of this occurrence, novel at
least to myself, and certainly confessed as such by those
'who have examined the case. This patieat has also been
seen by a friend of the highest surgical and anatomical
attainments; and though, as I confess the determination of
this case was perfectly accidental on my part, yet by that
gentleman it was considered as one ending so very happily
for the patient, that he deemed it a circumstance worthy of
professional notice.

I could have wished to have made the recovery of this
patient complete, by removing the edges of the opening, and ^'
thereby procuring by the first intention the complete Iicaling Z

of the wound. '

. I

To the Editors of The Medical and Surgical Spectator. - a. "i

Gentlemen'^ In your last number, I observed a letter from a
^rrespondcnt, dated Cambridj^e, containing remarks on the «

nature and treatment of Tinea Capitis ; I conceive it there- j^

fore but justice to myself to observe that the same prac- ' ;/
tice detailed in that letter is an outline of what has been - . «^s
r^ularly my plan of treatment for the last three years, and j v
as surgeon to a Publip Institution, I have had the fullest . >.
opportunities of trying its success. I long since communi- ** ,.
jcatcd my ideas to Dr. Hi^ighton, my worthy colleague, as '•)

well as to my friend Mr. Astley Cooper, both of whom have
had opportunities of appreciating its merits, and to both of
whom I intimated my intention to publish a short detail of
those cases, in which this plan has proved successful. I
have endeavoured as much as possible to disseminate ray
ideas on the subject to every practitioner \yhpm I have ever
had occasion to m^et on this disease, which occasions have not
been unfrequcnt, and I am therefore glad to find, tha|; the same
praptice has been adopted by others as well as myself,

1 am, Gentlemen, your obedient servant,
St. Mary Axe, Jan. 13^ 1809. THOS. LUXMOORE,

'4

«

1809.] Surgery. 131

BEMARKS ON SPHACELUS OF THE TOES AND FEET, BT A
MEMBER OF THE ROTAL COLLEGE OF SURGEONS.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — ^Had all writers given, like Wiseman, a detail
of tlieir unsuccessful practice, our professional knowledge
would by this time have largely accumulated.

I am not without hope that the following communication
of my successless treatment in cases of Sphacelus of the Toes
^ and Feet, denominated by some surgeons as Mr. Pott, morti-
fication of these parts, will not bo without its use. No
-writer has since added to the stock of information on this
f subject with which Mr. Pott favoured the public. The object
'• 'Of his publication was to recommend in a curative point of
• view the internal use of opium ; a remedy which, in the several
; cases in which I have tried it, seems entirely undeserving any

eulogium.

^ . . It would be proper to premise that it has frequently fallen

''to my lot to treat mortifications arising from cold, inflamma*

tion or accident ; but in none of these cases did the quantity

^of opium required to allay irritation justify me in con-

' ^sidering it as possessing any thing like a claim to the charac*

ter of being a specific remedy, as intimated by that writer. In

^, those cases of mortification analoi]:ous to the instances de-

' .scribed by Mr. Pott, I have not succeeded in arresting the

*" progress of sphacelus, and in some cases failed of procuring

^'ease. From the encomiums given to this drng by Mr, Pott,

^had I not attentively perused the account this author has

communicated to the profession, I should have been led to

conclude that we had been treating different varieties of mor-

^ tification.

I have directed this medicine to be given in gradually
increased doses ; but it had no influence oyer the complaint^
for my patients died.

This event, however discouragiijg, determined me, upon the
first case of painful affection of the toes, to try the efficacy of

L 4

152 Surgery^ [Febnmry,

the remedy previous to the existence of moitification, hayings
upon inquiry of every patient, found that they had for days^
in some instances \reeks, experienced excruciating torture in
tiieir feet before the part manifested any change of colour
or appearance of disease.

An opportunity soon presented itself to my notice in the
person of Mary Evans^ a robust woman of the age of forty.
She api^lied to me on account of extreme pain which she felt
in her toes, which she described as of a shooting and fiery
nature, depriving her of rest. I informed her that her feet did
not seem in their appearance, or on handling them, in the least
disordered, but that I would direct a medicine for her which I
hoped would relieve her. I ordered her twelve pills of the * ;
extract of opium, containing each a grain and a half, of which
she was to take one every hour until case was procured^ .»>•
After the eighth hour by this mode of treatment she became '
perfectly easy. To ascertain the credit due to the remedy, I
caused more than once pills to be sent of the same number and '* .1
complexion, but containing only half the quantity ofopium«
She did not seem aware of any imposition having been ^jk
practised upon her, but asked if her pills were the same, as her -■*' *
pains had returned, though in a weaker degree : upon which
communication I ordered 12 grains of the narcotic to be daily
taken for the space of a month, when the proportion of the ^^^
opium was afterwards gradually reduced. She is now in Ji^
good health, butalwajs describes her sufferings at the time to i. ;
• have been dreadfully severe until she took the pills. ^ '

It is some years since the occurrence of this case ; but I have** ?
succeeded also in two other cases by this practice in allevi-
ating and removing this very painful affection of the feet. . I . "
most perfectly accord with Mr. Pott in the propriety of ^ ,'
adopting the mildest external applications : the linseed i)oul«
tice wa« the external means I used in those cases in which mor- ^
tification had made its appearance previous to my being con- .^
suited. It may be right to observe, that the patients always
complaixiedy if the cataplasm was more than lukewarm^ of

.>

1909.] Surgett/. 153

ilustr sufieringft being incr^sed by U. The intelligent reader
-will determine for himself what degree of reputation opium
merits as a probable preventive to the occurrence of spha-
celus, if resorted to before there is any manifestation of dis-
order in the feet.

It having been suggested by a friend to give an account
of some of the cases of mortification of the feet, in which
opium was taken internally without any advantage, I beg to
think differently from this gentleman, believing that the sheets
of I^e Medical and Surgical Spettator might be more usefully
occupied. Suffice it to say that my practice in these cases bay
always been open to the observations of other practitioners.

ON THE FUNCTIONS OF THE LIVER.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — May I beg you to accept my proper acknow-
ledgment for your ready compliance in inserting my former
paper on the Spleen, and to request you will do me tbeik-
Tourto give this a place in your next.

Your most humble Servant, S.

Gentlemen — ^Having in the first volume of The Medical
and Surgical Spectator offered some observations on the na-
ture and uses of the Spleen, and besides its ordinary and import-
ant function of insuring a constant and regular supply of
blood to the stomach, I suggested the idea that it may on
particular occasions sustain a vicarious office. Pursuing that
idea, I consider it a depot of pure prepared nutritive -blood
stored by the animal ce onomy when in health, for the par-
pose of supplying the system when diseased \ I consider it
in this light from the short circuit the blood takes from the
heart to the spleen, from thence through the vena portarum to
the vena cava; after its oxygenation from the pulmonary
arteries, the blood is soon distributed to the stomach and
jpleen, whence^ after performing its office in the ordinary

154 Surgery • [Februaiy,

course of digestion, a deposit of pure blood ig laid np in tho

cellular substance of the spleen : that its bulk is capable of
enlargement and diminution is acknowledged bj most anato-
mists. ^^ Monsieur Lieutand in Hist, de Acad, dcs Scienc.
Paris, Ann. 1733, argued for the spleen being larger by a
greater quantity of blood in it when the stomach is empty,
and that the blood is pressed out when the stomach is full io
increase the secretion of bile." Cyclopaed. But that the liveris
fully competent for the secretion of bile without the help of
the spleen I think will be generally allowed. That it is a
magazine from which the system is occasionally supplied, I
was strengthened in my opinion from two of the experiments
of the ingenious Mr. Home upon asses that had been kept
four days without water and two days without solid food.
Upon killing those animals, the spleen in each was found di*
minished to half the ordinary dize, being a pretty strong proof >
that the animals, during their fasting, were partly sustained by
nutriment from their own depots. As there is an accumula-
tion of adeps in its proper cells when the animal is in good
health, and plentifully supplied with nutritious food, which
is capable of being again taken up into the circulation by*
means of the absorbent or lymphatic system, so in like man-
ner I imagine the spleen to be an extra store of pure blood
ready to supply the sanguiferous system when needful. Con-
sidering it in this light, how useful must such a viscus be in
the animal ceconomy : how often do we find the stomach in -.
such a state as to reject food for many days together, under '
which the animal's strength would sink very fast, if it was not
for this wise provision of nature within itself. Hence I con-
clude^ that, besides its constant duty of assisting the stomacU
in promoting digestion, the spleen, from its proximity to the ■".
heart, its nervous and vascular texture, contains a kind of
extract of the finer particles of the blood, perhaps chiefly
red globules, highly animalised, and abounding with living ^
principle, from which a little being distributed in the rouji^

1809.] Surgery. 155

of circulation, the animal may be sustained for many days^
wlicn the usual supplies of ndurishment are cut off.

Yours yery respectfully,
Jon. Ig, 1809. SCRUTATOR.

To the Editprs of The Medical and Surgical Spectator.
Gentlemen^^l have conned very attentively oyer the com-
munication from Dr. Reece, in your publication of this month,
containing the case of Admiral Henry ; and whether it be
owing to my impenetrable dulness, or to Dr. Recce's style
.partaking too much of that which Burke would call a portion
p{ ih'e sublime^ I cannot tell, but so it is, { do not perfectly
understand him. I allude to the following passage in his
.letter ; " The Admiral having cured himself of many ob-
i* I ^tinate attacks of Rheumatism and Gout by severe friction,
*8ftid j702^»(/2;i^ the part affected with a wooden hammer ; re*
•olyed to make the experimeiit on the right eye; and after
persevering with great fortitude for about a monthy he found
^'. ^bat he could discern a luminous body, and continuing the
:.*<Pt^ctice, the diseased lens was gradually diminished, and
» t«c gallant Admiral is enabled to read small print." Now
* 'Wish to be informed how the experiment of severe friction
\^ ^*^d pounding (for the word experiment refers to both)
2^^«^ performed on the eye of the gallant Admiral ?
^T * We are told again, that by the experiment of rubbing
•^ •'•Xd pounding the eye, the diseased lens was diminished.
r *- liere appears to me some ambiguity in this sentence : from
^ ^*X« manner in wliich it is expressed, we must suppose
Mj^at the lens itself was diminished; andyet I cannot help think-
■ •x^ the doctor intended to have said, the disease of the lens

^s diminished. A ray of his information in your next
'^ Vimber will pierce the darkness which surrounds me, and
jr mind shall be no more

like a clouded lens,

Bat clear and bright as other men's.

f-cndon^ January 23, 1 809. T B*

156 Surgerjf. [Februaiy^^

Practical Obsertations on the Diseases of the Joints^ comh
monly called White swelling ; with Remarks on Cariet^
Necrosis^ and scrofulous Abscess, in rchich a new and .
successful method of treating these complaints is pointed
out. Bjf Bryan Crozcther, Member of the Royal CoU
i^S^ of Surgeons in London, and Surgeon to BrideweU
and Bethlem Hospitals.

(CoDtiDued from Vol. I. page ^i.)

Society is certainly under the greatest obligations to those *
practitioners, who, by their assiduity to the duties of their
profession^ extend our knowledge of practical science, fblr
one practical observation is worth ten thousand theories.:
theory may please, but fact elucidates : the one has the absinM* '
dity to flatter itself, that by its specious garb proselytes "^^^
flock io it, while fact establishes itself by the feober simpli-
city of its manner, and solidity of its argument* Such wiuf '
the state of information respecting caries, when Mr, Crowr -
ther opened a new field on this interesting point, and calleA. \
the attention of the medical profession to some new factsj^'*
connected with a subject hitherto involved in great obj^''
si;urity. As a writer, we consider Mr. Crow ther as neitbe^
wishing or anxious for literary fame ; he has soared stilK.-
}iigher, by his attempts to be useful to the public. Th tf^
writer is most particularly deserving of credit to his asser— '^
tions, because his writings contain simply a narration of facts^^
unconnected with any theoretical opinions. With respect
the diseased state of bones consequent on whiter-swelling, he
has stated an opinion of Mr. Lawrence, Anatomical Demon
^trator of St. Bartholomew's Hospital ; that the bones in tb
jpomplaint undergo no enlargement. Mr. Crowt)ier has, with^
that liberality that should ever attach itself to a profession
character, given io this anatomical surgeon the credit 6:
having first commupicatc^ this important information ; im<
portant it is, for Mr. Crowtber b^ observed, the seemiogl

1809.] Surgery. 157

enlargement of the ends of the bones of the joint has induced
many surgeons to recommend and adopt the removal of the
limb. We learn from this author, that the mere distended
itate of the joint will put on such appearances as to in-
duce the most experienced surgeon* to imagine the bones to
be actually expanded; but after a local antiphlogistic treat-
ment, derivation of purulent discharge from the integuments
covering a diseased joint, this seemingly encreased size
of the ends of the bones disappeared."
. This supposed enlargement has, by Cheston, Kortum,
and other practitioners, been confounded with rickets, an in*
stance of which we give in Mr. Crowther's own words :

^\ Kortura, on scrofulous affections, speaks of the bones

being expanded; but, it is very extraordinary that he

' ' Bhpald describe the complaint as proceeding from a scro-

falous or rickety source, as I have never seen a case of

scrofulous caries arise from a rickety disposition. A mis-

g,. taken opinion was several years ago given on this subject

^. by a surgeon of eminence : when a little boy was brought to

bim, with a disease of the knee, he told the friends it was

ouly the rickets, which cold bathing, country air, and

^Die, would remove. In this boy's complaint the knee was

enlarged ; there was no fluctuation in the joint, and little

..^■^neasincss on moving it ; and it was one of those cases in

'^hich the condyles of the femur appeared to be increased in

'^teir dimensions. I gave my opinion accordingly, and

^e relations were satisfied that my notions respecting the

^.^; child were correct, and that it was in fact a white-swelling,

li^d not the rickets. In consequence of this opinion I ]jave

**Oce been induced to examine particularly many chililren

- ^ho have been brought to me, on account of scrofulous af-

*^tion, and I have always remarked that they were totally

*^^ from any trace of rickets.

*' In rickety children we do not find one joint only affected,
^'>t tJie corresponding limb shews marks of the same disease.

158 Surgert/. [F^ebrtiary,

— Mr. Cheston says, * It has indeed been commonly ad-'
^ Tanced, that the bones are almost always enlarged; this I ■

* never observed, unless in young subjects, where it might

* have been complicated with the rickets, though I have

* examined a great number of them when injured by this
^ complaint. I am fnclincd to think that this notion either
' arose from the deceitful feel through the diseased in-

* teguments, &c. or its being confounded with spina ven-

* tosa.' I have seen but very few joints dissected after am-
putation, but in those affected with spina ventosa, or scro-
fulous caries, which I have had an opportunity of inspecting,
the bones had not undergone any increase in size, although
they were softened in their texture, and excavated from
within outwards. In those cases where the bones are in-
jured in consequence of disease occurring first within the
cavity of a joint, although they are frequently deprived of
their cartilaginous covering, and sometimes even sufi^r losr
of substance, yet the structure of the bone is not changed, as .
happens in the scrofulous caries." \

Mr. Crowther speaks of bones being affected in two ways t
*' The bones, in this complaint, are affected in twa
ways : in the one, they are affected primarily from disease
originating in their interior structure; in the other, secon-^ *
darily, by their articulating surfaces becoming diseased^ in*
consequence of a previous affection of the internal surface
of the joint.

^^ In the carfous state of a bone, it has been said, that,
io expedite a cure, exfoliation should be promoted; but ^
experience tells us, that exfoliation rarely occurs, and when V
the complaint does not seem to require it, may we not infef
that it should never be encouraged ? It is very probable,
that if mea!is had not formerly been employed to promote
exfoliation, it would have been found an unusual occurrence.
The supposed necessity of exfoliation in scrofulous joints
formerly gave rise to an unnecessary, painful, und mischicv-

1809.] Sufgtry. 159

OUB practice, such as the making use of the knife, caustics
and cauteries : the last of these remedies were to dry up,
what was termed the rottenness of the bones, and to destroj
the hypersarchosis, or the exuberant fungus, with which the
surgeons of those days were frequently troubled."

From our knowledge we believe his statements to be
Twyjust. He believes when bones are originally afl^cted,
they become the spina ventosa of the ancients, or a scro-
liilous caries of the modern surgeon.

We are of opinion with this author, that in whatever man-

- Ber the bones are diseased, the treatment must be the same, and
qimfined to the exterior covering of the articulation. We
oannot notice, in a publication like ours, every nice distinc-
tion which Mr. Crowthcr has observed in his practical

. book, and therefore shall content ourselves in noting some im-
portant occurrences marked by him in his practice. Speak-
ing of fungi he thus expresses himself:
■ ** These fun^i, by a probe, will be found to lead to dis-
eased bone, and in some instances into the cavity of the
Joint. The interspace between these excrescences, from tlie
inflated appearance of the integuments, might incline the

^, practitioner to believe, that he felt fluid fluctuating under-
' iieath. This sensation b delusive ; but I would recommend,

- particularly in this state of the complaint, to avoid the
use of the knife, as diseased parts will ill bear the attack of
inflammation; and, I have observed, that they suffer less
by openings, which the disease spontaneously makes."

Mr. Crowther, and, we believe, most experienced practition-
^ .crs condemn the use of the knife, for if the mass cf abscesses
ftrmedi were^not likely to insinuate itself into the surround-
ing part, they had better be left to burst of themselves, but
under all circumstances the smallest opening should only be
. employed to evacuate the contents of such collections.

Of delusive feel of the parts covering diseased bones, wegi ve
the following quotation from the book under consideration :

160 Surget]/^ (Tebrnaay^

^^ In cases of diseased bones, the parts, i^hich coter them
mppear afiected, and they afford to the examiner the feel of
fluid very perceptibly to the touch. I shall gire such part
•f a case as is interesting, and applies to this part of eur sub*
ject.

^^ A man applied to me, wi account of a tumour, occu«
pying the whole extent of the frontal bone i it was thought
it contained a considerable quantity of fluid, and if aa aper«
tnre were made, the swelling would subside ; but, upon tbe
part being punctured, no evacuation took place, and the
tumour preserved its elasticity. By the introduction of the
probe, I discovered that ,the bone was rough in some parte
and denuded in its whole extent. I brought the lips of the
orifice together, which healed by the first dressing, and sent
him to the hospital. The surgeons were positive that the
swelling did contain fluid, an opening was made into it^
but not any thing fluid escaped. Tliis case is mentioned, as
a caution to practitioners, to be guarded in their prognostic,
when they make openings into such tumours^

^^ As we are on the subject of diseased bones^ it may not
be improper to mention, that I have, in cases of abscess,
formed in the course of the tibia, let out the matter, at a
distance from the bone, by pressing the tumour on one side,
and then puncturing it ; on the introduction of the probe,
in such instances, the bone has been found rough and de-
nuded. Simple dressings were applied, and over them a
compress of linen pressed out of the saturnine lotion, and the
cure was effected without exfoliation.

^^ In a case of a venereal node, which a gentleman had
on the shin-bone, this treatment happily succeeded, with a
proper mercurial course; and this patient also recovered
without exfoliation.

^^ If absorption of the fluid or matter does not take place,
the tumour had better be punctured, to preserve the skin
and prevent the occurrence of sloughing.

18»»i ' Siirgetifi- isi

*^ In a compbund oblique fracture of the tibia, tfce lowet
portion was drawn undei' the upperj the pointed ejctremify
of which projected; a fungus arose, which covered the
hmt and the space of an inch surroiinding it : 1 Introduced
a layer q£ lint between it and the integuments, and th H
covered the surface with the same : the extremity of ih6
bone was absorbed, and the patient was cured wiCbout ex-
fjliation; the fungus shrunk up, and the sore healed by
bandage and simple dressinsr* I regretted at first not
having removed the end of the bone at the time of the ac-
cident ; but from the pleasing termination of this case, I am
liappy in having acted otherwise.

** I lately amputated above the jknee^ under circum-
stances little desirable ; the patient^s health was hardly such
as to justify the operation ; it was perfomied at his own
vequest ; and the best amends for the anxiety I suftred on
JkiM account are that he recovered.

- ^^ On my first dressing, although the muscles ahd integu-
SBents were amply saved^ I observed the parts to be ftabby^
jret still in contact: they yielded abundani serous discharge,
the soft parts investing the bone, I anticipated would not
Keep their situation ; I therefore confined them by more slips
cif adhesive plaister, and directed bark and wine with a
snore nourishing diet.

** The patient was afterwards seized with hysteria^ which
prevented him from tkking sufficient food : the integuments
«nd muscles retracted, and the bone protruded about an
^ch and a half. The success of the former caise taught me
mot to be too busy with the exuberilnt granulation^ which
afterwards covered the bone ; but the circumstance of hav'
Sujj^ saved the inlegtinients sufficiently^ and kno^^ing t could
liecover them by proper attention, and the use of adhesive
^dabter, afforded me a little comforts The end of the bone
*iras absorbed, at least It never exfoliated, and the patient
^covered with a welUformed stump; I am persuaded, that^

VOL. II. M

169 Midwiferyi [February,

if the fungus had been destroyed in cither case^ exfoliation
must have unavoidably taken place.

^^ I was many years ago present at an amputation abo¥^
the knee, in a case of white-swelling, in which the knife,
in making the second circular incision through the muscles,
had nearly divided the bone, so exceedingly soft was its tex-
ture. This circumstance induced the surgeon to detach the
muscles farther up, and saw the bone Iiigher : the same oc«
currence happened ; the knife was again let into the bone,
and the remoral of the limb was finished by the saw. No
exfoliation took place, and the operator obtained the credit
of having made a most excellent stump."

We also with pleasure remark some observations on
caries novel in themselves, and which at a future period may
be considered of the highest practical utility.

We promise to continue our review of Mr. Crowther^s
work in our ensuing publications until the whole be fi-
nished.

III. MIDWIFERY.

MiDwiFERT forms a compound of the other departittents
of the profession. In the diseases of pregnancy and child-lbed
if. claims the attention of the physician. This was pointed
o\it in our last number under the head of Puerperal Convul-
sions. In the pr^ent we shew its connection with Surgery,
by stating th^ cure of one of the most formidable local
diseases that occurs to the accoucheur in his practice. This
\& Inversion of the Uterus,

INVERSION OF THE UTERUS.

A striking case of which is thus related by Mr. Merriman :

" Several years ago,'* he observes, ** my friend JDr.

Scares and myself bad an opportunity of irendering- the most

essential service to a poor woman, ih whom an invasion of

the uteru« had occurred : with your permission, I will lay

1809.] Midwifery. 163

the psirticalars of it before your readers, as an additional
proof tbat the mischief Which must necessarily result from
an inversion of the uterus may, by prompt assistance, be
prevented.

** In January, 180?, Mrs. Edwards, residing in Brick
Street, Piccadilly, was delivered of her first child by Mrs.
■ , a midwife of considerable practice and experience.
The labour was natural, and of no considerable duration.
Some little time after the child was. bom, Mrs. -en-
deavoured by tightening the navel string to exact the
placenta, Trhen (though she asserts that no force was used
which could possibly occasion such an event) a very vio-
lent pain came on, and the uterus^as completely inverted,
the placenta remaining attached to it ; on this Mr. Scares
was called in, who, finding things in this state, desired that
1 might likewise be sent for.

** When I arrived, which was not many minutes after the
accident happened, the uterus with the adhering placenta
was lying without the os externum ; blood was flowing pro-
fiisely, especially from those parts where the placenta was
detached'; and the woman was in such an exhausted state,
that we doubted if she could survive till the uterus should
be replaced. We perfectly coincided in opinion respecting
the plan to he pursued ; and as no time was to be lost, Mr.
Seojes removed the partially separated placenta, and return-
ed the uterus witiiin the vagina, whilst I was laying bare
my arm. J then introduced my hand, carrying the fundus
uteri before me, till I had passed my arm quite to the elbow
within the vagina; at this moment, I found the fundus utr«
ri, as it were, spring from my hand, and theos uteri began
to contract;! therefore cautiously withdrew my hand, aiid
presently found that the baeinorrhage ceased.

^^ Mrs. Edwards, during the whole operation, was in a state
of sjcncope; but on our giving her some wine and other
cordials, . she revived, and afterwards recovered perfectly

/ r

184 MidOiiferj/^ [Fcbrnarjr,

• • » *

vUhottt a sii^Ie bad symptom. She bas since borae seyeial
children, aod bas never found any inconvenience whatever
from this alarming and dangerous accident.

. ^' The only merit which can be claimed in this case, was
for doing immediately that which was necessary U> be done.
Had we allowed a very little time longer to elapse before
proceeding to reduce the inversion, the patient would
probably have sunk beyond recovery, from the profuse
haemorrhage ; or, bad the haemorrhage been stopped by tbe
contraction of the uterus, that very contraction would have
prevented us from making any impression on the funduf^
and iht os uteri would haire been closely shut against every- :
attempt which we could n&ke to relax it.

'* Tbe cases which have come to our knowledge, of womea
surviving this accident, present a most distressing account
of mental and bodily sufferings ; these sufferings can be pre-
vented by one method,^ and by one method only ; an im«*^ .
mediate and absolute determination to re-invert the uterus* -
A momentary panic in the mind of t ho operator may occasioo
too great a loss of time to allow of his success ; for unavailing
have proved all endeavours at restoring tbe parts to their
origiual site, when once the contraction of the uterus bas
completely taken place."

What is peculiar in this accident is that it often occurs
aAler tbe easiest labours, and where the placenta bas come
oW in the most complete manner, and without any effort on :
the part of the operator. This should lead a practitioner to
be cautious of blaming those that have bad the direction ^ -
tbe labour. Where the powers of the fundus uteri are
strpng, and it is possessed of much irritability, while the
neck and orifice ate in a highly atonic and relaxed state, ^
t^n the movements of the female herself occasioning a
contraction of t^ fundus,* and the latter, finding no resistance 1
from tb9 neck and orifice, may cau^ it to be forcibly protirud* >
€d in an almost spontaneous manner. This has happened in a

1809. Midmifery, 16S

varietjof cases, and which Mr. Merrimaa might have takea
ftoticeof as a circiimstaiice which shoald be always in the re-
'ixdlection ci young practitioners.

SPINA BIFIDA.

This is a disease of maUconforination occupying generally
the lower part of the spine. It appears at birth, is always
&tal, though the life of the child may be protracted for 'a
twelvemonth, or even more, under cautious management ;
for the moment the fluid contents of this tumour are
evacoated, the child dies. A very remarkable instance of
this tumour, from its size, is mentioned by Mr. Cooper in his
Surgery : the child lived with it one year and a half, and its size
equalled its head; the following case came lately under the in-
flpection of Mr. Washboum of Marlborough, which he thus
details:

<^ The disease termed Spina Bifida,*' he remarks, ^^ may
be considered as the effect, and that the Hydrops Medullar
Spinalis appears, ab origine, to be the primary and proximate
cause of this morbid affection.

^' About three months sin/ce I was requested by Bfrs. DixoM^

4of this town, to give my atten4ance and opinion, relative to a

swelling occupying the lumbar region of her female infimt, who

xras then three days old, a very ^n^ ai^d l^caltby looking child.

*^ The case on inspection was most obviously and de^

cidedly a defipiency o^^ y^^nt of two of the inferior spinoiii

^ processes of the lumbar vertebra. Tbrougli the aperture

- projected a long sac or tumour, containing ^ 4iapiHUMniB

^flttid, and i^hich appeared to be au elongation laf ^ dura

^nater. On making ^ gentle pressure with the ba^d upon

^he tumour, ^there was evidently a free Gomm1^licf||tipa

^)etween it and the ventricle* of the brain, (Bonstitutioj^ tl^ie

disease called (iydrocepkalifs Intenius^

'^ The h^egd was large, aad the fontei^elleB and dtftnsnt
>iiitures of the craaiaiu were preternaturally divided. The
^^d fix>m its fa^rth had strabismus ; aad it did not appoar

166 Midwifery. February,

to have suffered very much from the disease, and had Hft
use of the lower extremities until about a mouth previou^ tdl
its dissolution, which happened on the 1st instant (Dec.) at
the age of about 13 or 14 weeks.

*' Although there was a perpetual exudation of a perfectly
colourless fluid from the tumour, it gradually increased in
magnitude till within a few days of its death, when small
incipient, ulcerations took place upon difiereqt parts of the
tumour, accompanied with inflammation. The case being
a hopeless one, I advised the use of soft emollient cataplasms,
which appeared to be the best and easiest kind of application.

^'dimensions of the tumour.

■

'^ A line drawn across from its basis in a horizontal direc-
tion from the superior part of the sac measured nearly 4
Riches, the longitudinal direction measured 34^^ inches*

'* Before the child was buried I examined the part, and
found the integuments were become corrugated and flat, and
the contents quite evacuated ."

€!A8E OF THREE CHILDUEN AT A' BIRTH, BY MR. FRANCIS
&1ERNAN. MEMBER OF THE ROTAL COLLEGE OP SURGEONS*

Tjo the Editors of The Medical and Surgical Spectator.

Gentkmen^-^A plurality of children in the human
.subject seldom exceeds twins. The iastances beyond-this
are few, and where they do occur, deserve to be recorded-

About a month ago I was ^sailed to the wife of Mr. Bagste;,
of Sondrners Town. She was, according to her own calcula*
/tion, in her eighth month ; and when I visited bei;, her
labour hiid actually commenced. She wias soon delivered
of one child) which, from its size, and the apparent state ^
ihe uterine expansion, J was sensible could not be. the only
one it contained, and accordingly I found, on examinatioo,
imother, the menibranes of which were unbroken, and con-
tinued, so ibr ten binutes. As I was in no anxiety to hujury
t)ie labour,' when' the.' ruptui^ took place, the child was
delivered by a footling preistDtation. I then considered my

'«.

7809.] Midwiferj/. 167

business as complete; and on attempting to extract the

placenta, I found the head of a third child advancing,

Trhich came off^ith the same ease' as the other two. Two

of the children were born alive. The whole labour did

not exceed two hours. The placentae came off of themselves

without any interference or any pain. Two of them were

united ; the other, was single. The patient said there was

rio discharge of waters with the first child ; and when I

examined, I found the membranes ruptured. She is only

about twenty years of age. It was a first case, and she

promises as a mother even beyond what the wishes of the

husband may find convenient.

I am, Gentlemen,

Your obedient Servant,

F, KIERNAN.
Lower Charlotte Street, Bedford Square^

January 18, 1809.

REMARKS.

Plurality is a rare circumstance in the larger and more
perfect animals. It occurs, perhaps, ofteher in the hqiman
race than in others, for twins are by no means uncommon.
Three, as in the above instance, are not often met with,
and four still serdomer. A case of four i^ related by Dr.
Nisbet, which he attended at Edinburgh. The woman
was only in the seventh month : three of the children
were born alive. The mother was in her 45th year,
and had never had a child before. This case is also authen-
ticated by^ the late Dr. Hamilton, Professbr of Midwifery.
Five at a birth has been met with on good authority, withia
thfese few years, in the metropolis ; but all beyond this is to be
considered fabulous. No plurality beyond twins can be
erpected to go to/uU time, for even twins are remarked to
dome ten days or a fortnight before the completion of the nintt
Iponth;

II 4 ■■

• -I'' ■>»"'*'•■ ...'■•.

11)8 Pharmaegf^ [Febriyuy,

IV PHARMACY.

Ik this department of the profession, scepticism is moie
niBce^sary th?in any oth^r. Mistatement and false colourii^g
aire natural to the soil; and, after a labour of so n^anjages^
one specific only has been found in mercury to reward the toil
of investigation and inquiry.

CAVTHARIDES.

Tffis powerful medicine is still, in the hands of Mr«.
Bob^rtoni a neyer-failing remedy in those diseases o( the
fpmale organs connected "with spasm^ debility ^ and deranged
action of tlieir functionSf Those diseases, under the name
of habitual Menorrhagia Chlorosis, whether from suppression
or retention, leucorrh^ and dysmenorrhaea, he considers
little in appearance different from each otl^er, tp arise frpm
th0 same cause.

In stating his opinion and practice in tbes^ cases, Mr.
Roberton offers his objections to the theory of raenstruatioi|
advanced by Dr. Cullen, and to the mode of practice founds
ed on that principle. Antispasmodics, particularly opia(eS|
he considers as giving only a temporary relief.

^^ The same diseased state of the parts," he pbservesi
^^ still continue, and the only service derived from thesoi
substances is, perhaps, relief for the tima; but when the.
next n^nstrual period arrives, all the former symptpHifl^
perhaps in an aggravated degree, recur, and the harassed
and enfeebled patient at length sinks under her accumulated,
sufferings by the supervention oi dropsy in one or other
form^ probably by consumption of the lungs. PractisiQ|f
with the remedies, recommended by CuUeu, or indeed wit^,
any remedies, (if they be auited to his general mode of
reasoning in these compl^ints^) will, I venture to assert, be
in every case junsuccessful, except in very recent ca^^^^ where
the general health and strength have been unimpaired, when
the disease has in a great degree deranged the general health|
Cullen seems to think it incurable. The only remedies he
then recommends are, external aiid internal astringents, opld

1800.] Pharmacy. 169

bathing, and chalybeates, of which, with similar applica«
tlbns, I have repeatedly given, and that to the greatest
extent, withoat, in such cases, deriving any permanent adf
vantage from them.

•' The cases which I h^ve lately ^cen of what female
j>atients call lumbago, are too nifmerous to be particnlaris^ ;
many of them entirely depending on a diseased action of the
generative organs, and capable pnly pf being relieved by the
removal of such disease. Although I was aware that painsy
in many respects similar in their nature to those of lumbago^
are very common in far advanced and very bad cases of
leucorrhoea.; yet, till lately, I never have met with cases aft
leucorrhcea, where the discharge bad always been of small
Ajuantity ; indeed, in some cases, scarcely perceptible ; and
in these, the most acute pains of the loins accompanied it.
Such a state of disease has not only been considered as
lumbago, chronic rheumatism^ gout, &c. but treated as
such, and the unfortunate patient has been obliged to under-
go, in vain, every variety of treatment recommended by
authors for the removal of such complaints; when, as might*
have been expected, want of success attended their labour,
even the horrible supposition of lumbar abscess being the
cause of the pain, has been entertained, and Heeding, blistering,
with the use of setons, have been obstinately persisted in for its
reiapyal. What might not seem very extraordinary, how--
jever, the patient remained uncured ; but when such means
were applied as were suitable for the removal of the com-
plaint, the rheumatism or lumbar abscess, or whatever term
they chose to give it, entirely disappeared.

** Thus, by considering these complaints as totally differehf,
and recommending entirety a different mode of treatnent
for each, the practitioner not only fails in that success which
is wished for, but renders their natural simplicity extremely
perplexing.

** If one or more of these complaints be brought on by
lon^ continued, thoaf l| ^slight, leucorrhoea, our attention

170 Pharmacy. [February,

bciag principally paid to this last, and a complete removal
of it effected, almost all Ihe former affections are completely
removed.

" The treatment of these complaints has Ix'cn various, re-
gulated rather by accident, or the whim of tbe moment,
than by the success attending it, or by any fair mode of rea«
soning, ivhen such has at all been attempted by tbe phy-
sician. In consequence «)f this complete want of success,
these complaints have long been tacitly considered as in-
curable, unless some favourable change accidentally took
place in the constitution of the patient, which was all that
either the physician or patient looked to for relief. Phy-
sicians, therefore, considering these diseases as incurjable,
instead of devoting their time to discover some successful
mode of treatment, employ themselves in amusing their
patients, by assuring them that the various natural changes
which, at certain periods of tlieir lives, must take place
in the system, will probably effect a removal of their com-
plaints. Thus, in anxious expectation of such changes
taking place, the patient's vigour of constitution is gradual-
ly yet surely wasted ; and too often, without the arrival of
the long and ani^iously wished for relief, other diseases,
consequence^ of the first, attack them, which, for the most
part, only terminate with their miserable existence.

** It is by the reasoning adopted by authors respecting the
nature, &c. of complaints, that the treatment in them must*
flpw; and in proportion as this is right or otherwise, our
cures, except by some accidental occurence, must l>e few

or pumerons.

** Although during the early stages of menorrha^ia, if it
occur, which it oftei* docs, in stout plethoiip persons,
lyhen the pulse is unabated in strength, when no apparent
debility has been induced ; in short, when all the other
functions of the body seem unimpaired, and even wheq
lflood*)fitiitig is indicated J)y the. apparent fi^lnes^ and ifli

1809.] Pharmacy. 171

flammatorj action of the system^ the greatest caution^
even at this period, ought to be observed in adopting ge*
neral blood-letting for its removal. Even the exhibition
of medicines that may ultimately induce debility, ought
to be resorted to ^ith nearly equal caution. For. even al-
though these means may, in almost every case^ remove
the morbid discharge^ I have often observed, that, after
such treatment, it was long before the patient recovered
her usual strength, and she remained often for years, sub-
ject to returns of the menorrhagia from the very slightest
causes. But when such practice has been adopted in wesik-
ly and debilitated habits, (for it is too often indiscrimi-
nately applied,) the system is not only left in a dreadfully
debilitated state, liable to almost Qpntinual flooding, but
the most obsitinate and troublesome cases of leucorrheea
that I have cv(:r mejt with, haFe been brought on after ti^e
application of such means* The remedies then which
CJullen recommends are either hurtful, inactive, or of a
trifling nature, and, uppn the ^vhple^ by no means suited to
tte removal of such complaint^* H^ fprbids the use of alt
:inedicines that may irritate the partf. I think^ however,
that what J haye to §tate will completely prove t)iat such
Yennedies only as Cullen t^iinks would irritate the uterus,
are calculated permanently tp pmove such diseases; aqd
that the chalybeates, j^c. if deeo^ed. necessary along with
such medicines^ may b^ useful^ but neyer can, except ia
the very slightest cases, efii^t a cure.

'^ If, during these complaints, ^hich doe^ notqften hap-
pen, the pulse indicates inflammatory action^ ai^d the j^
iient happens jto be of 4 fiill plethoric l^abit,. should can-
tharides be prescribed, \ grant that it would require no
difficult calculation to foretel what would be the result.
Benefit must be evidently sought for from very different
treatment.

*^ In all these complaints, however^ I believe the 4ml j me«

172 Pharmacy.' [February,

dicines that can be employed ^itli decided advanatge, are
those of a stimulathig nature. Food and driak, as vrtW
as medicines, ought all to be considered in this way. In
these affections, the uterine vessels are in a great state of
disease ; but it appears to me that the general habit of body
has 1)een and is equally deranged. The medicines there-
fore to be anployed are such as will sufBciently affect the
whole system, and the generative organs as a part of the
whole.

' *^ It is of importance to observe, that a great proportion
of women have been taught to believe that leucorrhoea is
a natural discharge, the existence of which is, for the most
part, absolutely necessary to the preservation of their
health ; and even if their health be already considerably
impaired by it, the old and experienced matrons console
themselves and others in the supposition, tha^ \q this dis-
charge alone they owe the little health they possess. It is
not therefore to be wondered at that women often so stie?
nuousTy deny being a^cted by it."

MINERAL POISONS.

The effect of mineral poisons cm the stomach is a question
of high importance in medical practice, as, in the tracing of
these accurately, and ascertaining the morbid appearance^
.they produce, the opinion of a practitioner falls to be formed
in delivering questions of life and death. A case of this kind
v^s tried ^t Lancaster Assizes, as stated in a former number.
A difference of opinion arose on that occasion, which has in-
duced Dr. Bostock, a party in the business, to institute a s6t
^if experiments to support the evidence he then delivered.
From these experiments, he contends, that ^' an animal may
be suddenly killed by receiving a metallic poison into^
the stomach, and yet that the nicest tests may not be able
to detect any portion of the poison, after death, in the con-
tents of the stomach.

'* This conclusion appears incontrovertible; and though

• ■

1809.] Pharmacy. Hi

some analogous facts had occasioaally been noticed, it is so

different from the generally, received opinion uppn the sub-

jaGity that I think it must have considerable influence on all

Mature judicial proceedings, in which the question of poi-

ssoning is agitfited.''

But though no particle of the poison may be discovered
l)j the tests, it is clear, without the diseased appearance.of
"tbe part or organ that receives it corresponds with the .
^ual phenomena known to occur where it can be detected,
"ihese inferences are certainly to be considered as delusive,
«nd 110 foundation b to be buUt upon them in. spite of Dr.
X|p$tock*s assertion, as leading to the mest dangerous con-
sequences to the peace and happiness of society, and put-
<i{|g into the hands of medical men an authority and a con«
£dj^nce which they ought not to be entitled to. In ih&
^:ase of Miss Burns, the appearances, on opening the
etpmach, were not what usually attend the operation of
arsenic, Ihe poison alleged to have been given. The ap«r
pcarances from arsenic, Dr. Baillie describes to be ^^ that
the stomach is affected with a most intense degree of inflam-
tnaiion ; its substance becomes thicker, and there is a very
^rceat degree of redness in the inner membrane, arising partly
from the great number of minute vessels, and partly from
extravasated blood. Portions of the inner membrane are
sometimes destroyed from the violent action that has taken
place in consequence of the immediate application of the
poison. I have also seen a thin layer of coagulated lymph
thrown out upon a portion of the inner surface of the sto«^
tnach. Most commonly too, some part of the arsenic is to «
ba seen in the form of a white powder lying upon different
portions of the inner membrane. '^

'^ According to this statement, it is obvious thai a very •
considerable partoftheinjujry w^ichh^d been.siistained bj
the alomach of Miss Bums^ wa;$ not wh^i. ia commonly pro»
duced by the application of mineral poisons.

174 Pharmacy. [Fcbraarjr,

'' On raising up the stomach, an opening through its
coats M^as found io the anterior and inferior part of its great
curvature. The natural structure of the coats of the stomach,
for a considerable space around the opening:, was destroyed,
and they were so soft, pulpy, and tender, that they tore with '
the slightest touch. Arotmd this pert of the coats of the '
stomach there were no traces of inflammation.

*^ Now, if the hole and the surrounding alteration of struc-
ture were efiects of arsenic, we do not see how they could be ''
produced in the way contended for by the authors of this
pamphlet.

'' A mineral poison could act only by exciting inflamma-
tion ; and the question is, how could inflammation produce
the appearances described ? The hole could arise only from
one of four causes; from ulceration, from mortification, from
putrefaction, or from solution by the gastric juice. As these
authors contended that it was theefiect neither of ulceration nor
putrefaction, nor solution, they have only one cause left to
which to refer it^ and that is mortification ; yet the appear-
ances described are not similar io a part which had sustained
that process. The coats were ** thin, pulpy, soft, and semi-
transparent ;" these are not the characters of a mortified part»
and there was no trace of inflammation, (the only possible
cause of mortification,) except in a remote part of the sto-
mach.

■

'^ But supposing that the appearance of Miss Bucns*s sto^
mach was completely similar to that which commonly arise*-
from the action of a mineral poison, it would have been only^
the appearance produced by very intense inflammation; and.
how did the writers ascertain the cause of this inflammation T
No poison was to be detected, either by the eye or by tiie best^
tests, aided by the experimental dexterity of Dr. Bostock*
To refer this inflammation to poison, in the total absence o^
all medical, or anat<.mical, or chemical eridence, the only
eridenoe they had any business to interfere with in the

1809.] - Pharmacy. l75

pacify in wbich they were employed, was surely an unwar«
rantable and an unconscientious degree of boldness."

ARSENIC.

Poisons seem to claim, at the present period, a markedat-
tention ; and Mr. Ilill of Chester has entered into the use, forms
and effects of this powerful medicine with much elaborate
investigation. " To Dr. Fowler," he observes, *^ the medical
iirorld stands much indebted, for his accurate attention to the
power and salutary effects ofarsenic judiciously administered;
xmd all those practitioners, whose practice has been most
intermixed with cases of intermittent fever, treated by the
"tasteless ague drop, will doubtless bear tesUmony to the
safety with which this Herculean remedy may be administer-
«d. But, notwithstanding intermittent fever in its most for-
midable shape has been cured by tlie arsenical solution, yet
^here have not been wanting alarmists to excite the fears of the
jiimid, that the medicine created more mi3chief than it had re*
^noved, in various shapes, as tendency to hepatic obstructions,
phthisis, asthma, &c. Of such results, I confess ray entire
ignorance. That such may have seemed to have occurred, I
am far from attempting to deny ; but I must continue \o dig-
Tbelieve they have happened wlien this poison has been admi-
nistered with all that caution its great powers demand, and
w^hich has so diligently and successfully been employed, in
T/espect to others, upon proper subjects. I adduce intermit-
tent fever in its most hostile form, as that disease which must
ever be highly illustrative of the tonic effecls of arsrnic.
Impartially calculated, who will fail to decide on the positive
value of that medicine, wLk^h can cure such a disease with
speed, safety, and in the form of a few drops, after it has
continued for weeks, or rnonths, in defiance of disgusting

■

quantities of cinchona, and all the mim>r tribe of tonic febri-
fuge remedies. Still 1 conjure my readers not to hastily
conclude I am aiming at the establishment of a mor^ extensive
ise of such a medicine, as arsenic is well known to be, >\hen

I7d Phitrmacy. tthfrnHvyi

• ....

others, I^ss dangerous, and as certainly curatire, Mrill answer
crery purpose of the prescriber, and his patient, this being
by no means the case. I merely contend, that terrific and
mistaken apprehensions hare caused it to be neglected, where
liM administration might hare been greafly and safely benefit'
icial. In some degree to dissipate these, consists my present
intention; but never to bring forward a virulent poison as a
J^ealthfiil remedy to the exclosion of any other, not oJF tbb
description, and which is equally salutary. To hesHate
lAottt preference here, would perlmps fell little short of cri*
hiinality.

*^ Secondly, Want of attention to ascertain the exact and
teltttary mode of its application. Such hare always hither*
to b^en the antipathy to, and dread of arsenic, as an article in
the list of curative remedies, that little attention has bem
bestowed upon the various preparations of which it is capable.
The consequences are natural and evident ; they have been
\tTy limited and 31 defined. Had not such prejudices existed,
to almost universal extent, this semi-metal would have under*
gone many more experiments than it has yet suffered. Hence,
it will be no presumption to assert, that if the subject of this
iquestion had not had such obstacles to encounter; and, on
the other hand, had experienced the attention which has been
bestowed upon mercury, antimony, &c. &c. it would have
been found as extensively useful an article as either of them.
It appertains to the vile practices of charlatanism to as*
nounce concentrated preparations of certain powerful drugs,
and ignorantly to boast of specifics for every disease ; but
men of just and enlightened views of science, with honourable
Intentions, shrink from even the appearance of mystery, and
have but too frequent cause to lament the scantiness of power*
Tul agents, to counteract the multifarious, evils " flesh is heir
to." Tliat arsenic is a remedy of the description called tonie
Stimulant, is sufficiently ascertained : that it possesses great
power in a very contracted sphere, when comparal with

1809.3 Phartnact/. If?

I

ikkers of this class, is no less certain ; iSnally, (hat itis delete-
fidus effects are as much under subjection as those of raer^
cury, opiuni) antimony &c. ScCk is or may be satisfkctorily
]i!nawn.

- '^ A saturated aqueous solution appears to be the most
ftimple formula, and that \<rhich comes nearest io certainty of
linifbrm strength of any other. Whel-e the di^easCj its feme*
dy, and the subject of both, can be judiciously adapted io
mth other, this medicine, from its great power in small
Volume, possesses decided and incalculable advantages; The
sanguine wishes ofyoung practitioner often lead them to attack
Violent diseases by very enormous doses of medicine, think-
ing to mow down, as it were, all opposition io their wishes, by
dcoup de main; but the mineral solution of arsenic is a wea-
pon that will not admit of loose and inattentive application^
in tlie haTids of careless or over-eager practitioners, with
iioipunity. It is almost superfluous to observe, its admini-
stration must commence with very small doses^ when exhibit*
ing it for the first time, and that its effects cannot be too nar-
rowly watched : for there are to be met with certain 'habits^
whose idiosyncrasy will cause it io be rejected, notwithstand-
ing €very precaution^ in whatever dose given, or under
whatever form ; but this, it is well known, is not exclusively
the case with regard to arsenic, the fact resulting from opium,
digitalis, mercury, and evei) the bark itself. I lately attend-
ed a gentleman whose case appeared to indicate the use of this
Iftst mentioned valuable remedy ; it was given in the simple
fbnn of decoction ; a dose or two induced such feelings as are
better comprehended from sensation than learnt from des-
cription. He soon informed me what he had been taking,
although not apprised of the composition of his draughts ;
the medicihe was then tried in anotlier form, but was instantly
discoverjed. " Sir," said he, emphatically, ** j'ou have been
giving me bark again, and I cannot bear it.'' Such willoc*
casioaally be the case with arsenic. Itis, however in this

VOL. II. N

J 78 Pharmacj/. [February,

view but ou an exact footing with other remedies deemd
sufficiently mild to persons in general. Symptoms announc-
ing its disagreement are, nausea, pain, with a sense of con-
traction of the stomach, horripiiatio, thirst, with a clammy
tongue and fauces, increased by drinking any fluids, milky
or oily ones eircepted ; strong feelings all over the body, such
as were never experienced by the patient before, on any occa-
sion, and which he is at a great loss to find words to describe*
In children^ incapable of giving any description, its dis-
agreement, whether from idiosyncrasy, or over-dose, may be
kaown by its producing, soon after being taken, nausea, pale-
ness of the lips, sleepiness, clamminess of the skin, at length
vomitings or purging, with great restlessness ; but justice de-
mands (from me at least) the acknowledgment that few such
instances have fallen under my notice^ It would be sacri-
ficing time to point out what mischiefs have originated from
irant of attention to these circumstances, consonant to the
position advanced, and in direct opposition to that accurate
care, and close attention, which all other Herculean medicines
require, and have indeed generally received.

^* Tiie next arsenical remedy which deserves notice is a pill>
the formula of which will be found in the 2nd volume of the
Asiatic Researches. — ^* Take of recent white arsenic 105.
grains, black pepper 630 grains, beat well, in an iron mortar,
fi>r four days, at intervals; when reduced to an impal-
pable powder, remove to a stone mortar, add water by degrees,
so as to fonn a mass of a pilular consistenc.e : make piHs of
ihc size of tares, or small pulse (abeut 800) ; keep them in a
^ry and shady place ; give one night and morning, with a
little colfl water : gentle cathartics precede their use with
' consivlcrable cifect." These pills are most conveniently pre-
served for use in a stone-bottle, originally destined to convey
quicksilver. In the above work, arsenic is recommended as
T.ery useful in the cure of paralysis and cutaofious diseases;
but too little is said on the subject.

1809.] Pharmacy. 179

^' I think no mode of using it e!xternally is mentioned ;
lience, the same errors are liable to operate, as have too often
t tatic^ from its internal exhibition : for example, in the
W'YoIvof the Medical Journal, p. 508, the case of a young
woman is related, (by a Swiss physician), who had rubbed
lier head with arsenic pomatum to destroy vermin : the con-
leqnences, in six days time, were excruciating pains all
0Ter body, a general millet-seed-like eruption, covering the
whole surface, violent swelling of the head, and with much
difficulty she grew better. Now from this narration, what
can be learned ? We know nothing of the proportion of in-
gredients of this deleterious unguent, nor the quantity ap-
plied in the time specified ; but judging from what may be
every day seen in this country, when ignorant persons are
intrusted with active remedies, without due precautions, it is
reasonable to conclude the young woman was very bounti-
fal in the use of what was to free her from her troublesome
company; most practitioners having cause to regret how
difficult it is to excite and procure due attention to the pre*
dse dose, and exact periods of administration of medicines,
more especially those which, from their minuteness, are con-
ceived, by ignorant persons, to be of little consequence.
Arsenic, then, is perhaps that very remedy, in many violent
and obstinate diseases, which can be advantageously exhi-
bited in the smallest quantity, and with less necessity for
augmentation of dose than any other, demanding simply,
what every active medfcine demands, attention, to render
it generally and highly useful, as exemplified in the removal
i£ the whole tribe of fevers and asthenic diseases, painful,
local, or partial afiections, and many tiresome cutaneous de-
rangements ; when acting fevourably on the stomach, pro-
ducing in a few doses, and in a short time, a greater quantum
of increased tone of the system, than can be obtained by any
other known agent. All circumstances proving favourable,
the solution of Dr. jFowler, the simple saturated solutigp,

N 2

JW Pharmncy, ' [FebnialT:,

and the Asiatic pills, have been found, ft>r many years, 6X«
trfniely beneficial^ qnd much to be relied upoD in the removal
of the following diseases. Intermittent fever, typhus oph-
tbalroiii and palsy « The solution is the best form for the
tlnree first the pill for the last.

ELEGTRlCITy.

iToiM Editors qf Tha Medical and ^rgieal Spectator.

• Grfipi/fcween.^— AccoRDiJTG io my promise in the last num*
bar of y^SuT valuable publication, I now beg leave to trans*
mit you for insertion a few cases of sup^H^bssion of urine cured
hf Elecf iricity,. which will confirm the observations I offered
oh Mr. Calderwoocrs communication, and shew thai the size
of the machine is of material- consequence to the speedy
accbmpKshmeht of such cures. By such a machine, permit
n&ta state, the electric fluid cdn be conveyed with a force,
energy and e&ik^t isuperior to what can be conceived, and this
effect takes place in (hat mild active and unlocked for manner
that pteases every patient, and renders the form of a^hock ia
etery Instance unnecessary, the great bar as I formerly
noticed, with patients to the use of this means of care. In
many diseases the siiperior operation of this- machino- com*
parad with those of the ordinal ry standard and make, makes
it secin to act like a charm, and-asit were instantaneously, but
this quick eiSect in subduing the morbid state is pMiculaflJf
remarkable in those aiSections connected with a snspension or
impaired state of the nervous influence,, and it is easily ac-
counted for, if wc onceadraitit, as contended for by most
writers, that the nervous fluid and the electric matter are
ahaloguous. In this case it is alone the quantity of matter
thrown in that produces the cure by supplying the difiici'
focy of secretion in the nerves. The prefinrence therefore of
a large machine in giving out at once the quantity required
v( Jt be obvious ; were ii for the excitement merely that wa»

180».] Pharmacy/. 181

'wanted tlien the force or shock with whicli it is directed
wduid foHn the only point of attention ; but as all electricians
mtf^t allow that the cure of diseases is seldomer efiected by
riiocks than otherwise, so it is evident tTiatthe mere excite-
ment is not the successful principle of cure. The accumula-
tion of electric ittatter in the part is the great object,
asd this is only made quickly and with ease by an instnimeht
of extensive powers. To shew this in a striking mannet,
and confirm the sentiments I have delivered, 1 shall now nar-
rate some cases of diseases which fall under the denomination
of those stated as dependini^ upon a suspension or im-
paired state of the nervous influence, or spasm of the
organs*

I. Deranged secretion of the kidneys.
Mr. J. a gentleman of a strong robust habit, was
brought to me by Dr. Sequcira. For eleven days preceding
be had laboured under a~ total stoppage of urine, and that
there was no water in the bladder from the commencement of
the disease was evident, by the abdomeh retaining its natural
^^Nze and figure. In the progress of the disease, he had been
immersed no less than eight times in the warm bath : the two
first immersions gate a delusory hope of cure, by his being
enabled, while in the bath, to evacuate a teacupful of urine
each time. But this remedy, which as well as every other Dr.
Sequira's skill and experience could suggest, was found at last
entirely to fail, and as a forlorn hope electricity was proposed
by the Doctor to his patient. I had accordingly ah oppor-
tunity of shewing its miraculous efi'ects in this obstinate case,
for no sooner was the electric fluid applied by vibrations tlian
in les^ than half an hour it offered relief : at the end of that
time he signified (as 1 had previously informed him would
be the case) a desire to pass his urine. About half a pint
wa6 voided with pei^t ease and in full stream. The opera-
tion was continued about half an hour longer^ when the secrc-
tion became so copious^ that he was obliged several ^times in

N 3 ' ^

182 Pharmacy. [Fdlnriiaiy^

going home to alight from the carriage in order to. make
"water, and during that day he did it at his house no less than
15 times on the whole. In the course of next day previous to
bis attendiug me, he had also many evacuations; the enlarge-
ment of his legs and thighs, which had become oedmeatous
under the complaint ; lessened gradually in proportion to the
discharge, so much so, that I considered him convalesced, and
that the malady was removed. I then consigned him again
to the care of his physician, to whose liberality and candour
in proposing electricity he was indebted for his life..

That a suspended secretion of urine had here occurred is
evident, from the period of the complaint and the patient
having passed no urine for such a number of days. The
instantaneous effect of electricity is also a proof that its cause
depeiided chiefly on the state of the secretory nerves. What
is to be remarked in the mode of cure is the superiority of
electricity to all the powers of medicine. We possess no par-
ticular medicine, it is well known, whichacts exclusively on
any of the secretions. It is only therefore by a general action
pn the system that any particular secretion can be influenced,
which must render at all times its operation uncertain*
Independent of this, all internal medicines, by acting on tl^e
stomach and bowels, must tend to injure them, though they
relieve the disease. .Hence the advantage of a power which
confines its operation to theparticular secretory organ diseased,
which is certain quick and safe in its operation, and which
does not act either on the stomach or bowels or interupt their
offices.

II, SPASM OF THE URINARY ORGANS.

Nor is Electricity less powerful in these cases of spasm

which couie from an obstruction of the urinary organs, iif

- consequence of calculi or urinary concretions obstructing

the kidneys or their outlet^. Of this kind, I shall subjoin the

following case :

JAm L-7-7— applied to me on the SSd of September^. 179^9

-908. J Pharmacy. 183

ftr a violent pain in her loins, Which extended round to her
teft s^roin with great severity . From the situation and violence
of the symptoms^ I judge it to be stone obstructing the
the mouth of the left ureter: she was electrified accordingly r
in about an hour after the third operation, passed a rag-
geA stone of considerable bulk. I was certain from the
cfiect produced by the second, that tbe obstruction was
nearly removed, she having immediately after voided very
liigh coloured water^ mixed with an uncommon quantity of
sand. Her health, from the time she passed the concretion
liras perfectly re*established, excepting a slight degree of
xiumbness in her lower extremities, which, a few days con-
tinuance ot the electric vibrations, was entirely removed.

Ill* ATONY OF THE BLADDER.

A more frequent disease- than the former, where electricity
•ucceeds in a manner almost miraculous, is suppression of
"tirine which are connected with an atony of the organ.
These suppressions are known to succeed the recovery after
jpAany acute diseases, as continued fevers ; and the same is
^ very common complaint ia old age^. In these cases the
powers of the orgaii are so weakened, that the contraction of
the bladder cannot overcome the resistance qf the sphincter.
"Of this cogaplaint, the first case will shew how quickly
thedisease was removed, and the healthy action of the bladder
restored before the patient left the room.

How superior, tlien, is the application of electricity here
to the use of the catheter; the only means which can be
depended upon for giving even a temporary relief to the
patient. The introduction of such a hard body through
tbe delicate irritable passage of the urethra, it is clear, must
do infinite injury. By forcing the sphincter at the neck of
the bladder, it will still more weaken those parts already
In a weakened state ; and either increase the disease, or

N 4

IM Pharmaeg, [Febroatf^

or prodace what is yrorsc, incontinence of urine. ' Eleciri*
city on the contrary, by rousing and invigprating tliq natolral
powers and action of the organ, enables it to recover il4
functions, and to do its own work.

I am. Gentlemen, your obedient Servant,

F.LOWNDES.

ON MEDICAL ELECTRiriTY.

To the Editors of the Medical and Surgical Spectator. . .

Gentlemen — I perceive in your last number a commui
nication from Mr. Lowndes, medical electrician, in conie**
quence, as be says, of one from me in one of your last
numbers. When Mr. Lowndes understood that the cure by
electricity, (a circumstance which I am convinced neither be
nor I will doubt) was tedious, I fear he misconceived some
part of the statement of the case in question, which I am
iSfire 80 strenuous an advocate for electricity as he, eoUd'
not have done intetitionally. The truth of the matter iij
that thopgh the pare- altogether certainly was tedious^ y«l
Mr. Lowndes, if he resort to it, will find that it was soon ac^
0omplished^ after recourse was had to bis favourite remedy i
This circumstance I s^spept escaped him in bis great anxiety
fo establish a transcendant superiority of his own apparatM
(the largest ii^ this country) dyet those employed by surgeons
in general. .

It is an axiom, I believe, pretty well established in oiu
science that in proportion as any active remedy is capable of
doing good, when properly applied, that it is also capable
in the same proportion of doing mispt^tef, if it should un^
fortunately be unnecessarily or altogether misapplied. And
though I have no doubt, Gentlemen,, of the perfect inno-
cence of a rnaphine so large in the hands of a person of so
much discretion, discrimination and aiu^tomical skill as Mr.^
Lowndes, yet } must own I should be very apprehensive of
t^e consequence of letting loOse such an ele^ient as el^-«

I8P9^J Phttrmdcy. ISS

Aicity indiscrimiflfttoly on hit Maj^sty^s liege stlbjeote ivider.
^he.^irectioQ of any person hot so gifted ih those patrticulat^
^l& Mr. Lowndes is ^1 known to be. For biy own- pact I
^m perfeotlj satisfied with iht liiiitted -papers of my owb
jioctable apparatus, with which I can, At aiiy time^ produee
j)ower as far as, and considerably beyond what, from the
relative susceptibility of parts with vitality, it wonld be
prudent to catl forth. For in the ap{jUcatioh of a «tinfTnl9nt
4iucb as electricity, carednght always to be had, and the
idiea never lost sight of^ that the sus'ceptibiUty of the part to
Ibe acted upon, shouki not be so so far exhausted but that
should this peculiar stimulus eventually fall, other stimuli
may^ not without soaie prospect of i^ucdsss, be had redoufrse
-io. The case then alluded to, we are told, woidd hate beeft
<ured by one application from the powerful machine he uses*
J. have said no greater power was used tlmh that species oif
chock or vibration which is sent by the tube of (he liCydeil
jar. The effect of this is to produce a great vibration ivi the
muscular fibres, without inducing the pungent sensatipn oC
the shock, by passing the whole charge of the jar, whici^
the patient could not bear ; nor would it have been prudent^
in me to have done it, considering the diseased state of the
prostrate f land and bladder. The machine I usehasac}'*
linder of eight inches fitted up on the most perfect principle,
with a power sufBicient for all medical purposes, and equal
id the most destructive. The first oase which attracted
my attention to electricity was a schirrous inguinal gland,
the size of an egg, which resisted every means used by
myself, and the late Mr, Fearon, and an hospital surgeon of
emineiice. The patient^ a young man, returned to me in the
same state, the disease baffling the skill of those gentlemen.
I proposed electricity; he very readily assented to any treat-
ment that promised the slightest hope of benefit. 1 endea-
voured to send small shocks through it, but they in general
passed over it : I asked him if he had resolution to permit

186 Pharmacif. [Fehruarjr,

me to 'use it stronger:— he agreed. I then passed the fuUj
charge of the medical jar completely through it. The next:
day I perceived it was divided into two distinct portion *
a few more shocks in different directions occasioned a great ^
many more di -visions : in this state he left mej and after a
few months the whole disappeared.

This is a proof that the size of the instrument is no im-^;
perfection, for although the patients in both cases declared
they could not bear stronger applications^ yet had it been .
Becessary, more powerful vibrations and shocks could have
been used by a larger jar or combination of jars or batterer
even to destroy life.

I do not then^ Gentlemen, see the utility of possessing
power beyond what it is prudent to use, unless arrogating
to ourselves the power of the deity over another element,
we should wish to controul this so as sometimes to be able to
destroy that which we are not able to restore.

Though once very sanguine as to my hopes that the pe«
culiar modification of electricity denominated galvanisni
might be made subservient to the best of purposes in the
treatment of many diseases, yet I own those expectations
are fast vanishing.

I am now of opinion, that it is pot necessary (as an apv

plication to parts endowed with vitality) to concentrate this

active agent in a degree beyond what we are able to do

from our knowledge of it, previous to the brilliant discovery

of the ingenious Gralvani.

I remain, with respect. Gentlemen,

Yours, &c.

R, CALDERWOOD,

Great Surry Street^
Jan. 16, 1809.

1809,] ' Pharmacy. 18T

COMMtlNICATION OF MR. THOMAS HARDING, OF THE SUR-
BET DISPENSARY, ON A NEW AND SIMPLE REMEDY IN
GOUT.

To the Editors of The Medical and Surgipaf Spectator^

Gentlemen. — If, when opportunity suits, you will give
publicity in your excellent and widely circulating Journal to
the following, you may do much good, for you may be
the means of. presierying many valuable characters from dis-
aolution, many happy families and friends from the sharpest
/distress, and many perhaps from ruin.

A NEW MODE OF SATING LIFE WHEN IT 18 THREATENED.

GouT. — ^This most singular an,d most dangerous complaint
f^n attacks suddenly the stomach , or liiead, or both , and other
vital parts; ^nd fixes itsielf so firmly as to baffle every endea-
vour for removing its action to the extremities, and every efi!brt
for relief. The strongests stimulants by the mouth, yvith or
vdthout anopdyncs, rubefacients to the extremities, blisters
to them, sinapisms, the flesh brushy heat, howey<er used, arie
of no avail : excruciating pains continue, ai^d the unhappy
patient is left to lamentations and wishes only, until death
arrives anjd terminates bis sufierings«

A long time ago it occurred to Mr. Hayton, a well in-
formed practitioner, late ,of America piape, South wark, at
present of Great Guildford street, whose moderation and
modesty has not nor would now permit him, (fearing
^Iso that it would be considered a species of quackery), to
give the suggestion to the world himself, nor scarcely allow
him to consent for his name to be mentioned on the occasion
by any other, notwithstanding the simplicity and harmless-
ness as well as value and importance of the mode, it oc-?
cnrred to him, when thinking on these things, that if in such
cases, a blow with a piece of board was ^iven on the l^ottoqp)

188 Phurmucy. [Fdbrnifei^y

of the foot, so as to occasion a sharp and sudden shock fo the
whole habit, the strong diseased action in the vital part
might be almost instantly arrested, a goaty one set up ia the
extremity, and relief immediately obtained ; which, if it did
not prove permanent, might afford a valuable opportunity^ for
employing other remedies i^ith effi;ct, both locally and
generally.

With this impression strongly on his mind, he resolved to
make experiments as often as fair opportunities ofiered. In
the mean time, it may be well to make it known for general
benefit, and that trials may be multiplied to assist in detemiln-
ing its efficacy. Cases similar to those intimated above, *do
not frequently occur to one particular.

But it is not only in cases similar to those intimated above,
at the latter end of the affection, namely, and after every
other method had failed, that Mr. Hayton recommends the
employment of this mode, but at the beginning also as well
as latter end of the malady, before as well as after other re«
medies, and indeed in every state and stage of the attack and
' treatment. That it has been of use at the very onsii the
following case will testify.

But first, it may be observed, what will be at once admitted
and affirmed by all podagrics, and strongly evince the pro-
bability, at least, of benefit, that the feet are alwrays in a
high state of sensibility at these tiipes. There is always a
peculiar gouty feeling in them,* moderate perhaps, but
remarkably and strongly connected, some how or other, with
the severe diseased action in other parts of the habit.

CASE.

Mr, Day, of Union Hall, aged 53, of a corpulent and very
'gouty habit, was suddenly affected in the forenoon of yester-
'day with severe pain in his head, attended with great faint-

ness, prostration of strength, and loss of voluntary motion.

Mr. Hayton and myself saw him immediately, (happening

1SQ9.] * -' Pharmacy: IM

id be near at4be time,) and found him placed in a chair
with A codntenance pallid and eren ghastly ; a pulse snial!^
contracted, quick and trenMilous, and incapable of artico*
^tihf disthictlj. In-sdne minutes^ however, he so &T i«-
cdyend as to be able to mention bis statCi when he said ha
bad a severe pain in his head, principally at the back part;
that he felt extremely iaint, and that he could not soe«

Apoplexy and paralysis were somewhat charactmsed^ but
the afl^tion seemed to he the consequence of gouty action,.

Under this impression^ the stocking on the right leg was
taken off, and a sharp smack given on the bottom of the foot
with the back pitrt of a shoe-brash (being nearest at hand)
when he almost instantly exclaimed, <' I am better, I can

>>

''In about ten minittes, however, he began to relapse ; bad
ndw also a pallid ghastly countenance, and was soon de-
prived of all sense and motion, when Mr. Ilayton, who re*
niained with hihi, thinking tbe one stroke before given not
sufficiait ; again removed the stocking and gave two more
sharper than the first, when he instantly recovered, and the
pain left his head.

It is surprising, but his countenance also became almost
immediately as u^ual, when- in health.

He had a moderate stimulant, given with something warm,
was put to bed, his foot being enveloped in flannel, and in
less than half an hour a genial warmth was diffused, and he
became comparatively well, and so continues.

A bottle of hot water was applied to the foot, in which, it
should have been observed, gouty pains arose, after the
third sirbke, and in' the leg also.

Sometimes the manner of attack renders it impossible to
4^9;hibit any thing by tbe mouth, and blisters, rubefacients,
&c;l*^C^ to the extremities are very tardy in their operation.
The patient may not only suffi^r an unnecessary length of
time^ but be actuaIlyJostbeforebeQefiteaa.be derived from

190 Pkatmaey, [Febmaiy^

them. This mode is applicable at all times and under all
circumstances^ and though simple, yet powerful ; thougb
innocent, yet active, and efficacious.

A ferrula, it may be right to notice, similar iu form tpN
those used in schools, might be better than a piece of plaio
board ; and it should be made so as to smack soundly, but
not bruise. Perhaps about four inches in diameter, and half .
an inch thick. This might be kept in all gouty families^ aikl
by the bedside in all appearances of need. ,

Am bcir loom^ ah !

The smack should be very sharp ; as unexpected as pos*
sible, and as much on the ball of the foot as possible : repeated,
too, if necessary, and on both feet if required.

4

Mr. Hayton also observes that a similar mode of proceed-
ing might be adopted with good eJSect perhaps in most
other sudden and severe affections, and in most kind of fits*
Apoplexy, Epilepsy, Paralysis, Hysteria, &c. He thinks it.
may be of use when Erysipelas attacks the head severelyy
which is sometimes the case.

Perhaps it may be agreeable to you, Gentlemen, to invito
and receive accounts (post paid) of experiments and of cases
on the foregoing subject, and to insert them occasionally in
your valuable work. But if receiving will be too much trou<*
ble, I will with pleasure transmit them to you without
further trouble to the writer, if addressed (post paid) as un«
der. Public benefit is the great object : and if we can
save but one good person from death, or one good
family, or friend, from severe distress, we shall be ampljr
repaid for our trouble, in the satisfaction it will afford.

With many apologies, for the length of this, I subscribe
myself.

Gentlemen, your very obedient Servant.

THOMAS HARDING-

18, Union Street^ Sonthwark^ January 19; 1809.

1809.] Pharmacy. 1§1

To the Editors of The Medical and Surgical Spectator.

Gentlemen — I have just perused Dr. Lambe's late pub*
lication on Cancers : — Such another book, for its compre*
hensive and important information, I will venture to affirm^
hzis not i^de its appearance for these many years :— I except
none. I trust you will believe my enthusiastic praises of it
io'be at least conscientious ^ when I have assured you that I
not only nevier was acquainted with Dr. Lambe, but that I
do not even know him bj sight.

Unfortunately for the welfare of mankind, our great folks
are too busy, just now, about schemes of maniac warfare^ to
bestow one serious enquiry, one serious thought on the im-
portant truth contained in that little yd great production.

Yet I will venture to assert that it is as deserving of their
notice and interference as any discovery that ever was made—
not even the Jenerian expediency excepted.

One observation I have however to make, which struck
me on reading this book, and which perhaps has been over-
looked by Dr. Lambe : — that is, that if distilled water ba
essential to our perfect state of health, how can we reconcile
this to a natural state of existence ? For if divine providence
intended us to drink water at all, it would follow that in a
state of nature, we should have to drink it with all its impuri-
ties, by bending ourselves down to whatever stream wc met
in our way, as animals are accustomed to do. Hence it
would appear that either water was not intended for our be-
verage, or that if it was, we should take it with all the impu-
rities with which it may chance to be impregnated.

But another reason may perhaps be brought to aid us in
solving the above contrarilies to Dr. Lamb's system: — Is
there not a material difference between takiiig water into the
stomach as we would naturally take it, tliat is by going to
the sjrcam or river, and bringing ourmouthsin immediate con-
tact with the water, and our present way of procuring it for

fti Phmrmact/. [F^braarjry

coits^mption ? In the first instance we "would ta^e it with all
the active principles, not forgetting the living animalcules
with which water more or less abounds, and immediately
convey it into the stomach . So taken thej are perhaps cal-
culated to render the beverage rather wholesome than Qther«
wise. But in the last, by. first conveying it into pipes, tbeii
into reservoirs, and again into confined rooms, .&c. do we
not in part destroy these prifieiples long before, it. is conveyed
into the stomach, thereby giving them tiine to. evaporate, ap<i
to the animalcules, if it contains any qu^tlty? to putrify^
and consequently poison the water which ia its original state
was salubrious?

This opinion. Gentlemen, may prove on further enquiries
erroneous, biitlsubmit to your judgement the propriety of its
insertion, as calculated to throw some light on an important

subject.

I remain, Gentlemen,

Your obedient Servant,

Jan. 21, 1809. M.

COMMUNICATION ON THE EXTENSIVE USE XKP MIN£RAI«
FREPAEATIONS IN THE IPRACTICE OF MliBlCINE.

' To the Editors of The Medical and Surgical pectator.

Gentkmen.'^Thcrc seems <o be a fashion in medicine, at-
present to prefer chemical preparations, in the treatnient of
diseases, rather than draw our resources from the v^etable
kingtlom. This, perhaps, maybe accounted for from our
greater prepossession in favour of chemistry than. pharmacy,
and the supposed application to the one science over the
other. The remedies of the mineral kingdom, it must be con-
fessrJ, are !iot of that assimilating nature as the vegetable
productions : neither do we conceive that their combinations
and new arrangements in the system can be easily and cer-.
tuiuly established bifoi:e hand with the same ease as veget*

1809.] . Pharmacy. ^ J9S

able productions. The principles of vegetables are well iui«
derstood, and the nianner in which they act somewhat
clear and determined. The principles of minerals are itk
many respects conjectural and obscure, and dependent oa
accidental circumstances, in the degree and extent of their
action. If a narcotic is given in a ceitain dose, we know
it will have a determined effect ; but if a mineral prepara-
tion is exhibited, its operation will be varied by the present
state of the stoniach, and the new combinations which it \t
accordingly ready to enter into, dependent on the presence
or absence of certain matters, for which it has a greater or
less affinity. ^

Antimony and mercury are the great minerals which have
been valued in practice, and the former, till of late years, cer^
tainly held a preference over the other as a general remedy.
Mercury has, however, now gained the ascendancy ; and,
whatever blame may be attached to empirics for tiieir indis-
criminate use of it, regular practitioners are perhaps running
fast.into the same error. Many very able physicians of the
metropolis, we understand, prescribe little else than calomel^
and such is the rage for this preparation in every state, that
even patent calomel has been prepared and advertised. I am
much of opinion that this remedy should not be used in such
an extensive manner as it is done in the period •f infancy.
Calomel is the great catholicon for the complaints of chil-
dren. It is used to cure every indisposition to which they are
subject, from the most trifling ailment to the most alarming
malady. However proper it may be to excite large evacua-
tions in certain circumstances, it cannot be good to do it at
all times ; and mercurial oxyds given frequently are danger-
, pus at a period when the constitution is forming, by the ab-
j straction of that solid matter so necessary to give strength
and finishing to the fabric. Many serious consequences, I
know, have resulted of late from the large administration of
cal^el in the hands of a certain physician of the mttrop^Us*

VOL,. 11. o

IM Medical LUelligmce. [Februar;^^

Exfaliation of bones has been known to take^place under bis
practice— a sufficient proof that it was improperly exhibited*
Borrowing our ideas of treatment from the practice in the
warm climates is to be condemned. Circumstances ofcon-!
stitution, as well as the nature and progress of the diseases^
materially change the principles of cure. A constitution
that cannot now bear bleeding to any extent, which most
practitioners will assent is the state of habit of the present
day, can far less bear the large use of such aHerculeaA
remedy as mercury. These observations are called for by
the present mode of practice; and I shall be glad to find
my opinion confirmed by others.

1 am, Gentlemen, Your obedient Servant,

THE GHOST OF SYDENHAM.

BathyJanAby 1809.

MISCELLANEOUS.

The application of Poetry to Medicine is of very great
antiquity. The rules of the School of Salernum are all
wriltcfi in verse. Fracastor has used its imagery with beau-
tiful eflect in describing the Venereal Disease. Armstrong's
Art of preserving Health is in the hands of every one who
has taste to relish elegance of language, and good sense to
appreciate its ndaxims. Downman's Poem on Infancy com
tains all the necessary instructions of which that delicate
period stands in need by those who have the charge of it.

We arc much obliged to our classical correspondent, Mr,
Oakes, for sending us, from the seat of the Muses, the sub-
joined Latin Verses on the subject of Hydrophobia; a dis- .
case so much the terror of the day.

To the Editors of The Medical and Surgical Spectator.
Gentlemen — The following copy of verses was written by

1809. J Mescal Inteltigrndti 199

an old Physician several years since ; and if they ate worthy
of your publication, they are at yx)ur service.

I I am, Gentlemen, yours,

Cambridge, Jan: 22, 1809, T. V. O.

IX RABIEM CANINAM.

Torret agros radiis nunc Sol altissimus omnes
Depositisq; petunt S^lTanim falcibus umbrai
Tarn Messatores, ^itu victi atq; labore-— — —

Cur Canis hand solito quaerit pro more magistntiUy
£t cur Don bland® gannitu vocis adulat.
Cur jacet abjeclui demiss^ in gramine caudA,
Cur Don latratu, aed rauco murmure laotum^
Accipit ig^notos^ cur frustula grata recusat ;
Cu^q; gravi passu passos comitatur beriles.
Nee ludens campoj late yelut ante vagatury
Miratur Cor^don, comitis miratur ocellos
Non fervescentes, non ulla luce micantes.
At Qanis infectus funesti tabe veneni
Sentit iners intro saeyi contagia morbi
Serpere, praenoscensq; solet mi^rabile fatum;
Vix memor ipsius Domini, sed dente maligpo
Irruit in xunctos, spargitq; miasmata morbi.
At subito saevit virgs, carpiitq; Medullps ;
Turn Canis infelix, Dominiq; ob<!itus, <anheIaDSj
£x8er(& li.Bgu^, per devia nescius errat.
Nunc rapido cursu, nunc lento ; multa per ora
Exhalans spumosa^ febrisq; ardore perustus
QuGDrit aquas, borret yisu tremef^ctus aquarum^ |
Quam sybitoq; caput retrahit seu saucius ictu,
£t red it ad I^^mphos, pec fluctus accipit or^ ;
Nee sentit fatiq; genu?, mortemq; veneni
5ed putat esse sitim — rsed Jivida lingua calorq;
Intut ageps, et quae circumfluit albida rictus
Pestiferos spuma, et quasi pulvere conspurcata
^niDa, insequales passus, genus omn^ Cail^t|iD| ^

0% "

Hone Titan BMoent dirk oonttLge gx^waimm*
Tanta dia toleraie mtSas mala ; Mors rapida instat.
* Feles fttqye Canes cur non teterrima solos
festilitas vexat, tactCU cootagibus absque pestig*
Cur Bolam banc rabiem vuIdus disseminat, et cor
Noxia fit lantum couunisto sani^ioe pestis,
Fertilis in mortes, aut quid secreta nocenti
Hiscuerit natura tui, non cura laborq;
Kostcr scire valet, nisi qnas vulgata per orbem
Fabula pro vera decepit sncula causA.
(Febre laborantes Homines aliquando yidemus
Hjdropbobos fieri, nee fatom dente mioantes)
Caetenim dum torquent animalia membra Imboft
Sndorem v ideas fundentia corpore toto*
Bis cutis arctantur dens& spiramina, rodont
Sanguinis inde sales cerebellum mordicus ; aut quod
Alba subest linguas vermis, se live recondit
In sinubus frontis ; Tel viscera tenia pung^t
Kxcruciatve dolor denies, aut saevior anrei.

Dentibus exceptum non nunquam virus in aaooa
Se condit tacit^ latitans in oorpore, vanA
Spe ludens miseros felicia tempora vita
Bucendi, et placido claudendi Inmina letho.
Exerere Hebdomadis pauois plcmmq; suescit
Pesteferas vires, et certa morte timendas i

Tulnera parva lieet, nullam minitantia Doxam
Absque dolore omni, paucisq; imbuta lalivla
Fanenturq; cito, & vestigia nolla cicatrix
Impress! dentis monstret ; per corpora tota
Insinuat morsis tamen horrida gutta veneni*
* Moz dolor exoritur puogens ubi vnlnere primo
Infusum virus venis, volat impetn miro
Ilpnea vis, subitoq; pererrat sin2:u]a membra*
Occupat et vertigo caput, fit nausea, sordet,
£cce asrugineas Stomachus comitante Screatii

* G«ms C^oiaiMn, Lupos,* Vvlpet*

< i .. Fetinumi Tigridas, Pardos compreheQ4it*

]f09.;;! '■ MtHeat ItaeWgeiM'*- 197

ETomit, cxcruciant Sin^ltos, Pectora tebelant,
Somnia terrificanty gravitas in corpore, torpor,
Signaq; dejects mentis suspiria reddnnt
Sponte sua ejicitar Semen, gtnitaliii^i lestu
Tensa dolent, urget mordax stranguria, faucet
Yiseidus obturat mucus, sitis ; Horror aquarum
Visarnm saTus, ^ecuU solidive oiteotis,
Exagitat nenros, totos tremof occupat artuf,
Latrantiq; Cani similii nox edita terret
Astantes, mens mitis, oontans ; arger amicos .
Admonet ut fugiaat lethalia Tulneva dentif.
Extorquent spasmi ritam, Tel lenia lomni
Sluoera deducunt auimas JeheronlU ad oraf«

Nee ratio reraedl oommunis oognita eerto $ ■■ "
Sunt qui confidunt argenti in JSumine vivi,
Aut maris immerg^t miteninun corpora in undas,
}f^ prius iode tralpunt quam magno extinct^ Aniouii
Fan lit ; Tel tiBTi candentis Tiribuf IgBis
Exurunt partes, cnltroTe exscendere acuto
Audent, ut Tabo Tiviscens diffluat ulcus.

Antidotis male credendunr est quao Somnia monstrant*
3itTe CpnmrhHlm, tot rabidi Capis ipsjiu Hispar*
Pluraq; multoties qus fabula jactat anilis ;
Morbus, ni sanet Ferrum, immedicabilis angit;
Cplaq{ Spei minerii, nnllsiB tper»re Salntem.

MEDICAL INTELLIGENCE.

JosEFH MiLLBK, lenraBt to Mr^ Bates^ of Holrafirth, near Huddersficld^
Yorkshire, difd liwt weelc of Hjdropbobia* occasioned bj hayiiig suffsfe^i
JItc weeks before, a dojg, vhicb afterwards proved to be mad, to lilk the
wounds on hit hands and face. This proves Or. Caton to be correct, who
ttated in bis last commnirication, that it was onlj neoessarj that the calif «
•bfluld eome m contact wUb some animal fluid to produce ttue disease .

VACCINATION.
In panuance of the Resolution of parlwote^t paseed ip t^ iMt Seppi^* f

19B HMSea'MiUigenceV [FeteififlrjK

National TwgTmrTioir for promotinf^ YacciDation, is eBUblished under the
managemeot of a Board, irbich comists of the following Members —

Sir Lucas Pepys, Bart. Pi^sident of the Ro.Yal College of Ph^rsicians ;
Dr. Majo, Dr. Heberden, Dr. Satferlej, and Dr. Bancroft, Censors of
th« College; George Chandler, Esq. Master; and Robert Keate, Esq. and
Sir Charles Blicke, Governors, of the Ro^al College of Surgeons.

The Board have appointed the following Officers :

Director, Dr. Jenuer; Assistant Director, James Moore, Esq.; Resrister,
Dr. Hcrvey ; Principal Vaccinator, J. C. Carque, ^sq. ; Vaccinators at the
Stations, Charles Aikin, Esq. T. Hale, Esq. Richard Laae, Esq. Edward
Leese, Esq. S. Sawrj, Esq. and J. Vincent, Esq. — Secretary, Charles
Homiy, Esq.

5lf. Salvadiyr, (BraxH), July 19, 1 80.P.

Art. 2. The vaccine inoculation was first practised in St. Salvador to-
wards the end of the jear 1 804» and from thenpe spread through all the
provinces by order of the Prince of Brazil, who appointed Dr. J. A. Bar-
boza to superintend and promote the new practice, and so beneficial have
been its efiects, that the small-pox, which was verj destructive here, has
almost totally disappeared.

Id the cancerous ward of the Middlesex Hospital, we are given to un-
derstand that the intelligent Physicians of that Hospital are going to give
the distilled water and vegetable diet a trial : we think it a just tribute to
bmnanity, and solicit the result of the investigation. . .

Dr. Herdinan has been appointed Physician to His Royal Highness the
Iteke of Sussex*

Djr the death of Dr. T. Beddoes, physic has lost one of her ablest
practitioners J and philosophy a profound disciple. As an author he was
admired, as a ^lan loved. Generation will 9jic(X£ii generatipn before such
bright luminaries as a Black, of a Beddoes will adorn the lemispbere of
ycieoce ; the many laws of the physical action and reaction of Chenoijstr j
by his welf directed labours, has opened an ample field for medical inquiry
and illustration^ the just attributes of practical knowledge. As the founder
pf 1» new practice, grounded upon the intimate knowledge of the effects of
ihe hings, and the agencj of oxygen in the system, Dr. Beddoes met with
strong opposition ; which opposition, fortunately for society, called forth
the exertions of Dr. Darwin, Fercival and others, who hesitated not to d^
flTCr their unbiassed testimony in his f/ivour.

1809. J Medical InltUigence. 199

The Death of Dr. Richard Lubbock deserves also to be mentioned* He
was an eminent Fhjsician of Norwich, and particularl^r excelled in his che«
ijiica] knowledge. His practical opinions of medicine were framed on the'
tlieorj' of Dr. Brown, but applied with jedgmcnt and discretion. He wat-
coDsidered in practice as a successful physician, aud enjojed a verjr high de-
cree of public confidence where he resided. We shall, in a future Number,
extend these sketches of Biograpbjr as thejr regard Dr. Beddoes aud Dr.-
Lubbock.

Dr. James Hamilton, of Finsburjr Square, has been unanimoualjr ap*
pointed Physician to the London Dispensary.

NEW MEDICAL PUBLICATIONS.

Anatomia-Chirurgical Tiews of the Nose, Mouth, Larynx and Fauces,
-with appropriate explanations and references to the Plate. By Joha
James Watt, Surgeon, Folio. Plain, 11. lis. bd. Coloured, 21. 28.

The London Medical Dictionary, including, under distinct heads, ererj
branch of Medicine, viz. Anatomy, Physiology, and Pathology; the Prac*
t ice of Physic and Surgery, Therapeutics and Materia Med ica; with what-
ever relates to Medicine in Natural Physiology, Chemistry and Natural
History ; illustrated by a great number of Plates elegantly engraved. By
Bartholemew Parr, M. D. &c. 2 vols. 4to. 41. 1 Cis. boards.

Reports on the Effects of a Peculiar Regimen on Schirrous Tumours and
Cancerous [Jlcers. By William Lambe, M. D. Fellow of the Royal Col-
lege of Physicians, 8vo. 5s. boards.

Treatise on Scrofula. By James Russell, Fellow of the Royal College
of Surgeons, and Profes^iol' of Clinical Surgery, iu the University of Edin-
burgh, 8vp. 5s. boards.

L\ THE PRESS.

The Practical Materia Medica, in which the various articles are fully
described and divided into classes and orders according to their effects, their
-virtues, doses, and the diseases in which they are proper to be exhi-
bited,' are fully pointed out; interspersed with some Practical Remarks,
and some Select Formulae ; intended principally for the use of Students
«iud JunioJr Practitioners. One volume duodecimo.
Cooper's Dictionary of Practical Surgery, 8vo.

Ho6per*s Physician's Vade^'mecum, &;c. 8vo.

A Treatise on Cheltenham Waters and Bilious Diseases $ the second
edition. By Thomas Jameson, M. D.

^ «

200

Diseases and Casualties in London in the Year 1808.

Abortive & Stillbom 462
Abscess - - - - 49
Aged - - - - 1555
Ague - -. - - 5
Apoplexy & Suddenly 229
Asthma and Phthisic 586
Bedridden ... 8
Bleeding - - - - 28
Bursten. and Rupture 26
Cancer - - - - 54
Canker - - - - 2
Chicken Pox - - - 3
ChUdbed - - - 172

Colds 11

Colic, Gripes, &c. - 19
Comsumptiou - - 5220' Miscarriage - -
Convulsions - - 4164 Mortification • -
Cough, and Hooping

Cough - - - 326
Cow Pox - - - - 1
Croup - - - - 76
Diabetes - . - - 2
Dropsy - - - - 870

Evil 8

Fevers of all kinds 1 168 '
Fistula - - - - 1
Flux 10

French Pox - - - 28
Gfout ----- 33
Gravel,Stone,& Stran-
grury - - - - 18

Grief 5

Headmouldshot,Horse-
shoehead, & Water in
the Head - - 193
Jaundice • « - 39
Jaw Locked - - - 2
Inflammation - • 765
Lethargy - - - - 1
Livergrown - - - 14
Lunatic • - - - 172
Measles - - - 1386

2

200

Palsy - - - - 98

Piles 1

Pleurisy - - - - 17
Purples - - - - 1
Quinsy - - - - 3
Rheumatism - • - 7
Scurvy - • - - 2
Small Pox - - 1169
Sore Throat - - - 9
Sores and Ulcers - - 5

Spasm * •• * • xg
St. Vitus*s Dance - 1
Stoppage in the Stom. lH
Teeth - - - - 319
Thrush .... 48
Tumour • • . • 1
Worms . - # » 5

Bit by a mad Ca^ • 1
Bit by mad Dogs - S
Bruised - - - « I
Burnt - - - - 51
Drowned - - - 12S
Excessive Drinking - 7
Found Dead - - 17
Fractured - - - 2
Frighted - - - • 1
Frozen - - - - 2
Killed by FaUs and se-
veral other Accidents 77
Killed themselves - 36
Poisoned - . • - S
Scalded - ... 5
Starved - • - • 3
Suffocated - - - 4

Total 3SS

Christened -

Buried c

Ob

Males -
Females
Males -
Females

10189
9717

10228
9726

InaU 19906
In all 19954

Under Two Years of Age
Between Two and Five
Five and Ten
I'en and 1 wentv
Twenty and Thirty
Thirty and Forty

Whereof have died.

6075 Fifty and Sixty

2466 Sixty and Seventy -

847 Seventy and Eighty

643 Eighty and Ninety

1200 Ninety and a Hundred

1792 A Hundred

1971 A Hundred and Two

Forty and Fifty

Increased in the Burials this Year 1620.

1690

149!9

12d9

504

€S

1

I

This Register exhibits a considerable increase in the proportion of deatiit
under two ^ears of age, the whole number of deaths exceeding the preced*
ing year only 1 620, and the mortality of children under two years of hg^
greater by nearly SOO than in either 1806 or 1807. This may be. ai>
counted for by the great increase of measles, which exceeds every thing
that can be produced in any former years. It is also well known that is*
flammatory diseases have been more severe and frequent than usual. Th#
Yearly bills, inaccurate as they arc, confirm this ; as well as most other
facts 00 a large scale. . The number of deaths by Croup is greater than Ik
either of the two preceding years ; and under the general term of '* Inflam*
mation," the difference is not less remarkable. The deaths by Small Pox
are 1 28 Uss than last year, and 1 1 more than the precediiig yeaC.

Vol. II.] March, 1809. [No. VIII.

THE LONDON

SPECTATOR-

EMPIRICISM.

The functions of respiration, and the clianges it induces
wm the sy^tem^ have opened a wide field for what we mar
'term Soientific Empiricism^ Chemisitry has laid the found*
mtion of ibis, and her pneumatic discoveries have been ap-
jplied with a bold speculation to arrest the progress and ef*
.^Gact weWf&[y in vxbluj hitherto incurable diseases. The in*
.striiBients thus offered were first seized on by the genius of a
JBeddoes, land miade to acquire for a time some reputation in his
Viands ; but though moul>Ied with some judgment by him,
Qjad capable of giving even to his failures the plausibility of
success, they were but clumsily employed by the talents of in*
ferior practitioners. We blame not a Beddoes for the at-
.leaipt; but we consider the present perseverance in their use
SLS a q;>ecies of Charlatanism highly to be condemned, as those
means of cure are now to be considered, when regarded as me-
dicineiS, only as airy nothings. This line of practice, started
ly regular practitioners, was soon taken up by the empirics,
who, if they could not imitatethe principles of cure, at least
gave such an imposing appellation for the time to their nos-
trums, as the Vital Wine, Vital Pills, Oxygen Gas, &c.

But we shall examine the principles of pneumatic practice
in detail, first stating the airs or gases which have been em-
ployed.

VOL. II. p

202. . Empiricism. ^Mgtrc

Mr. Watts's apparatus is the only mode of exhibiting
them yet resorted to. This apparatus consists of an aleni-
bic, of a long pipe, conducting to the refrigeratory, of a re-
frigeratory of considerable size, of a hydraulic bellows, into
tvhich the gas is conveyed from the refrigeratory, in order
that it may be farther cooled, and of an air holder, into
which a transfer pipe discharges the air from the hydraulic
bellows. (Vide Beddoeson Airs, part II. p. 3.)

Vital ^iV.— Vital air is procured by exposing simply
black oxyd of manganese to a red heat, or by mixing it witb
two parts and a half of sulphuric acid, adding a moderate
heat, when a large quantity of this air is separated. When
fresh made, it is rather unfit for medical use, as containing in
it a quantity of the manganese suspended, and some caustic
lime should therefore be well mixed in the Water of the re-
firigeratory, or it' should be kept 1? hours in the air holder be-
fore it is used. In using, it is isometimes employed,' in ur-
gent cases, undiluted, but mote Commonly it is niixed with
'atmospheric air, from 20, 30, to 50 quarts of atmospheric
' air with two of vital air, eniployed once a day, is a common
"course in chronic diseases, gradually* lessening the frequency
of its application, according to circumstances, and even in-
termitting occasionally, when general appearances of in
llammation, as a whitetongue, &c. appear.

The effect of this dose is to diffuse a sense of warmth
through the body, and to occasion a suffusion of colour over
every part, and to render the pulse slower and fuller.

Pephlogisticated Nitrous Air is obtained by exposing
nitrous gas to wetted iron filings, or moist sulphuret of alka-
li. It may be inhaled either pure, or in a varied propor-
tion with atmospheric air, according to circumstances.

Carbonic Acid Gasy or Fixed Air, is obtained in ifs
purest state, by heating chalk or calcareous substances red
hot, and admitting to it small quantities of water, by which

«09.]

EmptridsfA.

SOS

the fixed air will be disengaged ; or it may be procured bj
pouring dilute sulphuric acid on chalk, and allowing the
gas to pas through water, and be inspired through a tube in
thatstate^

These inhalations may take place for 20 minutes, dcca-
sionally breathing an inhalation of atmospheric air^ and they
maybe repeated four or five times a day, unless pain of chest,
or other symptoms arise, that occasion it to be desisted from.

Hydro Carbonate Air is a modification of the former,
and procured by heating charcoal to redness, and dropping
ivater upon it. The water should bd admitted very slowly,
and lime should be mixed in the water of the refrigeratory, to
prevent any contamination in the process, and this air iisbest
used fresh made. From the great powers of this air it re-
quires, in using it, that the dose be measured out with great
accuracy, and its .proportion should not be more than one
part to 15 of atmospheric air.

The utmost care should be taken in preparing it that the
charcoal be previously well calcined.

To facilitate the exhibition of this, an arrangement of
different standards or changes of atmospheric air has been
proposed by Dr. Beddoes in the following manner :-^

Thus 28 parts. being the proportion of vital air usually
present in the atmosphere, he has altered it by the addition of
successive equal parts of it to one of oxygen, thus i-^

TABLfi t.

Oxygen.
1 part of atmospheric to 1 of oxygen . 64 i
1 of atm. • . to do*

3 dOk

4 do.

5 do.

6 do.

to do.
to do.
to do.
to do.
p 2

52
46
42
40
38

Atotk.

36

48

54

58

6b

62

t04

JSit^rkkmi

Ogygat.

7 ofatm;

. to l«f oxygen . S7 .

^

6 do.

. to do.

. M •

€4

9 do.

. to do.

. 35 .

«S

10 do.

. to'do.

.Ml.

efif

11 do.

. <odo.

. 8i .

<6

19 do.

• . todo.

TAB^E II.

. 90|.

•«l

^

Tbe standard is altered in the foUowingmaxmer^ by iad-
ffition of snccessive eqnal parts of oxygen to one of atmo-
spheric air :

to 1 atmospfaeric • 76 • 44

9 'Oxygen

3 oxygen

4 oxygen
6 oxygea

to do.
to do.
to do.

81 .

, 19

«5 .

. ts

86 .

, n

TABLE III.

BSTect €f£ the addition of different portimis of atmostflieric

to one of unrespirable air*

Oicygm. Uaresfir,

1 atmospheric • io I 'umcesrpiiabk .14 < 86

2 do. .

. 4odo.

. 19 .

tl

3 do.

. to^.

. 91 .

f9

4 do. .

. to do.

.99 .

n

5-do. .

. 4o<do.

.98 .

w

6 do.

. to do.

. 94 .

76

7 do. .

. to do.

. 94 .

70

IS do.

. to dp.

.95 .

75

'9 do. .

. to do.

.25 .

n

10 do. .

. to do.

. 95| .

m

TABLE IV.

Efiect of t}ie addition of different portions of unrespir-
able airs to one of atmospheric*

Oxygen. Unrespir*

I atmospheric • to 9 t^nrespirabk . 9 • 91

Oxjfgei^ Unresph.
1 atmospheric • to 3 unrespirable . 7 . 93l

1 do* • . to 4 do. . . 5| . 94|

1 do. • • to 5 do. . • & • 95

The abore Tables^ thougk ingenious, and on that ac«'
count deservifig the praise of chemical knoivledge and* ar«
rangementy ve are sorry to say, are no way applicable to the
core of diseases, ov as leading to any successful views in prac-
tice. All the gases which Contain a greater proportion of
oxygei^ than belongs to atmospheric air, in the same jn^opor*
tbn are apt to excite inflammation; and all those again
Hidnchi exceed in their proportion of azote beyond the due
qamtity established in atmospheric air, are liable to induce in
the same d^iee symptoms- of apoplexy, accumulation in the
ixmUf and atonic state of the nervous system. These ejects of
the pneumatic medicines were clearly ascertained by the French
chemists, particularly Chaptal ; and the point being esta- <
blbhed^ the matter was left at rest, and no more mischief done
by the experiments ; but in this country it has been different.
The introduction of the airs was a new species of medical
trade. It was a fine speculation to amuse, ^nd fill the
pockets ; and the line which the genius of Beddoeshad chalk*
ed out, when abandoned by him, was prosecuted by inferior
agents without success.; for this was a fact which every che-
mical physiciaa must have been convinced of; ihdA ih could
not he applied without infinite injury to those who.frere uun
fortunate enough to put themselves under their care, £vea •
in. thQ bandB of a Beddoea, the consumptive patients had
thfiii lungst inflamed by the pneumatic applications, which
wend then obliged to he suspended, and the ejects of the
eviVoounteracted by tiie use of opiates. The progress of the
disease was' thus accelerated) and th^ slow and insidious
stepa of it hurried on at a rapid paoe./

In othef eases, patients have died apoplectic, been seized
utitb giddiiMBs immedaatalji afler inhi^jig Ae. nuppeiaed sfil^* .

p S

906 Medicine. [Marcbi

taxy fumes, and dropped down to the confusion of the pneur
matist, and to the unexpected disappointmenf of their friends,
Hence it is perfectly ctear, that nature intended that for the
purposes of life, the gases should only be inhaled in a
certain proportion, a$ they exist in atmospheric air, that till
the function of inspiration is more fully understood, no
change in the component parts of this fluid can take place
ivithout serious injury. Nay, in almost all situations, it is
found that the quantity of oxygen contained in atmosphe*
ric air, is much the same, and that the cure of diseases
is more connected with its degree of temperature, than with
any change in its constitution. Hence, we consider pneuma-
tic medicine as a dangerous and bold innovation, and con-
stituting a species of empiricism of a more injurious tendt
ency than any of the nostrums of the Patent Warehouse,
for rapid are the strides from its use to *^ that bourne from
whence no traveller returns."

« I > ■ » >i

REGULAR PRACTICE,

I. MEDICINE.

GENERAL PRINCIPLE OF PATHOLOGY.

It is an axiom laid down, which applies very generally,
that no two actions can take place in the same constitution,
and in the same part, at one and the sarne time. The ex-
ccpUons to this rule are few, and on this principle may be
said to proceed the cure of the greater number of diseases^
The great point is to find out the proper means of exciting
that action which is to sii^nd or overcome the diseased one.
Of modern remedies, mercury has gained a decided prefer-
pnce; and in fevers and inflammations of a chronic nature,
which affect the larger organs, as well as in a variety of other
fomplaints, it is the only one to be trusted to ; but the us?

1809. Medicine. S07

of this remedy, like every other powerful means, may be car-
ried too far. The adapting the means to the end, is the great
criterion of judgment in the practitioner, and the use and
extent of any remedy is to be regtilated by this rule alone.
Hence failuiie and disappointment will accompany the same
means with one, which will be attended with complete suc-
cess in the hands of another. The practice of public institu-
tions to an observer demonstrates this every day.

On 4;he same principle of producing a new action, may be
explained the operation oi cold affusion in fevers, by counter-
acting the morbid one, in consequence of a superior sti-
mulus, and also of emetics^ which, independent of the
mere evacuation, exert a powerful and extensive influence on
the system; suspending the morbid action, and opening,
particularly from this extensive influence, the excretion by
the skin.

The effect of large blood-letting must proceed on a similar
ground, by the sudden depletion giving a suspension to the
violence of the morbid excitement. Hence copious bleed-
ing, and suddenly drawn by a large orifice, are the points
to ensure its success in acute diseases.

VACCINATION.

The triumph of Vaccination is much completed since our
last number by the munificent establishment of a National
Institution, under the direction of the two Medical Collies
of the Metropolis. I'he doubts which at present agitate
the public mind, it is to be Iioped, will be thus entirely
removed. But these doubts, which preclude the general
reception of tim discovery in Britain, seem not to have
extended their influence to remoter regions. In a former
number we stated the progress of vaccination in Ceylon, in
1802, from the report of Mr. Christie, chief medical super-
intendant of that settlement. A report is now published by
the same gentleman for 1807, in the official Gazette of that
government, wiiich we here insert. It is an *^ Abstract," he

• . -. .F-4

remarks, '^ of thenamber of persons vaccinated in Cejloa io
1807; which will shew the successful progress we have
made in disseminating the practice of vaccination , througliv
out the island, during last year.

^^Tbe linmber inoculated has been ccmsideraUj greater
than in any former year, particularly amongst the Malabaf
inhabitants of the Trincomallie and Jaffna districts, wbo^ bt'
the first instance, seemed less disposed io adopt the pmo-
tice than the Cingalese, in the southwest part of the
island ; but a conviction of the perfect innocence of vaccU
nation, and its preventive influence against smalUpox, is noW
very general amongst all ranks throughout the British po0*
sessions on Ceylon, though from the unfrequent occurrenoa
of small-pox, the natives, in many places, shew more indi&
fereuce and apathy ^bout shielding themselves from that nuu
lady,

^^ We do not, however, find any difficulty in keeping up
the disease at the respective stations, but the vaccinators are
now freqnently obliged io visit the different villages, and urge
the inhabitants to avail themselves of the benefits of inocula^
tion ; whereas, on the first introduction of the Cow-pox in
1802, when the Smallpox raged at Colombo, the natives of
their own accord flocked in crowds to the inoculators, and
expressed the greatest anxiety to be immediately vaccinated.

^^ The small-po]( was prevalent at Trincomallie in Januaiy
last, and from thence found its way to Jaffna, but has since
been banished frpm both places, by the beneficial infin^nce
of Vaccination, which has been very extensively fmciiatA
in these districts during the last year. The very successful
propagation of the disease at these places may, I think^ bq
attributed to the alarm created by tlie appearance of smalls
pox, conjoined with the beneficial eSkcts of a GovernoMnt
Advertisement on the snbject, circulated in the Malabar Itmr
guage, to which mnst be added, the e^ctreme assiduity €^ihB
Gollectors, in promoting with their influence a diAisioD qf
t)i9 practice^ {^ld th^ yer^ mqit^ious espertion^ of the Bf^-

IgD9,} Medicine. 909

isISuperintendante and Vaccinators in the dudwrge ot their
duty.

^^ Previous to the iatroduction of cow-pox in 1809^ the
small-pox scarcely ever failed to visit us at Colombo during'
the prevalence of the southwest monsoons^ when the port was
open, and generally carried off a great proportion of the in-
habitants, but of late we have comparatively snfiered very
little from that disease; It is tru^, that since May 1805, we
have had occasional cases of small-pox ia the Pettah ci this
place, which, in some instances, there is reason to believe,
was introduced from the Candian Country ; but the conta-
gion never spread as fcmnerly, and is at present extinct, not
only in the Colombo district, but throughout the whdie ci
the British possessions on Ceylon, agreeably to the most
certain information I have been enabled to procure, from the
respective Vaccinators, who are directed to report on this
snbjei^t.

^^ From a Rev^ of the Registers of Vaccinaticm, I find
that the total number of patients reported to me as having re-
gularly passed through the disease, up to the end of 1806^—
was 54,958, which, with 31,970, included in the Abstract
for last year, will make a total of 76,888 persons ; a lai^g^e
proportion of the limited population of these settlements.

^^ It would be abscird to expect that in such an extendi
practice, often conducted by persons not regularly educated
to the profession of medicine, some &ilures and mistakes
amy not have taken place ; but I can with truth affirm, that
in the' neighbourhood of Colombo, where small-pox has most
frequently occurred, I have been at great pains to trace to
its source, any report prejudicial to vaccination, and to in-
vestigate the circumstances of every case of supposed fail-
ure ; and in no one instance have I found that a person who
had been vaccinated, and declared secuie by the Inoculator^
(Tver afterwards had small-pox*

^' In a former tetter Z had occasion to nention^ for the in«
Ibnmtion of yoBir H edical Yeadersy thr yiux^ine 4isease hav»

flO

Medicine.

[March,

ingbeen communicated to a boy affected with leprosy ; and
from a melancholy instance which has since occurred, it is
certain that persons affected with that disease, in the most
malignant form, are not exempt from the contagion of small-
pox.

^^ Clara de Silva, a woman, 'aged about 50 years, wh0
had been confined in the Lepers IlospUal since May 1775,
with leprosy in the worst form, having been exposed to vari-
olous contagion, sickened about the 1st of August, 1S06, and
died on the llth of that month, with confluent small-pox. —
On the appearance of Small-pox in the neighbourhood of
the Lepers Hospital in May, 1806, vaccination was prac-
tised amongst the patients of that Institution, but this old wo-
man declared, she had had the small-pox when a child, and
refused to be inoculated.

^' The fact may be useful, by shewing that no disease of
the skin, however virulent, gives perfect security against
small-pox ; ^nd that in the event of an epidemic contagion,
no consideration of that nature ought to prevent us from at-
tempting to shield the constitution against its influence, by
vaccination.

Abstract of th^ Number of PalierUs inoculated in the dif-
f event Districts on Ceylon, during the Year 1807.

Superintendants,

^. High, Esq.

J. A.Stutzer, Esq.

J. Bath, Esq.

J. Adams, Esq.-

and:;.
Jl. Beynolds, Esq.

Pistricts*

f Caltura
I C'olumbo
/ Negombo

I Chelaw
I Calpeniio
iPutlam

SManar
Jaffna
Mullativo
Trincpmalie

Batticaloe

Hanbantott^

TangallQ

Matuira

Galle

Vaccinators.

F. W. De Hocdt
H.W.Schimmelkcttle

M. Mack

J. H. Vansauden

B. H. Toussaint
J. L. Janzen
H. Mattheis
J. C. Keegel
J. C. De Hoedt

N. Claasz, &
F. Van Sanden
J. W, Seyp

C. Hopmai}
C. Hersse

U. W.Pict^fEa
J. Seybrapds

No.

26P4

1610

USS

S40

799

860

1364

6083

247

90IC
1070

236
1556
1877

675

Jflbg.] Mtdicine. 811

HYDROPHOBIA,

Hydrophobia still continues the dreaded subject of the
day, and prevention seems very properly to engage noiedical
ihyestigation as much as its actual cure. ^^ As a means of
prevention," Dr, Wood of Newcastle observes, ** the me"
thod of dilution, pointed out by Dr. Haygarth, deserves our
first attention ; he recommends to wipe the wound with a dry
cloth, so as to absorb all moisture, then abundantly, and with
the most persevering attention, to wash the part with water
quite cold for several hours. After this, warm water is to be
used, to produce a flow of blood, which is to be poured from
the spout of a tea-kettle held up at a considerable distance*
The ablution should be accomplished with great diligence,
and without delav. In a bad wound with much laceration^
to this ablution, cupping and syringing are to be added ; and
la addition to this, it has been proposed that the wound
should be enlarged, and even excision of the lacerated parts^
when circumstances will admit of it'. Dr. Percival has pro-
XX)sed, as a farther security, that the parts after ablution may
l)e washed with the gastric liquor of an animal recently killed,
or with the juice of rennet ; next to ablution, the keeping up
a free discharge from the wound for a great length of timcy
seems to be of the greatest importance. This may be effect-
ed by repeated blistering, or by escharotics. It may here be
remarked, that all trials to arrest the poison by means of
caustics, gunpowder^ and the like, have invariably failed ;
but after ablution their use to keep the wound open may be of
service. Jjigatures above and below the wounded part,
where they can be applied, have been recommended during
the ablution, by Dr. Percival. Apparently, simple means
produce very salutary effects ; perhaps, after the ablution
recommended by Dr. Haygarth, the jpouring of warm cow's
milk from a tea-kettle in the same manner upon the wound
may be of use; we know that milk has the power of counter-
ficting the efiects- of Bpmo poisons receited into the sUHHachf

Sijf- Medicine. [Maich^

Sncfa are the means of pteyenticm most likely to succeed : we
iMtf come to the treatment of the disease when such have
not been used, or shall unfortunately fail. And here I may
observe, that I was of late more immediately led to the consi-
deration of the cure of this disease by seeing Dr. Arnold's
very interesting case of Hannah Springthorpe, which was
iwated by stimulants and antispasmodics, and terminated
fiivourably. From this case and some others, it appears that
our reliance ought to be entirely on such remedies, when the
symptoms of the disease appear* Opium, musk, cuprum
ammoniacum, calcined zinc, with the cold bath, have been
particularly named as most adapted to the disease. Doctor
Percival thinks that the digitalis, from its quick action and
sedative powers, seems to promise to be of service in this dis*
ease* Dr. Shadwell's case of John Cumbus, a drover, seems
to shew, that the internal and external use of oil is of consi-
derable service iii allaying the irritability and spasms. Frooi
our knowledge of its component parts, it promises to be useful
to answer this indication ; but instead of frictions, perhaps a
reqnent immersion of the whole body in oil of a temperature
a little above that of the body, might be more efficacious.
The warm bath has always given momentary relief, which I
attribute to the stimulus of heat ; but the effect of this stimuli
losj applied through the medium of water, may not be so
Xmrnanent as when applied through the medium of oil ; be«
sides the oil itself may act as a stimulant, and its eSects may
be also pernument. The internal use of oil should also be
had recourse to ; and when its use in this way is prev^ted
b^ the spasmodic affectiop of the muscles of deglutitjoQ^
peshaps it may be conveyed into the stomiach by the sani«
means as have been ]:ecommended for throwing food into thi^
stpmach in a paralysis of those muscles.

^^ The benefit experienced from the use <tf the spirit of
cawtii^ volatile alkali> in preventing the bad eSects of the hit9
pf ^speeieanf vipei^ indaces Or. Bwdileji tothiiii)i> UiaitMf'

itM.'i Medicine. 118

tedicme nay be of use in this diseftse. We casBOt have ted
huge a magazine of powerful stimidaiits to resort to inandi a
slateof the body, as a sucoession is required in a rapid namicr
-to<produce any sensible effect in so sborta period as conBnmdgr
k allowed for their action; perhaps tiie Perwoian balsam
itaay be no trifling vehicle for the volatile alkdU. Opium,
liitft anchor of all our hopes in many diseases, is to be chieAf
depended on in this disease. The4ate Mr. Hill used to giifc
it with his medicine ; but as a preyentiye, it cannot be of any
tte. I remember that Dr. Black, in his lectures, always -men-
tieiiied his^uspicion of arsenic forming a part of Mr. H.'s lene**
dtes. ^Fromthe powerful tonic effisct of the mineral soboion^ fit
appears adapted to eyery indication in the cure of oonyidaioas^
I have 'Stopped long established epileptic paroxysms by its
powers. It has not been mentioned by any author I Aam
Mad on this disease.

"^ To all the means of cure in Hydrophobia may be added
tOpK)&l applications to the throat, which m one instance, it
Mseras, was of the greatest use/'

Tbis case occurred to the late t)r. William TT^FtibuU, piiy-
flioian to the Eastern Dispensary ; and the particulafft ^of it or
wiBlffliy of narrating here.

^^ Robert Dixon, a weaver, of Norham Mains, near fier-
iffek, ^as bitten on the leg by a mad dog, SOtfa July, 1761.
The symptoms of Hydrophobia socm appeared ; pain gvadu-
Ayitteended from the wound to the knee, thigh, stomach,
w'llh sickness and oppression at the breast. These aensationa
flaily increased, and were followed by convulsions andidtric-
tores in fhe throat, which threatened 'Su£S>cation, parfiioulairljr
iHiete water was presented to him. To the wounded pafta
icstistic'was applied, and it was kept open by blistering, a^d
^liimnhting ointment ^ from the Jirsty until sometime after all
%hc 'Symptoms were entirely gone. The leg was often hssHbed
with warm oil. A tea-spoonful of a tonic electuary was
^fiftsk four times a-day, consisting of borkf valerian^ fnnsk^

914 Medicine. [Matrcb^

iiid camplior ; opium was also given in large doses, to assuage
ibe irritation and spasms. To the throat i?as applied a
plaister, consisting of opium, frankincense, camphor, asafce*
ifda,^ and gum galbanum. The man, after his recovery, de«
dared that he felt more relief from the plaister than any other
.thing : he said that it gave a pleasant ii?armth to his throat,
abd from thence its effects followed in the same direction to
ihe wound as the pain had^iscended from it."

CUTANEOUS DISEASES

- Are a numerous and obscure class, with the different species
sod varying appearances of which we are not fully acquainted.
A spiles of porrigo affecting the scalp, in the form of red
djrcular patches, is thus described by Mr. White of Bath.
■■'^^ The disorder is an eruption which affecis the heads of
children, particularly in boarding-schools ; and from its cir*
enlar figure, and spreading nature, it has generally, though
not with strict propriety, obtained the name of ting-worm,
lince that disease is usually vesicular^ appears on dififisxent
parts of the body, and is not contagious ; but the disease I
mean to describe, chiefly affects the head^ add is oflen com-
municated to the hands and arms of parents, or other persons
who have had the care of children labouring under the com-
plaint.

^f The disease commences with a small, red, circular
.patch, and slight elevation of the cuticle, on different parts
of the head, attended with itching. As the patch expands,
the centre of it gradually assumes the natural colour of the
skin, still however remaining scaly. A red circular line at
the circumference of the patch, marks the termination of dis-
eased action ; and as long as that red line remains, the disorder
icontinues to spread, and the hair falls off; which circumstance
commonly leads to the discovery of the complaint. Some-
times small papula;, or very minute pustules appear in the
vicinity of the patches. This species of scaly eruption,- for
the most part^ proves very obstinate, sometimes continuing

1809.] Medicine. S15

several months; and «vea after it appears checked from
spreading, it is a long time before the scaliness is remoyed,
md the cuticle assumes its natural appearance again. It is
not attended -with any constitutional affi^ion, but sometimes
children are observed to look ratiier paler than usual. The
disonler is evidently contagious, because it is speedily com-
municated to children who happen to use the same;^comb, hat,
&c. belonging to those i¥ho are afibcted with it. Whether it
be communicable merely from sleeping together, I cannot as-
certain ; but from the inquiries which I have made respecting
it J I am inclined to think it is not.

X '^ Notwithstanding the disorder is, at first, somewhat dif-
ferent from the porrigo, yet if through neglect the scales be
jiermitted to accumulate to a considerable thickness, pus-

• *

tules and a scab will at length be formed. I have at present
under my care^ a case^of porrigo, accompanied with small
icircular patches of scales on different parts of the body.
These entirely disappeared on the administration of the mi-
neral solution ; but this medicine has not materially benefited
the head, for though the scabs are removed, the cuticle re-
mains red and scaly.

^^ Although this species of porrigo above described may
appear of a trifling nature, yet I never met with any cutane-
ous complaint more perplexing, and which proves a greater
source of uneasiness to parents, and particularly to persons
who have the care of youth, as it spreads with great rapidity
when it makes its appearance in schools, and is very difficult
to manage. With regard to the mode of treatment, a variety of
applications have been used, and frequently to very little pur-
pose; for, however carefully the. scales are washed off, they
very soon appeared again. Mercury in different forms,
nitric acid, solutions of zinc, and of arsenic, &c. &c. have
been alternately tried. In some cases^ I have known an alka-
line lotion, in the form of the lotio saponacea of the old Edin-
burgh Dispensatory, succeed better than any other appli*

McOcine. [Ifodi^

cbKah. I do not know that inlerBal medicines are of any aer«
wiee^ bat sometimes I have given small doses of calomel com-
Umsi uritii natroa. Unless ike diaeaae be very sliglit, Ibe
head is almtys duvved, and ibe dhaviag repealed once a week
« long as ii appears necessary. In order to prevent its spread-
iag) eaohchild is directed to bave a separate comb, towdy
Ac. and i^jiey are likewise alarictly prokifailed from iraanuig
oaoh otikevs hats, caps, •&e/*

fiVTTElt OF DR. J. ARCHER, TO THE HONOURABLE SA-
IfUEL MITCHELL ON TACCINATION AS A REMEDY IN
HOOPING-COITGH.

Jfarforfi Country Mart/land^ Nov. IS, 1908.

Dear iSVr—You may recollect that about three or fonr
years ago, I mentioned to you my opinion, that raccins^tion
iroald cure the tuffis corrmlsiva ; that I had made one expe-
riment; and that it succeeded fully to my expectations. I
mentioned the case to several physicians, and requested ikt
making a trial of its effects when they should have any pa«
tients ivith hooping cough. The beneficial effects of vacci-
nation above-mentioned determined me, in every instance <9mt
occurred of the booping-cpugh, to vaccinate. I therefiyre
lave vaccinated six or seven patients vfrho bad the booping-
Cdugb, 'and in every case, it has succeeded in curing this most
dliStressing disease.

The booping«*cougb does not come to its beigbt in less
than six weeks from its commencement, and Chen, whoi ^
^favourable termination is expected, the declension of the dis-^
ease is gradual; and does not terminate in less than six wedks
more. To arrest ibis afflicting disorder in its progress, 1
'would recommend vaccination in the second or third week of
the hooping-cougb ; that is, when tlie symptoms of the
Tiooping-cough are fully ascertained, then to vaccinate.
Should the convulsive cough be violent, I would immediately
vaccinate^ being well assured that the distressing symptoms

tSB9.J Medicine. SIT

#f the bocyping cough are checked by the Taccine disease •
Tkc termination of the Vtecme disease will be'the termination
of the hooping cough : that is, as soon as the vaccinated
ptvt loses the efflorescence, and tbe scab begins to dry, and
bittpmes of a blackish or brownish colour , there will then be
BB evident change in the hooping-cough for the belter, and
Ihefievere symptoms will cease.

*< Thus two of the formidable distempers, to which the
imman race is liable, arc arrested, the small-pox and hoop*
ing cough ; the former prevented and the latter cured.

^^ I am, with respect and esteem,

" Your fellow citizen,

« JOHN ARCHER."

CAt9 OF HYDROPHOBIA, BY DR. N18DET, AND MR. MORRIS,
MEMBER OF THE ROYAL COLLEGE OF SURGEONS, LONDON.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — In a disease of late so frequent in its occur*
tence, and so ineffectual in its treatment, every thing that
can add to our acquaintance with its history is certainly
worthy of attention ; and in that view the following case is
requested to be inserted in your useful work, as affording a
mite to the histories already given by so many eminent prac*
tHJoners on this obscure and interesting subject.

Isidore Le Mercier, a Frenchman, aged S5, residing in
Bedfordbury, was by accident, in the month of August last,
mttacked furiously by a dog in the neighbourhood of Totten*
ham-court-road. The animal bit the forefinger of the left
luuid, and likewise the wrist. In the height of his resent-
ment, and to prevent the enraged animal from injuring him
fiffther, he grasped the dog forcibly by the throat, till be
stiangled him. The wounds he had received were super-
ficial. They healed up in a day or two, and he thought
ao more of the matter ; so that the influence or impression
Ml the mind was no way concerned in the production

TOL. TI. Q

218 Medicine. [Maicb,

of the future symptoms ; a circumstance so mucli dweU
upon by the opposers of the specific nature of this dis^
ease. In the month of January last, five months from the
time of the accident, he was seized with appearances resem-
bling a common cold. The symptom he cbi( fly complained
of was an inability of swallowing, or the ftoMng of sonie-^
thing as if choaking him when he attempted to <jet any
thing down. These symptoms continued, for tv o days,
before they assumed the last and aggravated form ofthedis^
ease. On Sunday morning about four o'clock, slight convul-
sions and spasms of the chest first attacked him. Their fre^
quent repetition alarmed him, and about eight o'clock the
next morning, Dr. Nisbet was desired to see him by a
friend, who seemed rather to make light of the alarm which
the unhappy man felt for his situation. On seeing him, I
was particularly struck, though i had never witnessed the dis-
ease before, with the peculiar wild anxious look which the
patient's countenance depicted — it was an expression of bpr*
ror and dread of his situation, which I can faintly descril^,
and which, I immediately decided, could not be connected
with a common case of spasm. The fondness fo^ life was
expressed with the most anxious and restless solicitude for
Jiis recovery, and with the seeming dread observed to receive
an unfavourable opinion. Every part of his behaviour^
which was most restless and unsettled, shewed a marked and
uncommon suspicion of every person around him. The
opening of the chamber, the smallest movement in the room,
gave the most unspeakable distress. At tliis time I desired
him to take a draught which stood by his bed-side, and which
JUr. Morris had sent. On presenting it in a cup, I was asto-
nished he could not bear it to come near him. Sora«thinff, he
said, choaked him, and he begged I would take it away.
My opinion of the case \\as now settled ; and as soon as I had
an opportu:iity of meeting Mr. Morris, I stated my conviction
of the disease, in which be readily acquiesced, and the usual

1809.] Medicine. 219

plan of opiates in liberal doses, as a mere palliation of symp-
. toms, was resorted to, not seeing, indeed^ what else could be
done. Particular engagements prevented me from again
visiting the patient that day, and next morning, about eight
o'clock, I was sent for along with Mr. Morris; but by the
time we had arrived, the unhappy patient had breathed his
last. On inquiring into the subsequent progress of the dis-
ease, we were informed that the whole of the previous night
the convulsions had been most violent, and repeated almost
every five minute^i requiring no less than five persons to
command hin?^ that the patient continued sensible during the
intervals, and lost none of his recollection till within two
hours of his dissolution. At one time he expressed himself
with the greatest anxiety for life; at other times he seemed io
f^Il into a state of despondency ; but during the whole of hii
illness he never breathed a hint of the cause of his malady, or
that he had been accidentally bitten. It was only from the
persons in the house that we learned, after his death, the
particulars of it. Permission was not given to examine
the body, which is to be regretted.

I had never, in a long experience of medical practice, seen
a case of hydrophobia before; and the symptoms therefore in
this case made a greater impression on my mind.

After the very accurate histories given to the public by
Dr. Powel, Dr. Pinckard, and others, I could have no hesita-
tion in deciding what it was; and I think no person, who
on(^ sees such a case, can ever be mistaken in it.

The strong "pathognomic symptoms are a wild anxiety
depicted in every feature of the countenance ; a perpetual
increasing restlessness and agitation ; a peculiar suspicion
and dread displayed by the patient respecting every thing
about him, as well as of his attendants.

The opening or shutting of the door alarms him;
every new face creates distrust and dismay. His feelings
are rankled even by a breath of air blowing upon him j

q2

Medicine » *[Marc^

and such was the unhappy state of the patient I describe^
that he caused even the Tvindows of the room to be closed up
lest the air should touehhim. The horror of liquids is there-
fore but one circumstance. The same horror penrades eycry
thiug -that makes an impression in this state of general and
local morbid irritability, and especially in regard tQ thoate
things which require an action of the organs of d^Iutition,
From what I have seen, then, lam ready to conclude tt^a^ this
disease of hydrophobia not only exists, but is pecuHfir in its
tkaractery specrfic in its causCy and requiring on this acpount
a treatment e^t^a//^ specific, if^e can once acquire al^QWr
ledge of it. The line is pqinted out by the interference pf the
legislature, and it is to be hoped, for the sake of siiflfering
humanity^ it may be an opening to the necf ssaijry discoveries*

If the above can lead to any farther information on the
history of this obscure disease, my object is attained.

I am, Gentlemfq^

Your obedient Servanti^
Lmidon, Feb. 10, 1809. WM. NISBET.

MEDICAL REFORM^ ^pINBUR^H.

From a correspondent at Edinburgh we learn with regret,
some disscnf ions exist among the Professprs and the Students;
in consequence of the former haying doubled the graiduatioi^
fees. Respecting the propriety of this measure,, it does not
fall to our province to applaud or censure ; but as we are oa
the subject, we shall with due deference express pur ideas on
the points at issue. As friends to liberal science, we confess,
without some very cogent reasons are assigned for this i^ug-
mentation of fees, we are inimical to the measure : inasmuch
as we conceive these superior tribunals are not erected for pri-
Tate advantage but public good ; and where an individual is
found worthy of the academic honours, that honour wewould
havcconfeiicd gratuitously: the resident student most assu*
jedly should not be too much oppressed ; in his favour the
fees ought to be moderate ; as one of the children of the;

180&0 MeJidne. ttl

jUlna-Mater, some distinction ought to be sfaewn him^ otbeiw
wise you place him on the lerel with the Empiric, and de^
gffade the medical character : manj a scientific genius will
be prevented entering the medical profession, if thej are thus
to be fettered with unnecessarj fees. Zealous as we are for
the rights of corporated bodies, we conceive in this instance
they exercise a power io which no legitimate claim is at-
tached, and think the fiiir principL^s of equity somewhat
distorted. The period is not long passed, since the expenses
of a Medical Education at Edinburgh were by no moans
high ; three guineas a session to each professor was the fee,
three guineas to the infirmary, and three more to the clinical
lectures. That universities should be tenacious of their
academic honours no one will doubt, and it is with pleasure
we announce from our own knowledge, that the principals of
the Scotch college have come to a resolution not to grant
diplomas to any one who has not had a classical medical
education. Sir A. Bannerman in this has particularly distin-
guished himself, and merits the applause of the medieal
world: this will shut the door upon the Empiric; for the
privileges of a diploma once granted, are unrestricted, the
ezerciie of the right of that diploma being secured by repeat-
ed acts of parliaments, and which the union of Scotland and
Ireland secured to each kingdom.

We now give our correspondent's letter, and trust their
achism will be succeeded by a perfect harmony.

" University of Edinburgh, Feb. 12, 1809.
f < Gtntlemen'^l take the liberty through the medium of
3rour Spectator of making a few observations on the profess-
ors of this university, more particularly, with regard to a
]aw lately passed by them doubling the fee for graduation.
I will not at present take up your time, in considering the
propriety of large sums being given to the professors by
students who have already paid them dearly for the know«
ledge thejr have acquired, in order to obtain tbistestim^

qS

StS Medicine. [Marc

nial of their abilities. It must be evident to every one that no
more at least ought to be given than will compensate for their
trouble, and for this the former fee, even by the professors
themselves, is not said to have been insufficient ; indeed it is
hardly possible to conceive that men receiving 1000 and
1200 guineas for a quarter's course of lectures could complain.
Still, however, they have for some years wished that their
income should be greater, and this they think they have
accomplished by doubling the ^graduation fee«

•** It is curious to observe on what grounds they have done
this; they are ashamed to confess their avarice; they know
they could not complain of insufficient remuneration for their
trouble, but they wished to pass it off on the plea of increas-
ing the respectability of the profession. Let us see then the
conduct of these very men on another occasion.

** In February, 1807, the Royal College of Physicians, of
whicli the professors of the University are Editors, Censors,
&c. &c. returned an answer to Dr. Harrison's letter con-
cerning the Medical Reform, from which I extract the fol-
lowing —

* Whatever regulation be enacted, they are of opiniout
that these should have chiefly in view the benefit of the com-
munity at large and not merely the emolument or respecta-
bility of the Medical Profession.

^ It appears to them, that several parts of the proposed
plan may tend rather to diminish the number of those who
might hereafter engage in the medical profession, than to
promote the welfare of the public, by increasing the facility
and the certainty with which they may obtain proper advice
and assistance in sickhess or in bodily injuries/

^* Again,

* Whatever regulations are enacted, it would be unjust
that these should affect practitioners already engaged
in business, or students who have entered on an education
6w any of (be branches of the Medical profession.'

80^.] Medicine. 223

*^ Such was the opinion of these men in 1807, but in April
1808, they pass a law, having in view merely their own
amolument! Their speeches concerning the tax of five
shillings on each student can now be perfectly understood-
If the law were intended to increase the respectability of a
d^ree, why did they not make it as public as possible ?

*^ The professors will not however long enjoy the pecuniary
advantages arising from this law, for although several will
lather pay a double sum than at the end of their studies re-
move to another university, that will not long be the case.
Already some students have gone to a neighbouring univer-
sity, and others have been kt^pt merely by the idea that
so unjust a law would not be persevered in.

^' Let the magistrates of Edinburgh also consider whether
80,000/. or 100,000/. circulated annually in their cify be
such a trifle as to be endangered by the private emolument of
a few men. In my next, I shall ^\ve some farther particu-
lars of libf*rality in certain of the professors to the students.
^^ I am, Gentlemen, with the highest respect,

'' A PUPIL OF THE EDINBURGH SCHOOL.
^^ P. *y. I have just learned that the associated student9
intend to publish the whole of their proceedings, as soon as
the a.rtswer has bern returned to a petition, which has beea
for about two months before the magistrates, the patrons tf
the university." •

To the Editors of The Medical and Surgical Spectator.

G^ ntlemefi-^W liihST I cannot but be gratified by thie
handsome terms in which your correspondent M. has noticed
my Reports on Cancer y in the List number of your Journal^
I think he might have observed, tliat I have, in more pas-
sages than one, sulliciently declar<'(l my own opinion, how
the practice which it is my object to establish is to be recon-
ciled to our ideas of a natural and healthy state of existence.
I apprehend, not that pure water is necessary to a perfect

q4

224 Medicine. [Ij^^ardh,

state of Lealtfa, but that, under a diet, strictly confermable
to the nature of man, he would not experience a necessity fn
drinking: in a word, that, naturally, man is not a drinking
animal. In p. 3 of the Reports^ I have thus exf^essed
myself: — *^ I have found that one of the strongest objectioni
in the minds of many sensible and well informed persons,
against my proposal of introducing the use of pure distilled
water in the treatment of chronic diseases, has been that the
practice seems wholly unnatural. If they can once bring
themselves to suspect, that the practice of all drinking what-
ever is equally unnatural, a strong prejudice will be re-
moved, and they will more readily comprehend, thatifan
unnatural habit be at all indulged, especial care should be
taken to prevent it from being likewise a nervous one."
Some other passages to the same purport might be produced;
and if they made bat a slight impression upon ymir corre-
spondent, it is, I presume, to be attributed to the rapidity of
reading, and to his attention being fixed on more prominent
parts of the argument.

Nothing can be more striking to a contemplative mind, than
the perfect adaptation of the organs of animals to their habi-
tudes and necessities. Examples of this are so obvious, that it Js
almost superfluous to cite them. We may remark it in t3ic
gizzard of the fowl, in the webbed foot of aquatic birds, tit
the light and hollow bones of those that j9y. JCan we loek
at 4be formation of the heron, and not be convinced that
nature has adapted him in every part of his structure to his
peculiar occupation of wading itito shallow streams, and
catching fish ? But if I survey in the most superficial manner
the structure of man, I perceive that drinking is an action
ofwhich he appears naturally tobe hardly capable. Not a par*
tide of liquid can get into bis lips, that is not conveyed thitltet
by some artifice. His upright form, and the flatness of hit
mouth are in direct opposition to the action of drinking,
It may be said that he is utterly unprovided by nature with,
any organ suited for this purpose. In this respect man is

I80§.]' Medicine.

nu»re destitute than the sheep, who can drink uritiiout diA-
calty ; thong'h he too is not by nature a drinking animal ;
be nerer drinks when he can procure abundance of succulent
food ; and almost all his diseases may be readily traced to
the operation of water. It is true tiiat a man can drink bj
stooping down to the stream like the aninialB ; but this mode
is almost as much a constraint upon hkn as walking upon km
liead instead of his feet. ^

It may be thought that the feeblest exertion of intelleei
would teach him to surmount this difficulty. But slight a*
it is, it includes a process of reasoning, of which animals ap«
pear incapable; and all the accounts of children, who hare
been discovered in the forests, living wild upon what thej
could collect, inform us that the human animal is in this
condition inferior in intelligence to the quadruped. It 9
highly probable that those beings really did not drink at all.
This hypothesis takes away all the difficulty which is sup«
posed to attach to the idea, that the streams which are des-
tined to the service both of man and brute are impregnatad
with poisonous matter ; since it is evident, that what acts tm
a poison upon the human race, may have no such eSect upoii
animals which are formed by nature for drinking. At the
same time I must say, that, it appears to me that all o«r
domestic animals are injured by drinking, much in the same
way that mankind is : and I believe that if they had alivayt
plenty of fresh succulent food, they would rarely drink ftt
all, and that very sparingly. The ejBTect of common virater
is extremely evident upon small birds in a cage. The wood*
hrk is a bird of so delicate a nature, that it can hardly ba
bred up in a cage. A lady of my acquaintance had often
attempted to raise them without success. But lately, by di««
tilling her bird's water, she has succeeded perfectly.

I am, Gentkmen, your obedient Servant^

WM, LAMBE,

2, King^s Boadj Bedford Row^

February 20, 1809.

9f6 Medicine^ [Marchy

Reports on the Effects of a Peculiar Regimen on Scirrhous
Tumours and Cancerous Ulcers. By William Lambe^
M* D, Fellow of the Royal College of Physicians.'-^pjf^
190, 8vo. 3s. boards «

(Concluded from p. 137.)

In our continuation of this Review, we hare selected this
case as the most prominent among them for the elucidation of
ibff author's practice, as well as collecting in a brief point
of view, all the fruit of his as yet limited experiment, and
with it we close our account of this well written book.

^' Case ix.— A widow lady, aged 46, had perceived for
some years an uneasiness in the right breast, and in 1802, she
applied for surgical assistance for a small lump, which had
appeared just above the nipple. It was attended with some
pain, but neither at this time, nor since, has that been very
severe- The tumour was treated with lycal applications,
(the tinctura ferri ammoniac alis mixed with spirit us vinosus
ttnuior) which seemed to contract or flatten the tumour, acting
most probably on the parts surrounding the substance of the
tumour. During the year 1805, the tumour increased, and
in February 1806, a small hole had formed in the skid,
which had become discoloured, and there was a fetid matter
discharged from it. At this time the regimen I have so often
spoken of, was recommended to her, but it was not adopted ;
and I know not what occurred from this time till the beginning
of June 1807, except that the ulcer never closed, but con-
tinued to discharge a serous fetid matter ; once the whole
inflamed, and a number of oval vesicles came out ; afterwards
there was a discharge of a cream-coloured matter. After
this the ulcer contracted greatly ; it, however, never closed,
but enlarged by the gradual destruction of its margin.

" In June 1807., I saw the case. The ulcer was still no
larger than a half-crown piece; there was some scirrhous
matter around it, but it did not occupy the whole gland;
there was a sinus of some depth at the upper part of the

1809.] Medicine. 9g7

ulcer, and some fangui ronnd the margin. Though the
greater part of the breast was occupied by the ulcer and mtr
rounding scirrhus, yet the gland being naturally small, the
whole disease was also proportionably small. ~ The general
health too was very good; that is to say, for a person with
such a disease; for I have been lately informed, that her
health has been delicate many years. However, there was
neither muscular debility, emaciation, nor any other ap-
pearance, threatening a speedy termination of the disease.
-_ " Here then, at length, a perfectly fair opportunity (which I
had long and vainly solicited from the benevolence of sur-
geons) was obtained of ascertaining the effects of this regimen
on the ulcerated Cancer ; for the lady declared her readiness
to follow my advice ; and she has done so most rigorously.
The result has been such as, I hope, will be perfectly satisfac*
tory to the most scrupulous, but sincere inquirer, aftet the
truth. It may be described in a very few words.

. ^^ She left off the animal food gradually, first taking a little
every second day, and, after three or four months, using it
only once a- week : at present she uses none ; nor has she per-
ceived any inconvenience from the t;hange, but has found
herself cooler and more easy. Her strength is now quite as
good as it was at the first.

^* For a twelvemonth there was little change in the diseased
part ; no fresh thickening took place as long as the scirrhiis,
which had been formed, remained ; but once in the course of
the year, the same train of circumstances took place, as
before the adoption of the regimen ; viz. the part inflamed,
a quantity of oi)long vesicles sloughed out, and afterwards
a creana-coloured fluid was discharged. The ulcer then
contracted a good deal, but it still continued open ; so that
at the end of the year, it was nearly the same magnitiule as it
had been at first. When all the scirrhous matter had sloughed,
the edges all around again, tliickened. About the middle oi'
June 1808, she began to feel more pain than usual ; some

HBB Medicine. [Matcbi

hmtnt hage took phce ; this was soon followed by a con*
loderable degree of inflamination^ attended with more pain,
and a much ^eater discharge of waierj matter ; the scinhoui
edges then began to soften and come gradually away in
pieces of aboat an inch long, and as thick as a quilL In
consequence of this, the carity of the ulcer was greatly in-
creased in magnitude ; and the discbarge again assumed the
colour and consistence of cream. This process was attended
with OHich fetor. The dbcharge gradually abated, the ulcer
contracted, and now it perfectly and completely closed up,
the surrounding skin being brought down to the base of tb^
ulcer, and covering it perfectly. So entirely is the ulcer
obliterated, that, except for some relics of the disease, about
to be related, it would be impossible by mere inspection to
determine the precise situation, which it had occupied.

^^ The relics of the disease are these; a small quantity ot
scirrhous and discoloured substance remains, which occupies
the uppo: parts of the original seat of the breast. It is quite
loose, and unconnected with the parts beneath. This, there
being no ulcer, must be regarded to be small occult Cancer*
Immediately beneath this, is a ridge of an inch, perhaps, in
breadth, and half as high at its summit, running downwards^
and rather backwards, with a small curvature, upon the side*
Its whole length is between three and four inches : it is firmly
bound to the side at its top ; at its lower extremity it tapen,
is much smaller and looser, aiid it is finally lost in the skin.
Along its whole length runs a ckep oblique furrow, making
it, in fact, two ridges placed close along side each other ; the
basis of the furrow has no cuticular covering, so thai there
is from it as much discharge as may moisten a piece of Unl
placed in it. From its position, I conclude that the uppor
part of this ridge was an adhesion of the gland to the side.
It swelled, and assumed its present form in July, either wheD,
or immediately after that the remaining part of the glaad
ihad sloughed away. The lower part is, of course^ much

1809.] Mtdkme. 019

Iteloir the situation of the gbuid, aod shews^ in a vesj curious
fnanoer, what was the whole extent of the contaminated part.
Resides these remains of the disease connected immediatdy
with the diseased glapd, the skin is a litUe roughs and tuber«i
pulated near the sternum.

(^ Th|s adhesion seems to have been formed rety early in
^e disease. As fer back as 180g, when first examined hj a
sui^g^oni the gland ^^ was perfectly moveable, except a very
riight attachment just beneath the nipple, and by this the
nipple was rather drawn a little obliquely downwards/' I
use the words of her sui'geon^ in the country, taken firon hb
f»;m8pondenp8 on her case.

'* Since this time, the disease has been stationary and quite
Qree from pain. I saw it in October, 1808, and have de^r
jK»il^ it as it then appeared."

^ Pra^kai Dictionary of Domestic Medicine ; comprising
the latest Discoveries relative to the Causesj Treatment^
and Prevention of Diseases. By Richard Reece^ M.D.
Member of the Royal College of Surgeons in London^
4*. ^c. Royal 8yo,

Popular Medicine has for some years past becotne the
rage of the day, and we are doubtful whether more good or
injury is apt to arise from this species of writing. We ad-
mit there are circumstances in which, to a certain extent,
it may prove beneficial to society. These circumstances are
i^ cases of sudden attacks of disease, or accidents, where
medical aid is placed at a distance. A person on the spot,
even with a superficial knowledge, may, in these particular
instances, apply it with much advantage to society. But the
progress of science induces every one now to read, and has
given a turn for investigation on subjects which do not belong
to them. The random knowledge thus acquired is apt to be
carried too far ; and on a subject so essential to the interests

230 Medicine. [March,

of life, may lead to consequences often dangerous^ and not
unfrequently fatal. The maxiin of Pope applies here with
peculiar energy :

** Drink deep, or taste not the Pierian spring ; —
^* A little learDiDg is a daog'rous tbiog.''

At the same time it must be allowed that those will be more
ready to attend to rules of living, and those instructions ne-
cessary to the preservation of health, who have traced with
careful attention the injuries arising from a neglect of them,
than others who are ignorant, and an idea of remote advicfe=-
will not make the same impression. Map.y of the diseases that^
assail human nature have their origin more in the follies aud_
vices of mankind than any other cause ; and to point out th^
fatality of these may be of service both in a medical and moraL
pomt of view. Sucli works, therefore, as consist chiefly o£*
cautions, and treat of the preventive part of the subject, we
consider more important than systems of practice. The
chief fault of systems of practice is, that their readers at-
tempt to become critics on the regular practitioner, and oftea
form a judgment of his conduct and professional character oa
.very lame grounds, suited to their own limited acquaintance
with the subject. This is the fault of Tissot and Buchan,
and of many other writers of great name. The present work
before us sets out on a different principle. Instead of being
intended merely for the people at large, it is directed for a
class of the community who stand on a different footing.
These are the clergy, and practitioners of medicine, who,
perhaps, have not had all the benefits of an extended educa-
tion. The first being men of science, whose minds are na-
turally turned to investigation and research, will certainly
receive more benefit from such works than any other persons.
They are displayed also through different parts of the country,
where medical aid is often difficult to be obtained, and they
possess an influence on the community, from their sphere of
life^ which makes their sphere of life be attended to and re*

!809.] Medicine. 831

•«pected. A knowledge of popular medicine to tuch persons
is of valucj and they will apply it with a degree of judgment
which cannot be expected in olher sorts of readers. Their
liberality also will lead them to give up their knowledge to
the regular profession where they attend, and thus they will
never err on the head of presumption. Such men will prove
yaluaWe seconds to the practitioner, and be the means of his
precepts being more strictly enforced. The intention of the
author, in directing his publication to this body in parti-
cular^ we consider as highly praisewiprthy. But there are
subjects in this work which do not fall under the general cen-
sure we havo attached to popular medicine. These are what
respect medical jurisprudence. Questions of life and death
are the too frequent subjects of investigation, aud it is proper
that every one who is placed in the delicate situation of de-
ciding the fate of his fellow-creature should be able, from his
own judgment, to form some opinion, and not trust entirely
to professional evidence. We had occasion to state this
lately in the case of Miss Burns, and whoever peruses the de^
tail of proceedings in that trial, will agree with the justice
of our remark. The arrangement of this work into the form
of a dictionary we deem particularly useful. Each separate
9rticl0 contains in full what we wish to know on the particular
points; and a reference is easier made in this form to the
different subjects we desire to be acquainted with than in any
ptb^r. With respect to the execution of the work itself, we
observe that the author's description of diseases is not scien-
tifically intricate nor tediously minute. The symptoms and
causes of disease are briefly but perspicuously detailed, as
well as the most approved plans of treatment. We remark
that much attention is paid to give the pathognomic or dis-
tinguishing symptoms of each malady, which is the most
useful method that could be adopted. The diseases of the
mind seem not to have been omitted more than those of the
jbody. This is a point on which medical works are ofieq de^

Medicine. [Mareh|

fective, aad which this author has properly supplied. To
enable the reader to judge, we shall give an extract from the
article Passions.

^^ Passions have been styled, not unaptly, by a number of
authors, the gales of life; and from them, in the language
of scripture, may be said to proceed the issues of good and
cril. They are the source of every agreeable and of every
painful feeling.

^^ The passions have been properly divided into two kinds,
the exciting or enlivening passions, and the depressing ones.
They operate on the body either suddenly; or in a slow, pro-
gressive, and gradual manner. Death has been known to be
the immediate efFect of the former; the latter generally pro-
duce a gradual decay and consumption. The choleric and
sanguine constitutions suffer chiefly from the violent pas-
sions. The phlegmatic and melancholic ones, whose sen-
sations are dull, fall victims to those of an opposite kifid*
The long continuance of one passion, by harassing out ths
mind, is ever apt to produce bodily disease, and one termi-
nation peculiar to the e^ct of the passions is also apt to arise,
viz. incurable mental imbecility. The cure of ment&l die*
eases has at all times formed the most difficult task for the
physician, so much so, as to render it proverbial. Thm^
in the language of Shakspeare, — ^' who can minister to a
mind diseased?" Change of objects, of impressioas, and
ideas, afford the only nieans for the guidance of reason, and
argument has generally little sway. The early mattagemeat
of the mind, by a proper education, is the best guard against
the mischievous effects of the passions at an after period.
Their controul becomes then a habit with the individusd, and
prevents any excesses which might otherwise spring from
their occasional excitement by unforeseen circumstances*
Hence it may be laid down, as a leading maxim, that the
controul. of our passions is an indispettsid)le requisite to the
proper enjoyment of heatth. But in order to point out tht

.1809.] Medicine. 99B

effects of passions more clearly, it will be neoessaty to coo^
aider each of them separately, and with some minuteness*
-The first of the passions, and one vfe naturally vrvah to begin
with, is joy. It is that state of mind in which there is felt
extraordinary pleasure, and in which a high degree of ani*
mation takes place. The heart becomes expanded; circu-
lation is rendered fitia and vigorous ; the eyes sparkle ; the

rves feel a sensation connected with complaisance and mild-
Hence this state is favourable to the enjoyment, and
efea recovery of health, wh^e it is languishing under dis*
elues of a slow or rooted nature, and of a depressing kitid«
Of this passion, a variety of modifications or degress occut,
wder the names of gaiety, cheerfulness, mirth, &ۥ &c/'

The practice in this work, it may be also remarked, b not
liftble to the imputation of inertness, which pervades the
jftftacims of Bucfaan^ It is active without being too bold, and
t«ch as may be employed with safety. The reader will be
aUe to fi>rm hb opinion of this by detailing the practice
feecom^ended in gdut.

'^ Treatmeni.'^Vhe treatment of the gouty paroxysms
altist be ijpxkd according to the age of the patient, the mh-
4Ural strength of his constitution, and more particularly
•ttiQeording to his previous habits of living. Indeed, so vari*
4M8.are the constitutions of gouty people, that it is imjtossible
to lay down a general or invariable plan, eithpr for the cure
of the paroxysm, or the prevention of its recurrence^ which
are the two indications to be attended to in its treatment. On
til^fipproaeh of the fit, it will, in all cases, be proper to Clear
the stomach and bowels by a brisk aperient medicine.*'

On the whole, if popular medicine is to be useful. Dr.
Reece has adopted the best plan ; and by enriching his work
with a coj^ous Pharmacopceia, he haa added to its value, as
the forms seem well adapted to the purpose intended. This
lietn^the first dictionary of popular medicine, we hope it will
itteet the ap'prolbatroi) of those for whom it is intended; and

TOL. II. R

S34 Medicine. ' tMafcb,

we give the author much credit for his industry in bringing
forward such a work, which will not fail, from the other
specimen he has already given, to meet improvement in a fu-
ture edition.

. FATAL CASE OF PASSION, ATTENDED BY DR. BUCUAN.

To the Editors of The Medical and Surgical Spectator •
Gentlemen — The influence of the mind on the body is bet-
ter felt than understood. Thatdeatli is capable of being pro-
duced by violent affections of the mind is also admitted;
but that it should happen in an instantaneous manner, as if
struck down , is rather uncommon. A case occurred about ten
days ago in Tottenham-court-road, in consequence of adispute
on some trifling affair, in which a female was hurried into such
an extreme of passion as instantly to drop down. Dr. B»-
chan, of Percy-street, who related it to the writer, was cal-
led in, but life was so completely extinguished, that every
attempt failed to produce the smallest symptoms of resusci-
tation. The patient had been in perfect health before, and
the influence of the mind was so powerful, as to produce at
-once apoplexy in its most fatal form. From the v^tability
of the female system, such an efiect is certainly more apt to
hap{)cn with them than men, and causes of provocation should
-accordingly be more studiously avoided when they are oon-

cemed.

I am. Gentlemen,

Your obedient servant,

■Tottenham-couri-road^ AN OBSERVER,

Feb. 20, 1809.

COMMUNICATION ON CUTANEOUS DISEASES, BY T. M. CATON,

M.D.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — Of all diseases that occur in practice, tlie
most perplexing are chronic eruptions of the sluu^ the

1809.] Medicine^ 235

cause of which is obscure, and cannot be traced* These are
at present too often met with t and in such cases I have
followed with success a practice first pointed out bj Dr. Clarke
of Dominica, and first made known in this country by Dr.
Garthshore. It is the oxyd formed by a combination of
minerals, particularly the arseniates of antimony and
mercury.

The arseniate of antimony is prepared with the acid of
arsenic, and the crocus or vitrum of antimony, in the same
manner^ and nearly in the same proportions as the autimonium
tartarisatum, only witli a larger proportion of the acid
arsenici filtered, crystallised, and pulverised. So powerful.
is this medecine, that one-twelfth of a grain is sufficient for
a dose twice a day, which may be gradually increased to
one-eighth in the same manner* This will be found by every
one who uses it a most powerful and successful remedy. Dr.
Clarke states it Ls an almost certain cure in leprosy. Its
action is by sweat, the most certain method of producing a
fevourable issue in cutaneous diseases. As obstinate eruptions
are alleged at present so {frequently to succeed vaccination,
and which have received he appellation of the Psora
So'oillay this medicine will be found one of great importance.
In looking over Dr. Willan*s extensive work on cutaneous
diseases^ I am surprised to find no mention made of this
preparation. I am convinced it would only require a trial
from the ingenious author to make him adopt it in that line ,
of diseases which forms so much the object of his attention.
I shall in a future number make some farther remarks on this
subject. The present communication is meant to draw the
profession to the use of this remedy.

I am, Gentlemen,

Your obedient Servant,

i^ci- fS, 1809. T. M.CATON-

R S

936 Mtdkine. [Malch,

OJ« THE MBDICAL I^EPAETMENT OF TRE ARMY.

Tc the Right Mm. Sir James Pnlttney^ Bart. Secretary at

War J Sfc. Sfc.

^Sir — At a time like the present, when the exertions of
the state are called forth in the most energetic manner
to serve^ what no Briton would perhaps wish to acknow*
ledge, a sinking empire, it is the duty of every individual
to add his mite both to amend what is really deficient in the
execution of any department, and also to propoie what may
add to its energies, and improve the benefits it is intended to
extend. Parliament has abnndantly seen the necessity fi^r
this by the establishment of the Commission bf Military In-
quiry ; in a communication to his Royal Highness the<Com«
mander in Chief, I some time ago pressed on his attention
the necessity for a code of Military Medicine aitd Surgery,
drawn from the reports of the Army Surgeons at large, so
as to include the whole exjk^ri^hce of that department. As
the subject comes equally within your official ndtice as hi&
Royal Highnesses, and sis it is one, the preisent defects of wliich
cannot have escaped your observation, permit me to con«
firm the reasons I then urged so strongly for the improvement
of this branch of the service. I can have no doubt that
one like you, who serves bis country without enkolument^
c^m only be actuated by the highest motives of honour and
patriotism; and from a conviction that the present plan
will meet the fuH approbation of such a character, t sWl
beg leave to lay before you the outlinet of the numeroiia apd
impottant topics, which a code of medical regulations^ such
as proposect, would embrace.

Education. — The ficst object which such a code should'
naturally consider, would be the proper education of a military
practitioner, and the circumstances in his professional studies,
to whieK^ Be ought peculiarly to bend hb special attention,^
with a view to his fiitare Une of practice*^ This Imng jtomt^

4809.] Meikine. flSi

od out and settled upoA^ he is next to be regarded as making
bis debut in the senrioe*

Inspection* — One of the first objects here, on ^hich he
wUl be frequently consulted) is the Inspection of men. He
should not only be able' to judge that they are free from
disease; but his knowledge should extend fiirther. He
should be able to determine the state of the future man from
the appearance of the lK>y, and the particular service for
which each recruit will be best fitted, and give his opinion
accordingly.

Outline of Practice. — In the actual discliarge of his
medical duty, two great points ought to be embraced by him.
7he first is the prevention of diseases ; and the second is the
adAial cure of them.

Prevention of Diseases. — If attention b paid to the former,
much oTthe disagreeable part of his duty will be avoided,
and an army will be often kept effective by a strict regard
tp a number of simple and apparently trifling particulars in
what respects the regulation of barracks and quarters^ of
diety of clothings of sleep and watching^ of exercise and
discipline^ which n^lected, lead to serious evils, and the
xxrtain injury of thfs service. In fact, the military practitioner
who is conscientiously to perform his duty, must look more to
the avoiding of malady than the actual cure of it ; and with-
lOttt entering into the ntmu^to of a soldier's life, he is unfit to
perform the most important part of his task.

Hospitals. '^The cure of military diseases is conducted
chiefly by the establishment of hospitals; certainly the best
plan, as rendering every patient more immediately under
medical direction and controul. Military hospitals are
accordingly one of the first subjects for a medical practitioner
to study ; and their regulations should be formed on such a
/Scale, as* not only to comprise af set of general rules, but they
fthoiiild descend to particular regulations for all the chief forms
^fdisieascs to which a military life is subjected. One of the first

bS

tSS Medicine. [March ,

subjects here is the precautions that ought to be observed on
the introduction of patients into the hospitals according to the
nature of the diseases. Fevers and dysentery elaim this at<p
tention in a particular manner, and demand a minute set of
restrictive directions.

The treatniiMit of the sick in the hospitals must be regulated,
besides the form of the disease, by the various circumstances
of climate and situation, having it always in mind that military
practise requires bold and energetic measures : and that the
absence from duty in the day of actual service is perhaps an
irreparable loss to the country. Hence the necessity of a
medical practitioner possessing superior professional know-
ledge to others, much decision^ and a great deal of acquired
experience; nay, his judgment will often decide him to
abandon the hospital system, to choose insulated situations
for the sick in warm climates, rather than croud them
together, when it is known to prevent or retard recovery.

Camps. — There are two situations you, Sir, know well, in
which the life of a soldier is passed ; either in quarters and
barracks, or in the camp. The latter is the situation in which
he is most exposed to diseases ; and much depends on the
medical practitioner to avert these by judicious advice, and
by a knowledge of what will oppose the evils that would
otherwise arise. One of the first pointjs here is the scite of
the camp, or the spot where it ought, to he formed in regard
to salubrity and convenience. The next is the most
proper mode of fitting up the residence of the meh ; the
3d is, the regulation of their conduct Avhile in camp : and
thelth is, the actual treatment of their diseases.

These are a few only of what I may term the preliminary
subjects that belong to a military practitioner ; but even these
give rise to observations which cannot fail to strike, one of
your experience in military concerns, and to point out the
necessity, iu order to the welfare of the service, that the
CQmxnander and medical practitioner should thoronghlj

1809-] Medicine. 9S9

tmderstand each other on these topics. The commander is
to see that the surgeon performs his daty, and the surgeon is
to give the proper advice to the commandep in what may
affect the health and convenience of the men. No commander
Clin judge whether a surgeon is competent to his duty^
without some code of regulations or instructions to give him
information; no surgeon can execute his duty without
hwing experience on the different subjects that constitute
the foundation of it; and which, if he wants a set of proper
regulations^ such as are now pointed out would do much to
sfipply.

That improvement is wanting in the medical department, I
havethe evidence of the Report of Military Inquiry, which ex-
pressly declares so, to confirm . In his interference at different
times no doubt his Royal Highness, as commander in chief, has
made every amelioration in his power, as far as suggestions were
imparted for his consideration. Bat the professional characters
the commander in chief applied to had nowish, and what is
nearer the truth, no interest in making alterations that would
only increase the duties of their situation. Trifling changes
therefore, of little moment, could only b» looked for* His
Royal Highness not being a professional character, could
not be supposed to find out a radical cure : but common
sense, and the general opinion of mankind, will both concur
in this fact, Gi'oethe military practitioners the proper share
of knowledge they ought to possess^ and this is the highest
of improvement in this department that the service requires.
That the present plan proposed may be termed a radical cure
will not admit dispute; for if medicine, which the profession
are unfortunately compelled to acknowledge, is at best a
conjectural act, the great improvement it requires is to place
it as far as possible on the fixed basis of united collected
experience, and not leave its application entirely to the
caprice, gnorance,- erroneous judgment, or inexperience of
jBoung militAry practitioners, to giViS certain ^stabli&hed"

]t4

MQ M^ciue. [March,

^ta to go by, certain I^nd marks to carry tliem through the
abyss of professional doubts and difficulties, and to clotba
the gr^aborn with the garment of experience, and the i¥is«
dom of age. In doing this, Sir, you will also obser^, the
present plan makes no lofringement on the present order of
tilings X it includes every improvement which has consefron^
other quarters, while it strikes at the foundation of every
defect without erasing a stone of the present superstructure.

With these important facts kept in yoqr yiewi I proceed.
Sir, in my detail,

The introductory subjects already stated lead to the
main object, vi^t the varied circumstances which the treat**
ipcnt of disease, and the restoration of health and vigour in
military l^fe demand, In tracing this we are led to consider
the various stations of military service, and to point out
what is peculiar and importan|, in each, — The doi^inioiH^
belonging to the British empire are so extcadad a3 to form,
in a medical view^ no less thaQ six diJeretU medical atfUiofUi
and of these, the first> and perhaps least iir^poftfint of tb«
whole, is the home station^

Home SttUion,'-^he diseases of Britain may be divided
ii^ta those of the winter, and those of the summer moivthSf
They differ from the diseases in civil life less than in otiiev
luilitary stations, because the service of the home station is
regular and established* No ei^traordinary exertions atteiid
it, such as in scenes of action, and where war is the busiaefl^
of the day. Jt may be ooi^idered merely as the school oi
discipline to prepare iTor fpreign seryice. The pauses of dif«
ease here are also less varied, and they arise either from
vicissitudes of weaiher^ cir ei^ctps and indnlgei^ce. They
occur in subjects also thai ^mit a bpld and energetic pcac^
tice. On these acpomts, the diseases of the home station are
not the field to giyo experience to the military pradiiiioiier.
They want the malignity of appearance ; the rapid pragross^
a^^e4^tructi?e,r{^¥itjj;es which attend tl|e stops of disease

1800. J Medicine . HI

w^ry closely ia 4be forelgo stations. The surgeon ia Brilaiii
may trtist a great deal to the efforts of nature for the recovery
^bis patient, and recovery will take place, though tha
{service may be longer deprived of the attendance of the meQ
oo duty.

Leaving, then, the further consideration of the hooie
Utation, as admitting a more regular, simple, and defined
practice, in the exercise of which abilities and superior expe^
rience are less required, I proceed to direct your attention to
services of more unhealthy occupation. But before com-
mencing this description, permit me to state the necessity of
^n acquaintance with certain preliminary points, whlcb^
you will perceive^ form no less an object of the surgeon's
duty.

Introduction to Foreign Stations. — These are, the pre»
cautions to be observed in transporting troops. As troops
for foreign stations must all be conveyed by sea, the best
nethod of shipping them is certaiply a subject of study;
their accomodation also while at sea is connected with it.
The various circumstances necessary to the preservation of
their health in this situation are no less important objects of
ijBquiry^ as well as the most suitable treatment for such com-
plaints, as arise during their voyage, should these precau-
tions prove insufficient. Without a due regard to all these
circumstances, it is clear the troops will be unfit for service
when kuided, and the very object of fitting out an expedition
f(^ a foreign station thus defeated. These, you will allow^
are topics highly interesting to the military practitioner*
No man can acquit himself in these situations, or give dirocf
lions by intuition, and wheise, under the present system, is he
to find regulations and instructions to point out bis conduct ^
It is not a lesson he has been taught at school, and till he ac«
quires it by personal experience, he must commit many
serious blunders^ These are plain truths that must speak to
your mind, and to the conviction of every amu without thm

H9 Medicine. [March |

possibility of denial. I shall, however, suppose (he troops
are landed : I shall next trace the various circumstances in
which the foreign stations differ in climate and diseases from
(he home service.

The Mediterranean Stal ion. ^-'Yhc first of the foreign'
stalions, and one of the highest interest at present, is the
Mediterranean, which includes the three sdtlements of
Gibraltar, Minorca, Malta, and perhaps also Sicily.

This station may be considered as an intermediate situa-
tion between tlie service of Britain and that of the tropical
climates. The diseases of this station resemble those of sum-
mer in Britain, and do not make that rapid progress which
distinguishes those of the tropical regions. They consist
chiefly of fevers, inflammatory afl^ections of chest, and dy-
jsentery. The affections of cliest are evidently the conse-
quence of tl>e sudden transition from the variable climate of
Britain to the more steady and tenj iterate atmosphere of the
Mediterranean^ The dysentery, though connected with the
same cause, is too often augmented, if not produced by the
excessive use of wine, a beverage to which troops from the
mother country are unaccustomed.

The certain attack of these diseases, and the mortality
they produce, will point out to you of what importance it is
to prevent them, by a proper attention to the health of the
men on their passage, by lowering the inflammatory habit of
the colder climate, and taking such precautions as may render
the action of any morbid cause on their arrival less ^ectual.-
Nor is an attention to the regulation of diet less requisite.
The directions respecting this should be properly laid down
by the surgeon, and enforced by the commander. It is expe-*
rience, and experience only, can teach the means of doing'
this, and impress the necessity of its being complied with.

West'India Station. — But the topical • climates are the-
fertile seat of disease, and none of them so much so as tht*
West-India station.

l^.j JkedMne. 243

The mortality of the West-India islands has been long
and deservedly a matter of the deepest regret, while they forn\
aneof the richest gems of the British crown, yield a revenue
highly productive, and prove the greatest nursery for the
naval strenglh of the country; this revenue, and these imr
portant advantages, it must be admitted, are acquired at an
expence of population to the parent state alarming in the
highest degree. Nor has this mortality been confined at any
time solely to the period of war. The same ravages of dis-p
ease have embittered the enjoyment of peace, and the laud-r
able career of enterprise and industry displayed by the emi»
grants from the mother country, is too often cut short, ere
they have well fixed themselves in their colonial situations;
and much more does this mortality fall upon the troops.
The mortality of this station-has, indeed, b^n long prover?
bial ; of late years it has increased by the appearance of a
new disease, rapid in its progress, and fatal in its nature;
this is the yellow fever, or what may be more properly
termed, the plague of that hemisphere. On the treatment of
this disease, you are aware much difference of opinion pre*
vails even among the most experienced of the profession.
This being the case, is it not proper that sonie general regu-
lations should be drawn up for the information of young
practitioners ? In a disease of such general mortality, is it
fit that every practitioner should be left to his own discre-
tion? Besides on this station there are not only diseases
peculiar to the climate, but also to certain parts of it, as
witness the peculiar diseases of Barbadoes, which are totally
unknown in Europe, and do not yield to European practice.
How is the military practitioner to know these without
directions ? and what directions would be so fit as those drawn
up in the manner I propose ? On' such points, I beg. Sir, you
will pause : they cannot be answered or contradicted.-^ But
if the mortality of the West-India station is so great, ought

pot precautions to be taken also in the pasi^^ge of the troojps,

S44i Medicine. [B|ai€b|

io guard as far as possible against tbeir attack ? Ought pot
the regulations proposed ivith this view to be pointed out, am)
in the possession of every military surgeon? And ought not
also a similar medical attention to the conduct of the troops
upon land to be enforced| in order ijo prevent excesses which
may render the causes of disease more active i

East-India Station. — The next military station in poiqt
of importance is the £ast Indies. Here, from the extent (tf
territory and the variety of climate, a wide fi^ld opens fof
the conduct of the military practitioner. For this station n
separate establishment prevails, under the ilirection of the
East India Company, and one in many respects, if you, Sir,
will take the trouble of investigating it, superior io the me^
dical establishment of the other pai<ts of the empire* But
still, though the surgeon, from the constitution of the esta-
blishment, and the promotions by seniority, comes sooner
to be a man of more knowledge and medical acquirement
than in the regular establishment, yet his first onset, his det
but, labours under the same disadvantages and imperfectoins
as elsewhere* The variety and extent of practice require
experience and observation, which he wants* Tlie diseases
are also many of them peculiar here, and difiqr from those of
the other tropical regions. Witness the Berbery of Ceylon^
a disease only known in that quarter*, The troops also are
Iwo-thirds natives, under the name of Seapoys, whose di&«
eases and mode of living are different from European troops*
You, Sir, will also be pleased to remark, that while dyseoterj
may be considered as the most fatal malady of troops in
other stations, and may be viewed on land in the same light
as scurvy at sea, hepatic complaints are the most formidablt
on the East India station. All this a military practitioiier
may be told in general, but this giving accurate and minvte
directions is the only plan that can lead to a successful prai>-
tice* The more the present subject is prosecuted| the xyuKa
jOttwill be convinced of the propriety of the suggestiom

1809.] Medicine. f&

noir addressed to your consideration* Bnt I sltaU: proceed to
tlie remaining stations.

America J as now c^n to the British troops^ confines their
situation to the province of Canada, the temp^nture of
which may be riewed as the climate of Britain in extreme*— •
Long and severe winters are succeeded by short and scorch*
ing sttrnmers ; the winter diseases are thefefiMre highly inflam«
matory. Those of summer tend to a prutrescent disposi«
tion« Though this station does notafibrd the same field as
the tropical ones, yet you will admit, that hardening tixx>pi
fer this climate is a point of important Cbnsideiration.

jS^gj^/yf •— -The last, and perhaps what may be termed only
an occasional station, where troops are sent to^ is £gypt ; a
country peculit»r in its climate, manners, and diseases, the*
idi^ues of which the troops of Britain have e9tliy day cause
to deplore. The two chief diseases of thi» climate are (di^ae
and ophtfaahnia. You, Sir, from trhat you have seen, wilt
not surely deny the necessity of experience in these.—*
Measures to check the progress of plague have met the en-
eoiiragement of every government in Europe, and io sessist
the treatment of Egyptian ophthalnlia, it has even been
fttihd necessary, as yon know, for the inspector-general to
draw tip directions. If these directions are of any use on
cme subject, why are they not extended to the whole, and
Whete b the plan equal tpo what is now suggest i The
fttiii d atibtt of all science is facts drawn from experience ;
experilshce, unless drawn from others, is the slow ofispring
of time : it can only be matured in the manner I propose.
Ih finishing this outline of the diiKrent medical stations of

9

miKt&ry service, an important subject remains for your no-
tice, the precaution that ought to be observed in the change
of troops from Britain \o the warmer regions.

Seasoning of Troops. ^i is well known the humaii con-
ifiti&tfon. can accommbdJEite itself to every change of tempera*
tilit wilhotit dai^^, if changes are brought on byckgrees*

f4d Sttrgery. [Matelt,

II. SURGERY.

•

The leading merit of a practical Surgeon is to be found
more in bis proper management and mode of regolattng in-
ibmmation tban in any other part of the science. ^ is by
this process all changes of parts, whether morbid or salutary,
take place, and to terminate it happily when of a morbid na*
ture, or to render it an active agent to produce a successful
issue, are points that require often much judgment, nice dis*
crmination, and a proper knowledge of the powers and ener*
gies of the liring machine.

This might be instanced in a vast variety of cases, perhapi
iht radical cure of hydrocele by injection is one of the most
striking examples. If the inflammation here is either excited
in too high a degree, or does not reach the proper height, the
operation in both cases will fail of its efl^t in completing aft
adhesion of the sides of the sac, and the surgeon^s after-
management entirely guides the success of the opcsation*
The treatment of inflammation, then, may be considered as
the beginning and end of all a surgeon's knowledge, and hit
attention to it cannot be inculcated too strongly.

Next to iuflanunation, the treatment of wounds is a sub-
ject of great importance. To be able to determine what na-
tnre will do from a dose and attentive observation of her
efibrts is the summit of practical knowledge in thia brancb*
In the human subject, her powers are not equal to what she
displays with the inferior animaliB. The cIlErvr of a crab will
be entirely renovated when torn ofi*,. and an eel cut in pieces
will renew its lost parts. In man, however* nature proceeds
to renew her work witb a sparing hand ; yet still we are at
times unexpectedly surprised with cures which could not
be looked for. It was perhaps from this fact, though not
frequep^, tbat^lguer, surgeon to the great Frederick ef
Prussia, laid aside entirely the operation of amputation in

ISOd.] Surgery. lift

gunshot wounds. In this Mray^ certainly many iimbs were
saved; but whether the inconvenience arising from tedioui^
cures, aud the incomplete iise of the member afierwardft
might not counterbalance the advantages attendant on pre-
i^erving it has been doubted by many authors.

llEPLY OF nk. ilEECE TO T. B; dN ADMIRAL HENRY's CASE
OF CATARACT, WITH THE ADMlRAT^S OWN STATEMEITr.

To the Editors of The Medical and Surgical Spectaior.

Gentlemen-^^lv your last number^ an explanation is lei^
Quired from me of some particulars in Admiral Henry's case
bF Cataract. Whether the obscurity stated by your corr&«
spondent is owing to the sublimity of my style^ as hinted^ or
to the fhult your cbrrespdndent attributes to himself, I shall
not determine. I have thought it best^ however^ to malU^
the gallant Admiral tell hb own s^ry, which ^ like the pro*
<:eediiig of a teal British tar, is more occupied in the state*
ment of facts than the frivolity of ezpressioii.

I am^ Gentlemen, your obtdieiit Servant^
BmriHta Street^ Feb. 15. R. R££C£«

Dear J^ir— 'I received your favdut df th^ 4tb insti yes-
terday. With a phial- bottle about 5 in* long, and about |
inch diameter^ I puilcbed mjr eye, and rubbed the eyeball
from side to side^ with as liiUch violence as I coilld possibly ^
iiear, and with tlie rim^ at the mouth of the bdttle, I did the
tame yip aiid down ; when the eye would no longer bear sd
Violent an applicatibn, I let it rest a few days or a week^ and
HSpeated the operation as soon as it would admit of it. The
tomplaint in my eye was a CatitMu^^ and by the above me«
tbod| I suppose an absorption took place^ and I see with it
just as trell as if the Cataract, had been extracted 4 I see to
read the smiiUe^t print in the newspapers with a glass of S^
in. focus, and I see, things at adistance tolerably wdU with;
ijfhe of 3) itt* focus, but with neither glass, so weU a« whts

*50 Sargtfi/. [Blanftfi/

the eye tf as goml . Both my eyes had Cataracts in fhi;my
one Med afler extraction Rrom inflammation and tire s^ht i»
totally lost.

Tox the gont and i&enmatism I recommended Ijfte nanr
instrument, and to be applied iirthe same manner to the partir
affected Tvhen the fit is off; irifththe addition of pinching the
ports with as viuoh strength as the fingers and thumb can
give* The phial shonkl he worked uj) tight, and the cork
cut dooe to the glass* I rcxsooimended a phiul because it
never breaks up the skin. It is always best tn x>perate for
tbegotrt or rheamatiiim in<me's bed; I mean tobe icr Lon*-
tei in May, when i shall be glad to gii« any iiuther ia-
ioroiatiROii in mjr power.

I ans Sk^ your AKKtobodieat SerYiuiti

#OHN HENRY.

ITiroM tire til^TOte Statement I t^n If ate no idottbt t^
sorption of the lefn^s mttfft fiate Yalien >[4awe. Tte
iSelwg articotetefl to the ^tfpsnte, 4mt in a slight man-
ner, a'ny change which may profiu06 a vepaiatum «iv
casions tiie iens to become then an extraneous body
floating i* the humour^ and its vitality being tlius destroyed^
il iMst «hrtt»k and be absorbed. It is only in this way we
eafli 'aooouirt for cures cf cataract frequently taking place io-
tb^ btfndk of <!he suigeon, vi hile preparing the patient for the
open4k>fi. The fre%uent examination and irritation of the
^y^ inay in the hai^ned state of the lens produce this s^ia-^
MMttUn stated, «Ad tffe -absorption in consequence ef that go
on^ Thtft irtstaoces of the -absorption of the capsule alsa
iaSi^ |>boe baB been pff»vdd> But the qpinion suggested, wc
MDoeite tbis vaiii^^r of the tNi^ and -as no ^isseoUons 'have
b^nmadls to tfSiOertMa this ciscumstance^ thoqgh the fact of
aifteh tresis Mffioientljr established, the explanation that it
aafte(rt«nd«Hnf>lest,tind<lMB4i0t xe^fuiie the exertion <of ex-
traordinary po^Ym ia the pait, is the one to bt ade^ted*

THE |3A«E 6lt A »OT WHO fiWAIiLOWEO A HAtiF-ttENffY,
FROM THE eOMMUMCATION OF DR. BLEOBOROUOH.

The foUowiHg eofniBunication was gi^en vhd Doee hj Mff
eonfspoA^ent, Dr. Bt^borougb^wfaose avocations at preae^
did not permit bim leisure to commit it to paper. Tbe easfe
it singsUr, fif leading 4o fiev^ral important conclusions.

The 60A of Mr. T)iorapsoH, coacli«maker, of Pleasant- taw,
{tlack£riars-Foad, a Bay of three years old on the 90th of June
imiBi, «A tiiie Sdth ib( Ooteber cicddentally let a tiaif-penny
^w» bis throat, lor we cannot say he ^swatlowed ft : it eon*
tinned in Ike guHet.to the Slst Jamniry, when it^was ilis*
charged in a fit of the hoopiBg-eeugfa with which isfi hvA
fceen reused. Dii^ring tlie whole jof this time the Io(]gtnent of
this egrtiuneous body gaye no ^neasfness, thongfi it could be
even feK, and on carefully inepecling it, it does not appeair
to have fiuifered any solution or oxydaliou from the action
^the animal fluids secreted in its neighbourhood, and coming
fH eontact with it. A similar case occurred to t4ie same genr
tkomn «eferat years ago, which was retained for iht same
length of time, and also gave no uneasiness: it was at hat
brought up by a strong exertion of vomiting.

fVom these case? the following conclusiooe mky be 4rawii<$

First, 7hat the gullet is a part of little sens^ility; 1^ it
is capable of much extension, witboi^t incoHvenienee ; and
that fJiough possessed greatly of rausquUr fibres, which are
-placed both iu a longitudinal and circular direction, tiiey
4o Bot eeem to possess tliat etrong kiitabUity as in other
parts. Unless this be the case, how ejfe we touccoant'fox
the retention of sulpistauces fqif sucb A kiJ^h of time without
inconvenience and withoiit pain. ■ 3ut thi^ jl^^ned iirit^*
bUity would jseem as if confined mpre to the u,ti.(kr til^Q Qjppipr
jpart of the canal ; for the occurrence pf spis^^m apd otb^r n^jr-
Toi^ symptoms are pi;po& that no Ij^^^n^ JJ?l^tal>iUty preyaJUi
At the comqienGi»ment of iji^ passage.

A mwnA cw^ioo ^o l^ drAWd j&cw thv Accid^ i^

>S5f Surgtrjfi [Blarctr^

that the secreted fluids both of the mouth and throat possess
little power of solution* Whatever activity the saliva maj
receive on passing into the stomachy and mixing with th«^
gastric juice^ it is innoxious^ it would seem. in its original
state.

A third conclusion to be drawn is^ that copper, however
virulent as a poison, is only rendered so by oxydation, and no
acid being present to produce this chaHgc, even if aocidentaUy
produced from the food and drink passing into the stomachy
its application does not seem to have been made sufficiently
long to ensure this eflkct. The halfpenny appears, on in*
spection, to have no marks of solution.

Since writing the above^ a still more remarkable case of
the same kind has been mentioned in Mr. Capon, whe
formerly kept the Crown Inn, Lowestofie, in Suffolk. This
person accidentally getting a crown-piece into his month, it
passed into the throat, where it was retained for several
years, and at last was brought up in a fit of laughter*
No inconvenience occurred during this period from its
retention.

Practical Observations on the Diseases of the Joints^ com^
monfy called White^swelling ; with Remarks on Caries ^
Necrosis, and scrofulous Abscess^ in which a new an4
succes/ul method of treating these complaints is pointed
cut. By Bryan Crowiher, Member of the Royal Col-^
ledge of Surgeons in London^ and Surgeon to Bridewell
and Bethlem Hospitals

(Continued from VoL II. page 16S.)

lit olir continuation of this useful performance, vre [have
to observe that many of Mr. Crowther's ideas on this
subject are tiew and all very important : our limits will not
'permit us td make many extracts, therefore, we shall conclude
this Review with the Author's statement on Necrosis.
' '< JTjie soft partg iaVes^g the bone which ia undeqsdbf

lEdd.] Surgery. 9SS

necrosis, suffer in. tbe same maimer as ^e bare deseribed
in "wbke-swellings : . they inflame and suppurate^ and at
tbis period the patient is brought into a very alarming and
bazardous sitoation. To relieve this complaint, an operation
hm been proposed, that of denuding the new osseous shell,
and perforating it with a view to extract the sequestra* la
aome cases, in which the bone has become dead to a small
extent, and is thinly covered, such an attempt might be
feasible ; but in the majority of instances, and especially in
tbe thigh bone, it must be utterly impracticable. — AmputatioA
might certainly be performed in tliese cases, but not without
the probability of extensive exfoliation. I can recommend
a mode of treatment which supersedes the necessity tif
either of these formidable operations, which indeed is
exactly similar to that adopted for tbe relief « of soft parti
corering a diseased joint. .

^^ Theoccasional application of leeches, combined with the
use of blisters, and the savine cerate, wiU ohrhte the
occurrence of abscess; a most important point in tbe
treatment of the complaint. If the external parts are kept
free from disease, by these means, the absorption of the
sequestra wQl in process of time be efiected. The extent
to which these remedies must be employed, and the frequency
of their repetition must depend upon the irritation excited
in thie external parts. If there is an interval of ease, and
the limb is neither swollen or tender to the touch, tb^
treatment may be interrupted for a time; but whenever pain
is again felt, the use of leeches must be immediately resorted
to ; and when ease has been procured by their applicatjoji^
blisters and the savine cerate must be again employed^ The
first case I ever treated in this manner^ I mistook for a
disease of the thigh bone. The patient became so weU as to
quit St. Clement's Workhouse, to which she r^urned after
an absence of above six months^ in a bCfC^iQ ^^nd miserably
ledttced condition, having just quitt^ a hig^piial, ki wbicb

• 3

IKM Sm-gitry. [MMct,

ika bad hem folivated. AUbough I ^ik^dedad ift pitfMi{i%
the formaiidfi of abs^esi^ ^b« died iii thf^d wedti^, abd
afibrded me an oppifrtniitty df <fianlinit)g iMir disease, wbi^b
I foaod to bo A6driiii§5 atid itot^ dd I £rst «2ftminM) a csarhHis^
Ifoiie. Ihftte bedn equally ^Udc^ftfiil^ arid tef» ighdfuiit df
the natlire &( tbe da§€» ih dtbei* infttaneds ; but I Will ildt clabli
ibe m^tit lif being the original {yfopOscfT of this tndde of
Mes^tment: ibr whc^fi 1 ^OmMUnicaicd tirty tiotioHs Oil tb^
subject to Mr. ADfett^fitiiv^ I fouad that h^ had alUMdyiA
bi6 leetuirds ptoitiul^tftd tbis doctrine ; to him Hbttthtt
msukbind is mor^ lairgdy iudebfed fot tbe v^fhltieM .tird
propmty Of this mode of tt^id6At, than may bate beeh
bitherto oohc^itedi I only kAOw^ that If6 think alike oii
tbe dttbjo^t of ciii^, and shall teaVt* to his Much IftOre abk y&A

Iba paUioation of his o\f n rematk^. ' '

bjf Mt, Fk Kiertt&n, Member oj tht Roytil Ctllege 0f

Surgedm^ London.

To th^ Editors 0f The Medicd tnd Stttgkdt ffpedtttor.

O^nikmat'^iio disease i§ perhaps so little In tbe po>mr
#f the Safgeon as tbe treatinent of Gonorf h(«a. That it will
•pontatieonsly eease without any means, pmotitionen agtoe^i
and ooniequenees ofteq arl^ from this apparently simple af^
Jfe^tion^ which equally sufpHse and distress us. I allude
bore to some peculiafr ai^tiotis which hate been mentioneil
by authors as immediately succeeding^ sudden suppyession dT
its disdiatgUv and which has led of course to a oonfirmation
of tbe Opinion fbrmeriy entertained ^ that thete was mmt^
thing critical in it& evacuation ^ and that the modes of prats
tice should be such as promoted it. The laws of sympathy
Weareas'tyetnot suffieiently aoquainted with, and therefbM
ti^deby tbem and their consequences, would be presuming
t(Mi tsoTi thouf b 40 admit them {mplidtly, would satou?
ItHtt^lf at tiva aoma. tfaM tf t»«dulity . All il|e aifectiottj

■

aii^ng froHL tliis tomce, are marked by a Tiolence of «jrmp«
•toms uncommon to the OAture of .the disease, and twoofthecu.
bave beea particularly in^sted oa, OpUthalmia and Deaf-
ness,

Both of these afiections are attended here with the moat
acute injSammation, more sq^ perhaps, than in any other
case, so as totally to destroy in a few days, if continuing, tbff
functions of the respective organs. TJie foi mer pf these way
first described by Mr. Ives iu his Treatise on the Diseases qC
the Eye. It was afterwards taken notice of by Dr.* Astrue^
and is lately mentioned by Dr. Swediaur : and other in«
litances of it occur in different periodical publications. It ii
Aow by more modern Writers assimilated with theEgyptiaa
-Ophthalmia, and supposed to derive its origin from a similar
«ourc^ The eye in this case becomes reddish and inflamed|
with copsiderable pain, and a constant flow of tears* Tbf
€ye-lids likewise partake of this state, being swelled so ^ not
,U} cover the eye, aud a thickish yellow matter <xa£a frpji}
the ^aceous glands. The disease, if continuing, is soon
attended with an opacity of the cornea i wd though $y iup«
toms of lues frequently affect the eyea^ yet ihey are u^ver ^t*
.tended with the daoger of the present complaint, as if not imr
isediately relieved, blindness commguly ensues in a f^w daysf
The cure is effected iu two ways : either^

1st, By recalling the original disease ; or 2d, lessening iu»
llammatioa in the part, by scarification of the conjunctiva,
and other topical means of removing increawd action, . ,

Deafness, the other affection from the same sQurce|is^eq[ua^y
violent in its symptoms with 4he former, attended with most
acute painsy and tuppvration soon forms, and the structure
jq{ the ear coming to be destroyed, the loss of bearing is
never to be again repaired. The method of treatment i^
much the same with that of opbtbfdmiai allowing for the dif*
ferent structure of parts, and the grand poiut i^ in ^l these cases

i 4

*56 Surgerj/. [Marcli^

to 8ubdae the actiriiy of the inflammation before' ft pass into
any secondary state, particularly suppuration •

Paralysis has been also mentioned as an eflfect of Retropulsed
Gonorrhcea. It is generally partial, and in the 6th volume of
the Medical Commenfariesb recited a very remarkable case of
this kind, which obstinately resisted every remedy till a
Mercurial course at last being begun a complete curt wa8e&
iected, and in its progress the original afiection of the urethra
returned with the same violenpfs as marks the incipient state
of the disease.

But all these affections are to be considered as very raro^
and as yet we have not had sufficient experience to ascertain
with exactness their true nature, so that we ^re obliged to gQ
by the opinions of authors who frequently ascribe to this
cause wliatever affection occurs dpring the progress of gonor?
jrhoea, where it perhaps may be m.ore justly referred to another
source; for, even the cure by mercury, and also the return of
the original affection are by no means certain ^rks of the
disease arising from this source : Mercury cures many diseases^
and its stimulant powers are certainly favourablein many cases
to the removal of paralysis, while ihe urethra, we kno^, a£>
ter gonprrhosa, similar to other parts the seat of hetmorrhage,
tetains its disposition to continue the discharge ; and this
more especially when an universal increase of cirpulation is
produced by the action of mercury.

' If the above hints will induce any of your correspondents
t6 &vonr me with a full account of these different sympathe-
)tic affections, they will confer an obligation on,

Gentlemen, your obedient Servant,

F. KIERNAN.

■ /

ChathHeSreetjBpdford Square J
m, 15, 1809.

im^\ Midwifery, '«>

Hi. MIDWIFERY.

• f

It has h^en loji^ a subject of doul^t with accoucheuis
^betber labour is to be considered a^ a state of .a.ctual diseasf.
n was on this principle praptitipneprs formerly used to direct
their treatment, aad the antiphlogistic plan was therefovt
jbarried on by them to ai^ extent, which from the debility in*
du,ced by it, frequently ended in real disease. One of the
great modern improvements in ojbst.etrical practice is treat*
ing the patieQt as bordering pn the slate of health, apd nei*
tber subjecting I^r to low diet or tedioiis confinement.

Certain symptoips in .childbed have been considered as
giving a prx)gnosis in respect to recovery. One of these if
the regular flow of the lochia ; but even to this, many except
tion;s frequently arise.. A, case pccurred 9^bput a month ago
to an eminenjt accoucheur, where no appearance ^t all took
place from the yery termination of labour to the period of
recoyery^ and tl^e patient got sooner well without the ap-
pearanqp than in any pf her former lyings»in. This case,
sp singular in its course, aj^d deviating so much from com-
inon habit, was ininutely examined by several practitioners,
^hose testimp;iy pan be adduced to support the truth of it.
All general rules are liable to exceptions ; and the anxioma
built upon them shew the weakness of the structure on which
they are raised.

COMMUNICATION PN RETROyERTED VTERU0, BY MR. MCI^
lilS, MEMBER OF THE ROYAL COLLEGE OV SURGEONS,

. To fhe Editors of The Medical and Surgical Spectator »

Gentlemen^^Iv a former nupiber of your valuable work,
a case was related of inversion of the uterus ; a disease gene-
rally fatal, unless immediate relief is afforded. There is ano*
they: disease which, though not so fata), is apt to prove highlj
fn^nyenient and distriessiDg to many wom» during j^f*

258 Miixdftfjf. £IIarclip

iiancy — ^tliat is, the retroverted uterus. Dr. Hunter has the
merit of first descrttm^ this formidable complaint. It oo
cuTS> about the fifth month, immediately before the uterus
rises to be supported on the promontory of the Sacrum* At
this period the uterus^ being Tv«ighty from some 4:ause, its
fundus is apt to descend suddenly into its hollow, Mrhich ocr
casions the os tincae to be tilted up in the opp^ite direction;
and thus the situation of the urethra becomes altered^ an4
an obstacle occurs to the discharge of urjne.

The symptoms of this disease are at first mild and dcceitr
ful. Some uterine pain is felt, attended with a slight ior
clination to void urine. It passes with difficulty, at firsts
but as the efforts and pain increase, a total obstruction occurs^.
This obstruction allowed to continue, and the displacemeiMt
of the uterus always augmenting^ produce soon the most
dangerous situation to the patient. From the passages of the
urethra and rectum being both shut up, inflammation and al^
its consequisaces arise, and it is sometimes hardly possible to
replace the retroverted organ. Of this disease many re-
markable instances are to be found in authors, where the
quantity of urine accumulated^ and distension of the blad-
•der had proceeded to the most extraordinary lengtli.

The late Professor Young used to state in his lectures one
case, where he drew off no less than 18 pints* The late
Dr. Aikin relates another, where he took off 12 pints. I
have myself known several fatal instances of this disease^
The victims of it are commonly in the lower order of life.
Women of better condition, when they feel uneasiness and
i)earing-down pains, at this period, are inclined to take rest^
which abates the symptoms, and prevents the disease prop
^osedingto a ibrmidaUe kngtlu The prerentim should in
all cases be the great object ; and wonea should tberefoie be
cautioned by those who attend thcai, of what may occur at
this period, so that any formidable increase of it may be pvCi-
wtBM* Those women in whom the pelvis is w^ made, ancl

ISO?.} Midmtf^ry. 959

«i{ilt(^iotiS) «re mdre liable to iU The fatal termination in
ibis disease is dither by fever or convulsions; and before tbe
loiter enanef tbe dtstrwrion of tbe bladder is generally so great
M to reaekas high, in tbe abdomen as what marks the seventh
0t eighth month of pregnancy^ or much above the umbilicus.
These bints are merely directed to young practitioners^ in
order to avoid an evil vrbicta may always with a little care be
Mstiy prevented. The treatment is obvious by drawing off
the urine where it is practicable^ and replacing the organ*
In the last stage of tbe malady^ this is too often not easily
tcc^tnplished ; and various expedients have been proposed
for producing abortion by opening the os tineas^ or even
dividii^ tbe gymphysh pubis by the operation of Sigault.
^e first is difficult, as the os tineas in these cases cannof,
easily be reached. The latter is hardly admissible, except
in the most forlorn circumstances^ ; neither am I convinced
that it would prove successful if performed.

1 am, Gentlemen,

Your obedient Servant,
Thotnkaugh Street, Feb. 12, 1809. JOHN MELLIS-

OBSERVATIONS ON RIGIBlTl' OF THE MEMBRANES.

To the Editors of The Medical and Surgicol Spectator.

Gentlemen^-^HBicts^uMB of the membranes has been
mentioned as a cause of tedious labour, and there can be no
doubt of its frequently proving* so. This thickness or
rigidity is not in general to any great extent ; and in such
cases it is surprising what wonderful effects arise from a single
bleeding to expedite the labour. I have seen a woman who
had lain for hours with the strongest pains, without their ym^
dttcing the smalkst effect, and after the tincm had been folly
dilated, on being bled to the extent of eight or ten ounces^
Instantaneously has the labour accelerated, and she has been
delitered in the course of a ^w pains, though they had Mt

960 iliimiferif. r$farGh,

^before had the sknallest influence, or a total suspension of them
had taken place for a gi^eat many hours. Onoe in my life
'I met with a morbid thickness of the membranet^ to that
'degree that the omm was expelled entire. On catting int*
'them, thej seemed something of a fleshy textdre, aiid in thii
case there were little or no waters. This complete'expulsion
of the ovum has been considered by some as the mosit
natural state of labour. It is, however, certainly a most
dangerous one, as flooding may occur, and nature has
provided that this circumstance should rarely happen as a
precaution against it. If these observations contain any tiling
worthy of notice, they are at your service, from,

Gentlemen, your obedient servant,

T. BROWN.

Oxford-Street J Feb. 1,2 1809.

On the Symptoms and Nature of Schirrous in the Uterm^
hy Mr. Kilpatricky Member of the Royal College of
Surgeonsy London.

To the Editors of The Medical ar^ Surgical Spectator.
Gentlemen — It is chiefly by changes in the uterine
system of females, that their good and bad health is found to
be regulated. This disease often occurs at an early period
ofli% and afiects mensuration, &c. Thestructure of the
uterus, like those of the liver, is very liable to this state, though
more frequently it takes place about the time when th#
menses depart.

The symptoms of this disease are, 1st, a sense of weight or
heavy pain in the uterus or about the pubes.

Sd, Irregular and long-continued floodings, seldom drying
up, or soon returning.

3d> Morbid state of some contiguous organs, as strangury,
tenesmus, &c.

t Though schirrus may occur at any time of life, yet it ii
mpA Qfequenily^ pA yffi observed, tonr^rds its decline, that itf

JI809. 3 Midmiferjf. 9&k

attacks aT0 made*. The. several glands thefu.lose muchof
that activity Tvhich they displajied in the former period ; to
vspedite their secretions^ and the loss in part of their activity,
(exposes them to all the effects which slowness of circulation^
rising to a morbid degree, produces. What is the peculiar
change that takes place in schirrus we cannot determine.
jBy many authors, • a partial loss, of vascular substance in the
part is supposed to arise;, but, even admitting this, it is not
stt£Scient to account for the peculiar morbid state we find
induced.

Injuries of the uterus have been supposed a common caust
'Of schirrus. They may be so, and, it is probable, are hoi
\^\ki we find that women who have had children, whose uterus
consequently has been most exposed to such injuries, are th^
jQie least subject to this disease. The same may be said of
jnany othw causes enumerated by authors. From obser«
Vation, we find that it is most usually from some internal
•ource, the existence and operation of which we cannot detect
till it is beyond our power to remedy it.

The trjeatment of this disease, it is in vain for any practi-
tioner to attempt; a palliative plan,; by mild diet and opiates,
is all that is in our power. I have never seen any benefit
from the preparations of iron, so much praised by some
practitioners. The advantages of a water-diet have been
strongly pointed out by Mr. Pearson, in his Treatise on
Cancer ; and the same have been prosecuted fiirther wKh much
industry by Dr. Lambe.

lam. Gentlemen,

Your obedient Servant,
^. Martin's Lane, Feb. 20, 1809. W. KILPATRICK.

m kUhfift^ys . [llttC^

On iht Us€&f ike JE^ver, by Mr. Grice^ Member o/ tkg

Sjoycd CottngepfSurgwm.

Qenllemen — ^The use of instnunents in the practice tJt
midwifery has been blamed^ perhaps, in some degree it dod
not deserve. Without such menas in tedious casef» th6
lives of manj females, as well as of the children, conld
not be saved. One of the most useful insttumenti in this
view is the simple lever applied either to the pubes, or Iht
side of the pelvis. lA the former case, however, it has mort
purchase.

On this instrument it may be remarked^ that befoie its
publication as theRoonhuysita secret, it possessed a decree ctf
credit equal to the greatest discoveries ; but no sooner was ft
in4de tsnown, thfm it lost greatly of that reputation it ha^
jfbrmerly acquired. The sif^piioity indeed of fht contrf^
vance, and some inconveniencies that appeared toaCfosiditi
application, were the causes of this change ; and the forceps
seemed, therefore, an instnimcnt more deserving attention,
^ well as more capable of iniprovement* Thus, from (be
time the forceps came to be employed^ most of the writers pa
midwifery have entered into a comparison of the relative ad*
vantages attending the use of each >

The objections urged against the lever are chiefly on aO
count of its fulcrum, or rest in action^ bein^ on the pubest
as its power, if sufficiently strong, must be proportionally
exerted against the urethra, or bladder of urine. On thij^
account, many accidents have been known io succeed its ap-
plication ; and several practitioners have directed its being-
inhroduced, on the OMitrary, from the side of the pelvis, of
IB3pDg the mjf%Q^ «f one of tjms ieohin ; but in iJm fiiitwtioa
it cannot act with the same advantage, as the resistance to
the passage of the head is chiefly from the transverse diame-
ter of the pelvis.

The objections tl|us urged against the lever, we contend,
bare arisen more from practitioners when employing it, not

f86d.] Midwifery. 9SS

attending to particular circumstances in its fbnn> size^ and
aj^plicfttion.

With respect to its size, the ouglnal Roonhnysian one'
was too small, and on that account pressed entirely on tho
situation of the urethra^ not being sufficiently expanded to
rest upon the more distant parts of the pubes. It was at the'
same time entirely solid, so that it could not aToid injuring
^ part on which it pressed. We would, therefore, re-
commend that its breadth be pretty considerable, that its
Ufide should also be hollowed for the greater part, so that a
sufficient :space may be allowed for the safety of ttie urethra;
whichi if the practitioner is attentive in his application^ w3l
escape eutinely being compressed by the instrument. lii re»
gard to its form, its blade should possess ^ greater curve thanr
the forceps^ :so as to be applied accurately to the convexitf
•f the occiput^ that it may not slip after being applied ; for
k is generally more difficult to introduce it than the forceps^
t&e s^ace being more confined, and this difficulty is even iu^
creased by its curved shape : for this reason the late Dri
Aikin has constructed what he terms a living lever, whidr
Is introduced straight^ and, by turning a screw, it fhea te*-
€mrc& the pmy^er curve, which adapts it to the presenting
part ; but the fault of this instrument is, that what advan^
tage it possesses over the other facility of introduction is
eanttteibaSauced by its piroportianate want of powar ; for
trli^remuch force is required, it bends 4oo seadilf , and thus
easily loses its bold, requiring a new iatFodiiction^

At the chkf tobjection aiose again&t the lever, ffom its i;est
being wt the pubes, soodern ;practitioners have endeavoured'
b^^meanstifahxile at ibis pai^, throiigh which ^ piece of
iMng isfatftenttd, by fpuiling itdawinJiere with -one hand^
Whfle^he dtber is applied to tfaeiMkadle, to lessen its 4)ressure,
and^lnn aivoid (the vonseqfienoas which its ^use, according to
Ihe fisrrmer ^aflthod, ^oduoed. it m with;Us improvement
that it is, at present, much employed by the London prac*
titioners.

. Tbe length of the lever is also a drcoofstance, in order to
its saccessfal application, requiring attenXion t for if too
^hort^ its power is not sufficient to bring down the ^cad ; and
tiitf longer, tbeltefore, it is nttde, tfie more successful will its'
application be found.

For tiiese reasons, we considet the lever as, in mciny caaes/
a very useful instrument, and as by n6^ means des^tving that
indiscriminate cciisure it has received fr6m many authors.
Its application would certainly be by nd means proper in
high cases of distortion^ neither will it succeed where the
presenting part is still high, and not at least an ineh witbio
the pubes ; but in those situations Tirhere the head hat de-
scended low, where the pelvis is well formed, add where Uuf
labour is protracted, chiefly by the absence of pain from the
exhausted state of the patient, and some rigidity of the soft
partS) it is an instrument better calculated for ddiveTy than
the fi>rceps, as it can be used even without the knowledge of
the patient; and its action may be inCiteascd by chang«i
ing her posture, or placmg her on her knees, while her armar
ace extended round the waist of another person seated for thig

purpose.

I am, Gentlemen, your obedient Servant,

Charlotte Street, Fitzroy Square, Feb. 16, 1809- T. G-

Bemtirkahle ease of suceessful delivery in extreme di^ortion^
such as is generally considered to require the CcesariaH
operationy hy Mr. T. Mainwaring.

To the Editors of The Medical and Surgicdi Spectator*
Gentlemen'^CASEfi of extreme distortion, fortunately for
the sex, are but rarely met with, and where delivery is bc<
comiilished in such unfavourable situations, it is aproof ofthe
gieat improvement which modern times can boast in theexer*
else of this branch ofthe healing art. In looking over the casea
of d^ormed pelxis^ in which the Caesarian operatioa luis been

4
.. ■ • •

\

I8bd:5' ^ Midwifery. JSf

performed^ it Will be fonnd that none of thes^ treremoriF
contracted in their dimensions than in the following case :

M« 6« aged twenty years, at the fiiH period of uterogeste*
tion, had regnlar labour pains at foar o'clock on Monday
morning, Dec. 30, 1799 ; they continued until eight of th^
aame evening, when the membranes were ruptured by con«(
tractions of the Uterus ; the activity of which was rather in-
creased until Wednesday at noon, January 1st ; when T. Af.'
gaw her for the first time, he found the projecting angle of
the sacrum so near to the ossa pubis^ as left no more space
tJhan about three quarters of an inch ; on the right side, thef
space did not amount to one inch, on the left it exceeded it ;
he perforated the head at eight in the evening of the same
day, after drawing off the water, and as much as possible
evacuated its contents by the aid of the curved perforatoTj^
mnd repeated the efforts to the same effect, the next day, witii
the end of a spoon, the patient being very free from febrile
affection, though the pains had not ceased during the whole
time,(with very little sleep). No further endeavours were made
to effect a delivery, until the forenoon of Saturday the 4tb^
when the pulse being so frequent as 140 a minute, and the foetus
highly putrid^ some of the bones broken by the perforator^
were found to have been pushed near an inch forward, and
somewhat loosened in their attachment. And several pieces
were carefully extracted by the fingers only ; at length a hold
was found, and the crotchet safely fixed, and guardedly acted
with, the two frontal bones were brought away ; a number
of efforts were made to get another bold, bat unsuccessfully,
the labour pains continuing, the operator's, fingers were em^
ployed in extracting pieces of the upper part of the cranium,
during which the crotchet was again applied in the basis of
the skull, and about half of both (acting by the arm so as to
eome short of detaching it), the body was brought down.
The whole time employed was two hours. The placenta was
suffered to remain for three following reasons ; first, that tbs

166 Mi^Jtrjf. [Bfmli,

p^rtg were much irritated^ by the operation^ and the patient
greatly fatigued. The funis so likely to be detached, by
lightly acting upon it ; and above all the difficulty of in-
tioducing the hand into the uterus ; that it was determined
to let it remain for a few hours, during which the patient
fell into a sound sleep ; when she awoke, a glyster was giyea
in the evening for the third time ; the following day, light
pires^rp being made upon the abdomen, the placenta came
^ay, without acting upon the funis after remaining thirt^n
hours. The patient passed her water in the usual way
during the first five days, after which it came away, without
her Juowledge, of course without uneasiness. When ^he
became able to leave her bed, it was not in her power to
retain it for more than a few seconds, after the inclination t€x>k
]p}Ace. It should not be concealed that the bladder in a sraa^l
degree sloughed, so as to let the urine pass through the
aiferture : this misfortune may best be accounted for, . j^j
haviqg given a longer time for the bones of the he^ to
loosen, than was consistent with the sa&ty qf that iniportant
receptacle.

At the distance of one month from her delivery, the
dimensions of the pelvis were attempted to be aacertained-r-
^ deformity vfas found somewhat to differ now frpp^ itf
jfta^te when the he^ was wedged within its aperture^ the left
fvSLp was so much wider th^n the right that.it admitted three
^ngcrs from pubis to sacrum, when tl^e other s^dmitted ^f
only one. In the centre it did not quite admit of two fingers,
but that state of it most remarkable, was the prcgepting apgle
pf the sacrum, which had the shape and size of a considerable
round (and hard) tumqr, between twe and t])ree inches if|
diameter, projecting so far forwards, as to require tlie pa.ti^t
ip lay on her right side, in order that the right liand of the
operator might make the examination of the dimensions i^itl^
Spmd degree of accuracy. I am, (GrentkcBeni

*** Your obedif nt perrant,

Strand, Feb. 25, 1809. T. MAINWAWNQ.

m

mEHAUKS.

The above case differs from the celebrated one of
Dr. Osborne thus far, that the projection is more from pubet
to sacrum than from side to side. The patience and
perseverance displayed by the operator reflect oh him toe.
highest credit. The allowing the putrefaction of the child
fully to take place was certainly favourable to the ckeliverr^
«hd shewed ihkch judgment. Dr. Bland, we understandj^
t^s present at this case, and the patient still survives, whicb^
£tom the recovery, exceeds the delivery made by th*
Osborhe.

IV. PHARMACY

. At present offers nothing new to our attention Mmf^i ^
ihe . oxyds lately introduced into practice have agaia
disappeared, and there is something in the influence ^
ilietallic bodies more than the effects arising from thiii
joxydation.

. We consider the decline of vegetable remedied in Hk^
present state of practice as a serious evil. The meiaUtc (xxydM
are too active powers to be strongly used or too lo^g co|v^
tiaued. The changes of morbid action produced by them
must always be at the expense of the constitutent principlen
or. energies of the living fibre. We wish to see the simp)8
system of vegetable meantf more generally revived and movQ
actively persevered in,

A new species of Bark has lately been shewn its froni the
West Indies. It possesses much astringency, but Uttit
aroma. Of its qualities we shall perhaps be able to speak from
experiments with it in our next number.

T 2

fiS8 Pharmacy.. [Miur€%,

On the Influence of Metallic Substances as Electric Agent$

on the human body.

To the Editors of The Medical and Surgical Spectator.

pentlemen-^In your last two numbers the subject of
Electricitj has been discussed in certain cases of disease.
This called my attention to so interesting a subject a§ well as to
the general influence of metallic substances on the body^ &c. .
I was particularly pleased by meeting with a very original
and rare publication by my friend Dr. Bache of Birminghami
which possesses so much ingenious reasoning, that | beg
leave to request your insertion of the following part. It will
be new to your readers, as I believe it wa|^ only given to the
Doctor's own friends.

*' In the Wide field of nature, Electric Matter is often so
active, that it separates the most dense bodies ; it fuses, vitri-
fies, and variously combines different substances: by its direct
and indirect action it is capable of producing inflammation in
all eombostible bodies, and of causing such a variety of efflu?
via and gyrations of air, as arc capable of affecting our senses'
very extensively: all these phenomena have been so fre-
quently produced by lightning, and its similarity with Electric
Matter has been so clearly proved by Dr, Franklin and others,
that I ^think it unnecessary ib appeal to particular experi-
ments for a farther proof of the certainty of any of them.
The degrees of hioifcion in Electric Matter cannot be de-
scribed, as they depend so much upon particular circum*
stances, that at one time it has been observed to pass through
a wire of three miles extent in less than a second, and in other
instances I have been a witness that a small quantity has been
some hours in making its escape from one side to the other
of a small open vial.

f* In charging and discharging the Leyden vial, we haye
an evident proof that this matter is of a very elastic nature \
fhis, I apprehend| U s^ necessary consequence of repellent

1909.] Pharmai^. ied

particles being driven into the sphere of each others action :
and that explosion is the natural effect of a sudden prevalence
of the combined power of such particles over that power by
which they were so impelled, together with these circuni-
siances taking place in a medium poissessing the properties
of air. The inherent properties of Electric Matter are probably
but few, but froni its peculiarities, subtiltjrj and force, toge-*
titer with its various modes and degrees of combinatioh with'
other matteris, their joint actions are so numerous, so much
divaricated, are often produced in siich a gradual mannek*,
dnd in consequence of such previous and numerous cbncurring
circumstances, that they extend too far beyond the reach ot
our senses for us ever to be able to decide upon, or perhaps to
form a tolerably just conception of them; they may therefore
properly be termed infinite. I cannot however help 6bseryih|^
that it is by much too common with thankind, eitlb^ from su«'
perstitioh, or au unphilosophical degreeof fear(lest tWy shouM
£nd a solution upon natural principles above their teach) to
tefer every wonderful phenomenon in nature, to the immediate
influence of a Divine Energy : such ideas encourage inddlence
in researches, by plausibly shielding it from reproach ; but
had Lord Verulam*s, or Sir Isaaci Newton's geniiis, fallen
victims to such ignoble prejudices, their names would never
have been enrolled in the annals of science, and our own
understandings would probably have been more dircuthscrib- .
ed. Electric Matter is generally diffused through the system
of nature ;-^this appesdrt by its being easily obtained in every
quarter of the globe where electrical estperiments have been
attempted.

*^' It is also a natural agent, which does sometimes evi-
dently answer purposes highly important to animal life : of
this we have a striking instance in the Gyninotas. Thii
animal employs it as the means both of procuring its food,
ahd annoying its enemies ;-^iand when we have such clear
tettimony of its existence, in an aoimal whose natural reri-

T 3

970 PhflTvma/. [Maidr,.

dence seems to be the most unfavourable of all others for the
employment of it, as a constituent part of its system, sui;eljr
we can find no difficulty in conceiving that it may exL^t in
tbe bodies of beings, that are apparently much more fiivour-^
ably circumstanced for its retention, and that it may be io
them a source of effects which are in the highest degree im-
portant to their welfare ; and as various natural occurrences
and experiments give their united countenance io the idea of
its bein^ the Primum Mobile of the animal machincj it will
appear to be deserving of some pains to bring into one view^
various instances of its connection with the human system,^
^hat we may form some judgment of its importance to its
welfare, and of the injuries that may result to our constitu-
tions, from its deficiencies or excess. Also to point out some
probable means of its introduction into the system, and of
accelerating and retarding its escape from it, that we may^ b^
f^e to increase or diminish its influence in some degree
according to the direction of our will,, and thus to emplpj^ itt
medically witji advantage. Captain Brydpne observes, thf^t
during^ the Siroc wind atNaples, he was scarcely able^ by bis
electrical machine, to obtain any electric matter ; and that,
persons exposed to theinfluenceofthat wind,, were commonly.
«o much afiectedby it, in the state of their spirits, that those,
who at other times were the most active and volatile that caa
be imagined, became so destitute of vivacity, as to rendef
them the proverbial objects of comparison for whatever is^
totally void of that principle ; he observes, that it unfits
both the body and mind for performing their usual func;
tions.

** We are also informed by the same gentkiiian, that he
,iias collected from a clean and strong head of hair, as muclt
electric matter, in a few minutes, as he found was sufficient
to. kindle common spirits, and by means of a sn^all vialj to
give many smartshocks to a company who were; pre^tat the
experiments.

1809.] Pharmacjf.

<' In diseases I hare observed, that the hair oonocmonlf
becomes soft, and when combed, the action is generally sue*
ceeded by head ache or languor.

^^ In ClarusHystericusy where the disease has been of km^
standing (in itiost instanoea that have fallen under mf ob«
servation) I have found the hairs as grey as in old age up6fe.
the part affected, though- not so upon any other partofthnr
h^ad. Over that part of the human head, where the brain is
situated (which is^ considered as the fountain of nervous
^erg^jT) there is a considerable quantity of hadr at the period
-df birdi, and it generally Increasesas long as tfaeener]^ of tJie
system continues to do so, and to become somewhat darkor in.
its colcmr ; but as the vigour of the body dedines*,' it geaeMly
becomes^ lighter, and gi^dally falls oiBT.

^< It id observable also, that hair does not grow upon tfie
piibes iki ai&y remarkable quantity, until that period, when
the nervous eoetgy in those parts becomes more con^iderabfe
thau'in the system at large, and then its increase is greiit.
When Electric Matter is collected by a machine, and thrown
liitiD^ the human' body, the hair of the head expands; k ia
observable, also, that a similar effect has sometimes been
* seen' to take place, in cases of great fright : and the records of
iiiedicine afford us some instances of syncope taking place
oii shaving the head.

^ ^ To suppose the hairs destitute of use, is to ari^ign the
-wisdom or power of the gdeat Author of nature, in their
fhstittitioli : and 1 think the * several partieulars specified
above, together with the. nature, figure^ add situatton of
the hairs, give some countenanee to th^ir being one of
the eiiJfetory organs to* thfe nelrvotis^ system. EvtN^
other matter emjployed in the^ body, Hfler having ex-
'trted its influence for a tim^^sf^nts^ sa.ftir changed in its
nature, as to require expulsion, that oth^ matter, similar Id
It, in( a primaiy stat^ may be ^ntroduietd^' and by exerting
'Hts ijillueiKkMfiii: a tininj^M^y support tbrM<<^iMed' vigour of

T 4

die animad, which the alterations induced in the former i?t'onld

BO longer admit of its doin^: and analogy leads me Uk

suspect that electric matter may be subject to like changes;

Imt succession, as far as we can observe, seems io take place

in all other matter as neoessarily, and naturally, as in time*

But the humfui mind has its horizon, as well as the organs ai

Tvliion. The boundaries of nature are extended beyond our

attach, and as the laws of matter are too much diraricated f<v

Hm complete investigation, it becomes us to remain satisfied, if

iuvidttity and the stretch of our mental powers can bring ut

ivfthin the sphere of probability, where mathematical demonr

Jtration, or positive proof, cannot be obtained .^

'; ^ If we attend to all the particulars above recit^, I presume^

we shall find but little room to doubt that electric matter

fiirms a constituent part of the human system; and, when

me consider its very active nature, and extreme subtilty, we

iaiist admit, that great obscurity will inevitably attend many

joi its operations, but that it is of great importance^ if it really

rfbrms a constituent part of the human system, to discover

aihie means by which' it is introduced into it-^^^-also its mode^,

jloid degrees of combination and evolutions, with their several

iieadses, should be investi^ted as far as possible, by the mck

sdica^ faculty : and till they are in some measure attended to

and understood, we shall continue to wonder at the. pheno<*

JKbeaa they produce, shall frequently ascribe them to false

'.datises, and must therefore often be very erroneous and un-

iimccessful in oar modes of application, for the removal of

Iwany diseases ; and that there really are many, which dp

•now remain the aprobria of all past and present medical pracf-

T^icC) I presume I need take no pains to evince to you, as it

.has often been publicly acknowledged by the sage, the truly

: ingenious, and ingenuous professor of the practice of med^-

t/oiflte. i\\ thi^ university*

r , -'^ It is very observable, tbat a frequent application of food
'*M necessary tojupport the humaa body in a jitate of

throtigh All the cTiffisrent stages of infancyi joMth, nianhood^

and old age. The articles of food are extremdy various.ia

their nature ; some of them seem to possess two distinct pro*

periieSf one of which^ by being fitted to nourish .the flaids,

-enables theni to support the solids; and the other ncenm

inuch better constituted to support nervous enangy. With

xespect to the processes by which these effects are produced^

they are indeed, at present^ involved in much obscurity* and

every attempt to investigate them will probably be attended

"with many mistakes ; but I am disposed to hope, that per^

jieverance, and repeated corrections, may do muck towkrdt

'placing the matter in a tolerably clear view, and thus render

the human judgment a far letter agent than it is at present, for

' administering to the comfort and happiness of our species.

*^ Under the influence of this, idea, I shall now venture io
'throw out some conjectures respecting the nature and mode of
operation of the various articles of food.

'^ I think it highly probable, that every distinct substanct
in nature possesses a portion of electric matter, which is pecu*
liar to itself; or, in other words, that it has chemically com-
bined with it a certain quantity of electric matter, by which,
if I may be allowed the expression, it is as it were exactly
laturated ; and, as it changes its nature by means of chemical
attractions or decomposition, its prior quantity of electric
matter is diminished or increased, according to the manner
of its changes; and hence, when different substances, take^
into the body, are decompounded by the digestive process,
and their component parts form new affinities, a portion of
the electric matter which they primarily possessed may be
Evolved into the system, and employed in invigorating its
animal spirits, whilst other portions of it, forming a consti-
tuent part of the chyle, may, with it, enter the blood in, a
state of chemical combination, and afterwards be secreted by
the brain in its passage through it, and be diffused by that

fTA Pharmacy. [March,

.organ ibroug'h tlie nerves, as being the best conducting parte
'of theaBimal system. : ;

- ^* I also think it not improbaUe, that it may often be com-
.bined with other very subtle matteriif, that may retard, accd«
leraie, or otherwise vary its modes or degrees of operation on
irarious parts of the body, and subject it to a particular in-
.floence from variotts- substam^eif, internally or externaUy ap-
yHed to it.

^^ In support of these opinidns I must observe, that those
^fubstances which are found (o be most nutritious to the ani*
'ittBl system, generally contain either much gelatinous maUoTy
or much of the principle of inJQammability, as is* easily ob-
Mfrvable in animal fibres, fats, vinous spirits, fermented li-
quor9. Sec. and thus some of them may contribute to sap«
port the body, by restoring its wastes and decays, and others
snore immediately renew the powers of the mind ; and, when
taken in excess, excite in it an inordinate and irregular d^iee
^of action. It is, I think, natural to conceive that these sub-
stances may, by various means, each be contaminated, and
may thus become both, in different ways and degrees, im-
proper subjects for nutrition ; giving out other matters, or
other proportions of them, in the process of digestion, than
• what may be consistent with the health of the body. For I
ccmsider health, as the result of a balance of powers ; but
admitting of a very considerable latitude, before injury is
getisibly perceived to take place, either in the functions of
tibe body or the mind •

*^ Some years back I amused myself by endeavouring to ac«
€X>mit for the sudden metastasis, often observed to take place
-iti the gout; and, was led to suspect that both gouty, and
olher pains, might often depend, in some degree^ .upon
^ther ft depraved state, or quantity of electric matter in the
tyslem. I sometime afterwards had the following^ opportu-
Uttiea for experiment, which I embraced ; and now solicit

jpur attention^ whilst. I &itlifulljr and particularly lecilfi

^< A geatlemaniQjtnay^acquaintance yas teizedrntbthagcwt
ia both his great toes ; ho had coafiaed himself to bis be^
9JbiQttt two d^ys, Yfix^ I first saw them. I took off tteJBa%>
;iebs ia which onoo.f tbe«n was wraptt ^d begged that Ji^
would give me leave: to lay a bit pf bec3*wai[j^ abouti tlie dr<^
cumference of a shillings upon the joint ajSbcted ; he si^mtt
ted to my request, but ia Ies9 titan two minutes he complain*
<d that the. part b^jEune extremely hot ; I endeavoured In
divert him from Sruch an idea» and b^ged he would pennil
ib^ wax to remaUi; he did so, but iu a few miautcf
pipre, said that the heat became too intolerable ta be borne*
I removed the wax, lapped the foot up as before, and put it
into bed ; I then asked a lady in the room to favour me with, a
UlIJl ribbon ; I obtained the object of my request , and after
liaving held it to the fire for some time, to make it per&ctljf
^y> I begged of the gentleman to let mesee his other foot ; hoi.
I^t it out of bed ; I took oflTthe flannels, ajiid lapped the ribbon
iQund it as loosely as. possible. I then put oathe fianneb
JIS. before, apd replaced the foot in bed, be^mgthat he would
P^Dftit the riUbon to remain on until I should seahim agaii^
which I promised to. do in an hont and an half; he assuced
m^. he would, comply with my solicitation; I left him, and
i:eturned in the time mentioned, but no sooner had I entered
the room than he reproached me^ in very strong tenns„ and
^d^ I had caused him the most excrutiatir^ pain he had
ever felt; I expressed a degree of surprise at the charge, and
begged that he would explain to me how I had injured him ;
be said he did not know how the effect was produced, but ob*
lerycd that the foot upon which I had put the ribbon rerj.
fpon became extremely hot, and was attended with shooting
p§tins^ which he submitted to for about half an hour, when^
being unable to bear them any longer, he ordered the ribbpi^
tj»^ be taken off| and ha thea assured me^^ that upon thfit foot

\

itt% Phairmact/. [MarcB^

the gout w^s ^ot lip into tbe ancle. I examined it^ anid
found it inflamed ; I begged that he would permit me to k^
plj abitoftinofoil tothe part, andatoured him that I be^
lieved that he would not find any inconvenience from it. Hi^
mbmitted with relnctance ; but after the tti^tal had continued
on for some time, he thought himself much ea^ by it. TK^
part underneath tbe foil became very moist, and the infiamma-^
tion was apparently much abated.

*^ A young lady of my acquaintance, during the last
stage of a tabes mesenterica, complained of a violent pain,
which shot down from the cervical vertibrie to her right
wrist. The pain usually begau about eleven o'clock in the
forenoon, and four in the afternoon, and continued each time
about one hour. I desired that she w6u1d give me leav6
to put a bit of metal round her arm. She consented, and
I applied a bit of rolled tin, about the middle of the
humerus ; at the two next periods of her attack, the pain
descended as far as the metal, but no farther. I afterwardit
took it ofi^, and at the next paroxysm, the pain descended t6
the wrist as before : she requested that I would apply the
metal again ; I did so, and on the return of the pain, it did
not extend farther than the metal, as before. Encouraged by
this degree of success, I entertained a hope that by con*
necting another piece of metal, extending from that upon the
arm to the cervical vertibrae, the whole of the pain might be
taken off; I made the trial, but without any sensible ad«
vantage, for the pain continued to extend to the arm, without
any perceptible degree of mitigation.

** A friend of mine, in Warwickshire, after complaining
for some days of slight pain in the region of the kidneys, a
sense of heat in the urethra upon making water, and a loss of
appetite; called to his assistance an eminent physician. The
doctor at first apprehended the affection to be a nephritic onei
the patient found but little, or no benefit, from the medicines
administered. In a few days fresh symptoms took place, which

1809.] Pharmacy: 2T7

caused tbe physician to change his sentiments respecting the
nature| of the disease, and he then termed it a lumbago*
Various applications i^ere made, but -without any sensible
advantage; various hypochondriac symptoms came on,
jQatus, lowness of spirits, frequent perspiration about the
precordia, and in the palms of the hands: ongoing tobed,
he every night felt an uneasy sensation of heat upon his
back, and a creeping, as he expressed it, which was so
troublesome as to prevent his sleeping during the night; these
sensations usually went off about six o*clock in tbe morning,
from which time he commonly slept till near nine: when
he awoke he was but little refreshed, was languid and dull
through the day, but did not complain of aay pain ; bis
pulse was a little irregular, and rather low, hU tongue clean,"-
aiid belly bound ; his urine was rather small in quantity, -
stimulating to a frequent discharge, was not changed in its
colour, and did not depose any sediment. When the uneasy
sensations in the patient's back had continued about a fort*
night, he requested my sentiments concerning them, I su8«
pected they might be the effects of an electric matter, that
had not a proper means of escape from the body ; and oIh
served to him, if my own situation was similar with hia,'
I would try the application of a metallic substance to the
part. By my direction, he obtained a strip of thin rolled
silver, such as is commonly used for plaiting buckles, &c.
Its length was sufficient to go round his bpdy, and its width
about three inches y a bit of flannel was sewed upon each
edge. This instrument was seen by the physician, and
smiled at as a ridiculous application ; but as he acknowledged
it could do no injury, is* wis applied all night, during
which time the patient did not fed my of his former sensa-
tions : he slept well, and arose in the morning very much
xefreshed : the doctor however refused to admit, that the
metal had had any influence in producing these effects, and
^Mpribqd them to tbe patient's former fatigue. The metal

27* Phqrmacj/^ [Mfurriij

wiui applied the succeeding night, and ease and comfortable
sleep ensued as before. The doctor ftill ^continued to assert*
that the metal was a ridiculous applicaUon^ and said that
he had no doubt if it were laid aside, that the same circum*
atances would take place as when it. was applied to the body.
The patient submitted to the trial the ensuing night,, but had
a return of the sense of heat, creeping^ and want of sleepi
to as great a degree as before the met^l was first applied ;
he resolvedi therefore, to yield no more to the doctor's
request of laying it aside. He applied it qg&in for scrreral
^ensuing nights^ when ease and sleep uniformly accompanied
its application, until by the flexures of the body, the edges
be;gan to break, and starting through the flannel gate him
some uneasipess^ I desired it should then be laid aside, and
that his back should be bathed with tepid water e?ery nigb|
before he got into bed, ei^pecting that it would act as a CQBr
ductor apd rebu^ent to the sk^n, and, by tliose means, pro*
dace the same beneficial effects as the metal had before dope ;
and in this expectation I waa not disappoioted. About a
week after we took a small joiimey together in a post chaise;
the ^firsi afternoon we travelled only fourteen miles; in tbaf
eyeaing be expressed a concern that be could not, at an insr
convenieotly get his back batbed« I oflered him my assise
jBsfliee in that particular ; lue gladly accepted of it, and at.bed
tjme calledfor a bason of warm water, and a bit of soft rag^
tl^y were brought, and my firiend then took oS his cool and
l^istcoat^ and drew up his shirt ; there was not the least ap^
faarance of disease upon hts back* ) bathed it equally for
about a minute or two, when I obserycd two spots, upoa
frhich was a change o£ polour ; they soon became very red#
\ was 9i|ri^isad at the a|>peaiai|ce, but n^as sileat vespeetiog k,
iptil I had inquired in^ what part of the back he felt tho
wnsatioiis he bad before oomplaiaed of? He put Jiia^ haiuk
j^ind hioii and laid itfisstupoD'Oaeand theaupon thedtber^
fif the |iiaces that hud. changed in> their eolour,. 9hei|Mlfipi^

was not benefited by tbe excursion ve iR^e then upWi but
soon after our return homehewehttoBaxton, bathed, dl'aiA
the waters, and rode upon Ifae neighbouring hills daily tef
itfear a mpatfa, and then capie back to his family in tolerabte
bealth.

Reply of Mr, Lpwndes t9 Mr. Calderwoodpn hh Com^
fnunicationon Medical Ehctricitt/t

. Tq the Editors qf Tks Afedical and Surgical Sp^ctalor^ .

Gentlemen-r-Iv the last number of your yalnable and
si^ientific work| I had the honor of being particularly noticed
by Mr. Calderwood ; and as Mr. Calderwood and I diflfei
entirely in the principles of our reasoning, the cmiclusicrfis we
draw cannot accordingly meet in unison op the subject of
electricity,

I agree perfectly with Mr. Calderwood's maxim, that any
active remedy, in proportion as it is capable of doipg good, is
also capable of doin^ misehief* This being granted I sbaH
proceed to shew that the sii^se of my machine as I contend
for is tbe great and leading point on which the success of
electricity, in the cure of diseases, depends. The principle
OR which Mr. Calderwood sets out, is that eledripity act^
etttirely by its stimulant operation. If this^ were the truths
t iPiery stimulant acting with the same degree of cqperation
would be equally successful in tbe cure of diseases; bol
we find eren in the case Mr. Calderwood adduces for the
auccesf of electriqity in his own hands, that other stimulant
and active plan»w|sre resorted to without any effect. Wens
stimulus alone wanted, a smaH machine might certainly ia
most cases answer every purpose and give shock sufficiowt to
have an influenice on tbe mcurbid action. But contrary to Mr.
palderwood's sentiments^ I contend that elediicity i» a^
peculiar matter, the stim^lasof «hicb is wlj a sepondai^fr
point; that this matter is {tn^ogous to tl^at fecretiqa which

180 Pharmaey. (^lif^cl^

iBtsuppoaed to give power and sensation io the nervons sjateniy
wd that the quick supply of thii matter to parts, where thejft
^ve lost their energy in consequence of its being deficieoti
js the great principle that constitutes the cure* If this prin^
ciple is just, a quick accumulation of this matter, Mr. Cal«
derwood will perceive, can only be made by a large machine.
it }s not my practice to operate much by shocks, nor have I
9een much benefit from them. I have tried machines of every
description and size, and what I have stated in regard to
this essential point is from a long and extensive experience.
I hope Mr. Galderwood will be satisfied ; I allow him every
merit for his treatment of the case he has published, and
though we differ in principle on this subject, we both agree in
tJliS wish of being useful by our observations to society « I am^

(gentlemen,
''St. PauFs Churchyard, Yo^r obedient humble Servant, .
Feb, 19, 1800. F, LOWNDES,

On the New Chemical Nomenclature^ as adopted in the
Specimen of the College Pharmacopoeia.

To the Editors of The Medical and Surgical Spectator*

GeHtlemen-^TinE profession anxiously look for the New
IHiarmacopceia of the College, which has been so long under
the inspection of that respectable body. In the specimen i
have seen of that work, circulated through the membeni
there is a circumstance which does not seem to have stilick
them, but which would certainly be highly useful to prevent
mistakes. The College have very properly adopted the
latest chemical nomenclature. Chemistry may be termed a
revolutionary science, which has been shifting its terms so
frequently, that mistakes are very apt to arise from this
source. There are at present three stages of nomenclature;
the oldy the modarnf and the v^ry modem. It would hn

i«(».Jj Pharmacy. m

bigbltf advftniageotis that each ariide ih tliq most Inoiitera
term sb^ttld bare appended to it the other syhonymes* l^be
ftiifltafeci &{ one substanceibr another, the Cdllege d^nnot b|l(
Ite a\fare, may be attended with the nkort dadgeiroud* CQm^
quinces, and tbeymnet likeivise knoW, that the ol Jer pdrt of
the profession SnA it difficult to unlearn the lessons formerly
ianght them. Sach a siitkpte addition would do much for th^
b^efit of the publiC) as well as relieve from inuck per^
plexity many who, though well ac<^uainted with . £he atepi
fb^ ought to pursue, may be in danger at times ofdiis-
ttMng the proper instruftient that ou^ht to' be employed ^
Tbi^ is merely hinted by one who, though a well-wisher to
€lrery- isiproTement, thinks no sacrifices ought to be made or
lives endangered for the parade of Chomicai purity in dic^
tion. I am^ G^titkmM,

Your obedient Servant,

ITaj/markei, Feb. 16, 1807. AN OLD CHEMIST.

ON THE USE OF ALKALItlS IN MEDTCtJ^^^.

To. the Editors of The Medical and Surgkial Spectator.

Oentlemett'-*Hbe use of alkalies b^ lately been 'ext^fided in
pifactiee, and the principlo of it is certainly founded on ac>
i0iirate observation* The fluids c^ the. stomaqh are^ in their
naitiral state, neltfaer acid nor alkalbevbut w.heix the do*
nngemeat of tiiis organ takes place,, they evidently partakf
•f an acid tendency, which occasions iiew arrangements to he
fon^ed, and the natural chylifsctive 'procesf.to: be intciN
rapted. This state detours in most diseases ;r aQd.thoit^b tlie
use of alkalies is by no raeans to he held out as general reme-
dies, yet they will be found in a high d^ree to palliate those
symptoms of irritation m the prhtias tim which tend-elthek to
<9Mitiaue x)r aggravate the. oid^al affe^tionr ,

98f Pharmacj/l [Mirci^

In the complaints of children, they have long been conn'
aidered as highly beneficial ; and from this circumstance^ i^
theory of the diseases incident to that period of life "wat
founded ; but though this reasoning v^as erroneou3 in not
making a distinction between the actual diseases and the
aymptoms merely of the priwce vice^ their good etkQis b$
palliatives cannot be disputed. The practice introduced
by Harris has therefore been contiuncd tp this present day,'
though his reasoning is laid aside.

In the diseases of women, the same state of the primfB tia
exists as in childhood. A disengaged acid appears on any
irritation of the primes vim^ and tlie use of alltalies is therer
fore found beneficial, not as specifics for the disease, but as
correctoirs of uneasy symptoms occupying this situationi
which continue it or aggravate its violeppe.

The same may' be said of gouty habits, in whom a
si|foilar derangeipent of the stomach occurs, ai^ an attentiofi
to the use of alkalies becomes here generally useful and
necessary.

In yenereal pomplaints, also, where an excess of oxygen i|
introduced by mercury into the system, and the solid passes
into a state of ulceration in difierent parts, alkalies form the
only remedy against such ravages. They require to be
largely used, and the v^etable alkali is the most succeBsfiil.

In scrofula, alkalies are no less specific. In this haUti
a state of incomplete animalisation occurs^ and this state oiF
the stomach prevails where a disengaged acid is conspicuous*
Though alkalies are here so useful, I dp not mean to say
that the disease depends on thi$ predominant principle. All |
contend for is, that as a symptom of this imperfect aninoAlif
sation, there prevails in scrofula a derangement of stomach
and bowels connected with a predominant disengaged acid;
and that the relieving this sjnmptom, if it does np^
cure, by taking off a source erf* irritatioif existing in soiniv

jportant an pigan, yet forms a leading step towards it,
I consider^ therefore, an extensiye iise of alkalies as of material
service^ and thej are, perhaps, better employed in tht
carbonated state than in any other*

I shall, if the above remarks are worthy of insertion,
proceed farther on the subject. In the mean time)

I am^ Grentlemen,

your obedient servant,
Exeter, Feb. 10, 1809. S. T.

Op( THE ^EST M^A^S OF PAOMOTING SUPPURATION IN TVf

MOUBS^

To the Editors of The Medical and Surgical Spectator.

Gentlemen — ^To apply means equal to the effect ireguired,
is the great and successful principle that ought to direct our
practice. These means seem to fail more in surgery than in
medicine, and in the case of tumours it is often a most tedi*
ous and perplexing circumstance to bring them tosuppu*
ration. It is the rule with the first surgeons to trust gene*
tally to the ^njimpn poultice ; as the action of this remedy
depends entirely on its degree pf beat, U is clear that the
moment that it loses its increased temperature at tfaaj .moinent
it loses all its influence in promoting suppuration. Besides
the teguments can only bear a certain degree of increased
temperature, not so high as is really sufficient to produpe n
quick c^nge on the first stage of inflammatipn in the p^urt*'
The loss of heat in the poultice occasions it to lie an useless ah4.,
hurtful mass on the tumour, and from its coldness rather to
retltfd, than hasten the process for which it ws^ iptended.
THo obviote this circumstanc^e it hsis been usual to cover thf'
poultice with some stimulant applications, as gum galbanum,
^ little cf^nphor, mustard flour, &c. But such stimulants^
J[i9wever properin their principle, I contend^arenot sufficiently

tM Stixgtn/^ [Marcb,

penetratLpg to answer the purpose, and at the same time thejr
they S^^^. ™uch V^^^ Ai^d much irritation. Instead of
this practice for the maturation of indolent tumours, I would
propose substituting the use of some of the cheaper essential
oils. They possess a all sharp, acrid and burning taste* They
areof adeeplj penetrating and powerful! j stimulant nature,
so as in their concentrated state, to act even as caustics. In
blending them as maturant^ they should be blended in a
certain proportion with some of the unctious plaisters, but
not in that proportion as to lessen or^ destroy their full in-
fluence. The most useful and the cheapest, I have found to
be the oil of pepperment, and this application^, I hare
experienced the most successful in many tumours of the
most indolent naturq.

The form of a plaister is also for the patient a more con*
yenient on^ than a poultice. Camphor has been a substanca
Qiuch applied as a maturant, but this substance is not rea^
dily dissolved, neither does it act in the same complete and
imperceptible manner as the essential oils. The subject is
one which comes so often under the care of the- surg;eQnj^
that too much attention cannot be paid to hit on the most
^ffi^ctual m^ans to bring them to a speedy and effectual i^niek
I^odem surgery is in pharmaceutic preparations^' ofitejx tioa
inert. The principle of trusting to the powers Qf Datum
1^ the change and renovation of parts has been carried too far^,
and though a proper rule to lay down, U admits of more excep»
tiphs' in the class of tumours than in any other local diseases*
. Every one acquainted with this subject will concur in %'
The class of tumours is more e:a^tensive than any othci: claMt
of local diseases. They are divided intp twp lunds^' ;the
acute and chronic ; but this diyisioa is hot suffi^pieotij? vA^
nute to lead to. ^n acquaintance with their real naiture^ Mj;.
Aberne thy ha^ properly formed. a more scientific divi^iwa
which approaches a step nearei; ia what is wantsfl*. Th^ 1^^
arrangement would Ire one foroied from the particular kiiid itf

180Sf«] Phdmaty. "^

•stfuctare a&cted/ as discovered by dissection, Because the
^term woald then expUin both the morbid change, and also
point oat the mode of treatment to be adopted.

How often do we see Aneurism mistaken for a tumour
of another description, even by surgeons of expedience;
juid how often has schirrus of the testide been mistalren for
simple hydrocele. These are proofs how imperfect is onr
Jmowledge of this chiss of diseases in their proper diagnos-
tics; and consequently how deficient must,. in mafty re-
spects, be onr treatm^t.

I am. Gentlemen,

Your obedient servant,

AN HOSPITAL SURGEON.
Xomfo«, Feb. 10, 1809.

On the Neglect of the Medical Police in regard to the
Situation of the Public Buildings of the Metropolis^
occasioned by the late Fire at Drury Lane Theatre*

To the Editors of The Medical and Surgical Spectator.

* Gentlemen — ^The (reqnent and fatal accidents which have
lately spread terror through the metropolis and its vicinity,
by the destruction of so many places of public fiiscination
U|yfire, call loudly for the interference of the legislature to
fftevent as far as possible the dangerous and extensive evils
which are apt to arise from the casualties to which such
places are unavoidably more than others subjected. The
Ant circumstance that must naturally strike every one in the
IMy of precaution is this-^they should be built in a separate
0t insulated stttrnfion, unconnected with any edifices or
bnildings, having the avenues to them spacious and
ftfefe. However valuable the property of ground may be
itt London, no expense should be spared wheit the publi^^
. itofetjr h sii irthtteriaily p6nderned .

166 Phflrmdcj/. [MMA,

Aneiher advantage attending an insulaled tod spaciouf
situation is, that such a construction of the edifite can take
place as may best ensure the prcservdtionf of health. Ont-^
third of the deaths of the metropolis may be dated from colds
caught at places of public smmsement, or from the vitiated
and unwholesome atmosphere breathed in such situations.
To be kept for a kn^h of time in the stewing beat of a
.crowded playhouse^ bathed in constant pen^iration, and
.then suddenly exposed to the chilly damp of a winter nighty
is more than most constitutions can bear« No wonder that
the young and the gay, who are so much the frequenters of
these scenes, are so quickly cut off. Indeed it is almost im*
possible that those with weak lungs can escape. The sudden
check to the fluids on the surface repels their circulation' intft*
.nally, and accumulates it in the lungs, while thpse organS|
accustomed for some hours to draw in a heated aiid unwhole*
some current of air, loaded, in the languge of chemistry,
with azote, as suddenly are brought, on getting out of doors,
to inhale a cold oxygenated fluid, disposing them strongly
to inflammation. This change of temperature, joined
with their accumulated circulation, immediately b^ins the
pulmonic disease which too often proves fetaL Nor wit
the victims of such rashness rendered wiser even where they
escape. The giddy round of pleasure still attracts them to
the fatal gulph of disease, and they generally fall victims
to a second or at most a third attack of what they term a cold
caught at seeing some favourite piece.

But, independent of cold, public places, in the confined
situations in which they are built, in this metropolis, are too
often visited by the seeds of febrile contagion ; ^nd from
these seats of amusement the fatal poison is inhaled, which
saps the principle of life and enjoyment. It is from a oon*-
siderati(Hi of these circumstances that the situation, structoii^
and regniatiou of public places^ I contend, should jform a sab*

M0&3 Pharmacy. SST

Jectbf the firtt importance. The plibii<$ interest) not the
imdlUment of Individ udlsj should be the first object, and to
thatj every thing else should bend. The legislature, iirith
(iropelr advicej shduld dirett etery thing respecting them
points i and it ^oald be well if the sam^ attention were paid
to the isubject {is is ddne on the continent^ where publie
amtiseihents dre An object of the regulation of govei-nmeiif^
And are not left to the caprice of individuals.

These hmts, I flatter myself, will not be lost^ All the acci^t
dents from pressure and crbwds^ as well as the predisposition
to disease, from improper ot neglected ventUation, would
b6 then avoided.

I am, Genttemeii,

Your obedient servant,
fa. a!5, 1809* MEDICUS POLITICUSu

OK THE MEblcAL ETftClti 6f TlkoBtAOiitJti

To the Editors of The Medical and Surgical Spectator.

Gentlemen — ^For some time past it has been much the cus*

torn to adopt German medicine as well as Gferman literature

and mo^lity. The plays of Kotzebue have sapped the foun*

dations of female virtue in this country, and the writings

<tf several of the German physicians have led to wild and

•lleculative remedies iu practice, the action of which is

Ibonded entirely on chemical theory. One of the most

ponferful and dangerous of these is the well known substance

ive term phosphorus, which may be considered in no other

light than as liquid Jire^ It combines, it is well known^

with oxygen at the lowest temperature : and ithen exposed

to atmospheric air, it emits a white fiime of a foetid smell, and

is-highly luminous in the dark. With these strong similarities

to fat itself, its qualitiea as a medicine must be of a more

Pharmacy: [Marcb^

than phlogistie nature; aiid, however iii combiiiatioa ita
powers piay be modifiedi so as to form a constituent principle
of tb^more solid parti of the animal machine, in its pure state
it is the most powerful agent that cap be employed U} des*
troy it. It has been represented by the G^erman physicians. as
an instrument pf such powerful animal excitement aa to
|:eoall the fleeting breath as it passes through the lungs, per-
forming respiration in its last struggles. It produces, we
are told, by its acticm, an universal heat and glow, and
quickois the pulse, rendering it at the same time full and
strong ; but it is addedy that it is one of t^o^ rapidly ex-
citing agents, which is only safe where the vital powers are
extremely low ; where the functions of nature are, as it were,
altogether suspended ; and where every chance of recovery
IS past* Henoe it is strongly recommended in th^ last sta^
of typhus, where involuntary stools and urine have^come on.
In such cases I have several times seen it tried, but not with
the success or marveloy^ effects which the German physi-
cians declare*

One of these cases was with my respectable friend Dr.
Garthshore, who, zealous in the pursuits of his proftnioo,
and anxious to give every scientific practice a fair trial, pv^.
scribed it in a case of the last stage of typhus, attended iilsa
bjr Messrs. Main waring and Jones. The first exhibitioQ of
it roused the patient, and gave a short-lived and dec^ptiv^
appearance, which immediately aftafwards was succoede^
by a more gloomy relapse ; and the patieiit did not loQf
survive. Since that time I have witnessed the same result ift
several other instances. It is clear that this remedy can im\f
a^t by exciting inflammation, and the inflammaiion it cxeitil
is of that very active and overwhelming nature, that a YCiqp
short period completes its triumph over the unhappy paliMit*
Hence even its German panegyrists observe^ that whore it ist
improperly used, the worst consequences have sUtsadod its

admiobtnitum. Balancing^ then, the injury ariiuig firooi
what if tarmed its improper uae» and the uncertainty of its
permanent benefit in cases where it does really apply^ it is •
medicine which I think ought to be wholly discarded. We
have mischievous remedies enough in this country ^ without the
Germansteaching us toswallow liqiddfire. I observe the phoe#
phoric acid and ether is prescribed in certain cases of impo«
tency by. Mr. Roberton of Edinburgh. Perhaps futura
and more enlarged experience will make him abandon thif
highly prized specific.

I am, Gentlemen, .

Your obedient servant^

CLINICUS.
London^ Feb. 10, 1809.

Communieation on Medical Editcation^ hy Dr. John Reid,
Licentiate of the Royal College of Physicians^ and late
Senior Physician to the Finsbnry Dispensary.

«

To the Editors of The Medical and Surgical Spectator.

. Otntktnen^^Th^ success with which you have dereloped
the artifices of empiricism, entitles you to the gratitude as,
WPeU of the medical profi^ssion as of the public at large,
but (o deanse the accumulating filth of this Augean stable
is a labour that the legisktive poif er only can ever hope to
achieve* Many other professional abuses, however, call
^udly for reformation, nor do I conceive that the '^ lytedical
Spectator^' can be more usefully employed in its censorial
capacity, than in bringing some of these fisiirly before the.
public, and in suggesting such expedients for their removal,
as ; ^ 4ne consideration of tbem will necessarily produce.
That the general routine of Education usually purs^ued by.
medical students is radically and essentially defective, few
will ^ disposed to deny. It is indeed a lamentable, but aj%
Hndoi^bt^ facts tfafU^ among the numerous students that aow

Miscdwneii flUltti^

Bually resort to the metropolis for the acqtibitiofi tf( medical
knowledge^ verj few are prcyperlj prepared by scholaiticr
acquirements for the reception of that information which m
the object of their porsuit. If to one class of men moit
than another^ a liberal education, ail enlarged nnderstaad-
ing and a wdl cultivated mind^iire indispensably reqaisite^
If in one station of life more than another^ Urbanity ti
manners and an intimate acquaidtanoe with the human hearty
are absolutely required ; surely those who are engaged in
either of the departments of the ^' healing art^" ought in an
eminent degree to possess these necessary qualifications^
How then does it happen that young men designed for the
practice of Surgery and Medicine are often so miserably defi^
cient? Is it true, persons in a sphere 6f life where the tuMi*
ration of literature is less attended to, introduce their sons
to the profession, or does it arise from the necessity that ex«
ists of removing early from school a boy destined to the
drudgery of pharmaceutical preparation for the next seven
years? To the latter oflthese causes^ I think the evil is in
general to be attributed. A youth at the age of ^ourte^n is
taken from school and placed behind an Apothecary's counter*
There the mixing of potions, powders, See. probably ooctt«
pies most of his time. The Pharmacopceia is perhaps- giveii
him to study^ and in due time he is initiated into themys^'
teries of bleeding and tooth-drawing. In the course of his
apprenticeship, he will most likely collect a few empirical ideas
respecting the efficacy of medicines, and will perhaps -lettrn
to make a suitable application to a sore. He may even by
some lucky chance attend a pauper in a fever, and after much
ineffectual search be fortunate enough to discover the pulse^
though certainly without knowing the distinction between an
artery or a vein. Curiosity may sometimes induce him to
take up a *' system on anatomy" or " CaHen*s first lineal'^
Sut the alphabet of every science is dry and uninteresting*
Hef feds the want of a classical key, and is soon diagurted

' irith nameSi phrases and descriptions tiiat }fo \atti art inconi*
prehensible. Confinement is always irksome^ but particm-
larlj so at that time when the mind begins to expand^ aoll
the youth feels himself become a man. He therefore natm-
rally looks forward with patience to the day of liberatmiy
and fondly fancies that liberty includes every enjoyment thit
human nature is capable of tastmg. A new scene nowopeda
•to his view. He arrives in London, enters at tbq Hospitals^
and is expected in the course of six or twelve months to make
•such a proficiency in anatomy and surgery as will enaUo
him to pass an examination at ^^ the Hall," which is held
out as being the grand object of solicitude. But here again
obstacles occur to impede his improvement. Released so ie»
cently from restraint, and transported at once from perhapa
an obscure country district to the centre of the metropc^is^
without experience to guard or discretion to direct hin^^ caA
we wonder if the blandishments of pleasure induce his atten-
tion from the sober path of professional duty, or that stimii*
lated by the example of too many of his associates, and at-
tracted by the novelties with which he is surrounded, hit
attendants should be lax and irr^ular, and his mind be-
come dissipated and unbent. Grant however, that from
lectures, dissections and hospital practice, a general outline
of useful knowledge is gleaned. The ordeal of examination
passed, and the student thus fledged, ready to take his flight
into the country, there to erect his standard as a licensed
destroyer, or perhaps having procured an appointment, je
dispatched to tamper with the lives of our soldiers and sai-
lors, which at the present juncture are so valuable both in a
political and pecuniary point of view. If this picture be
not overcharged, (and for the correctness of it I can confi.^
dently appeal to every man who has had opportunities of
making observations on any of our modern schools,) it only
remains for me to inquire ought these things to be? Is an
apprenti^ship necessary, or even desirable as an iatroductio;!

ifedieal IntdUgenee^ [lifarclii

-to the tnedical profession, and ought &ot some system of in-
itruction to be formed and enforced io insure it from beii^
invaded by incapable and unworthy members? Without a
classical education, no pupil should be admitted, and gram-
tttars of anatomy, chemistry, &c» might easily be compiled
"tOK the use of such boys while at school, as were intended
'for the difierent departments with which those sciences are
(Connected. If the dispensing of medicines cannot be alto*
^gether omitted, a youth from the age of sixteen to eighteen
'might be employed. The present mode of Hospital attend-
tace requires a complete revolution, and might with adyan*
^tage be placed upon a footing somewhat similar to that at
oar universities. A certain sum of money should be paid
•«|i entrance, and a certain course of study be laid down
{tom which no pupil could deviate. To this plan, thrae
years at least should be devoted, and a rigid examination
should then take place in each particular branch of science, and
-those only who should be found in rtery respect competent|
should be allowed to practise. These desultory hints, hastily
4hrown together, are submitted to the candour of the Editors,
with the hope that they may excite the attentim of men
tictter informed on the subject, who may have the wisdom to
suggest, and the power to put in execution some permanent
plan for the better regulation of medical instruction.

I am, Grentlonen,

Your obedient servant,
GreviUe Street y Brunswick Square. JOHN RBID;

MEDICAL INTELLIGENCE.

Accounts from Brazil state, that the vaccine inoculation, first practiied
in St. Salvador, towards the close of 1 SO^, has since been spread through
all the provinces, b> the orders of the Prince Regent. His rojral falghnest
appointed* Dr. J. A. Barbaso to superintend and promote the new practice 3
and 80 beneficial have been its effects, that the. 8inaII-poZ| fonnerl^ very
dcitructive tbere> hai totally disappeared. '

A 9jfeme$ pC wasp which builds its nedis in trees bat lateljr been obsew^i
Id Taiiott» p^rtw of thi» Goantrj, and wai fro^iientlj met with dmhng iHab la|t
VilBiner in different pnrts of the West Riding of Yoricsbira. It appcsrs At
be a new introdueticiDi and H supposed to have been brooght aeiow the Al»
lantio into sbme of the port* on the western shore of the isbuid, and i» gtmt
dnallj intrododqi^ siMlf through the ceuntrj. The trees on. which the nte^
h&Te been JBott livqventijr observed, are the gooseberry and curmrt, aad
Hn iBStaace of it has been met with on the c«mnion elder^ to which hieeeit
ID general are averse. This spectes is. smialler thaa the cobiidod wvifs Wl
|t is DMieh leqa voracious, and less easiljr iniUted.

Jku improrempnfc on obstetrical ins(rmicnt» ha« for tome ytan been h^
troduced in his private practice bj Mr. Mainwaring, which fe 'e# oonffiHefi
able importance. In those unfort n oa t e eases of distortion, where a diraif
nation of the child's head is unavoidable to permit deiiverj, the ins^minti
commottlj in use are the long scissars and crotchet, or blunt hook. ThD
latter is perhaps an unnecessarj instrument. Mr. M^inwaring ha^. wiA
mnch advantage andsioipHcit^, coiyoi^ed the two former instrumenlsiDtoeotk
This instminent is a pair of long scissars completely blunt on all Hideni
except i^t the points,, at a small distance from which are placed two piwt^
pectiflg points or stops. When the perforation of the head takes place tti
the full extent, and the evacuation is made, which can be all dooe with
the saqiie instrument on expanding the blades to. a certain extent, the
stops take a firj^ hold of any projecting parts -of the bones of the head in
the same maqner as the crotchet, and are not so liable to slip as that in-
strumeot, neither of slipping from tbfir blunt sqrftice to do injury. The
slipping of the crotchet is always a dangerous circumstance, unless weU
guarded by the hand of the operator, and even the withdrawing one.instm^
ment after perforatuig aqd employing another, is attended with ineonvenl*
ence, and muoh delay in the delivery. On these*. acaouqt» we hope iMe pro^
jector of this improvement will make itig^eralljr kppwn, and state the par^
ticulars of his own experience with it.

AqoAer extraordinary instance of abstinence at present ^xist^- in No.rt^«j
Wales.— This extraordinary being is also a woman,, named Ji/i^f^; Thontojfy
She is now of the age of a4> jearsr; 63 of these she, has bfi«ttt' 9>M>^^d to^ '
the bedi| and d^rin^^ this.loBg neriod has: lifed ne^rW witheol cacfeg <y^

SM

iMkal IrUeUigaiee.',

[iiani.

driBkias- For ten jtan, about the middle of thii Iode term, the wh in^
ported abfolatelj withont fbod ot aaj kludt thCD Ijin^ in a torpid ttaie,
tneoncioui or her own exidence. In IS07 ber Aiscf<B iiere coafined tp
«me ounce of biead and a {;laii of water in fourteen daji [ aad Ibii wai iB<
miablj KJMtEd from her Momaeh in a few mioatei after being tdcch
Under tbii exteoded period of abitineBce ibe ia reduced to a bremtlunf
■kelelon. An eaiacDt artiat, Mr. iamei Ward of Newman Street, hai
!■ hi* poMcuioD an admirable iketoh, naique in iti kind, of tliii baaf,
Inkeu from the life b; himself. Il it (Dperfloooi to ob>erf e bow mwh pW-
loMphen and phjsiciani would be Ratified by an etchiog^ from tbii «nrioM
portrait, eieculed with the truth and tpirit iii poMeiior ii capuble of [ir-
ia; to it t and aocompanied with neb antfacDtic bcti, Bi Hr< Wa^'i kaow-
kiEf of Ck woman can luppl/.

B; (he Report of tfie Small Fox Hospital, it appean that the diieonlinnp
■Me oflBoenlatian for Small Pol has bjno means checked the cainal dlseaiei
■•d that, on the contrarj, the mortality from Small Pox has fncivaied (rOM
■B aTeraee of 42 in April and Ha;, ta HI each for the monthi of October
and Noiember. Tbii proueds chiefly from the dislike of uaaj to tha -
practice of Vacdoation. Tfae following is the stateneat of paticpti, aa4
the ravlt of Iheir ca«e* ftom January to Novcnber.

In-Palienis. OtU-Palienls, *

January
February
Marcb •
April- -
May - •
June - -
July - -
August -

October - ■
NoTembei •

.»«

K

"S

1

1

i

Jg- =

J.

1

1

i

Si|°

1

1

>

i
>

1

mil

7

gf

32

67

171

9

19

m

96

108

9

29

101

190

89

4

36

113

184

46

4

S5

214

196

39

15

W

I

117

51

14

10

2

53

92

3

10

105

78

6

SO

156

103

10

23

3

159

96

34

£9

114

167

1909.] < Mei^a Itttfiligmcfi*i_ 1^

Dr. John Reid, ^p are sonpr to underytand, ipteods discMtiiiiiiog;^ jui
Ifontbljr Reports of Diseases. The aifirant^get of stuth repbcttt ve am of
japinion, are verj great for the informatioii of praetitioners s and we sboaid
urish to see them extended in the manner pointed out in, a forn^er number of
this work*

lECTURES on the THEORY and PRACTICE of MEDICINE, hj
Dr. REID^ Member of the ROjal Collig^e of Phjsiciaas, late ^nior Phjr-
ficiaa to the Finsburj Dispensarj, &c.

The Course wiU comprise Thjlr^j-iQir^ I^ptures,

The Lecturer conceives that this inunber will afford sufficient scope fov
that extent of acquisition which is i^equisite to lajr a foundation for the at-
tainment of practical knowledge*

The science of life will be treated of ^s^ distinct from, although not in«
.dependant of, other branches of il^Ji^r^..

Tbe principles of Brown will be expUined, ap4 f^ yi^w taken of other
pjrstems which^ in the present dajr, have any claim to critical Investigation. '

Tbe advantages which have been derived from ap application of ti|s
principles of modern Chemistrj to medipal knowledge will be<pointe4ontt
Strictures, at the same time, will be made on the UDJystitiable degree to
which chemical philosophy has been extended, for the purpose of e^«
plaiuipg the Phenomena of health and disease.

The ^high importance of attention to the conduct and direction of the in-
tellectual and moral condition of man, as affecting his pbjrsical organization
and chai^cter^ will be ptate^} an4 illustrated \^y examples.

The order df tbj& Copr^e wi^ be in a grpat m^pure guided bj the nq-
sologj of Cullen.

A printed Syllabus^ including the heads of each Lecti^re, will be delivered
to a pupil upion his ebtrance in the Course.

The introduatorj Lecture will be given at nine o'clock in tbe morning, on
Wednesdaj, March 15» at Dr. Reid's House, where tbe subsequent I^tiirea
will be delivered, at the ^ame hour, on Mondays, Wednesdajs, and Fridays.

Terms of */itfendtmcp — For one Course, 21* 2s. Od. — Perpetual Pupil,
31. 3s. Od.

Further particulars may be learned, by applying at Dn Reid*f House^
No. 6f Grcville-8treet| Brunswick*square.

Dr. Ram^bptl^am w|U commenc* his Course of Spring L<Bc^res on the
science and practice of Midwifery, at his house, No. 9^ Old Jewry, on Mon*
day, the 1 3th March, at seven o'clock in the evening. Two Courses will
h% given during the Summer season | th« first of which will be commenced

♦ It

999 Itedtta Iktelligem. - [Marcb,

file meeond Mo&daf in Maj, at un o'clock io the momiajg^ i 6acb subject of
«ie« Leotureft it eiueidated bjr apptvpriate speciuKiM of nataral add iAmmii
parts from a oelebrated anatomical CQliectinu

NEW MEDICAL PUBLICATIONS.

Bnni*8 Observations on some of the most frequent and important diseases
of the Heart, %yio» 78. boards.

The Phjsician's Yade Mecnm ; containing the Symptoms, Causes, Diag*
Bosis, Prognosis and Treatment of Disease, accompanied b/ a select collec-
tjion of formulas, and a glossary of teams* fiy ttobert Hooner, M. Df
•mall 8vo. 6s. boafds.

IN THEI PRESS.

Mr. Charles Bell's second vohraie of hh operatire snti^ry, fbunded on
flie basle of anatomy, will appear n a few days. .

Two highly-finished engrairingSy the size of nataw, one rqnetentiiig OM
basis of the human brain, the other the cartty ^io wlueh it is contaiiie<|
together with two plates of outline io the same, with figures of difference,
also a full description of the origin ^ «lie nerves arising from that organ,
and the openings of the cranium througo which they pass. By T. J. Petti*
grew, Fellow of the London Medical Society.

The drawings executed from nature bj T. Baiter, and engiayed by jj
Hopwood I the whole under the fanpectiott of John TaootM, It^ Member
of the Royal College of S«rg«oi^ L«idoot Smrgeoa to th&^City and WHm
bury Dfipenearksy Citjr Tmss Society, and LectUMr on Anatomy,- Pby*
aMogy, te. Priee 15s*

A system of Surgery. By Jawia Rvssell, f . R. a S. 4 toIm. av«» :

TO CORRESPONDENTS.

We are $orr^ iO inform Jp C. thtEt we ttmnot in^eri his let"
ter on Hj/drophbia : it contains too many persohafities\
and too few facts to deserte insertion. TT. Vs. tint sKalf
ie attended to in our next.*^There is nothing new in ihe
mode of operating in eamertms cases recommended by A
Constant Header; it is "knowri and acted upon by many
eminent surgeons of the day.

Vol. II.] Jpril, 1809: po. IX.

/

THE L01!^D0N

SPECTATOR.

mmSt

EMPIRICISM.

■ ji*i.

AS Quackery exteifids, in a political vierr^ the profession
are benefited. The mischief from this souite falls to be re*
paired by scientific bands, and the Quack is the active agent i
to cut out work for the regular practitioner. . Since, then, the
predilection to this department of the healing art is too
strongly rooted to be erased, and since the revenue drawn.,
from the same source is too strong a temptation to put a stop
to this trade against health and constitution^ the best plan
would be to restrain it within limits of salutary extent b^ i
establishing a board of medical inquiry to license these tern*
pies of Ciroean deception, and tor admitting only such ar-
ticles for sale, the composition of which should be unfoldedl .
to the individuals of this board under secrecy of not being
divulged; and by their authority, if approved of, the no* .
strum should be adtnitted to sale. In this way few or
no medicines would be rejected ; for the individuals .com-
posing the board, if they saw any articles of the com*^ ,
position dangerous, or not applying to the purpose stated>
as medical men, could advise the substitution of another ar« .
tide in place of it, so that the nostrum would always cpni^.:
forward, and in this way in an improved state as a medicipf^^ »

VOL. II* %

298 Empiricism. t [Aprilj

' By >ucTi irfeginalioh/scKiiety ^^B5M"be BeneSted in a; high
dcgree^^ &nd even the revenue to gov^mftient improved. For^
as the compositions of the Patent Warehouse would not then
be so detriiUental to health, the patie;nt8 would continue the
use of them longer, and not so soon fall a prey to their in«
jurious consQoraepce^,

The diseases of children open a \ride field for the specula-
tions of the empiric^ and worms are a never-failing cause to
account for every ailment that may attack them. The sale of
worm-medicines is therefore beyonfl calculation, and we shall
consider the merits of U few of the principal of these speci-
fics, beginning with the celebrated ^

CHIvd's WORM liOZENGE*

The f6rm of a lozenge is certainly a convenient one foV;>
children. As being- a sweet^meat, it is easily swallowed,
and has the advantage of giving no disgust to the child^ :
Gfaihg's specific-is the calomel and jatop made up iii the foU >
lowing manner into a yellow and brown lozenge s

YJ&LLOW liOZElTGE..

iToka of cafomel, lib. — Whit* sugar, 9Ibs,««Safiron^
half an ounce-spring water, 1 pint. *

- ' BftOWN LOZENGIB.-

•Take of resin of jalap, 8^ lbs.— Galomet, 9 ozs. — White
siigar, 9 lbs. — Spring water, sufficient to make a mass.' '

One of the first, or yellow lozenge, is given at night, and *
a -brown one in the morning to work it off.— This remedy, it
is clear, is nothing more- than the common medicines used •
in worms by the regular apothecary^ and we can make no '
ol:(jection to Mr. Ching's prescription, if proper regard is had
to the doses, suited to %he ages of the patients. But that a
common remedy should be held in this manner as a specific is
both ridiculous and dishonest ; and that the powers of such a
commpn remedy should be ferther vouche4 by noble, reve-
rend, and scientific characters, - shews the mbecility of the

I

1809.] ' £f^irkim^ 299

iiami^ mind under certain impressions, and that the prin«
^plet of scieiice do not run ^ro^g^h tjh^r whole line of con-
>dfict» howeyer 4igAifi^ <Nr learaed in other respects Ihejr
majr be. This may, perhaps^ be pae strong reason in favour
xif pppular medicine^ as a more thorough acquaintance with
its jpowers would withdraw from the mind t^hose extraordi-
liary impressioni which onlj gross ignorance can excuse from
the testimonies in favour (Of particular r^ediea. which we
ifvery day sfe brought forward*

-LB,. GARDNlQIl's ^'OaH MEDICINE*

This is anqthor nostruiti^ of which such tales are lold as
^exceed even the improbabilities^ of Baron Munphauscn. Hvd
jGaidaer even loses sight of common sense in his narrations,
^uch less has a semblanoe of probability^ The museum of
ivprips^ which he has ^Uected to astonish his customers, is
in a great part a deception formed for the purpose of point-
ing out Uie frequency of. the disease^ and the great^ practice
ie hfis in thfit line. They are chiefly made of chickens^
guts, iir^iclij coiled up in his manner^ and suspended, re-
aeml;)le the tape-worm, and may be easily mistaken for it.
The idea pf worms^ as a cause of disease^. is ai popular one«>
and persons recollecting how they may have been infested by
them in childhpodj Me y^y e^ily knade to credit that the
aame may still esfcist ajfter they are grown up. Dr. Gardner'*
medicine happens to be nothing more tha9 a common purg«>
ing pill ; tibe prescriptioiji for whieh acciden^tally fell into his
way while in the humble statji^n .'Of a ^^oldicr ia the guards ;
And considering the pill as a pp^pre.dignijGed weapon ihan the
bayonet, he gave up the on/e^ and has con^in^ed bis waifare
<m society^ we are told vei^ successfully, with the other^
The chi^ ingredients in the pUl aire jakp^ gajaibe^ wd ca*
iomely which require strong bowels in )the common doses in
which such medicines are exhibited, iiot to be irreparably in-
jured. Whether Dr. Gardner conceives he has an^.title to a
patent fox such a remedy, we shall leave the public to judge.

300 JSmpiri^sfn. [April,

WORM irVT8.

This is nothing more than calomel introdneied ifito this
form, and is the same with Chinjffs loienge. The same db*
jections, therefore, that apply to the one, ai^ct the other ;
and if left in a damp place, that the solution of the sugar, or
saline matter, in their composition is effected, the calomel ac*
quires an increased activity, which adds to the danger of
their use in very yonng or weakly constitutions.

THE SWISS BEMEPT; or, worm iPECiriG OF IfABAMB

KOUFLEli.

This remedy acquired so much reputation en the ciMiti-
nent for the Cure of worms* particularly the tape-worm, that
the secret was purchased by the King of France, and pub-
lished for the benefit of society. ' It was then found to be the
powder of the male fern, which, possessing some tonic and
aromatic qualities, by strengthening the bowels, weuld tend
to destroy the disposition to worms. The exhibition of the
powder was followed by a drastic purge at interrals, and a
perseverance in this plan for some time generally effected a
cure. The principle of this medicine was certainly a proper
one— the keeping it a secret as a specific constituted the im*
position.

With these remedies of the Patent Warehouse for the use
of worms we shall contrast a few of what constitute the spe?
cifics of regular practice*

GOWAGE.

The cowage, or a West India remedy, was first made
generally known by Mr. Cfaamberlayne, whose treatise
on thb subject shews the success of this medicine in a
very convincing manner. We consider it as, p^haps,
in its operation, the safest of all the anthelmintics by
acting entirely in a mechanical manner, and thus «e«^
moving the very nidus or bed in which such insects are
generated*

1609.] MediciM. SOI

>ILIMG« or TIN

Abe an old remedy acting on the same principk of me«
chanical aitritioDi and have been equally snccessfiil in dx&*
lodging worms as any other.

INDIAlf PINK

Is an American production. An infusion of the root is a
specific for urorms^ It possesses tonic and narcotic powerd^
so that the principle of its action is easily understood. For
the same reason, all bittars possessing something of a narcotic
property will be equally successful.

Lime-*water ind oils operate differently : the former is a
certain specific against the ascarides, and acts both as a poi-
son to them, and decomposes the mucus or slime in which
they are inclosed^ The latter is a poison to the smaller worms^
as well as to many other species of insects.

REGULAR PRACTICE.

I *.i ilB

L MEDICINE.

POCTBINE OF TEMPERAMENTS.

It is a common obserration which a practitioner daily
hears his patients apply, that such a person, accustomed to
attend them, is better acquainted with their constitution than
another. This is certainly pointing out in other words the
advantage of experience; but, in the language of medicin^
it goes &rther— it includes a proper acquaintance with that
tanperament or habit of body, by which one individual is
distinguished from another. The doctrine of temperaments is
one that ought to form a leading foundation in practice. On
this subject much has been written by physicians ; ^' and the
more," says Dr. Ferguson, ^^ I think on this subject, the more
I am impressed with its importance, and I find that the most
oeld[>rated physicians have been of the same opinion. When
the theory and practice of medicine aie established upon «

x3

SOf MedMiU. CAIIW»

sure foundatioDi ^hich can ouljr render it eminently useful
to the pbTsician, the doctrine of the tenq^truneott will be
no longer imperfecti unintelligible^ ctf dabsumased; the light
thrown upon the one will be reflected by the other. I shall
now offer a few observatiooB for ypur consideration : Ckillen^
and all the tsodern writers uppa this subject,^ consider the
nervous power as modifying the temperaiQentir oS men^ vA
upon its state depends the state of all the other partiir^ The
brain ia the organ which is the seat of nervous power ami
mental actiou,— It is acted upon by our sensual motions^ and
its own functions, which give sensation and motion to alt
parts. It appears^ therefore) that all oUr motions are derived
from the action of the bnun, which is peculiarly <nrganiia4f
for the purpose, and which communicates a contractile power
to the muscular system. This contractile power is the prin*
ciple of all animal motion. It is excited into action hj de»
sire or aversion^ which is termed volition. . If our pleasareS'
and pains depend upon the imagination, certainly cmr voli-
tions are much connected with it; and some are oi opiniAnf
that judgment, memory, and reason, are only modificationa
of this. '* The imagination perceives, reasons, judges, pe-
netrates, and dives into things. The finest, the greatest, and
the strongest imagination, is therefore the properest for Ae
sciences as well as arts.'' What would the man of scienoe^
the orator, or poet, be without it? A certain quantity and
sti:ength of it are necessary for the comparing the amdogy or
resemblance of ideas. The power of the knaginaticm in
marking the various relations of the qualiflcatimis useful to
ourselves and others^ gives occasion to volitions ; therefore^
the operation of the imagination in marking the fitness or uiw
fitness of things, and diffisrence of this dpttution. With 9^
quicker or slower perception of relations, asethedi^nguiih*
ihg characters of the temperaments oi mm. It appeal))^ there-'
for^, that the temperaments depend upon the condition- of the^
imaginati^j which Condition is difier^nt upon certain oca^

. 18690 • ^ttMne. i'-SpS

Mons in the same person. TJie facilit/ of rene^ving oar
ideas, and. the degree of reflex sensation, or pleasure and
pain attending them, are owing to .^e state of the imagina-
tion, h it not by the imagination that we can combine our
ideas; that we can acquire sensations of relation; that our
ideas are renewed bj bur memory ; that we can compwre our
ideas ; and that our sepsatioiis are modiS^4^

^^ Imagination is the chief faculty employed^iad^ciiptitcin,
invention, and persuasion, tod informii^ tbe;T^iifi[U3.opi*
, nions by which mankind are goycrnedj These opinioiisrX)r
imaginations are confirmed by habit; and when erroneoiis,
are not corrected even by experietic^e. . He that has most ima-
gination, ought to be regarded as endowed with j^ost wit
and genius." There are certain. conditions of it necessary for
the formation of oratorsk^, inusiciaos, painters^ ^nd poets,, and
a different condition for tUe i^ilosophcr. . ,...

<^ Although the imagination be weak in some, yet it isyi^y
impetuous and quick in. others^ especially in young persons,
.. where it requires to be bounded by study and experiences^ it
. seems also to be depcnd^$ on the energy of the biaipi :Curgaps
of sense, and excitability* Is it not evident^ that where the
imagination is s(rong,,there is vigorous excitability^ tivacity^
understanding, and knowledge ? Persons of this tempci^-
m^ut have large brains and Strong nerye^; tbey.are^ how-
ever, very liable t^o be aflfected with particular jvaii^s a^d
stimuli^ The sanguine andj choleric temperaip^/s^pf the.An-
cients seem to be varieties of this^ The oppp^jff^qf the alioye
temperament is attended, with a dull imagyi^iion ; the brain
is small, and the nei;ve8 sieger. This agrce^^^plh thephleg^^
^atic temperament of the ancients; the excitability is lan-
guid, ideas are defective, anc| the judgment weak. Persons
of this.tempet^aixiexit are more able tq b(z;ar, fatigue aixd hard*
ship of every kind, than those of the quick t^mperamcnjt.
Of these. two we may con$id^ all the temperaments to.be

x4

304 Medicine. [Aprib

formed, those of debility, as well as those of strength, the
sanguine, the melancholy, the phlegmatic, and choleric.

** We may consider the strength of the system to be regu-
lated by the functions of the brain; for where there is a quick-
ness of imagination, there is a facility of performing volun-
tary motion, a stronger energy of the brain, and a more Ti«
gorous excitability, or that facility of muscular contraction^
termed irritability.

*^ I perceive Mr. Humbold thinks it ^^ highly probable,
that the property of matter lobe affected by stimulus, depends
upon its composition, and that every thing altering this, mo-
difies its excitability ; and he therefore concludes, that no-
thing is of itself either stimulating or sedative, and that the
action entirely depends on the state of the organs with which
it enters into combination ; and that the great process of life
consists in a perpetual alteration of decomposition and union,
and that substances arbitrarily added to, or abstracted from
living matter, sometimes diminish, and sometimes increase
the activity of the organs.'* It is, therefore, very probable
that the different proportion and combinations of elasticity
and density may modify the excitability. We must, how*'
«ver, remain in a state of uncertainty with respect to that
peculiar state of the organs of sense and motion, which mo-
difies the vitality and temperament, until, as you obsei^f
we are better acquainted with the chemical changes which
happen during the functions of life. But let us proceed with
our observations on the particular temperaments.

'^ I should sappose, in the temperament of vigorous ima-
gination, where the sensibility is in its utmost perfection, that
the functions of the brain were performed with great regula-
rity, that the secretion of the nervous fluid was in due pre*
pcMiion and of proper density, that the vis nervea was o£
sufficient force, and obeyed the volitions of the imagination,
and that ^e excitability was vigorous: in consequence of

I8e9«] , Meditine. 305

this, I should suppose the judgment to be strong, attended

, with greatness of mind, and those qualities agreeable to our-
selves to be predominant, as knowledge, cheerfulness, cou-
rage, tranquillity, and benevolence. << Nor should I suppose
this character destitute of those qualities considered agreeable
to others, as justice, good manners, wit, and ingenuity*
Does he not esteem justice, fidelity, honour, veracity, alle-
giance, and chastity, on account of their tendency to pro-
mote* iLhe good of society ? And is not that tendency iQsepa-
rable from humanity, benevolence, lenity, generosity, grati<-
tttde, moderation, tenderness, friendship, and all the other
■social virtues ? Nor can it be doubted that industry, discre-
tion, frugality, secrecy,* order, perseverance, fore-thought^
judgment, and the whole class of virtues and accomplish-

* -ments, of which many pages would not contain the cata-
logue : c&n it be doubted, I say, that the tendency of these
qualities to promote the interest and happiness of their pos-
sessor, is Ae foundation of their merit?

^* Who can dispute that a mind, which supports a perpe-
tual serenity and cheerfulness, a noble dignity and undaunt-

' 'ed spirit, a tender afifection and good will to all ardund, as it
has more enjoyment within itself, is also a more animating
and rejoicing spectacle, than if dejected with melancholy,
tormented 'with anxiety, irritated with rage, or sunk into the
most abject baseness and degeneracy ? And as to qualities
immediately ftgreeable to others, they speak sufficiently for
themselves ; and he must be unhappy indeed, either in his
own temper, or in his situation and company, who has never
perceived the charms of a facetious wit or flowing affability,

' of a delicate modesty or decent gentleness of address and man-
ner." This temperament we have supposed to be of the most
finished cast, possessing the most enjoyment and the least
suffering, with the most perfect mental organization, free
from imbecility; with a spacious forehead, well defined
te9tuieS| 4iiid a large brain. Of a healthy and fresh colour.

306

vfith onion and harmony in the ftNrm. The expregBion of the
countenance^ indicatiy^ of the state of the mind^ having a
beautiful serenitj, or a mixture of modestji sensibility , and
sweetness* Nor should we suppose the fbllawiBg signs of
* force and vigour absent, tis. ^^ Broad shoulders, a lankbelly^
. firm joints^ and taper legs." This is the temperament most
capable of mod^riition^ and of doing most good, and will
serve to answer the four foUofwing queries^ ^' Which is tile
teMprrament most capable of friendship? Which is hiippiest
'Viiiled in marriage i Under what lemperameiEt do men live
'* longest }" and^ ^^ Which is most free from disease ?" Some
vnH observe^ that there are very few who enjoy iSuch a happy
i temperament as I have described ; I rather suppose, that thaps;
are a great many of this tempeittmenty and that there wodll
be morCi if it were not owing to ambition^ avarice^ and in-
temperance. The times in which we live, require the great*
est diligence and ceconemyi to procure a Tespeetftd appear-
ance, and supply our wantsj which, from our increased de-
sires, are become many. Professional men ore eager in tke
pursuit either of fame or riches^ Commerce gives such ,tL
bent to the mind, that is often productive of the worst eon-
sequences.

'^ There are so many different scenes to be met with in
&shionable life, which affect the mind in such a manner^
that it is no wonder, when they excite in us the most df-
stractive passions, and enervate our mental, functions ; tJhey
are too frequently productive of luxury and dissipatioii^
which lead to follies, absurdities, and crimes*

^^ We are not therefore to expect that we shall often meet
with this temperament among professional men^ nor the com«
mercial world in general. We ought to meet wUii it where
the wants are least, especially among those who enjoy a happy
retirement from the busy, scenes of life ; whotneither indulge
in luxury nor dissipation^ but enj^y a calm domestic agricul-
tural life. May we not expect to meet with>it iq.fBlisrgjfmen i

18090 Medicine. Stfl

^^ The opposite temperament to this I should supfk)se to
consist of a small brain with slender nerves; the imaginatioii
less rigorous; the excitability either more languid or exA
hausted; less sensibility; ideas more defective; judgment
weaker ; memory untenacious ; and greater irregularity and
weakness of the mental functions; we are not therefore to
expect those virtues and ^alities agreeable to ourselves and
othersy to be so eminently displayed as in the former tempo*
lament ; but, on the contrary, there, must be less enjoyiaeat
and more sufferingi because, instead of those duties referable
to probity and justice, there is nothing but malioe, foUy^
£ear, sensuality, and dissipation*

^* The eiOfects of a dull imagination will be evident in the
countenance, which is the index of the mind ; the conditioB
<if our mental faculties is represented there, and every pas-^
sion and mode of thinking has its peculiar expression. We
can be at no difficulty in distinguishing when a man looks
upon us with pleasure or pain; or where there is a deficient'
•y of ideas^ by the vacant and unmeanmg aspect.

^^ Nor is it to be expected that in this temperament theie
should be such a beauty or uniformity in the appearance*
<^ The body and mind have such mutual influence, thai
whatever contributes to change the human constitution in its'
form or aspect, has an equal influence on its powers o/ reason
and genius. And these again have a reciprocal effect in
forming the countenance.'*

^ Thus have 1 considered the two classes of temperaments,,
depending upon the state of the imagination and mental fa-{
culties, which diversify to infinity the differences that are to^
be' found among men. It is to this that some are called good,
and others dull, rustic, choleric, melancholic, phlegmatic,;
craelt malicious, and dissipated ; wicked, virtuous, and vi«i
dous; learned and unlearned; reasonable and unreasonable.
Thoreba certain balance of the mental functions which is;
necessary Xm^ and toostituieii the first class of temt)cramentsi;

30S Medicmem [^AptUp

this, i¥hen propeily supported, gives energy to the nervous
system ; but if by any means this balance is broken, either
by intemperance or excess of the passions, predispo6itk>n and
disease are the consequence. The same balance gives to
the mind its share of good and evil, and is also necessary
to the excitability of the system and action of the brain.
The imagination in excess may, therefore, be the means of
destroying this balance; and a permanent predisposition be
formed to mania, fever, and inflammation. This is similar
to the temperament known by the name of choleric. There
is often a degree of energy and ferocity in the countenance;
small eyes and contracted eye*brows; the actions of the
nraJscles quick, especially in walking and speaking ; much
inclined to dreaming ; fond of fermented liquors and animal
jfbod ; eager to undertake hazardous enterprises^ and very
desirous of commanding,

^^ When the imagination is weak, with deficiency of exci«
tability and sensation, this is always accompanied with mo-
ral weakness, and corresponds with the melancholic tempoa*
ment ; there is a languor of the countenance, the muscles of
the eye-lids and brows. hang down, and give a dejected ap^
pearance to the face ; the hair black ; they bear pain better
than labour; are much ai&cted by the changes of the atmo*
spliere, and are disposed to have cold feet; thdr volitions
are slow ; although they are very attentive, yet they are flow
to learn ; they submit to labour with patience, and are very
frequently passionate and revengeful. Those of this tempera*
ment are subject to hysteric aflfections, spasms, hasmonrhageSi
nervous fevers, and the other diseases of debility,

^' The hypochondriac is a variety of this temperament;
they have been supposed to be very subject to diseases of the
liver ; at any rate they are very whimsical, disccmtented^
and envious. God forbid that any magistrate should be of
this temperament. From the different mizUires of the qaidk
and dull temperammts, all Uie^otbofs flwy be siippoied to

19090 Medkin9. 309

be formed ; the mild^ the rustic^ the female, &c. The fe«
miale temperament may be supposed to diil^ in several re*
spects from the male. Thej are formed for giving pleasure,
and are therefore tender, delicate, and affectionate, but weaker
than men. There is also a difference occasioned by the ute*
fine and mammillary systems, -which hare a very great efl^t
upon their excitability. Although they have not such a
depth of thought as the male, their sensibility is greater, and
they have a very quick conception of things. Their passions
are for the • most part strong, and they have not the same
power over them as the male ; they are very credulous and en*
thusiastic, and yet their affection and love are more durable
than the male ; they are also very patient, benevolent, and
modest, but are very easily sunk into melancholy, or raised
to rapture. I observe that novel writers make their heroines
veiy liable to syncope upon very trifling occasions. Is this
a characteristic of the female temperament ? I believe they
are more pamanently predisposed to the diseases of debility
than the male."

HEBEOITABT DISEASES. ^

Connected with temperament, and proceeding on the
same principle, may be considered hereditary or family dis-
eases.

^^ It cannot be disputed,** says M. Portal," that there are
diseases which are transmitted frond parent to child ; while the «
latter inherits the general exterior resemblance of his father, or
even his shape, characteristic traits, looks, or voice, he also in-
herits his father's health, strength, and sometimes his diseases.
Thus Fernel, the celebrated physician of Paris, observes.
Maxima ortus nostri vis est, nee parum f dices bene nati.
It cannot be denied that there are also families, the indivi* *
duals of which attain a greater age than others ; and this
circumstance has occasioned a remark, that there are short as
well as long-lived families.

^* We may safidy addj that if children have a physical re-

^0 Mcdkint. lAV^

jembla^ee lo the parents, they resemble them ia their moral
characier also. '^ We find/' sajs Montaigne^ ^^ that not
only are the marks of the body transmitted fronpi fafjber to
«0D, but also a resemblance of temper, complexion, and in,«
clinations of the mind." This is well ascertained by the
result of examples which frequently fall under our obserya^
tion ; and is not one of these resemblances, physical of
moral, a natural consequence pf the other ? Would not thft
moral resemblance be more striking and more frequent^ if
education did not produce a difl»rence ?

<< We may venture to assert, that nature originally forsKBd
mankind in the most perfect manner possible, as well as all
other beings, both as to the structure of the different partSf
their configuration, size, and relative situations. Thus nuuii
in the state of natui^, would enjoy the best healthy the
{greatest strength, and the finest and most regular shape;
finally, the moral faculties would exist in all their enersyt
if some extraneous cause did not intervene to weaken them^
can we refuse to adtnit this as an inoontrovertible axiom ?
^ *' But there are many causes which derange this ad-
mirable harmony ; may not the parents previous to their
marriage have contracted diseases, which have occasioned
in their organs real affections, rendering them totally different
to what they were in a state of nature ? Thus, at the moment
of procreation, they receive the different cbaracteristicjs ojT
their parents, which they have unfortunately acquired, and
which they may transmit to their progeny. Has not the
mother during pregnancy an influence over the infant in her
womb, cither by assimilating it to herself in some measui]0
by the nourishment, she gives it, or by causing it to f&A^
part of the evils she herself experiences, and cpnimunicatiiig
fome impressions resulting from these causes?

'* The infant, on coming into the world, may be very dif-
ferent from what it would have been had these causes not
existedi which are as it were extraneous to it, and which

1809.J j MfidieiMf. 811 .

make it differ. from its parents as to their primitive state,
of healthy and make it resemble them in their diseases ; and .
as the nnmber and inveteracy of diseases increase as men
advance in life, however strong or healthy they may have
been originally, the children of old;men are. subject to here- ,
ditary diseases, and their constitutions moit feeble. The ,
nnrsiQg of the child by its owu mother, or by a strange
nvirse, may also produce other differencei mor^ or less re* ,
markable, with respect to its physical or moral constitntiony ,
but which will produce a . resedtblaace. to its nurie* Thus :
the. ancients, who regarded the nurse as a second mother, ;
comprehended among hereditary diseases the morbi congenitif
xQgnati, seu fiormutriti of Hippocrates, the morbi parentales
of Pliny, the hasreditarii of Fernel, and those which infants ,
contract from their nurses; and in factj these are too fre-
quently conspicuous.

^' Hippocrates, Galen, Femel, Iiigi:as3ias, Baillou, Lazare,
Riviere, Mead, Boerhaave,Moigagni, Stahl, Senac, Lieutaud,
Haller, Zeller, Van Swieten, and other great physicians, :
whom it wbuld be futile to name after them, have admitted
of hereditary or family diseases, and have included in this
class, scrophula, rachitis, mania, epiLfpsy, convulsions,
apoplejLy, paralysis, diseases of dentition, pulmonary con-
sumption, asthma, dropsy, gout, and stone in the bladder ;
and can there be a single practitioner, more especially in a
great city, where the examples of these diseases are more nu-
merous, who is not convinced from personal observation,
that the children of parents who have been subject to these
diseases, have generally inherited them^ We say generally,
because there are numerous exceptions on this head, even
when the l^itiraacy of birth cannot be questioned.

*f Tq these hereditary diseases may we not add cancer and
cataract, with deafness and dumbness from the birth ? Mor-
gagoi saw three sisters who were dumb from their infancy,
pther authors have mentioned similar instances ; and many

512 Medicine. C^prii,

sttch hare oome under our own obsenration. Those ae*
qaaintcd with herniary complaints do not hesitate toaffinn
that hernia is more freqoent in some families than in others ;
'to far, therefore, from limiting the number of hereditarjr
diseases, and still fiurther from denying their existence en«
tirely, as some authors have done, we think their nomlieiB
are very considerable. Without, however, wishing io go
to the extent that Hippocrates has done, who was of opinion,
that all diseases were hereditary, aliqua qtddem ex parie;
and that all children inherited, more or less, the temperament
of their fathers.

" The opinion of Hippocrates has been followed by all
except Semiert, Ethmuller, and Maurice Hoffman, who do
not admit of any acute diseases being hereditary. As to the
transmission of chronic diseases from father to son, they hate
regarded it not only as possible, but as very common ; and
this doctrine was so generally ad<^[>ted in 1748, that the
Academy of Dijon proposed a pri2e question, with a view to
determine how the transmission took place. M. Louis, who
subsequently became so celebrated in the Annals of French
Surgery, instead of answering the question proposed, pub-
lished a well written Dissertation, in order to prove that
there were no hereditary diseases ; but his arguments Ott
this subject are more ingenious tbau well founded.

^^ The difficulty, or rather the impossibility of a satisfac-
tory explanation of the communication of diseases from
parents to children, has more than once given occasion to
medical authors, to deny the existence of hereditary taints ;
as if it were always necessary, before admitting an effect,
to know its cause ; and yet,, by a strange contradiction, tbe
same writers do not hesitate to recognise the external resem*
blance between children and their parents, which they can-
not account for. Rerum event a magis arbitroTy quameausasj
says Cicero, qu(Bri oporiere; et hoc sum contentus quod
ttiam si quomodo quidquidjiat ignorem^ quodjiat intelligo.

1809.] ilf«4tCM«. « ^5

'* L?t us $tudjr the phenomena of aatu¥ifi| evfjn when she,
conceals from us the means she employs fpr producing them ;
to be acquainted with them is always curious^ c^^d it is useful
if it facilitates the progress of the healing art.

^ The Royal Society of Medicine gave out, a$ Questioni
for the Pri^e Dissertations for ITSTrr-Ut, Do hereditary dis-
eases ^xi^t, and wb^t ^re they ? Sdly, Is it in the powfx of
i^e4icine to hinder their develppepient, or to cure them wben
they have l^roken ou|; ?

^^ Soqip of the memoirs pre^nted on this occasion hayo
l^een pirinted, I^i^t what t)idr anthors have i^aid, does not
appear to us to have e:diausted the subject. The present
remarks being the result of our clinical and ^naton^ic^l obf
servations, prove that there are family or hereditary diseases,
and also seem to lead us to the knowledge of the nature an4
treatment of several pf thesp diseases^

^' Hereditary disease consists not only in mal-cpnforma*
tionsj^ more or less extensive^ of the e:iipternal parts, but fre*
quently alsp ef internal deformities^ an4 which dissectiovi
alone can demonstrate ; it U from these internal mal-con*
formations, and also from peculiarities in structure, that the
alterations of the functions, or the various symptomatic he-
reditary diseases, proceed. We shall enjlefiyouf to prove
this in the following pages..

^^ j(i£tei jpentioning such in^«-conformations as are exter-
nal, we shall proceed to speak of those which we have dis^
covered in the internal paxtsu

^* It cannot be denied, that there are families^ the indivi--
duals of whicl^ have largar heads, than usu^l. There arp
spn^ al^o, but not so common, who have $rna}l beads (^nd
large bodies; at other times, and in the same family, we
meet with craniums, long^ narrow, broad, short, or high in
proportion; this, however, is of no consequence relative to
tb^ moral and pliysi9al consi^ftHtjon, if the papacity of th^

VOL. II. . T

514 ' Medicine. fAprfl,

etanlum be the sarae^ ^hich is generally the case^ as Hippo*
crates and otber accurate observers have remarked.

" To return to the differences observed in families : — The
children of some parents have the nasal bones and cartilages
more elevated or flattened; shorter or longer jl and more or
less covered with a fatty substance. Hence it follows, that
the individuals of certain femilies have nos^ of a form and
size which distinguish them from others ; thus, the family to
which Charles Boromasus belonged, was remarkable for large'
aquiline noses, which are to this day observable in his dev
scendants, The Bourbons have all large noses, and the in^
dividuals belonging to the Austrian branch have, thick lips/
I have known families, in which the ears were very large,'
and in others in which they were small ^ and almost without
any lobulae.

" There i^re individuals also, the bones of whose faces are'
more or less convex, the lower part of the chin hoUow or de^
Tated; the face more or less oval, or irregularly trian^lar
or square; more prominent or flat, and sometimes as if trun<»*
dated at the low^r extremity from a defect in the developed
ment of the lower jaw^

^^ In certain families the individuals have eapacious*
chests, and in others this cayity is narrow and con«v
tracted ; some families have broad shoulders, others narrow,
and this last defect coincides with tbi^t of a too narrow
chest.

** There are many families, the individuals of which are
hunch-backed. 1 know one^mily at Paris, in which there
^ seven of this description ; others have th^eir limbs distort-
ed, or too short, or too lon^, in proportion tQ the rest of their
bodies.

" There are persons also, with small or large hands, and
with short or long feet. A man was once exhibited to us, at
pie Academy of Sgiences^ ^hose b?^uds weie of a mon^

1809']. Medicitle. 31$^

stroiis me^ and he ' assured us that hid fether^s were equi^f
large.- ' • • ' ■ '•' ^

^^ Some families, as motioned by M. Memind, in U p^
per printed among the Memoirs of 'the Academy of Scieircet
(1769) were remarkable for having children with six &igets.

^ External deformities in families have been noticed in ill
ageS) and the ancients never doiibted that they were heredi'
tary. -They were so ccrnvinced that children resembled- their
parenti^ythatthey used the terms macrocephdli a macrocfs*
phalh; Bn^iht'lXoinMaky gofUimes a cajpUonibus^ pufniliotm
a pumilionibus* ' .< "--

f^ Independently of Ihese diibrenceis ^ith respect to the
developement of the bones, we may remark' in some fionttiifil
real diffit^nces in the volhme of the muscles of the truidi
and of the limbs. I hkve seen instances .wbeve a fatbHc
and his two sons hadr ^be lefl side of the body, with ie-
apect to the muscles, itatch larger tl^EUi the right ; tl^«p
thcfiefore uied the left «ide and limbs more frequently ^tluih -
the ri^t, and were ofeourse left landed. In' somej^eorl
flons'llie )efl side is stronger than the right ; but this. is. ^aryl
raie, fyt men of all countries are generally strongest jn 'thd
right side. • ! . j .'....':»

^^ I knew a family, tbe father and cfalldken of which posf
sessed sUch a disposition in the ihuscle^'^f the nose anil of
the Ifps, and such greftt mobility in the cartilage^ of the
nose, that they eould net speak without tfiering thenu , la
the act of speaking, the point of theln^se Was constantly 'ia
motion. '

'^ I knew a Spanish- rioblcfman who had oii^'cheek lai^get
than the other, the maxillary iione on one side and th#
integuments being larger than the natwal size. He told
me that his father and his uncles had a similar deformity^
which was certified to me1>y several Spaniards then in Paris.

^^ Somis authors have described families of triorchideSf <or

y 2

9n M(4>t»m, [Ascijl,

ihentioned. On this subject, however, we should not fofff^t^
. that w«» may apiMti«bea «i)»tf^^ ft fif^x^^XWf^ tumeiur in

th^ bursaei^ or »n epipl^cfte, foi s» t^stiokj.

^^ TlHe^e externaldefdrmiU€» Qu^^t td ted ws ^ in(|Rifif|
iritk rospecti t^ tbe intericMr pf the humw Ugd^t M*y there
lioA be mttural or morbid rehtioAs b^twf«ki (be iot^n^l §Bid
•kleimij parts 7 I ha^e collected ariraml €t]|0.ioLp)ea oi ^ xt^f^ri
resembhuiGea in pessons of (be saaofi family^ itrho died.of tfe^
lame diseases ; and I do not doubts 4al if th« inqpurfd^ noif
suggested are followed up, the results will t^mj <tey piQV«
mor^ inter^tiftgw . Futtue aftatpmioldi r^aircl^es ^ttl shew,
tiifit the Yisceia; in. thc^ Ji^diridiiajf nf certak fumli^ i^v^
liii^r oi ' smaller^ and inor$ «r Itew ^ifSenmi m ^eit ^^V
stabce; co as to produ^ee hereditary, dil^eise^, ,
« xi^^ Amopg seveial fhota of this Udd/wbicb I )t»mM\l^^
^/I shal} confine mymliUi i^oiivwM^ i ih^m ^-Yttfl* Ruf
fiiailit& Pere^ ; and Vtll«(Ment,|*perfiln»si^ Maf<^b^.8(«c M^P^
tft^ese families, toferal indiviiuaia died ^ pa}|A(a);iga j^ thf
]|eaft,rafter mediqai ^^p«q bad'^foeisti Admiiti^qp^ !#. v^t
I (iraa ptssQnt atthe opcmiag of (be- bodies, of (w» «C t)tts^ il9r
tients, one in each family, and I saw that the left ^jQi^fi^
«dsr¥fery m»cb 4iteted, aUtolllfii fte jpar/^lt ^(^M ven-
ladeiwas euQWaoasly tfew* i«^JM> wbjeote- . ^s i^bfr yda?
iitas bad also died itp^r c^^^c^^mt^p^ee pwfcc^^y sip^r, iff
nfey Beaswably «ipppie:(hat if tJhfy \^^ i|^^ i¥D«fl^> (be
same waliwpfoi^atwp w^W bftw lwy»,f^

** Palpitations of the heart, in consequence of an^i^^n,
^i^veb^a cifVm ifttioed.by Wtt»^*n4 PWtici^i^lly ^)j| Lan*
^, wbo cites «aw q^ (bi^^fejUiJ? >«^h4fil* 1^ ^!^|t^^ed ia
Italy, and wbteb aie s(iU yery- frequent in j,\i^t ^P^^t^y- I
^T^ often b^n i^n^ulted: ipys^l^ by jltidiaiv^, for siwlar eom**
plaints. The Gcw^rfyi fw#y pi^ese^ts .^ ^tj^ilji^ ^iR^pVl ctf
Ibi3 de^uyiptitu., ww Uft^er QUf.efei^yftliw-

^< Ate ihisie mt ftfed mtmui tdA spcmoAit affecHonj in
(ktaffi^ ifhloh«ldMtg»tIi«'^iiietfMB dtf th6 mind? o»9 do
these functions remain unaffected dilrili^ catittiMonB or ift*

<^ How tiifo«y fathiUes Urt ihete^ in ^hich maiiia^ tijnfterictt,
^ttA ^liakiilj^s 6his6 Ktmbs Ar^ b^itaty f At Paris, we hatie
Hfefeii this Msub^al de Bc^u^^tito ilhtl ifour of his sisters, ^b
*itm ^M)$^ tb yieyy ^{ngt^kr shedcings of the head. It majr
perhaps be supposed, that this kind of cdnVUlsion waH ttte
MMl <tf ftiiitdtlidtt fiOtii tlie potties freiiueiitl j ie^ing iiach
dt6er, 6f which th^id Ar% eiaitiples ; but it could not ht so fn
fhis AtiSd^ for the i^kttie^ wer^ herein long resident together ih
6^:fl&te. It is ^o himaifclible^ that this shaking of thb
head attacked all of them at nearly the sathe a^.

** Bt^gtlgfii hia Recorded the hfetd^ df h family, some of
the iiidiiridii&Is df Whi^K died from ^tce^iiiTe vdmitiiTj^. Ok
tike of these p^rsofid) ivho^e body tfks' bpl^lilbd, the itohacfi
1ftl§fdtifid shrivelled ti^, tbeptocte^ hktdy hs if sctiirroUlJ,
hnd (h^re wer^ numerous boncittldns tf hich utiited thi^ ^t9»
i^diuih to the heart. ^

" There are families remarkAbfe <br TriiViitt^: ttfe ^iplbttA
en^l'tiidusly stirioharged with fat, o)r with htt^r b^IItes than is
y^dUt^ for theif irize in otb^r t^pecid; itlh^ kind of tMF-
cottfoi'mlation is frequently fbllowed by dfo^;, ahd on opeik'-*
ing iht bodies c^persbfrs of this de^ipC^n^'sMtotilatUS cDli*
cretions are generally found. I ctmld aVMhbe'i^yeral eit^
attrplis ift ffap^rt of i9}M I advlihfW. •

*^ 06 these heredii^fy diseasei^rKe firdM variMi^ causes^
^ ar6f they t6 tie tusci^ibed ih hic^t easc!^ td oiie alohe? Ifhli
ijliestidh iekihs Wotthy of sbtAedti AMi6to. ' ' ' • '

'• ItL fhe fitst place, it Is tMAia, that ^A-at ttf <h^
dls«a6e»Are indiei^Ied by the e^tent^l iUtidgirf&tioit ^T ^^4
bdny ^tU, fending tn^te bt h^ tor^clrttt^, *<rhich 1^ tff
€Mnpe (M^|N^(ed ih families^.

y3

• ..-/' ' .■■.

I

318 rMtikinc. {}^y

<< May not epileptic and maDiacal persons bave an exter«*
. nal eonfdrmaliofl ; of the cranifUn for instance, which inclines
.more or lesa to rachitis ? .

^^ Are not pulmonary phthises annpunced hj the narrow-
ness of the cbest, a bad conformation of the j^ides, or the
iclavicles, with a projection of the shoulders from behind
({[9capul<B alatcs)? If tiiese questions are answered in the
^rmati ve, it follows ihat^veral hereditarj diseases are more
.or less allied to rachitis. . ;

I '< This vicious conformation, biOWQVcr,.' does not exorcise
iM its bad cifiscts in a yisible manner upon' the osseous part
ipf . the trunk ; it produces internal deformities. These aw
.olten discovered in the female pelvis, when the .body appears
in other respects, well formed. . • , .
:. ^^ But rachitis, or the aflection of the bones, wUdi alters
tbeir form, being an effect of the altoation in the lymphj well
ascertained bj the symptoms of the disease and by d^issec*
tjp^, the alteration of these substances from the same cause
.may probably take place in other internal parts, without thU
bones being visibly affected. A thousand facts might .be ad-
.^ced in support of tbi^ opinion.

.^^ However di&rent these diseases may appear, there is
Uttle doubt that they are the effects of one cause, differing
;Qnly with respect to a few modifications, and with respect
to the. diversity pt the different organs, affected, the functions
of which are varipualy disturbed.

^^ Thus there are scrophulous persons who hay^ steato-
iiaatous congestions in the internal parts, without having the
Inlands swelled; in the same way, rachitis, which is the
effect of a scrophulous habit, particularly of an hereditary
^aipt, may produce a developement more or less irregular of
jtbe body, or of some of its parts, or even a d^cieucy of
liutrition; j[n suqh a .manner that certain parts ^sMquirc an
increase of size^ and others lose if. T^ nec£ssar^y ' occa-

1809.1 Medieini, 319

sions diseases, Trhich are propagated in families as the schro-
phulous taint is visibly transmitted ^hen it Is ^ell charac-
terized.

^^ The brain in maniacs, epileptic and apoplectic persons,
' from their infancy, (whether the craniums of sulbjects that
.have died of these diseases, have more or less deformity, as
is very common, or appear in their natural state,) is always
xnore or less hardened by steatomatous substances, and. par-
ticularly the medulla oblongcUa, and the adjoining parts of the
brain ; as is the case in scifophula. This fact is proved by
anatomical observation 4

*^ Out of the many cases of this description, with which
I ank acquainted, I shall only mention that of a young man
who died of epilepsy, and whose mother was scrophulous, as
was manifested in the glands of the tieck, and who was also
subject to epilepsy herself. The son died of an apoplexy
after an epileptic fit, as is generally the case ; and M. Mark-
bam,, my assistant, opened the body. He found in the me*
duUa oblongata, and in the productions of the brain and of
the cerebellum adjoining to it, an almost cartilaginous indu-
ration ; there was no apparent malcouformation in the bones
of the cranium.

^^ Anatomists have frequently observed similar indura-
tions in the brain, and sometimes also in other organs of
the chest and abdomen, with swellings in the lymphatic
glands, in patients who had been maniacal, or who had died
of apoplexy, and whose parents expired under the same dis-
ease, without any malcouformation of the cranium*

^^ The same appearances have been found in subjects
when the mind was partially and at times alienated; in these
there is sometimes an apparent malcouformation of the
cranium, or some symptoms of a scrophulous taint, or
perhaps none of these morbid affections wete accompanied
\}y external signs; but are the indurations of the brain of

'T 4 '

i** »

\rc>

820 Medidirie. [Aj^,

the same nature ? It is impbssible to attribute mny other t6
theto.''

HTDROFHOBIA

Ofpbrs nothing farther, since our last^ to remove tike yeSl
of obseurity that overshadows it. Amid the lack of niiskn^
Mrhich medicine bestows to ^tmnteract the tlBbtts of this suIk
tle and too active poison, the random injection of medibineft,
and the application of gases, haVebeen proposed, both thcisfe
plans \^e should cdnstdcr equally dangerous, and imcompe^
tent for the end proposed.

SPASMODIC DISEASES.

Spasmodic Diseases are a class of more fVcqlie^t Occur-
fence in modern life than most others. In their mild fidiH
tliey are much under the command of the ^ctitidnet; but
in their aggravated state, as tetanus and its several varieties,
they too often baflSe every means of relief. The history of
these diseases, in their worst stage, is instructive, and "we arfc
presented with i\^6 by Mr. Hbwship, aiisirtg both ftbttk
wounds, which he thus details : . ^

'* Case I. Of Lotk Jaw with Tetanus^ which teffniAdteS

fatalli/.

" On the ever memorable 21st of October, 1805, a liid, six-
teen years of age, was struck on the hip by a splinter, while
engaged on board H. M. S. Colossus. The wound Was just
opposite to the spine of the right os iliiim ; if was not
large, but it was deep, and like the general run of w6uni&
from gunshot, very foul and slow of digestion. Vei^
little pain was felt either iii the t¥OUhd 6r its neighboiirhbod.

^* On the 5th day after, he complained of difficulty in
swallowing ; this, however, was but the prelude to sufiering)
infinitely more severe. On the 8th day, when I visited that
ipart of the hospital, he was in dreadful agonies, full of clis*
stress and spasm. His jaws hy this time were firmly cldseid.
la erder to ascerlaia trhether ^ny visible actton iiou^d be d^

Mrtred in thte ftiitiatimii rrhiH tftr fmins n^dre desorilvd t#
fee iiioit ur^ttit) the ckylhes vtere tfarbwn aside^ whto tbe
whote d^ tte miMcles of Uid abdteieh and Itinbil irtte fouml
ill a «tatfe of alterntite ribtation^ felUn^ in suceesiioA liiidte
tfte influente of tbe palli And i^tation^

*^ The Ikftb bdiow tbe i¥0ti6dcd part be coftiplained mocli
of^ as also of tbe whole of bit bmast. A iravni bath vtvlb pro*
{NMed akd got ready ; but it vfkt nbt \\^ithout great diftculty
and infiaitiK difttrasS) that the patient could bt tmei from bur
bed and placed in th6 batb« He found bimftdf, hdWeVer,
Wfisiderably tdieved from the viol^ioe of the fipacbift aildr
(he flm ten itiiautedi^ In ttf enty his dtra^^tb Med ^ he wft»
tberefore tal«M ftmatt the batb^ well rubbed^ aad laid ia dtf
blafik(^s.'

<< Tbe benefit derived from this e^p^imdnt il^as a fetyipo^
#ary alletiation in the ^verity of the igym|>t6mi^ It ^m
iMToposed ib try the ^fffeet of fil^cttty^ the ointment Of ^bit^l^
Haa Btwral (ime^ tabbed ih ov^ the fipine md limb&« Th^
tfyasm^ itere now uhit^imV and piobably from the itritsAu^
Ming coa&^nt, the sp^^modic actioa wa^ constatit a1so» tit
father the contractions returned in so rapid a succession, d^
fb kee^ the whole fran^ in un^^sittg ahd t^rible action ;
While the poor creal^ite at times grindiftg his teeth, wa^
eonstahtl;^ moanihg from th^ exbe^i^ve violence of the paiitei.

** Ih the middle of theday after he had Mtsed the bathj thfc
]^alse was eten, ^ick^ and Sofleir than before. On the nejtfc
ijay fth* 9lh)^ the fireqtiency of the *pasm«, atid the hot^
rtbld toniMit^ they produced, eontitiued to inctiease upoh

blm.

^ Toi^atds the evening Ihfe spa^ttts bi^eame moi^and mom
let^eieih th^irieffeds upOh ib^ brgaas of respiratidn^ ahd at
length he expired^ appaMfitly at tbt time wheii the same
^^nMdib iictfoh itei^ed tipdn tilt heatt.

^ ^A (^ oai(!^ tht otily point in the tf raiment Whrch ma|
IH» «6ilJiid(Ma to han Hmttiktd any thij^S;, waid ihali^f lA^

m Medicine* f Apl^

irodmbing ihto the system a sufficient quantitj of fnercilrj M
alter the* preyailing tone and disposition of the nerr^us sy^
tern. The frictions did not in this expetiment produce any
decided effect upon the mouth ; but in other oases^ in which
the most satisfactory proofs of the full action of the. lemedy
hare existed, it has been found to hare no power to arrest the
progress of this most formidable disease^
^^ Case II^ In which Lock Jam^ tUiended with TetaMs^

ended fatallyl within d Period uncommonly shorid
. <^ W. R1CHET5 an Italian, aged SO, seaman on boaid.bia
Majesty's ship Bellerophon, Icfst his right arm, which was
shot away by a heavy balL Part of tha upper extremity of
the humeru3 remaining, it was removed soon after by aH <^Mi^
ration similar to that which is performed for ampujtation at
the shoulder-joint. Unfortunately the limb had been carried
away so glose to the body, that it was not possible to. make
any provision for the formation of a round stump by a fold
of the integuments. The muscular parts projected consider*
ably beyond the edge of the skin, aad neither pressure nor
adhesive applications rendered much assistance in bringing
it into form.

'^ This man constantly said he felt but very little pain in
or about the wound. On the 8th day he complained of
stiffness and pain about the angles of the jaw, and these
.pains increased and extended their influence so rapidly, that
he was with much difficulty raised up in his bed on the fol-
lowing morning, in order to his being dressed and shifty ,
There seemed by this time to be an established state of ge-
neral rigidity affecting all the muscular parts of the body
and limbs, which prevented him from all voluntary motion i
while his being in any manner disturbed in his person, was
constantly productive of aggravated pain.

<^ On the next day (the 10th) he was worse, all his suf«
ferings being greatly increased ; in the.evening, be had^ with
much diffipulty, been raised up tp drink some i^ater i hi^to*

,1809.] * iitdicine. 32J

•turned the Vessel to the nurse, aftel*.he bad sWallotred sotne
.ftftbe fluid, without any apparent increase of pain, or other
ilggravatioh of bis symptoms; he complained of no digress
'W new uneasiness; he laid himself back in the bed, and
:ailently breathed his last, jiot eiven uttering the least sound
expressive ^f disturbance;

.;; ^\ In thijs case the progress of the disease was so rapid,
that almost before any vigorous measures were adopted for
Jms relief, the man was lost. Mercurial 'frictions were com-
;nenced upon, but duly on the day before the evening on
jwhich bis dissolution took place.

^^ There is nc^ a doubt, but that in this case also, the sud«

■jkn and Unexpected close of the scene was the consequence ci

^.saddmspa^m seizing upon the heart, and probably the

jOKgans of respiration ; the most general mode of termi|iati<Hi

-^ki.thisdiseiise."

PULMONARY CONsyMPTION*.

^ t ThIi infectious nature of tbb malady is a sid)ject on which
ranthors are much divided. Jn. Spain and Portugal it is con-
•idei^ so certain, that the clothes, and every th ing the diseased
jhas used, as bedding, &c. are regularly burned. Some ob«
^vi^tions of Dr. Kinglake tend to confirm this opinion :
5f It is well known," he observes, */ that diseases of various
descriptjions generate and evolve during their existence, and
' more particularly towards their termination, a certain pro-
flffrty, whether of a material .ox motive nature, that has a
pudency to impart its morbid quality to those who m^y cpme
wi^in the sipher^ of its active power, and whose constitu«
tfiQftkdX sus0eptibiljity may be favourable to its infectious influ-
CfkQ^. The occasional extension of common fever by per«
aonal intercourse, as well as that of a more typhoid character,
fivincesits capability of conununicating infection. ' This e&
^ect^ hp^iKev^r, is not dependent on the mere existence of an
lai^ctious power, ^d on an opportunity of imparting that
uijfeftion, ^t pa ^ yairiety : (rf* collateral circumstances yiiiXi

S» Meditink. l^pA^

%bteb the relative efficiency of thes^ dtdiei is etfstetlail^
coimected. These cireiudstanoes ate ohieiy a giten ciNtoMi*
Imtion (tf t6e infedtioun eanse^ and ft certam captASitf «r
dj]lUude for reeeitiri^ \h ktiirt itfitprensioii ; If eitber die die
Of the dthtr eholild fkil^ hilppily no eteci U p<'(idilt^« Tliii
incongruity fortunately often prttente tuid ooudaetf Hm
empire of infectious difte^se tt^itblhi cotibpiuutiv^y Haftow
limits.

<^ Matter, in all its tfttioM arf aiigeiAfeiits^ posfteilM pNJL
pertieb characteristic of the patticalat nature of iit euMtMl^
i\& active powers in some form are mo^e diied audi eftidMt
than iti otbem ; bat ia ilb ihape wbalev^ is it iMkntiMt
ie sapfK»e It quite i»ert« la the peculiar coiidi(i6ai ikMh
nary to ai^imal health, no deviation caa happea eottittiMi^
with the atoidatice of dlMa^. Wh^n di^^a^e ^}gMy fMh
curs, effects, different from those of health, neceMuSy aitei
These will be vartou^ actMTdin^ly to the dcfgree or intensity
of the laorbific caune^ and trill possei^ properties and divert
aa influence cortespondeat to the particular aatttre of Ihl
active power. It is in this mode of intimating Ibe etiicieMy
of morbid p6wer, that ^omejust c<»iclasioa may te draat
respecting the iafectious ag^oj^ of diseases (a geimnd^ «ni
more especially of tho^e that se^m clireetly to imij^tl
their morbid influ^ce ia suitable circumstancei fer iM tfn^
ration*

^< la the adtaaced staglf of phithlsi^i pulmoaalis, ttm
particularly, occurs an aggravated* state of di^asethat wefflU
seem well adapted to concentrate and give foil effect io aay
iafectioUd powers, which, ki commou Wilti afl diMaMi
chduges ftofn the healthful cOUditioU of lijf^ it may be W^
posed t<^ pa^esij The hectic comMotiOA, tba Wea'ring d^
compodLtioit, the coUsequeut extHcatioa bt th^ ooastiia^

principles of animal matter, aad ibe ae\4^ anrangemeut wld<A
ftiay be fovmed of these sufartan^es, sayiag nathin^ of iM
pecaliar morbid a<Aiaa ^M ainiDe i)i this ^i$«m^ and wliicB

rmy b^ emhoAkA mA tmiiferrody t eoder it extmmlj pro*

^§hh th^i thia diamae is capable of exerting infeptioas infla«>

^QOi 9ad ibat it actunlly does appear to me verified by some

IMiRMes of its having been imparted to persons closely at^

iouding the last stage of its e^isteape. ] have more parlica-

ImtIj in my recoUection tlie o^o of one sister sleeping vf\ilk

Md otosely ^ssociatiiig Mfith anpth^r, nvho laboured under

phthisis pulmonalis in its worst form, in whom, tiloeration of

Hit liitga appeared to haye taken plaipe, accompanied with

ih0 mosi embamiseiiig state of cough , fotid expe^storation,

tiid cadaverously smelling night-sweats. Qeath, at length,

elosed this hopeless scene of disease. The surviying sister,

Iffho ha4 anxiottfily watched and assisted during ks destruc*

ti?9 progress, soon became disordered by stricturcd breath*

iog, ' piuajftil cough, febrile rigours and heats, loss of appe^-

ttte^ and sleepless nights ; to these symptoms were speedily

•dded, bloody escpeotoration, night-sweats, and every other

a]^fiearliiee pf a^' advanced and irreparable state of plilmo*

nary consumption, which sooii terminated as the preceding

instance.

'^ It should be remarked, thatin neither of these cases did he-
rcdttery or sciophulous predisposition to pulmonary disease
npj^ear to exist* Both sisters bad been uniformly free from
every suspicion of even a tendency io the disease, until it ac-
tudUy surprised the one, and overtook the other, as a pro-
bable consequence of an unremitted personal intercourse. I
kave often had an opportunity of (Serving a threati^ning de-
gree of pulmonary aiflfection to have apparently resulted from
' iBGtutiottsIy inhaling the distempered vapour of phthisical
piitients, but do not recollect any instance in which the effect
was so direct and unequivocal as in the case recited .

^^ It does not follow, that on every occasion in which in*
jury is done, that it should be of the irreparable natur^*
which marks pulmonary consumption ; it may disorder the
lUBgs without inducing that deeply diseased affection of

SSn ^ Mediem^ [Aprifi

them r it may produce a dispoftition to akftnuh'^lfiMd'an'tip-'
titdde for pulmonary ailment on occasions which might not
otherwise hare become actire; In this view of the snbjecty
It wonld be adviseable to avoid being too closely inifiited
with patients in the dying stage of pulmohary disease. At
n period when no benefit can be rendered and mnch misdikf
may arise, it will.be no imputation on luHnanity to witbheU
unnecessary attendance. ■'.

^^ It does not appear that the ground for suspecting the ill'
Actions nature of phthisis pulmonalis wouM warrant a M*
lief that it is (^ that active quality as would justify even Iks
timid. in not paying a due degree of personal attehtioil to tli#
diseased ; it is (he incantion of dwelling with sach patient^
in leaning over them by the hour, in breathing in the immo^
diate atmosphere of their luugs- without restraint^ that dei
serves to be pointed out as exceptionable,, becanse in itrif
useless j and certainly fmught with serious evil' to those nJM
may. pursue that hitherto. unobjected and auppoeed nnai^
jectionable course of conduct.?

OBSERVATIONS ON BYDS0PH0B1A. '

To the Editors of The Medkal and Surj^al Spectai&r. •'
Gentlemen — The government having directed th^attentiip
of the medical world to Hydrophobia, Lfa^ leave to sobnil
the following observations to your care. The medical pro*
fission are divided on this dreadful disease t. one partjr eon*
sider it only an aggravated case of Tetanus, while the otbaf
refer it to a specific contagion communicated to man by aa
animal in a rabid state. To the latter I belong. In the ftst
pLice, to render thii disease a complete ease of tetanns, we.
must suppose, that in every instance usually termed hydro*
phobic, the bite must necessarily produce such a quantum of
compression and laceration, as shall occasion the symptoms
that mark the common cases of tetanus, t>tfaerwise, down
go the contest and controversy: we will take the wcB^

1909.5' Medicine. • SS7

marked «ase of Ann Chandler, in ifhicli I think I am war«
ranted to saj, and which a reference to the case will confirm,'
that the compression and laceration produced by the inser*^
tion of the cat*s teeth, were not so violent as to induce tetanua
if the cat had been in a state of health. Many are the facts
that prove animal saliva to be inimical to the human con-
stitution, and none more than that of the dog^ who, perhaps,
an\ong the animal creation, may be ranked the only beast that
delights in fbetid ulcers ; yet that saliva in a state of health and
tranquillity has never been known to produce tetanus or hy-
drophobia; why then perplex us with vain and futile hy-»
potheses? why deny the cause of a disease which corre-
sponding fiicts prove? IsnottheXti^5 Venerea comm\u\icablei
« Is not the Lues Bovilla^ a disease peculiar to cows, communi-
cable to men ? Is not Hydrophobia acknowledged to be a
disease peculiar to dogs ? When I say peculiar, I mean a
disease spontaneously arising without previous cause or
infection. Having established this fact, the inference I draw
is this, that if the Lues Bovilla can be communicated, of
which the Jennerian system is a proof, why shall we deny
the cause of Hydrophobia, unless we wish to place society
in a delusive state of security ? A doubt on my mind remains
not respecting this point, that an animal in a rabid state can
communicate, by the insertion of a specific contagion, from
whatever unknown cause, a certain disease, similar incharac*
ter and symptoms to that under which it labours, and that
iHie vehicle of this contagion should be the saliva, is not at
all singular when we reflect that dogs never perspire ; there-
fere, as nature is ever correct in her operation, the saliva!
glands are to them, what the miliary glands are to man, and
in a state of heat, thirst, or anxiety, the dog discbarges more
•aliva ; and as that saliva in a state of irritation becomes
acrid, fever and delirium succeed ; thus the customary law
<»f the animal economy becomes confused, and death closes
i]ie terrific scene. If the facts were not suffici^ly conclusive

;SS8 Medtdn^t fAprB,

to 8€eptical miiids, let them take Malogy for t^eir gnidey mo&
9ee what eflfiscts obstructed pefapurMioii produces on mao^
fever, deliriunis frensj, are Hm e^tf i but ber^dQUrium iiri$ef
not so much from the xsencaesion Hud l^^J^iion of the part
wounded, «w from the vitiated state of the blpod^^fxr is de»
lirium a necessaiy con6omitoBt9 for m^nj cfttea are on record
where the patient retadaed the full possession of his reason j
Aor has the miad any thing to do with the aversioii to food
and drink imy more than it has in anorexia ; this nyersion,
though the strongest chamcteristic of h jdpopliobi^, depepdf
entirely on the connected spasmodic afl^tion of the 9esQ*
pbagus $ and therefore I conclude from these fx>f responding
facts, that the disease known by the name of 'hydrophobia is
absolutely communicated by a rabid animal, and that we
never shall ascertain the particular natuce of tbi^ disease
until we have an opportunity of seeing it in f^U its stages
in the animal itself* It is of the first impor^jance t^
society, to endeavour to secure the life of tbf r^bid animal^
and till that desirable object is obtained, the cur^ of the
idisease is beyond huipan poweiu

The following case illustrates these observation^ i ^^ Dsu
vid Hale, of Bidford» Warwiplpihire, a young nwi ^bout
twenty years of age, while leaning over the gatp of hif
Cither's garden, on the evening of the Ut of Septembert
ji808, observed ti gat coming down the gard^ walk towardi
him. As the animal resolved to pass under the, gate, tb^
young man placed his foot in the way to prevent her, which
she instantly seized, and on putting down his hftnd to e^trif
4;ate himself, she bit him very severely by the thumb, Th9
father of the young nmn hearing a noise, ran out of the h0U9»
with a stick ; he pointed it towards the cat several times, and
she as often seized it in the most ferocioi^ ipanner.- A||r«
Hale then declared the animal was mad, and immediAtely
destroyed her. The young man went, without ddi^, t#
Witminster, and was, according to the opiui09a c^^idviswi

^t)Hsr|99 ivrop^Iy 4!Uppe4 ia ibe salt irM^t ^^ ^^ I^P^ of
fnvc^ii)^ the dreadful consequences that m^t otherwise arinf
ix0V(i tb? bUf of the ABJiaML {ie returned borne again, an4
to jaore tban ^ month enjoyed his usual health • On Tue^*
d^^ tb^ llth -of October, the jpoung mao was taken Ul wit^
l^h^ headrapbe« Oa Wadaesday, his head»ache continued
^d SPt worse ; and in ibe eyenkig h^ had symptoms of i|
fOfe throat. On Thursday, the soreness of his throat in^
^^ir^ased; be c^ld not swallow; his head was Tery \xA\
a^ if auy liqwl was offered hinni was wuch agitated aQ4
cpuTulsed;, On Fridayj he could not suffer any liquid to
cCon^e o^ar him ; but he ate a small bit ef toasted bread. H^
was aensibl^ of his fiituatioa, and desired every one not to e^i^
dagger t^tqpisdves by attendins him. He foamed at th^
laoHth very much, wd at times was greatly convulsed. O^
'Saturday, his malady increased ; and on Sunday he was con^
jQoed in his bed raying mad« Tti^ people were constantly
«mpIoy^ in wiping tiie foajm froaa hi«i, which issued from
hb mouth and nose in largp qnantities. -On Monday moqji*
ing^ |tb(^ 7th, th^ unfertunatQ yojang man w^s released fro^
"the inpsi dKeadful of 93\ human pflictions ; he expired about
i^en ii^'cloqk in the greatest agonies."

i lemain, Gentlemen,

If 9ur obedient Mrrant,
iojMtoi*, March 25, 1«09. T. MOTT CATON^t

OSSERYATIONS ON THE PECULIAIt STIlUCT<ORE OF CEBTAI|9^

FARTS*

To the Editors ^ The Medical and Surgidal Spectator* i
Gentlemen — A curious and perhaps useful subject entcrt
fd into by physioiogisjt^ is, the reasons for the peculiar struc-
ture of certain parts « In ^plying this on the subject of th^
genital system in the ^cxes, I shall \)eg leave to hnzard ^ spu^
•CMlation which ^ay perhaps lead tp some important comi^Iii'^
«M>ns^

VOL. lu z

S30 Medicine. f-ApriJ,

In examining then tbe difierence of these parts of the body
in the sexes, I would remark, that the sensibility of all parts
is mcreased by secretion : hence, in the male, that union of
passages adapted both to the urinary and genital parts; for
the use of the genital part taking place only at times by
means of the urine constantly pervading the passages, the
latter are retained in a certain sensible state. That this is
the case, appears from the different situation of the urethra
in the female, in consequence of the menses haying the same
tfkci ; and we find in general that a fluid pervades all ses?
sible parts, and seems necessary to continue their sensibility.
Hence, from this efiect of the fluid we deduce the propriety
of attempting to lessen its power, and by dilution blunt
ihe irritation of its stimulus, either where its acrimony is
morbidly increased, or the surface it pervades is in too sen?
sible a state.

All tbe principal parts of the genital system are particularly
liable to be increased in their sice by irritation. Hence we
find, especially after venereal aQections, they never regain
entirely their original state. They are always largest in sa«
Iftcious animals ; and on this account they are observed moisf
so in the inhabitants of the warmer climates, bearing no pro^
portion, as is-conspicuoifs in the other organs, to the natural
proportions of the body. In the testicles this is so remark-
able, as to be mii$taken for enlargement from disease; and of
this you will find examples in De Gkaaf, though the mere
eflect of venereal excesses.

The exact structure, therefore, of all the parts of the ge-
nital system is of material consequence to be known for pro-
perly understanding the treatment of their complaints. With-
out it, we can never (iilly ascertain those various consequences^
^hich are known to succeed the primary action of the vehe-
feal virus in gonorrhoea, and which frequently during lifer
Ct^ntinue their effects on those parts. It is remarked by Mr.
Pott in bis Lectures, that no part is so liable to become'^dis?

J80^.] Medkwe. 391

eased frem tbe effects of any preceding disease, as the pros*
4ate ia the male. These effects are scldwifelt, as the prt*
mary disease is forgotten tiU advanced life, when tbe flaid
secreted by it ceases t» flow* and it becomes in a manner
useless, as no longer designed for generation. It is then par*
ticularly in tliose, who have been often under gonorrboBa^
that the prostate and parts connected become extremely pain*
fill from its hard, indumted stAte» which renders the le*
mains of life generally miserable. Hence tbe necessity fat
paying attention to the early remoyal of those complaints of
the urethra which, from sympathy, have a tendency to a&
feet these parts.

The manner in which the functions of tlie genilal system
are performed, and their influence on the rest of the body^
are no less important than the preceding topic.
^ Though the nervous system is allowed to be the raediunt
of sensation^ and fihould occupy, therefore, our chief atten-
tion in 4he cousidemtion of the economy, yet the origin of
this sensation may be considered as the effect of that process
peculiar to the structure of glands, and which has in general
received the name of secretion. This particular effect. of
glands has occasioned some of them, in which . it is mom
apparent, to receive from physiologists the appellation of in-*
centive, and under this title we would especially Gompr&i
bend the brain, and those glands that are characteristic of
the sexes. The first of these has afforded much dispute, am}
whether acting by moans of a fluid whose influence pervades
the system, or depending on a simple state of fibre affected,
has been often and most unsuccessfully combated. We ob-
serve, however^ that it is sufa^t to those diseases peculiar to
glands; that tbe acutei^ess of sensation is every where height*
ened by a glandular structures .and the subtility of somo
particular fluids favours strongly thfi supposition. The struc*
ture.of all the incentive glands appears to possess much ana*
Ipg^t I^alV tfaic .secretion, where we can detect it, is cai^i

z 9

8» rJUedicme. [i|rlU

lied on ijlowlj, aiid its rapidity oeenii^ 6?n^ plW^vNd Iqr
the. manner Ia wliidi tiie circulatioa to tfa^jo^ j^ WPipU^
Xhii is rery ranaikafale in iJie leBtjcks, TJb/e sp^jr^a^ati^ .aitep
ties are perbaps longer than aojr otbor» pf i\it jbqdy • T^ey
we^mall and dense in proportion to tbe fi^ of ibp gj^ip^
^y supply, and I^ feeling the pulse in ik^ iffi^fit^ijgfA ^
iate they arriye at the testides, their ckc^hUio^. i§ fofm4
even more languid. In Ihis ifvay the falo(yl i$ jeU^dfn^ in t^f
Inlands, and their yeins i¥e find very liable to b^poqi^ iwff>
4M>tts. In the brain, again, we obserr/e the fiNTC^ of t^e Uo(d4
ixoken as it ascends by t)ie angles whi^b ^he 9rte|rj^ forfu ji|
their entrance to the skull, by their yariou$ conv<»li|(j^Q9^t
which are even more minute than those of ikfi t^sjiicle^, find
the circulation is also retarded in its return by the riB^pti09
of the blood into large sinuses, where a slow p^ss^ge thr^ugll
them is only permitted « In the o?ariuia of km9le» the $per-^
Bdatic arteries obspri^e a similar dietribiriioa. Tk^y i^M^ ^^
(rise at a considerable length from the g^^n^s, and, after ^ririyr
ing At them, maike a auimber pf serpieaiiQa t^rns, wbipb 9^f
lainly sersre a partioular purpose.

From tbe moment of eaci^tenoe, the aetiopiof the braj^ ivm^
mences. It supplies that energy to every part ^rhieb is ue^
Mssary io the exercise of its functions. This energy, aa
fiur from observation as we pan determine, seems to consist in
t certain excitement of tbe part, wbicb increases the original
i|iiantity of ^uids determined to it, and thus renders stronger
the mutual redaction oa which lifis depends* Tbis energy,
bowevcr, is not communicated to every organ io tbe same
degree at tbe same time. Certaii^ laws determine this, co^'n
aectpd with the original fprmatioa of the body ; and in caa«
sequence of these laws, the incentive glands peculiar to tbe
lexes receive only this energy at a particular period of li&y
wfaicb has been termed, from ihe appearances thea occnr!?
ting, the age pf puberty. It is at this age the &Gility of the
fibres tp elpuga^n begu^to dinjiinisb} mi the <^etermin4lpilf

18094' Mtdkinei SS»

wbiok indiserlBilnately took place to every part during tlua
forniet period^ is now directed chiefly to.certain glands. T)ra
tedimdahey' of fluids peCHliaf to the puerile state, whidi
icr^td by ite retention for a ready supply of additional mat*
ter, tod for tt^ f^nidt ekmgation of that matter when Ibrmedl
into solid^ b now converted^ from the resistance of the solid^
W the same rapidity of elongation, to form new secretions^
which have an eSkfUf by giving additional tone to the action
ef the solids^ to increase the different discharges, and to di9i«
sipate, ds no longer heeeisary, the redundance of fluid parts*
The semen, therefore^ is absorbed into the circulation, and
acts as a natural stimulant oa the sensible fibre, and as af-
fording additional vigdvr io the contractions of the heart.
Hehc6 we may consider a certain redaction between the brain
and the other incentive organs as taking place, and the con*
se^uedce of this rc-aetionr, which is at the same time a proof
of ity we find to be tlie cmre of many diseases depending on
the state of the brain, and particularly on the force of its
cireadation. But as (he constitution 6ft he female is intended
to diflfer from that of the male^ this ildditioBftl vigour, wliick
the age of puberty would otherwise induce^ and which W09I4
prove unfavourable to the purposes of gerieration, the prii^f
cipal object of the sex, is counteracted by a discharge of »
particular nature^ which is frequent,- proftHe, akid immedif
Ately affects the force of the heart, by proceeding from the
general mass of fluids, and consequently destroys the tone of
the system. This is the menses ; and thdir origin depends
on the satfiie causes which influence the secretion of the tesr
tieles; for the Mood being determined, as we fornterly B9r
marked,- in considerable quantity ^ to alt the incentive glands^
is, by the manner of their circulation-, retarded there ; a
proof of whidi' we gave in the fiteqnerit varkose state of tbf
spermatic vein. In the female, from- the stmctuie of the
vessels of tiie part, wftA the intention which nature possess^

ttrprodnee ^^dieebfiTge, <he detMtimKioii irt tiam •tewiOM

z3

5S4 Medidne. t^P^f

iheir rupture at tbe most resisting part, and this ruptdre m
always repeated on a certain degree of accumulation: taking
place, nirhich the natural texture of the vessels, the degree of
irritatioif on the ovaria from the brain, and custom itself at
last establishes in regard to its frequency. The action of the
incentive (Organs peculiar to the sexes lasts only a certain pe*
nod, Vfhich, during Hs continuance, has been termed the
age of passion ; and the propensities and desires which their
acti<m creates, are much stronger than any oiher^ which ac-
tuate the human firande. The mischiefs ia society from this
source occupy equally the pulpit and the bench.

I am, Gentlemen,

Your obedient servant,
Manchester, Jf/arch 9, 1609. T. W.

SINGULAR CASE Of CONTAGIOUS MANIA IN ANIMALS, BY
MR. FRANCI9I KlERNAN, MEMBER OF THE ROTAiL COLJCEGE
OF SURGEONS.

To the Editors of The Medical and Surgical Specfaior. .

Gentlemen'^SivcE the attention of medical men has been
called of late «o particularly to the subject of Hydrophobia,
ft!^ appearance and progress in the brute creation ought to
form tbe basis on which their observations are made. It ap-
pears, besides the virus of hydrophobia, there are other
sources of active contagion affecting animals, which prove in
their consequences equally fatal. This remark I have been
mduced to make from a circumstance just now related to mt
nf a very extraordinary nature. Two horses, the property
\of Mr. Stanford, of Bond-street, were seized suddenly with all
the symptoms of furious insanity to such a degree, that with
their teeth they tore the manger, and the flags of the floor of
tke stable were forcibly rent up with their hoofs. In this
H&teof extreme and unaccduntable agony they -continued three
days, when they died. So sudden was the attack, that one
«»f the holnm Jiad bctia out the d»y previoua to hiji| illnes9;

1800.] Medicine. 836

Soon after f his^ a dogi the property of the same gentleman^
and which li?ed in the stablei was seized in the same manner
as the horses,, and the disease likewise in him proved
equally fatal. A cat, which was also an inmate of. the same
place, was (equally unfortunate^ and fell a victim to a simi*
lar train of symptoms. This disease was clearly not hydro-
phobia^ and yet it was One of a highly contagious nature.
The animalS| though in extretne agony, shewed no disposi-
tion to bite, BO common in hydrophobic cases. Neither could
the disease be one of simple inflammation, or increased ex-
citement; otherwise, though it affected the horses, it would
not have been communicated to the other animals. This fact
then only points out the varied nature of contagion, and tho
difficulties that attend our detecting either its origin or its
nature; Tbb should teach those employed on the subject of
hydrophobia to proceed with extreme caution, and to form
no deductions which are to influence the mode of treatment,
but such as are sure and unerring. If any of your corre-
spondents can throw light on the above statement j they will,
oblige,

Gentlemeii, your obedient servant,
Charbtfe-street, Bedford^square, F. KIERNAN.

Mtirch 10, 1809.

ON THE ORIGIN OF THE SPECIFIC CONTAGION OF TVpUITS.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — ^The debarkation of the troops from Spain
at the different ports, has of late presented scenes of disease
that tend to horrify the picture of war in even more detest*
able colours than what reason and philosophy generally
paint it : SO and 40, we are told, are daily falling the de-
voted victims in spite of evety medical exertion, being cutoff
by a typhus ieter^ the consequence of complete exhaustion.
It is on this subject I would bq^ieate to offer a few obsecvar

z 4

936 MtOkihe. iA^^

Cion^. Ft aetiainly wduld be of mucb 'mimtttake to
irhetlier such a (eret ever exists ifritbMt the fffipficatioti of
contagion to produce Ibe specific fotiii flfrdiBtase. Authors
in general leave this point undecided ; and) in eitttmertitiBgi
the causes of fever, conceive it to be gmeiM&A indcpeiMbitt
of a contagion , on tlie idea of nvere debili^* Bat if the dif«^
ease can be proved to exist uifdcf cireamsfttncss iir wbiGh^Ao*
debility is present, afi ia well known to iake place, tben- the
theory of mere debiTity is desfi^oyed. The fisMD* tbafi de&ftvoys
Mtirely the supposition of a non^coffilaigiou^ prbicrpiko i(^ tMe^
circumstance, that typhus coiitagioil once abtoad: attadcs
more frequently the fldwef of ytHith atid manhood) the ptimo
of life, than any other period. A coUta^iMS prioiipky
then, being evidiently^ the origin of typhus, the qtKsfidi^
next is, how is this principle generated- ? The actual mannev
it is certainly impossibk to detect; but a leading point is^
does the isappurative process in^ woimds tend' any way U> its
prod uctton ? If th i^ w^re the case, then: the treatment of such
patients, and confining them as muchi as possible to^tu**
tions by themselves would be a point to be greatly studied in
all hospitals. We know indeed that erylipekis of a conta-
gious nature is a common consequence of sucb injliriesy
where large suppurations take place, and attack all in the
saiiic wards, or within the precincts of the same atmosphere.
But we should conceive that the state of suppuration is not
capable of generating this specific cause of typhus, that
mottality must first proceed to a great degree, and that then
the decomposition of animal matter which dSeath occasions,
under eertuin circumstances of activity, gives origin to thin
contagious principle which produces the typhoid fotta of dis-
ease. Hence the necessity of flying every crowded scene of
mortatfty^ which may generate this cause ; and We should
therefore doubt whether a vitiated airoosplicre froin- tneru-
confinement of a nmnber of persons crowded togeUicr^ or'
firom- any other wajr i«; whioh Ihil mi WcoiMii fotntcdi i/fvuiA

,18090 Jfedtt&e. iSf

4^penie td piodato ^is pecuiky msAiet. ^Kr« catiCtihrt the
«<Hivoe df iyphva to^br a cont^gbtt gm^tkti^ froiki tlie de^
compesiiion of dsad asimal ttlittef afone) under circtttil*
stances witii wkich tre are yet tttiacquaintedp

I aoit Gadtiemen, yomr obedient fiervant,
J^lyiiMuthy March 16, 1809. W- R.

Qhserl^astioni on some of the $nost frequent and impehrt€tni

Dnei&es of the Jfeart; on Aneurisfn of the Thoracis

Aotta,' on pMetrtatural Pulsation in the JEpigastrie

S^ghmi arid on the unusual Origin and Distribution pf

soAieof the large Arteries of the Hitman B^tti/. llUit^

irated bp Cases^ By Allan BumSj Member of the RoyaX

College of Surgeons f London ; and Lecturer on Anatomy

4ndSurgeryj OlasgotB. Edmbutgh. 1809. pp. SSS«

It is'wiffi pleasute we present these Observations to tW

atftentioD-of tlK profession ; we have seldom read a work nuir^

vepkte wkh soand cbctrine and general information than th^

one before us ; and^ under a conviction of its general utility^

we thuftk a iHedical library would be incomplete without it.

Ba( to give aa idea of a wo^l that will materially tend (xv

fikcilitate tlie aequisition of moifbid anatomy^ and lead to zt

fltore ceortain mode of treatment in the diseases of tbisorgan^

we have selected. Ml** Bums's observations.

*< On th0 coilfiequeaces resulting from cltango of structure
of the substance of Ibe healrt.

" Mr. John Hunter very justly observes, that a hcafi?
cannot be cssentiaUy nece^ary for circulating the hXof^Ay ii^
as much as some aainiais altogether want it. In the cater-
J^ar tribe, wc have no defined boart ; tliere is no reservoir
^bere^be blood is colleoted to lie delivered over in quantity
to the arteries. On the contrary^ the returning veins ter-^
mihatc directly, in the arlei^y which descends along the back
of theahinial; where it can^ tltvough ihd transparent skin^
ki sem oonM^tingijim it* sontenti^^woinf tbem oa with a«

)

*

'39$ Medicine. t^P^>

midulatory mottto. When we ascend a step higber hi tbe
jicale of being, ve meet with an imperfect heart, and in some
jtribes, we see this heart entirely appropriated to the pnlmo-
nic circulation, the systemic being carried 6n as in the ca^
tcrpillar, by the arteries. In other varieties, the arrangement
is recorded ; we find no heart for propelling the blood into
the pulmonary vessels, but we perceive, that these vessels
deliver over their contents io a heart which is attached to i%i
systemic arteries. The fish has a pnlmonic heart ; the snail a
systemic One. These were facts with which Mr. Hiiiiter was
fiuniliar ; I cannot therefore conceive^ what led this distin-
guished physiologist to conclude, that in the hiiraAn subject,
the ventricle sends the blood throtlgh the body, and is there-
fore tlie proper heart, while the auricle is only an appehd*
age; Having once embraced this notion, he observes : ^* And
as the ventricle is the part, which propels the blood to the
different parts of the liody, its muscular power must be ade^
quale to that purpb^e^ and therefore, it has a verj strong
musculilr coat.'*

'' To prove that the auricles are subservient to the vcn^
triclcs» Mr; Hunter has stated, that in those animals whelie
the veins near the heart are large, there is no auricle, and
he has convinced himself, and endeavoured to persuade
others, that the ventricle is more valhablfe than the auricle;
because, when the heart is imperfect, we always find that
the ventricle is the part present. I shodld be very averse io
atart objections to any of Mr. Hunter's Opinions, for they
arc, in general, the result of cautious indnction from un*
questionable facts. Comprehensive and accurate as his views
generally were, and elevated as his mind was above the letcl
of most of his predecessors, still it woiild have been expect*
ing too much to have looked for absolute perfection id
all his opinions ; although most of them have stood the
test of the strictest criticism, and are now considered as
itxiQms Vfk medical seiencc. Injippreciating):hotreverj^ tkt.

I60d^ MediciMe. S30

.relative value of the difTerent park of the hearty and

*

even of the heart itself, ^itb respect to other parts of the
^jstem, I think he has err«d. For, although we regard^
in general, the ventricles as stronger than the auricles, we
must not from thence conclude, that this is because the
..ventricles in a state of health are ^^ the chief agents
in the circulation." Until we possess clear notions re-
specting the natural function of a part, our ideas coik*
,cerning its morbid actions can never be otherwise than
vague and unsatisfactory • But oflca our opinions regard-*
ing healthy function are corrected, by observing what
.takes place in disease. In the present instance, it is prin-
cipally by attending to the deviations from the natural
condition, that we come to a knowledge of the true rela-
,tion which the heart bears to the sanguiferous system."

*^ We may be still more certain, that the heart does

not circulate the blood, from attending to what often

takes place, where the aortic valves are ossified. It is a

-fact well known, . and fully substantiated by observation,

.that in this disease the heart contracts sometimes twice

for each pulsation of the arteries, which could not ha^i-

.pen, if in reality the heart by the vis a (ergo drove ou

the bloods On the contrary, when so small a quantity

of fluid is sent out from ths ventricle, that the artery is

. not fully filled, it does not re-act on its contents, till tlie

next contraction of the heart fills it; then it acts, and

.then the pulse is again felt. If. we would estimate justly

the value of the heart, we must look on the auricles as

reservoirs to the ventricles, aud the latter again as serv-

^ng the same purposes to their respective arteries.

** That the ventricles during natural circulation, by
their percussion, drive the blood along the vessels, is hard
to conceive. To my apprehension, they only propel it
with due vigour igto the arteries, and they of themselves
circulate it. The c^es which are afterwards to be d«-

^ L '• » '«» ' i»'i

d4b Meditine. [_^P^i

i^XeA, ara ct^r dnd tmyfrating proofs of ttrbi sindf tfais^
itflbrd ah umple r^futatiotf of Mf^ John Bell'i^ cbiilMXiti^
that the ductuft arteflostis ^< g^Veff the full ^rCe of th6
tight tentticle to the bfood of the ftort^^ td fiddttfcm to
that of the left ;" fdt ift them the blodd \^ad dlf&abU^
l^lthout the aid of either tentrtcle. Sbttie baYe tH&Ay tfrit
the parts of the aorta near the heart att vlgiofrdud'y ott
the bloody but that the jSafts ifiote remote hate Aeed df"
the i?w d tetgo to drite on the fliitd. ff, hdWeyetj It be
admitted, and few vrill {Pretend to deny ^ that ah jr poMidn
of an artery can propel itd blOoif in^t^ndenft 6f any
impulse eommnnie&ted from the heart, sUteiy #e' itdjr
be allowed to infer, that the y^hofe dtusty oan dd ^[^
mnck ; so that a vessel thirtjr-si^t feet in len^, OMl Ve
just as capable of propttling its contents, trn one of a siagk
foot.

^« It m&y natorally then be afekedi why have we bolt
an anricle and d ventricle, if the circulatloir can be catf«*
ried on without either i In i^eply^ t would observe, tiistt
according to the scheme of the perfect citcM&tidti, both
parts are necessary. No doubt. We see in the lower tatiks
of the creation, that the animals do efqilally Veil ^ithoAt
a heart as with one^ of with a dn^le, as k^ double h&Mi
The caterpillar without a heurt diScfaafg^ In perfectfbh
all its necessary functions; and the fishj although' it hd»
no heart to propel the blood through its long %nd flei*
iblc body, yet circulates it with ease and regularity, by
the sole unassisted action of its Vessels. In none of thetfe
animals, hoTvever^ do we find the functions §o complicated
a^ in man ; their wants are few and siinple ; their mode
of life and cEConorty are fitted to their' inferior rJink in
organizntion. Man, however, has othet functions to pet*
form, and other relations to maintain, alid- for the'dis*
charge of hi* muttifarious duties, the struetuTe of liJn

%m(S fequiren to be m6re CompQtsttM; yet it is Onl/^

1809.] Medicine. 341

much 80y as to fit him to hold the station which has been
assigned hini, in the scale of created beings.

'• In the caterpillar, and its tribe, the body is small,
and the vessels comparatively large; so that in thera,
there is no necessity for a reservoir to collect the blood,
and to propel it into the artery in sufficient quantify to
distehd it canal. In the hunmn subject, however, from
the proportion which the vessels bear to the body, a heart
is rendered necessary ; a reservoir is required to collect such
a quantity of blood, as, when impelled into the vessels, shall
let them feel that they are in some degree distended. Be*
sides had .there been only an aorta, and veins in the human
object, the blood could not of necessity have circulated an
equal number of times in a given period ; neifhcr could the
pulsations have been equally frequent, if he had only had
an auricle appended to his sanguiferous system. To circu-
late the blood sufficiently, frequently, and harmoniously, an
auricle and ventricle are both provided. The auricle di-
lates, is filled, contracts, and propels its contents into the
ventricle, and while ^ the latter is acting on the fluid it con*
tains, the auricle is again filling, and by the time that the
ventricle is emptied, the auricle is ready to contract; thus
the vascqilar system is always kept full, for the heart sends
out just twice the quantity of blood, that it could have done
with the same exertion, had there only been a ventricle. In
this mechanism, I se^a beautiful contrivance for furnishing
such a quantity of arterial blood to the system, as shall be
sufficient for its wants ; but t cs^nnot do otlierwise than be-
lieve, that so long as the heart and arteries continue healthy^
they act in a manner independent of each other; each per*
forms its own part, but both tend to the same purpose ;
unity results froni their action. Still without being imme*
diately fatal, one part of the heart may lose its muscularity,
or the arteries may have their power of contracting greatly
Impaired. In the first instance, however, that part oi tb#

Sit Medicine* [April

heart wliich remains healtby, perfornjjus^ berides Us ownfimf:*
lions, a considerable portion of the action belongixig to the
part diseased ; and in the latter case, the lieart is compelled
^o act with redoubled vigour, for in propoflion to the k)ss of
arterial poTv cr, so is the heart called on to make up the defi*
ciency. Tiic circulation can in eitb^ case be carried qn^ but
the vascular system is in a precariaus state ; very trifling
causes derange this mode of circulation ; nay, in some casqsy
put a final stop to it."

The Physician'' s Vade^Mecum i containing the Sj/mptomsf

Causes, Diagnosis, Prognosis^ tind Treatment of Dis*

eases. Accompanied by a select Collection, of Fermuleey

' and a Glossary of Terms. By Robert Hooper, M. JD.

JLicentiate in Physic of the University of Oxford, and

the Royal College of Physicians of Ij>ndon ; Physician

to the St. Mary4e*bone Infirmary; and Lecturer an Me'-

dicine in London. 1809- Small 8vo. pp. 274^

Reviewing a book is, at any time, a painful task : for

how seldom does it happen that an author thinks the man

'who takes upon himself to decide upon the merits o^ demerit^

of his work, to be actuated by pure motives or impartiality.

Dr. R. Hooper's book, we admit, is replete with erudition :

•— but wc caimot help thinking it too much on the plan of

a ready-reckoner : — In the mercantile world, it may be of

advantage, for the dispatch and convenience of business, ta

have a book which may at once save much useless and icdious

calculation, but in the science of physic,^ we fear it is otherwise.

Dr. Hooper's intentions arc certainly well meant, but we think

that books of this class are already so numerous, that to muU

tiply them is unnecessary. It ratlier tends to make the stu«

dents, who are the general readers of them, idle, and to trust

too much to the scanty and curtailed information they con*

vey. Dr. Hooper,, we believe, has been at much 'pains witli

t)M$. little iPolttitM ; and he certain^jr deserves ]pie character

1S09-]. Medicine. ^

• • - ■ • ^

of ^ laborious and indefiitigable writer. . His Object h ta
furnisb a set of school-books, which are always best applied
whejoi commented upon by the master. As text-book^ to his
own lectures, they may do very well ; but we think them n<4
9^fficiently extended for general perusal.

In looking over the work, we are sorry to be obliged to
point out what we consider as a defect. In the enumera^
tion of fiyraptoms, he brings into his description everjr
symptom which can arise, without specially dwelling on
the leading ^or pathognomonic ones^ and holding them to
marked attention. We shall give an instance in his states
ment of catarrh, taking in the whole disease to shew his
plan^ though it is tlie enumeration of symptoms we chiefly
object to.

^' Cat arr hits, or Catarrh. — Species. Catarrhus afrigore,*

common cold. contagious, the influenza.— 'An increased

scretion of mucus from the ixiucous membrane of the nosC^
fauces, and bronchiae^ attended with pyrexia.

^^ Symptoms. — Pyrexia ; weight and pain in the head ; —
oppression of the chest, and impeded respiration ;— -sense of
fulness and stopping up of the nose ;<^-watery inflamed
eyes;— coryza; — cold shiverings, succeeded by transient
flushes of heat; — soreness of the falices and trachea; —
cough;— pains about the chest; rheumatic pains in the
neck and head ; — increased secretion of mucus from the mu-
cous membrane of the nose, fauces, and bronchiae.

^^ CAusES.-^Tiemo^e.— Cold applied to the body ; — conta-
gion, — Proximate. — ^An inflammation of the mucous mem-
brane of the nose, fauces, bronchiaB, &c.

^* Prognosis. — It is seldom attended with danger, when in
a mild form, and arising from common causes. UnfaxotiT'
able, — Predisposition in the constitution to phthisis; — tend-
' ency to asthma, or peripneumonia.

** Treatment. — Indications. To reduce the febrile action
of the system. — ^To alla^ the irritation of the affected parts.
. ^* General bleeding may be necessary, if the type of the

344 Medicine. [April,

fever be sjnoclial, and the sj^mptoms are violent ^ in such
cases purges will be beneficial, saline diaphoretics, and the
antiphlogistic diet, as recommended against syuocha, or in«
flammatory fever.

^^ When the system evinces typhoid actions, the contrary
must be observed.

" The second indication requires, I. Frequent use of tepid
diluents, mucilaginous and oily demulcents. — ^R. Spermatis '
ceti, two drachms — Vitcllum ovi unius— Syrupi simplicis,
half an ounce— Aqua3 cinnamomi, two ounces— — distil-
lat^B, four ounces.— Fiat mistura cujus capiat seger cochleaie
- inagnum frequenter.

** R, Olei amygdala*, six drachms— Syrupi tolutani, one
ounce — Aquaj distillata?, five ounces — — — kali prcparati,
q. s. — ^Fiat emutsio cujus sumantur cochlearia duo secunda
quaque hora, vel urgenti tusse*

•^ R. Mucilaginis Arabici, one ounce and a half — Aquas
cinnamomi, five ounces— Syrupi mori, one ounce — M. cujus
sit dosis cochleare medium urgenti tusse.

*^ 2. Mild expeflorants and diaphoretics. — ^R. Aceti scil-
Ixy one drachm— Aqua3 menthaj sativa?, five ounces — Syrupi
croci, one ounce. — M. cujus sumat cochleare magnum quando
rauccdo urget.

*^ R. Oxymellis scilla?, half an ounce— Spiritus aitheris ni«
trosi, two drachms — Aquajmentha^sativae, five ounces — Syrupi
cprticis aurantii, three drachms.— Fiat mistura de qua capiat
a^ger cochleare magnum subinde.

*^ R. Nitri purificati, one drachm — Lactis amygdali, seven
ounces — TinctuhT scilla*, one drachm— Syrupi tolutani, half
an ounce. — M. sit dosis cochleare magnum subinde.

" 3. Mild opiates and diaphoretics when the inflammatory
diathesis is reduced. — R. Syrupi papavcris albi, one ounce
— Xitri, purificati, one] drachm — Aquae racnthae sativae, six
ounces. — Fiat mistura.

■

" R. Syrupi papavcris albi, one ounce — Oxymellis scill^
half an ounce — Aquae mjcnthai salivap, ^\x ounces.- Fiat mist

tiira cojus sumantut cocht^rra dtto ikift^a tertia qnaqnt
liofa.

^ R. Pulveris ipecacuanhas compositi two gralm attd a
hal&^ConserVas rosee^ q. fi.— Flat pilala quarta qnaque hom
samenda.

** The trodhisct glycyrrhizte cart oplo.— ft. Decdcti koi^
del compositi, fourteen ounces and a half— Synipi papaverto
Atbi; one ounce and a half— M. dujns capiat i^er eiatb«fii Ti«^
liosum parvum secunda quaque hoKU

'* 4. Blisters to the breast, if there be uneasiness thejfe, or
pain^ or difficult expectoration, or sense of oppression.

'^ 5. Inhaling the steam of warm water/'

Upon the whole, the book of Dr. Hooper may, ft is true,
1^ of great assistance to the young practitioner ; but we be^
lieve of no real utility to the experienced professional man,
trhose proper Vade-mecum ought to be so much at his finger^j
ends as not to requim the aid and infbnnation which this
\yi6bi affords.

n. SURGERY-

Amoiyg (he objects of Surgery, the diseases of the genital
system form a leading part, and are more frequent fiubject$.
of a practitioner^s attention than any other.

The urethra in the male, as the passage to the bladder, or
urinary organs, is subject to a variety of diseases from tfcat
source, independent of its other functions, cx>nnected with
(be purpoes of generation.

XA€£iKATlOir OP THE IQj^a&TIf RA*

A itCMAitKABi^E case of laceration of the arethnt is de-
railed with much interest and practical utility by Mr. Bel^-
fertiy t

RoMurr DAimrTj a tfeaMMi, ^f hW Maj^sty'i ship Oloif >

TOti. II. A A

846 Surgery. C^pi^^

jen the 20th of May^, 1806, fell from the gangway, across the
gunwale of a launch along side ; he was much shook, in
considerable pain, and a little faint ; but walked with a little
help to the sick birth. On examining the perinaeum, there
was no appearance of injury, except a trifling fulness, and
scarce any pain to the touch ; he so soon recovered as to be
earnest to return to his labour, whiqh I would not allow,
fi^ring more serious consequences; a large compress with
saturnine lotion was applied, and strict rest enjoined. My
fears were too soon realised, for in about an hour afterwards,
on attempting to make water, he fainted away, and not one
drop passed, and yet he felt the bladder empty ; a greater sense
of fulness occupied the perinaeum, but as yet no appearance
of swelling or fluctuation. Anticipating great inflammation,
he was immediately bled, ad Ibi. The cold lotion was assi*
duously applied, and an opiate given; two saline enemas
were administered in the evening, which operated copiously;
he had also a natural stooL

At 4 A. M. on Slst. y. s. ad Ibi. He was eonfined (o bed,
and the scrotum suspended. This day no fever^ but repeat-
ed the enema, lotion, and kept him very low ; only a little
tea^ and that as sparing as possible, to prevent secretion of
urine. . He lies quiet and half asleep ; occasionally a yery
sharp pain for about a minute in an hour, about the mem-
branous part of the uretlira; extremely acute, as if the urine
came so &r and went back again. To the question, if he
felt a sense of water trickling through ? He said, Yes^ some-
jttting.pf that kind. A considerable rigour followed his
fainting ; very much like Sharp's case. The perinaeum soon
began to swell, and the scrotum likewise, followed by dis-
colouration, and rapidly extending in every direction, so as
to become this morning one livid mass ; the whole scrotum
and penis swelling, and as it w^e filling out together; so
also around the perinaeum and tuberosities of the ischium,
presenting a hwtid appearidicej Hike a pait in ^complete

1809i] Surgerj^^ 3i7

stale of sphacelus ; but it is chiefly the effect of extravasa-
tion and the blow, and the suppression of circulation! from
the quantity of urine insinuated into the cellular membrane.
The prepuce is puffed like a large phimosis, or as in extensive
anasarca of the penis ; the glans is quite hid, and, in short,
the whole of those parts are about six times their natural size.
Perinaeum very sensible to the touch, but no heat or tension;
feels most like a bladder about half full; the region of the.
bladder is quite fiat, and not sore, as if there was not a drop
of water in it. From the first moment I suspected serious
mischief, therefore acted as in a case of inflammation. It
was now necessary to examine the state of the bladder, as he
had not passed off any urine since 11 A. M. of 20th; the
desire was continual, but every effort gave intense though
not long pain in perinaBum. Proceeded to ascertain the state
of the bladder : at the first attempt it went very little beyond
the membranous part of the urethra; felt some resistance; .
would not force, but withdrew the instrument ; about two .
ounces of clear blood came off; a bad indication; shews
internal rupture of blood- vessels ; some clots also came off.
The introduction of the catheter did not give much pain,
and at the second attempt it passed easily its whole length .
into the bladder, but not one drop of water came off; a.
little more blood, then fainting, rigour continuing, and the
swelling fast advancing. I still directed my attention to the
effects of inflammation; determined either that the bladder
is burst, or the membranous part of the urethra lacerated.
He had drank about a quart since the last micturition. Feels
a sense of water passing, and constant filling of the perl*
naeum and. scrotum.

Got him into bed ; had a stool in the evening rather in-
voluntary; I emptied the rectum alto by a stimulating enema,
and seeing the importance of an empty bladder in case of in* .
flammation, passed the catheter a third time; no force requir-

•donxesifftancSemade^i no urinefiowed; conti^vled9 v^yU«

4 A 2

ft

M Smrgeh/. *[Aptir

beral application of the cold lotiotiy and in the evening ^
i^hen the circurlation was restored frbm fainfingsy and hav-
ing some fever, and a little fulness of pulse ; Hlkd hith
ail one pound. Rep. enemni, and gave opium, gr. I,

" Has had several slight rigours^ and as his pvthe is still
fall; bled again this rabfning, ad one podnd, at 4 A.. 51.
sutee \vhich he has looked pale and weak, pulse sniair, soft^
and not quick.

'^ Not a drop of water has passed, and bfaddcF is quite
&icclA ; lie feels abbiit cvef j^ houir the greatest de»ii^ to mdke
j^ier; and a few drops seein io pass through iiito the ]pciU
n'acum ; and as this happens, so dlsb the peni^ and i^^rotilm
distend, itiid ali^o around the isChiuiU, anus, &c. Except £(t
tlit^se tlAcs of a few minutes schse of micturition,, he lays
ptetty easy, and sleeps tolerably. What m»re can now be
done, than first to obviate the danger of infidmihatibii, SvhieK
appears pretty well obviated at present ; has no setibhs syinp-
t6nis of fever, or pain in tie belly ; hdve less reason to tekr
rhpldrc of the bladder, and increising reason to KeKeve thjit
of the meinbranous part of the urethra ; must wait, and per-
sist ^gauist drink', although he begs and pr^ys ibf it ; as a
gfeat point will be to reinove ^Vhdt fluid there is, and to pre-
vbnt the accession of more, till nature can bperate, if poS^
8?ble, some favourable change.

** Through this clay I gave up the apprehension of rup-
tured bladder, and tiecaihe coiifirmed in that of the mem-
branous part of ttie urethra, in which pari, al night, the
swelling was larger, fuller, arid more tense, givuig the feel
of ^ictravasated fluid; by lightness, niost proliafcly water,
dispersed in the cellular membrane; the scrotum full the size
of a small bullock's bladder ; no fever, and (olerably easy,
eiccpt at the time of sense of micturition. Th itie evening
additional confirmation, if any required, for now the sere-
in^ b so distended that it is mt slbh io bear any inbre, and

.1809.] Svrger^. U9

the ccgioa.of the bladder abpye the pubis not a little di^tead*
«d, s^nd ^^come sensible to the itouch, and his danger must
r^pi^Iy increase, iiD,less.$onie er^cu^tion be procured. In«
troducing two .trocas in the depending and ^i^ther posterior
part of tl^e sqrotuna ; a.^hifi.fluid ooz.ed out, to the taste that
of urine, and tinged with blood; secured thl canulas, and
^t off before eight o'dpcjc a full pint ; of course, to the
^reat rdipf of the patient, but j^et.qp diminution of the size
of the scrotufp, beodpse it filjed.up.as fast as he feels the de«
5Sire to ^I^Ict urate, but got pff a pint and a half mpre to the
.iBvident great reduction of Che bladder, and a .little of tjie
.^rotuiu; about four ouncesjpfbloo^ mixed with ^he urin^;
one or tivo yery slight chills in thc.night. l^iepeat^^ itjie
enema ty?ice this day, andg^ve opium, ^r. i. vespere. jEne-
.sxia feels comfortal^le, empties, even pompo^es .to ^leep,
Jthough on^ of Wc^rm water.

" May .82. To assist the perforation of the^rocar, I^st

^ey^niflg, I. made a. few pretty de^p , incisions with aJan9et

in the scrotum and ^penis^ .^nd aU Ojozed s9i^thing apd

.I^elped the ^eperal . intention. Jn.ti^e middle watqh last flight,

anpther pint aod a half dropped p/f, so that at ^l A. JVf . Ux^rc

.ji^as a .^toiJtiUjg .flkiccidft^ of the >yhple, jpspeci^Jly of ^e

blafld^r, but thep^^ts aje,ie(}^v^lljr,di^colouref], .,quiJLe,I^].a4|k,

jjijkA only, sensible to p^^abqfit^ tljiLe ^perinflfum ; slept , t^lera-

i^l[yw4ll ; forbears ^riqjc ; ^^as not had above a piut $iuce

Jmrt,,to,.8thisp»|rniii. ?:i,e;«duciionpftJie;sjj;elijflgc3n.

. ♦inwfis, j^ if J,e4ni^o?p, h)m^xafa. ^uids, aa^ fee is a.n ,a^-

dieot ftstieat,; jijfay bope, if (he (^|f9j;^tioas .5X)ntinu.e to (f^je,

.^ratptal r£<|iU9ti0a of the ;5j*;eJHng ; J^e je.yi^ently , jias ^o

ifcypr.. Vr other .nxairk pf iijflaui^ipn. I f^nptfi^^i^s ^^gpp

Thim parching with thir*t, jtwit.1 h?ye/(?Pfle,jIj)elj^ye^ aj\ t]^at

,> ju^tjtfijljje.at. pjcsfient ; ?jpd if .L }^e , ofe'^ifttpd ^£?R§J3l -yi.

^mffl»ti9n, ,wju hay^ft<iwjp,|?pj^«.nd,.9ply WP»1 .fi^'

danger of gangrene, communicated inflammation, and the

A 3

* 350 Surgery. [April,

great obscurity which all these parts, and the nature of their
afit'ction are -wrapped in. I had an idea, if the plan of per-
fbraiing the scrotum had failed, and the bladder had filled
to excess, of peforating it ; now to do that, the rectum is the
east objectionable way ; it would be a present indication of
cure, for the water to flow that way, till nature, assisted by
an, might restore the mischief in the canal. Repeat the
emena twice a day, give opium gr. i. pro re nata ; keep him
low ; keep (he parts dean and cold by lot. saturn. At night
looked rather sunk, and pulse weak; several rigours, and
regular chattering of the teeth ; scrotum and bladder kept
well emptied, of course little or no oozing, only one pint the
whole ^4 hours ; he cries out bitterly for a few moments, at
each sense he has of the urine trickling from the bladder,
which being an involuntary act, shews a paralysed sphincter;
swelling just kept at bay by oozing, and the absence of
drink. 'Can take no food ; great distress from thirst; lips a
little black, pulse regular in time, skin without heat, peiri-
na;um yet very full, hard, and all round to the anus the
whole is black, but sensible in every part to the touch ; the
most sensible part has always been the right groin, and the
side of the scrotum touching that part. By frequent rigours,
I apprehend matter is forming in the perinaeum; no hiccup
nor mortification ; thus may hope for formation of abscess,
and fistulous opening for the urine, as the only probable
chance of saving him. What if an artificial opening be
made on purpose ? but cannot tell the exact place ; may
do it below the wounded aperture, and communication' with
the cellular membrane; besides, why not hoi)e to restore
the urine to the regular canal ? for if lacerated on the lower
side, it does not follow, when all swelling and inflammatory
thickening and obstruction are gone, that the urine should
not pass on through the regular canal. There has also been
a glary dischaige for some time after the accident^ which I

J809.] Surgery. 351

attributed to injury of the prostate, but now in the form of
matter, and is rather putrid ; some confirmation of the hope
that matter is forming; remember the state of such dischai^
from Sharp, whose case was not much unlike it, and relief
given to the narrowness produced by former inflammation,'
by the formation of abscess and fistnla, and so might have
lived, though a burthen, many years, if not for that unlucky
secondary inflammation and gangrene; such will be the
course here^ either abscess or mortification, and to day 33d j
by the severity of rigour, strong chattering of teeth, and
more frequent recurrence, at least a dozen since 6 o'clock last
night; hope for the formation of abscess in perinaK), which
part continues very full and hard; not yet fluctuating, where-
as all the rest remain lax, and very little larger than nature,
and now able to draw back the prepuce. Matter oozes from
the penis still, with a little blood; all the effect of the great
bruise, giving hopes of matter forming there ; injecting some
warm water into the urethra, does not return, which confirms
the opinion of the rupture of the membranes of the urethra,
and that the water escapes into the cellular substance;
must therefore be cautious, how I nspeat the injection*

^^ Last evening he seemed to sink a little, very weak and
pale, looks low to day. Allowed half an ounce of wine four
times a day, just to keep up strength and tone, also a little
soup ; had yesterday about a gill of soup, and in the whole
twenty-four hours about a pint of fluid ; in fact, just as
much as I think will ooze ofi^, and keep the parts empty ;
some acid eructations, but no hiccup. Some fear of gan<!»
grene^ because less pain in every respect, and particularly in
that of water going through ; does not cry out so much as
he did. Apply large hot poultices to perinaaum, and suspend
scrotum well ; continually applj^ hot fomentations to region
of the bladder ; last evening took an early hint by seeing a
greater occurrence of rigour, and hopes of matter, to leave off
sepdlaiit and cold system, and began waro^ foiQentationS|

A A 4

dW . Surgery. [April,

irtikh leU more comfortable, and neoesaary ,to encoaiage €ir«
OttlaUon ia the paits so leUxed, and for fear of gaDgraae i
flbaU ^tlso give a coidial ia #maU form. Coafect. aromatic
jSpr, x^ augendo de 4ie, beoaase aio»t a£raid of debility ; tbuat
is liifbly dtstremiig, but must persist against drinlu

'^ i24. Oa the ^bole is ivorfie, in great dagger;, scaoce <pos#
siUe 4o iive ; tbe danger of gangrene bas greatly increased;;
\ty noon, yesterday, the ernptations amouatod to hiccuj^
"wdichhasinOseased^oasto^ftalKeandiiiir-t htsi much; has
had at leasttiwentjr fits^f it]r fecesimk, ey^es deadly ; pnlsc^
tboii^h f qgnkr in twe» is weak; skin oool, tongue browi;i
atid dry i lips and. iwik «omewihat blaol^; ao4&ead^ac)i*; and
again, -cenlMry to mortifiGation, tbere lare ^troiig signs of
inflammation <«md fomiationpf (matter ; rjgow$ much atropger
and loiigeci itU 8 last niigbt, ^ce tbat slower and 'iveahqr,
bnt ^ostefday very se^rey hy r^tilajr ^battcfii^ of teeUi^
very distressing, yet be got a Uttle ste^p. I bayexon tinned
stoiolly a <)arge hot i^atapiasmand -fonientatjpn to ^tbe whole
ll^ibes, •soTiOtumi &€* which ease and ise<4he ; miost -oS Urn
priSees eontiniieto-ooiw, bat not «%ttal t^fluid t^ken, which
was rather tnoi^ aada)ged ye^tesday» on aacaijintof his cries,
ftnr it, and ta be alloK^ad 'niOEeifieely; after a naost .pleasing
oiriHimiltaili^, 9i -S P. ftC. |>ftpas$ing4h^ -oa^ietei^ a ^^^
small one, ^retly Easily, ^hen at (he ^rt >supposed ^to Ha
Hf^ured, and'k^ thejpoint of itbewriDg on the i^per sideof
the canal, £[)r fear ofteHtei^ing the laeerated .part, -bat it went
oompktely m^ aad -dreur off 'A whole pnut ^ water, to n^y
great fiiatisfactian^and his. de%ht; tlK)ugh:byiheunea^)PO»
sition he almost ^fainted* Bladder didnot fiaej, ^or ajipear 4o
be fulL I b^^an to^pass Uie oatheteoT'ehiefly wiih^ vieif^i^
gentle means, ^f^scepiainii^ if any, and^wher^ rtheobljl^fue*
tion mj^t be, asalao toitiduce a true jpassag^^by (i^ee]^^
it open, not unawaite-of the danger of ^exeiting new^ibflemi'
mation» Scrotum* had not eiUaigedi thpi^h felthaidef ,HUid

bsiievpi^moifl^^'^ by'4be w9As«,&ffm tb^i^HMiU tyieilt^.

1600.} SurfS/uf^n

injecffid to wikIi mt mittrr «iid muoiiSy ;iRkh a ItMf bkod
from the i^enis ; ii# v^ter iietmn^ agw^ wh&f^ done Jjut
ni^t, and scKotyxo ^eeoMsd to ^ ih»rd^ stiU j .to be mor^
iMifikward in ite usie^ esppciallj if i cao :SjiM:c^e4 oopi^ionaUjr
fMu^iqg tba -oaUiBter, then m^y }im>^ rmvch, if fgm§i;ftiif
doep not advanoe; but loss of sti%i;gtjiy £^i4ne^y Jucpiip^
black tong^e, &c. are^stroi^ and dangeHHV <M8<^» ^^ ^''^*
rium, but loss of fypirits; ^d^ dqjiectedf nund sp;^ Jt^ibw if
vj^xy ill ; is very furfful. 4jt fnigbt^got^iKOi^ ; n(wpb jpaJin V^
lK>ttQm.of i)ieUy9 no doubt £rom inflfumniitiiHi ^pce; /itil^^dif-
lects .obie%ito the^igbt side of.iirgnes^ jji^st.ii)[)os^ tb^ {Wb^
wbora to day jtbere is,an ^evidsntc^wdUiWy s^ixf 4^\^wAi^Wk
(be bladder, aod remaining |ifteri9Ul^¥i^^Uf4iP9r'WM^
Ti^psated tbis xnoimi^ fverjr bs^^lft »bMt.ai»t iiaAf.p jpui)^
^ramrn off^ yet the Madder seen^cd ^em{i,li(id ^' 4^ .fdtboji)^
so vmc\i onore has been .drank ; -trhis Jl ^ocwxki %«i)y.tbf
gr€)aler oosdn^ /rom this^ii^rlH^eMU), ^qt% ic^ <the.l#fisid(^
X made lastoiight a'ileqp44HH«ioqi (^ .fV««f$rtiiiii .if ^y ;if^tr
tor,; found none. Intqgu^ents >iiayr Jw^rd^ ,by ithioliiviugigs
inoision about half .an 4u^ iWqg* J Jbq^i^i^ rtbiii^iad¥4nl(^g^
if^no40(iatter wAs.foua^j itbat by ^a7ii^:of .mgime sk^ftjbiio^
Uiere*would be a dwinutiop of jUnjHftV^ 4^rdn^^9 4)4«m9f
and redness of .tliat^id^; beaides^ having ^vfm ^s^ncti^to ,tb^
bladder^ithere appeared a 4imiau(ion(of.aUvd9Jt}gfe!;;,ibi^ti^t
4if gangrove^ nod e^ven pf^that, if J fqankq^p^p,bi5.ft^roqgj(^
ivitbout <^eiti9g inflamimfUiQPvof tbe ri^Iarbkr} vqr yreUMj^i^
ap.must .cautiooaly jiuppQ«t iand tsIihimM^) U> t^(\QWi;fig^
nmUioatipn <af Ttbe vycriiMpiw^^jby fviMftow ^ JQtHf • 9^
may lessen a great cause of extensive irjHtatinn ^aod^^^MH^biQC
from effusion of urine, if I am so bi^gpy«ta(iK>^tifllie^di|i\¥iiig
itjolf, wbicdiX could not do ait ibur-tfiia^wpriijvig* A^i^ds^Cy
fdGter. beiqgi dressed, be .e3|pCjQii«fed.igre.atrMiHiatii9^H^ ^^i^i se^Mie
^f fulness of the 'Madder^ .b^MtP^xjificnal/ i^lifgrf lot .dis-
tended ; :gtieAteiit dititmss, taim(¥)) wdcF^^ i^ Abe .jf^^

1^4 Surgerff. - fApril,

** At 4, resistance to catbeter, bnt not pnident io employ
force. Gave opium two grains, last night, but scarce slept;
and the distress and restlessness for drink urns so great,
was obliged to increase the indulgence; in the last S4 hours
bas taken three half-pints of tea ; he looks forward ijo the
bope of satisfying his thirst, as the greatest possible blessing.

^' At 9 this morning, after a few attempts with great cau«
tion, a very small catheter got in, but not the whole length,
little fiirther than neck of the bladder; yii so opened it, at
least the obstructed part, that the urine flowed freely : now
it may be that the urine is lodged without the bladder, and
stopped by the lacerated part externally, where closed by in«
flammation, thickening, &c. He strained and vomited a
little last night; not to day; and bas kept down a gill of
ffoup; also confect. aromatic gr. x. quart horis. c. yin. |ialf
mn ounce, with about four ounces of lemon juice, and as
much wine besides* Seeing the great good of the last indv
ftion in perinaeo, made a still more ample one on the other
aide, close down to the muscles : be slept a little to day, since
water evacuated, and took a cup of tea ; also last night a
few ounces ot gruel, and a tea spoonful of brandy in it. — No
feetor from the scrotum, and not vesicated or having any
more putrescent appearance; rather wonderful with all the
rigour, hiccup, &c. that a crisis has not taken place. To
check hiccup, and stimulate gently, though it will excite
water, yet given because it will at the same time cool, and
l)eanti-putrescent,kali gr. v. in efiervescence with acid wine
alternately every two hours, witii confect. aromat. in yin*
one ounce singul. dos.

^^ R. Catap. fotus, &c.

^' 85th. The poor fellow is closing his sufferings festj
they have been immense, but now less by the relief of deli*
rium ; he is so restless, that it is impossible to steady him $
cannot now keep on .any dressing, but haye hitherto persu^ed
in the use of cataplasm to perinaeum and inguen, but on tba

i809.] Surgeri/. S55

latter the weight of it is too great ; the part is so extremelj
sensible of pain, equal to touching the eye; kept tolerablj
composed, and had some sleep after drawing off about a piiit
of water yesterday.

^^ At 4 A. M. took some tea at break&st; felt refreshed,
but the fever continued. Teeth quite black, tongue drjr
and brown ; less hiccup all day ; one or two slight rigours
only, but state of parts worse, now in solution and perfect
gangrene, but uo foetor; to day one spot, half dissolved, and
breaking through at the bottom of the scrotum ; it is alto-
gether a most dreadful case of extreme anguish ; so as to pro-
duce in a most iSrm mind, frequent restlessness and delirium,
yet at times he is rational and patient.

^' I have succeeded, by great pains, in the application of
the catheter, in drawing off, at ^tbree different times, three
half pints of urine ; but the canal is full of interruptions,
as if closed by inflammatory thickening, especially in the
membranous part. We come now to a new view of the
case. The ipart he has always most complained of, was the
right inguen, which yesterday appeared fallen, but by noon
it became rather red and hot, more prominent, and extrei^elj
sensible to the touch ; this redness, fulness, and degree of
pointing by the pink colour of the centre, has gradually ad«
vanced.

^^ There seems to be a general and deep thickening
through the whole depth of the parietes of the abdomen, and
I doubt not the explanation of all the rigours, internal pain,
&c. is to be found in distinct inflammation of the coats of the
bladder ; feel assured that if he could live long enough,
should see suppuration of the bladder take place. But I an-
ticipate that he is very soon, at all events, to finish the sum
of his sufferings, as great as ever I beheld. We recollect
how soon Sharp sunk under a nearly similar state; with the
ftxtraordinary combinations of inflanunation and gangrene at

3b6 Surgery. lApijJ,

ihe same time; there is excessive pain, heat, jredneffi^rigouijSi
jilisipwitieu.to suppuration, and actually local inflanuoatioii,
^wbilst-somepfictsajc half putrid, and all along^ ^ince dan'
ger, a slow fever : black teeth, dry brown tongue, and small
^ul^, ,coW i^kin^ hiccup, discoloration ; ^lot all the effict
of bruise fmd e^iavafiatipn of blood and urine ; it is triply a
^^ case to be compftred wjth Sharp's. In passing the ca*
tUoter, not mich pain expressed, which would be if the Ijlaji*
^dor wa3in^med. X>issection would be highly ^^pl^^^7
^d ^soful^ a^ I h^d so much jpapre j;>ain ^n evacuating tfie
jibddcjc^ and. ^thii:^t was, his greatest distress, and had yes«
tc^:^y .indulged him ,in vf^rip^s jfluids, s^qh as t^^ succ.
iimou. and every two hours vi^. one ounce, c« confect*

•^roipatic.Aiidi^aU.pp. .^ aUo ^^ith sorue soup, and, a ]it£le
JiKioe pjQC^siQn^lliy. H^ often .felt faint yesterday, and in ^e
j^gm,.aRdQi^C|Bgr^at\y spat 2.^. M. appeared to be ^ing
^jpff ; 0(1 tbe^i^hple it appears vain, fiirth^r to try any mieaiis

.^^Cfitf^. Jke^p,hipi,a,s pli^n and quiet as possible, indubs

, jhis .d^s^P fpr j)ripk> ivbigh has not been evacuated in pro-
^p];tipn .to whAt {le h^ reipciyed; and as the, sc^rotupi was
very terjse, ^hoijgh ,ppt so brge as formerly, yet I ipade
j^ey^ol d^ piiQctitres i;i , the scrptu^i. last evei{iiig, from

j[i«hi^ .th^re ^a,s a cpnj^julerfU^le Qoz[pg; this Tirill allow Uie
freer use of fluids^ which appears to be his great^t ,^A»

. ^jwlatippj W.d'? fl^crcy no?v to let^Ura die^as easy as ..I,cap.

*^ !26. .ThCjpoar ff^flpw.c^-n^^rce be,sj^id,to be.a|ive,^aQd
J^ qot h*d. a ratip)5^ftlii»terval^sin^ 6 A, ,M. jycjst^r^ajr ; t^

..icsile$soe§s is ia^nxefi^y it. as in^pqs^ible.to.l^e^p on ,apy dr^-
.ing. ,The.^e became Qxed abpjat^. J^\\]^ ,.gf ^U^il/ Mh
.ficarccjpcrceptible,.,body stretch^; put.

^^ At 0, b7:^tji^)g4aI>ori^s, and he :}yas tj|;iQYght to h^

goin£; i)B\ but piilsc^gut i}p^,^g^n, ai^d h^ sec^i?^)^ |^,|better

the rest offtbe d^y^;ithci^ u^as a]so.^|ce b^t,i»f;|Jie bo^y

.^vva^f; the kct, th^. for, ^p ^j^s pa jit i , ]ij;hich^ jjijif ^ jp^ture

ISOS.] Surgery. ^

of body, as is oftefi felt before tbe Ias< jjrftorf, aftrf^hicfi, iff
ofie uiiejtperi^Ged, migbt lead to ain opinion Aef t^stii IMtcffy
but it is onljr the last effort and labour cf nature^.

*^ i7. He survived all yesterday tffl T P. M". iihiiH hH
bicdlbekl bis last very quietly.

<^ I firoceeded to dissect. The first object iv&s to* ai6et-^
tflih i\iQ nature of the swelling of thfe groin \ It was hdifeiiig
mOre than ejttrava&ated urine, which the serotiiM Was Aot
able to hold; it was evsicuated lipf^ards, only uhd^t the iti^
tcguhieftts a few ounces lodged there, and the cdlular mefii-r
biahe t^fU dissolved and corroded by it, and gail^ehe afsd ;
so tfcat the extreme sensibility there was the effect of ih-
flamniatioh of the integuments ; muscles, though thicker oft
tbilt side, liot decidedly inflamed, nor was any of the t)llrttd-
nifeum attached to the bladder; found the bladder sunk deep
in the pelvis, small, and hard, partly solid, and pftrtty dt
that thickness produced by inflammation ; its ftilidiis e±(^^
n&lty fed, not a drop of urine in it, firmly united, but hot ^6*
strongly as Sharp's, by adhesive layeris, but yet Very fiirmlj^
to the peritdiiJeum behind, and on its sides, and to the ai-cli
of the piibis. The next object was the state of the scrotuin ;
integuments gangrened, the dartos wds covered with fo&tid!^
matter, and nearly black, mixed with serum, urine, arid"
blood ; so also tbe same kind of matter beneath all the parts
wbich were dissolved.

*^ This layer of matter, supposed to be the cause of the
repeated and severe rigours, but undoubtedly many of those
rigours also attended as indicative of the great inflammation;
for the integuments of the scrotum did not seem to have niiv
into gangrene, as tbe effect of inflammation alone, but
ihostly, perhaps, the effect of extravasatcd blood, and dis-
organization from tbe fall. Tunica vaginalis thickened, and
£rmly united to septum scroti, but bodies of testes natural ;
so was also the cord. Now the great point is to refer to
tbe pcrinsum ; I dissected off tUe integuments cautiously^

858- Surgery. [Aprily

exposed in the anterior part (spealung as a bodj is usaallj
placed for such dissection) of the membranous part of the
urethra; an aperture decidedly not made by the knife; it
has all the appeatonce of an old hole, about the size . of
a small oblong bean. I had previously introduced the ca«
theter as far as it could go» but not into the bladder, even
now after death ; it appeared to be stopped by the neck of the
bkidder. Here was a full explanation of the cause and na*
ture of his disease. In proceeding to take out the bladder^
and dissecting the sides of the urethra, where it attaches to
the arch of the pubis, found, on the right side, the knife unr
expectedly to slip into a large cavity, exterior t^ the pel-
vb; when, by taking off some of the integuments of peri-
naeom, and towards the anus, saw a distended layer of the
n^embranous part of the urethra, to the size of a small hen's
egg ; it was soft, and so putrid that it would not bear the
knife, and being then accidentally divided, a few ounces of
urine came out ; so this part had formed a sac for urine,
the parietes of which were formed above by the still remain-
ing entire side of the urethra, till it came to the immediate
laceration spoken of, which was rather on the left side ; here
the waters first escaped, since that, gradual solution of the
inflamed sides of the urethra has gone on, so that at last infe«
rior parietes of the sac were formed rather by the perinaeum .
itself, which alone suspended the urine there lodged ; this
decay has been the work of the inflammation, and consequent
gangrene : had it fortunately terminated in abscess at first, as
was hoped for, fistula in perinaeo might have saved him ; but
the contusion bad been too great, and there was no indica^
tion for making an apertur^ in perinseo, for want of a place
indicated ; as also the state of the parts forbid it ; moreover,
till the last day, after the first inflammation, the urine had
been evacuated by the catheter ; in short, it appears^ in my
opinion, that nothing could have saved him.
" Compare this case with that of poor Sharp ; it 13 sin-

1809.] Surgery. JiQS

gttlar that I should have two sucli^ so.quick^ and «o highlj
important^ interesting, and unfortunate in their consequences.
In this case I would presume to fix the attention of the prac-
tical surgeon on this grand and leading particular ; that whea
the urethra is divided, the passage of urine through such
aperture, will not be a remote and secondary consequence^
but a primary and immediate effect/'

HYDATIDS OF THE URETHRA.

A SINGULAR disease that sometimes occurs, though rare, is
hydatids of the urethra, and the following instance of it is
recorded by Mr. Kenworthy :

^' In August, 1808, I was requested to visit a man in thie
poor-house of Saddlewortb, about 45 years of age, who wap
suffering excessive pain from long retention of urine. I im*
mediately introduced the catheter, and drew away about two
pints of high-coloured foetid urine, which produced tha
same glutinous effect, as it dried on my hand, as a weak solu-^
lion of gum arabic or glue. During the time of its flowing
off, I several times applied the tip of my finger to the mouth
of the catheter, for the purpose of preventing faintness by its
sudden discharge. When the bladder was completely emp«
tied, 1 questioned him particularly respecting the progress of
his disease, and he informed me, that upwards of three years
he had been troubled with uneasiness in the urinary organs^
which had never, during that time, entirely left him ;, such
as a frequent and ineffectual desire to make water, pain in
his loins and throughout the hypogastric region, with other
symptoms of disarrangement, which had gradually increased
during the whole of the time. In the early stages he had no
sickness, heat, nor thirst ; but, towards a later period, he had
frequently, after using an increased exercise, or change of
weather, suffered from the characteristic symptoms of sym«

fftttfeef Id iiiiattmtit&fy feter, from Trhich t ^tipectei ttd
Eime Uiettt iai^thmMM had been carried da ; the testtiii
•^et6 ffeqttttttly painftfl to the tiwieh, nud pArtkJuIariy, when
Ir^ had ttford imeadftess in mdkin^ trater, the^ retracted very
tdnHAetibly ; there W^s a nnmbness in the btittocks eittertd-
ilf]^ d(mtt f he thighs ; aAd tvtthnt the three or four monthl
preceding the time I first saw him, be had BufteteA etcceed^
]ng1 J from nausea and vomiting ; feverish symptoms and rest'
lessness, and an excessive and frequent desire for micturition^
lyhich induced him to strain so violently at times, as to force
the rectftm do\rh to the extent of several inches* He in-
formed me, (hat in June he had beeit exaniined by a Mr. B.
Htfho sounded liim^ and gaye it as Ins deckled opinion^ there
^s a calculus lA the VeiSiCa urlilafiaf; he accordingly or-
dered him to Manchester Ihflflnary for O^yeration, the man
not being cdpdble bt discharging the expenses likely to be
incurred; but as th^ sufgeofis of that institution could not
possibly disc6ver anjr thing of the njitnre of a sii)^^ be was
(dbnsequently returned without operation.

" While yet the catheter Was re^ained Within the trl^etfird,
1 endeavoured to examine whctht^r there was any extraneous
Ibddy lodg^ Within the vesica urinaria, and in passing the
'pbihl of th^ instrument carefully in difierent directtons, 1
discover^ a tumour of considcrtdJe magnitude, attached
h'ear to the heck of the bladder, of a rather soft consistence,
yielding to the point of the catheter, without inducing the
least paih. The cause of retentioa was evidently mecha-
nically effected by this preternatural growth, acting as a
valve. Pursuing my examination, as to the bulk, form, &c.
of the tumour, I accidentaTly ruptured one side of It, anid ft
large <juantity of hydatids, from three-fourths of an Inch
diameter to tire size of a pin's head, weTe slowly discharged
through the canal of the urethra, perhaps to the amount of
til V0O half pints, i ordered h im the following mixture }

leOS.J Surgiiy* Sol

^^ R; 01. amygdal dale. Mucil: g. aiab. aa. six drains.
Tinct. opii gita. thirty. A^pue distiQai* ibar ounces and a-
faalf. M. signa. Capt. cochl. major.. ij. Sqq.hora.

^^ The puixs and periiieam to be fomaited witlii warm
;irater ; confined htm to a lecombent position^ and directed
ihe u^e of iufus. simenis lini^ together mth a diet of milk^
broths, &c. He continued ia this course about a fortnight ;
he has suffered no material inconvenience since^ and now en-
joys a gck)d state of health, except, that at times he feds a
slight uneasiness from excess of exercise, or the variations of
the atmosphere.'*

TINEA CAPITIS,

We have already stiated, in a fonner Number, is a disease
'^hich often disappoints the practitioner in its cure. A sue-
tessfui riiethdd is pcdnted out by Mr. Morison, of Dublin^ in
the fbUoil^ing catse :— «

^^ The friends of B. D. a^ about 16, made application
id me' cbncernintg Ub disease, which was a caste of inveterate
Tinea Capitis, stttended with those troublesome symptoms
observable dn i^udh occasion^ ; such asextrenie itching, heat,
Ac. On k itiintite iii^uiry into the progress of this formi«
dable ctftnplaint, 1 was told, that he' had applied to every
medical lind surgical advice that this l^reat metropolis could
afford, without the necessary rdief, and that it had continued
tmiiiteYruptedly for about four years.

^< Wheitf I carefully examine the parts afiected, I per-
ceived the eAthre ik^p to be overspread with a loathsott^ in-
enistated ^cppieafttiiccf, and that it emitted, at the Same time, a
fingularly oflbnsfve fistdr ; there was, moreo/Mr, a disposition
io debility in his habit of body ; the digestive powers were
milch impaired, and many predisposing ttiarks of a scrofulous
constitution were apparent.

^^ Though an intimate atquB&tsace with the ttrttcture of

36f Sirr^ff. fA'pt*,

the human Ibody Is indispensably Yi^ibfessftfy fed Qtralifytt man
for becoming a good surgeon, ^et m'a)!y 1^h6 are not mieptg
in anatomy may be instructed so ^t6 assist th^ fettow*
creatures in cases of emergency. The operation for perfect-
ing a radical cure in cases of tii^a capitis, I hw& stem per-
formed by persons unacquainted with ^e profession^ and ifitb
amazing facility.

^^ I gare directions to the siibject of thb case td have hit
head as closely shaved as was possible, and in sudi parts
thereof as the razor could not touch, Ihescissars wasiiecet^-
rily substituted ; a common poultice was then applied ova:
tlie parts affected ; at the satne time my patient was advised
to call upon me in the ctmrse •f a few days.

<^ Wh^ "he CRfifie as instructed, I observed ihsAAf^ponkicc
iMfed effected its purpose, so far as to render soft the iQonist&-
iloB ; yet tt ex4iibited a very foul appearance, and with little'
ot no diminution of fcetor ; also, the scabs continued im rue
liighelr and thicker above thesurface.

^^ Afler «Miotlier careful removal of the hair, and the head
being well washed with warm soap and water, I applied the
paste com pounded as befew^ and spread on strips *9£ strong
-finen : Of yellow resin, two ounces ; of best ale, one pound;
^ the finest flouri three ounces^ To the melted resin, add
the ale and flour gcadually, the two latter ingredients having
been pievkHisly kilermingled in a. bason together.

^^ Each morning I removed the pastes strip after strip,
which gave, on the first .«|^^catiomf, some dqpm of pain
and uneasiness. It was also attended with a sligbi effiiaion
of4>lood; yet be told me, with amch satisfaction^ after its
removal^ that bis bead was much easier than be bad cemen^-
bered it since the commencement -of the disease*

** I cautiously and attentively, for three w^dui, xeiuoved
and re«applied. this adhesive paste, observii^ that my pa*
tient was less affi^ted with pain after each succeeding appli-
cation : I also, with a pair of ^scissars, clipped off the hair

1809.] Surgtri^i 96$

wfaiofa begsnio gronr, mud geptly separated sueh rising part^
avttsfbt pieTfiAt the adhesion of tbe paste. From the first
application to that period wherein I could pronounce a per*
feet cure, the effusion ofi)lood was observed to diminish
gradually, that had issued on the first dressings, and all
lyflier appearances proceeded fiivouraWy.

** Some years ago, I inserted a paper in the Annals of Me*
dictneof Edinburgh, on the foregoing disease, which has
since been transcribed tn(o the fourth edition of Doctor Un*>
derwood's Treatise on 'the Diseases of Children. In that
case, with the account therein given of its radical cu^-e by the
above paste, I perceive, what must have been an error of the
pressy the yellow resin is directed to be added to the other
ingredient|i the intention (according to the rules of phar-
macy) was^iD have the resin first dissolved, and to add the
thinnest part of the ale and flour gradually ; continually
stirring it in a brass skillet, on a brisk fire, until the whole be
perfectly incorporated, and assume a thick gelatinous ap«*
.pearance. ^ •

^'^ The paste was directed to be spread as above and re-
newed each day, whilst, at the same time, the head was to be
rubbed well with a coarse cloth, towards the termination of
the disease. By this mode of procedure, I have radically
cured, in about eleven years, forty-eight patients; and, as
far as I can understand, not one of them has had the least
return of the complaint ; they most generally enjoy good
heahh, and have remarkably fine hair.''

We are sorry to observe, that we do not conceive that the
above paste can be formed. That the only efiect which the
ale can produce must arise from the alcohol, and, therdbre^
that the preparation may be made in a much easier and even
more c^ctual manner. * •-

BB 9

564 Surgery. D^P^H^

ON TH£ REMVHEKATION OF MEDICAL MEir, AND THE PKO«
PRIETT OF THE LEGISLATURE ENACTING CERTAIN* REGIT-
LATIONS ON THAT HEAD.

To the Editors of The Medical and Surgical Spedaior.

Gentlemen. — The profession of medicine is properly a U^
beral one, and in the exercise of it is often too liberal an one ;
for it must be allowed, there is not that remuneration attend*
ing its services which is paid to the labours of the law and
the church. The care of the goods and chattds is repaid ina
more munificent manner than the care of life and health, and
the opening prospect of iminortality, which the churchman
holds forth, secures a belter lecompence in this world than
what he often sets before his votaries in the next. The ad'
vantage to these professions arises from their being interwoven
with the constitution of the country; the one being the
guardian of property, and tlie other supposed to be of morals.
The health and constitution is left out of the business as an
inferior consideration. From <his circumstance, the situation
of the medical profession is rather a hard one. The fee ($f
the physician is entirely a gratuitous business; and he can
* have no claim for his recompei^ce'but in the generosity of
the patient; a generosity which js too often forgotten when
the hour of pain is past. Law does not even sanction, or if
be put in his plea, allow it to be made good. The surgeon
fttands much in the same situation. His claim can be dis-
puted, and his^ science and operative dexterity pass, unremu-
Iterated* The apothecary is* the only one that is entitled io
. possess a legal claim, because, in the language of trade, he
furnishes goods, and gives what John Bull considers as value
received. He is obliged, therefore, to pay for what he terms
the Doctors iiufff, while the knowledge and advice of the
physician, and the manual skill of the surgeon, are weighed
io a lesser scale, and, in bis opinion, found wanting.

Would it not be to the honoiu and ciedit oC the Legisia*

1809.] ' Slfrger^\ 36?

lure, that the medical pfbfenim were put nnder similar re*'
gulations with the other kindred professions o£ the hiiw and
the church, it would be payings proper attention to the in-
terest of the ccunmunity, and it wonM be placing those whose*
care and skill are directed to the noblest of purposes, the relief
of their fdlow-creatures; on a more sure footing than they at
present stand* Whiie their privileges, as a college, are
protected by royal charter, their remuneration is left to tite
whim and caprice of every one thej' attend. It is well known
that neither generosity nor gratitude are qualities universally
prevalent ; and where they are wanting, and there is no com-
pulsion, recom pence may be forgotten, or justice both lame;
and blind on the occeauon.

We eodiend, therefore, that it would be an act beneficial
equally to the eommunity as io the profession, that medical
foes were regulated by law, and that these regulatioas should
extend to the three orders of the profession, in their separate
departments of physician, surgeon, and apotheeary. On the^
cxmlinent, the fees of the physician are settled by law, and the
oonsequoice of this is, that the pabUc, knowing the extent of
their expense, he is called in regulaily on the most trifling
occasions, and thus mischief prevented, either from neglect,
fiom a dread (rf'expense, or from passing into ignorant hands.
In Britain, the same plan ought to be adopted, and the fees re*
gnlated by the value of money, as ascertained by the rates of
Jibing. Indeed, we are of opiftion, such a n^samiif) should be
concerted by. the profession themselves* in a rq^lar meeting
of the ph^cians, surgeons, and apothecaries, in their sgia*
rate capapitie^, and resolutions should be entered into by thetH'
of petitioning parliament on this head* Such a step would
by no means be a h^r to generosity. On the contrary, it
would risndor it. more striking, and satisfy the patient to what
extent he was carrying it. , '

If one prol^ion deserves to be liberally rewarded more
than another^ it is that of pliysic. When we consider the

BUS

S06 Swgtrif^ [AjMili

auiely ilkatntiendflthe oondileiof t medical pntctitiontfi
tbe nice circumttances with which his repntiltian b pos?
nected) and the certainty of blame being attached to hiniy too
often without a cause, fiom tlie caprice of the patient, and
the slow progress that has as yet been made in this conjectural
art ; it may be justly said that the serrices of the profession
cannot be bought t^^o high. So trt^ is the langiiiige of John^
•on>on this point, ^lat, when speaking of mediciiie> lie says^^
^^ It is the most disgusting of all professions, iot it ciptnmsta oi
a melancholy attendance on misery,^ a mean submission to
pcerishness, and a continual interruption of fcst fuid
pleasure."

Yet, instead of high remuneratipn, it will be fbiiiKl thM the
^rt4ne8 made by physic are few indeed ; and that, after an
dqpensiye education and arduous study, to prepare A)r piac^
tifSej^ a life is spent in parsuing the latter, witboui being aUe
to jetire to the otium with whatnuiy be termed bate comfo^
much less €»m J/gict/a^e.

Qbl the cpntrary, the practitioner in law soon aniasaiet, ftmoi
his fees, a handsome iodepesdenoe, and white yet his powenf
Itfe. entire, withdraws himself firooi the bustle of business, and
closes the evening of life in happiness, the firtiit of industry,
no doubt, but still of less anxious care than what has attended
the life of the medical practitioner. A new system, thbre^
feie^ should be adopted in physic ; and> sis the laBdorer ia
eyer worthy of his btre^ the profession should leriously
apply to place themselves in a situation that they nmy knf»W
what they should receive, and also have it ia their Mwrer tp
enforce it.

I am. Gentlemen,

Your obedient servant)

G.BAK£R.

Salisburjf, March 5, 180.9.

,#N TUZ l|ANAG£|I^KT QF TttP TfiETgi AVD THE EMPIRE-
i^AI. APPUCATlOltS IN Vm FQ9 CLEANING AND PR£-
ftE&VIHG THEM,

Tq 4hc Ediion of The Medical ap4 SurgiQgl Spectator.
Gwtlcmett^-^WBX tUe diseases and flcianagetneot of tbe
. tqeth should be given up b)r tjie surg^n^ and made a sepa- -
rate bi^ioe«^, I cannot svirmi$e« The dentists avail tbem-
4EM4vf4^of the influence of the surgeon ^i and make this branch *
iof wb^t is properly surgery, a luciative concern) notonljr
. in their operation^ but by means of their quapk preparations
. for beautifying, as it is in fact, and preserving the teeth.
71|6 direcHons for the use of these are replete with the
<nost/'idicu!oas mid uninteUigifale nonsense, ivritten, I pre-^
surae, to amuse the mind and catch the atteatigi^ of the igno-
/ant, and especially of the fairsex.

. Placing myself in the situation of one who have a set
i)i teeth, I suppose J. may be allowed to consider the dis«
eases to which they are subject» without iupurring the impu-
tation of presumption from these gentlemen. It appears to
mt that manj of the diseases to which the teeth are subject^
^originate from a disordered state of the gums. The ms^tter
that co^ects in the tceth^ scicntiScally termed by the dentist
iart^r, is evidently a Qiorhid secretion from this part^ in conse-
quence of its inflammation, its spopgy state, or its being de-
tached from the teeth, the latter of which is the most frequent
fiource of this collection. Thebrushan4 tooth-ppwder employ-
ed, for the purpose of removing this matter, both tend to
aggravate the evil, by detactiing the gum from the tceil^^
and irritating its edges. Hence people, %vho ^e in the
habit of using them, are obliged to do it every morn-
ing to remove the concretion that collects during the night.
People^ on the contrary, who are only in the habit of nsing
a sponge and cold water, have no such collection. The
l^ums are also less spongy, qnd their edges level with the
teethe The gums^ judging from the firmness of their te^:*

3 p4

■

368 Surgef3/i. [4P^f

tare and vascnlaritjri not only aflbrd n gmt sni^rt to
tbe teeth, but also give them nparishment ; and if they
be diseased, the teeth will be liable to assume the same
state which the mechanical actioik of the tooth powdo:
will accelerate. On examining a diseased toothy we are
certain always io find the surrounding ^ni either con-
siderably abraded, discoloured^ or soft and tender. The
enamel of the tooth I believe to be principally or entirely
supported by the gum^ and if it be detaphcd or irritated
every day^ a tooth will not be properly nourished, and ca-
rics will of course follow. Every tooth-ache I believe io be
au inflammation of the membrane lining the socket, and tfai^
inflammation generally terminates in the formation of mattef
termed gum boil.

Dentists tell us not to employ acids of any kind^ be*
cause they destroy the enamel; and if that be destroyed,
caries will certainly follow^ But I have known many
people who have had their teeth brpke off by accidents^
which have not been succeeded by caries, and fheepfote I an|
inclined to doubt the veracity of thfs doctrine; besides^ few
chemists* will allow that diluted mineral or v^etable acid^
(with which dentists are very free themselves) will act on
a healthy tooth, f f a person gently washes the ^nm thiea
times a week with a little jsponge (fastened to the end of
a little ivory) moistened with an astrin^^t tinctore, as
that of Rhatany Root, or Cinchona, ho will find that
his teeth will not only be firmer and sounder, but free from
tartar and topth-ache ; and if he will take the trouble to
examine the gums of those who have been in the constani^
habit of using powder and brushes, he will be convinoed of
their destructive effects.

These few hints are intended to lead persons to pay mOrp
attention to tl^e state of their gums than to the teeth them*
selves ; for^ if the ^ums are kept healthy, an applicatioi|
tp the dentist will seldom be necessary. It Tfoold be well.

I8Q9.3 Swgpfjf, m

then, that nnqpeona iraw in this dipartment resumlAg tUei|:
rxmi TiglitB» ttod trcAtiiq; tlje ditwaen yf the teeth as a clas^
deserving thebi attentkm equ^y wltb tbo^e ip other parts
pf the body. Mr. Joba Hiiuier has sh^swn i)^^ ia his judir
cioQS treaijie 011 the natural history and dij^ses of tlie teeth,
that it if a subfopt worthy iRvestigation, and had the outline
he chalked out besQ imnutdy ^led up^ and studied more
by surgeons, a door ^ould have been shut against the der
ceptioos of eflt)pirical pretenders* There is no dentist with-
our his tooth powder or tincture^ ^bich are both considered*
as yaluaUe seorets^ thoi^^h the iSrst is generally ap absorbent
powder^ as the scuttler&h-bone, with a proportion qf myrrl^
or other aromatic, and coloured with red, either with In«
dian pink, or sanders, to give it a pleasing appearance*
(The tincture again is a vegetable astringent, infused in spiritsi
leither with tincture of myrrh ^ or bark, and containing a pro?
portion of mineral acid.

I might enlarge on this subject, but I hope these feif
observations will answer the intention of calling the minds of
the profession to so interesting a topic.

J remain^ Gentlem^,

yqur pbsdipnt; serFai^ty
Benrietta-Street^ March 6, 1809. ' R, REECE,

jinatomtc<hChirurgical Views ofthcNos^, Mouih^ Larynx ^
and Fauces; txnih appropriate Explanations and Refer^
pices. Bjf John James TVatt^ Surgepn. Together witb^
an additional Anatomical Description of the Parts. Byi
Mr. TV. Lawrence^ Demonstrator of Anatomy at St.
Bartholomew's HospUal.^^Tbe Engravings executed hif
Hopwoody from Original Drawings^byT. Baxter. Fplio.
Price \l. Ms. 6d. plain^ or 21. 2s. coloured.
The publications on anatomy have of late years much
ii|creased. Little, however, original has been added to
p^r stock of knowledge on the subject, and the labour , of

3T0 SwrgtPsr^ [April,

antfaors hfts been ebieflf oiSpciidtd ia lalpnitaHng a(«iiis
controyerted potnlB, and gNriiig votitmtA aridL'imfOfiitifie to
tbe stud^ hy their detineation^* Tfce aiUharbrfftQ ti«]Mif
selected certain parts of the body ot high eous9<|iiCPef » is
order, by ^I:icing them in new poiiti(»ia,^to«lncid»be IJMW
jtlearly their stnictnre, with a vi^v t» loetdar the seat of
their diseases more distinct^ and thm^ traiitflieiii bailer itiider«

$tood. /M . .:■ ;

The first plate exhibits an outline of the back pviaf itbf
liead, to shew the posterior potRion of^tbe <psq[>bagiis awl
trachea, in points of view in whilpfa tiiirjr ore not nsoaUj
iaken by other anatomists.

The same plate is continaod by a delineaticoiy acoordiag
to the natural appearance, done with care and fidelity, and
equally creditable to the anatomist and engcaver. The e^*
|danation of—

The second phite exhibits a front view of the same partSy
£rst in outline, and then according to (be natural appear^
Unce, tlie pails being cut open in such a manner as to gin^
a clear and perspicuous view of the whole*

The third plate- delineates a side view of the same parts
of the human strncture, and has equal merit with this
former.

The fourth plate gives a ww of sqme parts not so di-
Minctly laid open in tbe former ; continuing tbe former
iriew, and the whole is finished by a brief demonstration
of the organs delineated, and f heir functions, from. the ^n
lif Mr. Lawrence.

The anaton^ical demonstrations in this work are very mii-
f|ute, accurate, and well described. The explanation of
^e plates is by Mr. Watt himself. We can only say, if
imatomy is to be learned by delineations, which we think is
^e best plan, the present publication has a title to ^tand
)iigh in point of beautiful engravings, accurate descrip^
iftlofi^ and prominent ]iine of viewing the subjecta^ We

1809.] MHwifvr^. J71

jhope Mr. Watt will extend his piesent plaoi viik equal
jfidelity and merit, and his snbscribersy who a?e numeroosaiK)
fespectable^ wUl tiot fall off from this ftrst specimen,

JJL MIDWIFERY.

As 4fae plass of slow labour is more perplexing to the ac«
' concbeur tbda any other) ao aoquaintaiioe with the cause
Jbould {^Iways be studied earlj to lay down a proptT mode of
procedure. Manj fancifi|l causey h^ve been enumerated by
authors, and aniong them has l^n stated shortness of the urn*
bilipal cord* The umbilical cord is indeed sometimes twisted
found the child's neck, bnt raretj to th^t degree that it
woqld retafd the child's labour. The good effects of bipods
letting, in slow labours, particularly in women of a tentfi
llbre, and after a certain period of life, are well known ta
praptttioners^ and though this practice, as Ifepommended oa
lliiQ^rent principle^ froiQ what dir^t ps in this country hy
Pr. Hush, may be f^arrted too fiur, yet a rettUinabls bleeding
in a slow labour will dp more to expedite delivery thati any
other means. This fact is stnmgly ocHiieilded for by Mr«
Brown in the following communication :

^^ ^xs. G. aged 38, a powerful ^^roi^g woman, of large sta*
^re, was taken in l^boiir of her first child^ em Sunday moriH
ing, at four o-clock^ When I saw her ^fU IwelTe o'clock, it
was reported to me, that her p^ins had bei>n almost incessant,
and as strong as she could possibly support. Accustomed tor
these expression^, I did not at first much regard them ; but
I fouiid the rspresentation had not been incorrect, for iha
distress induced by the pains> and their frequent and appa*
rent yiolence were fully corroborated by my own observation.
The OS uteri I found slightly dilated, rigid, and unyielding^
and its cerrix appeared constricted internally, as if by a li*
^amentoug band of sonie breadth. From this period til|

372L Midwifery. [April,

seven o'clock iu the evening, in 'which time I saw her fre«
quently, there did not appear any material alteration, ex-
cepting that the pains were more frequent, and the consc-
quent distress to the patient greater, as the labour did not
seem advanced by them. The os u^^ri, at this time, ap-
peared dilated io nearly the size of half a f^rown, but equally
rigid and thick as before, with the same degree of constric-
tion at its cervix.

^^ I now determined upon bleeding, as the most likely means
of diminishing those powers of resistance which prevented
the progress of the labour. I took away twenty ounces of
blood. Its first effect appeared to protract the recurrence of
the pains, and to render their remission more perfect in conse-
quence. The subsequent effect upon the uterus, was to relax
Ihe constriction and diminish the rigidity of the os uteri;
so that each succeeding pain produced its proper ^fkcU
' The relaxation of the vagina and os externum were in equal
ratio ; and by ten minutes past twelve the child was born.
Considering the time of bleeding and that at which the child
:fm bom, it was not i^»sonable to expect that the result
icould have been more speedy or favourable^
. ^' This being the first instance, in an extensive practice of
thirteen years, in which I have resorjl^ to bleeding under
difficult panorition, its complete sncoess induced me to
believe tliat the publication of it might be i|sefu) to iS^
jfounger practitioner of this island."

To the Editors of The iffidicaf and Surgical Speciaiw^

GejUlcmen — Were there no other objection to the use of
the lever, in the practice of midwifery* and there are maoy^
it might be strongly opposed upon the very ground, for
which yo<ir correspondent, T. G. page 862, of your last
number, cliiefly recommends it, namely, that it can be used
without the knowledge of the patient, I am sorry to find n

1809.] UUwiferjf, 37*

single line in your useful puUication nhich eatf be supposed
to countenance the very improper practice of using instra*
ments secretly. The subject may be brought into a small
compass : if instruments are not necessary^ except to saTe the
time of the practitioner, it is highly reprehensible to make use
of them, even suppose they can be safely used : what then caa
we say when an instrument is recommended for common use,
the management of which, accordiag to your correspondent's
own confession, requires great management and adroitness I
If, on the contrary, a case in midwifery occurs, requiring the
aid of instruments, it adds much Xo the reputation of a prac*
titioner that he was able to conduct a woman safely through a
labour attended with such untoward circumstances, so that
he loses credit by using his instruments secretly. .

No possible means exist of preventing the unnecessary and
mjudicious use of instruments, in the practice of midwifery,
unless accoucheurs candidly state to the friends (^the patient
when they become indispensable, and apply them, not only
with the consent of the patient, but with the approbation of
the by-standers, who are, in general, much more ready to re-
quest that instruments may be employed, than the conscnen-
tious accoucheur is to have recourse to them.

Another correspondent, p. S59, supposes that the rigidity
or thickness of the membranes, in some cases of labour, is to
be remedied by blood-letting. The accoucheurs in France
?were formerly, and perhaps still are, of opinion that blood-
letting might be usefully employed during labour^ with a
view of facilitating delivery : the same plan was occasionally
adopted by Smellie and other English practitioners, and hat
lately been revived in America to an enormous amount, not
for the purpose of relaxing the membranes, but for relaxing
the soft parts of the woman, viz. the 9s uteri, vagina, an4 €0
externum.

The abstraction of blood for this purpose ts, doubtless,
sometimes useful ) but the indiscriminate adoption of bleech

S74 Midwifery^ f^pnl^

iHf ^ pnrtiMkrly to the kiiAierMe anKHKft mt ate toM of in
Am^tea, cannet ht oAhti ttmii fntschteroiis, of wbich 9onio
proofe miiy be collected from (he American eases : but hf
wimt metifis the'draifffig of blood from the arm can take off
the (hicknefts and rigfditjr of tbe membranes, tis. the chorion
aa<] amnios, remains to be rsplained.

Yd«ir correspondent informs us, that he has seen a ^woman^
who had lain for hottrs^ wi(h the strbngtst pains, i^ithont
their producing tlie ^naUest effect, and alter the os tin^ had
been/tt%^«Cerf.'* This 'woman, on being Medio the ex-
tent of eigM or t«n ounces, ^wtm delivered in the coune of a
. Ifew pains. N >w, I cafinot conceive, after the os uteri is
fidty dihitdj thait the rigidity of f he membranes can preaent
an obstacle to dettvety for teveral fte>imr, while the strongest
fHrins are acting, nor that bleeding is equal to remove such an
cbstaele if k did exist. The obvious remedy, tinder such
48itG«mstances, would be to rupture the membranes, which
irould be, at siich a time, perfectly jostiPable. But if the
4iclivery were retarded by rigidity of the soft parts, blood-
idting would certainly be the more appropriate remedy, and
capturing the membranes liurtfiU-

While I have the pen in my hand, permit me to request a
more detailed account of the case of obliteration of the os
titeri, spleen of in a former number. Was not this a case of
fetfoversion of the uterus ?

I remain, Gentlemen, &c.

March SylSQB. OBSTITOR.

on liACBHATION Or THE FERTNiBUIl IN LABOUR*.

To the Editors of The Medical and Surgical Spectator^
Gentlemen — It is a point of practical midwifery not yet
"^etenrmned, what support should be given to the perinaeum
in labour, in order to prevent laceration. This part towards
<the termhiation, as the head advances, is more on the stretch
^hftn any other, mid unless the progress of labour is gradual| it

is an accident whicli Gaanotikil to happen Jiiequiently. There
are two situations in whiob it is moce especially to be guarded
against. The one is a first labour,- and particularly where;
the patient is very young. The parts being both contracted|
and not baring the expansion of full growth, a rupture will
certainly ensue, if the pains are strong and rapid. The other
is where the pelviS) or bony cavity, is capacious^ and well
made, and where, from the violence of the pains, the head
suddenly descends to the under part of the pelvis wi^out
making its common turns. In this case, it is often pre-
cipitated with such force as to be expelled through the
perinsum, instead of the natural passage. An instance of
this came under my care some years, ago, where the head wa«
at once precipitated through the perinaum, making a com-
plete rupture of it without inclining to force its way through
the natural passage^ The rupture was afterwards healed^
and in the succeeding delivery, which was not so rapid^ the
head was protruded at the natural opening* That some
benefit may arise from giving some support with the Jiand<ta
the pact, I have no doubt. In giving this&upport, however,
the pressure sheuld not be so great as to bruise the^part by
the resistance which the head of the child wiU oppose to iU
In otlier cases, this cu^cident is the consequence of a diseased
state of the part, which is unable to bear the force of the
stretching power from the weakness of the solids, and accord-
ingly gives way. Here the £ure must be tedious, and such
a state of th.e part may probably often be connected with a
venereal cause. Partial laceration of the perinaeura will
always easily (^e repaired ; but a complete lucemtion, extend-
ing to the anus, must always be tedious and troublesome in
its treatment^ and often incoraplete in its cure. A young
practitioner, tUerefortj^ cannot be too much on his guard to
ffive every assistance to prevent^ if possible, this accident.

I am. Gentlemen,
Your obedient Serva;it,

Bethnal^green, March 16, 1809. G, HART.

6n conyulsions iir prvgitanct.

To the Editors of The Medical and Surgical Spectator.

Gentlemen — One of the mast alarming discaises of pra^«
iiancy is the dccnirenc^ of Convulsions. Tbefy arie here^
sudden in their attack, \<rithout any previous signs (o* indi-
catc their ajipro^ch ; more rarely, however, they are pre-
ceded by at -weight, 6t heavy pain^ ift the uterine region^
siich as marks dbtension.

This disease attacks in paroxysm^ ot fits. They are gene^
"rally preceded by violent pains in the head, Varying in its
situation ; Tvild motion df the ^yes, -which roll in an uncom-
liion manner in their sockets ; and a geheral determination to
the head, appearing from the flushing and turgescence of the
lace. In the. paroxysm itself, all sense and ntdtion come tCf
he lost, and the face and some of the extrcifiittes, aref distort-
ed in a particiular manner, while a frothy moisture issues at
the same time from the mouth, and the tougue is forced out,
Dr retained closely between the teeth ^ so ais to suffer c6nsidcr-
able injury. ^'^

That this disease iu pregiiancfy is sympathetic, mi arisel
from uterine irritation, is not to be doubted; but itxemaios
a matter of doubt, whether in this case a fulness of the
Tessels of the brain necessarily attends this uterine irritaltionr.
Convulsions in pregnancy wre find occur iq tefy opposite
liabits; at one time they attack the robust and evidently ple^
thoric, at another time they attack those of ail irri(al>le and
debilitated constitution : hence we would isiSetp tbUt a tur^
gescence of the vessels of the biUin, or an increased impetus
of the circulation to tlie bead, is by no means neoesi^ to
this afiection ; that, as the circulation! is generally irlrregubur
in the time of the paroxysm, such an accidenfsl pJl^ora
may occur. But, in the cure of the disease itself, iC reqiiir<^
no primary attention ; and that the nteritie irtitatioii, or ori-
ginal morbid cause, demands chiefly pur attention. To re^

1SO9.0 m^ififery. 3S7..

c • •

tnoY0 t|ii9 in absen<5e of the paroxysm) yenesection taking off
tfie ut^ril^C itccumulatiop^ . •should .be perfo^-med, a^d t6al
even libelrally : the intestines are then to be cleared, and
afterwards a large opiate exhibited in ^Ijrster to the seat of
the af^ction itself s the principal indication seems to i)e to
restore the energy of the brain, ^nd that by the sudden appli-
cation of cold to the face. This is a practice recommendeil
hy Dr. Denman, and whiqh he has foundf succeed after every
other meanS) particularly bleeding, has been ineffectually
employed . Bl^eding^ however, in all cases of pregnant con-
vulsions^ is found a useful palliation. It is recommended hjt
, every ^vriteron the subject ; smd^ among the French particii*
larly^ was formerly used in this disease to a most extravagant
height; but^ in delicate \vomen, the after-conseqjaences of
such evacuations are to be considered, and, inhere the disease
is mild| an4 approaches somewhat to hysteria^ venesection'
should be very sparingly employed.

But this disease often arises from certain accidental causej^
which cannot be relieved by the treatment enjoined : thusit
BOtnetimes depends on an improper position of the foetal head^
pressing on some part of the pelvis \ or it is product at timi^s
by {^n oblique positi9n of the uterus, in some cases of distbif* .
tion, where its expansion is prevented.

Where convulsions begin early in pregnancy^ they ^re
less to be dr^ded; but in the letter months tne^ i^re
often alarming, and a single paroxysm has been known (o
kill. '" ' * '

In the convulsions of pregnancy, particularly where ad-
vanced^ there is this peculiar circumstance, that the motion of
the child is felt uncommonly strong;— a prpof of that sytn*
pathy which subsists between the nervous system of tUe
mbtl^er and that of the foetus. ^ *

Some authors hs^ve observed, that convulsions at thii
period are more common to the inhabitants of some countries
than others, and tfcfit they occur more tr^gu^tl/^. for exam- ^

VOL. 11. C C

5t8 Midanftry. [April,

pIjBt in ^ngUnd than in Scotland. This fact, however, may
\^ called in question ; and I know, from some eminent pnie-
tjitioners, that in sopne p^rts of England a case of them is
almost never knovvi) to occur.

How alarming this disease is in pregnancy ; conyulsions
aVe no less alarmipg in labour, every appearance of convul-
sions in labour is to be coqsiderpd as alarming. Their
attack is geperally sudden ; and the symptoms preceding
them are violent pain] of the head (chiefly the forehead),
staring or wild motion of the eyes, which appear red and
tui^gid, and general flushing of the face.

The caus^ of this a^ection in labour may l^ |:ed|iced to
three heads.

I. Morbid irritability of the os tincse. Hence it is fret
guent in a first labour, and in this case a proof of it : the
vagina too feels so painful and irritable, as hardly to be^r ex?
juninatioq.

S. Over distension of the uterine cavity, ^hus it ofte^
pcpurs in case pf twins, and affords, even before tfie deUverr
of the first, a proof ol them.

Sf Pressure on sentient parts synipathising with the brain^
It IS for this reasoi^ it is 4ot uncomnionly met with in pratter*?
natural cases*

« •

Our prognosis in such cases is deteijrmiiied by ^n attention
to three circumstances, — Wn&x frequency^ duration, and effect.

With respect to the first, many have more . than a single
paioxysm without any repetition ; others h^ve then^ fre-
qiiently{in time of labour, as twelve in the course of eighteen,
or twenty in the twenty-four hou^s, and that eyen without
any danger ; so that less stress is to l^e laid pn this circupi*
ytance, and even the more so if the patient has been formerly
subject to the disease, or to hy sterjj in a yiplent degree. It is
sorprising they often observe a periodical recurrence, or re?
galar distance between the paroxysms, so that you can coun^;
Ofi tlie repetition of thepr attack within a few minutes*

1809.] Midwiferi/, 879

In regard to the second circumstance, or tbeir duration,
Vfe observe that In some they last a much^shorter time than in
others. The symptoms also are in some less exquisitely
marked, and approach more to the nature of hysteria, \?hile
in others the paroxysm is oAep so violent as to prgvp fatal at
once.

The third circumstance, or their leffect on the systepi after
the paroxysm is finished, ha$ beeQ most generally attended
to in forming a prognosis. Thus we find, that recollection in
many returns as soon ai$ the paroxysm is ended, oj: at least
in a few minutes afterwards. )n others the sienses spem aljto*
gether suspended, when the patient either continues in ^
state of stupefacjtion, or delirium succeeds. In this last si*
tuation they generally, though not always, prove fatal.

A prognosis may also jbe d^rawn wit}i respect to their influ-
jence on the labour itself. Thus, where slight^ the laboi|r«
pains are generally assisted by them^ or rendered more ef-
fectual. Where very violent, again, the child is either sud«
dei^ly ^hrpwn off in a paroxysm, or the uterine efforts are en-
tirely suspended.

For the treatn]i,ent of convulsions in labour, two methods
prevail, which in different situations are both equally
proper.

The first ii? merely paliiat^Vje, *i^d trusts entirely to nature,
after obviating symptoms for the accomplishment of delivery.

The other consists in assisting the palliative treatment, by
the application of mechanical means, a$ soon as in our power
to facilitate the progress of labour.

In executing the fprmer, three indications come to be
fprmed*

The first i$ to lessen primary irritation io the original
affected part, which* being the uterus, we attempt it by a
full dose of opium in glyster, at once taking off its irrita*
jbility ; and its effect in lessening the action of the uterus, ia

Hffl Pharmacy i

fliete cases, inhere tarn ing is required, «ufl|ci^qt][jr points Oixt
its.prdpriety.

The second is to remdref distention ixom the system in
MUeral,^ and particularly fir6m the seat of the disease^
ifhi^i^li (s best performed bj copious t^e^^ction ; and,

Tfec third is to osteite A more poi;(rerfiit and Sudden itri^
tat|(MEiin the! same situation. This ii§ best and expeditiously
ejtecuted by the appellation of cold Mrater to the &ce^ ac^
cording to the practice of Dr. Oenman^

I am^ Gentlemen^

JQxford Street ) Yours, ^c.

jjfiiriA, 10, 1809. \ *- Dean-

3=3=

tV. ^HARMA€Y.

.iStlrcE the tenovation of tlie digitalis, nb active testable
production has been introduced to excite experiment, or pra<
duce the tale of wonder* In our last number we stated hav«
ing met with a new species of bark« This species has lately
bepn imported from the Brazils, under the name of Cinchona
riibra [Braziliensis. It is paler than the red bark received
t(6m Peru, btit yery similar in its appearance, and n6t less
powerful in its sensible qualities. It is rery productive of'
rtein, and in aroma it approximates very near to the old pale
haaifi. Dr. Rush, of Philadelphia, has lately published some
ir^arks on the Brazilian red bark, which tend to prove it
e^ual to any species of Cinchona, and very superior ip mo3t
anployed in Europe, in consequence of which the expensiye
species of Peruvian bark are very rarely prescribed by the
A.me|rican physicians. A quantity of this species of Cinchona,
id the hand of Recce and Co. is now supplied to the fiuDultyi
id' order that it' may undergo the trial to which Its sen^blt
^ii^Uties, and the testimony of Dr. Rush, entitle Jt«

. I

■ I

'.i;

i»i

MEDICAL INTELLIGENCE.

■ . . . ' ' . • ■ ■

The Professors of the Uniyersity of Edioburgh have t^is season not less
than two thousand Students*

A tea-plant', three reel high, in the possession of Mr. Capel Lout, of

Troston-hall, near Bdry, blossomed in the parlour of that Gentleman^s

• . .., , . ■ . • .

bouse on the 18th December last, notwithstanding the thermometer^ in a

gonthem aspect, was at 28 degrees. The buds appeared earlj in September,

The scent of the ffower was delicate and evanescent, resenibling that of fint

l^reen tea dried.

A Gentleman has discovered a vegetable product of British growth,

which, bj particular management, maj prove an excellent lubstitute for
» • • . • ».,.■■•.

foreign co^ee. — This is the iris pscudicorus, flower de luce, or common

yellow water flag ; the seeds of which, being roasted in the same manner

as coffecj very much resemble it ia colour and flavour, but have somethinig

inore of a saccharine odour,' approaching to that of extract of liquorice*

Coffee made of these seeds to the proportion of half an ounce, or an ounce,

io a pint of boiling water, is extremelj wholfesome and nutricious.

»

....... •

DIED. — On Thursdaj, Feb. 16, at Aadover, in Hampshire, Dr. John
Benminig, formerljr Physician to the Oscutton Dispensarj.

Means of cleansing Houses, &c of Rats and Mice* A ]|tant, which
grows ia abumlance in everjr fold, the dogV tongue, tbe €;yn§glostum 40*
eiaale of Linnasus, has been found bjr M* Boreux to possess a vei7 Talwible
quality. If gathered at the period wbep the sap is in itg full vigour, bruis*
ed with a hammer and laid in a house,' bam, granarj, or anj place fire*
quented bjr rats and nuee, those destructive animals immediately shift their
quarters* The success of this method, M. Boreux sajs, is equally s^edj
^d infallible.

EMfHct €f a Letter froin a Regimental Suf%i6n stationed m the coda--^
^[ At present lam so much engaged, that I have not time to take down a
tenth case out of the many I am obliged to attend from morning to night, to:
the fever lately imported from Spain. We Hegimeatal Surgeons bert are
half dead, two eiltirely from fatigue and fever.''

VOL. II, ^D

3S2 ileiicatJklelligmce. £Aprif^

Socieljfforikc Relief of the Rvpiurcd Poor^ No. 52, Wo9iSlreetj Cheap^
tiie^ InsUiuted 17 9 O* — A special general meetioj^ of the GoTernors of
this charitj was held at the London Tavern on Wedoesdaj the 22d of
March, when His Rojal Highness the Duke of Sussex, (ponuant to his
polite offer,) was elected Patron of this institntion*

I

Mr. Trooghtoo also attended at this meeting as the executor of the Witl of
Mr* Kempenfelt, (brother to the late Admiral of that name,) and paid a
legacj of three huudred pounds bequeathed bj thatgeBtriemm to" the charitj,
in aid of its benevolent intention*

On Wednesday the Sth of March, the Medical Society or London held'
their Anniversary Meeting at their house in Bolt Courts when the following
Officers and Council were elected for the year.

President.— Dr. Lettsom.

Vice-Peesidents. — Dr. Bancroft, Dr. Babiogton, Mr. Norris, Mr. Ware;

Treasurer.*— Dr. Sayer Walker.

LiBRARfAN.— 'Dr. Clutterbuck.

Secrpfarxes. — Mr. I. M. Good, Dr. Hamilton, Dr. Pbignand* Foreig^ii
Correspondence.

Kkgxstrar. — Mr. A. B. TtimbuIlL

Members of the Council. — Mr. Andrew, Mr. Field', Mf. C&ambeF^
laine^ Mr. Hooper, Mr. Hurlock, Mr. Haighton, Mr. Abemethy, Sir John
M. Hayes, Bart. Dr. Adams, Mr. Ring, Dr. Bradley, Mr. Seaton, Dr«
Thornton, Mr. Griffith, Mr. Heaums, Mr. Robinson, Mr. Astley Cooper,
Mr. Taunton, Mr. Maedonald, Mr. Hopkins, Mr. Young, Mr. Platf, Mr.
Addington, Dr. Lidderdate, Mr. Hamsden, Dr. £. N. Bancroft, Dn Law-'
rcnoe. Dr. Shearman.
^^o 'deeiv^r the Anniversary Oration for 1 800. — Dip Birkfieck*

After the election,. Dr. Sayer Walker delivered the Anniversary Oratioa
on the best means of promoting medical science. A numerous body of the*
Fellows of the Society afterwards dined together at the London Coffee-
Houte.

' The Conncil of the Society have lately come to the resolution of pub*
lishiflg at short intervals, and with as much regularity as circumstances wilt
admit, a selection from the communications lard before the Society, instead
of waitiog as heretofore for materials to complete a volame* This cani^ot

3 869 . ] Mtdical Inteiligence. 353

iail to be of preat advantage ip soiencd aad fo the commnnitj, bj the more
rapid difTasioD of those practical improvements which the inquiries of indi-
viduals are dailj briiif ing to light.

Dr. Rapasibotham will commence a Summer Course of Lectures on the
science and practice of Midwifery, and on the diseases of women and iofaiftfl(^
on Monday, Mjij 8tb, at ten o*ClQck in the moming, at his house, \o. D,
Old Jewry.

The descriptive and physiological parts of ihcfie Iicctures are clncidated
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\ •

INDEX.

A.

• Zi

ABERKETHY, Mr. 46, 49. 354. fit4
Abstinence, remarkable case of, 10*^
' cxtraordhiary instance of* in North

Wales, 293.
AtkiOj Pr. 258.

Air,dephlogisticated nitrooi,^902.
AiTy fixed,' or carbonic acid ^as, 20»?*
Air, h^drocarbonic, 203.
Air» ntal, 202.
Alkalies, S. T. on the use of, in medi-

cine,S81.
Allen's Pectoral Balsam of Liquorice,

100.
Andrews, Dr. 57.
Aneurism, 143. opertdonsby Mr. Cline

and^Mr. Astley Cooper, 144. often
' hiiftaken for a tumour of another
• description, 285.
Animal Heat, 120.
Antiphthisical Specifics, 98.
Archer, Dr. his letter on Vaccination
' •• 1 remedy for hooping-cough, 216.
ArtisAf or Betel-nut, 8.
Arsenic, 175.
^T$es^Q A?id,77.
Armstrong's Art of preserving health,

' idt

Arm>M» Dr. 212.
Ash, Dr. C. 98.
Astr|ic, Dr. 255.
Atfoy of the bladder, 183.

B.

iABlNGTON, Dr. 89.

^aclie,Dr. 268.

JBandana soap, 2.

Baillie, Dr. 127. 135. 147. 173.

Bai]lou,311.

Baker, Mr. on the remuneration of me-

' dical men, 364.

Barbel, ill efRects attending the eating of

this fish, 83.

3srbo8a, Dr.' J. A. first practises vacci-

UJ^On iit-St. Salvador in 1804, lt)8.
dob '

Barclay, William, Antibilious pill, 2.
itirk, new species of, 2^7.
Baxdsiey^Pr.35. 85.87.212.
B^dbes i>r. 17— character of, 198.

201. 203. — his t&bles of airs, 203.
Beer, Mr.' the celebrated oculist, 140.
Bell, Mr. Charles, 296.
liell, Mr. John, 340.

Bill, G^ralt pf Christeningt and Ba«

rials within the Bills of MortaHty*

94w
Black, Dr. 198.213.
Blair, Mr. 9. his grammar of chemi9«

try, 383. •

Bland, Dr. 267.

Bieednig, serious consequencci of^ 5I«
Blegborough, Dr. his case of' a boy whp

swallowed a' half-^nnyi 251*
BlcomofVeous,2. • - '
Brodum's Specific, 2.
Boerhaave, 147. 311.
Booth, Mr. 109.
Bostock, Dr. 173.
Bourne, Dr. 10.
Brown, Mr. on riridity of the mem-

'br:mes, 259. on' bleeding in slow la^

hours, 271.
Buc^an, Dr: 233. — his fatal case of

passion, 234.
Bucholz*s process, 78.
Buri^e, Mr. 155.
Burns, Miss, experiments in consequence

of her death, 173. '^

Burns, 50.
Buxton, Dr. 95.

C.

C^'SARIAN operation, C9, 70,S64.
Calderwood, Mr. 84. 86. 18Q^^— oq

medical electricity, 184. 279.
Calculus, l45.
Cancer, 96. — ^Review of Dr. Lambfe

on, 132. 226. ' ' *

Cantharides, 168
Capon, Mr. swallowed a aown-piece,

252. '

Carditis, Dr. Davis*s inquiry into the

treatment of, 96. 125.
pa^-lisle, Mr. 58.—- chosen professor of
* anatomy to the Royal Acadetny, 9S»

122.
Carmichael, Mr. 96. 133.
Carwardine, Mr. 4S.
Cataract, Dr. Keece's treatment of, 59w

Mr. Wat^rop's mode of (Are hi, 1391.

— admiral Henry's, 249.
Catarrh, 343.
taton. Dr. his yepjy to W. Y;'i criti-

cisra on Dr. P'owel'S case of hydro-^

phobia, 27. 197. his cemrnonicktioh

^n cutaneous diseases, 934.<--on hj"

drophobia, 326. ' '

INDEX.

Chandler, Ann, Dr. Powel's sequel of
^ his case of hydrophobia in regard to

her child, 14.
jCheston, 157, 158.
Ching's worm lozenges, 298.
Christie, Mr. his report of the progress

of vaccirifetion at Ceylon, 207%
Chamberlayne, Mr. 300.
Chrance, Mr. 48.
Clarke;Dr.T1.235,
Clarke, Mr. 1$.
Cline, Mr. operates for aneurism of i^e

carotid artery, 148.
Clutterbuck, Dr. 95.
Consumption of the lungs, 122.
Contagious mania in animals, 334.
Convulsions in pregnancy, 376.
Cooper, Mr. Astley, his operation for

carotid artery, 143. 150. 165.
Co wage, 300.
Craraor*s balsam of Iceland liverwort,

90.
Cretinism, observations on, by Dr.

Reeve, 116.
Croatz, Mr. 70.
Crown-piece, Mr. Capon of Lowestoffe,

swallowed one, 252.
Crowther, Mr. on Diseases of the Jointa

156* — continued, 252.
Cullen, Dr. 168. 302. "
tundell, Mr. 103.
Cutaneous diseases, 214.

D.

DAL BY 's carminative, 2.

Dancer, Dr. 17.'

Daran, 57.

Darwin, Dr. 131.

Davis, Dr. 96. — Review of his book on

Carditis, 125.
Day, Mr. cured of gout by a new

mode, 188.
Deafness, 2.36.
De Graaf, 330.

Downman's poem on Infancy, 194,
Dixon's antibilious pill, 2. "
Diabetes, new practice in, 20.
Diseases, Dr. Nisbet*8 letter respecting

monthly reports of, 21— in London

in 1808, 200— Cutaneous, 214. 234.

of the eye, 255. hereditary, 309

spasmodic, 320.
Dispensaries, Dr. Herdm?n's proposal

for the improvement of, 121.
Distilled water, the use of preferred in

the Middlesex hospital, 1S8,
Dunn, Mr. 77.

E.
^ECTRICITY, its effects in sup-
pression of urinep 84. 180*— in de-

ranged secretion of the kidneys, 181
—in spasm of the urinary organs, 18SL
— in atony of the bladder, 183.
Empiricism, 1. 97. 201, 297.

F.

FEMALE pill of Hooper, S—of Wi-.
dow Welch, ib. *

Ferguson, Dr. 301.

Fearon, Mr. 185.

Fernel, Dr. 309.311.

Fish-Poison, Mr. Kieman's communi-
cation on, 83.

Fordyce, Dr. George, 77.

Fowler's Mineral Solution, 77.

Fowkr, Dr. 175. 179.

O.

GALEN, 3 11.

Galvahism, 85.

Gardner, Dr. i»99.

Garthshore, Dr. 23S.

Godbold*s Vegetable Balsam, 98.

Gout, new mode of curing by Dr.

Reece, 187.
Grant, Dr. 17.
Grice, Mr. on the use of the leretf

262.
Gonorrhoea, Mr. Kiernan's letter on

some alleged cases of, 254.
Guest, Mr. Bamet, 1 03.

H.

HAEN,Dr.l7.

Hamilton, Dr. 21. 167 — appointed
Physician tu the London Dispen-
sary, 199.

Haighton, Dr. 150.

Httrdwicke, Mr. his case of hydropho-
bia, 104.

Hawes, Dr. 93.

Haller,31I.

Haygarth,Dr. 211.

Hayton, Mr. 187, 188, 189.

Haslam, Mr. Q6.

Harding, Mr. his new mode of saving
life, 187.

Harrison, Dr. 222.

Half-penny, case of a boy who swal-
lowed one, 251.

Herdman, Dr. his proposal for the im-
provement of Dispensaries, 92. 121,
122 — appointed physician to th*
Duke of Sussex, 1 98.

Henderson, Dr. 96.

Henry, Dr. William, 93.

Henry, Admiral, lijs case of cataract,
55— -his mode of curing the goutj
55, 155.— his letter, 249.

Hippocrates, 146.311. 312.

IXBEX.

«Hili, Sir John, called the LimuBUs of

JBritain, 102.

HilI>Mr. 175.213.

Hodgson, Mr. 15,

Hcjffiian, 3i2.

Home, Mr. 57. 60. 135. 137. 154.

Howship, Mr. cases of lock-jaw, 320.

Hope's hectic pi^s, 103.

Hooping-cough*, vaccinatipn a remedy
for, 216\

Hospitals, 237.

Hunter, Mr. John, 52. CI. 337. 338.

Huy, Mr. 55,

Hunterian Museum, 135,

Huy, Mr. 55.

Htimbold, Mr. 304.

Hydatids of the nrethra, 359.

Hydrophobia, 14 — sequel of Dr. Pow-
el's case of, ii, — Dr. Bardsley's case
of, 3.5. 92. — Meeting of the CoUege
of Physicians on the subject of, 93.
104. — Mr. Hardwicke's case of, ib.
— Dr. Pinckard's case of, 106 —
Latip verses on, 195. 211. — ^Dr.
^'urubull's case of, 213.— Dr. Nisbet
and Mr. Morris's case of, 217. 32a —
Dr. Caton'^ observations on, 326.—
.<»8e of David Hale, 328.

J.

JAMES'S autibilicuK pills, 2.

Instruments, obstetrical, a new im-
provement on, 293.

Indian pink, 301.

iQjg^rassiab, 311.

qpispseudicorus, or flower-de-luce, 381.

Jones, Mr. ;>8fe.

Ives, Mr. his treatise on diseases of the
eye, 255.

K.

KEMPENFELT, Mr. 362.

Xentish, Mr. 50.

Kiernan, Mr. on Fish-poison, 83 — cau^
of three children at a birth, 166 —
^ observations on some alleged
consequences of gonorrhoea, 254. —
singular case of contagious mania in
animals, 33 -J.

Kidneys, deranged secretion of, 181.

Kilpatrick, Mr, on schirrus of the ute-
rus, 260.

Kinglake, Dr. on pulmonar}^ consump-
tion, 32.3.

Kortum, 157.
.Kotzebue, 287.

1..
LACERATION of the perlnteum,

274— of the urethra, 345.
Gardner's prepared chivrcoal, 6— ^ron-

centrated solution gf ditt o, if. •
Lawrence, Mr. 156.
Lazare, 311.
Lambe, Dr. on cancer, review of, 152,.

— his letter to the Editors respecting

his reports on Cancer, 22S. 261.
Le Sassier, Dr. 36.
Leydenjar, 185.
Lever, on the use of thp, 262 — Obstitor

on the use of, 372,
Lectures, by Dr. Buxton, 95. — by Dr.

Clutterbuck, /A.— by Dr. Reid, «^.—

by Mr, Taunton, /^. — ^by Dr. Squire,

96. by Dr. Reid, 295,. by Dr. Rams-

botham, 295. 383. '
I^eucoirhoea, 1158.
Lind, uv. 3.

Lieutuud, 147. 154. 311.
Liver, Scrutator on the functions of,

153.
Lloyd, Mr. 106.
London Hospital, lecture at, by Dn

Buxton, 9.5.
L6ck-jav/, * Mr, Howship*5 cases of,

320.
Lowndes, Mr. on electricity, in snp*

pression of urine, 84. 180. 184. his

reply to Mr. Caldervvood, 279.
Lubbock, Dr. Ricliard, 199.
Lues bovilla, 3271 •
Lues vener.-a, 327.
Luxmore, Mr. oi^ Tinea capitis, 1 50.
Lumbago, 169.

M,

MARCET, Dr. 87.

Main waring, Mr. case of successful
delivery in extreme distortion', 264.
288.

Medicine, 9. J.04. 206. review of Recce'^
Dictionary' of Domestic, 229. 301 .

Medicus on vaccination, 138.

Mead, Dr. 311.

Mellis, Mr. on rupture of the parturi-
ent uterus, 67— on retro verted ute-
rus, 257.

Medical Intelligence, 90. 197. 292. 381.

Medicid Education, Dr. John Reid on)
289. ' ■

Medical department of the army. Dr.
Nisbet's letter on the, 236.

Medical Board, a hint to the, 90. 92.

Medical Lectures, see Lectures.

Medical Publications, see Publications. .
'- Police^ Medicus Politicus on
the neglect of, 285.

Medical Reform at Edinburgh, 220.

Membrane, rigidity of the, 259.

Menorrhagia chlorosis, 168.

Metallic sabstances, thdr influfRce tm

' the human bddy, ^68*

\

INDEX.

'>Ief(rDry, its pftwers in tat* ions dit-
eases, 256.

M/« rtmarks on Dr.Lambe <m Cancer,
191.

Midwifery, 63 — London practice of, 71.
162.257.S71.

Mineral: poisons, 172.

Mineral preparationt, on the ezteniive
use of in medicine, 1 92.

M6rg;agni, 48. 147. 311.

Morrison, Mr. 109'->cure of tinea ca-
pitis, 361.

Morris, Mr. his case of hydrophobia,
217.

Morand, Mr. 313.

Montaigne, 310.

Munchausen, Baron, 299b

N.

NATIONAL Institution for prombt-
ing vaccination, officers of the, 198.

Newell, Dr. 91.

NewtOB, Sir Isaac, 269k

Nisbet, Dr. his opinion respecting
the teeth and tooth-powders, 3— oh
monthly reports of cfaseases, 21 — case
of four children at a birth, 167 — his
case of hydrophobia, 217. his letted
on the medical department of the
army, 236.

Nomenclature, new chemical, .280^

■

ODIER, Dr. 87.

Officers of the Medical Society of Lon'^
4on,S8&

Opium, the produce of Porto Santo,
equal to Turkey, and superior to
£ast India, 82%

Ophthalmia, Egyptian, Mr. Ware's opi-
nion respecting, 96. 143. 255.

Osborne, Dr. 267.

Oxyd of bismuth, 86,

Oxygen gas, 201 .

P.

PATENT Medicines, British, not al-
lowed to be imported into Russia,
98.

Paracelsus, a saying of, 104.

Passion, f.ttal case of, related by Dr.
Buchan, 2£24.

Paregoric Elixir, 2.-

Purton, Mjv50.

Parry, Dr. 116.

Parr, Dr. Bartholomew, 1"99.

Pathology, general principle of, 206.

Percival, Dr. 211. .

Perrin*s Balsan^f Lungwort, lOl*

Pectoral Balsam of Honey, 101.

Pennington, Sir Isaac, 9.

Pearson, Mr. Stft^eoii to the BritiA'

Factory at Canton, 10. his treatise oii

cancer, 133. 260.
Phosphorus, Clinicua on the medicaf

iftSectsof, 287.'
Pharmacy, 77 . 1 68 . 267. 380.
Physicians, College of, their meeting

on the subject of hydrophobia, 93.
Pinckard, Dr. his case of hydrophobia,

104.219.
Pills, Vital, 201.
Pliny, 118.

Pneumatic Pulmonary Practice, 103.
Powel, Dr. sequel of his case of hydso^

phobia, 14. 93. 219;
Pott, Mr. 151. 152.330.
Publications, Medical, 96. 199. 296.383;
Pulteney, Sir James, Dr. Nisbet's letter

fio^236.
Puerperal convulsion, 64. 162.
Pulmonary consumption, $23«
Purpura, 11>6.

♦ R.

RAMSBOTHAM/Dr. 3831

Rats aAd mice, mode of driving theai'
from houses, &c. 381.

Reid, Dr. 23. 95. on medical education,
289. intends discontinuing his month*
ly reports of diseases,- 295.

Review of Dr. Bardsley's Medical-
Reports, 35 — ofDr.Uwins's modern
medicine, 44-*-of Mr. Wadd, on'
stricture of the urethra, 57*-Londoa
practice of midwifery, 71 — of Dr.
Diivis on carditis, i25 — of Dr#
Lambe on cancer, 132— of Mr. Crow-
ther on the joints, 156 — continuation
of Dr. liambe on cancer, 226. — of
Dp. Recce's dictionary of domestic
medicine, 229 — continuation of Crow-
ther on the joints, 252 — of Bums on
diseases of the heart, 337. of Hooper's
physician's vade-mecum, 342 — of
Watt's Anatomy, 369.

Reece, Dr. Richard, on white swelling
of the jointsj 53 — on cataract, ib. —
his cure* of cataract by pounding the
eye, 55— ^on vaccination, 137. 155.
review of his domestic medicines 229
—his explanation of his mode of
curing cataract, 249— on the ma-
nagement of the teeth, 367.

Reeve, Dr. his observations •n creti-'
nism, 116.

Regnauh's syrup and lozenges of Ice-
land liverwort, 100.

Report of the small-pox hospital, 294i

Rin^,,Mr. 9.

Riviere, 311. •

Roberton, Mr. 168. 289.

OaiiEk.

h

iobnhuysian lever, 265*
uspini. Chevalier^ hit tooth-powder,'
7 — tincture, 8.
Russell, Mr. James,' 199.
Rupture of the parturient utefvs, 67.
Rumbold, Mr. 109.
Rymer's cardiac tincture, 2.

iENNERT,3IJ.

$enac, 311.

Selle, 126".

Seares, Dr. 162.

ficquiera. Dr. 18?.

Shadwell, Dr. 012.

Sharp, Mr. 61.

fiibly's soiat tincture, 2.

Sicilian bloom, 2.

Sigault, operation of, in rclroverted
uterus, 259.

8mall-pox, prevalent in Staffordshire,'
93 — extinct at Ceylon since the in-
troduction of vaccination, 209.

Soda Water, g7.

SoIomon*s halm nf Gilead, 2.

Sphacelus of the toes and feet, 151.

Spina bifida, 165,

Spasm of the urinary organs, 182.

Stahl, 311.

Surgery, 46. 139. 248.345.

Suppuration in tumours, an hospital
surgeon on, 283.

Swiss remedy for worms, 300.

Swieten, Van, 311.

Swediaur, Dr. 255.

Sylvester, Mr. Charles, on the effects
of carbonate upon cancer, 96.

T.
TATTERSAJLL, Dr. voted physician

to the Surrey dispensary, 93.
Taxed medicines, letter on, 87.
Taunton, Mr. 95.
Tea-plant in blossom at Capel Lofft's,

Esq. 381.
Temperament*, doctrine of, 301.
Teeth, l>r. Reece on the management

of the, 367 •

Thomson, Mr. Henry, his reply to Dr.

W.Y. on hydrophobia, 31.
Tinea Capitis, letter on, 56.150. case'

of, by Mr. Morrison, 361.
Tin-filings, 301.
Tooth specifics, 3.
Tumours, 4 6 —a remarkable chronic,

ib. — encysted, 148.
Tumbull, Mr. his case of hydrophobia,

313.
Typhus, sp.-cific contagion of, 335.

T. W* OB Ac feaikt itnietiire d

certain parts, 329.
T. S. on the prognoiUin labour j 66*

V.

Velno's Syrup, ^.

Vaccination, 9 — its introduction into
China, iA.<— Essex Report of, 90—
116. 137. 138. 19Y— officers of the
National Institution for promoting,
^98— 207— progress of in Ceylon,207
— ^number of patients vaccinated at
Ceylon in 1807, 210— a remedy for
hooping-cough, 216.

y win's, Dr. Modem Medicinc»44.

Verulam, Lord, 269.

Uterus, case of inversion of the, by Mr.
Merriman, 162— retro verted, 257,
Mr. Kilpatrick en schirrus of the^
26a

. • . . W.

WADD,Mf. on stricture 6^ the urethra,
57.

Ware, Mr. re^>ecting the sameness of
hifection in venereal gonorrhoea and
Egyptian ophthalmia, 96.

Wardrop, Mr. his proposal for conduct-
ing the incision 01 the cornea in
cataract, 139.

Ward, Mr. 294.

Watt, Mr. his new practice in diabe-
tes, 120 — Chirurgical views, 1 99

Whately, Mr.58.62.

WoUaston, Dr* W. H. 9«.

Woolcombe, Dr. on consumptioli of tlie
lungs, 122. .

Wood, Dr. 2f I.

'S^''orm-medicines, 298 — Ching*s, ibir—
Gardner's, 299.

Wheeler, Mr. 16.

WiUan,' Dr. 137. 2S5.

Watts, Mr. his apparatus. 202r.

Ware, Mr. 55,

Wine, Vital, 201.

Wenzel, baron, S5*

Washbourne, Mr. on spina bifida, 165.

Wasp, new spedef of,' 2^

Wisemaii, 151.

Y.

YELLOW fever, 17.— Dr.Henderson's
suggestions for the prevention of, 96.

Yellow Fever remedy reprtbated in
Spain, 98.

Young, Dr. G9i «58.

ZeUer^Sll.

Z.

*

(