Full text of "Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge. Volume 1, 1793."

See other formats

CASE II

Climate

London

Preceflion ot the feafons

three very cold and long winters, a vef

yarm beginning of the fpring, but two cold months from a north-eaft wind

•

Prefent temperature

cold tor thu feafon ,

Epidemics

in different parts of the town different difeales were

more frequent. In the part where the patient lived, violent fevers and difeafes with fyraptoms of irritation prevailed

Temperament

bilious ftrongly marked ; complexion brown ; ftrong blackilh hair ; judgment accurate; determination great ; habits fixed

Peculiarities

none

Mode of living

free but equal; dined at the fame hour, five; eat heartily; drank a bottle of port after dinner;

no fupper

ufed much exercife

•

Times and contingencies

aged thirty- five ; not married.

but does not abftain from w'omen

Occalional caufes

fat up with a friend who died of a violent lever a fortnight before the attack

Pulfe.

Skin.

Heat

Therm

Heat
feel of pat.

Heat

Touch.

Eyes.

Tongue.

Refpka-

tion.

Praecor-

dia.

Stomach.

Food.

Drink.

Inteftines

. Sleep.

Urine.

Occalional Remarks.

1 Medicines.

June.

4 p. ra.

ifi

130

very dry
and con-
tradled, &
of a dulky
colour

105

very cold

cold ex¬
cept in the
palms and
mouth

unmean¬

ing

white mu
cous co¬
vers it

very diffi¬
cult

tenfe'

naufea

he had
lived as
ufual be¬
fore the
attack

regular

he was feized at three wif
coldnefs, or rather a numb
nefs growing into coldnefs

Tjhora oftava vefpiertina fumar
-jipec. gr. vj. cum tart. emet.

1 S'"- j* R ''in. antim. tart. Jij.
fumat gutt. XXX. cum hauft,
fequent. fexta q. h. R aq.
menth. fativ. g j fs. fp. cin-
nam. gij. fach. pur. gfs. m-

I p. m.

Th.

Ill

104

contraft-
ed, not fo
dry, more
of a dirty
yellowifh
colour.

102

very hot

hot, and
in the
palms of
the hands
burning

a ftupid
flare

flimy

relieved

ftill tenfe

naufea
gone off,
no naufea

no folid
food

only bar¬
ley-water

had two
evacua¬
tions in
the night

a little
confufed

a white
flaky fedi-
ment

very great head-ach above the
eyes, and externally at the back
of his head

perftet in ufu medicam. au-
Jgendo dofin vin. antim. tart,
duabus guttis fingulis dofibus

moon

102

nearly
the fame

103

the fame

not alter¬
ed

the fame

no appe¬
tite, but
medicines
and drink
agree

as before

no evacu¬
ation

confufed
and Ihort
fleeps

one in the

niorring

clear.

Four

white

P.aky fedi-
ment

head-ach continues, and he is
a little delirious

repetan. hauft & vin. ant. tart.

R infuf. fen.'^j. fs. tinft. fen.
giij. tart, folub. jj. ft. hauft.
ftatim fumendus. Applicentur
epifpaftica pone aur.

3 p. m.

106

fame

104

complain¬
ed much
of the heat

npt fo
burning

moifler

browner

frequent

the fame

no appe¬
tite with¬
out naufea

as before

was purg¬
ed twice^

lafled the
night with
great reft-
eflhefs,
ittle a,nd

quite
tranfpa-
rent, and
ligher co-
oured

head-ach fomewhat relieved,
but confufion continues ; forty
drops of the medicine made
him fick ; the dofe was only
thirty- eight

perftet in ufu medicamentorum
hauft u laxante omiffo

July-

.8 p. m.

1 t

Sun.

dry and

contraft”

ed.

105

violent

burning

more con-
fufed

more co-

vered with
mucus, a
little
brownifti

the fame

not fo
tenfe

as before

no evacu¬
ation

broken

deep

lad rather
a better
night

tranfpa-
rent thro’
the whole
day

head-ach but little in the morn¬
ing, but is now returned

perftet in ufu medic.

noon

I 2

104

moif, anc
not much
contract¬
ed

lOI

not very
great

milder

fomewhat
more fen-
fible.

Sill co¬
vered
with a dry
brownifti
mucus

not very
uneafy

not tenfe

the fame

Tuits,
loiled
larley,
i^afe, po¬
tatoes

'mall

leer, bar-
ey-water
actu¬
ated

natural

evacu¬
ation this
morninq-

very con¬
fufed the
firft part
of the
night,
flept af¬
terwards

tranfpa-
rent and
high co¬
loured,
except the
aft, in
which a
mucous
cloud

head-ach not fo violent as in
the evening; not altogether
free from delirium •

1 1

perftet in ufu medic.

3 p. m.

Tu.

1 00

nearly the
fame

103

fame

rather

pungent

again
more con-
fufed

the fame

no evacu¬
ation

fliort and
reftlefs
through¬
out the
night

tranfpa-
rent the
whole pe¬
riod.

head-ach ftill, and confufion
of ideas

perftet in ufu med. Sumat
pulv. rh, gr. xx.

I p. m.

loS

dry and
contradlec

too

great

not very
pungent

more con-
fufed

dry, and
browner
fer

more dif¬
ficult

tenfe

as before

the fame

one eva¬
cuation
this morn¬
ing

none till
four, fince
that time
broken

quite
tranfpa-
rent and
ligh co-
oured

head-ach continues, and is at¬
tended with delirium, without
any appearance of fulnefs of
the velfels, or flufhing. He
grew much worfe in the even¬
ing, was extremely reftlefs,
became very delirious about
twelve, but grew a little more
compofed about four

nuch. applicetur epifpaft. hauft
vefpert. adde fp. aether, vitriol,
gj. vefp. extremitat. inferior,
applicetur fotus ex aqua calida
per horas ij.

3 P-

Tlu

I io

not quite
fo con-
trafled

104

not fo

confider-

able

the fame

not fo
difficult

tenfion

lefs

as before

the fame

no evacu¬
ation

fliort and
broken
through
the night

the fame

this night was not fo confufed
as the preceding, but very un¬
eafy

perftet in ufu medicam. injici-
atur enem. e decoft. pro enem.
gxiv. eleft. ien. Jj. etol. lini

noon

•

1 12

dry, and
very much
contracted

the pa¬
tient is
not fen-
fible

enough to
judge

not fo
lungent,
except in
lis palms

very much
confufed
and wan¬
dering

the fame

very diffi¬
cult

not very
tenfe, but
forae ten¬
fion of the^
abdomen

cannot

udge

the fame

two co¬
pious foe¬
tid ftools

hardly

any

the fame

paffed a very reftlefs and deli¬
rious night; the delirium is
now confiderably abated as to
raving, but he is confufed, and
does not know well wKat is
about him .

perftet in ufu medicam. onin.

2 p. m.

Sat.

108

not fo dry

103

the fame

ftill darker
brown

not fo dif¬
ficult

the fame

no naufea

the fame

a little

wine

added

no evacu¬
ation

very much
dift'urbed,
and not
more than
lalf an
lour at a
time

nearly the
I'ame

clyfter came away without fe¬
culent matter

the fame

^ p. m.

Sun.

118

very dry,
and very
much con-
tradted

105

very deli¬
rious, and
not able
to explain

very pun¬
gent

unfteady

very dry,
and fome¬
what

glazed on
the fur-
face

frequent

great fla¬
tulency in
the inief-
tines, and
tumor of
the abdo¬
men

does not

reje(fl;nou-

rilhment

the fame

milk and
water for
drink
added to
larley
water

a copious
and very
foetid eva¬
cuation

lad a bet¬
ter night

in the
morning a
ittle

cloud, at
laft quite
tranfpa-
rent

great reftleflfnefs and delirium,
fo that he knows nobody

R aq. menth. fati. fs. caft.

ruflT. in p. trit. gr. x. tinft. opii
gutt. viij. fach. alb. gj. fpirit.
cinnam. gj. m. ft. hauft fextis
horis fumendus. Repet. enem.

a p. m. I

I 2

104

hitherto
has been
much
Jbftrua-
:d, but
lowwith
efs obit,
fmall &
weak

not very
dry or
contradled

102

very deli¬
rious

not pun¬
gent

a little
ftupid

no fur, but
a very
glafly fur-
face when
dry

not much

diforder-

continues
the fame

the fame

the fame
with a lit¬
tle more
wine, a
lint in 24
lours

the fame

none, but
great de-
iriura till
five, flept
or dofed
a little af¬
terwards

a little
cloudinefs

perftet in ufu medicamen.

2 p. m. I

10 1

108

moifter

too

the fame

very ftu¬
pid

the fame

flatulency
more con-
fiderable

the fame

the fame
with beef
tea

two co¬
pious foe¬
tid evacu¬
ations

dofed the

whole

night,

hardly

flept

the fame

perftet in ufu medicamen.

I p. m. I

4 ^

100

nuch

offer,

veak

noift

98 '

not ca¬
pable of
explain¬
ing

not differ¬
ent from
a man in
health

the fame

tongue
moift, but
rather raw

eafy

ftill con-
fiderable

the fame

one, but
not till
the morn¬
ing

flept two
hours this
morning

a confi-
derable
cloud,
and the
fluid moft
water

the firfl: part of the night was
pafled with extreme difficulty,
and with hardly any expefla-
tion of the patient’s living til
the morning, from the extreme
debility and delirium

perftet in ufu medicamen.

noon

Th. I

108 c

ut not

uite

egular

the fame

feels bet¬
ter

the fame

dry and
glazed

the fame

one foon
after the
clyfter,
copious,
flatulent,
and foetid

flept three
hours
without
interrup¬
tion

a lateriti-
ous fedi-
ment in
the urine

with great difficulty the at
tendants can be reftrained froir
giving him more wine

perftet in ufu medicamen.

1 ^

From this Time the Patient gradually recovered without any particular Crifis.

T R A N S A C T I O N S

O F A

SOCIETY

FOR THE

. ./ ,

IMPROVEME N-T

1 ' os

MEDICAL AND CHIRURGICAL

\ ,

KNOWLEDGE,

ILLUSTRATED WITH

COPPER-PLATES.

LONDON:

PRINTED FOR J. JOHNSON, N2 72, ST. PAUt’s
CHURCH-YARD. 1793.

Jr\

- . ✓

.-v- • • -r -

CONTENTS.

I. ✓Reservations on the Small-Pox, and the
V-/ Caufes of Fever. By G. Fordyce, m. d.

F. R. s. &c. - . - - I

.11. Obfervatlons on the Inflammation of the internal
Coats of Veins. By J. Hunter, Efq. f.r.s. &e. i8

III. A Procefs for preparing pure emetic Tartar by

Re-cryftallization. By Mr. Jenner - 30

IV. An Account of the DifTedlion of a Man, that
died of a Supprefiion of Urine, prodaced by a Col¬
lection of Hydatids between the Neck of the Blad¬
der and Rectum : vdth Obfervatlons on the Man¬
ner in -which Hydatids grow and multiply in -the
human Body. By J. Hunter, m.d. f.r.s. &c. . 34.

V. Cafe of a Gentleman lahouring under the epi- ■

' demic .remittent Fever of Buflbrah'; drawn up by

.Himfelf " * ” . ” 53

VI. On the Want of a Pericardium in the human

Body. By M. Baillic, m.d. f.r.s. See. 91

VII. On introfufeeption. By J. Hunter, Efq.

F. R. s. &c. - ' - - 103

Vill. Of uncommon Appearances of Difeafe in
Blood- ve'lTels. By M. Baillie, m.d. f.r.s. Szc. 119

IX. An Account of Mr. Hunter’s Method of per¬

forming the Operation for the Cure of the'popliteal
Aneurifm. By E. Home^ Efq. f.r.s. &c.' ■ 13S

X. A Cafe of Paralyfis In the Mufcles of Deglu¬
tition, cured by an artificial Mode of conveying
Food and Medicines into the Stomach. , By J.

' Hunter, Efq. f.r.s. Szc. ‘ - 182

XI. Of

CONTENTS.

Page

'XL Of a remarkable Deviation from the natural
Stru6lure in the urinary Bladder and Organs of
Generation of a Male. By M. Baillie , m. d.

F. R. S., &C. - - 189

XII. Cafe of Emphj'fema, not proceeding from local
Injury. By the Same - . - ’202

Xill. Cafe of unufual Formation in a Part of the
Brain. By 'Mr.. A: Carlifle ' - . 21^

XIV. Hiftory of a fatal Haemorrhage from a Lace¬
ration of the Fallopian Tube, in a Cafe of an

• , extra-uterine Fcetus. By J. Clarke, m. d. &c. 215

XV. Some Obfervations ^on the loofe Cartilages
found in Joints, and mofl: commonly met with in

^ that of the Knee. By E. Flome, Efq, f.r.s. See, 229
XVL An Attempt to improve the Evidence of
Medicine. By G. Fordyce, M. d. f.r.s. &c. 243

XVII. Obfervations, and Heads of Inquiry, on
Canine Madnefs, By J. Hunter, m.d. f.r.s. &c. 294
XVIII. Some Obfervations on Ulcers. By E.
Home*, Efq. f.r.s. . - _ - 330'

Blank Schemes for taking Cafes according to Dr, Fordyce^ 5
Plan^ fmilar to the two Sheets at p, 289, may be had at
Mr, Johnson’^) St, Paul’s Church-^yard, Price 1 s.

: TRANS-

TRANSACTIONS, &c.

I. Obfervations on the Small-Pox^ and the
Caiifes of Fever. By George Fordyce,
M. D. F. R. S. Senior Phyfcian to St.
Fhomas" s Hofpitaly and Fellow of the Royal
College of Phyficians in London. Read De¬
cember 5, 1783.

Nine years ago I inoculated a family
confining of three young ladies, for
the fmall-pox. It was my cuftom, at that
time, to make three fmall punffcures in one
arm. It happened in the eldeft, that the
fuppuration in one of thefe, came much for¬
warder than in the other two : it was per¬
fect on the feventh day, and the fever took
place. I expedted a great increafe.of the fe¬
ver, which was already confide rable, when
the other two pundlures fhould perfedl their

* This paper was printed in the year 1778, but not
publifhed,

B fuppu-

[ 2 0

fuppu ration, and was not a little alarmed for
the fafety of my patient : but was greatly
furprized to find, when the firfi; of thefe per-
fedted its fuppuration on the beginning of the
eighth day, that it produced no efFed: what¬
ever on the fever; neither did the fecond,
which perfeded its fuppuration on the end
of the eidith.

The reafon of making more than one punc¬
ture, was to cnfure the difcafe’s taking place,
as it was fuppofed that a fecond inoculation
could not be made with fafety, till it flaould
be certainly known that the firfi; had not
taken place, which is not till eight or ten
days in many cafes, a time of dreadful an¬
xiety to parents. I conceived now that this
opinion was erroneous, and accordingly made
no more than one pundure after that time.

It was not till the year after, that a cafe
happened, in which I was in any doubt of
the taking of the firfi: pundure ; and that
was in a young gentleman, in his feventh
year. On the third day after the firfi: punc¬
ture, I made a fecond. They both came for¬
ward. The fever was produced by the fup-
piiration of the firfi:, was very flight, and
when the fecond fuppur^ited, was not at all

.9 increafed ;

[ 3 ]

increafed ; and there were not twenty puflules
in all. . •

It happened in about a month afterwards,
that I was employed to Inoculate a boy of
four years. His parents fcnt him a little way
into the country, fappofing he^would be fafer
in a purer air. In viliting him, the day after
the eruption had appeared, I found a child
of the woman who kept the houfe playing
with my patient. I afced the mother if he
had had the fmall-pox ; was told No, but
that he was preparing for inoculation, which
was to be performed in two or three days.-
It occurred to me, if the natural infecflion
had taken place, that it might be prevented
by immediate inoculation, as I had grounds
to believe, that it was generally from twelve
to fourteen days after receiving the infection,
that the natural fmalhpox took place. It
was impoffible to meet the other pracftitioner
till the next day. I therefore perfuaded the
mother to let me inoculate the child imme¬
diately ; flie infilling, however, that I Ihould
not mention it ; which, as I conceived the
life of the boy was at ftake, and there was
no pecuniary conlideration, I confented to.
Three days after, the child was inoculated a

B 2 fecoud

[ 4 ]

fecond time ; my punflure being fo flighty as

not to be perceived. It inflamed however ;

the fuppuration was perfected on the eighth

day, the fever took place, and the eruption

was beginning. The wound made afterwards,

fuppurated ; but no new fever arofe, and the

patient had about fifty puftules.

I have now fo often repeated this pradtice,

that I have no doubt, but that variolous mat-
«

ter has loft all its power of producing fever,
after the firft twenty-four hours, from the
time it is carried into the blood vefiels. I
wiflied, however, to try the effe(5l of inocu¬
lation upon a perfon who had gone through
the difeafe, and accordingly inoculated myfelf
on the back of the hand, by a flight punc¬
ture. It inflamed in the ufual way, and a
puftule arofe ; fo that I was under fome ap-
prehenfion of having the difeafe, efpeciaHy
as I had already had two eruptive difeafes,
which my phyficians believed at the time
were the frnall-pox, infomuch, as after the;
firft, no care was taken to avoid expofing me.
to the infeftion. I fllould believe, that they
w^re miftaken in the firft. On the fifth day,
when die puftule had arifen to the fize of the
head of a large pin,, it was hard,, and with¬
out

[ 5 .1

out any matter, and gradually went away
without llippuration, I have inoculated rny-
felf feveral times fince. Sometimes the fame
i:ind of puftule has taken place, and fome-
times there has been no inflammation at all.

Dr. Rutherford, my learned mafter, in
his ledlures on the prad:ice of phyfic, to af-
certain the time the natural infeftion of the
fmall-pox is latent, before it produces the
fever, mentioned the cafe of a party of fol-
diers marching through a village where the
difeafe was, that they were feized from twelve
to fourteen days afterwards with the fever,
and that this was the ufual time. I have
feen many cafes fince^ which confirm this
opinion, although it alfo happens, that the
infedlion fometimes takes place fooner. I
therefore thought, that, if inoculation ren¬
dered the fyflem callous, if I may fo fpeak,
to variolous matter, inflead of there being
any danger in inoculating a patient who had
already caught the difeafe, as the infeftion
was quicker in its adiion, the * inoculation
had a great chance of preventing any mif-
chief, by producing the inoculated inftead
of the natural difeafe. And this explained a
circumftance, which had before furprized

B 3 and

[ 6 ]

and aftcniilied me, viz. the fool-hardinefs of
certain empyrics, who brought a perfon to
be inoculated into the room of a patient,
when the fmall-pox were at the height, as
in many inftances he muft catch the na¬
tural fmall-pox at the fame time ; but the
inoculation coming before the natural kind,

’ prevented the mifchief. It is neverthelefs a
dangerous practice ; for, if the inoculation
• fhould not take place, and the patient be
infected, there is all the rilk of the natural
fmall-pox.

Since the time of my forming thefe opi¬
nions, I have knowm many inftances which
confirm them ; fo that I have no doubt in
recommending it to any perfon, who may
chance to have been expofed to the natural
infedlicn, to be inoculated immediately.

To afeertain the caufe of the fmall-pox
being more or lefs numerous, has been a
matter much wi&ed for In the family I
have already mentioned, the lady in whom
one pundlure fuppurattd before the others,
and alone operated in producing the difeafe,
the fmall-pox were much more favourable
than in the other two, where all the punc¬
tures fuppurated together. This led me to

refledl

[ 7 ]

rcfle(5l on the cafe of a girl ' of five years of
age, whom I had inoculated about a month
before. The mother of this child was ex¬
ceedingly anxious, would hold the child
herfelf, and ftarted in fuch manner, that
the two firfi: pundlure-s hardly drew blood,
and I was induced to make three more ; five
in all. This child had the difeafe very fe-
verely, which I confidered at that time as
accidental only, but now began to think,
that the quantity of matter abforbed, and
adling fo as firft to produce the fever, was
the circumfiance which rendered the difeafe
more or lefs favourable. I therefore refolved
to try a very fmall puncture for the future,
which has fucceeded fo well, that although
I have inoculated a great number fince that
time, I have not met vcith one cafe in the
fmalleil degree unfavourable ; whereas, when
I made a wound as I did at firft, and applied
the matter on a pledget, the difeafe was often
unfavourable, and the wound very trouble-
fome, which made me change my method
to making pundtures, of which I made three,
rather deep ones, and ftili I met with many
unfavourable cafes, fo as always to inoculate
with terror. I apprehend then, that the

B 4 pnnei-

[ S ]

principal, if not the only confidcration in In¬
oculation, is the manner of making the punc¬
ture, which fliould be done as follows. Run
a lancet into a puftule, either at the time of
fuppuration, or before, fo as it be moiftened
v/ith the matter ; let it dry 5 moiften it a fe-
' cond time ; let it dry ; view the point with
a magnifier ; if it be covered to the very
point, it is properly armed 3 if it be not, it
muft be dipped in the matter again, until the
point is covered compleatly ; juiT; before the
pund:ure is to be made, dip the point in wa¬
ter for a fecond ; let it lie for a minute or
two, till the matter be foftened again ; lay
bare the arm, and about the infertion of the
deltoid mufcle make a puncfture, penetrating
the fcarf fkin, fo that it may be felt on raif-
ing the point of the lancet : if no blood ap¬
pears, the better. Or if you have frefh mat¬
ter in a quill, dip the point of the lancet in
it, fo that the point be perfedlly covered, and
proceed to make the punfture as before. Or
if you have dry matter in a quill, moiften it
with a very fmall quantity of water, fo as to
bring it to the confiftence of recent matter,
and then proceed as before directed. It is
not neceflary to apply any thing to the arm ;

after

[ 9 ]

after three days examine the arm ; if there be
no rednefs, make another puncflure about an
inch diftance : this, however, will very rarely
be found neceffary.

Thus, I flatter myfelf, I have found what
is mofl: elTential in inoculation. Prepa¬
ration, it is true, has been fuppofed to be
of great ccnfequence : but I believe this opi¬
nion is only a taint of that fuperilition, which
originated with medicine, from the firfl:' prac¬
titioners, in the lefs cultivated fliate of man¬
kind, being priefts and conjurers,, as well a
phyficians ; and I am afraid we fhall never be

able to get clear of this taint, which is the

foundation of quackery. Preparation is a
great inftrument of fuperilition. A man is
prepared to die, by rubbing a little oil on his
breaft ; turning a chair three times round, is
an excellent preparation for playing at whifl ;
fo eating foup for a month, renders the body
perfedtly prepared for mercury. •

Taking the matter of preparation ferioufly,
the propofition is, to put the body into
a flate, in which matter of the fmall-pox
fhall produce lefs fever, fewer puilules,' or fo
that the puilules fhall have lefs effedl on the
fyftem. Now unlefs this flate be known,
how Ihall we know in \vhat manner it is to

5 be

[ lo ]

be produced ? Will any one fay, that he
knows, on producing a perfon to him, who
is to be afFedted with the fmall-pox, whether
he will have them fivourably, or not ? Cer¬
tainly he cannot, on any pHnciple hitherto
known, I have had opportunities frequently,
in St. Thomas’s Flofpital, of feeing perfons
ufing mercurial, antimonial, and other regi¬
mens, recommended as preparations, (eized
with the fmall-pox, which were in no ways
more favourable, than in thofe who were not
ufing any of thefe remedies. The only thing
that feems to have been of any advantage, is
living for a little time on vegetable food ; and
this is even doubtful. I have the greateft
reafon to believe, that it is hot of the fmallefh
confequence, whether the matter be of the
mild or confluent kind. I never knew of an
inftance of any other difeafe being communi¬
cated by inoculation of the fmall-pox.

There is therefore only one other circum-
ftance, excepting the pundture, to be at¬
tended to; which is, that, of the children
who have died in London of inoculation for
many years, as far as I have been able to col-
ledt, more than two thirds have been under
nine months; and therefore I have confi-

dered

[ “ ]

dered it as improper to inoculate before teeth¬
ing. It happened to me, that a family came
from America, whofe children had not had
the fmall-pox. One of thefe was under nine
months, and on the breaft. They applied to
me. I refufed to inoculate this child, and
advifed that it fliould be kept out of the way
while the others v/ere inoculated; but rather
than fubmit to this inconvenience, they ap¬
plied to another pradiitioner, who inoculated
the whole, and this child died.

Since frefh variolous matter has no effeft
on the fever in the fmall-pox, it follows, that
that which is already in the blDod-veffels has
alfo no further effedt, after the difeafe is per-
fedly brought on ; and as other fevers are fo
exadtly limilar to that of the fmall-pox, that
it is impoflible to diftinguifli them till the
eruption takes place, it is very probable, that
other iiifeftions, as well as the variolous,
only adt for a fliort time in producing the fe¬
ver, and that They alfo have no further ef-
fedt. That this is the cafe, we have greater
reafon to believe, from this obfervation, that
patients who have caught infedlious fevers in
St. Thomas’s, and other Hofpitals, and con¬
tinued there, have gone thmugh the difeafe

[ 12 ]

in a ward where the infeftion was ftrong,
with as mild fymptoms, as where peculiar care
has been taken to keep the air as pure as
poffible. And in general many more people
recover of fevers in our Hofpitals than in pri¬
vate families, with fimilar pradlice ; owing
moft probably to the directions of the prac¬
titioners being more ftridtly attended to ; for
fuch is the difpofition of mankind to quack¬
ery, that you can hardly ever prevent, even
a fond mother, from trying experiments on
her only fon, lying ill of a dangerous difeafe.

Moreover, if a crifis fhould take place in
the middle of an infectious fever, it happens
when the infeCtion is ftrongelt, and its effeCts
therefore the moll powerful, if it aCts at all
on the patient.

Again, thofe who have once gone through
the fever, are lefs fubjeCt to the infeCtion,
than thofe who have not had the difeafe.
This has been long remarked in the plague.
I have obfei ved it in our Hofpital, in which
there are alrnoll always violent fevei's, and
therefore infectious ones ; for all fevers, from
whatever caufe they arife, I have obferved,
generate infectious vapour, and commonly
according to their violence. Another Itrong

inllance

[ 13 ]

inftance Is, that fome of the felons, who
have brought infecftion into a court of juf^
tice, fo as to deftroy almoft half the court,
have had no fever at the time. In the la ft
cafe which happened at the Old Bailey, the
felon was not at the time affedled with fever,
or any other difeafe.

From all thefe circumftances we may con¬
clude, that during the courfe of a fever,
which arofe from infedlion, the Infeftious
matter has nothing to do with the fever, nei¬
ther increafing, nor dimlnifhing, nor any ways
altering it; and that therefore it is not ne-
ceflary to pay any attention to it in the cure
of the difeafe.

It is worth while enquiring, how far other
caufes of fever have effecft upon it, after it
has once taken place. Expofure to cold or
moifture, or to anxiety, are two other caufes

which I have known produce fever. I have

feen feveral cafes, in which thefe have un¬
doubtedly brought on the difeafe, which has
arifen immediately on their application.
Where the anxiety is gone off, the fever has
neverthelefs continued ; and when the patient
has been brought into a warm and dry air,
the fever has continued, and gone through

its

[ H ]

its natural courfe ; fo that it is only necelTary,
that thefe caufes of fever fliould be once ap¬
plied, fo as to make an impreffion. The dif-
eafe being once produced, goes on of itfelf ;
neverthelefs, both anxiety, and cold or moif-
ture, have an effedt in keeping up fever*
When intermittents cannot be cured in fenny
countries, they give way eafily ,on the pa¬
tient’s coming into dry air; as I have ob-
ferved in patients brought from Lincolnfliire
to the Hofpital, who have been eafily cured,
although ■ the fame remedies have been ufed
before without fuccefs. And I have, in fe-
veral inftances, feen continued fevers fpun
out to four, five, fix weeks, in confequence
of diftrefs of the mind.

Why violent fevers fhould have been called
putrid ones, is very difficult to guefs, as fre¬
quently we find them pafs through their
courfe without any fign of putrefadlion.
There are no purple fpots or marbling, no
loofenefs of the gums, no blacknefs of the.
tongue, no hemorrhage, mo fetor in the ex¬
cretions except the fasces, no fetor in the
breath, no frothinefs in the urine, in a great
many of them when they are highly infec¬
tious ; fo that inteciious vapour is a matter

totally

[ 15 ]

totally different from the vapour which arifes
from putrid fubftances, which, however, is
alfo certainly a caufe of fever, and which has
been fuppofed to adl by being introduced in¬
to the blood-veffels, and producing putrefac¬
tion of the fluids. Now it may be quef-
tioned, whether putrid vapour does not alfo
adl uno zBii, in the fame manner as the caufes
we have already enumerated. That it does
not adt by inducing putrefadlion of ,the fluids
is rendered probable, in as much as this flats
of them in a fever depends evidently on the
depreflion of flrength, and may accordingly
be forefeen. If at once the mufcular ftrength
be greatly depreflbd ; if there be great fenfe
of weight about the precordia, with fighing ;
if there be great flupidity in the eye, and
want of attention and general diflrefs of the
mind ; we may expedt fym.ptoms of putre-
iadlion to appear, whatever might be the
caufe of the fever.

Moreover, thefe fymptoms of putrefadlion
when they appear are always the confequence
of the fever ; for it is feveral days after the
fever takes place, before they make their
appearance.

Again, I have known them go off entirely
when a phlegmon has arifen, and the fever

flill

[ i6 ]

ftill continued. This happened In two cafes.
In lefs than twelve hours, the pulfe be¬
came hard and ftrong, inftead of having that
lanraor with which it beat before. And

fometimes in fevers arifing from putrid va¬
pour, no appearance of putrefadlion takes
place, and the fluids do not become putrid
more readily in thefe with the fame depref-
fion of ftrength, than in others ; and the
progrefs of the fever is feldom different in
confequence of thefe fymptoms of putrefac¬
tion ; fo that I fufpedl that a fever brought
on by putrid vapour. Is alfo independent of
its caufe, and would go on, when once pro¬
duced, if there were no longer the leafl: par¬
ticle of putrid matter in the body.

Food of difficult digeftion, T have alfo
known evidently produce a fever, and very
often occafion relapfes of fevers. Thefe fe¬
vers go on when the prim^ viae have been
cleared of alf offending matter, and therefore
are independent of their caufe. All fevers,
however, are much increafed by improper
food, from whatever caufe they arife.

Upon the whole, therefore, it would ap¬
pear, that a fever produced from any of the
known caufes goes on, notwithftanding the

caufe

[ "^7 ] •

caufe be totally removed ; and that the adtion
of infedtious, and probably putrid vapours,
in bringing on a fever, renders the body in¬
capable of being farther alfecfted by thefc va¬
pours, in fome cafes, for a fliort time only,
and in others for the whole life-time, of the
patient ^ and that therefore it feldom is of
ufe, to employ any remedy to remove the
caufe of the difeafe after the fever has actually
taken place'.

f‘ I

II. Ob*

t ]

II. Obfervations on the Injlammatlon of the
internal Coats of Veins, By John Hun¬
ter, Efq. F. R. S. Surgeon Extraordi¬
nary to His Majesty, and Surgeon-gene¬
ral to the Army, Read Feb. 6, 1784.

The following obfervations will fhew that
the infide of veins, as well as of all other ca¬
vities, is a feat of inflammation and abfcefs.
I have found in all violent inflammations of
the cellular membrane, whether fpontane-
ous or in confequence of accident, as in com¬
pound fradlures, or of furgical operation, as,
in the removal of an extremity, that the
coats of the larger veins, pafling through the
inflamed part, become alfo confiderably in¬
flamed j and that their inner furfaces take on
the adhefive, fuppurative, and ulcerative in¬
flammations : for in fuch inflammations I
, have found in many places of the veins adhe-
fion, in others matter, and in others ulcera-
tion. Under fuch circumilances, the veins
would have abfcelTes formed in them, if the
' matter did not find in many cafes an eafy

palTage

[ 19 3

paflage to the heart along with the circulat¬
ing blood, fo as to prevent the accumula¬
tion of the pus : but this ready paflage of
the matter into the common circulation,
does not always' happen. It is in fome cafes
prevented by the adhefive inflammation tak¬
ing place in the vein between the place of
fuppuration and the heart, fo that an abfcels
is formed, as will be fvirther obferved.

Where the inflammation is mofl: violent,
there we find the vein moft inflamed ; there
alfo, after fuppuration, we find the purefl
pus ; and as we trace the veffels from this part,
eithe;* farther from or nearer to the heart, we
find the pus more and more mixed with blood,
and having more of the coagulated parts of
the blood in it.

As th^fe appearances are only to be feea
in dead bodies, they cannot be defcribed but
from thence ; but it is fo common a cafe,
that I have hardly, ever feen an inftance pf
fuppuration in any part, furnifhed with large
veins, where tfiefe appearances are not evi¬
dent after death. I have found them in the
bodies of thofe who have died from ampu¬
tations, compQun4 fraftures, and mortifi¬
cations.

C z

Thefe

[ 20 ]

Thefe Circiimftances all confidered lead
lis to account for a very frequent complaint,
that is, an inflamed arm after bleeding ; a
complaint Vvhich has by fome been imputed
to the wounding of a tendon ; becaufe the
tendon of the biceps mufcle lies under fpmc
of thofe veins, in v/hich we often bleed> and
when the complaint occurs, it is unjuftly
fuppofed to arife from want of flcill in the
operator ; by others it has been fuppofed to
arife from the wounding of a nerve ; and
again it has been kid to the charge of a bad
conftitution.

But if we cbnfider more critically this
confequence arifing from bleeding, we fhall
■find that it happens frequently after bleeding
in veins where no tendon could poflibly be
'wounded, and alfo where no particular nerve
' could be in the way. It feems likewife to
happen as frequently in conftitutions where
there is no appearance of want of health,
as in thofe difpofed- to difeafe. As a proof
of this laft, upon bleeding in another vein
in the fame perfon, perhaps with a view
to aflift in the cure of the inflammation ari¬
fing from the firft bleeding, the wound has

healed very readily.

o'.

[ 21 ]

I£ .we examine the proportion which th
number of thofe inflamm.ations that hap¬
pen after bleeding, bear to thofe which arife
from as flight a wound where no large vein
has been injured, and even perhaps where
the wound has not been rnade by fo clean a
cutting inflrument, and the fame pains not
taken to clofe it up, Vvc fliall find that thofe
from wounded veins are much the mofl fre¬
quent ; and that fuch inflammations feldom
or. ever happen under the laft mentioned cir-
cumftances ; therefore, we mufl: look for fome
other caufe to explain this effed: of bleeding.

The manner in which thofe fore arms

f ; > ■

come on, fhows* plainly that they arife from
the wound not healing by the firfl: intention;
for the external wound,' in moft cafes, firfl:
fefters or inflames, then fuppurates and ulcer¬
ates, fo that the cavity of the vein becomes im¬
pervious. In fome this fuppu ration is only fu-
perficial, the vein and parts below having unit¬
ed. In others thefkin lhall appear to be united,
but not clofe to the vein, fo that a fmall ab-
fcefs' fhall form between the Ikin and the
vein ; it fbali burft and difcharge a thin wa-
Uvy fluid, and no iurther miiciiief happen ;

C 3 but

■>

[ 22 ]

but when this imperfection of union is conti*
hued on to the cavity of the vein, then the
vein inflames both upwards and downwards,
and that often for a confiderable way, and the
furrounding parts join in the inflammation.

We find all thefe variations in different
cafes ; for the difeafe fome times goes no fur*
ther than an inflammation in the vein near to
the orifice, which is often refolved ; at othct
times the inflammation is carried further, but
fuppuration is prevented by the adhefive in*
fiammation taking place in the vein at this
part, fo as to exclude the fuppurative inflam¬
mation, and the veins in fuch cafes may be
plainly felt after the furrounding tumefadlion
has fubfided, like hard cords. But this fa-
lutary effedt is not always produced, and fup¬
puration in the vein is the confequence, but
often fo confined, that only a fmall abfcefs
forms in the cavity of the vein near to the
orifice. The confinement of the matter in
this part of the vein, arifes from adhefions in
the vein a little above and below the orifice*
But in many cafes the inflammation and fup¬
puration are not confined to this part from
the adhefions not having taken place; for it
frequently happens that an abfcefs is formed,

occupying

[ 23 ]

occupying a conliderable length of the vein
both ways ; and we often have more than
one abfcefs, nay at times there is a feries of
them, and generally in the direction of the
vein, between *the orifice and the heart ; but
not always in this courfe, for we find them
fometimes betv/een the wound and the ex¬
treme parts.

I have feen from a wound in the foot the
vena faphaena inflamed ail up the leg and
thigh, nearly as high as the groin ; and I
have been obliged to open a firing of abfcefles
almofl: through its whole courfe.

In cafes where I have had opportunities of
infpedling veins after death, in which the in¬
flammation had been violent, upon examining
the vein at fome diflance from this violence, I
found the inflammation in the adhefive ftate:
in fome places the fides of the vein were ad¬
hering, and in others the inner furface of the
veins was furred over with coagulable lymph.
Where different abfcefles had formed, I have
always found that the fpaces of the vein
between them had united by the adhefive in-,
flammation, and it is this union which cir-
cumfcribes the abfceffes.

C4 '

Upon

[ 24 ]

Upon examining the arm of a man who had
died at St. George’s Hofpital, I found the
veins, both below and above the orifice, in
many places united by the adhefive inflam¬
mation. I alfo found in many parts of the
veins, that fuppuration had begun as we find
on an inflamed furface, but had not yet ar¬
rived at ulceration ; and in feveral other places
ulceration had taken place, fo as to have de-
ftroyed that furface next the fkin, and a cir-
cumfcribed abfcefs was formed. The vein
near to the axilla had taken on fuppuration,
beyond which adhefions had not formed, and
this had given a free pafTage for the matter
intO'dhe circulation, of which mofl: probably
the patient died.

In thofe cafes where larger abfceffes have
come on than thofe formed Amply from the
ulceration of the wound made by the lancet,
I have always found that the vein was after¬
wards obliterated, having united and healed
up as any other cavity does, fo that fuch pa¬
tients could never be bled in the fame vein
again, which is a proof that the fides of the
vein can unite by the adhefive inflammation.

Inflammation of a vein is a common effedt
after bleeding horfes, which is ufually done

[ 25 ]

In the neck. The operator on this animal
does not always take fufficient care to clofe
up the external wound ; for although the
method ufually employed would at firft fighf
appear to be a good one, that is, by a pin
paffed through the wound from fide to fide,
as in the hare-lip, and over-tied by a thread
or hair, yet, if not executed with fufficient
attention, I fhould be inclined to believe that
it is the very worft, as it very readily pro¬
motes inflammation in the cavity of the vein,
either of the adhefive or fuppurative kind,
according as the ligature does or does not
communicate with the cavity.

In fome of thefe inflammations of horfes I
have feen the jugular vein inflamed through
its whole length, and all the fide of the head
has been confiderably fwelled, and the, in¬
flammation carried along the vein quite into
the cheft. In thefe cafes there is always an
abfeefs formed at the w^ound, and often fe-
veral along the vein, as in the human fub-
jed: ; and whenever the complaint is carried
fo far as this ftage, the cavity becomes united
at thofe places by granulations, and the vein is
ever after impervious. Many horfes die of this
difeafe,but what is the particular circumllance

' which

[ 26 ]

which occafions their death, I have not been
able to determine. It may either be that the
inflammation extends itfelf to the heart, or that
/ the matter fecreted from the infide of the
vein, paflTes along that tube in conflderable
quantity to the heart, and mixes with the
blood.

I am inclined to believe that the expofure
of cavities of the larger veins in cafes of ac¬
cidents, and alfo of operations, is often the
caufe of many of the very extend ve inflam¬
mations which fometimes attend thefe cafes,
and indeed may be the reafon why inflamma¬
tions extend or fpread at all beyond the fphere
of continued fympathy.

In all cafes where inflammation of veins
runs high, or extends itfelf confiderably, it
is to be expefted that the whole fyftem will
be alFedled. For the mod; part the fame kind
of affedtion takes place which arifes from
other inflammations, with this exception,
that where no adhefions of the fides of the
Veins are formed, or where fuch adhefions
are incomplete, pus paifing into the circula¬
tion may add to the general dilbrder, and
even render it fatal.

[ 27 I

In all cafes of inflammation where adhe-
iions take place, they arife from an extrava-
fation of coagulable lymph ; but how fuch
adhefions fliould take place on the internal
furface of veins, appears at firfl: fight difficult
to conceive, fince it is moft obvious, that the
coagulable lymph thrown out by the exha-
lants on the internal furface of the vein,
mixing with the fame fluid circulating with
the other parts of the bloocf, would be fwept
away without producing any effeft. But fince
fuch adhefions do in fad: happen, the coagu¬
lable lymph muft undergo fome change con-
neded With the difpofition which produces
its extravafation.

Although the operation which is the moft
frequent caufe of this complaint is to ap¬
pearance trifling, yet as it is often of very
ferious confequence, both to the life of the
patient and the charader of the furgeon, it
requires particular attention in the operator
to prevent as much as poflible an evil of fuch
magnitude. With this view he will be parti¬
cularly attentive to the mode of clofing the
wound, and binding up the arm. This is to be'
done by bringing the two fides of the w’ound
together, that they may unite by the firft in-

4 tention.

[ ]

tentlon. To accompliih this, let the fur-
geon, with the thumb of that hand which
holds the arm, pufli the fldn towards the
orifice, while he draws it on the other fide
to the fame point with the comprefs ; thus
the flvin will be thrown into folds at the
wound over which he is immediately to ap¬
ply the comprefs. The comprefs fliould be
broad, to keep the fkin better together ; and
thick, to make the compreflion more certain.
Another advantage arifing from this caution,
is the prevention of the vein bleeding a fe-
,cond time. I have known an inflammation
attack the orifice, which appeared to have
arifen from the firft union having been broke
through, and no fecond union formed; but
,this probably did not arife from the vein
being opened a fecond time, but from the
fides of the orifice not having been again
brought together. I would recommend a
comprefs of linen, or lint, in preference to
flicking plafler ; for I imagine that the bloqd
drying over the orifice is a kind of bond
of union more natural and effedlual thair.any
^ other application : ' and this conclufion is
drawn from pra(fl:ice ; for I have feen more
fore arms in confequence of bleeding wheye

plaflers

[ 29 ]

plafters have been afterwards applied, than
from any other; and in cafes of the compound
fradture, when attempted 'to be cured as a
iimple fradlure, if the wound will allow of
being fcabbed over, I have feen it always do
well ; whereas if it has been kept moift, or
prevented from evaporating by plafters, or
other applications, it has always fuppurated.

When inflammation takes' place beyond
the orifice, fo as to alarm the furgeon, he
ihould immediately make a comprefs upon
the vein at the inflamed part, to make the
two fides adhere together ; or if they do not
adhere, yet Ample contadt will be fuflicient
to prevent fuppuration in this part ; or if in¬
flammation has gone fo far as to make the
furgeon fufpedl . that fuppuration has taken
place, then the comprefs mufl: be put upon
that part of the vein juft above the fuppura¬
tion. This I once pradlifed, arid, as I fup-
pofed, with fuccefs.

HI. A

r 3<> j

III. A Procefs for preparing pure Emetic
Tartar by Re-cryfallixation, By Mr. Jen-
NER, Burgeon at Berkeley. In a letter
to John Hunter, Efq. Read June
1784.

Sir,

I BELIEVE it is generally acknowledged,
that no preparation of antimony obtains fo
much in the modern practice of phyfic as
emetic tartar; yet how greatly ought it to be
lamented, that a procefs of fuch confequence
to the health of mankind has hitherto been
conduced upon an imperfect plan. In the
ufe of this valuable medicine, the phylician’s
warmeft hopes are too frequently allayed with
fear : for, while fo many formulce for the com-
pofition of emetic tartar are extant in difpen-
fatories and chymical treatifes, the pradtiti-
' oner, wanting a fixt criterion of its quality,
muft often- prefcribe with uncertainty, and
generally be difappointed in his conclulions.
Indeed the faculty are well aware that a tin¬
gle grain prepared by one chymid; may excite
full vomiting, though the fame quantity pre-

[ 31 ]

pared by another may not even produce a '
naufea. Thefe confiderations, added to the
great importance of the medicine itfelf, have
induced me to attempt fome experiments,
with a view of bringing it to the greateft de¬
gree of purity. The refult of thefe proved
favourable to my wifhes; and without enter¬
ing into a tedious detail of them, I flatter my-
felf that emetic tartar made according to the
inclofed procefs, will bear the tefl: of a fcru-
pulous examination. It will be found to be
a pure neutral fait, compofed entirely of tar¬
tar and the reguline part of antimony,
formed in cr}^fl:als beautifully white and
tranfparent, and perfectly foluble either in
water or wine. I am.

Sir,

Your mofi: obedient

and obliged fervant,

Berkeley^
fib. 5, 1 7 84.

Edward Je#jner.

[ 32 ]

Frocefs fir preparing pure 'Emetic Tartar
by Re-c?y/iallization»

Take cream of tartar and glafs of anti¬
mony levigated, of each one pound. Mix
them together, and pour upon them in a
clean earthen veffel two gallons of boiling
water. Stir the whole together a few mi¬
nutes, and the cream of tartar will be fully
faturated. Let the faeces fubfide, filter the
liquor, and boil it immediately in a well^jtin-
ned vefihl, till the whole be nearly evaporated
to drynefs. Pour as much boiling water on
the emetic tartar, thus rudely formed, as will
dilTolve it ; put it into an earthen velfel, and
let it remain twenty-four hours. Emetic
tartar will now be formed in cryftals adhering
to the fides and bottom of the veffel, but
not perfectly bright and free from impurities.
Decant the liquor, and boil it till a pellicle
appears on the furface. Set it by to cryftal-
lize. Colled; thefe cryftals, and mixing them
with thofe formed before, diffolve them in as
much boiling water as is fufiicient for that
purpofe. Filter the folution immediately 5
put it into clean glafs veffels, and let it re¬
main

[ 33 J

main twenty-four hours. The cryftals which
appear now are in a perfeft ftate. Having
waflied them with a little clean cold water>
place them in the (hade on white fpongy pa¬
per to dry. To obtain the whole of the eme¬
tic tartar contained in -the remaining liquor^
the proceffes above mentioned muft be again
and again repeated* . ' ,

[ 34 1

IV. An Account of the DiJJeBion of a Man,,
that died of a SiippreJjiGn of Urine^ produced
by a Collection of Hydatidsy between the
Neck of the Bladder and Redfum ^ with Ob--
fervations on the Manner in which Hydatids
grow and ?nultiply in the human Body, By
John Hunter, M. D. F. R. S. and
Rhyfcian to the Army, Read April 17,.
1787.

Th OMAS Bell, aged forty- fix years> a
carpenter, and a ftout man, died fuddenly,
March the 17th, 1786. The following par¬
ticulars were all that could be learned re-
fpedling his difeafe previous to his death :
that he had been complaining for four or
five weeks of more or lefs pain and diffi-
.culty in making water, which he himfelf
fuppofed to proceed from gravel, but by thofe
about him was fufpedled to arife from fome
venereal complaint. In confequence of this
fufpicion he was vifited by a furgeon, who.
examined the penis y and found a natural phi^
rnojisy but no venereal complaint. When
queftioned jefpedling his difficulty of making
water, he faid, that he had been in much pain,

, ' but

* f

' t 35 ]

but was now ealier, and that fome urine had
come away involuntarily. He was able to fit
up in bed at this examination, but in an hour
after, in attempting to turn himfelf, he ex-
' pired.

The body was examined thirty hours after
death.

Head. — The brain was in all refpedls na¬
tural ; it was not firm, however, for fo fiiort
a time after death. The water in the ven¬
tricles was in the ufual quantity. The blood
in the veffels was fluid both in the head and
other parts of the body.

Thorax. The vifcera were all found.

Abdomen. The belly was very tumid,
which, on removing the common integu¬
ments, w;as found to proceed from the im-
menfe fize of the bladder. It was diflended
enormoully, and reached fully eight inches
above the pubis ; its fundus was within* two
inches of the arch of the colon. Upon let¬
ting out the water, which amounted to five
or fix pints, it appeared that there was a large
tumour between the neck of the bladder and
the return, which completely filled the pelvis,
and thruft the bladder forwards and upwards.
On cutting into the tumour much water!

D 2 rulhed

t 36 1

rallied out, and along with it many hydatids

of various fizes ; the largeft was about an
*•- *

inch and an half in diameter, and the fmalleft
not larger than a pin’s head. The tumour
was intirely filled with hydatids and the water
that furrounded them, and both together they
were more in quantity than a pint and an half*
There were befides two or three fmaller tu-
nioiirs near the neck of the bladder, alfo con¬
taining hydatids ; and there were two bodies,
fiot larger than common beans, adhering to
the bladder, containing a foft cheefe-like
fiibitance.

Between the flomach and the fpleen, and
over one end of the pancreas, there was a large
tumour, to v^hich the three above parts adher¬
ed; the ftomach and pancreas flightly by cellu-
' lar membrane ; the fpleen more intimately,
fo as to make a oaf t of the tumour : with the
fpleen it was about ten inches in diameter.
It was irregularly fhaped, and made up of
feveral fmaller tumours. There was confi-r
derable variety in the contents of thofe tu¬
mours ; in one there were hydatids of various
fizes, like thofe mentioned above ; in another
there was a fubflance like ifinglafs, a little
foftened in water ; in a third there was clear

9 ^

water

Flatel, p.^j.

[ 37 ]

water in a confiderable quantity, with very
minute particles, like fmall grains, adhering
flightly to the fides ; and in a fourth there were
hydatids, fome full, others burft, and with
their coats compreffed together, and forming
the ifinglafs-like fubftance. The tumours or -
facs had all thick coats, endowed with a
ftrong contractile power, that forcibly pro¬
truded their contents through any opening
made into them. They had two coats ; an
outer, which was flrongeft and thickeft, and
an inner, which was tender, foft, and pulpy.

. As to the ftruClure of the hydatids, it was
-the fame in large and fmall 3 a tranfparcnt
bag, uniformly round and fmooth, filled with
clear water. The bag appeared to confifi: of
two coats, or layers 3 for on handling them,
r the outer coat would get rumpled, and occa-
fion a degree of opacity, but, by wiping the
hydatid, it became again clear and tranfparent.
They appeared to be completely fpherical,
except that the. large ones were a little flat¬
tened by their own weight, when laid on a
plate They adhered no where to the fides
of the fac, nor to one another. When they
were opened, their coats polTeffed a llrong

♦ Vid. Plate Ift. Figt i.

D 3

con-

[ 38 ]

coiitraftile force, fo as to roll themfelves up
ill part. On examining a number of hyda¬
tids, fome of them appeared of an amber co¬
lour, and with thicker coats than the reft ;
and when opened, their inner furface was
found covered with fmall hydatids, which were
not fo large as the heads of pins, and looked
.like minute pearls or ftuds fet in the inner
coat '

I Some .of the water containing the fmall
grains mentioned above, was examined with
a microfcope, and found to have floating in it
numerous minute hydatids; of which the
largeft were the little grains vifible to the na¬
ked eye, and t-o-o part of an inch in diameter ;
the fmalleft were lefs than a red globule of
blood ; and they were^ of all intermediate
fizes. The coats of the largeft were a little
.rough with numerous filaments, or w7//; and,
on ufing a deeper magnifier, they had fome-
what of a mulberry appearance •f*. -
, When the young ones growing in the coats
of the larger were examined with the micror
fcope, they were found not to be fet in the
coats, like pearls, but to be covered by a

' * Vid. Plate Ill. Fig. 2o t Vid. Plate H. Fig. 5.

< thin

f 39 1

thin tranfparent membrane, fo as to lie be¬
tween two layers. It is not improbable that
the -fmall globules attach themfelves by the
villi to the fide of the hydatid, and to each
other, and thereby give the appearance of
being covered by a thin membrane. How¬
ever that may be, the globules being found
of various fizes floating in the liquor. Teems
to prove that they are originally formed there,
and not in the coats of the hydatid, upon
which they are afterwards depofited. The
jiumber of thofe that had young ones in them,
W''as few in proportion to the others.

The * hydatids in their growth and decay
appear to - pafs- through various ftages ; they
are firfi; found floating in the fluid that fills
the’ hydatid, and afterw’ards attached to its
coats. The hydatid thus pregnant with
young, if the exprefiion may be allowxd, ad¬
heres to the neighbouring parts, increafes in
fize, and becomes itfelf a fac, containing nu¬
merous fmall hydatids. Thefe after a certain
time decay, and the fleins or empty bags are
fqueezed together into a fubftance like ifm-
glafs. It is probable they ftiil undergo a fur¬
ther change; two fmall bodies, of the fize
4>f the common bean, of a cheefe-iike con-

D 4 fiftencc.

[ 40 1

fiftence, and covered with a ikin, were taken
. notice of adhering to the bladder near its
neck; it may be a queftion whether thofe
were not the remains of hydatids ? but that
muft be determined by future obfervations.
It is to be obferved, that the young hydatids
are found in two very different ftages ; in the
one they are attached to the coats of an hy^
datid, that floats loofe in the parent bag or fact;
in the other, extremely fmall globules adhere
flightly to the inner furface of a bag or fac,
which is firmly attached to the neighbouring
parts, and covered with a ftrong outer coat.
It is obvious that the progrefs of growth is
very unequal in thofe two, and indeed invert¬
ed ; fordn the firft the young ones are as large
as the heads of pins, while the parent bag is not
larger than a walnut, and floats unattached ;
but on the contrary, in the fecpnd there is a
large fac with a flrong outer coat, and a more
tender inner one, adhering ftrongly to the
furrounding parts, while the young ones, that
are very flightly attached to its fides, are not
of a larger diameter than a part of an
inch. Whether thofe are merely accidental
differences in the growth, or depend upon

fome

[ 41 ]

fome more effentlal diftindlion, muft remain *
to be determined by future obfervations.

The term hydatid is ufed in different fenfes ;
thus the hydatids of xht p lac e7it a ^ of the ova--
ri'a, and of the kidneys, which may be con-
fidered as morbid changes in the fubftances
of thofe bodies, are totally different from the
hydatids of the prefent cafe, which produce
their like, and multiply in great abundance,
without any further connediion with the hu¬
man body, except in fo far as it affords them
a nidus. The obfervations I am going to
make are confined intirely to this laft men¬
tioned kind. They have been found in va¬
rious parts of the human body ; they have
been difeharged both by vomit and by flool
they have been brought up from the lungs
by cough 'f ; they have been voided by urine ;
and they have been difeharged from tumours
in different parts of the body J. Le Cat has
taken notice of their inner coat being covered
with fmall inarnillc^i an appearance produced
by the young ones, and fuppofes them to be
the glandular grains of the fpleen diflended

* Philofoph. Tranfaft. Vol. xxii. p. 1797*

+ Med, Tranfad. Vol, ii. p. 486. .

J Philofoph. Tranfaft. Vol. xxy, p. 2344.

with

[ 42 ]

-with lymph. They have alfo been confi-
dered as difeafed lymphatics ; but it muft be
obvious, that the young ones growing within
the larger; at the farxfe time that thefe laft are
floating in a liquid without connection with
the lides ’of the fac, cannot proceed from any
difeafe in- thd lymphatic fyftem, if by that he
utiderfto6d^%e ^ablorbent veffeis. ''Tt is un-
'heceflary to aniiriadveft upon Le Cat’s opi-
nion,"^as anatomy has^-iiot hitherto been able
to' demonftrate the ‘exiftence of any glandular
grains in the fpleen, which appears to be a
congeries of blood- veffels. It may be a quef-
'tion, whether the hydatids are not of an ani¬
mal nature^ and poiTeffing a life peculiar to
Themfelves ? We are not yet in poffeflion of
• a fufficient number of faCls to afcertain this
point ; but the difcoveries that have been
made refpeCting the nature of hydatids in
'other animals, promife to throw fome light
Upon the prefent fubjeCt,

" Tlienngenious naturalifl: Pallas, in his Mif-
cellanea Zoologica has given an account of
the obfervations made by others upon hyda¬
tids, and added difcoveries of his own. There
.are only two before him, who knew the hy-
* jEd. Hagac Comitum, 1766, p* 157,

datids

' [ 43 ]

datids in animals to be alive, and to pbffefs a
peculiar ftrudure and power of motion. Thofe
were Dr. Tyfon and Phil. Jac. Hartmannits,
Pallas confiders Tyfon as the firft difcoverer,
but feemingly v/ithout reafon, for Hartman -
nus publifhed his account in the year 1685 ^ ;
and Tyfon in 1691 ‘f*. Neither of them ap¬
pears to be acquainted with the other’s difco-
very. Tyfon obferved the neck and niouth of
the animal, and faw them in motion ; Hart¬
mann further faw the ‘whole body in motion
by putting them in warm water.’ iTallas has
examined them .very minutely, and gives theth
the name of hydatigena, from finding th^ir
heads of the fame ftrudlure as that oTthe fce^
nia. But in all that Pallas faw he never found
any pregnant, fo that he was unacquainted
•with the manner in which they multiply.
Goetze, a German writer. Has given figures
of the young ones adhering > to the parent
bag ; and Mr. Hunter has preparations of
that kind in his colledlion. The Abbe Fon¬
tana X obferved them in fbeep, feen
the motion of the young'- ones adhering
to the fides, and alfo with a microfcope

* Mifcell. Nat. Cur. dec. 2. An. ^to.

+ Phil. Tranf. for that year,
ppufcoli Scelti, tom. 6,

.^xamine^

r 44 3

examined the heads of them, and found them
refembling thofe of teenier. So far the ob-
fervations of authors go with refpedl to the
hydatids of animals ; in regard to the hy¬
datids of the human fpecies, Tyfon has re¬
marked that they are diiferent from the for¬
mer 5 that they are uniformly round, with¬
out any appearance of a neck or head ; but
. he declines giving any opinion of their na¬
ture. Pallas ^ likewife mentions a kind of
hydatids found in the human and other bo¬
dies, without any neck or mouth, but leaves
their nature to be decided by future obfer-
vations. He fays their coats are very elaftic,
and when cut re trad: with fo much force as
to roll themfelves up, turning the infide out.

' It is not altogether allowable to conclude,
from the refemblance of the human hyda*-
tids to thofe of quadrupeds, that the firft as
well as the laft form a part of the animal
kingdom; yet they agree in fo many cir-
cumflances, that fuch a conclufion .appears
very probable. In quadrupeds they have
their feat generally in the abdomen^ and moft
commonly in the liver or fpleen 5 the fame is
true of the human hydatids. In the human

♦ P. 172.

they

-[ 45 ]

they multiply by the young growing on the
ilifide of the hydatids ; and the fame has
been obferved in quadrupeds. The analogy
fails when we look for a mouth and neck in the
human ; nor has any periftaltic, or undulat-
Ine motion been obferved in their coats ; but

this laft appearance has not been looked for
in a proper way, that is, by putting them in
tepid water as foon as they come from the
human body.

With regard to the time requifite for the
growth and decay of the different facs con^
taiaing hydatids, it is difficult to form a con-
jedure. Our patient was able to follow his
trade as a carpenter till five weeks before he
died ; it is probable therefore that in that time,
or a little more, the fac between the neck of
the bladder and redum had grown to that
iize, which produced a fuppreflion of urine
and deaih. The growth and decay of the
hydatids ferve to explain the increafe and
diminution, which have been obferved in
tumours of the abdomen proceeding from
this caufe, as in the cafe mentioned in the
Medical Tranfadtions It will not be
deemed out of place to mention fome par¬
ticulars of a diffedtion that have come to

^ Vol. II.

[ 46 ] •

iny knowledge, that in a great meafure ex¬
plain the appearances in , the cafe above al¬
luded to, and confirm the truth of the con-
jedlurc fubjoined to it. '

A patient died in the Infirmary at Edin¬
burgh, with the fymptoms of the encyfted
dropfy. His abdomen was fwelled with
many irregular protuberances. On examin¬
ing the body, , there were found numerous
encyfted tumours full of hydatids. They
had their bafis in the liver, from which they
proceeded not only downwards into the abdo¬
men, but upwards into the thorax, and mak¬
ing their way through the diaphragm, came
in contacft with the lungs. Had the patient
lived a little longer, it is not improbable that
a communication between the bags contain¬
ing the hydatids and fome of the branches of
the trachea arteria would have taken place,
which muft have produced the fame fymp¬
toms as in the cafe abovementioned.

To return to the dififedlion. The hyda-*
tids did not appear to have done any injury to
the parts, except by mechanical preflure,
for the vifcera were all uncommonly found.
Of the numerous cafes of hydatids related by
writers, it may be remarked tliat hardly any

(

[ 47 ]

of them proved fatal whenever they found
an outlet. In the prefent cafe, the preffure
vtpon the neck ’ of the bladder, and confe-
quent fuppreffion of urine, are evidently the
caufes of death. The manner of death from
fuch a caufe is not unufual ; after a time, the
pain produced by the diftention of the blad¬
der ceafes, there are no more efforts to make
water, and yet the patient dies fuddenly.
This fudden death has been 'imputed to a
tranllation of the urine, as it has been 'ex-
preffed, to the brain. If any idea is to be
annexed to thefe expreffions, it mull be, that
the urine is effufed either in the ventricles,
or upon the furface of the brain ; but no ap¬
pearances of that kind were obfervable in the
prefent cafe.

When the prefence of hydatids is fufpedled,
it would appear to be of great confequence
to procure them an outlet ; but it mull be
obvious, that being generally feated in the
abdomen, that bufinefs mull be left intirely
to nature. Upon . the fuppofition that they
belong to the animal kingdom, no internal
medicine promifes to be of fo much ufe as
mercury, which appears to have been given
in one cafe wtih advantage But this is a

* Med. Tranf. Vol. II.

fubje(ffc

i 48 ] ,

fubje£t there is no entering upon without a
greater number of fadls..

To this account I will fubtjoln a query re-
fpeding the manner in which the hydatids
came to be ^ lodged between the redlum and
bladder. It has been obferved that they are
moft commonly found in the liver and fplecn,
and In. the prefent cafe their original feat
would appear to have been in the laft of thefe
vifcera ; may not, however, one of the facs
or bags In the fpleen have burft, by which
the contents would be fpread all over the ab¬
domen, and from their own gravity would
naturally fall into the pelvis ; and may they
not have adhered to the neighbouring parts,
and fo multiplied there ?

I have been more particular In relating the
circumftances of this cafe, becaufe fuch fel-
dom occur even to^perfons in extenfive prac¬
tice ; in confequence of which it often hap-
, pens in rare cafes, that the views and expe¬
riments fuggefted by one cafe, are of no avail,
for want of another opportunity to verify
them. It will therefore be underftood, that
what is advanced refpedting their being en¬
dowed with a life of their own, and alfo

their

f 49 1

their mode of breeding or multiplying^ is
given merely as probabilities, and as well
deferving of further inveftigation, whenever
opportunities may offer*

Charks-Sireet^

April 17, 1787.

-SUPPLEMENT.

In the year 1788, I had an opportunity
of examining fome hydatids that \vere found
in the abdomen of a fheep. Before I faw
them the bowels had been taken out, and
they were adhering to the fat about the kid-
nies, and alfo to the liver, and to the fat near
the urinary bladder, in confiderable number.
They would appear to differ in fome effential
particulars from the human hydatids, yet
they refemble one another in fo many things,
^ that there is reafon to infer therefrom, that
both belong to the animal kingdom.' It ap¬
peared to me, that a fhort account of them
would form a proper fupplement to the cafe
of human hydatids, read fome time ago to
the fociety.

The

[ 50 ]

The hydatids in the fheep were exad;ly the
fame with thofe defcribed by Tyfon They
confift of a mouth, neck, and oblong fpherical
body. The mouth had nothing of the cruci¬
form appearance, if I may be allowed the ex-
preflion, that late writers have made the cha-
radleriftic mark of tcenia, and which they fay is
to be found in all hydatids. The mouth, ex¬
amined with fome care with the microfcope,
appeared to be a fimple longitudinal aperture.
The neck was compofed of rings, and there
appeared very line circles furrounding the
body. They varied in lize, from that of a
chefnut to the dimenfions of a turkey’s egg.
When put in W'arm water, though it muft
have been 'twelve or fourteen hours after the
iheep had been killed, they moved briikly,
with a'kind of periftaltic motion all over the
body. Each hydatid was lodged in a feparate
fac, which was little more than fufficient to
hold it, for the neck was refledfed upon the
body. The fides of the fac were lubricated
with a mucous fluid.

The human hydatids havT no neck or
mouth, and they are in great numbers in the
fame fac^ and of various lizes. In thefe par-

^ Phil. Tranf, 1692,

tlculacs:

(

[ 51 ]

ticulars they differ from thofe of flieep ; nor
could 1 find any young ones attached to the
infide of the hydatid, as in the human. In
their mode of decay, however, they refembled
each other completely. The fac became
thicker and ftronger, and at the fame time
diminifhed in fize, and compreffed the coat
of the hydatid into a fubftance like ifinglafs.
In the laft ftage this fubftance became like a
mixture of chalk and water, and the fide of
the lac hardened, and appeared in fome degree
petrified ; for the hardnefs was more like that
of a ftone, than of a bone.

I had, in the fummer of 1791, an oppor¬
tunity of examinnig the hydatids which are
found in the brain of flieep, producing the
difeafe called, in Ibme parts of the country,
the JicLggers, The hydatid is lodged in the
fubftance of the brain ; in one fheep dicre
were two hydatids, one in each hemifphere
of the brain ; they were of an irregular oval
fhape ; they had no mouth ; their coats had
the fame appearance as in the hydatids found
in the abdomen ; and, when put in warm
water, they had a ftrong periftaltic motion.

In fome there were clufters of young ones,
adhering to their inner coats, Thefe were

E fome-

[ 52 ]

fcmewhat oval in their fliape, and adhered
by one end ; but on detaching them carefully,
and examining ‘them >with good magnifiers, I
could never find the cruciform mouth de-
fcribed by fome writers.

We may obferve, that the mouth -is not
eflential to the hydatid in fheep,' which ren¬
ders it ftill more probable, if not altogether
certain, that the human hydatid is an ani¬
mal

■* There being great reafon to believe that hydatids form a
diftinft genus in the animal kingdom, and being fo elTentially
different from the watery veficles which are found in the oua-
Ttuniy kidney, and placenta y it might be proper, in order to
avoid ambiguity and confufion, to diftinguifh them by a name
peculiar to themfelves. Linnasus (a) calls the hydatid in Iheep
Hydra Hydatula ; buf neither his generic charader, nor fpecific
differences, which are chiefly taken from the mouth, apply to
the animals in queflion, in fome of which there is no mouth.
The Greek language, that inexhauftible fource of derivation,
readily fuppiies us with a name. The word ‘y^pluy Hjdriay is
very appoflte. If that be adopted, we fhall have Hjdria Hu^
tmnay Hjdria On)illay &c.

(a) Syflema Natunv, Vermes, Zoophyta, Hydra,

« „ ^ V.

C 53 3

V. Cafe of a Geiitleman labouring under the
epidemic remittent Fever of Buforah^ in.
the Tear 1780 ; drawn up by himfelf', with
an Account of various Circimfances relat¬
ing to that Difeafe. Communicated by John
Hunter, Efq. F. R. S. Read June 17,
1788.

INTRODUCTION.

The follov/ing cafe is that of a gentleman,
not unacquainted with medical learning, tho'
not of the profeffion. To this circumftance
it is owing, that an explanation is neceffary
of the fenfe annexed to the term plague^
which occurs frequently. Our author ufes it
in a fomewhat vague fenfe, but probably fuch
as is cuftomary at Buffo rah ; and calls by that
name the remittent fever, which prevails every
year, with various degrees of violence, in
confequence of the annual overflowings of the
Euphrates. But there is no refemblance be¬
tween the plague, properly fo called, and the
remittent fever ; they differ in their fymp-
toms, progrefs, and caufes, of which any
one may eafily fatisfy himfelf, by confulting
the excellent treatife lately publilhed by Dr.

E 3 Ruflell

[ 54- 1

Ruffbll on the Plague. There is further this
remarkable difference between them, that
they prevail in different feafons of the year.
The warm weather of the month of May puts
an end to the plague at Bufforah, and it is
not to be feen in the fubfequent hot months ;
whereas the remittent fever begins in the
month of May, in which the Euphrates
ufually overflows its banks in the neighbour¬
hood of Bufforah, and prevails chiefly in the
warm months that follow. Our author fre¬
quently mentions the plague of 1773? flip-
pofing the remittent fever, and that epedemic,
to be the fame difeafe ; but that is not the cafe.
It w^as the real plague which raged at Bufforah
with fuch violence in 1773; and from au¬
thentic accounts of it in the poffeflion of Dr.
Ruflel, it appears that it firft fhewed itfelf in
February, increafed in March and April, be-;
gan to diminilh early in May, and by the end
of that month intirely ceafed.

It is impoffible to read the narrative of the
fufferings of the patient, without wifliing that
he had had the affiftance of medical people,
who had been acquainted with the proper
mode of adminiftering the bark in fuch fe¬
vers. The numerous remiflions he had, fur-
niflied the beft opportunities of giving it ;

and

[ 55 ]

and as in the end he owed his life to it, fo
there can be no doubt but a more early ufe
of it, would have faved him from niuch fuf-
fering and mifery.

Ever fince the great plague of i773> in
which it is eftimatcd feven-eighths of the
inhabitants peridied, Buflbrah has feldom
efcaped, every third, or fourth year, a vifita-
tion from fome malignant putrid difeafe.
Whole families died, and remained unburied,
until covered by the ruins of their houfes.
Thoufands were interred in the ftreets, but
fo near the furface, that I have feen the bones
of the dead in many places appearing above
ground. To complete the calamity, the in-^
habitants, in lefs than three years after this
plague, fuftained a liege of thirteen months
againft the Perfians, in which they expe«- ,
rienced every diftrefs that the fword, ficknefs
and famine, can inflidt upon mankind.

The overflowing of the Euphrates, and its
waters ftagnating on the defart, have always
been accounted the leading primary caufes of
epidemical difeafes at Buflbrah. The great
floods, from the melting of the fnow on the
mountains of Diarbekir, happened in the year

E 4 1780

[ 56 ]

1 7^0 early in the month of May, when the
heats in Perfia and Arabia began to be excef-
live. The defart, which reaches to the gates
of BulTorah, is, for many miles, incrufted
with a furface of fait, which, when mixed
with the ftagnated waters and expofed to the
fun, produces the moil noxious effluvia. So
early as the 25 th of May, the town was fur-
rounded with a fait marfh, the heated fteam
ariiing from which was, at times,' almoft in¬
tolerable j but the canal that runs through a
great part of the city being filled with the
dead bodies of animals, and all kinds of pu^
trid matter, and at low tides all thefe fub-
flances expofed to the fun, made the air in
the town fcarcely fupportable ; and being to¬
tally deftitute of police, the ftreets were in
many places covered with human ordure, the
bodies of dead dogs and cats, which emitted
^ flench rnore difagreeable and putrid than
any thing I ever experienced in my life.

From the accumulation of fo many caufes,
it is not furprifing that epidemical diforders
fhould have reigned at Buflbrah in the year
1780 j it is more wonderful that thefe difeafes
are not both more frequent, and more fatal.

As to the degree of folar heat during the
period of which 1 am about to fpeak, it far '

exceeded

• t - - - ‘

[ 57 1

exceeded what I conceived the human frame
to be capable of bearing. The fenfatlon under
this heat was totally different from what I had
ever experienced ; it refembled the approach
of a heated fubftance to the body. Accord¬
ing to Farenheit’s thermometer the quicks
filver rofe in the fun to between 156 and 162
degrees. From the 30th of May I never
faw it fo low as 156, but generally between
158 and 160. The glafs was fixed to a wall,
covered at top, but expofed to the refledled
rays of the fun. I am told, that after I left
BulTorah it was feveral degrees higher.

In the cooleft part of the houfe, with the
aid of every invention to decreafe the heat,
the quickfilver rofe to 115 degrees; but after
I came away I was informed that it rofe ftill
higher, even at feven o’clock in the morning,
the hour which we accounted the cooleft in
the day. Much about this time two gentle¬
men, who had hitherto efcaped the infedtion,
were taken ill, and fled from the fadtory;
they reported that on the day on w^hich they
left BuflTorah, the heat was fo intolerable that
no one could expofe himfelf to it long enough
to obferve the thermometer in the fun,

I have

[ 53 ]

I have heard from fome of the oldefl: in¬
habitants of Buflorah, that they never re¬
membered to have felt, or to have heard of
fuch a degree of heat in any part of Arabia or
Perfia. Before we were all taken ill, the
natives of the country appeared more alarmed
at the heat of the weather than* the Euro¬
peans ; nothing could induce them to expofe
themfelves to the fun after ten o’clock.

From the loth of May the people of Buf¬
fo rah began to foretell that the feafon would
be marked by a fevere and general ficknefs.
This predidion was foon verified ; towards
the end of the rnonth an intermitting bilious
fever made its appearance in the town, which
•in a« very few days fpread with fuch amazing
rapidity, that upon a computation not a fourth
part of the inhabitants were exempted from
this calamhy.

About the latter end of May I was fenfiblp
at times of extreme and unufual internal heat
and glowings, with fenlations which I cannot
defcribe, and once or twice I perceived an
inclination to fhiver. I feldom made water
piore than once in twenty-four hours, and
then in fmall quantities, and of a very deep
r colour*

[ 59 ]

colour. My appetite and every, other cir-
cumftance continued as ufdal.

I left' Bufforah for Aleppo the 30th of
May. On our arrival at Zebire, the heat
was lb intenfe that even the Arabs funk un¬
der it. Moft of the gentlemen who had ac¬
companied me to this place' felt it in a ftill
more fevere manner. I was quite overcome;
I felt an unufual languor, weaknefs, alternate
heat and cold, and many other fymptoms
which indicated an approaching fever. I
could not immediately be prevailed upon to
relinquifh my journey ; and although upon
refledlion I had not a ray of hope that I iliould
be able to proceed, yet at that time a difap-
polntment appeared to me equaiiy dreadful
with certain death in the defart. At night
eveiy fymptom increafed, the enfuing day all
hopes of purfuing my journey vanilhed, and
in the evening I was carried Back to Bufforah.
In two days I got tolerably well, but pains
in my back, loins, limbs, and great proftra-.

tion of ftrength ftill remained. About this
time two gentlemen of the fadlory were feized
with the fever, which now began tp rage
with violence.

[ 6o J

5 til June. From this day I date the ac¬
tual commencement of my fever. About
two o’clock after dinner I was fuddenly at¬
tacked with a violent glowing heat ' all over
my body, uneafinefs, anxiety, and oppreffion,
but in a very inconfiderable degree to what I
afterwards experienced ; alfo a fwelling in my
tongue, which had been coming on fome days,
and is one of the firft fymptoms of the fever
that prevailed. The fit continued about two
hours ; a flight perfpiration fiicceeded, which
removed the fever, but left a head-ach, thirftj
and pains in my back and limbs. In the
evening with afliftance I got upon- the ter¬
race, when the moon and ftars appeared of a
bright yellow, and all obje(fl:s had that colour
through the whole of my difeafe ; alfo the
pain in making water and acrofs my loins
became intolerable, like that felt in com¬
plaints of the ftone in the bladder. I took
fome tartar emetic, which brought up a great
deal of bile, and the next morning a purga¬
tive of Rochelle falts, manna, tamarinds, and
annifeeds.

6th June, In the forenoon a fi*ee, copious
perfpiration, and a perfedt intertniifion of the
feyer i at night became very refilefs and un-

eafy.

[ 6i ]

eafy, could not fleep, which I partly imputed
to a draught of ftrong muflard whey, with
fome antlmonial wine, which inftead of
caufing perfpiration, produced the oppofite
effeft.

yth. By the advice of a phyfician I took
fome weak decodlion of bark, i oz. to two
pints boiled to one, in the quantity of three
tea-cups full before dinner. At three in the
afternoon I had another hot fit, but not very
fevere. In the evening grew worfe, heat
and thirfi; exceflive, drank muftard whey on
going to bed, but had a very bad night; — no
fieep, much oppreffed, fevere head-ach, and
pain over my loins.

8th. I took a gentle purge of cream ^of
tartar and manna, which operated and gave
me fome eafe. Left off the bark, as it feemed
to increafe the febrile fymptoms, and drank
fage and apple tea, decodion of prunes, ta •
marinds, &c. At ten o’clock in the fore¬
noon a very fevere hot fit ; heat intenfe, op-
preilion in my ftomach and breaft almoft in-

fufferable. Mr. ; - furgeon of the Eagle

cruifer, gave me a mpfl; naufeous faline mix¬
ture, which vomited and purged me feverely.
The quantity of bil^ which came olf my fto-
. . I mach

i 62 ]

mach was incredible, yet I felt no relief, and

the agony of the hot fit continued till four
o'clock in the afternoon, when it went off
by a moft profufe perfpiration. During this
fit my thirfl was conftant and intenfe. In
the evening my fkin became dry, the thirfl
returned, and I had a very bad, fleeplefs
night.

I now began, to experience fome of the
dreadful fymptoms which are I believe pecu¬
liar to fevers in Turkey and Arabia, a fenfa-
tion of dread and horror totally 'unconnefted
with the fear of death, for while the patient
is moll affli(5led with this fymptom, it is for
the moll part accompanied with a flrong de¬
fire to put an end to his exiflence. The
agony from the heat of the body is beyond
conception ; I have heard fome of my fellow-
fufferers roar hideoully under the violence of
the pain.

9th. I’ill noon tolerably well. About
one o’clock the hot fit attacked me, and was
full as fevere as yefterday; heat, and thirfl
rather greater, and but little relief for more
than an hour after the perfpiration com¬
menced. This attack left me very weak,
much exhaufled with cold weakening fweats,

quick

[ 63 ]

quick unequal pulfe, fevere head-ach, con-
fufion, anxiety, and inceffant third: ; a fleep-
lefs night, ftartings, anxieties, and a conftant
wiih to terminate my fuiFerings by death
loth. Forenoon, pretty free from fever.
Attacked at the fame hour as yefterday. The
lit more violent, delirium. The agony of the
heat -not to be expreffed ; the whole body as
if on fire ; unremitting third:, profufe perfpi-
ration, yet no relief till late in the evening ;
no deep, a dreadful night, &c. Pulfe about
120, unequal and fluttering.

A mere relation of fafts can give but a
faint idea of the wretched fituation to which
the fadory was now reduced : by this time
eleven twelfths of the inhabitants of Buflbrah
were taken ill, numbers were daily dying, and
the reports from Bagdad and Diarbekir of the
increafing ravages of the plague, left the fur-
vivors not a ray of hope that they could efcape
from the calamity. On every countenance
pain^ ficknefs and horror were ftrongly paint¬
ed 5 nor were we even left the comforts of
fympathy, as every mind was too much eii-
grofled with its own fufferings to think of
adminiftering confolation to others. Four of
us lay under the portico of one of the fquares

[ H ]

of the fadlory, calling out for water In a •
phrenfy of thirft. We ufed to fnatch it from
each other, and to fupplicate for a mouthful ^
with as much fervor as a dying criminal for
an hour of further life.

About this period of the fever my eyes
became very weak, and every objed: I faw
was quite yellow. This effed was moft per¬
ceptible at night, in looking at the moon and
ftars. In the evenings we were fome times
carried in our cots upon the terrace of the
fadory for air, but the wind was fo heated
by the burning lands of the defart, that we
felt it more intolerable than even the lower
apartments. We all remarked that the She-
maal, or northern winds, which blew with¬
out intermiffion at that time, greatly increafed
our heat and third.

The daily very evident increafe of my fe¬
ver, and its eifeds upon others becoming
every day more fatal and alarming, determined
me, while any ftrength remained, to embrace
the con ful’s offer of flying from the feat of
infedion to Bufliire, in the Ranger cruifer.

I ith. After an exceeding bad night I was
carried early in the morning on board the
Ranger, and was not very ill untihabo.ut nine

o’clock.

[ 65 ■]

o'clock, when I felt the fever coming on,
with new and more alarming fymptoms, vio¬
lent head-ach, giddinefs, dimneft of fight,
approaching delirium, horror, and a mo ft
painful oppreflion and burning heat in my-
flomach.

In defpair, and to try to quench the un-
fufferable heat in my Itomach and bowels, I
took a pretty large dofe of nitre. The op-
' predion and pain increafed, in my confufion
I took a paper of tartar emetic, which imme¬
diately began to operate. From that time,
about ten o’clock, till half pad: two in the af¬
ternoon, I know but little of what paded.

I was almofl all that time either diftraded
wdth pain, or in a fwoon ; and had it not
^ been for the extraordinary care and attention
of the commander of the cruifer, who fup-
ported me in his arms, and adminiftered fcch
cordials as I, in the diort moments of recol-
ledllon, could call for, I have not a doubt
but I mud: have funk under this attack. He
counted eight times that I fainted, and fome-
times an interval of ten minutes before he
' could perceive any fymptoms of returning life.

I was chiefiy fupported by wine, hartdiorn,
and fpirits of lavender. About three o’clock

F I had

[ 66 ]

I, had recovered my recolleftion : moft co¬
pious and continued fweats had carried ofF
^the violence of the fever, but fain tings and
total privation of ftrength and fpirits remain¬
ed upon me till late in the evening, when I
became to all appearance, for a fhort time,
perfectly well. A little ftrength returned,
every fymptom of fever vanifhed, and my
feelings were almoft the fame as if in perfedt
health. Some circumftances having pre¬
vented the Ranger’s carrying me to Bufoire,
I was taken ailiore in the evening. When I
was brought to the fadlory I had an appetite,
and ate fome chicken broth for fupper. Mr.
Rofs, who had hitherto efcaped the fever,

’ adminiftered a potion of laudanum, and, I
believe, antimonial wine, on going to reft.
I flept pretty well, and waked refrefhed in
the morning. I, however, foon became ill;
and at noon I had a fevere attack, which con¬
tinued three or four hours, and left me greatly
weakened, niy llvin extremely dry, pulfe quick,
fluttering, and irregular, beating from loo to
1 20, with an unquenchable thirft, which no
liquids could allay. We had no acids of any
kind, which we had great reafon to regret.

I did

[67] .

I did not know till late in the evening that
Mr. Abraham, the vice-conful, who for fome
days pafl had been ill of the fame fever, had
determined to embark in the Eagle cruifer next
morning for Bulhire, as the only chance of fav-
ing his life ; and a converfation which I over¬
heard to this effed:, that as I was fo very ill, and
no hopes of my recovery, it would be better
to leave me behind to die at Bufforah, made
me ftill more anxious to fly from the place,
although I remember well I had not the mofl:
diftant hope that I could live. I had fulfered
much at the fadory, and in the peevifhnefs
of illnefs I thought (perhaps. unjuflily) that
my living or dying feemed to be a matter of
too little confequence to thofe, whom in
health I had treated with much kindnefs and
affedion.

About ten o’clock, as I was lying in my
cot, on a terrace adjoining to the flairs from
whence the boat was to put off, I was feized
with fuch a fluttering, palpitation, ftarting,
difficulty of utterance from the fwelling of
my tongue, that I lay in momentary expec¬
tation of breathing my laft. This w^as, how^-
ever, probably the caufe of my hearing the
preparations for the departure of the boat.

F 2 About

[ *68 ]

About midnight they were leaving the fliore.

I could not make myfelf heard, and I was
too weak to get up without help. I made
feveral efforts, and at laft overfet the cott I
was lying upon, and brought myfelf to the
floor, from whence I crawled on my hands

and knees to the fide of the river. Huma¬
nity pleaded for me, and I was taken into the
boat in a fltuation of wretchednefs I never
can forget. We were, after being feveral
hours on the Euphrates, carried on board the
Eagle, oppofite to Margil, a country houfe
belonging to the fadlory, a few miles diftant
from Bufforah.

1 2th. The day was uncommonly hot, and
my fever came upon me about ten o’clock.

The heat was intenfe. Mr. - , a young

unexperienced Frenchman, gave me tama¬
rind water and cream of tartar, which had
not a good effedl. I now difcerned the firfl:
fymptoin of a cold fit, but it was flight, and
of ihort duration. This day, however, I
fupported the fever rather better than ufual,
and in the evening had a fhort intermiffion,
and flept a little during the night. The air
on the river was this day cooler and more re-
frefliing than on fliore.

1 3th.

[ 69 ]

13th. About eleven o’clock had a regular,
cold flilvering fit, fucceeded by a very fevere
hot fever, which continued till five in the
evening, when I was fomewhat relieved by
perfpiration. — This day the agony of the hot
fit was inexpreffible, with great pain in my
loins, and a conftant Inclination to make wa¬
ter, which came from me in drops like blood.
~I had a very bad fleeplefs night.

14th. By Mr. — — ’s advice, I took a
dofe of tartar emetic, which not working,
he gave me fome ipecacuanha. I brought up
a great deal of bile, but the fever increafing,
my fufferings under it were greatly increafed
by the operation of the emetic, which worked
powerfully both upwards and downwards. —
This was a trying day indeed. I can give,
no idea of what I fuffered, which mufl: have
been intolerable, attended with intervals of
delirium, and frequently fwooning. About
five the fever began to abate a little, and at
fix Mr. - gave me a fmall dofe of decoc¬

tion of bark, which feemed inftantly to caufe
a return of the fever, heat, third:, anxiety
and pain.

My fellow-fufferer, Mr. Abraham, was in
violent agony this day ; he cried out repeat-

F 3 edly.

[ 70 ]

ediy, that a fire was confuming his bowels,
and that he was in exquifite torture. The
captain of the cruizer had been complaining ;
he, -Mr. Abraham, and myfelf, lay in the
fame cabin. About four o’clock in the after¬
noon, when my pain was exceffive, I crawl¬
ed from my cott, with an intention to drop
myfelf from a port-hole which was under
the captain’s bed, into the river. I had nearly
acccmpliflied my purpofe, when the captain
perceived me, and had me carried into my
bed. I was not delirious ; and, in fpite of
all my refolution, the agony I fuffered this
day made me repeatedly fcream out. One of
our feamen died fuddenly, and the blood, I
was told, inftantly flowed from all parts of
his body.

This evening we arrived at Bulhire. On
our coming to an anchor, Mr. Abraham was
immediately carried afhore ; but I was too ill
to be moved, and accordingly followed in the
morning with Captain Sheriff, after a very
fevere fleeplefs night.

The heat was fo exceflive this dav, that
even the natives we had on board funk under
dt, and many of them were ftruck down with
the fun. By noon nobody could keep the
. ^ ' deck ;

[ 71 ]

deck ; and about this time tlie velTel run
aground on the bar at the mouth of the Eu¬
phrates, but fortunately beat over, and got
into the guiph. Tv/o more of our people
died in the evenin^^ : and I fliould have men-
tioned, that, in failing down the river, we
faw them throwing many dead bodies from
the veffels wliich were at anchor below Buf-
‘ forah, and many boats crouded with people
from the Arabian Ihore, ‘palling over to
Perfia.

The Perfians at firfl oppofed the landing
of our lick, and threatened to burn the fhip ;
but they were prevailed upon, by the com¬
pany’s agent at Bufliire, a moll worthy man,
to permit us to come afliore.

15th. I was fo weak, that it was with
difficulty they could carry me afhore in my
cott ; my ftrength was quite gone, and I was
helplefs as an infant. Some grapes, v/aterr-
melon, and ice, had been got for Mr. Abra¬
ham : of the latter he had eat freely ; I was
much prelTed to do the fame, but I was afraid
of its increaling my pain, and could hardly
be prevailed upon to tafte it ; I, however,
fwallowed a little, but by this time my tongue
gnd throat were fo fwelled, that I had dlffi-

F ' 4 culty

L 72 j

culty in getting any thing down. About ten
o’clock I was attacked as ufual, but I was
become fo weak, and the fever running even
higher than ufual, that I appeared in the
courfe of this day, more than once, to be in
the agonies of death ; perfpiration gave no
relief to the violent pain and oppreffion I la¬
boured under.

The fadlory at Bufhire Is a miferable,
wretched, mud building, bearing mucli more
refemblance to a liable than a human abode ;
the few rooms, or rather cells, are infulFer-
'ably hot, even to thofe in health, and the
reft of the building has no cover from the
fun. In one of the bell of thefe recefles in
the wall Mr. Abraham and I were placed,
and on the fame bed, as there was not room
for two ; our agonies were great, our cries
dreadful. About feven o’clock in the even¬
ing I perceived my companion in the agonies
of death. The company’s agent, Mr, Beau¬
mont, moft humanely afforded him every af-
fiftance in his power ; and, when every other
perfon was afraid to come near us, he him-
felf attended, and adminiftered fuch cordials
as he thought might give us relief. Mr. A-
braham died in great pain ; and for fear of .

alarming

[ 73 ]

alarming the inhabitants, or rather command¬
ant or fheik of the town, Mr. Beaumont
thought It nccellary to conceal his death. It
w^as fome time before the dead body could be
removed, v^hich had become very putrid, and
covered with purple fpots. I have been fincc
told, that Immediately after death great quan¬
tity of blood or bile flowed from him, as
. black as ink, and fo highly ofFenfive, as to
-be fmelt at fome diftance from the fadlory.
Pafl: midnight we were both removed to the
terrace, but, unfortunately for me, there was
only one fpot where we could lie, and the
fmell of the dead body was become intoler¬
able ; I was, however, by the humane aflifl;-
ance of Mr. Beaumont, cleaned and put in¬
to another bed, who fat by me, and treated
me with uncommon tendernefs. I recover¬
ed a little, but pafTed a dreadful night indeed.
I fliuddered at the agony which I was to feel
on the return of the fun, »and rnofl anxioufly
wifhedfor death, as the only relief from pain,
that I could expedt. I was unable at this
time to move hand or foot, and at times
could not fpeak. I told Mr. Beaumont- that
I thought a gentle dofe of phyfic, if it could
be got down, might alleviate the racking pain

[ 74 ]

in my breaft, ftomach, bowels, and loins ;
he accordingly prepared fome falts, manna
> and tamarinds, and gave it to me in the
mornings

1 6th. At eleven o’clock the violence of
the fever came on ; I grew delirious, fwoon-
ed, and the fymptoms of approaching death,
I was afterwards told, grew evident to thofc
around me. My eyes were fixed, my tongue
hung from my mouth, and my face grew
quite black. I recovered from this fit about
twelve o’clock, and felt excruciating pain,
and a burning fufFocating heat. My ftomach
and bov/els feemed all on fire, my lungs played
with the utmoft difficulty, and I felt a pain
and fenfation about my heart which I cannot
dcfcribe. I was unable to move ; my fervant
lifted rne ^ I fell into a fwoon for a few minutes,

' and, when I came to myfelf, a great quantity
of black DUtrid bile flowed from me. Relief

'.was inftaiitaneous, and I flept or fwooned till
.^bout five o’clock, when 1 found myfelf free
from fever, and able to fpeak, my recollection
clear, and my mind perfectly compofed, but
my body fo weak that I had no power of mov¬
ing, except one of my hands. They gave
me fome fuftenance ; I had a little fleep ; but

abQiU

[ 75 ]

about midnight I fell into a fituatlon, which
I had all the reafon to think indicated the
immediate approach of death. My tongue
cleft to my mouth, my extremities were as
cold as ice, and the coldnefs alfo appeared to
extend up my thigh ; my arm was defliitute
of pulfe, nor was the fmalleft pulfation of the
heart perceptible ; I never had my recollec-^
tion clearer, or perhaps fo clear, in my life.
My fervant was lying by my bedfide ; I was
convulfed for fome minutes; and, on recover-
ing, I got out the word Boy.— Fortunately
for me he was not afleep, and heard me ; I
then got out the word Wine ; on which he
brought me a glafs of claret, which, with
much difficulty, I got down ; I felt myfelf
much revived ; I reflefted on my fituation ;
and, although I had not the moft remote idea
of furviving that night, I recolleded that I had
fome fine powdered bark in my trunk, and it
occurred to me, that if any thing could be
done to preferve my life, it would be that
medicine taken in red wine ; but my fpeech
immediately failing me, I could not diredl the
fervant to give it to me. Death feemed ap¬
proaching ; coldnefs had feized all my limbs ;
my fight became <:onfufed, as I perceived

from

[ 76 ]

from looking at the liars, which danced be¬
fore me ; and the rattle or noife in my throat
was very perceptible to the fervant, as he af¬
terwards told me. I fainted, and continued in
a ftate of infenfibility, I believe, for about
an hour. The loud lamentations of the fer¬
vant, bewailing his own misfortune in loling
his mailer in a country fo remote from his
own, feemed to recal me to life. I felt as if
refreihed with a little lleep, and got out the
words bark and wine ; it was inllantly brought,
and the man gave me two large tea-fpoonfuls,
in a large glafs of claret. The effedt was in-
llantaneous, and operated like a charm ; the
coldnefs left me, I could fpeak intelligibly,
and could move my hands. I told the fer¬
vant to give me a tea fpoonful of the bark
every hour, in a glafs of claret. By eight
in the morning I had taken lix dofes, and
more than half a bottle of claret. I was con-
fiderably ftrengthened, and could converfe
with Mr. Beaumont, who encouraged me to
perfervere in the bark, and treated me with
uncommon attention. I had been fadly ne-
gledled at BulTorah, but this was amply made
up to me by the humane and tender atten¬
tions of Mr. Beaumont, who was a great pre-

deftinarian.

I 77 ]

deftinarian, and who never fhunned danger
when he felt it a duty to affift a fellow-crea-
atiire. He waited upon me like a nurfe, con-
foled me under pain and ficknefs, and, when
my fever was at its greateft height, he has
often held me in his arms, when I wanted to
be removed, or my bed fhifted. About this
time my legs and thighs became covered with
blotches of a dulky brown hue, fome of tliem
as broad ^s the palm of the hand, quite dry,
and they itched intolerably. At the fame
time feveral little boils broke out in different
parts of my body, but there was only one,
over my eye, which came to fuppuration ;
the others, and the eruption on my legs and
thighs, all diiappeared.

I continued the bark till twelve o’clock, and
then left it off till four, w^hen I topk another
dofe. The dreadful fever of the preceding days
did not return on this, but I was ftiU extremely
ill, had very great difficulty in fpeaking and
breathing; a. fwelling alfo in my throat, parched
tongue, and unquenchable thirfl. I had not
the mofc diftant hope of living. I tried to
take fome broth, but the fwelling in my throat
prevented my fvvallowing. I paffed a very
badmight, with dartings, anxiety, and great

pain

-[ 78 ]

pain over the kidnies, and what little deep I
got feemed to make me' worfe 5 I was fatigued
with it, and under the conftant dread of fuf-
focation 5 towards morning my throat grew
worfe, and my thirfl: was exceffive.

1 8th. Left olf the bark, uncertain what I
ought to do — no fever, but the fame fymp-
toms as the day before — drank a little chicken-
broth, which was the only fuftenance I had
taken for four days before; great oppreffion and
heat in my ftomach and bowels. Mr. Beau¬
mont found out an Armenian, who profeffed
phyfic. This man gave me a clyfter, which
gave me 'great relief, and a water to drink,
famous as a febrifuge among the Berdans ; I
drank of it freely, and found much benefit
from it. But the moft extraordinary of all
the fymptoms I experienced was this, that
the third day after the firfl: intermifiion of my
fever, one of my teeth, and one of the nails
of my hand, came out without the fmalleft
pain, only a little fw^lling in the gum, and,
on the nail falling off, fome matter flowed
from the end of my finger ; I never had had
the tooth-ach ; at this time the boil on my
eye fuppu rated.

From

[ 79 ]

From the i8th of June to the 5th of J uly,
being feventeen days, my fever did not re¬
turn. I recovered ftrength flowly, and could
walk a little, fupported by two men. My
food was chiefly chicken and veal broth, and
about a glafs and a half of Madeira wine a
^day. Yet I had ftill many fymptoms of dif-
eafe hanging about me — reftlefs fatiguing
nights — great thirfh — bad tafte in my mouth,
every thing I took feemed bitter and fait;
pains in my back, fldes, and loins, and great
difficulty in making water. In this tinie I'
palfed much bile, naturally and by clyfter,
and' I had a purgative from the Armenian,
which weakened me' greatly.

The fprings lifted, as feamen exprefs it,
the iff; of July, that is three days before the
change. The opinion is univerfal in thofe
countries, and alfo in India, particularly Bom¬
bay, where intermittents are prevalent, that
the change and full of the moon has an efFecb
upon all intermitting difeafes, of which after¬
wards I had many proofs in my own calc.
To prevent a relap fe, I took forne decodioa
of bark, but in too fmall quantities to anfwer
tlic purpofe.

4th

4th July. My water, from being thick
and muddy, became quite clear.

The 5th of July, after dinner, I was taken
with a flight hot fit, which Continued about
two hours, and then went off by copious per-
fpiration ; the remaining part of the evening
I Was intirely free from fever.

• 6th. I took decodtion of bark — no fever.

7th. At eleven o’clock a regular cold and
hot I fit; the former continued three quarters
of an hour, the latter two hours. Although
much lefs fevere than my former fever, yet I
fuffered a good deal from the hot fit. Left off
the bark by the advice of the Armenian, who
told me that it heated me, and made me
worfe. — Much weakened by this day’s illnefs
— nor did the perfpiration intirely free me
from the fever.

8th: Had a clyfler thrown up, and early
in the morning took a draught from the Ar¬
menian,' compofed of fine vinegar, fugar,
and a country feed infafed overnight in wa¬
ter. — A flight hot fit, but of fhort conti¬
nuance.

pth. The draught of yeiferday repeated —
at ten a regular cold and hot fit,' rather lefs
violent than the laft.

loth.

loth. No fever — tolerably well.

1 1 th. Between eight and nine in the morn¬
ing a cold and hot fit, much more fevere
than the laft — great heat/ thirft, and oppref-
fion — much weakened. • I now perceived I
had got a regular tertian, and determined on
the bark, but was prevailed on by the Ar¬
menian not to life it, he promifing to cure
me in a day or two. He gave me water-r
melon, and his infufion of vinegar and feeds.

1 2th. No fever — find the water-melon
to difagree greatly with my ftomach.

1 3th. Had not as yet indulged much hopei
of a recovery. I felt ftill, even in thofe days
previous to this laft relapfe, many alarming
fymptoms of difeafe, which made me appre¬
hend I could not recover ; and this laft attack
had again reduced me fo low, that it was evi¬
dent that, unlefs I could get i*emoved from
thofe fcorching climates, a very fhort time
would put an end to my life. Except in the
humanity and goodnefs of Mr. Beaumont, I
' was without a fingle comfor-t or conveniency
of life at Buihife. The heat of the \yeather
feemed daily to increafe, and the houfe we
were in hardly covered us from the diredt
rays of the fan. My fervant was taken ill,

G and

[ ]

ftnd appeared to be dying : it was with the
greateft pleafure, therefore, I received the
accounts this day of the Eagle cruizer having
arrived laft night from Bufforah, on her way
to Bombay.

At half pall feven o’clock I had a very fe-
vere fit — the hot fit was uncommonly violent,
and continued about three hours. I was
much reduced, and refolved, at all events, to
take the bark in powder and in large dofes,
and difmifs the Armenian. In this I, was
confirmed by Mr. Puget, who informed me
that the few furvivors at BulTorah owed their
lives intirely to the bark, which had at laft
been given in very large dofes.

14th. I took four dofes, or eight tea-
fpoonfuls, of powdered bark. It purged
me, and carried off a great quantity of black
putrid bile. — This evening I was carried in
my cott on board the Eagle ; refolved at all
events, even if I had been certain of dying
in the boat, to leave Bulhire, where I had
hardly Ihelter from the fun, and where the
heat was fo excellive> that Capt. Alderfon of
the Eagle, and two paffengers, were taken ill
from it laft night. I got on board very late,

. yet

[ 83 ]

yet found myfelf much refreflied from the
fea air.

15th. .The fever did not return. — I con¬
tinued to take the bark as yefterday, and
found myfelf furprifingly ftrengthened. I
perfevered under this courfe till the 3d of
Auguft, when the veffel arrived at Mufcat,
and I was aftonifhingly recovered for the
fhortnefs of the time.

From the 14th of July to the 3d of Au¬
guft I had taken feven ounces of bark ; and
as the fever had returned upon me the laft
day of the fprings at the preceding change of
the moon, two days before this change I in-
creafed my daily dofe, and continued in this
manner till the 4th, when the fprings being
over, and perceiving no fymptoms of fever
remaining, I left off the bark intirely. I
had generally taken fix tea-fpoonfuls every
day.

From the 15 th of July till my arrival at
Mufcat, a fea-port on the coaft of Arabia,
my recovery was exceedingly rapid. I had a
keen appetite, a pretty good digeftion, found
refrefliing fleep, and my daily increafe of
ftrength was very perceptible. My diet, till
this time, had been generally chicken broth,

G 2 rice.

rice, and boiled fowl, light pudding, &c.
On leaving off the bark I obferved no parti-
ciilar regimen, only abftaining from faked and
high- feafened meats, and confining myfelf to
three or four glaffes of Madeira. I found
that an infulion of prunes, with a fmall quan¬
tity of cream of tartar, was of much fervice
to me during the courfe of the bark, as it
kept me cool, and my body open. I was
fenhbie, at times, during my recovery, of a
flight but troublefomie pain under my fifth
rib on the right fide, cfpecially when I lay on
that fide ; but from feeling and preffing my
hand over the region of the liver, and from
other circumftances, I had no reafon to
fufpe«£l that my liver was affedted ; and as
it foon left me, the caufe was probably tri-
flino' or accidental.

On my leaving Mufeat, a large hoil came
upon the hip-bone, the fize of a fmall melon,
extending fome way up the fide and down the
thigh, with a hard bafis. After arriving at
Bombay, wdiich we did in fourteen days, it
broke, and in a few^ days healed - up. I
fhall only add, that at Bombay I was detained
fpur months, before I had an opportunity of
preceeding to Europe. In that time T had
9 three

, C 85 ]

three returns of mj ague, but, on taking a
few dofes of bark, it left me. Thofe attacks
happened at the change of the moon. From
Bombay to Europe I had three or four flight
fits of the ague ; the worft on our making
the coaft 'of South Guinea, at the fettlem.ent
of Benguela, where we found the wretched
remains of a Fortugueze garrifon, the fur-
vivors of a fatal putrid fever, which, as they
told us, raged in thofe parts for eighteen
months before. The lafl; attack I had was
the day we made the Rock of Lifbon, flnce
which time I have had no returns of the ague, f
although, when the wind continues long at
eaft, I 'am fenfible of a tendency to that com¬
plaint.

I flhall now give a brief 'account of the fate
of my fellow-fufferers at* Bufforah. This
unfortunate party conflfted of Capt. Sheriff,
of the Eagle cruifer ; Mr. Brown, a Bengal
merchant, carrying goods from India to Alep-

po ; Mr. Palmer, a gentleman returning with
his fortune from Bengal to Europe ; Mr. Rob-
fon, furgeon to the factory \ Mr. Abraham,
the vice-conful ; Dr. Rofs, who had pradtifed
many years at Conftantinople, fome time in
Bengal, and' was then taking the opportunity
* G j of

[ 86 }

cf accompanying me acrofs the defart ; Mr.
Smith, a merchant from India; and an Italian
Carmelite, the vicar of Bufforah, who came
from Bombay. It is unneceffary to fay, that
the feea dab is a common fymptom in the
Turkiih fever, or, in other words, a ftrong
defire of felf-deftrudiion. We had a fatal in-
fiance of it in our party. Mr. Brown, the
fecond day of his fever, being left alone, got
to his piflols, and, throwing in four or five
balls, difcharged it into his bread:, and was
found dead a few minutes afterwards. I be¬
lieve every one of us at times would have done
the fame, had we been poflbfled of the means
of accomplifhing it. Mr. Robfon died the
third day of his fever in great agonies, but
perfectly fenfible ; his was a continued high
fever, without any remiffion. Mr. Palmer
died the fourth day under the fame fymptoms
as the preceding. The Carmelite, the fecond
morning after he was taken ill, had opened
a vein in his arm, and bled to death, mofl
probably intentionally. Captain Sheriff was
feized with the fever on his return from Buf¬
forah to Bufhire. He died on the third day
in a manner which is even painful to relate.
He was a man of Angular ftrength of confti-

tution.

[ 87 i

tution, and fufFered unufual agonies before he
died. His cries were heard all over the fac¬
tor)^ ; he foamed at the mouth, gnaflied his
teeth, and tore his arms with his teeth.
Thofe who heard him compared his cries to
the bellowing of a mad bull. He was no
fooner dead but his body was covered with
purple fpots, and fo offenfive that the people
could hardly carry it out to be buried. Mr.
Sheriff's was what they call the worft kind of
plague.

Mr. - whom I have mentioned,

was an uncommon charad:er. He was fhut
up in a mud houfe at Bufforah during the
great plague in 1773, which he efcaped. He
had fortunately a large ftock of Bengal cotton
goods with him, which he difpofed of to the
inhabitants to wrap their dead in. They ufed
to depofit the price in a bailee t, which by
means of a long rope he let down, which was
then hauled up, and lowered again with the
cloth purchafed. He had an account of
70,000 winding-fheets which he fold during
the calamity. This fad: was attefled by Mr.
Abraham and the conful. He was a well in¬
formed fenfible man, and an excellent linguift.
On his voyage to Bufforah he was feizedwith

G 4 a fpecies

[ §8 ]

a fpecies of infanity : he fufpected the captairi
and fupercargo of his fhip to have confpired
his death, and he fancied he overheard their

• f

deliberations on the fubjedl : he always flept
^vith piflols in his cott, and refufed all man¬
ner of communication with his confpirators,
as he called them. He then imagined him-
felf poffeffed of the fingular faculty of over¬
hearing, by the peculiar confcrudtion of his
ears, the moft diftant w^hifper to his preju¬
dice. Although fuch an idea was abfurd, yet

he could argue upon it with a great deal of

ingenuity. In all other refpedts he was per-
feftly reafonable, and converfed on every other
fubjedl with much good fenfe and propriety.
On the breaking out of this ficknefs at Buffo-
rah he Ihut himfelf up in the upper room of
an Armenian's houfe, and had no intercourfe
whatever v/ith the other Europeans. It was
riot known how he exifted ; he, however,
efcaped the infedlion. Ele afterwards came
, to England, where I have feen him, and he
appeared' perfedlly well.

Dr. Rofs', whom I have mentioned, on the
firft rumour of the plague put himfelf under
a courfe of bark, which he continued taking
ill large quantities while I remained at Buffo-

i ■ ■

rah.

' «

[-89 ]

rah. I have fince feen him in England, and
he told me that when the illnefs began to
abate, he was taken with an intermitting- fe-
ver ; that he fled from BufTorah in an* open
boat towards Bagdat, but was taken by a
party of Arabs, who carried him upon the
defart. He contrived to get away from them^
orolTed the defart to Aleppo, and afterwards
got to England. , . ^

It was computed that 275,000 died in the
town of Buiforah of the plague of 1773? and
that 25,000 died in the town and neighbour¬
hood of this lait plague. We heard of its
approach from Afia Minor ; it ravaged Diar^
bekir, antient Aflyria, and kept the courfe of
the river Tygris to Bagdat, where many died.
From thence it followed the courfe of the
Euphrates to BuflTorah, and for about twenty
miles lower. The oppofite, or Perfian fhore,
although within a few miles, was exempted ;
nor did it fpread more than a few miles inio
the defart.

The firfl: fymptoms of this fever, or plague,
are generally fwelling of the tongue, a violent
head-ach, bleeding at the nofe, pains all over
the body, a conllant inclination to make wa¬
ter, which comes in drops, and attended with

great

^ •

[ 90 1

great pain, and is as high-coloured as blood ;
(if the urine, on ftanding, becomes purple, it
is faid to be a certain fign of death) extreme
heat, great apprehenfion, all objed:s appear¬
ing of a yellow colour, uncommon terror,
and at the fame time a great defire for death ;
there are alfo boils or eruptions on the Ikin,
which moft commonly appear either jufi: be¬
fore the dif^afe proves fatal, or the patient be¬
gins to recover.

[ 9» ]

VI. On the Want of a Pericardium in the^
Human Body. By Matthew
M.D. F.R.S. and Phyfcian to St. George's
Hofpital. Read Dec. i6, 1788^

It is of importance to afcertain, any devia¬
tion from the ordinary ftrucflure of animals,
becaufe it either affifts in explaining fomo
circumftance in the animal oeconomy, or
tends to give a more accurate view of nature.
This, however, is not equally the cafe with
every deviation ^ but it is of more confequence
to afeertain it in proportion as it may be rare,
as doubts may have arifen with regard to it,
or as it may be more connedled with any great
operation of an animal body. In which ever
of thefe lights we confider the lingular phae-*
nomenon of a want of pericardium, it is very,
worthy of being noted.

This is one of the deviations -from the or¬
dinary ftrufture of an animal in which nature
has been moll fparing; "very few anatomifts.
have had an opportunity of obferving it, and
the defeription which thofe few have given

4 has

[ 92 ]

lias been very imperfe6t The appearance
alfo of an adhefion of the pericardium to the
heart might be miftaken for a want of this
'membrane altogether ; and hence the bell:
’modern anatomifts have confidered this lufiis
as never having taken place. Even Haller,
who was by no means difpofed to be incre¬
dulous, has denied its exiftence. An opinion
thus taking its origin from the authority of
the moft eminent anatomifts, had at length
fpread into a general belief that the want of a

pericardium

* I have met with the following inftances of a want of peri¬
cardium being obferved by different anatomifts.

** Difcipulum item in Romana Academia mortuum fecur
faderat excellens Medicus Alex. Trajanus Petronius, a eivitatc
Caftellana^ acris judicii vir) huic mifero juveni pericardium de
craf, itaque fubinde in fyncopen incidebat, fubinde mortuo
ftmilis confpiciebatur, quo genere morbi exan;matus eft,” — >
Reald. Columb, Lib. xv. p. 265.

Cor pericardio plane denudatum quod & femel Columbo
obfervatum. Dextra auricula circa venae arteriofae orificiuna
aneuryfmatis modo ultra juglandis magnitudinem diftenta erat.”'
Vid, Barthol. Centur. iv. Hiftor. 20. p. 266.

. Monf. Lhtre.a trouve dans une femme de 54 ans le coeur
fans pericarde & enferme abfolument a nud dans la cavite de la
poitrine. II etoit fee dur c^unc furface inegale, raboteufe, il
:ivoit peu de graiffe & une graiffe peu onftueufe. On voit affez
par ce qffil y avoit d’extraordinaire dans ce coeur a quoi doit
fervir le pericarde, &c.” — Memoires de PAcademc Royale, .

P-37-

“ II

[ 93 ]

pericardium had never occurred in the human
body. It will appear, however, that this ge¬
neral opinion has been taken up too haftily,
and that fuch a lufus does fometimes happen.

Upon opening into the cavity of the cheft
in a m.an about forty years of age, in order
to explain at ledlure the fituation of the
thoracic vifcera, I was exceedingly furprized
to fee the naked heart lying on the left fide
of the cheft, and could fcarcely at firfl be-

“ II naquit a Grenoble un foetus monftrueux mort mais qui
fa mere avoir fenti remiier peu de terns avant fa nailfance,’^ &c.

‘‘ Celui la (fcilicet le Foetus) portoit f®n coeur en dehors pendu
a fon col comme une medaille de forte qu’il pouvoit aller &
venir fur la poitrine. Ce cceur etoit d’une conformation naturelle
fans pericarde, attache a fes gros vaiffeaux qui lui tenoient lieu
de cordons & qui etoient a decouvert comme lui. M. de Vau-
bonnais envoya cette relation a M. Parent bien atteftee par des
medicins & des chirurgiens de Grenoble.’' — Id, p. 39.

“ Qu’il (fcilicet le Coeur) puiife etre fans pericarde jel’ai vu
dans un chien fort vigoureux, mais je fuis ici un temoin recu-
fable, mes amis f^avent pourtant qUe j’ay de la bonne fai par
excez & que je fuis fincere dans le chofes mefme ou mon interet
m’obligeroit de dilfimuler.”— Difcours iv. p. iii, 112. Paris
1685.

“ In fine, I have obferved in a new-born female infant the
heart without a pericardium, and turned upfide down, fo that
its bafis, with all its veflels, had fallen down as low as the navel,
and its apex, ftill on the left fide, lay hid betwee^ji the tw'o lungs, ^
Philofoph. Tranfa<flions, An. 1740 — 1741. N®46j,

Ueve

[ 94 ]

Iieve wKat I faw, but the circumftances were
too ftriking to keep me long in doubt. The
heart was 9S bare and diftinft as it commonly
appears in opening into the cavity of the peri¬
cardium, and eveiy collateral circumftance
confirmed the fadl*

The mediaftinum confifled, as in common
cafes, of two laminae of pleura ; but it was
fomewhat changed in its direition, being in¬
clined to the right fide of the cheft, and ly¬
ing upon, the right of the heart. Both la¬
minae were connefted together through the
extent of the mediaftinum by the common
intervention of the cellular membrane, and
croflTed over the vena cava fuperior about an
inch above its entrance into the auricle. The
heart lay loofe in the left cavity of the cheft,
unconnefted in any way except by its veflTels ;
was of a large fize, elongated in its fhape,
and had its apex oppofite to the eighth rib.
The right auricle was obvioully in view in
the fame manner as when the pericardium
has been opened, and the vena cava fuperior
and inferior were clearly obferved entering
into it. The appendage of the left auricle
was as clearly in view ; and when the heart
was inverted, fo as to have its apex turned

upwards.

[ 95 3

Upwards, the extent of its cavity was feen^
with the two pulmonary veins of the left fide
entering behind the appendage. The right and
left ventricles were diftind:, with the coro¬
nary vefiels running upon them ; and the
aorta and pulmonary artery were feen clearly
emerging from them.

The heart was involved in the refledion of
the pleura belonging to the left fide of the
cheft, which became its immediate covering,
and, upon making the llightefl: incifion into
the fubftance of the heart, its rnufcular ftruc-
ture was laid bare, as in any common heart
deprived of its pericardium. There was no
connedion between the heart and the dia¬
phragm, but they were entirely feparate; and
the diaphragm oppofite to the flattened part
of the heart was covered only by a refledion
of the pleura. It is well known, that, in
ordinary cafes, a portion of the pericardium
adheres firmly to the diaphragm, which forms
a medium of connedion between it and the
heart. In adhefions, too, of the pericardium
to the heart, its attachment to the diaphragm
is always the fame as in the ordinaiy healthy
ftrudurc of thefe parts.

The

{ 96 ]

Th6 apex of the heart being lower dowii
than ufual, there was a deficiency of the left
lung correfporiding to this change of fitua-^
tion.

The phrenic nerv^ of the tight fide ran
between the two lathing of the mediaflinum,
near that edge of it which was applied to the
right fide of the heart. The left phrenic
fterve ran between the fame two laminas of
the mediaflinum, almofl immediately under
the flernum. This is a great deviation from its
natural courfe, for it commonly paffes on the
outfide of the pericardium, following the ob^
liquity of the left edge of the heart.

All thefe circumflances were feen upon
limply removing the flernum with a fmall
portion of the ribs, and therefore put the
want of pericardium in this fubjedl beyond
all doubt. '

In the adhefion of the pericardiurrl to the
heart, the diredlion of the mediaflinum can¬
not be altered, the heart cannot be feen ly¬
ing loofely in the cavity of the chefl, uncon-^
nedted with the diaphragm, the appearance
of its feveral cavities and veiTels cannot be
diflindl, nor can any of the other circum-^
fiances take place which we have mentioned.

Did

[ 97 ]

_ ^

Did the afcertaining of this fingular lufus*
naturae require any other evidence than the
defcription which we have given, it would
happen to be fupported by a very large tefti-
mony, for it has been feen by many medical
gentlemen in this metropolis, who are emi¬
nently {killed in anatomy, and by a great
number of ftudents, who are veiy capable of
judging.

In this lufus we may remark, that the
mediaftinum paffed fomewhat to the right,
fo that the heart was intirely in the left ca¬
vity of the' cheft. Upon a little refledlion
we fliould fuppofe that this would happen.
Had the mediaftinum been joined to the body
of the heart, it would have been difturbed
in its fundlion, from being confined by a tight
cord to the fternum. To avoid this incon¬
venience, the mediaftinum was fituated a lit¬
tle more to the right, and the heart a little -
more to the left, than common.

The right phrenic nerve pafled very natu¬
rally between the laminae of the mediaftinum,
for this was nearly its ufual courfe j but that
of the left phrenic nerve was necefiarily much
changed. It could not pafs over the body of
the heart, or of the lungs, which were each

H of

[ 98 ]

<bf them to be in conilant motion ; it had
therefore to feek for fonie fixed channel, and
the only one was in the mediaftinum. Ac¬
cordingly it was found, as defcribcd, between
the two lamina? of the mediaftinum, almoft
immediately behind the fternum.

It was natural to fuppofe, as there is a de- '
ficiency of the lungs in ordinary cafes, oppo-
fite to the apex of the heart, that where the

apex of the heart was altered in its fituation,

^ •

there fliould be a change in the fituation of
the deficiency in the lungs correfponding
to it.

It may be a queftipn, how far the increafed
bulk and elongated fhape of the heart, in this
particular inftance, depended on a want of the
pericardium ? It might be fuppofed that the
heart, being free from its ufual reftraint, had
grown beyond its common limit. This, I
think, however, will appear, after a little re¬
flexion, not to have been the cafe. The heart,
under the common circumllances, is originally
inclofed in a pericardium which grows along
with it, and the increafe of growth keeps
'pace in each. If, then, there fhould be at
any tme a difpofition to form a large iheart,
there is alfo formed a large pericardium to

contain

[ 99 ]

contain it ; or if the heart be fmall, there is
proportionably a fmall pericardium. If it
be ftill faid, that the pericardium tends to
limit the growth of the heart, a queftion na¬
turally arifes, What checks the growth of the

pericardium? Is it a principle within itfelf?
Why fliculd not the heart be poffelTed of the
fame principle ? I confider, therefore, the
increafed bulk and elongated fliape' of the
heart, in this particular inflance, as an acci¬
dental circumftance, and by no means de¬
pending on a want of the pericardium.

From the want of a pericardium' in an.
adult who had arrived at the middle period of
life, it is reafonable to think that its ufe is
not very effential. One ufe which has been
attributed to the pericardium is, the fecretion
of a liquor to lubricate the furface of the
heart for its eafy motion. This fort of rea-
foning would appear a priori to be ill founded.
It is is impoffible to fee how a bag like the
pericardium, or any other bag, fhould be pe¬
culiarly fitted for this purpofe. The furface
of the heart itfelf, and of the lungs, might
have had a power of fecretion ; and accord¬
ingly we find in this particular fubjecS a fluid
fuppjied by them for lubricating the heart

H 2 without

t lOO ]

without a pericardium. This account of the
ufe of the -pericardium was very unfatisfactory
to the mind of Haller, and upon the grounds
we have mentioned.

The more ftriking ufe of a pericardium is
to keep the heart in a fteady fit nation, fo as
to enable it to carry on its fundion uniformly.
This one is more difpofed to confider as its
ufe from its being a very ftrong membrane,
capable of bearing a good deal of reiiftance ;
and from its being firmly attached to the
tendinous portion of the diaphragm, which
preferves always nearly the fame fituation. If
we refled, however, a little, we fhall perceive,
that 'a heart without a pericardium is not
really left loofe in the cavity of the cheft,
but is confined in a great meafure by the
parts being exadly adapted to each other, and
completely filling up that cavity. The heart
may in this manner be fufficiently confined to
perform its fundion, although it cannot be
fo fteadily maintained in the fame fituation,
as when enclofed in its pericardium.

/ Such are the circumftances which prefent
themfelves to the mind as matter of reafon-
ina in the cafe before us ; but I was anxious
to learn fomething of the hiftory of the per-

fon

[ loi 3

fon during life, becaufe it appeared not
unlikely that it might throw light upon
the fubjed:. My inquiries, however, have
been without effedl. I cannot find that anjf
particular obfervatioa had been made upon
the pulfe by the phyficians who attended
him. It is not fair to conclude from thence,
that the adiion of the heart is exadly the
fame whether it be inclofed or not in its pro¬
per membrane ; but it is furely enough to
fhew that the adtion is not very much affed:-
ed by the want of it. The different confi-
derations which have been mentioned above,
will ferve, I hope, in fome meafure to explain
this effed:, and to point out how the circu-*
lation may be carried on, even for a very long
period, under thefe particular circumftances.

H 3 Expla-

[; 102 ]

Explanation of Plate II.

The fternum broken ofr at the joint be-

tween its firft and fecond bone.

B. .The mediaftirmm diredled a good deal
towards the right fide of the cheft,
and confifting evidently of two la¬
minae of pleura.

CC. The edges of the diaphragm, which,
together with the lower end of the
mediaftinum, v/as pulled upwards at
the time the drawing was made, in
, I order to give a more diftindt view of
the left fide of the chefi:.

D. The heart fee n naked, as it appeared

upon fimply raifing the fternum. —
The two ventricles, the right auricle,
the aorta, the pulmonary artery, and
the vena cava fuperior, are feen dif-
tindtly.

E. The lung of the left fide collapfed.

F. The fpace between the heart and diaph¬

ragm, ftiewing that there was no con¬
nexion between them.

Gi A porti^on of the lung on the right fide
feen collapfed. ^

VII. On

[ 103 J

VII. On Introsusception. By John
Hunter, Efq. F. R. S. Surgeon Extra--
ordinary to, the Kmgy and Surgeon General
to the Arfiiy^ Read Augujl i8, 1789.

Introsusception is a difeafe produced
by the paffing of one portion of an inteiline
into another, and it is commonly, I believe,
from the upper paffing into the lower part.

If the mode of accounting for introfufcep-
tion, which I am going to offer, .be juft, it
will moft frequently happen in the way I have
ftated, although there is no reafon why it may
not take place in a contrary diredlion ; in
which cafe, the chance of a cure will be in-
creafed by the natural adlions of the intefti-
nal canal tending to replace the inteftine ;
and probably from this circumftance it may'
oftener occur than commonly appears.

When the introfufception is downwards it
may be called progreffive, and when it hap¬
pens upwards, retrograde. The manner in
which it may take place is, by one portion of

H 4 ' a loofc

[ 104 1

a loofe inteftine being contra6led, and the part
immediately belov/ relaxed and dilated ; un¬
der which circumftances it might very readily
happen, by the contraded portion flipping a '
little way into that which is dilated, not from
any aftion in either portion of inteftine, but
from fome additional weight in the gut above.
How far the periftaltic motion, by pufhing
the contents on to the contracted parts, -may
force that into the relaxed, I will not deter¬
mine, but fhould rather fuppofe that it would
not.

By this mode of accounting for an acciden¬
tal introfufception, it may take place either
upwards or downwards ; but if a continuance
or an increafe of it arifes from the aCtion of
the inteftine, it muft be when it is down¬
wards, as we actually find to be the cafe ; yet
this does not explain thofe in which a con-
fiderable portion of inteftine appears to have
been carried into the gut below : to undei*-^
ftand thefe, we muft confider the different
parts which form the introfufception. It is
made up of three folds of inteftine ; the in¬
ner, which pafies down, and being reflected
upwards, forms the fecond or inverted por¬
tion, which being reflected down again, makes

the

[ 105 ]

the third or containing part, that is the outer-
moft, which is always in the natural pofition.

The outward fold is the only one which is
a6live, the inverted portion being perfedlly
paflive, and fqueezed down by the outer,
which inverts more of itfelf, fo that the angle
of invertion in this cafe is always at the angle
of refle(5lion of the outer into the middle por¬
tion or inverted one, while the innermoft is
drawn in. From this we can readily fee how
an introfufception, once begun, may have any \
length of gut drawn in.

The external portion acting upon the other
folds in the fame way as upon any extraneous
matter, will, by its periftaltic motion, urge
them further ; and, if any extraneous fub-
flance is detained in the cavity of the inner
portion, that part will become a fixed point
for the outer or containing inteftine to >ad:
upon. Thus it will be fqueezed on, till at
laft the mefertery preventing more of the in¬
nermoft part from being drawn in, will adl as
a kind of ftay, yet without intirely hindering
the inverted outer fold from going ftill further.

For it being tie middle fold that is ad:ed up¬
on by the outer, and this adlion continuing
after the inner portion becomes fixed, the gut

[ io6 ]

is thrown into folds upon itfelf; fo that a foot
in length of inteftine lliail form an introfuf-
ceptlon of not more than three inches long.

The diffe rent appearances which I have de-
feribed as taking place in an introfufeeption,
are diftindtly feen in the annexed plate, in
which the different folds of inteftine are
expofed.

I have afferted that the outer portion of
inteftine was alone adlive in augmenting the
difeafe when once begun ^ but if the inner
one was capable of equal ad:ion in its natural
direction, the effed would be the fame, that
of endeavouring to invert itfelf, 'as in a pro-
lapfus ani ; the outer and inner portioits, by
their adion, would tend to draw in more of
the gut, while the intermediate part only
would, by its adion, have a contrary ten¬
dency.

The adion of the abdominal mufcles can¬
not affifl: in either forming, or continuing this
difeafe, as it muft comprefs equally both above
and below, although it is capable of produc¬
ing the prolapfus ani.

In cafes where introfufeeption begins at
the valve of the colon, and nverts that in-
tefline, we find the ilium is not at all affeded ;

4 which

[ ]

M'hich proves that the mefentery, by ading
as a ftay, prevents its inverfion.

f'rom the natiiral attachment of the me¬
fentery to the inteftines, one vv^ould, at the

firfc view of the fubjed:, conceive it impof-

fible for any one portion of gut to get far
within another ; as the greater extent of me¬
fentery that is carried in along with it would
render its further entrance more and more
difficult, and we ihould expedt.this difficulty
to be greater in the large inteflines than in
the fmall, as being more clofely confined to
their fituation ^ yet the largefi: introfufception
of any known was in the colon, as related by
Mr. Whately*.

The introfufception appeared to have be¬
gun at 'the infertion of thedlium into the co¬
lon, and to have carried in the caecum with
' its appendix* The ilium pafied on into the
colon, till the whole of the afcending colon,
the tranfverfe arch, and defcending colon,
were carried into the figmoide flexure and
redlum* The valve of the colon being the
leading part, it at lafl; got as low as the anus ;
and when the perfon went to flool he only
ernptied the ilium, for one half of the large

* Vid. Philof. Tranf. Vol. Ixxvi. page 305.

inteflines

[ io8 ]•

inteftines being filled up by the other,, the
ilium alone, which paffed through the center,
difcharged its contents.

Since that time the following cafe has oc¬
curred, which is in many refpedls fimilar;
the patient was attended by Dr. Afli, and the
body infpedted after death by Mr. Home.
A. B. aged nine months, a large healthy
well-looking child, who, as far as appeared,
had never been indifpofed from his birth, was
feized with a ftrong fpafm, ftretching himfelf
out fuddenly, without having had any fymp-
toms of previous ailment. Either during the
fpafm, or immediately after it, he paffed a very
large loofe ftool, and after that difcharged, at
intervals, fmall quantities of mucous flime,
covered over with little fpecks of recent fluid
blood. Dr. Afh vifited him four or five hours
after this attack, and found him in all other
refpeds perfectly well ; the child fucked hear¬
tily, but Dr. Afh, on obferving his pulfe to
be lefs quick than is ufual in children fo young,
his heat to be rather below the common flan-
dard, and, added to thefe, the fmall mucous
and bloody difcharges, ffifpedled that morti¬
fication had taken place in the bowels, with¬
out being able to guefs at the caufe, as the

child

I 109 ] •

child had laboured under no previous indif-
pofitlon. In this uncertain fituation, various
_ineans of relief were attempted by purgatives,
ibmentations, the warm bath, and different
kind of clyfters, but without any good effed:.
On his firft examination of the abdomen he
felt (or thought he felt) a deep-feated fullnefs
or hardnefs under the left hypochondrium ;
blifters were applied to the part, and every pof-
fible means attempted, without obtaining any
evacuation by ftool, or any other apparent re¬
lief s his ftrength gradually funk, and his pulfe
became gradually weaker, although he con¬
tinued to take the bread: eagerly till within a
few hours of his death, which happened juft
fixty hours after the firft fpafmodic attack.

The following were the appearances found in
the dead body. Upon opening the abdomen,
the fmall inteflines confiderably diftended with
fluid contents, occupied fo much of the ca¬
vity as to prevent any of the other vifcera
from being feen; and the mefenteiy was fo
much confined, that the convolutions of the
fmall inteflines could not be readily followed.
This confinement was found to arife from an,
introfufception of the ilium and its mefentery,
together with the caecum, and afcending co-

loa

[ no j

Ion into the defcending part of the figmoide
flexure of the colon, the inefentery of the ili¬
um being drawn up fo obliquely acrofs the
root of the mefentery, as to prevent the je¬
junum from having its ufual freedom of at¬
tachment.

The only part of the colon which could be

feen was the figmoide flexure, in which was
diftinclly to be felt a hard fubflance, confift-
ing of the ilium and inverted colon. Thefe
parts being removed, for the purpofe of a
more accurate infpeclion of them, the fig¬
moide flexure of the colon was laid open, and
was difcovered to contain the caecum, and co-
‘ Ion in an inverted ftate. The internal fur-
face of thefe, when, expofed, were found to
have put on a dark red appearance, approach¬
ing to black ; the whole appearing like a folid
fubflance, rounded at the end, hanging loofe
into the defcending colon, and about four
inches long. Upon dividing the inverted co¬
lon, the ilium and appendix casci were feen lying
clofe to each other, and their two openings
found on the rounded end of the inverted co¬
lon, leading direftly into the figmoide flexure;
the portion of the ilium was a little twilled,
but not in the leafl corrugated, it was rather

' flretched

[ III ]

ftretched, and much prefled agalnfl the ap¬
pendix casci and its own mefentery, by the
furrounding colon, and a convolution of the
appendix near the termination was fo much
preffed againft the ilium as to make a mark
upon it, and probably had compreffed its fides
fo as to prevent any thing from paffing. The
portion of ilium was about four inches long.

The inverted colon had drawn in the mefo-
colon, and a portion of the omentum that was
attached to the tranfverfe arch. The portion,
of the colon near the valve, which formed
the extremity of the inverted part, was much
thickened in its fubftance by the eftedls of
inflammation, being four or five times its na¬
tural thicknefs ; it was a ’srood deal corru-
gated, or folded upon itfelf, the folds at this
part feemed to adhere to one another, and
form one mafs. The inflammation and thick¬
ening only extending two inches, the gut be¬
coming gradually thinner till it was of its na¬
tural thicknefs and appearance ; fo that what
was only four inches in length of introfuf-
ception, contained a confiderably greater
length of inteftine.

The figmoide flexure, which was the con¬
taining inteftine, had the natural appearance,

but

[ II2 ]

but was dilated or relaxed, and the other con¬
tents of the abdomen were in a natural ftate,
nor had the child any other apparent difeafe.
A reprefentation of the parts is annexed.

From the account I have given of intro-
fufception,' it does not fcem probable that
it fhould be of the retrograde kind, unlefs
from an inveriion of the periftaltic motion,
which could only continue for a fhort time,
and the natural motion being reftored, a cure
would probably be performed.

This difeafe happens moft frequently in the
firft fifteen years of life, not occurring fo
commonly in older people, neither does it, I
believe, ever take place in the colon itfelf,
although we find that gut affecfted by it
An introfufception can never be perfedlly
known till after death ; but where there are
violent affedtions of the bowels, attended with
conftipation, we have reafon, .from the cafes

* A prolapfus ani is, in fome refpeds, fimilar to an intro¬
fufception, and may poflibly begin in the fame way, but is con¬
tinued by the adion of the abdominal mufcles, never by the ac¬
tion of the gut itfelf. It differs from introfufception as not be¬
ing contained in a gut; for, inftead of having an inclofing gut
inverting itfelf by its own adion, there is an inclofed gut pro¬
truded by the adion of the abdominal mufcles, and the paffing
of the faeces through it, and the point of inverfion is at the
extremity of tlie protrufion, and as it inverts it pulhes out of
the body.

which

[ ”3 ].

which have been examined in the dead body,
to fuppofe that this difeafe may be the caufe
of them : there are, however, fo many other
difeafes which produce the fame fymptoms,
that nothing can be afcertained. But if an
introfufception is fufpefted, it will be proper,
in the mode of treatment^ to fuppofe it to be
of the progreflive kind*

In the treatment of this difeafe various me¬
thods have been propofed ; bleeding, to lelTeri
the inflammation that might be brought on,
and quickfilver to remove the caufe, are the
moft obvious, and the means that are ufually
recommended*

Quickfilver would have little effedt either
in one way or the other, if the introfufeep-
tion was downward ; for it is to be fuppofed
that it would eafily make its way through the
innermoft contained gut, and, if it fliould be
flopped in its paflage, it 'would, by increafing
its fize, become a caufe (as before obferved)
of ,afrifl:mg the difeafe. In cafes of the retro¬
grade kind, quickfilver, aflfifted by the peri-
ftaltic motion, might be expeded to prefs the

introfufception back ; but even under fuch
circumftances it might get between the con¬
taining and inverted gut into the angle of re-

I fledion.

[ “4 3

fle(5llon, and, by pufliing it further on^ In-
creafe the difeafe it is intended to cure.

From the account I have given of the
manner in which it is produced, I fhould
propofe the following treatment in cafes of
progreffive introfufception.

Every thing that can increafe the aftion of
the inteftine downwards is to be particularly
avoided, as tending to increafe the periftaltic
motion of the outer containing gut,, and thus
to continue the difeafe. Medicine can never
come in contadl with the outer fold, and, hav-^
ing paffed the inner, can only aft on the outer
below, therefore cannot immediately affeft
that portion of the outer which contains the
introfufeeption ; but we mufl: fuppofe that
whatever affefts, or comes in contaft with
the larger portion of the canal, fo as to throw
it into aftion, will alfo affeft by fympathy any
part that may efcape fuch application, t
fhould therefore advife giving vomits, with a
view to invert the periftaltic motion of the
containing gut, which will have a tendency
to bring the inteftines into their natural
fit nation.

If this praftice fhould not fucceed, It
might be proper to epnfider it as a retrograde

intro-

[ ”5 ]

introfufception, and, by adminiftering purges,
endeavour to increafe the perijftaltic motion
downwards.

SUPPLEMENT to the Paper upo?%
Introsusception. By Mr. Home.

The following cafe of introfufception up¬
wards has been communicated to me by the
late Mr. Smith, furgeon at Briftol ; in whofe
colleftion of morbid preparations I favv the
parts which had been removed from the dead
body, and preferved in fpirits. That the in¬
trofufception was upwards, is fufhciently af-
certained from the preparation, r

The particulars of the cafe, as far as they
came to the knowledge of Mr. Smith, who
examined the body after death, were as fol¬
low :

A cabin-boy belonging to one of the fliips
lying in Briftol harbour, was corredted by his
mafter for fome mifcondudt, at which the
boy was very much exafperated, and, in the
heat of his paflion, fwallowed fome arfenic,
which had been laid in different parts of the

I 2 (hip

[ ii6 ]

ihip to poifon rats* He was attacked with vio¬
lent pain in the ilomach and inteftines, at¬
tended with exceflive vomiting, and expired be¬
fore any medical afiidance could be procured.

Upon infpedion of the body, the internal
furface of the ftomach was found inflamed to a
very great degree, the inflammation extending
a confiderable way along the tradl of the fmall
inteftines, and in the ilium there was dlfco-
Vered an introfufception of above two inches
long, formed by a portion of the lower part
of the gut having been inverted, and puflied
into that immediately above it.

On flitting up the inteftine, to examine the
introfufception more accurately, a long round
worm was found coiled round the projedling
introfufcepted part, and is preferved in that
fituation in the preparation.

The circurhftances under which the round
worm vvas found, determines the kind of in¬
trofufception, lince I have obferved that Ipe-
cies of worm more commonly in the upper
portion of the fmall inteftines, in which fitua-
tion having been difturbed by the efted:s of
the aiienic, it had confequently moved, to
get at a greater diftance from the poifon. It
is likewdfe probable, from the coming on of
I inflam-

* .

{ ”7 ]

inflammation, that vomiting, an immediate
cifect of the poifon, by which the pefiftaltic
motion was inverted, and the introfufeeption
produced, had been followed by a contrary
aftion, or difpofition to purging, by which
the worm being hurried along till it came to
the introfufeepted part, was there flopped,
and, in the endeavour to extricate itfelf, had
.twined round the projecting part, in which
fituation it died. If the introfufeeption had
been downwards, the worm could not have
been in that fituation.

It is probable, that if the boy had outlived
the immediate effedts of the arfenic, and the
periflaltic motion had perfectly recovered it¬
felf, the introfufeeption would have been by
that means' unfolded.

Expla

[ ii8 ]

Explanation of Plate III.

a. The ilium paffing into the introfufcep-
tion.

The portion of the ilium included in the
introfufception.

The termination of the ilium in the valve
of the colon j from which a bougie
paffes, into the inteftine.

d. The orifice of the appendix cxci with a
briftle introduced into it.

• ‘e

e e. The courfe and termination of the ap¬
pendix casci.

f ff The inverted or contained portion of
the colon, the inner furface of which
has portions of coagulable lymph ad¬
hering to it, the confequence of pre¬
vious inflammation.

g g The containing colon laid open, to
expofe the introfufception. Upon its
external furface are the appendiculae
epiploicae.

VIIL

[ ”9 ]

VI I L Of uncommon Appearances of Difeafe in
Blood^vefels, By Matthew Bail lie,
M.D. F.R.S. and Phyjician to St. George's
HofpitaL Read Septe?nber 15, 17S9.

It is of confequence to remark fingular
appearances of difeafe in the body, even if
they fhould not obvioufly lead to any ufefui
obfervations in practice ; becaufe they open a
more extended view of the operations of the
animal oeconomy, point out more clearly the
. refources of nature, and render the invention
of the mind more generally fitted to affift,
when her efforts would otherwise be inef-
fedlual. It is in this point of view that I
think the following remarks upon fome un¬
common appearances of difeafe in blood-vef-
fels, may not altogether be unworthy of no¬
tice. Two of the appearances which I fiiali
defcribe are certainly very rare, and the other
by no means common.

It is known to every perfon who is ac¬
quainted with the animal ceconomy and pa¬
thology, that the blood coagulates, under cer¬
tain circumftances, in the veffels of the living

■ s

body. One cafe in which it coagulates is,

I 4 when

[ 120 J

when a ligature has been made upon a veffcl,
and the blood is prevented from flowing thro’
it at that part, as in the artery of an ampu^
tated limb. Another c^fe in which it coagu¬
lates is, when a veflel is dilated at any part
into a fort of bag, fo that the blood there
moves flowly, and as it were out of the courfe
of the circulation. The coagulum begins to
be formed at the greatefl: diftance from the
current of blood ; or, in other words, clofe to
the fides of the dilated bag at the greatefl dif¬
tance from the cylindrical cavity of the artery.
It is very rare that a coagulum is formed in an
aneuryfmal artery, until it is confiderably en¬
larged beyond its ordinary fize, and the blood
is a good deal removed from its natural courfe
of circulation. It is flill more rare that the
coagulum fills up the whole cavity in which it
is formed, fo as to prevent the circulation al¬
together through that part pf the veflel. Were
this lafl; circumflance often to take place, it
would frequently become the natural cure of
aneuryfm, and fuperfede the very painful means
pf a doubtful operation. It fometimes hap¬
pens, however, that nature deviates frpm the
ordinary courfe of difeafed operation,* and
forms a coagulum fo complete, as to fill up
entirely the cavity in which it takes place,

without

C I2I 3

without there having been any previous ftop-
page to the circulation by a veffel being ren¬
dered impervious, and where a veflel is not
much enlarged beyond its ordinary fize. I
had an opportunity of obferving this in the ca¬
rotid artery of a man, who was brought, about
two winters ago, to Windmill-ftreet for dif-
feftion. The whole of the arterial fyftem in
this man had a tendency to aneuryfm, the na¬
tural ftru(5ture being in many places changed,
and the diameter of the arteries being fome-
what enlarged beyond their natural fize.
There was, however, no part dilated into a
bag or fack, containing a coagulum, except,
as I ihall immediately explain, in the carotid
arteries,

In the right carotid artery, juft before it
divides into the external and internal caro¬
tids, I found an oval uniform fwelling, about
an inch and an half in length, and the dia-*
meter of the artery was fcarcely enlarged to
more than twice its ordinary fize. The fwel¬
ling was firm, giving the fame refiftance to
the feeling as a healthy abforbent gland,
and, if it had been felt through a thin layer
of mufcle, would certainly have been mif-
taken for one of a large fize. I mention this
pomparifon, to giye a piore diftind: idea of

' the

[ 122 ]

the tumor. When I cut through the coats
of the artery, I found its cavity completely
filled with a firm coagulum of blood, which
had not the appearance of blood being re¬
cently coagulated after death, as in the be¬
ginning of the pulmonary artery, but had the
appearance of an old aneuryfmal coagulum.

The coagulum adhered every where fp
firmly to the in fide of the veffel, that, in fe-
parating it, the inner coat was, in many
places, peeled off along with the coagulum.
In cutting into its fubftance, I found it con-
fifting of diftindl layers, as in a commori
aneuryfm. There was no part of it which
had the appearance of being recently formed,
and, therefore, there cannot be any doubt of
its having exifled for a Confiderable time be¬
fore the man’s death. It is obvious then,
that in this cafe a coagulum had been formed
in the carotid artery, undergoing the fame
procefs as in aneuryfm, and that the ten¬
dency to aneuryfm had remedied itfelf. The
whole cavity being filled up with the coagu¬
lum, there was no circulation whatever at
this part ; hence the caufe of further dilata¬
tion was removed, and there was no danger
of the rupture of the veflel, which is the
principal daiieer in this difeafe.

A fev/

r 123 j

A few cafes only have been related by au¬
thors of aneuryfms being cured without any
chirurgical operation, and even fome of thefe
have been fufpedted not to be authentic*
Two cafes have occurred lately to Mr. Ford,
furgeon, defcribed by him in the London
Medical Journal, about which there can be
no doubt. Mr. Home has offered a very in¬
genious explanation of fuch cafes, founded on
obfervations made by Mr. Hunter on the ftate
of arteries in mortification, viz. that it is pro^
bable the blood coagulates in the artery above
the feat of the aneuryfmal bag, fo as to ren-r
der it there impervieus. This explanation,
although it accounts fufficiently for the cafe
to which it immediately refers, yet is not ap¬
plicable to all cafes where aneuryfrns under¬
go a natural cure. In the one which I have
related there was no coagulum of blood forrn-
ed except in the dilated part of the artery,
no Heps whatever towards mortification had
taken place, fo that the natural cure depended
entirely on the coagulum fbrmed where the
artery was enlarged. The blood here had
coagulated much more readily than in pro¬
portion to the dilatation of the artery, fo that
the whole cavity was filled up before it had

enlarged

[ 124 3

enlarged to any confiderable fize. Wherever
there is a difpohtion in the blood to coagulate
greater than in proportion to the enlargement
of the artery, the coagulum will at length
fill up the whole cavity of the dilated part,
and produce a natural cure of aneuryfm*
This ftate of the blood, or rather of the co-
agulable lymph, may arife from fome con¬
nexion or fympathy it may have with the
difeafed ftruXure of the artery, but it is per¬
haps impoflible to determine this with cer¬
tainty.

We may remark, that in the left carotid
artery of the fame perfon, exaXly before its
divilion into the external and internal carotids^
a dilatation and coagulum were formed s but
the dilatation had more the fhape of a com¬
mon aneuryfmal fack, and the coagulum did
not entirely fill up the cavity of the veffel.
There was only, however, a fmall canal for
the current of blood, and I am inclined to
think that the whole cavity would very foon
have been filled up, fo that on this fide alfo
there would have been a natural cure for the
aneuryfm. — From the litiiation of the two
carotid arteries I fhall juft beg leave to ob-
ferve, that it is not improbable a perfon might

live

[ 125 ]

live without circulation through' a part of the
main trunks of both carotid arteries, fo' that
if it fhould become abfolutely neceffary in

T ^

any chirurgical operation, they might be
taken up by ligature. Mr. Hunter, in his
Ledtures upon Aneuryfm, has mentioned
nearly the fame opinion

OJ' the Obliteration Vessels.

a ■*

It is well known, that under certain cir-
cumftances both arteries and veins become
changed in their ftrudture, lofing their cavi¬
ties, and degenerating into a fort of fpungy
ligamentous fubftance. This happens when
it is no longer necelTary that the blood fhould

* This opinion is in fonie m^afnre confirmed by an experi-
ment made by Valfalva, where he tied up both carotid arteries
of a dog, which lived for two and twenty days afterwards, and
might have continued to live, but that he was killed for the pur-
pofes of difle^lion. In two othe/ experipients of the fame fort
the dog lived a much ftiorter timej in one inftance three days,
and in another fix,— Vid. Valfalv. Opera, Cura Morgagni,
Epift, xiiU p, 507.

It would require a great many, experiments to afeertain the
common event of fuch an operation; but from what has been
faid it appears very obvious that it is capable of fucceeding,
and it could never be propofed by any perfon of common un-
derftanding, except as the oal/ means left pf faring a patient’*
life*

circur

circulate in them, as in certain changes in
the circulation of an animal at a particular
period of life. When a child is born, it is
neceffary that the whole blood of the body
fhould be carried through the lungs, in order
to undergo a change which is intimately con-
nedted with life, and that there fliould be no

other communication between the blood cir¬
culating in the "pulmonary artery and in the
aorta, than through the lungs and the left
fide of the heart. Hence the dudus arterio-
fus gradually contrads itfelf after the birth of
the child, till at length it becomes a fort of
ligamentous fubftance without any cavity.
The time which is occupied by this procefs
is not long, although it varies in different
perfons, and in fome few inftances the yelTel
has been found in the adult date not entirely
obliterated. In proportion as the dudus ar-
teriofus contrads itfelf, the two branches of
the pulmonaiy artery become enlarged, till
at length they are able to convey to the lungs
the whole of the blood, which is thrown out

* Although I have mentioned here, and in othef parts of this
paper, that blood-veffels degenerate into a fort of ligamentous
fubftance, the expreflion is not perfedlly accurate. When theif
cavities are obliterated, they refemble a good deal ligament, but
they ftill retain many properties of ftrufture which belonged
originally to them, efpecially their dafticity.

[ 127 1

by the right ventricle of the heart, and in
this way the full circulation through the
lungs is completed. In the fame manner
the umbilical arteries and vein degenerate
into . a ligamentous fubftance when all com^
munication between the child and placenta
has ceafed, and when the blood is to be
thrown in different channels for the growth
of the child. It fometimes happens, how¬
ever, (although I believe it to be extremely
rare) that there is a procefs of obliteration
without any of thefe circumftances, depend¬
ing upon fome difpofition in the velTels, which
we cannot explain. — Some years ago a woman
was brought to Windmill-ftreet for dilfedlion,
in whorn the vena cava inferior was found ta
be changed into a ligamentous fubftance, from
the entrance of the emulgent veins even to
the right auricle of the heart. The cavity
here was fo entirely obliterated, as not only
to prevent all circulation of blood through
this part of the vein, but even in a great
meafure to prevent the admiflion of air by in¬
flation. It was in an attempt by Dr. Hunter
to inflate the vein from the lower extremity
which made this peculiarity be difeovered.
The blood being prevented from pafling thro*
the vena cava inferior, flowed into the lum^-
• : bar

'bar veins, enlarging them gradually as that
vein became contradted, till at length they
were of a fufficient fize to receive the whole
blood which returns by the vena cava. From
the communication between the lumbar veins
and the vena azygos, the blood paffed into this
vein, and was conveyed to the heart. It
happened in this particular inftance that there
was an additional vena azygos, upon the left
fide of the fpine, fo that the blood was con¬
veyed more readily to the heart than if there
had been one vena azygos, as in ordinary cafes.
The enlarged veins were in fome places
thrown into varices, as mull naturally take
place under the circumllances we have men¬
tioned. What time was confumed in the
obliteration of the vena cava inferior, it is
impoffible to fay ; but, if we confider the
proCefs as analogous to the obliteration of the
dudlus arteriofus, and the umbilical arteries
and vein, it could not be long; we ought
not, however, to reft a very ftrong opinion
upon this analogy^,

t We ought not to reft any ftrong opinion upon this analogy,
becaufe it is cafy to fee a reafon why the obliteration of the
cavity in the ductus arteriofus and umbilical arteries fhould be
a Ihort procefs ; but there is not the fame reafon for its being a
(hort procefs in the obliteration of the vena cava inferior, which
we have juft deferibed.

This

[ 129 ]

This cafe fhews, that, on fome occafions,
a procefs of obliteration takes place in the
blood veffels, independent of the natural cir-
cumftances formerly explained. It fhews
alfo the very great refources of nature, that
it can bear the function of the largeft vein in
the body to be fufpended without endanger¬
ing the life of the animal ; for it cannot be
doubted that the obliteration we have men-
' tioned had no fhare in producing the woman's
death. The blood ft ill circulated in the com¬
mon quantity to and ft'om the heart, but at
one place it took a circuitous road inftead of a
direct one. I think the natural refources of
the body in this particular to be fo great, that
I fhould not hefitate to believe, if the aorta
was to be obliterated in any part of its paf-
fage between the origins of the fuperior me-
fenteric and inferior mefenteric arteries, that
the circulation could be carried on by the
communicating branches of thefe two veffels,
together with the fmaller aids of the anafto-
mofes in the lumbar arteries.

It is reafonable to think, that v/here an ob¬
literation takes place in any artery or vein,
there are pretty large collateral veffels ;
where there are none, or very few collateral
branches, the difticuky of the blood’s being

K ^ impelled

[ 1 30 ]

impelled into other channels, would probably
prevent the obliteration from taking place. In
the natural obliterations we find; that there
are always in the neighbourhood vcfTels of
confiderable fize. Thus near the ductus ar—
teriofus are the two large branches of the
.pulmonary artery; near the umbilical arteries
are the large and numerous branches of the
internal iliacs ; and near the umbilical vein
are the large branches of the vena portarum.
In the fame manner, in difeafed obliteration
of veflels, the collateral branches mmft be fuf-
ficicntly large to carry off the current of
blood -f*.

* Morgagni mentions an inftance of the fame fort of oblite¬
ration in veins, and confiders it as extremely lingular.

“ Iliaca igitur vena dextra aequo erat latior, at finiftra ejuf-
que rami tenues adeo & pallentes ut rem nunquam antea a me
vifara miratus cav^ imum truncum aperuerim. Quo fafto vel
magis miratus fum. Nam pro Iliacae ejus venae oftio lineam in-
veni ipfius coalitum indicantem, qua in linea duo aut tria parva
erant ofcula cum iliaca vena communicantia, Quam cum fecun-
dum longitudinem incidiffem & printer filamenta polypofa queii-
dam fibrarum quafi fafciculum introrfum exftantem confpexiffem,
mox facile animadvert! venae parietes ab uno latere inter fe coa-
Juilfe, licque eum fafciculum mentiri cujus fpecies manu utraque
parietes diftrahendo, neque enim perdilTi cilis erat fejunftio, pror-
fus evanefeebat.” — Vid. Epill. 56. Artie. 10.

f I have had an opportunity alfo of feeing another inftance
of obliteration in veins, very fimilar to what I have deferibed,
at the Lyceum Medicum Londinenfe.

[ I3I ]

In writing upon this fubjed:, it may be
worth while to mention, that I once found a
ftricdure in the femoral artery of an adult fub-
jecfl, juft under the origin of the arteria cru-
ralis profunda. There was a contraftion of the
artery fo complete, that at one part the fides
were nearly in contaft, but, as far as I could
judge, without any difeafed alteration of ftruc-
ture. This took place where confiderable
branches are given off, by which the blood
could be readily conveyed to the femoral ar¬
tery, beyond the place of contraffion. What
could be the caufe of this contracftion it is
not eafy to imagine ; it certainly did not arife
from any mechanical conftriftion, and there¬
fore would feem to depend upon fome adlion
in the coats of the vefiel itfelf.

Let us fuppofe that an aneuryfrn had been
previoufly formed in the femoral or popli¬
teal artery of this particular limb, what would
have been the confequence? Would this con-
traflion of the artery near the groin prove a
natural cure of the aneuryfrn ? There is cer¬
tainly a great analogy between this natural pjro-
cefs of contradtion in the artery, and the ope¬
ration for the aneuryfrn as lately performed by
Mr. Hunter. This, in the operation for the
popliteal aneuryfrn, confifts in fimply making

K 2 an

[ 132 ]

an incifion upon the femoral artery before It
paffes through the tendon of the triceps muf-
cle, and taking it up there by a ligature, which
promifes to be a great improvement in the
art of furgery. There is this difference, how¬
ever, between them, that when a ligature is
made upon an artery, the blood is prevented
all at once from paffing through it, and it
takes a very confiderable time before the col¬
lateral branches enlarge, fo as to convey the
blood in any quantity to the principal artery :

- befides, the ligature is made fo near the aneu-
ryfm, that the enlarged collateral branches
communicate principally with others arifing ‘
beyond it. In the cafe we have mentioned,
the contradtion of the artery was probably a
gradual procefs, the collateral branches en¬
larging in proportion as the contradlion en-
creafed, fo that the fame quantity of blood
was always circulating in the limb. But flill
the Impetus of the blood rnuft have been
greatly diminifhed by paffmg through a num¬
ber of meandring channels, inftead of one
ftraight canal ; fo that if the progrefs of an
aneuryfm could not be flopped by it, it would
at leaft advance very flowly ; and if an aneu¬
ryfm had been formed near the feat of the con-

traftion.

[ 133 J

traction, it mufl: have been as efFefliually cured
by it as by an operation*.

Of the Ossification of Vessels.

There is no difeafed change of ftrudlure
more common in the body, than partial offifi-
cations of the arterial fyftem at an advanced
period of life. The time of life at which
this procefs begins, and its progrefs, vary very
much in different perfons. There is alfo con-
fiderable difference in the fort of change.
In fome there is a converfion of the coats of
an artery into a fubftance, refembling very
much the common bony matter % in others
there is a converfion of them into an earthy
matter, little blended with the animal gluten.
This fort of change is fo common, that when
a perfon dies about the age of fixty years, it
is more frequently found to have taken place

* There is an inftance of this fort of contraflion in arteries
mentioned by Morgagni.

“ .Sed illud peculiare quod fi eandem faciem (fell, interiorem
aortas) infpiceres, tuniccE latus arteriae finiftrum & pofteriorem
partem facientes ad angulum inter fe jungi, non curvae inflac
linear videbantur.’" — Vid. Lib. v. Epift. 65. Artie. 5.

[ 134 ]

in a greater or lefs degree, than that the arterial
fyftem poffeffes its original healthy ftrudlure.
The venal fyftem, on the contrary, is fo
rarely liable to this fort of change, that it
may be faid to be a difeafe in it almoft en¬
tirely unknown. There is one inftance, how¬
ever, in the colledion of Windmill-ftreet,
where a confiderable oflification was formed
in the coats of the vena cava inferior, near
its bifurcation , into the two iliacs'^*. Why
there fhould be this difference in the coats of
arteries and veins, is not eafy to explain.
There feems to be no reafon for it a priori.
It might, perhaps, be faid, that it depends
on the vafa vaforum being more numerous on
the coats of arteries than of veins, but it cer-
tainly does not depend upon this circum-
fiance. The vafa vaforum are more nume¬
rous on the coats of arteries in younger than
in older people, yet in the former oflification
fcarcely ever takes place. — Belides, it is ob¬
vious, that a peculiar effed rnufl depend on
a peculiar adion, and not finiply upon the

* This oflification was found in the fame vein whicli had the
extraordinary obliteration we have defcribed in the former part
of this paper. . ,

number

C 135 ]

number of veffels I do not, therefore,
pretend to explain why offification fhould be
fo commoman occurrence in the coats of ar-
teries,'and fo rare in thofe of veins, but I
know it to be a very rare occurrence in the
latter, and for this reafon I thought if wor¬
thy of mentioning, as Angular matter of

fadt in the hiftory of difeafed appearances ‘f*-

* Bony matter, whether depofited in the coats of arteries of
veins, can only be formed by the vafa vafonim fecreting bony
matter in the fame manner as it is fecreted in the growth of
bones generally. >

+ When offification takes place in the valvulae tricufpides, or
mitrales, it perhaps may be confidered as an offifica^on belong¬
ing to the venal fyftem, but even this is very rare. .

PLATE

A. The right carotid artery, with its en-

♦ *'•

largement, of the fame fize exadlly
as found in the body, the fize being
taken by accurate meafurement. The
tumour is laid open longitudinally, to
fhew that it is entirely filled with
coagulable lymph. i

B. The left carotid artery — d reprefenting

' ' the quantity of coagulable lymph in

it, E reprefenting the proportion of
cavity for carrying on the circula¬
tion.

/ ^

PLATE

♦ ^

f '

. ^ ■

/ ■

• (

I .. S*'.. ’

. 4

I >1

. : Vf':

•> ■■ ;

r , v- . ,
- ^ 'T

“s

'N .
/

' 9

- •* ■■

■ .

";vv>

•» A

.1 ^ • -

. f'v' : »

t' ■ :' ■'■

' vV-'. • ■

IT '

-‘ - Wr '

“>'7 ' '.

.^r • . ' ’

i.,-.

.'af T^.-'

ttk:

‘V

. » V! /

t -'■ ■

■r

:^^rc

^ \

i «

-■ >.

V’-

t:'

•i’

I T '-

■>J

' _,a.Vi ,!■ S

> «

J^lrde p.Jj;-

[ 137 ]

PLATE V . . ,

F. I G. I.

AA. Spme.

BB. Aorta, with the iliac branches.

C. The vena cava inferior, with a white ofTified
part, more fully ihewn in Fig. 2.

' D. The obliterated portion of the vein.

E. Left emulgent vein enlarged.

F: The vena azygos confiderably enlarged be*

; yond its ufual fize. • ■

G. An uncommon 'vena azygos of the left fide,
very much enlarged and tortuous.

^ H. Veins of communication between the left
iliac vein and left vena azygos. — They are
enlarged and tortuous. ► .

II. The two kidneys dried and fhrunk. > ,

F I G. II.

AA. A portion of vena cava inferior.

B. Reprefents the fize, fhape and irregularity of
the oflified part,

( '

N.^'B. Both of thofe drawings were taken from a
^ dried preparation long after it was made.

IX. An

[ ^38 ]

IX. An Account of Mr. HuNTER'i* Method
of performing the 0 per at mi for the Cure of
the Popliteal Aneurifm. By Everard
Home, Efq-, F.R.S. AJJiJlant-Surgeon to
St. George's Hofpital.

The popliteal aneuryfm being a difeafe
which frequently occurs, and generally proves
fatal, unlefs fome means are taken to prevent

it ; we carfnot be furprized that it has at-

tradled the attention, and called forth the
exertions of the ableft furgeons in this coun¬
try to difcover fome method of cure.

Experience' has fhown that all the modes
hitherto pradlifed are exceedingly precarious,
being rarely attended with fuccefs, and the
death' of the patient being, commonly a con-
fequence of a failure of the operation ; a cir-
cumftance which has led fome furgeons of
great eminence to prefer the amputation of
the limb in all fuch cafes.

Mr. Hunter, who has repeatedly performed
the operation for the aneuryfm, finding that
it in general fails, and having likewife ob-
ferved that the removal of a limb fo high up,

from

C 139 ]

from a perfon in health, feldom fucceeds In
preferving life, (and when it does, leaves the
patient difabled,) was excited to confider this
difeafe with more than ordinary attention.
The refult has been a mode of practice that
appears to poffefs many advantages over thofe
hitherto recommended, and to be an* improve¬
ment in the practical part of furgery ; at leaft
it is from this idea being ftrongly impreffed -
on my mind that I am induced to commu¬
nicate it to this Society, as Mr. Hunter is
too much engaged to permit his taking that
talk upon himfelf.

An aneuryfm is a preternatural dilatation
of a portion of an artery, and in general it is
a very fmall part of the arterial coats which
is thus afFedled. The dilatation is commonly
on one fide only, and, when once begun, gra¬
dually enlarges, from the force of the heart
propelling the blood againft the dilated part.
Thus in time a fac is formed, which being in
fome meafure out of the direcfl courfe of the
circulation, the blood, where it is at the
greateft diftance from the channel of the ar¬
tery, coagulates, and forms layers, or ftrata,
upon the iniide of this fac. As the enlarge¬
ment of the fac depends intirely on the force

with

[ 140 ]

with which the blood is adled on by the
heart, it does not, as at firft, continue to
fwell out at right angles from the fide of the
artery, but is increafed in a diagonal line be¬
tween that and the courfe of the artery itfelf,
from the force of the blood being applied in
that dirediion ; fo that the fac is protruded
along the outfide of the artery, and, by its
preflhre upon it, obliterates, in many in-
ftances, the lower orifice, which communi¬
cates with the artery, and produces a total
ftagnation of the blood in the fac.

If the coats of an artery are examined in
the commencement of this difeafe, the firfl:
appearance is a lofs of the natural luftre and
tranfparency of its internal membrane ; that
becoming opaque, afterwards thicker, acqui¬
ring a leather-like appearance ; and when the
fac becomes larger, the coats retain no longer
a refemblance to thofe of an artery, but have
more 'that of a membranous bag, communi¬
cating laterally with the artery by a rounded
orifice, (of different fizes,) the margin of
which refembles the internal membrane of an
artery, in a thickened flate ; but beyond that,
gradually degenerates into a membranous fub-
ftance.

The

[ HI ]

The popliteal aneuryfm, which we are at
prefent to confider, is the difeafe above men¬
tioned, affeding the trunk of the popliteal
artery, which funs down between the two
ham-ftrings of the thigh. From the fitua-
tion of the tumor, on whatever fide of the
artery the dilatation is produced, it will be
diftindly felt in the hollow between the ham-
ftrings, and will be readily afcertained by a
pulfation to be felt in every part of the tu¬
mor ; it feems to be one of the moft frequent
fituations of aneuryfm ; and though it may be
difficult to afcertain whether it occurs fo com¬
monly^ as in the aorta itfelf, it is certainly
found oftener in this artery, than in any other
branch which the aorta fends off. This cir-
cumftance, as far as I know, has not hitherto
been accounted for, and what is rather cu¬
rious, in many recent inftances of this difeafe,
the patients have been coachmen and pofti-
lions The popliteal aneuryfm has been in

general

* Morgagni and his friends found aneiiryfms of the aorta
more frequently in guides, poft-boys, and other perfons who fit
almoft continually on horfeback, which is attributed to the con*
culTion and agitation. — Vide Letter xvii. Art. i8.

♦

When we confider the popliteal artery as affeded by the
different pofitions of the leg and tiugh, and the obftrudion which

the

[ - 142 ]

general fuppofed to arife from a v/eaknefs In
the coats of the artery, independent of the
prefence of difeafe f if this were true, we
might reafonably conclude, that, except in
the part preternaturally dilated, the veffel re¬
mained in a found ftate, which would natu¬
rally fugged; the mode of pracftice generally
recommended, viz. opening the fac, tying

the circulation mull inevitably meet with in that artery, when
the limb is bent, we fee a probable reafon why it Ihouid be
more liable to difeafe than any of the other ramifications of the
aorta ; efpecially when it is found that aneuryfms in the aorta
itfelf are moft frequent at the curve of that artery.

If this obfervation is allowed to have any weight, the reafon
will be_evident why the difeafe Ihouid occur more frequently in
coachmen and poftilions ; for their knees being almoft confiantly
in a bent ftate, from the necelfary exertions of their bodies in
their difterent occupations, and from the violent motion of
their horfes and carriages, the circulation muft often be confi-
derably increafed ; while the branches immediately below the
popliteal artery will be in feme meafure obftruded by the aflion
of the gaftrochnemii and folsei mufcles, in fteddying the body
in the ftirrup, or againft the foot-board of the cahiage, '

- The unfavourable circumftances refpeding the popliteal artery,
do not in common life feem of themfelves capable of producing
difeafe, but when increafed to a great degree, as in the occupa¬
tions of coachmen .and poftilionS : They, at the fame time, from
want of fufiicientexercife, have their legs weaker and lefs healthy
than the reft of the body ; and the cafes to be mentioned appear
ftill further to prove, that thefe circumftances may produce fuch
a ftate of the artery at this part, as to difpofe to the formation
of aneuryfm.

[ H3 ] ■

Up the artery above and below it, leaving the
bag to fuppurate, and afterwards heal up like
any common fore.

Mr. Hunter finding an alteration of ftruc-
ture in the coats of the artery previous to its
dilatation, and that the artery immediately
above the fac feldom unites when tied up in
the operation for the aneuryfm, fo that as
foon as the ligature comes away, the fecon-
dary bleeding deftroys the patient, was led to
conclude, that a previous difeafe took place in
the coats of the artery, in confequence of
which it admitted of dilatation capable of
producing aneuryfm. But not fatisfied with
the experiments on frogs, given by Haller in
fupport of the opinion that weaknefs alone
was fufficient to produce the dilatation, he
refolved to try the refult in a quadruped,
which, from the veflels being very fimilar in
their ftrufture to thofe of the human fubjedt,
would be more likely to afcertain the truth
or fallacy of Haller’s opinion. That the ex¬
periment might have as much as poflible the
chances mofl: likely to produce aneuryfm,
the carotid artery, as being near the heart,
was feledled for that purpole.

Mr.

[ 144 ]

Mr. Hunter having laid bare the carotid
artery-of a dog, for above' an inch in lengthy
having removed its external coat, and after-
wards diffe(fled oif the other coats, layer after
layer, till what remained was fo thin that the
blood was plainly to be feen through it, left
the do Of to himfelf. .

In about three weeks the dog was killecf,
and' the parts examined, when it appeared
that the two fides of the wound having clofed
upon the artery, the whole of -the furround¬
ing parts were confolidated, forming a llrong
-bond of union, and the artery itfelf was nei¬
ther increafed nor diminifhed in fize.

This experiment appeared very conclufive,
as the coats of the artery were v/eakened to
a much greater degree, without dilatation,
than can ever happen from accident in the
-living body, independent of morbid affedlion :
but it was objected, on the other hand, that
the parts having been left to themfelves, im¬
mediately clbfed upon the weakened portion
of the artery', and, being cemented together
by the coagulated blood, eifedfually fecured

it againft any dilatation. To try the force of

this objedion, I made the following experi¬
ment.

I laid

[ H5 1 '

I laid bare the femoral artery of a dog, about
two inches below Pouoart’s ligament, for about
an inch in length, and differed off the coats,
till the hemorrhage from the vafa vaforum
was confiderable, and the circulating blood was
' dift-inflly feen through the internal membrane
of the artery. The hemorrhage foon flop¬
ped by expofure, the furface was wiped dxy>
and afterwards covered with a doffil of lint,
to prevent the fldes of the wound from unit¬
ing. The dog continued very well, 'and the
wound healed up from the bottom ; after fix
weeks the dog was killed, and the artery was
injedted, that it might be . examined with
greater accuracy. It was not perceptibly en¬
larged or diminifhed, and its coats at this
part had recovered their natural thicknefs and
appearance.

The refults of thefe experiments confirmed
Mr. Hunter in his opinion, that the artery,
in cafes of aneurifm, is in a difeafed flate ;
and led him to believe, that the difeafe often
extends along the artery for fome way from
the fac ; and that the caufe of failure in the
common operation, arifes from tying a difeafed
artery, which is incapable of union, dn the

L - time

[ 146 ]

time neceffary for the feparating of the liga¬
ture.

The femoral and popliteal arteries are por- ^
tions of the fame trunk, prefenting them-
felves on different fides of the thigh, and arc
readily come at in either fituation ; but where
the artery is pafling from the one fide to the
other, it is more buried in the furrounding
parts, and cannot be expofed without foinc
difficulty.

In performing the operation for the pop¬
liteal aneurifm, efpecially when the tumor is
large, the ligature is commonly applied on
the artery at that part where it emerges from
the mufcles. This mode of performing the
operation will be found inadequate, if the dif-
"eafe of the artery extends above the fac ; for
if the artery fhoiild afterwards give way, there
will not be a fufficient length of veffel re¬
maining, to allow of its being again fecured
in the ham. To follow the artery up through
the infertion of the triceps mufcle, to get at
a portion of it where it is found, becomes a
very dilagreeable part of the operation ; and,
to make an incifion upon the fore-part of the
thigh, to get at and fccure the femoral ar¬
tery.

[ H7 ]

tcry, would be breaking new ground ; a thing
to be avoided, if poffible, in all operations.

Mr. Hunter, from having made thefe ob-
fervations, was led to propofe, that in this
operation the artery fliould be taken up in
the anterior part of the thigh, at fome dif-
tance from the difeafed part, fo as to diminifh
the riik of hsemorrhag-e, and admit of the ar-
tery being more readily fecured, fhould any
fuch accident happen. The force of the cir-r
culation being thus taken taken oft from the
aneurifmal fac, the progrefs of the difeafe
would be fcopped; and he thought it pro¬
bable, that if the parts were left to them-
felves, the fac, with its contents, might be
abforbed, and the whole of the tumour re¬
moved ; which would render any opening in¬
to the fac unneceflary.

Upon this principle, Mr. Hunter perform¬
ed the operation at St. .George’s Hofpital.

The patient was a coachman,, forty-five
years of age ; he was admitted into the hofpi¬
tal in December 1785, with a popliteal aneu-
rifm, which he had fir ft perceived three years
previous to his admiffion, and had obferved
it gradually to increafe during the whole of
that period. It was fo large as to diftend the

L 2 two

[ 148 ]

two ham-ftrings laterally, and make a very
confiderable riling between them ; the pulfa-
tion was very diftindl, and to be felt on every
fide of the tumor. The leg and foot of that
fide were fo fwelled as to be much thicker
than the other, and were of a mottled brown
colour ; the fwelling was not of the cedema-
tous kind, but felt firm and brawny, pro¬
bably from the extravafation of coagulable
lymph ; the leg retained its natural fhape,
excepting that it was larger. Previous to
performing the operation, a tournequet was
applied upon the upper part of the thigh,
but not tightened, that the parts might be left
as much in their natural fituation as poflible.

The operation was begun by making an
incifion on the anterior and inner part of the
thigh, rather below its middle, which in-
ciljion was continued obliquely acrofs the in¬
ner edge of the fartorius mufcle, and made
‘ large, to give room for the better performing
of whatever might be thought neceflary in
the courfe of the operation. The fafcia which
covers the artery was then laid bare about three
inches in length, after which the artery itfelf
was plainly felt. A flight incifion, about an
inch long, was then made through this fafcia,
4 aloi^

[ 149 3

along the fide of the velTel, and the fafcia
diired:ed oif ; by this means the artery was
expofed. Having difengaged the artery from
its lateral conned; ions by the knife, and* from
the other adhering parts by the help of a
thin fpatula, a double ligature was paffed be¬
hind- it, by means of an eyed probe. The
doubling of the ligature brought through by
the probe, was cut fo as to form two fepa-
rate ligatures. The artery was now tied by
both thefe ligatures, but fo llightly, as only
to comprefs the fides together. A fimilar ap¬
plication of ligature was made a little lower.
The reafon for having four ligatures, was to
comprefs fuch a length of artery as might
make up for the want of tightnefs, it being
wifhed to avoid great preflure on the veflel at
any one part. The ends of the ligatures were
carried direcdly out at the wound, the fides of
which were now brought together, and fup-
ported by flicking plaifler and a linen roller,
that they might unite by the firfl intention.

The limb was found, feme hours after the
operation, not only 'to retain its natural heat,
but even to be warmer than the other leg.
The fecond day after the operation, the brawny
firmnefs of the leg was confiderably diminifh-

L 3 ed,

C 150 ]

ed, it was become foft, loofe, and a good deal
fmaller, and the aneurifmal tumor had loft
more than one third of its fize.

Nothing could fhew more plainly the aeftion
of the abforbents, than the change the leg
had undergone in fo fhort a time ; the dimi¬
nution of the tumor probably arifing from the
fluid blood which it contained having paffed
into collateral branches, or into the tibial
artery.

The fourth day, on the removal of the
dreffings, the edges of the wound were found
united through its whole length, excepting
where prevented by the ligatures ; there .was
neither pain nor tumifadlion in the part ; but
the anuerifmal tumour was the fame as on the
fecond day.

On the ninth day after the operation,
there was a confiderable difeharge of blood
from the part where the ligatures paffed
out ; a tournequet was therefore applied
on the artery above, which flopped the-
J)leeding ; and, although the tournequet was
taken off a few hours after, no blood fol¬
lowed. The head of a roller was then placed
upon the wound,, in the direction of the ar¬
tery, and over that the tournequet, which

was

[ I5X-]

was not, however, tightened more than was
thought fufficient to take off the impetus of
the blood in that portion of the artery.

On the tenth day appearances were much
the fame, only that between the comprefs
and the knee there appeared a little fullnefs,
like beginning inflammation. On the eleventh
day this was gone off, and on the fifteenth
fome of the ligatures came away, followed by
a fmall difeharge of matter, the tumor in the
ham being leflened. On the feventeenth day
the parts furrounding the aneurifmal tumor
were more reduced, and pliable, fo that it
was diflindlly to be felt.

About the latter end of January, 1786, fix
weeks after the operation, the patient went
out of the hofpital, the tumor at that time
being fomewhat leflened, and rather firmer
to the feel. He was ordered to come to the
hofpital once every week, and, in the mean
time, to make fome degree of preflhre, by
application of a comprefs and bandage, with a
view to excite the abforbents to adion, which ,
in moft cafes has a good efFed:.

About the middle of February the tumor
had decreafed, and was become ftill firmer.
March the 8 th, the wound, which had cica-

h 4 trized,

[ 152 ] ,

trized, broke out again, and the patient was
taken into the hofpital. About the 8th of
April, fome of the remaining thread of the
ligature came away, and an inflammation ap¬
peared upon the upper part of the thigh.
In the middle of May, a fmall abfcefs broke
at fome diftance from the old cicatrix, at
which opening fome matter was difcharged,
but no pieces of ligature wxre obferved. Se¬
veral fmall threads were, at diflerent times,
difcharged from the old fore, and the fwell-
ing fubfided ; but the thigh foon fwelled again
to a greater lize than before, attended with
confiderable pain. In the beginning of July,
a piece of ligature, about one inch in length,
came away, after which the fwelling went
off intirely, and he left the hofpital the 8th
of July, at which time there reniiained no ap¬
pearance of tumor in the ham, he being in
every refpeft well.

After leaving the hofpital, the man returned

to his ufual occupation of driving a hackney-

coach ; and being, from the nature of his em¬
ployment, much expofed to cold, in March
1787 he was feized with a fever of the re¬
mittent kind, which carried him off. He
had not made any complaint of the limb on

which

[ 153 ]

which the operation had been performed, from
the time of his leaving the hofpital.

He died on the ift of April, 1787, fifteen
months after the operation ; and leave was
procured, with fome trouble and confiderable
expence, to examine the limb, feven days af¬
ter death, at which, time it was intirely freC'
from putrefadlion.

The cicatrix on the anterior part of the
thigh was fcarcely difcernible, but the parts
under it felt hard. The ham had no appear--
ance of tumor, and was to the eye exadlly like
that of the other limb ; there was, however,
a folid tumor perceptible to the touch, filling
up the hollow between the two angles of the
thigh-bone. .

The femoral artery and vein were taken
out above the giving off the branch called
profunda, and a little b^low the divifion into
the arterise tibiales and interoffea. The ar¬
teries and veins that were pervious being in¬
jected, the whole was carefully diffeCted. .

The femoral artery was impervious from
its giving off the arteria profunda as low as
the part included in the ligature, and at that
part there was an ofiification for about an
inch and an half along the courfe of the artery,

r 154 ]

of an oval form, the rim of wliich was folld,
becoming thinner towards the center, and
not bony, but ligamentous. Below this part,
the femoral artery was pervious down to the
sneurifmal fac, and contained blood, but did
not communicate with the fac itfelf, having
become impervious juft at the entrance.

What remained of the aneurifmal fac was
foniewhat latger than an hen's egg, but more
oblortg, and a little flattened, extending along
the artery below for fome way ; the blood
preffing with greater force in that direeftion,
and diftending that part fo, as in fome
meafure, to give the appearance of a fepa-
rate bag. The fac was perfectly circum-
ftribed, not having the fmalleft remains of
the lower orifice into the popliteal artery ;
w^hether this arofe from the artery being
preflfed upon by the inferior portion of the
fac, as appears to be the cafe in common, or
was in confequence of the fac contradling
after the operation, I will not pretend to de¬
termine ; but it contained a folid coagulum
of blood, which adhered to its internal fur-
face. A feeftion made of this coagulum, ap¬
peared to be compofed of concentric lamellae,,
uniform in colour and confiftence.

The

[ I5S ]

The popliteal artery, a little way below
the aneurifmal fac, was joined by a fmall
branch, very much contraifted, which muft
...have arifen either from the profunda, or the
trunk of the femoral artery. About two
inches below the fac, the popliteal gave off,
or divided into the tibiales. '

The profunda was of the ufual fize, but a
rood deal offified, for fome length after leav-
ing the femoral artery ; the two tibials, where
they go oiF from the popliteal, were in the
fame ftate.

The trunk of the femoral vein, where it
paffed along the fide of the tumor, muft have
been obliterated ; for at this part it appeared
to fend off three equal- fi zed branches, paffing
over different parts of the aneurifmal fac :
thefe muft have been dilated branches, none
of them having the courfe which the trunk
of the vein (hould have purfued.

Thefe appearances throw fome light upon
the changes which took place in the limb
after the operation. The ligature upon the
femoral artery impeded the paffage pf the
blood into the fac fo much, as to allow its
contents to coagulate, and render the opening
into it from the artery impervious. By this

a ftop

[ 15^ ]

a- flop was only put to the increafe of the tu¬
mor, its reduction to the tize met with in the
dead body, mu ft have been the effedt of ah-
forption.

The conclufion-to be drawn from the above
account, appears a very important one, viz.
that fimply taking off the force of the circu¬
lation from the aneurifmal artery, is fufficient
to efFecft a cure of the difeafe, or at leaft to
put a ftop to its progrefs, and leave the parts
in a fituation from which the adlions of the
animal ceconomy are capable of reftoring them
to a natural ftate.

In confirmation of the cure of aneurifm
depending on taking off the force of the cir¬
culation, I fhall mention a cafe of aneurifm
that recovered without an operation, and in
which the mode of recovery depended upon
the fame principle.

The aneurifm was in the femoral artery,
and the fwelling appeared upon the anterior
part of the thigh, a little above the middle,
extending upwards nearly to Poupart’s liga¬
ment ; an attempt was made, by compreffing
the artery above the tumor, by means of an

W . « • •

inftrument fomewhat refembling a fteel trufs,
to give the blood in the fac a chance of co¬
agulating,

[ ^57 ]

agulating, and by that means to put a flop to
the progrefs of the difeafe. But, from the
pain which it occafioned/ every attempt to
make a permanent compreffion on the artery
proved ineffeduah The tumor increafed to
a very conflderable fize, a great degree of in-
, flammation and fwelling took place in the fac
and common integuinents, and mortification
appeared to be coming on the Ikin. While
in this ftate, no pulfation could be felt in the
tumor, or the artery immediately above it ;
fo that the fteps preceding mortification had
taken place which put a flop to the dila-
. tation of the fac, and all its confequences.
From the time the pulfation in the fac fcopped,

' the inflammation and fwelling fubfided, al¬
though very flowly ; and as the tumor di-
miniflied it became firm and folid, and the
patient got perfectly well.

It appears from thefe cafes, that furgeons
have laid too much ftrefs upon the fuppofed
neceflity of large collateral branches, to in-

On examining the bodies of thole who die. in confequcnce
of mortifications, the artery leading to the mortified part is
completely Hopped up with a firm coaguium for feveral inches
' in length ; this muft precede the mortification, and feems in¬
tended to prevent haemorrhage.

From Mr, Hunter s LeFlures.

fure

fare the fuccefs of this operation ; an opinion
'which mail: have arifen from anatomical know-
leclge, rather than obfcrvations' made from
pradlice.

The fecond time Mr. Hunter performed
this operation, was upon. a trooper about forty
years of age.

A tournequet having been loofely applied
upon the thigh, the operation was begun by a
longitudinal incifion through the integuments,
and the artery and vein were expofed, as in the
former cafe, but not taken up with a num¬
ber of ligatures, for nothing appeared to have
been gained by filch praftice, and the bad ef-
fedls of it were obvious in the progrefs of the
cure ; they were included in one ftrong liga¬
ture, fufficiently tight to prevent the pulfa-
tion in the fac, without injuring the coats of
the veffels. The ends of the ligature were
brought out at the wound, which was in this
cafe dreffed from the bottom. The advan¬
tages propofed by this treatment were, to
be able to fee the progrefs of the cure, and
to come readily at the artery, if any unfa¬
vourable circumftance occurred ; fince the
abfeeffes in the former cafe were fufpeded to
have arifen fcom the mode of healing.

After

[ 159 ]

After the operation, the fuperficial veins of
the leg became exceedingly turgid and nume¬
rous, and the limb, although warm, became
rather lefs fo than the other, particularly the
foot.

The next day the leg was fwelled, and the
heat 12° lower than the other; the fecond
day it exceeded the other 5° ; and on the
fourth day the two limbs were equally warm ;
tlie patient was free from fever.

^ On the fourteenth day the ligature came
away, and the tournequet was loofely applied,
as a precaution againft bleeding ; the farto-
jius mufcle was a good deal enlarged, and co¬
vered the paffage down to the artery, fo as to
prevent the matter from having a free djf-
charge^ a good deal being confined behind
it, and with difficulty fqueezed out at each
dreffing.

On the nineteenth day there was an hae¬
morrhage from behind the mufcle, the fwell-
ing of which rendered it nearly as difficult
to come at the veflel, as if the parts had
healed by the firft intention ; the bleeding
was flopped by applying prefiiire, after having
lofl about ten or twelve ounces.

r i6o ]

On the twentieth there was a flight bleed¬
ing, which was readily flopped : yet five hours
afterw'ards the femoral artery gave way, and
he loft about one pound of blood before the
tournequet was applied. The artery was laid
bare, and tied a little higher up, the patient
being very v/eak and low ; in this ftate he
continued till the twenty-third day without
bleeding, when it bled again from a fmall
veffel. On the twenty-fixth a confiderable
haemorrhage having taken place, he became
faint, then delirious, had vomiting with hic¬
cough, and died the fame day.

Upon examining the limb, finufes were
difcovered both upwards and downards, in the
direction of the artery and fartorius mufcle,
befides fmaller ones in different diredlions.-

In this cafe, the bad confequences and death
of the patient, do not appear to have arifen
from the operation, but were intirely the re-
' fult of the mode of treatment afterwards, as

v/ill appear from the following cafes.

The third patient-operated upon by Mr.
Hunter was a poftillion, thirty-five years old.
Compreflion upon the femoral artery was at¬
tempted, but the pain v/as fo great that it
could not be continued.

[ i6r J

In performing the operation only one liga¬
ture was ufed, and the parts healed by the •
firft intention.

On the feven th day after the operation, the
firft dreffings were removed, and a good deal
of matter came out by the fide of the liga¬
ture. On the fourteenth the ligature came,
away, and in four weeks the wound healed.

The fac in the ham, from being chafed
previous to the operation, burft at this itime,
but healed up like any other fore, and at the-
end of three months he was perfectly re¬
covered.

Mr. Hunter s fourth patient was a coach¬
man, thirty-fix years old.

The tumor in the ham was not very large,
and fituated lower down than ufual, the whole
leg being fwelled, and the veins turgid. The
pain he complained of was exceedingly vio»
lent, but being in a very bad ftate of health,
an operation was not thought advifeable, and
gentle prefliire on the tumor was attempted ;
but, from the pain it occafioned, the opera¬
tion was had recourfe to, as the only chance
of faving his life, although, from the irritable
ftate in which he then was, even that feemed
a forlorn hope.

M la

[ 'i62 ]

In performing the operation, the vein was
not included in the ligature, but in other rc-
fpefts it was fimllar to the former.

Immediately after the operation the limb
was benumbed, and continued fo for fome time,
which was Angular, as the nerve had not been
included. It became, on the fame day, four
or five degrees hotter than the other leg,
and continued fo for the firft fourteen days,
when the temperature became the fame as
that of the other limb.

The fixth day the firft dreflings were re¬
moved, and the ikin was united every where
except at the paffage of the ligature. It re¬
mained in this ftate till the twenty-firft, when
the cicatrix inflamed and ulcerated, with a
floughy appearance, and hardnefs up the
thigh.

' On the twenty-ninth day the ligature came
away ; the fore now put on a better appear¬
ance, fuppuration took place where the hard¬
nefs had been in the courfe of the artery, and
the parts became fofter, the difeharge gra¬
dually diminiflied, and in the feventh week
the wound was healed.

But it did not continue fo ; for in three
days an inflammation took place, and an ab-

fceft

[ i63 ]

fcefs formed, and burft at the cicatrix, which
alfo healed up.

About the end of the tenth week he^was
attacked with a very fevere remitting fever,
which lafted fourteen days, and left him
much reduced ; but in the fourteenth week he
was fo far recovered, as to leave the hofpital
and go into the country, for the recovery of
his health.

The fifth patient upon whom Mr. Hunter
performed this operation was Jofeph Cafwell,
aged forty-two, a man not accuflomed to
horfe exercife, or any mode of life which
could in the lead; aflifl: in producing the dif-
cafe. The aneurifm was in the ham of the
left legi

In performing the operation, the artery
alone was included in a fiirong fingle ligature,
and the wound was healed by the firfi: in-,
tention, leaving a pafTage for the ligature.
The local inflammation was extremely fmall,
and confequently attended with little lympa^
the tic fever. The ligature came away the
eleventh day, and in five weeks he went into
the country, able to walk with a ftick, the
Wound perfectly healed.

M 2

[ 16^4 ]

In this cafe the heat of the two legs was
caerfully examined twice a day, from the fecond
to the ninth after the operation, and the limb
operated upon was uniformly colder than the
other.

He came to town fix months after the ope¬
ration, and faid that the left leg was fully as
ftrong as the right, but, when expofed to
cold, he was more fenfible of its effedls up¬
on that leg. About two months after the
operation he had a violent pain in the upper
part of the left foot, limilar to what is felt
when a nerve is preffed ; this lafted for about
fix weeks, and afterwards went entirely off.
As no nerve was included in the ligature, this
affedfion probably arofe from the nerve in its
paffage through the confolidated parts being
deprived of its natural freedom. There was
a fmall tumor, the remains of the aneurifmal
fac, very diftindlly to be felt in the ham, but
\vithout pulfation, and to the feel perfectly
folid.

The following cafe was operated upon by
Mr. Lynn, furgeon of the Weftminfter Hof-
pital, in the fanie manner as abovementioned ;
and the account of the operation is given in
his own words.

Samuel

[ J

Samuel Smart, an hackney coachman,
twenty-five years of age, had a popliteal
aneurifm, for which I performed the opera¬
tion in the following manner. I made an in-
cifion down to the femoral artery, a little* be¬
low the middle of the thigh, and having fe-
parated the artery from the contiguous parts,
I paflhd under it, by means of an eyed probe,
a broad ligature, which was tied fo as to cut
off all communication with the tumor, and
the lips of the wound were brought together,
and retained by flicking plaifier, and the
patient put to bed ; this leg was rather colder
than the other, and ordered to be fomented.
The next day he was free from pain, and the
limb was warmer than the other.

On the fourth the dreflings were removed,
and the parts were found united, except at
the ligature.

“ On the thirteenth the ligature came
away, and in the courfe of the month the
whole was healed, and the patient foon af¬
terwards perfed:ly recovered.

Wm. Lynn.’*

This operation of Mr. Hunter’s having
fucceeded in the firft inftance, furgeons of

M 3 different

[ i66 ]

diiferent hofpitals were led to adopt it, but
with fome variation, according to their own
judgment> and the circumftances of the rc-
ipediive cafes. Thefe I did not introduce in
the order in which they took place ; for not
being performed exactly in the fame manner,
they would have interrupted the regular feries
of thofe cafes above related. But I fhall now
give them either in the words of the furgeons
who performed the operations, or as corredlly
as I can from having myfelf been an eye-
v/itnefs ; and although they were not attended
’with fuccefs, that circumftance will not be
found to affedl the propriety of the mode of
performing this operation which has been re¬
commended above.

' In a cafe of aneiirifm of the femoral artery,
the (Operation was performed by Mr. Birch,
furgeon to St. Thomas’s Hofpital, who relates
the hiftory as follows :

John Lewis, a negro, aged forty- three,
received a blow on the anterior part of the
right thigh j about a month after he perceived
a fmall tumor, which gradually increafed, and
his own expreffion was, that he could feel
it thump, thump.

[ 167 ] -

As the tumor enlarged, he came to Lon¬
don for advice, applied at St. Thomas’s Hof-
pital, on Thurfday, the 26th of Odlober, and
was direftly admitted. On examination I
found a large tumor, extending within two
inches of Poupart’s ligature upwards, and oc¬
cupying two-thirds of the thigh ; a pulfation
could be felt, and there was no doubt of the
difeafe being an aneurifm of the femoral artery.

I directed feven ounces of blood to be taken
from the arm, and an opiate to be given at
night ; the patient refted well, and the next
day a confultation was held, in which it was
propofed to perform an operation, and endea¬
vour to pafs a ligature round the femoral ar-
tery, giving the patient the chance of -nouriih-
ing the limb by the arteria profunda, and other
anaftomifing veffels.

On Friday, the 3d of November, it was
determined to perform the operation ; Mr.
Cline undertook to comprefs the artery as it
paffes through Poupart’s ligament, which he
eafily efJe(5ted with a hard comprefs, in the
flaape of a T, with a broad bafis.

It was agreed, previous to the operation,
that an iilcifion ihould be carried in a femi-
•lunar form round the upper part of the aneu-

M 4 rifmal

[ i68 3

riimal fac, in order to make room fof the lon¬
gitudinal incifion neceffary to dilTedl: down to
the artery ; this was accordingly done, and
the integuments raifed, fo as to make room
to feel for the pulfation of the artery ; fome
portion of cellular membrane and lymphatic
glands were neceffarily differed and removed :
v/ith my fingers I then feparated the mufcular
fibres, and tore away the conned:ing parts till
the artery could be plainly felt in pulfation ;
it was then neceflfary to divide a part of the
fafeia covering the artery, which was done by
carrying the back of the knife on Mr. Cline’s
nail, while his finger prefled upon the naked
artery; after which the finger and thumb
could furround and comprefs the veffel ; an
eye probe, armed with a ftrong flat ligature,
was then puflied through the cellular mem¬
brane, and carried under the artery. This
being effedled, we had fuch command of the
veflcl as to be able to ftrip it down, and pais
another ligature fomewhat lower. This lafl:
ligature was then tied, the firfl: being left
loofe, to fecure us againft accident.

The threads being feparated and fccured,
the wound was lightly dreflfed, the tumor left
in its natural fituation, and the patient put to

bed.

[ 1^9 ]

bed, with the lofs of only four or five ounces
of blood during the operation. No pulfation
could be perceived in the tumor after the liga¬
ture was tied.

On Saturday, November the 4th, he had
flept well, was eafy, and there was fufficient
warmth in the extremity to affure me of fome
circulation. On the 5th the difcharge from
the wounded lymphatics was fo abundant, as
to make it neceffary to remove the fuperficial
dreflangs ; the tumor was rather fofter to the
touch, and the fkin about the apex of it be¬
gan to fhrivel. . .

The difcharge of lymph continued till the
9th, and then the wound began to digeft,
affording, however, a very fmall quantity of
pus. The tumor grew thinner at one point,
and feemed as if difpofed to ulcerate the in- '
teguments. This day I paffed a bleeding li¬
gature round the leg, jufi; below the knee,
and the veins tumified fufliciently to have
bled 'freely if they had been pundlured.
loth. He was feverifii in the evening,
iith. He had flools from fome laxatives
' I had diredled, and was better.

12th. The tumor was very thin at one
part, and a fluftuation evidently to be felt.

The -

. .[ 17° I

The limb was warm and moveable, but the
patient was feveriih, and delirious at night ;
a decoftion of bark, with a fedative bolus,
v/as diredled for him, but he would not take
them.

13th. The wound looked florid, and af¬
forded good pus, the patient was feverifli
and delirious, the tumor was threatening to
burft. This day he took his medicines.

'14th. He became fenfible, but was lan¬
guid and hot ; the tumor burfl:, and difeharg-
ed ferum and grumous blood ; he fainted ;
the dreflings were not difturbed; he flept
compofedly ; fainted again about fix o’clock
in the evening, and expired. I faw him at
feven, when the limb was ftill warm ; I re¬
moved the dreffings, and found a fmall ftream
of freih arterial blood which had ifliied from
the wound.

It appears probable that if the patient had
applied for relief before the tumor was fo
much enlarged, the operation might have
fucceeded, as we Ihould then have been able
to have tied the found artery fo much lower
down.

J. Birch,

The

[ J7I 1

The body was examined the morning after
the patient’s death by Mr. Cline.

The integuments on the middle of the tu¬
mor were mortified. The blood contained
in the tumor was very putrid, and the greater
part of it fluid, it appearing to have been dif-

folved by putrefiid:ion.

Water inje<5led by the external iliac artery,
efcaped freely from the wound at the ligature
where the artery was open, and appeared to
have ulcerated at that part.

In laying open the artery from the ligature
to the 'heart, its internal furface appeared of
a bright red. This appearance leflened at
the curvature of the aorta, yet it was very
evident in its femilunar valvesl

The arteria profunda, which pafled off
from the femoral artery rather lefs than half
an inch above the ligature, was alfo inflamed
within. There were near two inches of the
femoral artery between the ligature and the
aneuryfmal fac, the internal furface of w^hich

was of the ufual white colour ; from this a
membranous-like fubfliance could be peeled
off that feemed to refemble coagulable lymph.

The opening where the artery pafled out
of the aneuryfmal fac was near three inches

'*V

below

[ 172 J

below the part where it entered. In opening
this part of the artery from the fac to the
ham it appeared quite found, and of its na¬
tural colour. H. Cline.

This mode of operating was adopted by
Mr. Pott in a cafe of popliteal aneuryfm in
St. Bartholomew’s Hofpital; which opera¬
tion having been the object of medical atten¬
tion for fome time, I fhall give a brief ac¬
count of it, as I was prefen t at the time it
was performed.

Mr. Pott began the operation by making
an incifion, about five inches in length, upon
the pofterior part of the thigh, through the
common integuments, a little higher than
the tumor, and in the diredlior. of the thigh,
between the two ham-fl:rings ; he then dif-
fedled down to the veflels at the upper end
of the incifion, which being there deep feat-
ed, proved both tedious and difficult* Ha¬
ving come to the veflels, a double ligature
was paffed, and the two portions tied iepa-
rately, at nearly half an inch diftance. The
depth of the incifion made it difficult for any
but the operator, and thofe immediately af-
fifling him, to fee what was included in the

ligature.

(

[ 173 ]

ligature, and at the time the popliteal artery
was fuppofed to be fecured by it. The
wound was dreffed up in the common way.

The fecond day after the operation, a pul-
fation was felt in the tumor, which afterwards
enlarged fo much that Mr. Pott amputated
the limb.

It is faid, that the aneuryfm appeared,
upon an examination of the limb, to have
been In an anaftomifing branch, not in the
trunk of the artery.

The following remarks upon this operation
will te{id in fome meafure to illuftrate the
method recommended and pradtifed by Mr.
Hunter.

The mode of taking up the artery in the
ham muft be always unfavourable to the fu¬
ture fuccefs of the operation, .if either the
artery itfelf fhould be difeafed, or if the tu¬
mor, by being fo contiguous to the violence
done in the operation, fhould be affedled by
the confequent inflammation ; which feems
to have been the cafe in Mr. Pott’s operation,
as I underfland two abfeeffes were formed
clofe to the fades of the fac.

Had the aneuryfm been fituated in an anaf¬
tomifing branch of the popliteal artery, given

■ 4 off

[ 1/4 ]

off below the ligature, there fhould have been
no pulfation afterv^ards in the tumor j and
were it in a branch going off above the liga¬
ture, the pulfation in the tumor fhould have
continued immediately after the operation,
and fhould have been increafed by it; neither
of which effefts appear really to have taken
place, which throws a doubt upon the litua-
tion of the aneuryfm, if the popliteal artery
was rendered impervious by the compreffion
of the ligature.

Mr. Cline, Surgeon to St. Thomas’s Hof-
pital, performed the operation for the popli¬
teal aneuryfm in the following manner, at
which I was ;,rcfent; and although not ex-
aftly as recommended by Mr. Hunter, it
was very nearly fo. The particulars of the
cafe I have not received from Mr. Cline,
but have taken them from my own obferva-
tion, and the information of gentlemen who
attended the patient, and were prefent at the
examination after death.

The patient was a failor, who came into
St. Thomas’s Hofpital to undergo the opera¬
tion for the popliteal aneuryfm.

Mr, Cline made a longitudinal incihon on
the anterior part of the thigh, and having

[ 175 ]

laid bare the artery, pafled, by means of a tin
inftrument, a double tape, about one inch
broad, behind the artery, the two pieces of
tape lying one over the other ; the piece of
tin which conducted the tape was cut off,
and a cork, nearly an inch long, was laid
upon the artery, and confined 'to its fituation
by means of the upper tape, producing in
this way a fufficient prefTure upon the veflel
included between the ligature and cork to
flop the circulation, and confequently the
pulfation in the tumor in the ham ; the other
portion of tape was left loofe. The inten¬
tion of fecuring the artery in this way, was
to comprefs the fides of the veiTel together,
and produce an union without ulceration.

The patient went on very well, and the
ninth day the tapes were removed, and every
thing feemed to be going on very favourably,
when the patient was attacked by a fever,
(which was fuppofed to be caught from ano¬
ther patient in the fame v/ard) of which he
died.

Upon examining the (late of the limb after
death, it was found that ulceration had taken
place through the whole extent of the artery
included in the tape ; and finufes v/ere formed

. I both

[ 176 ]

both upwards and downwards, in the courfe
of the thigh, to fome diftance.

I cannot conclude this paper without ob-
ferving, that it is feldom in giving an account
of a new operation, we are able to colled:
materials fufficient to render it fo fatisfadory
as the prefent, having in our poffeffion not
only the fuccefsful and unfuccefsful cafes,
but alfo an account of the appearances after
death, under both circumftances, fo that the

caufes of failure are rendered evident in thofe

, ^ '

, inftances in which it did not fucceed, and
the means that are likely to infure future
fuccefs are clearly pointed out.

The operation is in itfelf Ample ; It re¬
quires but a fhort time in the performance,
and produces little, if any, affedion of the
conftitution ; but its advantages are more
clearly feen by con trailing it with the com¬
mon mode of operating for the popliteal an-
curyfm. This is by expofing the fac in the
ham through its whole extent, laying it open,
fcooping out the blood, fearching for the two
orifices leading into it, and taking up the ar¬
tery with a ligature both above and below the
fac. When this operation is over, there re¬
mains a large deep-feated fore, compofed of

parts

i 177' 3

parts not perfectly In a natural llate, and In
a moft difadvantageous fituatlon ; which fore
is to fuppurate, granulate, and heal ; a pro-
cefs that Is not foon performed, and which
muft leave a ftiff knee for fome time after¬
wards. Yet this is confidering the operation
in the moft favourable view, fince there is
always a rilk, from the artery being dif-
eafed fo clofe to the fac, of the patient- dying
from a fecondary bleeding ; and when that
does not happen, there Is Hill fome danger of
not being able to fupport the conftitution
during the healing of a large fore, under
circumftances fo very unfavourable.

It is in comparifon with this operation,
the only one before in ufe, that the prefent
improvement is to be confidered, and it is in
this view that I have thought it deferving
the attention of the Society.

I cannot clofe this account without infert-
ing the following cafe, in addition to thole
already ftated, in favour of this operation.'
I have received it juft time enough to give it
a place, as the paper was in the prefs before
it came to hand, and feel myfelf obliged to
Mr. Earle for his readinefs in communi¬
cating it.

Hano^

[- 178 ]

Hattover-Square^ March lO, 1792.

Sir,

At your requeft I fend you fome account
of the following cafe, and am

Your moft obedient Servant,

James Earle,

John Smith, about fifty years of age, was
received into St. Bartholomew's Hofpital on
account of a fever. After having been un¬
der the care of the phyfician fome time, he
complained of a fwelling and pain in his left
leg, for which I was defired to vifit him.
He faid, about fix months before, he had
fallen from a fcaffold ; that his leg was caught
between the rounds of a ladder, which broke
his fall ; that he felt immediately pain in the
upper part of his leg ; foon after it began to
fwell, and had gradually increafed to its pre-
fent fize. On examination there appeared a
large hard fwelling under the heads of the
gaftrocnemii mufcles, reaching up to the
bend of the leg. A pulfation was plainly to
be felt in it, and there was no doubt of its
being an aneuryfm. It was now increafmg
very fall in fize ; the tumor, by its prelTure,
- .► caufed

[ m ‘ ]

caufed exquifite • pain,* all. .the lower part ot
the leg was loaded with; oedematous fwelling,
and it became abfolutely necelTary to performt
fome operation to prevent a mortification ta-
.king place^

Having noticed with much fatisfaftion the
fuccefs which attended Mr. Hunter’s method
of tying the artery in the thigh, in a iimilar
. cafe, I decided in favour of that operation ;
but as, in the prefent inftance, the artery ap¬
peared to be in its natural and perfed; ftate in
the ham, and in its whole courfe, till it reach-'
ed the dilatation below the knee, I preferred
taking it up in that part, rather than to tie
it in the middle of the thigh, under the far-
torius mufcle^ though it lies there more fu-
perficial, and more eafily to be got at ^ be-
caufe I thought the chance of the circulation
being carried on was equal, if not greater,
and if it fhould fail, and fymptoms fhould
•occur to create a fufpicion of an impending
mortification, there might be an opportunity
of removing the limb above the ligature,
which would be impracticable if the artery
was tied in the middle of the thigh.

Jan. 28, 1792. The patient being laid on
jbis face, and the tourniquet loofely applied,

N 2 I made

[ iSo ] .

1 made an inclfion about five inches long, in
the direftion of the artery, within thofe ten¬
dons which compofe the inner ham-ftring.

I then gradually feparated the cellular fub-
ftance ; in doing this the nerve was expofed,
which ran in its ufual courfe, external to the
aftery, and rnuch more fuperficial. In find¬
ing the artery, fome difficulty occurred on
account of the tumefaction of all the parts*
affeCled by their vicinity to the aneuryfm,
and from the imperceptibility of pulfation in
the artery till it was aClually laid bare : how¬
ever, having difeovered it in its ufual fitua-
tion near the bone, and in its natural undi¬
lated ftate, I pafled a ligature round it, about
two inches above the tumor. I now again
examined, and being convinced that the ar¬
tery was included alone in the ligature, I
gradually made it tight, till I felt a pulfation
above it, and none below, when I defifled,
concluding that any preflure beyond this de¬
gree would be ufelefs and dangerous,

I will juft obferve here, that I found the
common aneuiyfmal needle with a handle
very inconvenient, and would recommend in ,
this cafe, where the artery lies fo deep, a

9 blunt

[ iSi ]

blunt femicircular needle, with the eye about
half an inch from the end, without any handle.

The wound was clofed in the ufual man¬
ner, and the edges brought together by fu¬
tures. On the following day the man was
free from pain, the tumor much lefs tenfe or
hard, and the whole leg greatly unloaded. —
No perceptible alteration in the heat of the
limb could be remarked ; — when the current
of blood was obflrudled in the fuperficial veins
by prellure, on its tremoval they immediately
again became turgid ; and in Ihort every ap¬
pearance indicated a continuance of perfect
circulation.

On the 15th day fucceeding the operation
the ligature came away, the limb was foft
and unloaded, and the incifion nearly healed j
at the diftance of fix weeks there remains a
fmall tumor, with fome perceptible fludua-
tion. The patient cannot perfedlly extend
his leg, but is able to walk with the alTifi:-
ance of crutches.

X. A

■[ ifSa l]

■ / , 'i ^ :r

* \

X.. A Cafe of Paralyfs of the Mtfcks of De^

.glutition\ cured, by ian artificial Mode of con-^.

■ 'v eying Food and Medicines into the 'Stomachs

r) By John Hunter^ • Efq. F. R. S. Sur-^.

— geon Extraordinary to the King y and Surgeon

General toAhe.Armf^ Read. September 21,

1790* '' ? ,

. V . • -1 i \ ■

Diseases which are not mortal in them-
lelves, may )ofteri, from their fecondary ef-
fedts, become the caufe of death ; but if thefe
fecondary effedls are removed, the difeafe fre¬
quently adnlits' of a cure, or even Ceafes of
itfelf. 'Thus difeafes, when they attack the
vital ^organs, may, from the nature of the
parts alone,-' prove fatal; and this will be
-fooner or later, according to the particular
funftions of the parts difeafed. ; v

Obftrudlions to breathing, to. .the paiT-
ing of the urine, to the adi.of "fwallowing, or
the difcharge of the faeces, will all terminate
in death, if continued for a certain length of
time, whatever be the nature of the difeafe.

Difficulty in fwallowing, the fubjedt of the
prefen t paper, may arife from a variety of caufes,
- . ' lince

[ ^83 ]

fince an obftrudllon in any part of the canal
leading from the mouth to the ftomach, will
produce that complaint.

The fwallowihg our food is a complicated
operation, and includes two different adlions ;
the firft of thefe conveys it into the oefopha-
gus ; the fecond carries it along that canal in¬
to the ffomach ; and the parts which per¬
form thefe two aftions are in themfelves dif-
tin&. ; fo that one may be obftrudled, or dif-
eafed, while the other remains perfectly
found.

The firft aflion^s often impeded, or wholly
prevented by inflammation, but this is felflom
of long continuance,* and the cure is probably
promoted by the patient’s being obliged to
abftain from food. It is alfo impeded by fwel-
lings in the neighbouring glands, but this
will commonly be in a lefs degree ^ and where
'it threatens fuffocation, or a total prevention
of deglutition, the patient can often be re¬
lieved by an operation. '

The fecond adlion is fomfetimes obftrucfted
by ulcers in the oefophagus, which have a
cancerous appearance ; fom^times ftridluresin
that canal, which are of a permanent nature ;
alfo fpafmodic contractions, which are com-

N 4 monly

[• i84- ]

monly confounded with ftridtures, but may,
I believe, be readily diftinguifhed both frorn
ftridlures and ulcerations,

Ulcers and Hridures, from being perma¬
nent difeafes, in the end deflroy the patient j
but fpafmodic contradlipns admit of being
cured. I have known a cafe of this kind get
well in a fortnight from the ufe of electricity,
which had not been at all relieved by mer¬
cury, although the mouth was affeCled by it

for a month.

‘ • ... < «

There is another caufe of difficulty in fwaU
lowing, which is the reverfe of contraction,
viz. paralyfis ; whether the rnufcular coats of
the cefophagus are ever affeCted by it, I can¬
not determine ; but the mufcles of the pha¬
rynx have- become paralytic, and the patient
has died of hunger.

As this difeafe is only rendered dangerous
from the want of a fubilitute for deglutition,
jt becomes our duty to adopt fome artificial
mode of conveying fopd into the fiomach,
by which the patient may be kept alive while
the difeafe continues, and fuch medicines may¬
be adminiftered as are thought conducive to
the cure.

A fuc-

[ i85 ]

A fuccefsful inftance of this pradtice i»
given in the following cafe of well marked
paralyfis in the mufcles of the pharynx!; the
relation of which is given by the patient.

John S - 1, about fifty years of age, be¬

came hypochondriac, and attacked by what arc
called nervous diforders, in confequence of
anxiety of mind, brought on by various dif-
trefles. In the beginning of his complaints,
he felt fomething crack within his head, and
from that period his fenfations became very
acute, his pailions, fympathies, and averfion^,
exceedingly ftrong. , .

December 28, 1786, while under the ia-
. fluence of an uncommon degree of hypochonf*
drlafis, about one o’clock in the morning, he
brought up a glutinous fubftance from his
ftomach, like the white of an egg, which
feemed to relieve him, but did not remove an
averfioa which he had taken to his relations,
his children, and even to life itfelf, of which
he was tired.

JJe afterwards continued affedled with low

fpirits and pains in the head, became reftlcfs,
and turned his mind to religious fubjedts ; as
thefe affedlions either increafed or diminifhed,
Jie had frequent and fevere fits of crying.

About

[ i§6 i

About the 2lfl: of Pebroary; 1790; he had
a' violent cold in hi^' head,' with a cortfidefable
running from %e nofe ; and on the 7th of
March;-' between one and two in the morn-
fng, '*^^oke with a 'fenfe of choakin'g, and
ftlt^foOn after a numbhefs in the whole of his
'fide, together with a paralyfis of the
iriufcle'S' of deglutitibh; ' which deprived him
cif theipower of ^ '

' ' By the 'advice of ^^ phyliciati hc' was cupped,
bliftered round the thtbaf / and eleblrified j he
^fcus/‘in 'the 'meah-^nWb, -fuppbrted by nouriih-
ing clyfters. March the 9th, finding no be-
nefit^from’ this plan, he waited upon Mr.
Huhtet, /Vith a letter from Mr. Gumming,
'Watchmaket, accompanied'^ by Mr. Duncan
thefiirgeon^ ' ;

'Mr. Hunter confideriiig-the fupport of the
^tient; and fome mode of adminiftering me¬
dicine; to be the firfl: objeft, propofed that a
hollow ‘flexible tube fhould be pafled down
into the flomach, through which he ’ might
receive nourifhment and medicines; and men¬
tioned his having an inflrument of that kind,
riiade of.fpiral wire, covered with gut for the
purpofe'ofihjedling liquids into the ftomachs
of animals, which might be applied to the
- prefent

[ iS7 ]

prefent cafe ; but that Mr. Gumming was
better able- to aflift them in getting a tube
that would anfwer that purpofe. He alfo re^-
commended, when’, the .tube was rnadcy to
inject jellies, eggs beat aip* with a' lit tie water,
fugar, .^nd milk, .or wine,' ’ by way ’of food,
and that the : medicines might be - mixed
with] it. . ‘

In Icompliance with .thefe direft ions -they
■ contrived a tube, anddnjedted intp'-the ftomach
fome of the abovementioUedifubftances twice
a day ; three, drams of valerian we-pe^tn^xedwitli
this food, increanng. the dofe^'to^fe dram'S,.
Laudanum was given in the dofe^offefty d4*6ps,
by clyfter, and afterwards thirty^ drops by^ the
mouth 3 but both dofes affedled-the head, with¬
out procuring reft. The valerian-was continued
till the 26 th 'of* March, at which time hfc^'liad
taken four 'ouhdes, ' and had evidently ireco-
vered a degree of fenfation irt his throat. Mr.
Hunter wag again confulted, '''and’ ordered twb
fcruples of -flour of rhuflard, and one dram, of
tinBure of valerian, twice a day ; under this
treatment the’ power of fwallowing gradually
returned, and on the 29th the ufe of the tube
was no longer neceifary. The natural fenfa¬
tion of the throat and right arm had not re¬
turned in the month of April,

The

[ i88 ]

The inftt'ument made ufe of was a frefh
cel-fkin, of rather a fmall fize, drawn over
a probang, and tied up at the end where it
covered the fpongc, and tied again clofe to
the fponge where it is faftened to the whale¬
bone, and a fmall longitudinal flit was made
into it juft above this upper ligature. To
the other end of the eel-fkin was fixed a blad¬
der and wooden pipe, limilar to what is ufed
in giving a clyfter, only the pipe large enough
to let the end of the probang pafs into the
bladder without filling up the pafTage. The
probang, thus covered, was introduced into
the ftomach, and the food and medicines were
put into , the bladder, and fqueezed down
through the eel-fkin.

The inftrument did not produce irritation
in the fauces or cefophagus \ in fuch cafes,
the parts lofing their natural fenfibility, allow
greater liberties to be taken with them. An
eel-fkin feems vei*y well adapted for this pur-
pofe, being fmooth,* pliable, and readily pafTed
into the ftomach ; but as cafes of tins kind
may occur where eels cannot be procured, a
portion of the gut of any fmall animal, as a
cat or lamb, will make a vefy good fubftitute.

[ 189 ]

XI. Of a remarkable Deviation from the na--

tural StruBure in the urinary Bladder and

Organs of Generation of a Male. By

Matthew Baillie, M. D. F. R. S.

and Phyfcian to St. George's HofpitaL

Read January 1 8 , 1790.

♦

The fubjeft of the prefent paper does not
feem to throw any confiderable light either
on the phyfiology or pathology of the hu¬
man body, yet it is not altogether unimpor¬
tant. It exhibits a view of a lingular va¬
riety in a very efiential part of the ftruc-
ture of the human body, has been rarely ob-
ferved, and, I believe, has not as yet been
fully defcribed

The perfon in whom this variety was found
was a man of about forty years of age, of a
lliort ftature, of a robuft habit, and of a very
dilTolute life. Having occafionally got a good
deal of money, by exhibiting himfelf to pub¬
lic curiofity, and having acquired habits of
idlenefs, he very readily fell into drunkennefs.

There is a Hiort hiftory of a fimilar monftrofity, by James
Mowat, furgeon at Langholm, in which many particulars hav«
been omitted, Vid. Edinb. EJajs, Vol. Ill, article 14.

the

[ 190 ]

the moft prevailing vice among the lower clafs
of people. He was at length very rarely fo-
ber, and in one of his fits of inebriety he
'died. Through the. kind offices of one of
my medical friends, he was brought to Wind¬
mill- ft reet ’ for examination .

Description. External View.

In the external view of the abdomen was
feen, immediately above where the fymphyfis
pubis is commonly placed, a vafcular pulpy
mafs, about two inches in tranfverfe diame¬
ter, and an inch and an half from its upper
to its lower edge This mafs was feated in
a deep bed, fcooped out, as it were, from the
lower part of the Ikin and mufcles of the ab¬
domen. When this mafs was examined a
little more particularly, it feemed to refemble
fomewhat the pofterior furface of the tongue,
but without any follicular appearance. In
three places it projected into tubercles of no
very confiderable lize, and upon two of thefe

the ureters opened. At the upper edge of

This pulpy mafs was covered with a thick layer of vifcid

mucus in the living body, in order to defend it from the ftimu-
lu« of the falts contained in the urinc^

this

[ I9I- J

this mafs. the fkln^was in one part finer than
is natural, and a little puckered. This was
all the appearance of na^el in this fubjedl, for
there was* none in the ufual place. ,, At the
lower edge of this mafs, and about. the middle
of that edge, were fituated two diftindt rounded
orifit^s, which were found to be the openings
of the vafa deferentia and veficulas feminales.
Between thefe two orifices, and a little above
their level, was a confiderable canal, large
enough to admit a goofe quill, and leading to
the fubftance of the proftate gland.

' About half an inch under the vafcular mafs
I have deferibed, the penis was feen, of the
common fize v/ith refpeft to tranfverfe dia^
meter, and about a little more than an inch
in length. The whole of the upper furface
of the penis was fomewhat hollowed, and
had a finer Ikin than the common covering
of that part. Near its extremity, the canal
correfponding to the urethra opened by a
pretty large oval orifice. The gkns was of
the common texture, but fomewhat different
in its fhape, being hollowed upon the upper
furface. It was covered by a thicker cuticle
than ufual, from its being bare and .expofed
to fridlion. Under the glands there was a

loofe

\ t

[ 192 3

loofe projedion of ikin, correfponding to the
preptice. It was conneded to the glans by
a chord like the fraenum, but was neither fuffi-
ciently pliable- nor large to cover the glans,
as in ordinary cafes.

There were two confidcrable oblong fwel-
lings at the groin, covered with hair. , Upon
the infide the fwelHngs were formed of fat,
and had paffing through them the fpermatic
chords. They terminated below in a fort of
corrugated tuberculated ikin, forming the
ferotum. The cellular membrane on the in-
fide pf it, inftead of being fpungy as ufual,
was of a very firm compact texture. By this
membranous texture the tefticles adhered very
firmly to the infide of the ikin of the fero¬
tum, and the ferotum was divided into two
lateral cavities, by a ilronger feptum than I
ever recolledt to have fecn.

Internal View.

Upon the infide, correfponding to the fitu-
atlon of the vafcular fpungy mafs, there was
a fort of projedtion, not unlike the pofterior
outer view of the urinary bladder. It con-
filled of an arrangement of mufcular fibres,

fimilar

t 193 ]

fimilar to thofe in the bladder, but fomewhat
ftronger, and had opening through it the two
ureters. Thefe ureters were of a larger than
the ordinary fize, atid had probably been en¬
larged artificially.

This perfon had a cuftom of thrufting a
knitting-needle 'up each ureter when he ex¬
hibited himfelf to gratify curiofity, which
might, perhaps, encreafe a little the fize- of
the ureters near their external openings.

Above this appearance of bladder, there
was a confiderable fpace between the muf-
culi re(5li abdominis occupied by tendon
and the peritonaeum. In^the middle of this
fpace palTed the umbilical vein, degenerated
into a forf of ligament, fo as to reach' the
upper edge of what correfponded to the blad¬
der, where it was loft behind the integu¬
ments. The umbilical' arteries climbed up
each fide of what correfponded to the blad¬
der, and loft themfelves behind the integu¬
ments at the fame place with the vein. This
place correfponded to the fine puckered fkin
above the vafcular mafs mentioned in the ex¬
ternal defeription. . *

Upon each fide of the fubftance corre-
fponding to the bladder, the redti mufcles

O paffed.

[ 194 ]

paffed, to terminate in the offa' pubis, at
nearly four inches diftance from each other.

Between the fubftance correfponding to the
bladder and the redum, were fituated the
proftate gland, the veficulee feminales, and
the extremities of the vafa deferentia.

The proftate gland was fcarcely one half
of its ufual fize, and had an opening ex ter- •
nally under the mufcular mafs by a large ca¬
nal, as formerly mentioned. The veficulge
feminales were fcarcely more than a third of
the ordinary fize; the extremities of the vafa
deferentia were enlarged as in the natural
ftrudure, and opened by two rounded orifices
externally under the vafcular mafs.

The redum was, in its appearance, per-
fedly natural, nor was there any reafon to
exped it fliould be otherv/ife.

. The penis arofe by two crura from the af-
cending rami of the ofla ifchii, being nearly
of the ufual fize.

The crura afcerided for 'more than two
Inches before they united, and between them
was fituated the corpus, fpongiofum urethra?.

In that body was a canal, correfponding to
the urethra, having the fame j vafcular lining,
and the openings of lacunae. This canal

com-

[ *95 ]

•* i

communicated with a cbniiderable cavity,
fituated at the bulb of the urethra, and hav¬
ing the fame lining of membrane with the
urethra itfelf. In this cavity could only be
feen the orifices of the lacunae, and pofteri-
orily it terminated in a cul de fac.

The ere(flores penis and mufcles corre-
fponding to the acceleratores urinae, had very
nearly the natural appearance, but the tranf-
verfi perin^i were feven or eight times larger
than ufual. The mufcles about the anus were
exacftly natural.

The tefticles were of the common fize^
but the tunica vaginalis was almoft obliter¬
ated on each fide, probably from inflamma¬
tion. Their texture was perfedWy natural;
'they were fuppliedin the common way with
blood- veffels, and the vafa deferentia and epi-
dydimis feemed of the ordinary flrufture^
The vafa deferentia and a portion of the epi-
dydimis were injected with qilickfilver, to
fhew that the canals were pervious. On- each
fide the cremaflier mufcle was ftronger than I
almoft recoiled: to have feen it in any body*
There was alfo a hernia upon the right fide,
in which a portion of the. omentum w'as

O 2

[ 196 ]

In the anterior part of the pelvis, where
the fymphyfis pubis is ufually fituated, there
was a deficiency of bone for nearly four inches.
This was filled up by a broad ligamentous
membrane, becoming a fupport to the vif-
cera of the abdomen, and keeping fome of
the parts which I have mentioned in a fixed
fituation. The two acetabula were alfo re¬
moved at fcmewhat a greater diftance from
r each other than in an ordinary male pelvis.

In every other part of the body of this per-
fon, the ftrudture was perfedtly natural.

Such are the particulars of this very un¬
common monftrofity, and they afford very
little room for refledUon.

It appears clearly, from the account wa
have given, that this perfon was in every re-
fpedl a male, and had no mixture whatever of
the other fex. The tefticles and vafa defe-
rentia were natural, fo that the fecretion of
the femen could take place as in ordinary
cafes.

This ftate of the tefticles was probably ac-
companie'd by the venereal appetite as in or¬
dinary men, but ftill he may have been faid
to have been impotent.

The

[ »97 ]

The vafa deferentia terminated by two ori¬
fices at the lower part of the abdomen, and
there was no canal by which the femen could
be ejected with force fufficient for impreg¬
nation.

The proftate gland too and veficulas femi-
nales were in this perfon of a very diminutive
fize, fo that their fundlion, whatever it may
be as fubfervient to impregnation, was pro¬
bably imperfed:.

The openings of the vala deferentia did
not bear the fame relative fituation to the pe¬
nis as in the ordinary ftrudure j yet I have
no doubt that titulating the glans, fo as to
produce eredion, promoted the fecretion of
the femen as in common men. We are led
to this opinion from confidering the general
ftrudure of his organs, and it is in fome mea-
jfure confirmed by the imperfed knowledge
we have of his life. There was a woman
who lived with him as his wife or miftrefs,
and, from his very impudent behaviour in the .
company of women, he would appear to have
been fufficiently falacious.

The want of a bladder in this perfon fiiews
Amply, that it is not a part effentially necef-
fary to the body, but is only a refervoir to

O 3 , contain

[ 198 ]

.contain a certain quantity of urine, for the
greater convenience of the animal. This
might be readily inferred a priori from rea-
foning, without a lingle inftance of it having
occurred ; but it is certainly known from the
claffes of animals in whom no bladder is na¬
turally found.

The deficiency of the pelvis at the antCr
rior part, and the difcance between the two
acetabula being a little greater than ufual,
had feme effed: upon his manner of walking.
His ftep was lefs firm, the lateral motion of
his body greater, and his progrefs confequently
flov/er, than in common men f.

* Since this paper W3.s written, I have met with a njonftrofity
cf the fame- kind, in a young man about twenty, who is a na¬
tive of Cologne. . In the external appearance of the abdomen
there is no difference between this cafe and that which I have
deferibed, except that in the former the vafcular pulpy mafs was
more protuberant than in the latter, and the opening of the ure¬
ters more dependent. The conjeflure which I have formed
about the venereal appetite is confirmed by what I have learned
from this perfon. His penis is often ereded at the view of fe¬
males, but, from the ftrudure of the parts, he is incapable of
producing impregnation. — A defeription of the external appear¬
ance of the parts in this perfon has, I underfland, been given
by profeffor Bonn of Amfterdam,

PLATE

[ 199 ]

y '

L A ^VI.

A. Pulpy vaFcuIar mafs. "

’The ‘appearance of a cicatrix in the
I ^ . 'ikin, ''as a fubftitute for .the navel.
C. The penis, with an orifice feen upon
V, ' its upper furface; and- under it a
rrr, thick fold of Ikin, ‘as a fubftitute
' for the prepuce. ■ ■ : ! - / 's
p, D.. The fcrotumr; with hairs upon it.^

: O 1

- , i- - i .

' 1 r I

- y ^

j K / \

■^v

.. * * ’

• ■ < it.

/ (0:i.

" {

* *■) j t'

-f 1

r r

• e \

i. 1 « .

X -

* A

■ \ r ^ \ rv , ^ -j .

— * • * •m/ J ^ i ‘ -

O4 PLATE

[ 200 ]

L A T E VII.

F I G. I.

' I

• 4

A A, Portions of the mufculi re6li abdo¬
minis, feparated at a confiderable
. diftance from each other.

B. * The umbilical vein feen over two

briftles, Ihrunk into a folid mafs.

C. The poflerior view^ of what corre-
* fponded to the bladder, with the

two ureters feen entering into it.
The ureters contain bougies.

D. A fmall imperfed proftate gland.

E E. Very fmall imperfect veficulae femi-
nales.

F F. The vafa deferentia.

G. The reftum, with its internal vafcu-
lar membrane feen.

H H. The origins of the corpora cavernola
penis feparated at a great diftancc
from each other.

FIG.

;V<.»vij.»/,;.»'

■'. *i

:.}>t^}

:?>\v ■-■ ■• .--:5/.‘.^;:v-i?-ijs'5^

•** *'~* ' ^

4\'-V!.tf}

:a^.'

V'*-

^ . . t^e\.

sfi**«'

V ■- V ' -" -

■: ■ ; :• i

Mat

ii*

.sw41

:9Sfe«^

[ 201' ]

F I G. IL

Two Lcvugies In the external open¬
ings of the two ureters upon the
pulpy mafs.

Two briftles in the openings of the .
veficulse feminales, and a bougie
in an opening , which led to the
proftate gland.

V /

XII,

[ 202 ]

XII. A'Cajh (^Emphys^ema,' 7tot proceed-
ing from local Injury, By Matthew
Baillie^ M.D. 'F.R.S. Bhyjician to St.
George's Hofpital^ Read yuly 19, 1791.

I HAD lately an opportunity of obferving
gi very uncommon appearance of difeafe in the
living body, as well as of examining its ex¬
tent after death.

Margaret Buck, aged about ten years, was
admitted nearly three months ago a patient
Into St. George’s Hofpital, with anafarca and
afcites. Two days before her death I was
defired by the apothecary of the hofpital to
fee her, as Dr. Ford, the phyfician, who had
for fome time attended her, could not come
on that day to the hofpital. When I faw
her lying in bed, her appearance differed in
nothing from that of a perfon highly anafar-'
cous, nor fliould I have at all fufpedled that
there was any peculiarity in her complaint.
Upon attempting to feel her pulfe, however,
I was furprized by the crackling of air under
my fingers, and the fkin was confiderably
9 elevated.

[ 203 ]

,elevated, fo that the pulfe by that means was
indiftiinftly felt. I then preffed upon the
ikin of the back, breaft, beHy, &c. and there
was the fame crackling of air. Air was alfo
felt in the cellular membrane of the infide of
the ‘thighs. There was at the fame time a
confiderable quantity of water accumulated in
the cellular membrane of the legs and face,
as , could be readily diftinguiflied by the
doughy feeling upon preffure. The girl her-
felf lay in a fort of ftupid ftate, expreffing,
however, a fenfe of confiderable pain, and
having a good deal of difficulty in breathing.

After having examined the patient I fent
for Mr. Walker, one of the furgeons of the
hpfpital, who was at that time in the houfe,
that he might have an opportunity of feeing
,this very curious appearance of difeafe, and
defired that fmall openings might be made
through the ikin for emptying the air. The
patient died on the next day, and I took an
.early opportunity of examining the full ex¬
tent of the difeafe by diffedlion.

Air was found diffufed through the oellular
membrane of the trunk, arms, thighs, &c. as
formerly related. Upon making an opening

into

[ 204 ]

into the cavity of the abdomen, the ftomach
was found diftended, alinofl as far as it could
ftretch, with air, and the whole inteftinal ca¬
nal was moderately filled v/Ith it. The air too
had penetrated into fome parts of the cellular
membrane of the ftomach and inteflines.
The laminss of the peritonaeum, compofing
the mefentery, were feparated at fome dif-
tance from each other by the air which oc¬
cupied its cellular membrane, and the friiall
vefibls running upon the ftomach and intef-
tines were univerfally filled with it. There
was about a gallon of water in the cavity of
the abdomen.

Upon opening into the cavity of the chert,
a great quantity of air was found in the cel¬
lular membrane between the pleura and the
pericardium, but none could be difcovered in
the cellular membrane connedling together
the air cells of the lungs. A confiderable
quantity of water v/as found in the cavity of
the pericardium, and about two pints in the
left fide of the thorax.

What Is remarkable in this cafe is, the
colledion of air without any external inju¬
ry in the cellular membrane of any part of

the

[ 20,5 ]

the body. Emphyfema generally fpread over
the body has been obferved to take place in
two ways ; the one way is, by air efcaping
into the cellular membrane of the body, in
confequence of the lungs being wounded by
a broken rib ; the other way is, when air is
generated by a putrefadlive procefs, as occa-
fionally happens in mortifications. Neither
of thefe could have been the caufe of em¬
phyfema in the cafe which I have related.

I ft. It did not arife from any accident, as
that of a broken rib wounding the lungs.
We are perfedlly clear upon this point from
the following circumftances, viz. when in¬
quiry was made, the patient could recoiled;
no injury nor violence whatever having been
lately done to her cheft, and upon examina¬
tion after death the ribs were all found to be
entire.

2d. The emphyfema did not arife from
putrefadtion . There was no fign of putridity
whatever in the patient before death, and
upon preffing out the air in our examination
after death from different parts, there was
no fetid fmell to be perceived, even in the
fmalleft degree.

There

' [ 2o6 ;i

There are two ways in which emphyfeiiia,^
not arihng from external injury, particularly
when preceded by anafarca, may be fuppofed
to be produced ; the one is, that the watery
fluids, poured into the cells of the cellular
membrane, may undergo fome chymical
change, by which ^lir is feparated from them;
the other is, that the fmall blood-vefiels
diflributed on the cells of the cellular mem¬
brane, may have fome power, under parti¬
cular circumftances, of fecreting air, which is
afterwards accumulated in thefe cells* Which
of the two was the caufe in the prefen t in-
flance I will not politively determine, altho’
I am inclined to think it was the latter* In
cafes, however, of emphyfema, generally 2ivit
fing without external injury, I fliould not
hefitate to believe, that the moft frequent
caufe is, the fecretion of air by the fmall
blood-weflel-s diflributed upon the cells of thd
cellular membrane.

That the blood- veflels have this power,
there ,can be no doubt. Complete bags are
found in fome animals, containing air, being
part of their natural flrudture, as for inftance-
in many fiflies. The air could, under fuch
circumflances, be feparated only by the fmall

veflels

[ 207 ]

veflels diftributed on the bags themfelves..
Complete bags, containing air, are fometirnes
found attached to the mefentery of pigs,
where it could not enter ab externo. It is
very probable alfo, that in cafes of tympa¬
nites the air is fecreted by the Ifnall veflels
opening upon the villi of the internal mem¬
brane of the inteflines, and thrown into their
‘ cavity*.

There is no difiiculty in our conceiving the
poflibility of this adtion of the blood-veffels
taking place ; it is juft as eafy to conceive air
fecreted from the blood by the action of the
velTels, as the fecretion of the bile, milk, or
any other fecreted fluid How far the air
found in the fmall blood-veflels of the fto-
mach and inteftines in a dead animal is to be
confidered as a decided proof of this opinion,
I will not abfolutely determine ; but moft
commonly where I have found air in the in-

* Mr. Hunter has,_taken notice, in his Efiay upon Digeftion,

of a power in blood- veflels to ft Crete air ; and he has illuflrated

it by fonie of the examples here given, as well as by others.

f What is the peculiar procefs of air being feparated from the
blood in the blocd-vellels, I cannot pretend to fay; but wc arc
equally unacquainted with the peculiar procefs which takes place
in the feparation of any other fluid from it, *

teftlnal

[ 2o8 ]

teftinal canal, I have alfo found it in its fmall
blood- veflels. The time taken up* by this
procefs in the prefen t cafe was fhort ^ the
emphyfema had not been obferved by the
phyfician, who had feen the girl two or three
days before that on which I was defired to
vifit her ^ and Mr. Dampier, the apothecary,
told me, that fhe had fwielled fuddenly about
a day before I faw her.

Cafes of emphyfema arifing -»without ex¬
ternal injury or putrefaction, are extremely
rare. In looking over a number of books,
containing accounts of cafes and ’diffeCtions,

I have found only one example at all analo¬
gous to the cafe which I have related. It is
defcribed in a collection of medical cafes
U publhlied by Dr. Sickel, 1744 In the
cafe to which I allude, emphyfema is faid to
have fpread fuddenly over the body of a wo¬
man, aged above forty, without any external
injury whatever, and on the next day to have
left her in good health.

The account which the doCtor has given
of the caufe of this complaint is, that, a lit¬
tle before its appearance, the , woman .had
. eaten fome muftard-feed and eruca along .

* Vid, Sicelii Decad. quartam, p, 487.

with

. $

' [ 209 J

with a fail fa Q-e, which had expanded and fet
in motion the air contained in the blood, and
other humours, in confequence of w^hich it
was carried into the cellular membrane pro-,
ducing emphyfema. '

I have found fince writing this paper, that
Monf Littre has mentioned, that where there
is emphyfema from a wound in the lungs,
the air taken in by refpiration may be forced
into fmall blood- veffels, and carried over the
whole body in the general circulation, fo as
to affift in producing univerfal emphyfema.
The expreliions are as follows in the account
given of his opinion L’air etranger tou-
jours pouffe peut comme il a efle dit, en-.
trer dans les vcines & dans les routes de
** circulation, & par confequent fe repandre
‘‘ par toute Thabitude du corps'^.’' In this
opinion I believe Monf. Littre to be miftak^
cn ; and the air let loofe by the v/ound in the
lungs, is fufficient to account for the product
tion of general emphyfema, without the aid
of any other caufe v/hatever. W e fuppofe
the air to be generated in the blood-veffels
themfelves, and to be thrown out in the fprni
pf a fecreted fluid Into the pellular membrari?^

‘ ^ Memoir. Apad. Sciences, 171^. ,

P I Hay'S

I have found too, that Dr. Huxham, in a
.letter which he has publifhed in the Medical
Obfervations, has mentioned as a conjedture
the formation of elaftic air in the blood- veflels;
but he has confidered it as a putrefadlive pro-
cefs, and connedted only with putrid difeafes.
His words are, and it is not improbable, that
elaftic air may be generated even in the
arterial and venal fyftem, and be produdlive
of terrible fymptoms, vaft oppreffion, an-
xiety, palpitation, intermitting pulfe, de-
liquium, &c. which are too often obferved
tovyards the end of putrid fevers
We confider, however, the air depofited in
the cellular membrane, in the cafe we have
related, as having no connedlion with a pu-
trefadlive procefs, but as being formed from
the blood itfelf, by fome peculiar arrange¬
ment of its parts, and condudled into the
cells of the cellular membrane by very fmall
veffels. The opinion, therefore, brought for¬
ward in the prefent paper, is widely different
from all of thefe 3 we believe it to be new,
and we have been chiefly led to it by what

* See Medical Obfervations, Vol. Ill, p. 33. where a cafe is
jclated by Dr. Huxham of emphyfema having arifen during the
courfe of a putrid fever and fore throat.

Mr.

[ 2II ' ]

Mr. Hunter has faid about the formation of
air in his Eflay upon Digeftion.

Whether the air contained in the cellular
membrane and the inteftinal canal of the girl,
whofe cafe I have related, was the fame, I
cannot poffibly determine, becaufe I did not,
at the time of examining the body, think of
colledling the air; it is probable, however,
that the procefs of forming air was exadlly the
fame over the whole body, and therefore that
the air itfelf, or the refult of that procefs, ^
was the fame like wife, I have twice exa¬
mined the air which is accumulated in the
inteftinal canal. It was not inflammable, but,
on the contrary, extinguifhed flame ; when
made to pafs through lime-water, it rendered
it turbid, and chalk was depofited. The air
is, therefore, either entirely of that fort called
fixed air, or at leaft that air is in fome very
fenfible proportion I am not, however, fo
much accuftomed to chymical experiments,
as to be fatisfied with rny own examination of
any fubftance whatever in that way.

* Dr. Pearfon has informed me, that he has examined fQme
air from the inteftinal canal very lately, and that it confifted of
iixed and phlogifticated air, the firft in a fmall, and the laft in
9 much larger proportion,

p 2 XIII. J

[ 212 3

XIII. A Cafe of unufual Formation in a Part
of the Brain. By Mr. A. Carlisle;
communicated by Dr. Bail lie. Read OB.
25, 1791.

MarY' Harvey, a woman apparently
near tvveaty years of age, was admitted into
the Weftminfter Hofpital on the 2d of July,
1791, with an ulcer alfedting the tarfal bones
of the foot, and her general health being
much impaired, die was advifed to have the
-foot removed. The operation was performed
by Mr. Lynn, on the loth of July, but a
confiderable degree of fever fupervening, to¬
gether with great irritation, the died about
eight days afterwards. In the courfe of exa¬
mining her body, which was done in prefence
of Mr. Morel, one of the furgeons to the hof¬
pital, we proceeded to inquire into the ftate of
the brain; and, upon removing the dura mater
from the fuperior part of the cerebrum, a
very uncommon appearance prefented itfelf.
The falceform procefs was entirely wanting ;
the lower edge of the triangular cavity, form¬
ing the fuperior longitudinal iinus, proje(2:ed ;
but there was no portion of the dura mater

■whatever

f 213 ]

whatever appended to it, and this defeft pre¬
vailed equally from the crifta galli, backwards
to the tentorium. A depreffion was evident
along the middle of the fuperior^part of the
cerebrum, about half an inch deep, which
correfponded to the lower edge of the fupe-
rior longitudinal linus ; but this v/as limply
a depreffion, for there was no feparation of
the cerebrum, as is ufual, into two hemi-
fpheres, it being completely formed of one
fubftance. Although much care was taken
in the diffiedlion, and a very ffiarp knife ufed,
yet not the fmalleft , portion of pia mater
could be traced in the fituation of the natural
cleft ; a tranfverfe fedtion was then made
through the cerebrum, keeping above the
level of the corpus callofum, but ftill no
veftiges of membrane, or of cineritious fub-
fiance, or of previous inflammation or adhe-
fion, were to be found; fo that it fliewed
every appearance of this being the original
formation. The union of what ought to have
been the hemifpheres, extended down to the
corpus callofum, which was difficult to be
diftinguiffied from the common medullary
fubftance of the brain. Every other part of
this organ was in a perfectly natural ftate,

P 3 excepting

[ 214 ]

excepting that the opening in the tentorium,
through which the cerebrum joins to the
cerebellum, appeared larger than is common.
The woman, previous to the operation, had
her intelleSual powers as perfedl as people
ufually have ; and fhe was not obferved to
complain of any particular affection in her
head. I mention thofe circumflances, to
fhew how little we know of the phyfiology
of the body, as conned:ed neceflarily with
its ftrudture ; for had the prefent appearance
been difcovered in diffecting the body of a
man, who had been fubjefl: during his life-r.
time to any diforder which had been fuppofed
to depend on the brain, it is more than pro¬
bable that it would have been affigned as the
caufe of the malady. Such cafes, however,
as the above may teach us, that although
the formation of an organ in the animal body
fhould be conliderably varied from the cufto-
mary plan of nature, yet the perfedl and ufual
fundlion of fuch a part may be carried on fo
well by this fubftituted modification, that we
can hardly call it an imperfedtion.

XIV. Hi^ory

[ 215 ] I

XIV. Hijlory of a fatal Hamorrhage from a
Laceration of the Fallopian Fiibe^ in a Cafe
of an Extra-uterine Foetus, By John
Clark’E, M. D. Phyftcian to the General
Lymg-in Hofpital in Store-freety and to the
Afylum for Female Orphans, Read OB, 25,
1791.

►

To Dr. B A I L L I E.

Dear Sir,

I WILL trouble you to communicate to
the Society the following very remarkable
hiftory of a cafe, which, in fome refpedls, is
different from any, which it has occurred to
me to meet with in the books that I have read.

It is accompanied with a drawing of the
parts : and, as a farther demonftration of the
fadts, I will beg you to fliew to the Society
the preparation of ' the parts from which the
drawing has been made, which both exhibits
the ftrudlure ariling from impregnation, and
alfo the lacerated furface, and the coagula at
the extremities of the veffels.

I am.

Dear Sir,

Yours, &c.

John Clarke.

P 4 HIS.

[ 2i6 j

HISTORY.

The fubjecfl of the following cafe was a

tnafried woman, about thirty years of age.

Previoully to the attack of the complaint

which dejftroyed her, fhe had been occaiion-

ally fubjedt to fome bilious complaints : in all
> •

other refpedts flae had enjoyed a tolerably
good Hate of health, and had borne one child.
About two months before fhe died, fhe per¬
ceived a return (as fire thought) cf what fhe
called her bilious complaints, on account of
which fhe took, of her owm accord, fome
medicines, which fire had been accufLomed to
employ upon fimilar occafions ; and fhe paid fo
little attention to an obftrudlion of the men-
ftruous difcharge for one period, as never to
ha'/e mentioned it to her hufband, nor to her
apothecary, until a few days before her death.

On the 1 2th of May, 1791, lire went into
a warm bath, with a view to relieve her bi¬
lious complaints, and on Friday, the 13th of
the fame month, in the morning, without
'any previous exertion, fhe was fuddenly feized
with a violent pain in the lov/er part of her

belly.

C ^17 ]

belly, on account of which fhe lay down upon
a fofa in the room, where (he fell into a faint¬
ing fit, from which, after a few minutes, fhs
recovered*

At this time fhe fent for her apothecary,
a very fenfible and intelligent man, v/ho, as
fhe ftill complained of great pain, took away
about eight ounces of blood, fuppofing that
there might be inflammation in fome part of
the cavity of the abdomen, and directed her
to take fome laxative medicines, in order to
evacuate the inteftines, which were attended
with the defired.effed:. The: pain, however,
ftill remaining, he exhibited an opiate to pro¬
cure relief, which it did in fome degree, tho’
1^0 1 entirely. . : '

Ke kept the bowels open, and palliated the
pain by 'anodynes taken internally, thrown up
the redtum by’ clyfter, and applied externally
by fomentation, which formed the plan of.
treatment, and was purfued uniformly through
the Vv^hole courfe of the difeafe. — Neverthe-
lefs the pain was not removed by thefe means,
but returned with great violence by paroxyfms,
both in the belly and near the loins, and was
generally accompanied with vomiting, , yawn¬
ing, and fainting. The pulfe during all this^

time

[ 2l8 ]

time was not frequent, and the tongue was
of its natural colour.

By the frequency of thefe attacks her
ilrength was very much reduced ; neverthe-
lefs, oii Monday (May i6th) llie thought
herfelf rather better in the courfe of the day;
but towards the evening her pain returned
with aggravated violence, and fhe became
extremely faint and low.

At this time I was defired to fee her. I
found her extremities in a cold fweat : —
there was no pulfe at the wrift ; fhe was ex¬
ceedingly reftlefs, and almoft incapable of
Ipeaking (though fhe had within a quarter
of an hour been very fenfible) ; flie became
in a few minutes more and more refllefs^
more and more faint, and expired.

After her death we were defirous of afeer-
taining by difleftion, if it were poflible, the
caufe of this uncommon difeafe, which proved
fo fuddenly fatal ; and having obtained leave
from her relations, we examined the body on
the following day.

Upon dividing the integuments over the
cavity of the abdomen, we were ftruck with
the gufhing of blood in large quantity,
which, when collected, amounted to nearly a
, gallon.

[ 219 ]

gallon. It was partly fluid, and partly coa¬
gulated. When we had cleared away the
blood, the vifcera prefented themfelves not
only free from any appearance of inflamma¬
tion, but even more pale than they are com¬
monly found.

We now fought for the fource of the he¬
morrhage in the fituation of all the large
velTels near the liver, fpleen, mefentery, Szc.
but in vain. Upon taking hold of the uterus,
it felt more pulpy than it commonly does, and
was enlarged rather beyond its natural lize in
an unimpregnated ftate. Pafling the hand
into the cavity of the pelvis, in the pofterior
chamber, to wit, between the broad ligaments
and the rectum, I perceived ftill remaining
there a quantity of coagulated blood. This I
removed, and, after having carefully examined
all the furfaces, difcovered a lacerated appear¬
ance, furrounded with maflcs of coagulated
blood, in what at that time feemed to be the
right ovarium. I therefore cautioufly removed
the uterus with its appendages, and referved
them for farther and more accurate invefliga-
tion than could at that' time be afforded.

When the blood was removed from the
part (which in the confuflon occafioned by

coagula

- [ 220 [

cOiigula appeared to be the right ovarium) a

laceration was found to be in the Fallopian

tube, about an inch and an half in length,

each extremity of wdiich was about an equal

diftance from the rcfpecftive termination of

the tube in the fimbriae and in the uterus.

The diftention of the tube at this part was
nearly of the fize of a large walnut, form¬
ing a kind of pouch. More of the coagu¬
lated blood being removed from the lacerated
part, the fliaggy velTels of the chorion im¬
mediately appeared, interfperfed with fmall
coagula, and lying in contaft with the inter¬
nal furface of the pouch formed by the Fal¬
lopian tube : thefe being feparated, and the
chorion divided> the amnios ihewed itfelf,
containing a foetus perfeffly formed, of about
fix or feven weeks growth. The Fallopian
tube was pervious, both leading from the’
fimbriated extremity to the pouch con¬
taining the ovum, and from the pouch to
the infide of the uterus, fo as to be capable
of containing a briftle. The dianieter, or
calibre of the tube between the fimbriae and
the pouch, was rather larger’ than it is ufually
found in the impregnated ftate. The right
ovarium was the next objedl of examination,^

[ 221 ]

in which a large corpus luteum was found,
occupying nearly half of the fubflance of the
ovarium.

Laft of all the uterus was examined. This
vlfcus (as I have already remarked) had a
pulpy feel, and was larger than it is com¬
monly found in an unimpregnated ftate. Up¬
on cutting it open, two things worthy of
tice appeared. Fir ft, the whole of the cer¬
vix was filled with that gelatinous matter
which is not found except in the ftate of preg¬
nancy. Secondly, the whole of the body and
fundus of the uterus was occupied by the
membrana decidua, into the cavity of which
the briftles inferted into the two Fallopian
tubes penetrated.

Such were the appearances in this fingular
cafe ; to which I beg the liberty of fubjoin-
ing a few obfervations.

So many cafes of extra-uterine geftatlon
have been recorded by various authors, that
they ceafe to be matter of furprife. They
have clearly proved the feat of impregnation
to be in the ovarium, and have marked the
progrefs or route of the ovum towards the
uterus, 'its final deftination. They have alfp
eftablilhed thefe points ; that the uterus has

t 222 ]

no exclufive power of forming or nourifhing
a foetus ; that, in fad, it does not poflefs the
former property at all, and the latter only in
common with other parts ; but that it is only
better calculated for this fundion by its be¬
ing entirely appropriated to it, and by having
an external opening for the expulfion of the
foetus.

One thing particularly deferving of notfce
in the prefent cafe, is the formation of the
membrana decidua in the uterus before the
ovarian ovum ^ had reached it.

For the knowledge of this fad, which is
eminently confirmed by the prefent cafe, we
are indebted to the acute obfervation of Dr,
William Hunter, who, in regard to the ana--
tomical invefdgation of the gravid uterus and
its contents, flands high above all compa-
rifon.

The uterus then with its appendages, the
ovarium and the Fallopian tube, refembles a
piece of mechanifm, each of whofe parts has

* By ovarian ovum, I mean the ovum as it comes from the ^
ovarium, or at leaft as it exifls in the Fallopian tube, conhft^
ing of two membranes, the chorion and the amnios, which con*
tains the liquor amnii and the embryo, but without the decidua,
which membrane is formed by the uterus.

offices

[ 223 ]

offices peculiar to Itfelf, though conducing to
the fame general end.

Thus the ovarium, after impregnation,
forms the foetus, which, with its membranes,
is tranfmitted through the Fallopian tube,
whofe particular funftion it is to catch the
ovum as it comes from the ovarium, and
carry it down into the cavity of the uterus.
The office of the uterus is to form the de¬
cidua for the reception of the ovum, to fe-
Crete the mucus in the cervix, to nouriffi the
foetus during its abode there, and afterwards
to expel it ; fo that each part has its own
particular duty, feparate and diftindl from
that of all the reft. But as each organ, the*
individually defigned for certain purpofes,
makes a portion of the whole fyftem for ge¬
neration, fo it feems that the fcimulus, or
impreffion for aeftion, is communicated to
the whole at once, confequently to every part
of that whole. From the application of this
flimulus, or impreffion for adtion, the ute-
rus, as foon as impregnation has taken place,
.begins to form the decidua, in order to pre¬
pare for the reception of the foetus. Even
if the ovarian ovum ffiould not enter the '
uterus, the organ ftill performs its office,

having

[ 224 ]

having already received the flimulus for that
piarpofe, in confent with the whole, and in¬
dependently of the fortuitous delay of the
ovarian ovum, either in the ovarium itfelf,
the cavity of the abdomen, or the Fallopian
tube. Another circumftance worthy of re¬
mark in this cafe is, the ficknefs which the
patient had attributed to an habitual bilious
complaint. There appears to be little reafoii
for doubt, that this was occalioned by the
ftate of pregnancy; and it feems to prove.,
that the ficknefs in pregnancy depends upon
the general procefs going on, and not on the
affedtion of any particular part ; at any rate,
it has no connedlion with the refidence of the
foetus in the uterus.

But the moft remarkable thing in this cafe,
is the laceration of the Fallopian tube, and
the fatal haemorrhage thereby occafionc-d,
cfpecially when we confider that the patient
could not have been in a pregnant ftate more
than feven weeks. It is difficult to account
for the rupture of the tube, which feems to
have happened fpontaneoufly, at a time when
the was not only making no extraordinary cx*
ertions of body, but none at all, and one could

’ . hardly

[ 225 ]

hardly have believed, a priori, that haemor¬
rhage to fuch an extent could have arifen
from the Fallopian tube, even though en¬
larged in its capacity, as happened in this*
cafe, from the growth of the ovum in it. It
is plain, from a view of the pouch contain¬
ing the ovarian ovum, that the velfels are
more numerous than in the natural ftate of a
Fallopian tube ; yet ftill it feems very furprif-
ing when we confider that the enlarged part
did not exceed the fize of a walnut, fo much
blood could have been poured out from fo
fmall a part.

The firft fenfation of pain complained of
by the patient, may be probably referred to
the rupture of the Fallopian tube. As both
the pain and the fainting occurred by parox-
yfms, it is likely that the lofs of blood was
reftrained in the intervals by the coagulation
of a part of it at the extremities of the vef-
fels, and that when the pain was aggravated,
it w'as o wins' to an increafe of the laceration,
from which more blood being poured out,
the patient again fainted.

In hasmorrhages, which take place from
parts expofed to the air, perhaps the mere
expofure may have fome effedt, by ftirnulat-

ing

[ 226 ]

ing the extremities of the veffels, to produce
contractions of them, and fo may reftrain the
lofs of blood } but in deep-feated parts, where
the temperature is favourable to the relaxa¬
tion of the veffels, the natural means of re-
ftraining haemorrhage may be exerted with
more difficulty, and therefore a larger quan¬
tity of blood will be loft than could be fup-
pofed poffible from fo fmall veffels. But this
I offer entirely as a conjedture. .

Upon the whole, the fymptoms which ac¬
companied this difeafe were fuch as could not
have led any one to form a conjedhire refpedl-
ing the nature of it : and even if it had been
known, we could only have deplored the in-
fufficiency of our art to remedy a fituation fo
uncommon and fo fatal.

Expla-

(

f .

'l ^ ••

{

f pi

. ' '• '.■< r

tk •

..;,J

/ Xl' >

Flate.

8, p.2Z'J.

[. 227 ]

Explanation of the Plates*

PLATE VIII.

A view of the Fallopian tube, with the
laceration in it. — The chorion and amnios are
feen, the latter containing the foetus. — The
dark fpots furrounding the chorion reprefent
the coagula of blood formed at the extremi¬
ties of the uterine veffels. The briftles are
- inferted in the two extremities of the Fallo¬
pian t^be. The upper leads to the uterus ;
the lower to the fimbrise.

PLATE IX.

A front View of the Cavity of the Uterus,

A. The mucus in the cervix of the uterus,

formed in confequence of pregnancy,
which IS with difficulty expreffed in
an engraving.

B. The decidua, extending over the whole

cavity of the body and fundus of the
uterus.

C. A fide view of the rupture of the Fal¬

lopian tube, and the foetus feen fuf-
pended in the amnios.

0.2

PLATE

[ 2a8 ]

PLATE X.

u4 back View of the Uterus.

A. The ovarium cut open, fliewing the cor¬

pus luteum. -

B. A fide view- of the laceration in the Fal¬

lopian tube, with the foetus obfcurely
feen fufpended in the amnios.

C. A part of the cavity of the Fallopian

tube feen through a cut made in its
fide, with a briftle palling through it.

XV.

PlatelO.p.zzS.

-I

K ^ -r*. . . ^ ^• m

•vV 'V ■•

• >

•4

.•'h

\‘

•'' P!-'

• \. ,.'

■/?..; V

%y--

■ > ’< •■ • i '

■'■ ■'a'**;

•'» ' V

t ■ t

I •

. ' I'

' ' I ..

•Ji ^

'■ i*. ■' *

e-if'l; •

^ ,

•< - . ,' ,-

i- • ■ ^*9 « \

1 i

t ■

,v* ' ■'5::

• •¥

■ « L ,

•

v-l

/■

> •■

(•

' ^ ■< . •' '
•'■ ,' , '»• '•

iir

[

’ 'i

. (

• I

• '> ‘ / * i

f- ,

;

.i ^

[ 229 ']

XV. Some Ohfervations on the loofe Cartilages
found in fointSy and mofl coni7nonly 7net
with in that of the Knee, By Everard
Home, Ef, F, R. S, and Afifiant Sur^
geoji to St, George's HofpitaL

. Such detached and moveable, cartilages as
are the fubjec^t of the following obfervations,
are not peculiar to the joint of the knee,
they occafionally occur in other joints of the
body ; but as they are moft frequently met
with in the knee, and it is in that joint they
produce fymptoms which render them the
objedl of a chirurgical operation, I fliall con-
fider them more particularly when lituated in
that cavity.

Thefe fubftances, in their ftrudlure, are
analogous to bone, but in their external ap¬
pearance bear a greater refemblance to carti¬
lage ; they are not, however, always exactly
of the fame ftrudlure, being in fome inftances
fofter than in others. Their external furface
is fmooth and polilhed, which, being lubri¬
cated by the fynovia, allows them to be moved
readily from one part of the joint to another,
feldom remaining Iqng at reft, while the limb

0^3

[ 23° 1

is in motion 5 when they happen to be in
fuch lituations as to be preffed upon with
force by the different parts of the joint, they
occafion confiderable pain, and materially in¬
terfere with its neceffary motions.

The circumftance of their being loofe, and
having no remains of a vifible attachment,
made it difficult to form conjedlures refpedt-
ing their formation; and I believe that no
fatisfadlory account of their origin had been
given, till Mr. Hunter’s obfervations threw
light upon the fubjedt. The circumftances
wffiich led him to the inveftigation of this
fubjedt, appear at firft fight fo foreign to the
purpofe, that they require fome explanation.

In the courfe of his experiments and ob¬
fervations, inflituted with a view to eftablifh
a living principle in the blood, Mr. Hunter
was naturally induced to attend to the phe¬
nomena which took place when that fluid
was extravafated, whether in confequence of
accidental violence, or other circumflances.
The firft change which took place he found
to be coagulation ; and the coagulum thus
formed, if in contadt with living parts,
did not produce an irritation fimilar to
extraneous matter, nor was it abforbed and

taken

[ 231 ]

taken back Into the conftitutlon, but, in
many inftances, preferved its living principle,
and became vafcular, receiving branches from
the neighbouring blood-veffels for its fup-
port ; it afterwards underwent changes, ren¬
dering it fimilar to the parts to which it was
attached, and which fupplied it with nou-
rilhment.

In attending to cafes of this kind, he found
that where a coagulum adhered to a fur-
face, which varied its pofition, adapting it to
the motions of fome other part ; the attach¬
ment was neceffarily diminiflied by the fric¬
tion, rendering it in fome inftances pendu¬
lous, and in others breaking it off entirely*
To illuftrate this by an example, I ftiall men¬
tion an inftance which occurred in the exa¬
mination of a dead body. The cavity of the
abdomen was opened, to examine the ftate
of its contents, and there appeared lying up¬
on the peritoneum a fmall portion of red blood,
recently coagulated ; this, upon examination,
was found connedled to the furface upon which
it had been depofited, by an attachment half
an inch long, and this neck had been formed
before the coagulum had loft its red colour.

0^4 This

[ 232 ]

This fteeped in water, fo as to become white,
appeared like a pendulous tumor.

- From this cafe it became eafy to explain
the mode in, which thofe pendulous bodies are
formed, that fometimes occur attached to the
infide of circumfcribed cavities, and the prin¬
ciple being eftabliflhed, it became equally eafy
for Mr. Flunter to apply it under other cir-
cumftan'ces, fince it is evident from a known
law in the animal oeconomy, that extravafated
blood, when rendered an organized part of the
body, can alfume the nature of the parts into
which it is effufed, and confequently the fame
coagulurn which ' in the abdomen formed a
foft tumor, when fituated on a bone, or in
the neighbourhood of bone, forms more com¬
monly a hard one. The cartilages found in
the knee joint, therefore, appeared to him to
originate from a depofit of coagulated blood
upon the end of one of the bones, which had
acquired the nature of cartilage, and had af¬
terwards been feparated. This opinion was
further confirmed by the examination of joints
which had been violently ftrained, or other-
ways injured, where the patients had died at
different periods after the accident. In fome
of thefc there were fmall projecting parts,

pra^ter-

C 233 • ]

pra'ternaturally formed, as hard as cartilage,
and fo fitiiated as to be readily knocked off
by any fudden or violent motion of the joint.

This opinion Mr. Hunter has mentioned
for many years in his ledtures, and his argu¬
ments in favour of it are fo confonant to the
general laws by which the operations of an.
animal machine are regulated, as fcarcely to
require further evidence : but the following
cafe exhibits fo many fadls in confirmation of
this theory, that it appears to me to afford a
full explanation of the procefs abovemen-
tioned, and completely to eftablifh the opi¬
nion.

' A man, fixty-cight years of age, was
brought into St. George’s Hofpital, on the
20th of March, lyqij with a fimple fradture
of the right thigh-bone. The fradlure was
iituated about three inches below the great
trochanter ; it was treated in the ufual man¬
ner, but no bony union had taken place in
the beginning of June, about eleven weeks
after the accident, the portions of bone at
that time being readily moved ’ on each
other. There being nothing in the man’s
general health to account for this backward-
nefs in the parts to unite, he was delired to

explain

[ 234 ]

explain whatever circumftance he was ac¬
quainted with refpedting himfelf, likely to
throw any light upon it. This enquiry led
the patient to mention, that his right os hu¬
meri had been broken three years and nine
months before, but that the bones had con¬
tinued difunited, and admitted of motion more
freely at that time, than immediately after the
accident.

Reft having proved inefFe<ftual in producing
union in the thigh, and it being evident, from
the circumftance of the arm, that there was
a natural backwardnefs in the conftitution to
form bony union, he was directed to walk
upon crutches, and to prefs as much upon
the broken thigh as the ftate of the parts
would admit, without confiderable pain, with
a view to roufe the parts to aftion, forcing
them by a fpecies of neceffity to ftrengthen
the limb. In the courfe of a fortnight there
was an evident firmnefs in the bone, and in
lefs than two months the patient could walk
with the affiftance of a ftick. As there was
fome thing uncommon in the cafe, he was al¬
lowed to remain in the hofpital to acquire
ftrength ; in this convalefeent ftate he was

feized

[ 235 3

feized with a complaint in his bowels, which
was very violent, and carried him off.

After death the thigh-bone was found firmly
repaired by bony union, but the bone of the
arm, an account of which is more immedi¬
ately to the prefent fubjed, admitted of mo¬
tion in every diredlion at the fradlured part.

The arm was carefully diffedled, to examine
the ftate of the fradlured parts, between which
there was no callus, but a large bag filled with
a glary fluid, refembling fynovia. The inter¬
nal furface of this bag was fmooth, like a
capfular ligament, and its attachment to the .
bones was of the fame kind : it adhered firmly
to the furrounding parts, which were thick¬
ened and confolidated, rendering it very ftrong.
The two ends of the bone were adapted to
each other, all the irregularities having been
abforbed, and their furfaces were of confider-
able extent, from the fradture being oblique ;
the upper one was (lightly concave, or rather
had tw^o depreflions, with a middle ridge;
the lower one was fmaller and rounded, and
was adapted to both concavities, which re¬
ceived it in the different motions of the parts.

The furfaces of the bones fitted for motion
were not completely covered with cartilage,

but

[• 236 ]

but ftudded over with it, and the bone was
expo fed in the interftices ; a number of pro-
jedling parts, covered with cartilage, grew
out from the furfaces, fome exceedingly fmall,
others large. From the edges of the bones
and the capfular ligaments, thefe excrefcences
were larger, extremely irregular in their fhape,
broader in their attachments, fofter in their
texture, and ferrated upon the external edge.

Thirty or forty fmall fubftances, fimilar to
thefe .above mentioned, were found loofe in
the cavity, varying in fize from that of millet-
feed to that of a barley-corn, of a roundilh
form, and fmooth on the furface ; the largeft
of them were more flattened, and ferrated.
Their hardnefs varied confiderably, fome of
them being as foft as cartilage, others fo folid
as not to be pierced by a needle. Thofe bo^
dies rnuft have been originally attached, and
broken off by the friftion of the parts on one
another.

The praeternatural cavity which I have de-
fcribed, was in its nature and ufe fimilar to
the naturally formed joints of the body ; thefe
excrefcences and loofe bodies were its princi¬
pal peculiarities, the formation of which ap¬
pears to have been the refult of the violence

co.mmitted

[ 237 ]

committed on the parts previoufly to the for¬
mation of the joint, and may be explained
in the following manner.

When the bone was broken, the ruptured
veflels poured out their contents into the in¬
terfaces of the lacerated parts, for the pur-
pofe of uniting them again ; this, however,
not taking place, it was neceffary to accom¬
modate the parts to their difunited ftate, to
this end the blood, which had now become
ufelefs, was in part abforbed, and the new
joint formed. The remains of the coagulated
blood, which had not given the ftimulus for
its own abforption, underwent changes in its
nature, affimilating it as much as poffible to
that of the furfaces to which it was attached,
in fome parts its texture refembling ligament,
in others being more allied to cartilage, or
bone.

When we compare thefe fubftances with
the loofe cartilages found in the knee-joint,
which are alfo produced in confequence of
accidental violence, and fimilar in their ap¬
pearance, we are naturally led to conclude
that the latter originate from extravafations of
blood, altered in its nature by the parts in
which it is depolited, fimilar to thofe in the

artificial

[ ]-

artificial joint above defcribed. In both cafes
they are evidently new formed fubftances, and
the readieft mode by which we can account
for their producftion, is to refer them thus to
the blood, from which fluid every part of the
body was originally formed.

Thefe loofe cartilages, as’ they have been
commonly called, although they may occur
in any joint of the body, are found moft fre¬
quently in the knee ; and in this joint, from
the pain and inconveniences they produce,
have become the objedt of an operation in
furgery.

One or more of them may be formed in
the fame joint, I have known one inftance in
which there were three ; they are commonly >
about the lize of a horfe-bean, often much
fmaller, and fometimes confiderably larger;
when very large, they do not give fo much
trouble to the patient as the fmaller kind. A
foldier in the 56th regiment has one nearly
as big as the patella, which occafions little
uneafinefs, being too large to infinuate itfelf
into the moving parts of the joint.

In this difeafe, the removal of the loofe
bodies is the only mode of relief ; and it is
fortunate for thofe who are afflidted with it,

that

[ 239 ]

that the knee-joint is the moll favourable in
the body for fuch an operation ; for the ca¬
vity extends a confiderable way beyond the
moving parts of the joint, and is continued
into parts, which, when divided, will m.orc
readily unite than the common capfular liga¬
ments, and be lefs liable to communicate the
inflammation that comes upon the wound to
the general cavity.

As thefe loofe bodies cannot always be
found, no time can be fixed for the operation ;
but the patient, who will foon become fami¬
liar with his own complaint, mull arreft them
when in a favourable lituation, and retain
them there till the furgeon can be fent for.

Before the operation, the limb Ihould be
extended upon a table in an horizontal poli-
tion, and fecured by means of affiftants ;
the loofe cartilages are to be pulhed into the
upper part of the joint above the patella,
and then to one fide, the inner fide is to be
preferred, as in that lituation only the vallus
internus mufcle will be divided in the opera¬
tion. Should there be feveral of thefe bodies,
they mull be all fecured, or the operation
fhould be pollponed till fome more favourable
opportunity, fince the leaving of one will fub-
4 jedl

[ 240 ]

^ /

jedl the patient to the repetition of an opera¬
tion, not only painful, but attended with fome
degree of danger.

The loofe bodies are to be fecured in the
fituation abovemen tioned by an affiftant, a
tafk not eafily performed while they are cut
upon, from their being lubricated by the fy-
novia ; and if allowed to efcape into the ge¬
neral cavity, they may not readily, if at all
be brou.^ht back into the fame fituation.

The operation confifts in making an in-
cifion upon the loofe cartilage,' which it will
be bell to do in the diredion of the thigh, as
the wound will more readily be healed by tliQ
firft intention. If the Ikin is drawn to one
fide, previoufly to making the incifion, the
wound through the parts underneath will
not correfpond with that made in the Ikin,
which circumftance will favour their union.
The incifion upon the cartilage mufi: be made
with caution, as it will with difficultv be re-
tained in its fituation if much force is applied.
The affiftant is to endeavour to pufli the loofe
body through the opening, which muft be
made fufficiently large for that purpofe ; but
as this cannot always be done, the broad end
of an eyed probe may be palled under it, fu

[ hi ]

as to lift it out, or a lliarp- pointed inftrument
may be ftuck into it, which will fix it to its
fituation, and bring it more within the ma¬
nagement of the furgeon.

The cartilages being all extracfled, the cut
edges of the wound are to be brought to¬
gether, and, by means of a comprefs of lint,
not only prefiTed clofe to one another, but alfo
to the parts underneath, in which fituation
they are to be retained by flicking plaifter,
and the uniting bandage.

As union by the firft intention is of the
utmoft confequence after this operation, to
prevent an inflammation upon the joint, the
patient fhould remain in bed with the leg ex¬
tended, till the wound is perfedlly united, or
at leall all chance of inflammation at an end. •

PLATE

[ 242 ]

P I. A T E XI.

A Reprejentation of the artificial Joint,

a. The head of the os humeri.
h. The fradured extremity of the upper por¬
tion of the bone.

c, The lower portion of the bone.

d, d. The newly formed capfular ligament fur¬

rounding the cavity of the joint.

e, e. The furfaces of the fradlured ends of the

bone, adapted to each other for the pur-
, pofe of motion j the upper furface having
two' concavities, withl a middle ridge;
the lower one being rounded and convex,
in fome meafure fitted to move in either
of the cavities. Both thefe furfaces are
partially covered with a fubftance fimilar
to cartilage, in the interflices of which
the bone is expofed.

From the furface of the bones arife a number
of fmall hard projedting parts, very narrow at their
bafe. From the inner furface of the capfular liga¬
ment there are excrefcences of a fofter nature, very
large, ferrated on their external edge, and attached
by narrow necks. Many of thefe fubftances, both
of the hard and foft kind, were found loofe in the
cavity, their attachments being broken by the mo¬
tions of the joint.

XVI.

Platan, p.n.%2

;-iA.

A-"- / -

' '■''j

V-t^- ..v' ,.

> . .fc • ' .•■ ’^c ' •■' f-:»i •

' ■■ s '. • ■* ■ ' ;! ■■- ' ' *'. * • vH

‘ i

iv* #'‘-

kv' # -

IV ^1'

’ *' .

■ .■; V V,v, v
' V' ■ ■ /.

'»' ' ■ • ■ . "V”/ '

', V.s

, ■/,'! *

t ^ *'l.

• *■:

k'-

> . 'yv-

[ 243 J

XVL An Attempt to improve the Evidence of
Medicine. By George Fordyce, M.D.
F. R. S. Fellow of the Royal College of Phy--
fciansy and Reader on the Pra^ice of Phyfc
in London.

The evidence on which medical know¬
ledge is founded has hitherto been princi¬
pally deductions from the praCtice of medical
practitioners, made by themfelves, and com¬
municated to the public. The cafes them¬
felves from which thefe deductions were
made have feldom been publiflied ; and when
they have, they have principally been of ex¬
traordinary difeafes ; and thefe have commonly
been Rated, with a view to fome particular
point, in fuch a manner that they cannot be
brought as evidence fufBciently accurate to
be depended upon.

The following fcheme is intended to make
the evidence in cafes more compleat, by dif-
feCting them, placing the progrefs of each
particular fymptom by itfelf, and fliewing its
connection with, and the relation it bears to,
the other fymptoms of the difeafe.

R 2

t 244 ] • ,

If a perfedl fcheme of this kind was formed,
and if a cafe was taken corredtly according to
it, it is clear that fuch a cafe would bring
into view the whole of its evidence ; and
that a compleat colledion of fuch cafes would
form ' X. perfedl body of medicine as far as it
is hnown. The refult would be, that we
' fliould get rid of that variety of opinion which
pervades the whole of the fcience ; and our
opinions would be grounded on the folid foun¬
dation of obfervation, and not float, as driven
by the mere caprice of practitioners.

A fecond effeCt a perfeCt fcheme of this
kind would produce, is putting the evidence
which is brought in any cafe in a true point
•of view ; and fhowing what is ftill wanting
to make it conclufive. .

In this country it is the ufage frequently
to employ practitioners who are confidered as
of lefs note at the beginning of a complaint ;
and afterwards, if he thould not be thought
capable of conducting, or df he fliould not
cure the difeafe, another is fent for, as fup-
pofed of greater fkill. I do not mean to ar¬
gue the propriety of this ufage 5 but as it
exifts, it often happens that this fecond prac¬
titioner can obtain very little authentic evi¬
dence

[ 245 ] ■ ”

dence of what went before in the difeafe, by
which he can judge of it. It is meant as
another advantage of this fcheme to point
out to thefe praftitioners the things they
ought to take notice of: and if they fill up
the columns of this fcheme at the time, good
evidence will always be^ready both to them-
felves, and to any other pradtitioner, of what
has gone before in the difeafe.

The things to be confidered in a difeafe
are divided in this fcheme into thofe which,
happen before, or at the time' when^ the
difeafe takes place ; and the things ^v/hich
happen in the progrefs of the difeafe.

The things which happen before and at
the time of the attack are placed in horizon¬
tal columns ; and under thefe the things
which happen during the progrefs, in per¬
pendicular columns.

The things which have happened before
and at the time of the attack are not after¬
wards changed ; reciting them once therefore
is fufficient.

Thofe things which happen after the at¬
tack are conftantly changing ; all thefe are to
be enumerated in the order they arife, and
therefore mufi; often be repeated. Thefe

R 3 points

[ 246 ]

points are attained by placing them in this
order, as is evident from infpedioii of the
fcheme.

The firft of the horizontal columns is the
climate in which the patient lives at the time
of the difeafe. In which we are to remark,

I ft. T he part of the globe where it lies.

The evidence of fcience ought to be per¬
manent ; but towns and kingdoms are fluc¬
tuating, therefore the longitude of a place
fl^ould be taken from fome part of the earth
which is remarkable, and is likely to con¬
tinue. The latitude is not liable to any error
from any fludluation that can happen for
many ages.

zdly, The expofure to the fun.

^dly. The winds which ufually prevail ^
and the ftate of the atmofphere they pro-
duce.

4thly, The fituation for height compared
with the adjacent country, and above the
level of the fea.

5thly, The nature of the foil in regard to
Its moifture and drynefs-; and the fituation
with regard to rivers, lakes, or marfhes.

6thly, The qualities of the waters ufed by
' the inhabitants, and the quantity they are

fupplied

[ 247 J

fupplied with ; as that will often point out
the means by which the parts of the food
not ufed, as well as all other putrefcent fub-
ftances, are carried off.

ythly, The temperature of the atmofphere.
8thly, Any particular effluvia, or other mat¬
ter contained in the atmofphere in confequence
of the largenefs of a- town, mode of living of
the inhabitants, rnineral effluvia, &c.
qthly. The ftru(5ture of the houfcs.

I othly. The modes of living of the inha¬
bitants, by which is meant the ufual manners
and cuftoms of the inhabitants as to food,
drinks, lleeping, drefs, exercife, and employ¬
ment of time, which often gives light into
the nature of difeafes in every part of the
community.

As an example I have endeavoured to de-
fcribe the clim.ate of London.

London, latitude 51° 31' north, longitude
5' 37^^ weft from Greenwich, 5° 16' 23'^ eaft
of the opening into the Mediterranean from
the ocean. The town is large for an Eu¬
ropean towm, being in a body about five miles
in length, and three in breadth,- befides a
•number of rows of houfes lining each fide of
the roads going out from it. A mile is 1691,

R 4 6485

[ 248 . ]

648 5 lengths of a pendulum fwinglng feconds.
The greatefl: part of the town is lituated on.
the north fide of a river called the Thames.
The ground on which this part Hands is an
hill, which rifes with a quick afcent from
the bank of the river, and then gradually,
although unequally, to the north weft, which
is the rnoft elevated part.' The river on the
fouth fide is confined by an artificial bank,
the ground on that fide being flat ; but the
water does not ftagnate in the ditches, being
kept in motion by the tides. On this fide
Hands a confiderable part ‘of the town called
Southwark, in a body near a mile both ways :
above this there is at prefen t chly a fmali line
pf the tov/n on the fouth fide of the river.
London reaches along the river fide to the
weft, until the river leaves the bottom of the
hill and turns to the fouth. Above this the
river is confined between artificial banks on

both fides, and is lined with houfes till it
runs through two old towns, Weftminfter and
Lambeth, confifting moftly of ruinous houfes,
exclufive of the river, about a mile in length
and breadth.

London is furrounded, befides the houfes
>v’hich line the roads, with many large vil-

lages ii

[ 249 ]

lages ; efpeclally from the weft by the horth
to the fouth-eaft.

The river Thames runs through a valley
upon a bed of gravel, and probably clay un¬
der it, for many miles above and below Lon¬
don. The valley is bounded on both fides
by hills not exxeeding four hundred feet in
height. Where the river runs in the middle
of the valley, it is fecured by artificial banks
on both fides, which have lafted longer than
the memoxy of hiftory, extending in all more
than thirty miles. Thefe banks, when the
river walhes the bottom of the hills on either
lide, are only continued on the oppofite fide.
When not encreafed by either rains or the
tide, the river is about a quarter of a mile
broad, not more than twelve feet deep, and
now and then in very dry feafons it has been
forded by horfes. The tide in this river rifes
above fifteen miles higher than London. At
London it rifes at fpring tides from twelve to
fourteen feet. The water is very pure fomeu
miles above the town ; near the town it is
mixed with mud, and contains a fufficient
quantity of mucilaginous matter to putrify.
When preferved in calks it purifies itfelf by
putrefaftion, and remains afterwards more

pure.

[ 250 ]

pure, but it never putrefies fenfibly in the
river, nor in the cillerns in which it is fome-
times kept for a few days for ufe. At the
lower part of the tow^n it contains a little fea-
falt when the tide is at its height ; but this
does not reach to the middle of the town.
Its fpecific gravity is the fame with that of
diftilled water. The inhabitants are fupplied
with this water, which is pumped up by fe-
veral engines, principally worked by fire, into
their houfes.

The town is alfo fupplied with water by
an aquedudl, which is brought' from more
than twenty miles diftance from the north,
through a canal of about fixty miles in length.
The water of this aquedudl is alfo pure, and
unlefs when heavy rains bring down clay, it
is bright and clear, and does not putrefy on
■keeping. Its fpecific gravity is alfo the fame
with diftilled water. This water, as well as
the other, is carried in wooden pipes under
the ftreets into the hoiifes of the inhabitants.

There are fprings found on digging every
where in the town, which might yield
•large quantities of water. Thefe were for¬
merly ufed, but are now little employed, be-
caufe the fupply from the Thames and New
4 River

[ 251 3

River is much cheaper. The waters of thefe
fprings contain a fmall portion of fea-falt, and
a larger quantity of magnefia^ vitriolata, fo as ►
to be fenfible to the tafte, and fo as in fome
places to adl as a purgative. They alfo con¬
tain gas ; fome times in quantity fufficient to
give them brifknefs, and render them agree¬
able to the tafte.

Rain water is never ufed, being always very
impure from the duft floating in the air, and
lying on the tops of the houfes.

The whole fupply of water from aquedufts
and engines is 109,440 cubic feet in an hour.

The valley through which the Thames runs
is gravelly, generally dry, and not marftiy till
about a mile below the town, the water in
the river being confined between its banks. .

The hills, or rifings, on which the princi¬
pal part of the town ftands, are moftly a mix¬
ture of clay and fand ; the fand or gravel ge¬
nerally being in rather the largeft proportion.
In fome places the- foil is gravel.

• The winds from fouth-weft to north-weft,
and from fouth-eaft to north-eaft are the moft
prevalent. The wefterly winds blow over the
great Atlantic ocean, pafling before they reach
London over part of Great-Britain for about

two

[ 252

two hundred miles, and over Ireland when
they veer to the north. They are generally
moift, although much drier than when they ar¬
rive at the weft coaft of the ifland. The baro¬
meter is generally low when they blow. They
are commonly moft prevalent in February,
September, November and December. The
eafterly winds blow over the large continent
of Europe : they are alv/ays dry. The ba¬
rometer is high when they blov/. They are
mofl prevalent in January, March, and the
heginning of April. They are cold, except
fometimes when they blow in July and Au- .
guft, while the wefterly winds are almoft al-
w^ays warm, except in 'November, if they
verge to the north.

The heat of the air is very variable, feldom
remaining equal for many daysj and every
year differing entirely from the preceding ones,
not only in heat, but alfo in moifture, and
rain. Sorne times the winter is feverely cold,
wdth froft from November till May with lit¬
tle interruption ; fometimes the water is not
frozen for more than ten or twelve days.
Moft commonly there is a little froft in No¬
vember and December, but otherwife thefe
months are ufually very foggy and moift.

The

[ 253 ]

The principal froft generally Is in i January ;
February is commonly a mild, open, moift
month. March is generally cold and dry.
The fummer months vary as much ; fome-
times there are three months very warm,
fometirnes not more than a week ; the latter
half of July is commonly the hotteft. In
Auguft heavy rains often fall, efpecially in
the laft half of the month. The thermo¬
meter fometirnes rifes to above 8o“ of Fah¬
renheit’s fcale, very rarely to 86° j but the
moft common fummer heat is from 65° to
75° : it fometirnes falls in the winter to 15°;
it has been known to fall below the point
marked o, but very rarely. The moft com¬
mon winter heat when it freezes is between
20° and 30°; the moft frequent when it does
not freeze between 40° and 50°. •

The air when dry is always loaded with,
and often obfcured by duft, which confifts of
afhes and foot arifing from pit-coal, the fuel
which is commonly burnt ; horfe dung pro¬
duced, and ground to fmall powder by the
numerous carriages drawn by horfes, with
which the ftreets are always crowded ; pow¬
der of granite and flints, which form the
ftreets and roads, and 'are ground extremely

fine

[ 254 ]

fine by the wheels of the carriages. Thefe
powders, with various others, penetrate the
houfes every where, and undoubtedly enter
the trachea, adhere to the furface of the
lungs, and not uncommonly produce cough,
with difficulty of breathing, in people on firft
coming from the country.

The ftreets are generally wide ; few of
them fo narrow as to prevent two carriages
'from paffing, and many of them wide enough
to allow five or more to pafs, efpecially in
new parts of the town, which form more
than half of it ; they are from fixty to twenty
feet wide, thofe of great comm.unication fel-
dom lefs than thirty, in the old part of the
town ; in the new part moft of them are not
lefs than forty. In feveral places there are
fquares of a confiderable fize, i. e. from about
log to looo feet fquare. The llreets are
well paved, and clean, potwithfianding the
immenfe quantity of horfe dung conftantly
falling upon them.

The houfes, except moft of thofe in the
oldeft part of the town, which are not more
than a fourth of the whole, have a ftory funk
under the level of the ftreet. This contains
the kitchen and other offices. Below the

level

[ 255 ]

level' of the bottom of this ftory a covered
canal is dug under the ftreet, with which
there is a communication from the houfes,
and by which putrefcent matters fufficiently
fluid are carried off. Allies, bones, &c. are
conveyed away in carts twice a week. The
greateft part of the houfes are of an uniform
ftrufture ; in each ftory a large room in front,
a fmaller room and the ftaircafe occupy the
back part, and there is frequently a fmaller
room added behind. There are commonly
four ftories belides the one under the level of
the ftreet.

The town is fully inhabited ; there is hardly
a houfe unoccupied. The number of inha¬
bitants is very little known : calculations of
various kinds have been made by many au^
thors i but thefe have been founded on ele¬
ments entirely conjeftural, and are therefore
of no ufe. As far as my own opinion goes,
and nothing better than opinion can be formed
in this cafe, they are about a million. They
confift of clafles living in very different
manners.

The firft clafs Includes thofe living on their
paternal fortune, or riches fuddenly acquired,
comprehending a few merchants. The wo¬
men

[ 256 ]

men of this clafs live almoft conffantly in
their houfes, which are very clofe, although
the rooms are fpacious, and the whole houfe
perfedlly clean and neat, or in carriages, with
no labour and little exercife. This gives them
a delicacy in their appearance hardly to be
defcribed. As a flower brought forward by
the cherifliing heat of a confervatory, where
it is defended from the nipping winds, ex¬
ceeds any thing produced by nature alone,
like it they too have a tendernefs of confli-
tution, which fubjedls them to difeafe from
the flighteft expofure to any caufe. Their
lituation, however, prevents them from being
often expofed to infedlion or hidden cold,
which are the great caufes of violent difeafe
in this metropolis. Their complaints there¬
fore are generally flight, and very irregular;
nor can they bear medicines in any way of a
rough nature. Their diforders mufl: therefore
be touched with the flightefl; hand. This
has often produced an imbecility of pradlice,
not only in London, but throughout* the
kingdom, which firfl: infedls the medical
people who are immediately employed in the
diforders of this clafs. Although there may
Ibmetimes perhaps be found one or tw'^o

among

^ [ 257 ]

' among thefe who are not the moft learned or
judicious practitioners, yet they are the richeft,
which contributes not a little to the fpreading
of this infection. Notwithftanding the dif-
eafes of the women of this clafs are frequent,
yet they are feldom fatal, fo that they often
live to a great age.

The men of the firft clafs are much in the
air in the morning, and ufe exercife. They
live in the country part of the year, when they
are^often occupied in hunting and fliooting.
With fome exceptions, they are of conflitu-
tions fufficiently ftrong, are feldom difeafed ;
their difeafes are itrong and marked, and they
bear the operation of powerful remedies.

The men who are menial fervants of this

clafs, like the domeftic flaves of the ancients,
are idle, lazy, ufe little exercife, none when
they can avoid it ^ they are thus rendered ir¬
ritable, and being often expofed to all the in¬
clemency of the weather, in the winter fea-
fon often till three or four o’clock in the
, morning, they are exceedingly fubjeCl to dif-
eafe, particularly of the thorax ; and few of
them attain to any great age, except thofe of
the higher ranks,

S - The

- [ 258 I

‘The women fervants refemble in their con-
llitu'tions their miftreffes.

,The clergy are fewer here than in'^almofl
any other country in Europe. They are very
apt to be affected with hypocondriacal com¬
plaints, perhaps from an idea that they do not
occupy their proper rank in life. Being in
general regular in their manner of living, they
often attain to a great age.

The lawyers who are occupied- in- buCnefs,
ar-c often, from their great attention and
bour of miind, weak, and difordered imdteir
primae Yfe.'’ Thofe who are not emiplbyed^
may-^be confidered as in the fame ftateiwith
the independent ^gentlemen.

Phyficians are fo few,, thatv.itris: hardly
worth enumerating them. • Thef^ are not
xmich above two hundred in all, and hot -near
half that number are employed in -pradiice.
Except when they are cut off by infecftious
fevers, before they are habituated to infec¬
tion, although often difeafed,^ phyficians ge¬
nerally attain a confiderable age.

Attornies and apothecaries are to be con-
iidered in their manner of liff and conftitu-
tions in the order of tradefmen.

Merchants

t 259 ]

Merchants and traders of confequence form
the next clafs. The women of this, clafs live
a regular life, going to bed generally before
midnight, and rifing about nine in the morn¬
ing. Moft families have villas near town,
where the women pafs much of their time,
efpecially during- the fummer feafon. They
are much more in the air, and confequently
have neither the delicacy nor the irritability
of the clafs we have firft enumerated, enjoy
a much’ better ftate of health, their difeafes
are more' regular, and they bear the aftion of
powerful remedies. . Of the men of this clafs,
fome lead a fed^ntary life, ; their tirrie is much
employed in writing, generally leaning onr
their breafts, fuch are .fubjeft to complaints
in their primae vias ; others of them ufe ex-
efeife^ efpecially bn horfeback, and often deep
in the country: alhof them in point of eat¬
ing are luxurious. ' .

The lell^r tradefmen, Ihopkeepers, and ma-
nufafturers, are alfo fober and regular in their
manner of life s but they are much confined
to their houfes, efpecially the women of this
clafs, which renders them irritable and fub-
)edi to difeafe, often violent and fatal. Nor
is that part of the ^ men whofe bufinefs calls

S 2 them

[ 26o ]

them abroad lefs fubjed to morbid afFeftlon,
fo that they rarely attain to great old age.

The laft clafs confifts of the working part
of the mannfad:iirers, and labourers of all de¬
nominations - who, with fome exceptions,
are the moft diforderly, profligate, debauched
fet of human beings perhaps in the whole
earth ; working hard, and being dextrous
in their occupations, and of courfe earn¬
ing. large fums of money, which they fpend
in drinking, expofing themfelves at the fame
time to the inclemency of the weather ; al¬
ways idle while they have any money left, fo
that their life is fpent between labour and at^
tention above their powers, and perfe(ft idlenefs
and debauchery. Their women, alfo paffing
from affluence to diftrefs almofl eveiy week,
are forced, although foberly inclined, to lead
a very diforderly life. Pulmonary complaints
are more particularly common and fatal in
this clafs, as well as all other difeafes.

London is fatal to infants in general. On
a CQuiparifon of charity children fent to be
nurfed in the environs, with thofe nurfed in
town, it appeared the lofs in town, being thirty-
nine, was only twenty-nine in the fame num¬
ber and time in the country. But if this lofs is

great

:[ 26 1 ]

great altogether, it is tremendous among the
lowed: clafs, the mothers being almoft always
obliged to labour for their bread, and often
even robbed, by their hufbands, have no time
left to take the care neceffary for the rearing
of infants, lb that they are often left to wal¬
low in dirt, notwithftanding the general dif-
pofition to cleanlinefs in this country; and
can never receive that exercife, or purity of
the air, which is requifite ; nor can their
food be at all attended to. Add to this, a
pernicious prad;ice of continuing to give them
fuck for even two or three years, by which
they hope to prevent their having charge of
many children. This pernicious pradtice goes
even to fome mothers of the ranks above this;
while mothers in the higher ranks refufe the
natural fuftenance to their infants, leaving
them often to the care of d rangers, regardlefs
of motherly afteffion. From all thefe caufes,
the lofs of children in London is more than
one half before they attain the fifth year of
their age.

The fecond horizontal column in the fcheme,
is marked the preceffion of the feafons, or the
courfe of the preceding feafons.

s 3

This

as one

[ 262 ]

, This column is meant principally
ground of -invelligating the caufes of epi¬
demics.

It is well known that the fame fpecies of dif-
eafe fometimes rifes and fpreads through a to wn^
a whole country, nay over a whole continent
at one time ; . rages with violence for a certain
period, and afterwar# ceafes : when this hap¬
pens, we fay the diieafe is epidemic. I do
not mean to enter into the whole hiftory of
fuch difeafes, but only to obferve that the
different ftates of the human body arifing
from the temperature, moifture, &c. of the
atmofphere in which a man has lived for a
length of time, renders him fubjedt to parti¬
cular difeafes often more than its prefent flate.
The inhabitants of the fame town, nation,
or even continent, fornetimes are expofed to
the fame peculiar ftates of the atmofphere,
and the conftitutions of the inhabitants in ge¬
neral are therefore rendered equally fufceptible
of being affedted by the caufes of the fame
difeafe. If fuch caufes, therefore, diould be
generally applied, the difeafes will be univer-
fal, or epidemic, over the whole country. If
the caufes fliould be partially applied, the dif-
cafe will be epidemic in that town or country

where

t 2'63 ]

where they are fo applied • and if they be ap¬
plied no where, the epidemic will not arife,
notwithftanding the predifpolition.

For inftance, dyfenteric purgings are often
brought on in the autumn by the moffturc
and coldnefs in that feafon ; but in other au¬
tumns equally cold and moift, dyfenteric
purgings do not happen in the fame number.
In fome they are epidemic in an high degree,
in others they hardly appear. It is not, there¬
fore, the ftate of the atmofphere at this fea¬
fon that is to be looked on as alone producing
the epidemic ; for this would not have taken
eifeft if the preceding fummer had not given
the predifpolition. Hot and long fummers
produce difpofition to dyfenteric purging.

Our fummers fometimes , begin in April, and
%

continue till the end of Auguft, with un¬
equal, but fometimes great heat through the
whole ; at other times they do not begin till
the middle of June, and end in the beginning
of Auguft, the heat hardly at any time reach¬
ing to 70“. In the laft cafe there are hardly
any dyfenteric purgings' in the autumn, but
in the lirft they are very frequent arid violent,
efpecially if the cold and moifture of the au¬
tumn come on fuddenly or by fits. .But al-

S 4 though

[ 264 ]

though the fummer be hot and long, thefc
purgings do not appear if the autumn be dry
and warm.

How far we are to carry our refearch into
preceding feafons is difficult to fay ; I think
I have noticed effedls from three years back.
The years 1779, 1780, 1781, for inftance,
were years in which the fummers were long
or very hot, at the fame time the winters were
mild. It is well jcnown that living in warm
air gives predifpofition to intermitting and re¬
mitting fevers. At the beginning of thefe
three years fuch fevers were very rare, and
hardly to be met with ; they began to appear
in the fecond, and were very frequent at the
end of the third, fo that I took thirteen of
them at one time into St. Thomas’s Hofpital,
and thefe had arifen in the environs of Lon¬
don, and we were never without many cafes
of this difeafe

The courfe of former feafons maybe taken
from journals, which are often kept with great
care. Where they are kept by any public
body, it is no way neceffary for a practitioner
to keep them himfelf. A clock would keep

* Many cafes of people with intermitting fever come to the
London hofpitals from marfliy parts of the country.

them

I 26s ]

them the heft If Mr. Cummins’s principle
were adapted to the thermometer, quantity
of rain, &c. as it is to the barometer, which
might eafily be done.

By marking the courfe of the preceding
feafons, it Is probable that great light might
be thrown on the decline of difeafes, as well
as their fpreading ; but it muft require a long
time before much advantage will be gained.

The next column contains the prefent ftate
of the atmofphere, which ought to be marked
not only at and before the attack, but through¬
out the difeafe. This is difficult, on account
of the various things to be attended to, many
of which cannot be referred to public or pri¬
vate journals or clocks. The weight of the
atmofphere may undoubtedly ; the general
moifture may alfo. The wind, which is of con-
fequence in this refpedl, that particular winds
in particular countries have peculiar effedls.
The eaft wind, for inftance, is in this country
a drying wind, and produces cold by diffolving
moifture, fo as to be felt in^the bed-chamber
of a patient in rheumatifm, &c. as is well
known. The purity of the air cannot be
judged of by any thing external to the cham¬
ber in which the patient is, if he be confined

T ?66 ]

to Tiis bed or bed-chamber, 'with any degree
of accuracy. Methods have been found lately
of afcertaining the quantity of. pure air con¬
tained in the atmofphere,. but thete methods
fliew the pure air to be in as great quantity
in the atmofphere of a ward of an hofpital,
where the infedtion is in the moft violent de¬
gree, as on the banks of a ftrea'm murmuring
over pebbles in a gravelly foil.

It does not feem to be the quantity of pure
air contained in the atmofphere that is to be
fought after, but the various fubftances inter¬
mixed. In the fame manner as it is very dif¬
ferent to the drinker of water, whether he
drinks it with a duft of plain fand or arfenic^

The marks of purity in the atmofphere in
a room, or rather freedom from noxious va¬
pour or powders, or fmall drops of liquid
matter, are very obfcure. A felon brought
into a court of juftice, apparently in perfedl
health, has, from his cloaths or perfon, fent
out fuch a quantity of noxious matter, as to
infedt half the perfons prefent with violent
fever. Yet the men neareft him, nor in any
other part of the court, have been fenfible of
the leaft fmell, tafte, feel, or any other fen-
fation whatfoyer j fo that unlefs it had hap-
: 5 pened

C 267^ ]

pened more than once, or even if it had not
happened frequently, no man would have fuf-
pedted that the difeafe had arifen from that
caufe. Juft as when the venei;eal difeafe firft
broke out, no peribn fufpecfted that it arofe
from coition, but from fome malignity of the
air. The nuns therefore in Paris, in order
to avoid this infection, were not clofe ftiut
up in their convents, but houfes were fitted
up for them in the country, out of the in¬
fection of the air of the town.

» The purity of the atmofphere from infec¬
tious or noxious matters in the bed-chamber
of a patient, muft be taken from various cir-
cumftances, which our prefent knowledge
can give but little direction about. I have
often feen a perfon already infeCted and at¬
tacked with fever, go through a fever with
as mild fymptoms in a room where there were
feveral people ill of the fame difeafe, as another
who was kept in the pureft atmofphere that
could be procured.- Yet if feveral perfons
who had entered the room had been feized
with fever, we 'might determine that there
was febrile infectious matter. We are, there¬
fore, to take the purity of the atmofphere where
the patient is, more from the clofenefs and fize

[ 268 ]

of the room, current of air, &c, but the fub-
je£t: is not fo far inveftigated as to be capable
of being farther gone into. The heat of the
atmofphere of the room is of material impor¬
tance to be noted, both for the prefent go-^
vernment of the prad:itioner, and for the evi¬
dence of the difeafe. Heat in medicinal ef-
fedt is not by any means to be judged of by
the thermometer alone in the atmofphere in
which the patient at prefent is. There muft
be taken into confideration the temperature
he has been 'lately accullomed to. When,
therefore, we fay the air in a room is warm,
we cannot fix to that idea the name of a de¬
gree in the thermometer. In winter in this
country, 6o° of Fahrenheit's thermometer is
warm, or rather hot; in fummer 73° is .a
moderate temperature. In other countries it
is different. There are places in India and
'Africa, where 90^ in certain feafons of the
year is cold. Having firfl afcertained what is
generally felt warm at feveral feafons in a year,
we may then refer it to the thermometer. In
London in the cold feafon 55'’ is warm, and
in fummer 73°, varying in other feafons be¬
tween thefe two points. It is not here pro¬
per to enter into the effedl of hot and cold

atmo-

[ 2^9 ]

atmofphereS on difeafes. ’ I £ball only men¬
tion one inftance. jt In acute rheumatifm in
winter, if the heat be 6o° we £hall rarely have;
much metaftafis, while many fhall happen if
it be 45° or 50°.

Phyflcians in all ages have been of opinion,
that it is of great advantage to attend to the.
epidemic difeafes which prevail, not only be- v '
caufe it is ufeful in cafes of the epidemic it-
felf, but becaufe the fame caufes which influ¬
ence the body fo as to make it fubjedl to that
particular difeafe, render it liable . to be af-
fecfled in a peculiar manner when any other
difeafe takes place. I might ground, there¬
fore, this column upon the authority of Hip^.
pocrates, Sydenham, and various other phy-
ficians of great weight. But perhaps it may
be ufeful to make fome obfervations to deter¬
mine what particular epidemics are more ne-
ceflary to be noted.

Fir ft then, there are certain infecftious dift*
eafes that become epidemical. Thefe may
arifc from an infedion which produces a dif¬
eafe, which, when it has once happened, does
not recur during the life of the perfon, fuch
as the fmall-pox. In this cafe it may be, that
a community has guarded itfelf againft the

difeafe

C. 27a I

difeafe fo long, that a great number of pei*-
fons are liable to the infection* Numerous
cafes of fuch difeafe may arlfe on this account,
if the infection fhould be. by any accident in¬
troduced into fuch community, (although there
be nothing in. the air or the conrfe o£the fea-
fons, or any other circumftance, which renw
ders men in general at that tirhe more apt tp
receive the infection fuch a difeafe becom-'
ing epidemic in this manner is not of much
ufe to be notedjin this column, as it will not
govern in any degree any other, difeafe. But
infrequently happens that infectious difeafes,
whether they recur but once or oftener in the
fame perfon, arife and fpread at times tlifongh
a community which has not been guarded
againft them,Nor but negligently, as in Lon¬
don, where there is always fmall-pox, and
other' fuch infectious difeafes, which recur
but once, yet fometirnes they, fpread them-
felves much more univerfally than at others,
and the fame thing happens in the plague,
for the more perfecd hiftory of which phyli-
cians are much indebted to Dr. RulTel, and
in other difeafes which recur in the fame per-
fon more than once. When this happens,
there: mujft be fome peculiarities produceddn

the

[ 271 ]

* • ► *
the bodies of men in general, which renders

them peculiarly liable to be infected. * Thefe

peculiarities may have confiderable irifltience

on any other difeafe that may arife, but they

have not been hitherto inveftigated with any

degree of precifion. It is, however, "the ob-

objed: of this fcheme of difeafe, to bring out

evidence, and therefore fuch epidemics fhould

always be noted. * "

Another fet of epidemic difeafesf arifing

from caufes that are very commonly applied; '

are not infeftious, therefore the difeafe only

afifes. more frequently in a commttiiity at a

f .

particular time, becaufe the bodies of meri^rt^
general are influenced fo as-^ to be^' rhbre eaiily
alFeded by fuch caufesv-' 'Thus ih'lhe fpring^
the bodies of men are rendered fubjed to
phlegmoiibus inflammations, in the autumn
to dyfenteric affedions. ’ ' ' "

^ Gr there may be dileafes which may arife*
either from infedion or without any mfedibn,*
fuch as the eryfipeldtous fore throat; often
called the putrid or ulcerated fore throat,'
which is undoubtedly an infedious difeafe,
but which likewife arifes often where there
can be no kind of fufpicion of infedion.
Thefe certainly become epidemic from their

being

[ 272 ]

being peculiarities produced in the bodies of
men of a community, which renders them
fubjedt to be affedted either by infedlion or
any other caufe. In thefe cafes of epidemics
almoft every difeafe incident to the human
body is more or lefs influenced by the pecu¬
liarities which occafions the epidemic affec¬
tion, and therefore fuch require very particu¬
lar notice.

The next column Is meant to point out the
temperament of the patient. Hippocrates
conceived that there were four humours in the
body ; blood, bile, black bile, and phlegm :
hence men, according as one or other of thefe
humours abounded, were faid to be of a fan-
guineous, bilious, melancholic, or phlegmatic
temperament. This dodlrine pervaded the
whole of Greek medicine, and continued
through the Arabian during the reign of the
Abaflides, and came, with other Greek and
Arabian medicine, into Europe. The modern
knowledge of the fluids of the human body,
fliews that the doftrine which treated of
thefe fluids was without the fmalleft founda¬
tion. But it often has happened, that ap¬
pearances and differences , have been really
marked by phyficians both in health and dif¬
eafe.

t 273 r ■'

eafe, and have been defcribed in words which
were only applicable to the hypothefes of the
> caufes on which they were fuppofed, to de¬
pend. Although thefe hypothefes are no^
true, yet the appearances which occafioned
their formation are perfectly grounded. There
does, for inflance,* exift in certain men, born,
bred up, and living in all the circumftances
of others of the fame community, a difpofi-
tion to phlegmonous and general inflamma¬
tion. Thofe who have this difpofition, ' have
likewife their difeafes influenced by it, and
have been faid to be of a fanguineoiis tempe¬
rament. There are others in whom perfedt
regularity takes place in all their difeafes ; dif¬
pofition to regularity is alfo evident in their
natural functions. Such have been faid to be
of a bilious temperament. Others there are
in whom there is great irregularity both ia
health and difeafe ; thefe have been faid to
be of a phlegmatic temperament. In others
there is a degree of intracfl:ability in all
their difeafes, as well as in what happens in
their healthy ftate ; thefe have been faid to
be of a melancholic temperature. It would
require a much longer diflertation than can •
be allowed here, to point out the various paf-

T fages

[ 274 ]

fagcs ill the works of pradlitioners, to iliew
that this was what produced the idea of tem-^
perament. A phyfician, whofe pradlice is in
any degree extenlive, muft be very inatten¬
tive not to fee clearly thefe differences, which,
however, run into one another in all kind of
variety. It is much to be wiflied, that the
antient names for them were abolifhed; in
the fpecimen, therefore, I have not ufed the
term phlegmatic temperament. But whether
thefe antient names may be ufed, or whether
new ones are to be fubftituted, or general de-
feription is to be given, it is a matter of great
confequence to be noted, as it "often governs
many circumflances in the difeafe. As for
example : we fliould expedl in the fmall-pox,
-even before the eruption, a great degree of
general inflammation during the time of the
eruption, if a man had great difpofition to
phlegmonous inflammation; but if the patient
iliould be fubjedl to irregularity in natural
things, we fliould expect that the difeafe,
when the eruption took place, would exhibit
vvatery puftules, forenefs, great frequency of
the pulfe, and the other fymptoms of a difeafe
which I have called, in the Elements of the
Praftice of Phyfick, fymptoms of irritation.

Befides

[ 275 J

Befides thefe differences in the conflitutioii
of the body, which have been marked by phy-
ficians in ' alnioft all ages as' nearly general
among mankind, there are in particular ha¬
bits peculiarities, which have been called
idiofyncrafy, which may have influence in a
great degree on the appearance of difeafe, and
the effedbs of medicines. I have known, for
example, many inftances where the pulfe, in-
ftead of going on regularly, has been very ir¬
regular ; in feveral cafes without any other ir¬
regularity it has intermitted, and yet all the
fundions of the bo'dy have been carried on
perfectly. Perfons have been affeded by
opium, purgatives, and various ’ other medi¬
cines, in a manner totally different from the
effeds which they produce in mankind gene^
rally. Such circumftances often tend to mif-
lead, if they are not known; therefore, form
the next horizontal column.

It is fufliciently evident that it is neceffary
to note the ufual manner of living of a pa¬
tient previous to the difeafe, as it has not only
an influence on the difeafe itfelf and its ap^
pearances, but forms alfo a ground of prac¬
tice. For example : if a man had been ac-
cuflomed to drink a large quantity of wine in

T 2 health,

[ 276 ']

health, if he fliould be felzei with a fever,
and that fever go on till the ftrength be much
exhaufled, wnne mieht be exhibited in con-
fiderable quantity ; while if a man who drank
no vinous liquor in the ordinary mode of his
living, had an equal quantity exhibited to him,
he would be intoxicated. Although the fa-
fliion of fome pradlitioners at prefent is to
keep patients in fevers intoxicated v/ith wine,
in as far as I have been able to judge, the
prad:ice is very detrimental. So if animal
broths are to be exhibited in fevers at any
time, it certainly would be more pardonable,
to prefcribe them to thofe who have been
much accuftomed to live on animal food, as is
the cafe of the inhabitants of this country.

In the mode of living the points to be con-
fidered are, the kind and quantity of food and

drink which is made ufe of. The times of

tiling food and drink. The defence from, or
expofure to, the weather. The quantity and
times of deeping. The degree and times of
exercife.

The mode of living will therefore form the
next horizontal column.

The next column of thofe containing things
lo be marked previous to the difeafe, I have

called

‘ [ 277 ]

called times and contingencies. Thefe are,
in the firft place, the age of the patient.

It is not of great confequence to mark the
exaft age, that is, the exad: number of years
a man has lived ; but great changes take place
at different periods. The firft period may'
be confidered as happening for the firff nine
months. The fecond from the end of that
time, to the end of the fifth year. During
the whole of both thefe periods, while chil¬
dren are fubjecft to particular difeafes, they
are remarkable for the irregularity which takes
place in all their difeafes. The next period
is from five to fourteen ; the moft healthy of
the whole life-time of man, provided the
fmall-pox, and other fuch infedlious difeafes,
which happen but once, are either gone
through before, or do not occur till after¬
wards, and provided alfo that there is no
fcrofulous difpofition in the child. From
fourteen to twenty-eight is the tiext period 3

• t

during this time there is inflammatory difpo¬
fition in men, and to women it is a very try-

ing one. From twenty-eight to forty- five is.
again an healthy period. From forty- five to
fixty is to be confidered as the next 3 and

T 3 after

after that time the fyftem is wearing out very
faft.

In this column the ftate of the menftrual
flux is alfo to be noted, as well as any difeafe
the patient has formerly been afflifted with ;
fince difeafes have influence, in many inftances,
on thofe which follow them, as an intermit¬
tent will occafion a fubfequent fever, even
after years, to break down into an intermit¬
tent of the fame type, as I have feen in fe-
veral inftances. Laftly, any accidental cir-*
cumftance is to be fet down.

The laft thing to be noted before the tak¬
ing place of the difeafe, is the application
made to the fyftem which gives occafion to
the difeafe, and which is its occalional caufe.
It may be an application to any part of the
body, or to the mind. The knowledge gf
the occafional caufes of difeafes is of great
confequence for the prefervation of health.
In fo far it does not conftitute a part of the
hiftory of a particular cafe of difeafe, there¬
fore has Inference to the fcience of medicine
in general. The knowledge of the occafional
caufe is often alfo of great ufe in pointing out
the treatment of difeafes, in as. far as the

maxim

[ 279 ]

maxim that the caufe being removed the ef-
fed: will ceafe, is true.

The knowledge of the occafional caufe of
difeafe is extremely difficult,' and in many
cafes by no means as yet afcertained. The
difficulty arlfes from various caufes. The*
firfi: is the uncertainty of the adion of every
thing upon the human body, both caufes of
difeafes and remedies. We have feen, for
example, as in the cafe at the Old Bailey
during Mr. Naffi’s mayoralty, a felon bring¬
ing infedion with him into a court of juftice,
v/hich produced fever in a great number of
thofe affembled in the court, while thofe af-
feded fat promifcuoufly in every part of it
\vith thofe who efcaped, and there was no
human means of diflinguiffiing any difference
in the conftitutlons of thofe infeded and
thofe who efcaped. That a man, there¬
fore, has been expofed to an occafional caufe
of difeafe who has not been afteded by it, is
no proof that that particular application is not
an occafional caufe of that difeafe ; yet this
argument has been held by many praditioners
of great eminence. Sir J. Pringle, for ex¬
ample, affirmed that the cloaths of a man be¬
ing moiftened with water while he wore them
was nQt a caufe of catarrh or i^ieumatifm,

T 4 becaufe

•[ 280 ] ■

becaufe many men, even whole regiments of
troops, have had their cloaths wet while they
wore them, Vv^ithout either catarrh or rheu-
matifm arifing. Neverthelefs it is certainly
true, that I have feen more than two hun¬
dred patients at leaft, who, when in perfeft
health, on having had their cloaths moift-
ened while they wore them, were feized im¬
mediately with catarrh or rheumatifm, when
there was no other the leaft apparent caufe of
the difeafe applied. On the other hand, it
is equally fallacious to fuppofe, that any ap¬
plication to the body, if followed immediately
by a difeafe, was the occafion of it. If, for
example, a man, after drinking a glafs of
water, fliould be immediately feized with a
fit of apoplexy, it would not follow from
thence that the apoplexy was occafioned by
drinking the water. But if a difeafe fliould
be found to follow immediately upon any ap¬
plication made to the fyftem in a great num¬
ber of cafes by one practitioner, who was the
only one who had accefs to fee fuch applicar
tion made, there would arife a confiderable
degree of probability that it was the caufe of
the difeafe. If more practitioners than one
had had occafion to fee fuch application made,
and found that the difeafe immediately fol¬
lowed,

V •

[ 28l ]

lowed, the probability would increafe.' It
would increafe the more if thefe practitioners
had had no communication with one another ;
and it would come almoft to a certainty, if it
had been obferved by many pradlitloners dur- '
ing many ages, although the difeafe did not
arife more than once in ten, twenty, or even
an hundred times that the application had
been made. Such, however, has the inat¬
tention to accuracy been, that many occa-
iional caufes which produce difeafes imme¬
diately, are rather admitted from common
confent than from fuch evidence as I have
pointed out.

In the next place it happens undoubtedly,
that in many cafes the occalional caufes of ^
difeafe do not operate immediately, but the
perfon appears in perfect health for fome time
before the difeafe comes on. As in the fmall-
pox, after catching the infeftion, there is un^
doubted proof of the patient’s continuing ap¬
parently and adtually in perfect health before
the difeafe takes place. Here the difficulty
increafes in an immenfe degree. It is true,
indeed, that fuch difeafes as never arife ex¬
cept from one well known caufe, fuch as the
fmall-pox, and fome other infedtious difeafes,
have that caufe well afcertained even when it

[ 282 ]

is not underftood in what manner it operated
before its effedls became fenfible. But in
other cafes, where a difeafe arifes from many
caufes, it becomes extremely difficult to afcer-
tain the application which has adtually pro¬
duced it. This has been the origin of greater
confufion in medicine than any other circum-
ftance whatever : for a pradtitioner, in relating
either a fingle cafe, or the refult of his expe¬
rience in difeafe, has generally taken no man¬
ner of notice how long it was from the appli¬
cation of the fuppofed caufe to the beginning
of the difeafe. It is, therefore, a ftrld: rule,
that in filling this horizontal column, it fhall
' be fet down exaftly how long it was after the
application of the fuppofed caufe before any
jnorbid appearance was perceived in the fyftein.

When a difeafe arifes fbme time after its
caufe has been applied, it is clear that that
caufe muft have produced fome alteration,
which became a caufe of the difeafe. The
conjedlures with regard to this alteration, have
formed the greateft part of the fallacies, hy-
pothefes, and confufion in me(^icinie, they
being almofi: entirely from conjedture, and
not obfervation. It is, therefore, high time
that thefe fijould be laid afide, and the inter-

piediaCc

[ 283 ]

mediate appearances, from the application of
the caufe to the appearance of the difeafe,
fhould only be noted. Perhaps it may not
be overloading this differtation, already too
long, to give one inftance. Sudden expofure
to cold certainly produces difeafe in many
cafes. The difeafes which it produces have
been taken for granted to arife fome times at
a diftance from the time when the cold was
produced, and in this cafe it has been fup-
pofed, from the matter of the infenfible per-
fpiration being obftrudled, accumulated, noxi¬
ous, and capable of producing difeafe ; like-
wife 'that it did adlually produce difeafes by
its noxious qualities. Now of all this there
is not the fmalleft evidence.

Thefe things are to be obferved with re-f
gard to the evidence of the adtual caufes of
difeafe. There is another circumftance to be
attended to ; the effed: which the caufe pro¬
duces, if the application of it be continued
'during the courfe of the difeafe : for fome-
times the caufe continuing, is the occaiion of
the continuance of the difeafe. In this cafe
the maxim is true, that dempta tolitur

effedliis ; as if a thorn be run into the flefh,
it produces an inflammation, and keeps it up ;
but if the thorn be fenioved before the in-

flamn^atioi^

[ 284 ]

fiammaticii arifes to a certain height, the in¬
flammation v/iW diminifh and ceafe. Yet it
may alfo happen, that the occafional caufe
being removed, the efFeft may continue,
without any application of any new caufe
produced by the fir ft, and the difeafe may go
on. It may happen in medicine as in mo- ,
tion, that a body being impelled by a given
power, will move on, although there is no
new impulfe. If the caufe of difeafe con¬
tinue to be applied, yet no continuance of the
cffeft may be produced, as I have endeavoured
to fhow in a former paper in this volume on
fever. Want of attention to this point has
introduced an infinite number of hypothefes
in medicine, fuch as the idea of fome error in
the fluids being the occafion of the continu¬
ance of fever ; fuch error, or, in other words,
alteration of properties can never be admitted,
unlefs proved by experiments ; and although
I myfelf have tried various experiments to
determine the properties of the fluids con¬
tained in the blood -veflels during fever, as
well as the fecreted fluids, I never found any
properties exifting in them which do not oc¬
cur in perfect health ; nor has any perfon as
yet found out a means of diftinguifhing tha

blood

t 285 ]

blood of a perfon affefted by fever, from that
of a man in perfecft health, as far as has hi*
therto been made public, except that in fome
cafes of violent fever it does not coagulate fo
firmly, the red particles are broken down,
and there is an evident tendency to putrefac¬
tion, even fo as that there are initances upon
/

record of its being foetid. But this putref*
cency of the blood is the cifedl of the depref-
fion of ftrength, for it happens only where
there Is previous great depreffion of ftrength ;
and when fuch depreffion arifes in any other
cafe, the fame progrefs towards putrefaftion
is always obferved.

There are difeafes, in which the difeafe
once produced, goes on without any caufe at
ail, as the motion of a mafs of matter being
once produced, the mafs would continue to
move on if in free fpace.

In the next place it is to be obferved, that
this may be the cafe where the caufes pro¬
duce a difeafe immediately on their applica¬
tion, and alfo when the occafional caufe pro~
duces an effefl:, which effedl is or is not a
difeafe itfelf, but the caufe of the difeafe
finally produced.

I ffiall

[ 286 ].

I fliall jufl add, that difeafes appear to go
on fimply, without any continuation of the
application of any caufe : or one part of them
may be a caufe of the other reciprocally, as
feems to be the cafe in inflammations. But
this is foreign to the prefent fubjedt.

Thefe are the things to be obferved before
the difeafe takes place.

Thofe things which are to be obferved
during the difeafe, are placed in perpendicu¬
lar columns, as may be feen in the fcheme,
which will fufliclently explain Itfelf, as being
the things laid down to be obferved by all
authors who have pradlifed. There is only
one column which requires explanation, thq
day of the difeafe.

A day hffs been varioufly confidered, ac¬
cording to the purpofes for which time has
been meafured. It is almoft fuperfluous to
mention, that a day has been taken from the
riling of the fun to the riling of the fun ;
from the time the fun palTed the meridian,
till the time of its next paflage over the me¬
ridian ; from the time of a fear's palTage over
the meridian, until its next paflage over the
meridian. All thefe meafurements of time,
as well as others, have their particular ufes.

[ 287 1

It IS well known that almoft all the an-
tlents, that is to fay, the Greek phyfi clans,
have counted days in difeafe, as well as the
Arabians, moft of the moderns, the Chinefe,
and indeed almoft all nations in whom the
ftudy of medicine has made any |olerable pro-
grefs. Yet few authors have confidered when
a medical day begins. It is true, that al¬
moft all have taken the period from the
fun's paffing the meridian to the time of its
next paffing the meridian, as the length of
the day, which is unequal. It feems how¬
ever, notwithftanding, to be received with
univerfal confent, that this inequality is not
to prevent our confidering this period as
, the length of a medical day. But the time
of the beginning of the day is a point which,
for accuracy, ffiould have been after tained
from the firft. Suppofing two fevers in
different perfons to begin at eleven o'clock
in the forenoon on Sunday : in one of thefe
the crifis takes place on the Sunday fol¬
lowing, at eight o'clock in 'the morning,
and in the other at two o’clock in the af¬
ternoon ; if we count according to the ordi-
naryVeckoidng of days, both crifes would hap¬
pen on the eighth day of the difeafe. But

[ 288 ]

If v/e begin the day at the time (of the attack
of the fever, then that crifis which took place
at eight in the morning, would be on the fe-
venth day 5 and that which took place at two,

would be on the^ eighth. Therefore, unlefs
this point be previoufly determined, every
thing about critical days is thrown into con-
fufion. Perhaps there fliould be two modes
of counting the beginning of medical days ;
one from the commencem.ent of the difeafe
itfelf, whatever time of day it took place,
which feems to have been adopted, and is
proper, as far as I can judge, in pure phleg¬
monous inflammation, not attended with fe¬
ver But in the human body a natural
evening attack of fever is fenfible in all man¬
kind, even in the moft perfect health, and
this begins at five o’clock in the evening;
therefore that hour, in many difeafes, mufh
be accounted the beginning of a medical
day.

It would lead into a differ tation fai\ beyond
my prefent purpofe, to lay down the obferva-
tionsTrom pradtice and contemplation of the

* It is to be obferved here, that I do not mean by fever,
heat, and frequency of the pulfe, but what is often called fimple

fever, and by Dr. Cullen fever ilridlly fo called,

works

[ 289 ]

wotks of medical authors, to give the reafons
why I fix on five in the evening, much more
fo to enumerate the difeafes in which the time
of the firft attack of the difeafe is to be ac¬
counted the beginning of the day and the dif¬
eafes, in which five o’clock in the evening is
to be confidered as the beginning of the day.

There is another circumftance with regard
to the beginning of difeafe, which is obferved
by De Haen, to wit, that it happens in cer¬
tain difeafes, as in fever for example, that
fome flight flying appearances take place be¬
fore the actual attack of the difeafe, from
whence its beginning is to be counted. It is
alfo very neceffary to pay attention to this
circumftance.

Obfervations on the Cafes inferted in the Scheme

as Examples,

It is to be obferved, that in one cafe with
which the fcheme is partially filled up, there
is a column marked the mouth and throat,
which is a variable column, and is referved
for the appearances which take place in a part
of the body, if that part fhould be the feat
of the difeafe.

Qs^

t 290 ]

One of the cafes, which I have felecSed as
an example, may be confidered as not proper,
on account of its not being fully defcribed ;
but I chofe to take one lefs perfecfb, becaufe
it often happens that the hiftory of the firft
j^rt of a difeafe cannot be procured.

I did not fee the patient at the beginning

of the difeafe, therefore could only take the

firft days from report. I alfo chofe a fhort

difeafe, as not having it much an objefl; to

draw off the attention to the difeafe itfelf from
• »

the general-view of the plan. I have alfo
laid before the fociety a cafe of fever more
full, and I have many others in the fame
ftate. I have another reafon for chufing the
firft cafe asacafe of eryfipelatous inflammation.
In order juft to obferve, that although many
praftitioners in this town are well acquainted
with the life of cortex cinchonae, generally
' called Peruvian bark, in eryfipelatous inflam-
tnatioft, yet the knowledge of its virtues in
fuch inflammations Is not general. It is not
of much confequence who has made any in¬
vention in the fcience of medicine, for the
fatisfadlion arifing from being able to relieve
‘diftrefs by the application of a new medicine,
or one already known in a new manner, or
'for* new purpofcs, is a fufficient recompence.

I do

[ 291 ']

I do not mean, therefore, to difpute the pri-’
ority of the application of this medicine with
any perfon who fhall confider himfelf as the
inventor of it, I only mean to fhow by what
progrefs I have brought it in evidence that it
is the moft powerful remedy in eryfipelatous
inflammation. By eiyfipelatous inflammation
I mean inflammation of the Ikin when it is
only inflamed, or inflammation of the furface
of an ulcer where the very furface only is fore
and inflamed ; or inflammation of the mucous
membrane, when there is little fecretlon from
the mucous glands. It was in the year 1759
that I firfl: applied this bark in the quantity
of an ounce in twenty-four hours in a phy-
mofis, where there was much inflammation
of the Ikin of the whole penis, having ob-
ferved this kind of inflammation to be in-
creafed by evacuants. The difeafe gave vv^ay
in lefs than forty-eight hours. Afterwards,
in the year following, I juft came to fee my
friend Dr. Balfour RulTel die of what is called
the putrid fore throat, or fore throat attended
with ulcers by Dr. Fothergill. Dr. Fother-
gill attended him from the beginning of the
cafe, along with his brother. Struck with
the inefiicacy of the treatment by ftimulants
ufed in this cafe, and at the fame time know-

U 2 ing

[ 292 ]

ing from many cafes I had feett (for at that
time I had applied myfelf for ten years par¬
ticularly with a view to medicine) that the'
evacuations by bleeding, and other anti-phlo-
giflic treatment. Was very improper, I con¬
ceived that in this fpecies of eryfipelatous in¬
flammation likewife, Peruvian bark in larcfe
quantities might be employed with fuccefs.
1 ufed it in the firft cafe I met with of the
difeafe, and with great advantage. As the
difeafe was not uncommon, I had feveral op¬
portunities of feeing its effedts, which I found
always fuccefsful, and ventured accordingly
to extend its ufe to other cafes of eryfipelas,
liich as happen frequently in the face, and
often in other parts of the body. I w^as fo
far convinced of its power, that I ventured
to recommend it to my pupils, and publifh
its ufe in the eryfipelatous fore throat in my
Elements of the Pradlice of Phyfic, although
with that diffidence a young pradlitioner fhould
obferve in the introduftion of any new prac¬
tice. In the year 1771 I was chofen phyfi-
; cian to St. Thomas’s Hofpital, wdiere there
i is great opportunity of afeertaining the effir
• cacy of medicines in all difeafes. Here I have
had an opportunity of verifying to myfelf as
well as to my prefent colleagues, that in all

I cafes

[ 293 ]

cafes of eryfipelatous inflammation Vv^hlch are
pure, that is unmixed with phlegmonous in¬
flammation, or increafed fecretioh from the
mucous glands, even in fome cafes of the lat¬
ter intermixture, Peruvian bark is the moft
powerful remedy that can be employed, and
is almoft always fuccefsfuL It fliould be ex¬
hibited in fubjflance if the patient’s flomach
will bear it ; and in this difeafe it will almoft
always bear it, and In as great quantity as the
patient’s ftomach will bear, which is com¬
monly to the quantity of a drachm every
hour.

I believe there are many praftitioners in this
country who ftill adhere to the treatment of
eryiipelatous inflammations, and thofe of the
mucous membrane when pure, by bleeding
and other evacuations, which I have always
found hurtful ; and I do not think the ufe of
Peruvian bark is at all known abroad,, e^tcept-
ing in gonorrhoea, from the chapter of my
Text-book on the Lues Venerea being tranf-
lated for the ufe of the ftudents in fome of the
medical fchools in France This pradtice
requires only to be tried to convince any one
of its. utility.

* Montpelier and Grenoble,

u 3

XVII.

[ 294 ]

XVII. Obfervations ^ and Heads of Inquiry y
on Canine Madnefsy drawn from the Cafes and
Materials colledled by the Society y refpeditng
that DifeafeC 5^/ John Hunter, M.D.

' F. R, S. and Phyfcian to the Army. At
the Defre of the Society.

'The fociety having colleded many cafes,
and other valuable information, refpefting
hydrophobia, or canine madnefs, it is judged
that a fhort abftradl of the refult of their in¬
quiries would not be unacceptable to the pub¬
lic. It will fhew the prefent ftate of our
knowledge refpedting that very extraordinary
difeafe, and, it is hoped, be the means of
faggefting improvements both in its preven¬
tion and treatment.

I. Of the generation of the poifon.

It would be of great importance, if we
could afcertain the manner in which the poi-
fon producing canine madnefs is generated.
For fhould it appear that it did not arife
fpontaneoufly among dogs, but was commu¬
nicated by infection, as the fmall-pox is in

the

[ 295 ]

the human fpecies, it would then be poffible
either intirely to eradicate the difeafe, or
greatly check its progrefs, by regulations
fimilar to a quarantine. The following fadls,
though they will not prove that the difeafe
never arifes fpontaneoufly, yet are fufficient
evidence that it is moft commonly the.refult
of infeftion. Dogs are more numerous in
the ifland of Jamaica, than perhaps in any
part of the world. It is the ambition of
every negro to be mailer of a dog ; yet not-
withllanding their great numbers, particularly
in the towns, forty years have elapfed with¬
out a dog being known to go mad. The in-
fular fituation of the country fecures to it, in
fome degree, the advantages of a quarantine ;
and the rare occurrence of the difeafe proves
that it feldom, if at any time, originates of
itfelf. The length of the voyage from this
country to Jamaica is fuch, that it would
fcarcely be carried in the dog kind from
Great-Britain, for in them the* difeafe gene¬
rally proves fatal in three weeks ; but North
America is much nearer, and it is from that
quarter, when the difeafe has made its ap¬
pearance, that it has been fufpedled to come,

U 4 The

[ 296 1

The moft eminent fportfman ^ In this
country, to whom the prefervation of his
kennel from madnefs was an objed: of great
importance, has, for many years, preferved
his dogs from the difeafe, by making every
new hound perform a quarantine before he
was allowed to join the pack. From thefe
fads we may fafely infer, that the difeafe, if
not always, yet, certainly in the far greater
proportion of cafes, even among dogs, is
communicated by infedtion.

n. 0/ the fymptoms of the difeafe in the dog

kind.

From the above confiderations we are na¬
turally led to an inveftigation of the difeafe as
it fhews itfelf in dogs, in order that it may
be known early, and with certainty, and pre¬
vented from fpreading, by the confinement
or death of the animal. '

-v

Dogs fuffer a change in their natural man¬
ners, and become dull and heavy. They
grow peevifli and fnappifh, and are eafily of¬
fended. They rather take offence at fuch
things as come acrofs them, than run in

^ Mr. Mejnell,

[ 297 ]

fearch of objefts to attack them ; yet they
are more apt to quarrel with ftrange dogs,,
and to run after fuch domeftic animals as •
they have been ufed to hunt, as fov/ls and
hogs. In this ftate the dog ftill minds the
call of his mafter; and can be retrained by
him } but, as the difeafe advances, he difre-
gards him, appears not to know him, and
will bite him if he is near him. It is pro¬
bably about this period of the difeafe, when
his recolleffion of perfons is nearly oblite¬
rated, that he drays from home, and follows
any path or road he happens to meet with,
feem/ngly without purport or defign. In this
ftate he only bites or fnaps at fuch animals as
come in his way, giving apparently but little
attention to external objedts, fo that it is eafy
to avoid him. If he be confined in this ad¬
vanced ftage of the difeafe,. he bites and
gnaws every thing near him ; is furious for a
moment when approached ; and his chops
are covered with tough frothy faliva. With
thefe fymptoms he foon expires. Before
death there are fwellings about the throat,
and alfo of the tongue in fome cafes. He
can fwallow both folids and liquids during the
whole difeafe, and readily eats what is offered

him*

[ 298 ]

him. He has no fear of water, for he never
avoids it. It is faid that dogs know, and
avoid by inftindt, one that is mad ; and there
appears fome foundation for this opinion : for
dogs of fuperior courage and ftrength have
been known to run, after the firft encounter,
from thofe that are mad, as if ftruck with
horror.

There is probably fome variety in the dif-
eafe, as it fliews itfelf in dogs ; one out of
twelve or fifteen that were bit, and all died,
had no marks of wildnefs or fury about
him, never offered violence to any thing near
him, and expreffed pleafure at the fight of

his mafter, by fhaking his tail, a little before
he died.

The progrefs of the difeafe in the dog is,
in general, very uniform, yet it would appear
to admit of exacerbations and remifiions in
fome degree ; for a dog, after leaving home,
will return again ; and, after being enraged
at his mafter, will become fubmiffive.

There is no circumftance that contributes
more to fpread the difeafe, than the difpo-
fition which the dog has to leave home, and
wander about ^ and, on this account, all
ftray dogs fliould be approached with caution,
and never with familiarity. It is a remark

deferving

[ 299 ]

defer vlng the moft ferioas attention, that, in
a large proportion of the cafes collefted by
the fociety, the infedfion was communicated
by taking familiar notice of ftrange dogs.

III. What animals co7nmiinicate the difeafe.

All domeftic animals, birds, as well as
beafts, are fufceptible of the poifon of the
mad dog ; and, indeed, our experience has
not yet taught us that there is any race of
animals exempted from its efFed;s. Whether
every animal labouring under the difeafe is ca¬
pable of infeding others, or whether this
power is confined to a few only> we are yet
to learn.

The difeafe has been communicated to the

human fpecies by dogs, cats, wolves, and

foxes. The dog, the wolf, and the jackal,

have, by the late inquiries of naturalifts %

been afcertained to be of the fame fpecies ;

and therefore it is probable, from analogy, that

the latter is capable of communicating the

infedfion as well as the two former. The fox

alfo has a fhrong affinity to the dog, and is by

Linnaeus counted of the fame srenns ; but the

^ )

* Mr. Hunter's paper, Phil. Tranf, vol. Ixxvii. page 2 C5.

dif-

[ 300 ]

diftinfilons of natural hiftory will not avail us
here ; for the cat, an animal of a very dif¬
ferent genusy has often produced the hydro- '
phobia in the human fpecies. Many ,other
animals are reported to have the power of in-
fedting others, by biting them while labour¬
ing under the difeafe themfelves ; but the
fadls hitherto colledled are very vague, and
lead to -nothing conclufive on this head.
Were we to judge from analogy, from feeing
two animals fo different from each other as
the dog and the cat, capable of infeding
others, we might be led to infer, that every
animal fufceptible of the difeafe had the power
of communicating it, provided their natural
habits led them to bite and tear with their
teeth fuch animals as came in their way while
in an enraged ftate. But, though there are
inftances of men labouring under hydropho¬
bia biting fome of thofe employed in taking
care of them, no ill confequences have been
known tc follow. From this, however, we
can draw no pofitive inference, for it is but a
fmall proportion of fuch perfons as are bit by
dogs undoubtedly mad, who are infeded with
the poifon.

The bite only ferving the purpofe of ip-
cculation, the danger arifing from it will be

various^

[ 301 ]

various, as It happens to be In a part more or
lefs vafcular ; or as the teeth are more or left
loaded with the poifon. There is the greateft
danger from bites In the face, and the fymp-
toms come on fooneft; bites in the hands
ahfo, which arc generally bare, are full of
danger. In other parts of the human body
the cloathing, by wiping the teeth, greatly
leifens the danger of infedion. The bite is
not effentially neceffary for the application of
the poifon : a dog, by licking a fore, pro¬
duced the hydrophobia ; but he licked it till
it bled, fo that the poifon came in contad
with the newly divided blood- vcfiels. This
circumftance, if we may judge from the ana¬
logy of other poifons, is probably of impor¬
tance in giving efficacy to the poifon, yet it
is not clear that it is elTential ; for there are
two cafes of the difeafe mentioned in the Phi-
lofophical Tranfadions which arofe from
put^-ing the hands in the mouth of a poppy
that was mad, but when there was no bite ;
and there is a fimilar cafe in the -f* Memoirs
of the Royal Academy of Sciences of Swe¬
den. It is true, various other modes of in-
fedion are narrated by writers, but in all of

* Phil. Tranf. vol. xxiii. p. T074*
t Anno 1777.

them

[ 302 I

them there is much appearance of fabulous
credulity. There is good reafon to think that
tetanus has fometimes been miftaken for hy¬
drophobia, and given rife to the accounts of
the difeafes proceeding from the bite of a
cock, the claw of a cat, and fimilar hiftories.

Dogs are much more fufceptible of the in-
fedlion than the human fpecies. Four men
and twelve dogs were bit by the fame mad
dog, and every one of the dogs died of the
difeafe, while all the four men efcaped, though
they ufed no other means of prevention but
fuch as we fee every day to fail. There is alfo
an inftance of twenty perfons being bit by the
fame mad dog, of whom only one had the
difeafe.

There is a queftion which naturally pre-
fents itfelf here ; does the difeafe ever arife
fpontaneoufly in the human fpecies ? The
fadls relating to this queftion involve many
doubts. Francis Stannier ^ died in Novem¬
ber 1787, with the fymptoms of hydropho¬
bia, though it was not known that he had
ever been bitten by a mad dog ; and fimilar
cafes are related by writers. Yet as a large
bite is no way necelfary to communicate the
infedtion, the patient abovementioned may

* London Medical Journal, vol. ix. p. 256.

have

[ 303 ]

have been llightly bit, without knowing
it, as he was often drunk, and frequently in
the ftreets at night. There is good reafon
to believe that the difficulty of fwallowing,
which fometimes occurs in tetanus, has been
miftaken for hydrophobia in fome cafes ; and
there may be other fpafms about the throat
and the oefophagus, which may fo far re-
femble hydrophobia, as to give rife to errors
on this fubjedl. Something of this hind oc¬
curred once to Dr. John Hunter, in an hy-
fterical woman. Were we to be guided by
analogy in deciding the prefent queftion, we
fhould be led to deny the exiftence of fpon-
taneous 'hydrophobia ; for where is there ah
example of any of thofe difeafes which de¬
pend upon a fpecific poifon, as the* fmall-
pox, the venereal difeafe, or the meafles,
arifing fpontaneoufly ? But the full decifion
of this queftion muft be left to future expe¬
rience and obfervation. -

IV. Effects of the poifon on the hitman fpecies.

' In obferving the operation of the poifon
upon the human fpecies, we find, that from
the time of the bite till the difeafe appears,
there is no derangement of health, nor any
4 pel*-

[ 304 ]

perceptible change in the conftitution> pro¬
vided the perfon bitten be not under the in¬
fluence of fear. The effedls of that paffion
have, in fome cafes, been fo great as to pro¬
duce an imitation of many of the fymptoms
of the difeafe ^ ; the patient adlually imagin¬
ing that he could not fwallow, and fuffering
all the horrors of extreme defpondency, till
it has been difcovered that the dog was not
mad by which he had been bitten.

The wound has nothing to diftinguifh it
from the bite of a dog which is* not mad, and
heals as foon ; there are almoft always, how¬
ever, pains in and about the wound, and
fometimes fwelling, and even a frefh dif-
charge from it, fliortly preceding the hydro -

The interval between the infedlion and the
appearance of the difeafe, varies from thirty-
one days to feventeen months, in the cafes
laid before the fociety. The moil: common
period appears to be about forty days. There
is a cafe given in the Philofophical Tranfac-
tions, in which the fymptoms appeared nine¬
teen months after* the bite -f-. The difeafe is

* Vid, Philofopb. Tranf. vol. xliii. p. 257#

+ Ibid. vol. xl, p, 5,

reported

[ 305 ] ‘

reported to occur fometimes in a few days, as
four or five, after the bite ; but fuch cafes
have fomething doubtful in them, and are
probably to be referred to tetanus, or fome
other convulfive difeafe

The pains and difagreeable feelings about
the part where the wound was, are generally
defcfibed as paffing towards the head or heart,
and the hydrophobia follows foon after. The
dread of fwallowing liquids, though the moft
fingular fymptoin of the difeafe, and from '
which the name has been given to it, confti-
tutes but a fmall part of the malady. It is
true that none, or very few, recover who
‘ have this fymptom, yet they certainly do not
die in confequence of the difficulty of fwal- v
lowing liquids ; for the human body could
eafily exifl: double the tim.e in which the dif¬
eafe ufually proves fatal, v/ithout food or

drink. But the fick can often fwallow fub-
ftances that are nourifliing in a pulpy ftate,
without, however, having their life prolonged
from it. It is not, therefore, the difficulty
or impoffibility of fwallowing liquids, but the
effecfts of the poifon upon the conftitution a.t
large, which occafion death.

* Vid. Medical Tranf, vol. ii. p. 222.

The

[ 306 ]

The ufual progrefs of the fymptoms is as
follows ; the flieht oains about the wound are

O 1

foon fucceedcd by great depreflion of fpirits,
anxiety, reftleiTn'efs, extreme fenfibility to all
impreffions, and great difficulty, or an utter
impoffibility of fwallovving any thing liquid.
This Lift fymptom is generally difcovered ac¬
cidentally, on attempting to drink, and, after
a few trials, is accompanied with fuch hor¬
rible fenfations, that any thing which after¬
wards recalls to the mind even the idea of
drinking, excites violent agitation and inex-
preffible averfion. Of the lick who are more
compofed, and can, therefore, better deferibe
their own fenfrtions, fome fay, that, upon
attempting to fwallow a mouthful of any li¬
quid, they feel fomething rifmg from the ftor
mach which obftrudls the paffage ; others tell
you, that they have a fenfe of choaking or fuf-
focation ; and it is very obfervable, that the
attempt to pafs the liquid over the root of tlie
tongue, excites convulfions in the larynx and
pharynx, and even in the mufcles of the cheft
and abdomen. They complain of no pain.
There are, moreover, watching, inquietude, a
countenance expreffive of extreme mifery, and
fits of great irritability and almoft fury, from

9 trifling

[ 307 ]•

trifling caufes,as the fick themfelves readily al¬
low, and even wonder at when more compofed.
There Is often a fenfe of great oppreilion at,
the breaft, which the fick generally call a dif-.
Acuity of breathing, but it is properly the
anxietas pracordiorum, which probably is an
affedlion of the heart ; for they figh often,,
and make deep irregular infpirations, and find
fome relief from motion, as running' and
walking, which fliew the lungs not to be the
feat of the oppreffion.

The extreme fenfibility of the fick to all .
imprefiions, appears ' in the difpleafure they
exprefs at even the air blowing upon them ;
in their diflike to’a.ftrong light; in their
averfion to new faces, or even the fight of
their friends and relations ; and in the terror
they exprefs at being touched, which almoft
threatens to throw them into convulfions.

As the difeafe advances, the mind is more
filled with dreadful fears and apprehenfions ;
the- fits of fury become both more frequent
and more violent, and mifery and horror are
more deeply marked upon the countenance.
Thedaliva grows thick and ropy, and would
appear to be fecreted in larger quantity. The
miferabie fuiferer, not daring to make the ,

X 2 fmalled

[- 3<^8 ]

fmallelt attempt to fwallow it, fpits it out iu«
eeffantly, which he does With much vehemence
and difficulty, and with frequent retchings
and vomiting. What he brings up is a little
phlegm, tinged with brown or yellov/ bllc.^
In this flate the flighteft catife excites con-
vulfive tremors all over the body. They
fometimes call out they are fuffocated, turn
black in the face, and expire In convulfions^
It is not uncommon, however, for the ftrength
to fink fuddenly, the patient to become quiet
and calm, as if nature gave up the flruggle,
and to die without a groan. -

The pulfe in the beginning is not quick,
nor is the fkin hot ; and there is none of the
mufcular debility fo remarkable in fever ; but
in the progrefs of the difeafe there is Ibmie
feverifli heat, and, as death approaches, the
pulfe becomes extremely quick and tremu¬
lous.

The duration of life from the appearance
of the hydrophobia till death, varies from
thirty- fix hours to four or five days ; the moft
common period is from two to three days.

There is confide rable variety in the fymp-
toins 1 they are more or lefs violent, and in
proportion prove fatal in a fhorter or a longer

6 time.

[ 3'>9 ]

time* The hydrophobia, or dread of uval-
lowing liquids, is in very different degrees :
in fome cafes the patient can not only make
the attempt, but even force down a mouthful
or two ; in others, the firft approach of* any
thing liquid for the purpofe of drinking, ex¬
cites the moft violent commotion in the whole
frame.

There is no part of the difeafe that admits
of greater variation than the degree of men¬
tal derangement, which in fome does not
amount to more than extreme irritability and
impatience ; while in others it rifes into fits
of the mofi: violent rage and fury, in which
they bite and tear themfelves, and every
thing near them. This difference would ap¬
pear to depend a great deal upon the natural
temper and difpofition of the mind.

The difagreeable feelings in the wound are
defcribed by the fick fometimes to pafs to¬
wards the head or body, and when they reach
thofe parts they produce head-ach, or pain in
the breaft. In fome, though rarely, there is
a confiderable degree of fever. There are
inftances of the fiek having attacks of fits a
good deal refembling epilepfy. Priapifm is a
fyfnptQm of the difeafe in fome cafes.

X 3

[ 31° I

It fometimes happens that all the fymp-
•toms admit of remiffions and exacerbations,
and ‘ that with - fome degree of regularity.
Under thefe cireumftances the virulence of
the poifon would appear to be fomewhat
leffened ; and it may be a queftion, whether
the difeafe does-^ not at times fhew itfelf in
a milder form, as in the cafe defcribed by
%Iorgagni -f*, and in fome of the patients of
"wdiom the late Dr. Garden communicated an
account to the fociety.

' It^ deferves to be remarked as a lingular
^tiling in the operation of a poifon fo de-
ftrud;ive to life, that it afteds the mufcular
ilrength but'little. In two cafes the pant¬
ing and difficulty of breathing, as the patients
-called it, were remarkably relieved by run¬
ning; one of them found himfelf relieved by
"running rouhd Smithfield, which is nearly a
' quarter of a mile, a few hours before he
1 died. i -

^ DiffeBions. ‘ -

Many exarninations^of the bodies of thofe

. who have died of hydrophobia have been

communicated to the fociety. An appear-

■f De S'edibus Sc Caufis^MorborunnfJ epiff. 6i. 14.

‘ ; X ' ance

[ 3II J

ance has in general beeii feen on the inner
coats of the ftomach, near the cardia, fimi-
lar to what is found in the bodies of perfons
v/ho have had flight inflanimation, that is^ a
greater number of red vefiels with fmall
fl-reaks of red blood. In fome inftances there
•has been an increafed vafcularity of the pia
mater, or flight watery effufion on the furface
of the brain. In fome dogs that died of the
difeafe, the appearances upon the inflde of the
ftomach were fimilar to what have been al-
readv defcribed : but there was no unufual ful-
nefs difcovered in the veflels of the brain, or
its memb;:anes. Thefe appearances are ho
ways adequate to account for the iymptoms
of the difeafe.

Morgagni though he has not himfelf
examined the body of any that has died of
this difeafe, yet has colledted the obfervations
of his friends, and compared them with fuch
as are to be found in medical writers. In no
particular do they agi*ee ; and the change in
the human ftrufiiure upon which the difeafe
depends, -would appear to be beyond the
reach of anatomical inveftigation.

* De Sedibus & Caufis’ Moib, epift* 8* i >.

X 4 VL ijf

[ 312 ]

VI. . Of the prevention of the difeafe.

We have as yet difcovered no remedy, that
has any efFed; in the cure of this moil extra¬
ordinary difeafe ; the means of prevention
become, therefore, an objed of the firft con-
fequence. Whatever has hitherto been done
in this way is principally, if not altogether,
to be referred to the local treatment of the
wound, or part to which the poifon has been
applied. It is true, indeed, that numerous
prophyladics have been propofed, and many
are in general ufe, which are fuppofed, by
their effeds upon the conftitution, to coun-
terad or expel the poifon ; yet, upon fairly
weighing the proofs of their efficacy, not one
appears in titled to the fmalleft credit. None
has been held in higher eftimation for a great
length of time than fea-bathing, though there
is fcarcely a cafe of hydrophobia publifhcd of
late years in this country, that does not con¬
tain full proof of its inefficacy. The Orm-
fkirk medicine is in precifcly the fame pre-
- dicament. Mercury too has had a fair trial,
nor has it been more efficacious than the
others. It is hardly neceffary to take notice

[ 3^3 ]

of the inefficacy of the puhts antilyffus or
of the Tonquin medicine -f*. The queftion
may here be afked, admitting the frequent
failure of thefe remedieSj have they not fome-
times prevented the difeafe ? The anfwer
would certainly be in the affirmative, if every
perfon bitten by a mad dog, who did not ufe
fome means of prevention, were feizeel with
the difeafe. But this is not the cafe ; fpr in'
the human fpecies the proportion of thofe
bitten, v/ho are feized with hydrophobia, is
much lefs than of thofe who efcape, even
where no means of prevention are employed:
we can, therefore, infer nothing in favour of
thefe prophyladtics, becaufe they have been
given in cafes in which no hydrophobia has
fupervened. There can be little doubt, that
if in any cafe the virtues of thefe fpecifics
were fufficient to overcome, or counteradl the
poifon, they would often be ftrong enough
either to retard the appearance, or mitigate
the fymptoms of the difeafe, like to what
we fee from mercury in the venereal difeafe,
or bark in intermittents ; but nothing of this
kind is obferved, and the poifon produces its

* Compofed of the lichen cimierus ierrjiris ^ piper nigrum,
t Compofed of mufk and oinnabair.

peculiar

[ 3H ]

peculiar efFedls equally foon and equally vio¬
lent, when thefe prophylactics have been
ufed, and when they have not.

The prevention of the difeafe therefore
depending upon the local treatment of the
wound, various modes have been made trial
of, either with a view to procure the dif-
charge, or infure the deftrudlion, of the poi-
•fon. Cupping-glafles have been applied to
the wound, and it has been kept open by ir¬
ritating applications for a great length of time.
The part has been deftroyed by cauftics, and
by the adtual cautery; and it has been cut
out. There is good reafon^to believe that all
thefe have, at different times, been ufed with
‘ ; advantage ; but the fadls before the public,

. as well as thofe collected by the fociety, con-
; tain full evidence of the failure of every one
of them, except the lafl mentioned, that is,
cutting out the part.

In confidering the local treatment, the fol¬
lowing things appear to deferve attention :
iff. The removal of the poifon by wafliing
the part fimply ; adly. The deffroying the
part by cauftic ; and, 3dly, the cutting of it
out.

[ '315 ]

It has been recommended to wadi the
•part with cold water repeatedly poured upon
it, which is to be continued for fome time.
The pradlice is fafe, and may poffibly do
good, particularly if made ufe of immediately
after the bite. Cold water is better probably
than warm, as warmth increafes the fenfi-
bility, and quickens the adtion of all living
parts, which might render the lacerated fur-
faces of the wound more fufceptible of the
eifedls of ' the poifon. Though much ftrefs
cannot be laid on this mode of prevention,
yet, as cafes may occur where there may be
infurmountable objections to more effectual
fteps^ it ^may deferve a trial ; and it would
probably be more fuccefsul, if, after wafliing-
copioufly with cold water, the cauftic alkali
was to be added to the water. In fuch pro¬
portion as the part could eafily bear, and the
wafhing to be continued v/ith this for fome
time.

Cauftics may be admiffable in fome cafes,
where the knife cannot be ufed ; and though
they have failed in certain inftances, yet that
• was probably owing to their not having been
applied to all the infeCled furfaces. Late ex-

♦ London Medical Journal, vol. x. p. 295.

. periments

[ 3i6 ]

periments have indeed taught us, that all
cauftics do not counteradl the effedls of poi-
fons applied to the human body. It would
appear, however, that the beft cauftic has
not been ufed, which is probably the cauftic
vegetable alkali in a folid form, the kali
rum of the London Pharmacopoeia ; both as it
ads more fpeedily, and alfo more completely
deftroys and diflblves all animal ftibftances.
By applying it to the various furfaces of the
wound, and immediately removing with a
fpatula the parts upon which it has aded and
diffolved, it may again be applied, and the
part deftroyed to what depth may be deemed
neceffary : the furgeon feeing all the time the
' extent to which the cauftic goes.

What has been faid under the two preced¬
ing heads on waflring off the poifon or deftroy-
ing it by cauftic, muft be underftood to ap¬
ply only to thofe cafes where there are infur-
mountable objedions, either from the place
where the bite is, or other caufes, to cutting
out the part. Whenever the part can be cut
' out, it ought always to be done, as the only
•certain means hitherto employed of prevent¬
ing the difeafe. In perforiming this operation

* Vid. Foutaaa, v&l, ii. p, 5* aud Appendix.

care

[ 3i7 ]

cafe muft be taken to cut out every part witb
which the dog’s teeth have come in con tad:,
for the fmalleft portion left might produce the
difeafe. It becomes, therefore, neceflary for
the operator to examine accurately the part,
and to afcertain to what depth, and in what
diredlion, the teeth have penetrated, keeping-
in his mind the iituation of the parts in the
adt of biting, in which the fkin and the flefe
are pinched up, and therefore put out of their
natural pofition before the teeth penetrate
them

The fooner the operation Is performed it
mu ft be fo much the fafer * but there arifes a
queftion of confiderable importance, that is,
how long after the bite can the part be cut
out, fo as to prevent the difeafe ? Nothing
could determine this fullv but exneriments

•/ J;

made upon the poifon, an arduous undertake

* Mr. Hunter in one cafe removed the parts, as he thought,
freely, and there vyas nothing on the under furface of the piece
cut out, tliat led him to fuppofe he had not cut beyond the
bite. But on examining the furface of the wound, he found a
part in the middle which was hollow underneath, which fhewed
he had not gone deep enough, but had left a ridge, as it were,
over part of the paffage made by the dog’s teeth, and which
could only have been difeovered by examination after the ope~
ration. This is mentioned, to (hew the care that is requifite in
cutting out the part, i<nd alfo the neceffity of going to a proper
depth.

[ 3^8 ]

iiig, and not without much danger ; yet not
to be defpaired of, if w^c advert to the expe¬
rimental inquiries concerning poifons, which
a thiril: after knowledge has produced of late
years. Till fome thing of that kind is done,
the queftion can only be anfv/ered imperfedlly
from a few fcattered fad:s, and conjedtureSi
From the fadls before the fociety it appears,
that the part has been cut out ^ thirty hours
after the bite, and in one cafe as late as the
fifth day.

In one of the patients, an account of whom
has been communicated to the fociety, the bite
immediately inflatned and feftered, and on the
fifth day an abforption took place, as appeared
by the fweiling of agland in the arm-pit, which
was followed by a confiderable degree of fever,
that lafted fome days ; but none of the fymp-
toms of hydrophobia appeared till the ufual
period, and after figns of a fecond abforption,
when the difeafe proved fatal. From this and
fimilar fadts in the animal ceconomy, it is pro¬
bable that the poifon lies long in the part, as in

fome other cafes of inoculation, and would ap-

* Dr. John Hunter direifted the part to be cut out, and it was
done in his prefence by Mr. Foote, who has publiflied the cafe,
but appears to have forgot the operation, for he flates that the .
tooth perforated the part of the Ikin cut out, which if it had,
the operation would have been of no ufe.

pear

[ 3^9 ]

pear to be Incapable of afFed;ing the conftitu tlon^
till it had produced a previous change in the
part. If a conjedlure might be allowed on
this point, it would feem that the pains about
the wound riling towards the head or body,
indicated the abforption of the poifon ; and
that the poifon had been confined to the
wound till a day or two before the fymptoms
of the difeafe appeared. On this fuppofition
the part might be removed, even weeks after
the bite : but we mu ft wait for further infor-^
mation and experience before we can come to
a pofitive conclufion on this head.

VII. Of the treaUnent of the dfeafe.

After the lymptoms of hydrophobia have
appeared, no medicine or remedy that has hi¬
therto been ufed has relieved, much lefs cured
the difeafe. On this confideration it may
feem unneceflary to enumerate the- various
things that have been tried ; but, without a
knowledge of what has been attempted,
much time mu ft be loft in ufelefs trials and
fruitlefs repetitions ; and in fadl, the want of
preconcerted order and method in inveftigat-
ing the cure of this difeafe, is very apparent in
all the writers upon theiubjeeft, and is pro-

bably

[ 320 ]

bably a principal caufe that no progrehi has
been made in that important enquiry. In
ftating fliortly the various remedies that have
been tried, opium defervedly claims the firfl
place* Reafoning from analogy, there is no
article in the materia medica that would ap¬
pear fo peculiarly adapted to the relief or cure
of "^11 the fymptoms of hydrophobia, as opi¬
um. It has therefore, in various ihapes and
forms, had the moft full and ample trial, and
has been found to do no good ; and it can
only be imputed to the want of method and
order abovementioned, that this medicine ftill
continues to be given in almofl every cafe of
this difeafe. It is evident that, however much
might have been expected originally from opi¬
um, there are at prefent few articles in the
catalogue of medicines, that have not a bet¬
ter chance of curing hydrophobia.

Mercury has alfo had a fair trial, both with
a view to prevent the difeafe, and likewife to
remove it after it had adlually taken place*
But In neither cafe has it done any good.

Bleeding, the warm bath, alfo bliflers and
cantharides have been ufed, but with no bet¬
ter effedt-.

In order, therefore, to avoid a repetition
of medicines, which can be produftive of no

good,

[ 321 ]

good, we ought to have preconcerted various
new methods of treating the difeafe, which
may be tried as circumftances may indicate.
In moft difeafes the doftrine of the juvantia
and Icedentidy as It has been called, affords fome
direftion refpedting the treatment; in hydro¬
phobia there is fcarcely any thing obferved to
afford even a temporary relief. Among the
cafes colledted by the fociety there are two,
in which the relief obtained by running was
very remarkable ; in one the amendment was
fo confiderable, that the patient did not look
like the fame perfon after running about a
quarter of a mile. This fuggefls an experi¬
ment, which might be eafily tried. It would
probably be made to beft advantage in the
open air, in a quiet, retired, and fhaded place.
It would foon appear, whether it were better
to run brifkly for a fhort time, with frequent
flops between ; or to take a flower pace, that
could be continued for a greater length of time;
If the patient found relief, there would be
no difficulty in getting him to perfevere.

All the cafes of the difeafe laid before the
public contain proofs of the fnfferings of the
patients in attempting to fwallow liquids ; it
is, therefore, an experiment that fhould not

Y be

[ ]

6e wantonly, and out of mere curloii ty, mzie
upon them. At the fame time it is an ob-
jedl of 'much confequence to fupport by non-
rhhment and cordials a body labouring under
the influence of fa deflruftive a poifon.
Food, therefore, in a pulpy ftate, fliould be
got down as much as poflible ; and if mixed
with wine it would probably.be the better.
Bread or bifcuit foaked in wine would anfwer
this defcription. But if nourifhment could
not be got down, broths, or warm wine and
water, might be adminiflered by clyfter.
Some plan of this kind would be abfolutely
necefiary, if motion was found to give confi-
derable relief.

It has been flated, that the means of pre¬
vention confifted chiefly in the local treat¬
ment of the wound .; and it may be a queftion?
how far fom^ething of the fame kind might
not prevent an aggravation of the Aymptoms,
after the difeafe has come on. There is
reafon to fufpeft that the poifon is confined
to the part bitten till within a very fhort time
of the appearance uf the difeafe ; and probably
the moment the poifon is conveyed into the
general circulation by the abforbents, the
fymptoms begin. Judging from the analogy

[ 323 ]

of foilie other poifons; the greater quantity
that is conveyed into the blood the more vio¬
lent will the eftedis be-; good, therefore,
might arife from leffening this quantity.
With this view numero'us and deep fcarinca-
tions might be made where the wound was,
and cupping-glaffes applied repeatedly. Li¬
gatures may be applied. Might not ice, or
a freezing mixture be applied fo as to be¬
numb the part, and arreft for a time all mo¬
tion, and of courfe that of the lymphatics?

There is fome times an appearance of peri¬
odical remiffions and exacerbations in the
lymptoms ; and there is fome reafon to fuf-
peft that fuch cafes are of a milder 'nature,
and that fome of them recover. Upon this
ground the Peruvian bark might be tried.’ It
might be fwallowed in an eled:iiary, and alfo
thrown up by cly-ler.

In the Eaft-Indies, in the Carnatic, there
is a pill in ufe, faid to be a fpccific againil
the poifon of ferpents, and alfo the bite of a
mad dog. The principal ingredient has been
afcertained to be arfenic. It may feem ftrange
to propofe as a remedy in any cafe, a fub-
ftance that is a moft deadly poifon ; but we
know that arfenic can produce not only very

Y z great.

t 324 ]

greaty but alfo very falutary efFeils upon the
conftitution. The moft obftinate intermit-
tents have been cured by a few drops of a fo-
lution of it. It might be tried in the fame
form, and in a dofe fomewhat increafed, in
hydrophobia, as it is in agues. One tenth
of a grain diflblved in water is given in agues
three times a day ; this dofe might be
doubled.

It would not be difficult to enumerate va¬
rious other adlive fubftances in the materia
medica, which might be tried againfl the hy¬
drophobia ; but every one may readily chufe
for himfelf ; for our grounds of trying one in
preference to another are merely hypothetical.

Nothing would probably contribute fo much
towards afeertaining a proper treatment of the
difeafe, as experiments made upon the poifon.
It is true the undertaking would be both dif¬
ficult and hazardous ; yet the danger is pro¬
bably greater in apprehenfion than it would
be in reality. Dogs known to be mad are
often confined till they die ; and in this ftate
there would be no great difficulty in collect¬
ing a portion of the faliva, or poifon. The
point of a lancet would probably introduce
the infection as certainly as the tooth of the

[ 325 ]

dog. By experiments upon dogs, the feve-.-
ral ftages of the difeafe might be known ; the
lateft period at which the contaminated part
could be cut out with fuccefs, might be
afcertained ; aud various counter poifons might
be applied to the wound/ or adminiftered in¬
ternally. It might be determined, whether
the faliva of other animals, befides thofe for¬
merly mentioned, had the power of commu¬
nicating the difeafe, while labouring under it.
An experiment with the faliva of an hydro¬
phobic patient might ealily be made upon a
dog. It might be afeertained whether any
of the humours of the body of an infedled
animal poflelTed the poifonous quality, except
the faliva. The liver of a dog that has died
mad is reputed tg be a fpecihe againft the
poifon, and as fuch is eaten in fome parts of
the world ; but we cannot ahfolutely infer
from this that it is exempt from the poifon,
for the digeftion of the ftpmach deftroys fomp

vm.

[ 526 ]

VIII, Of the antiquity of the difeafe.

In the days of Plutarch ^ it was a quef-
tion, whether canine niadnefs were not a new
difeafe. The fame point is difciiffed by Cos-
lius Aurelianus •f' ; but their mode of treating
the queftion affords little fatisfadtion to a mo¬
dern enquirer ; their arguments turn upon
fpeculative and metaphyfical points, and they
negledt to examine into the matter of fadf,
the only ufeful information. But though we
are much farther removed from the origin of
the difeafe, fuppofing it to be a new one, we
are probably in a better condition to deter¬
mine the queftion, from the ample expe^
rience that later times have furnifhed of new
difeafes. In the courfe of the lafl: eight or
nine centuries there have appeared many new
difeafes ^ and it is remarkable, that they are
not only all infedlious difeafes, but are capable
of being produced by infection alone, at leaft
as far as our experience goes. Of the infec¬
tious nature of canine madnefs there can be
no doubt, and there is reafon to fufpedt, as

* Sympofiacon, lib. viii. probl, 9,
Acut. Morb, lib. iii. cap. 15.

[ 327 ]

has been flated above, that it Is only com¬
municated by infection ; in both particulars,
therefore, it ao;rees with what mav be called
the new difeafes of modern times. The quef-
tion limply of the novelty of a difeafe muft be
a thing of little confequence, but wdien that
is connected with the manner in which it is pro¬
pagated, it becomes a confideration of impor¬
tance ; and if it Ihould appear that there is
reafon for believing the hydrophobia to be a
new difeafe, it may be an additional proof of
the opinion already advanced, that it is only
propagated by infedlion.

It is faid in Plutarch, that the hydropho¬
bia was firft feen at Rome in the days oiAf.
fkpiades ; arid no mention is made of the dif^
eafe in Hippocrates, or in any preceding or
contemporary writer. It is a diftemper fo
fingular and ftriking in its appearances, that
it could never be feen without leaving the
4eepeft impreffion upon the mind ; and the
filence of Hippocrates is a ftrong prefump^
tion that it did not exift in his time, It has
been alledged that Homer was acquainted
with the difeafe, becaufe he ufes the word
Avo-o-cjo ; but it is evident that he means to ex-*-
prefs the anger or fury of a dog from paffion,

Y 4

[ 328 3

and not from difeafe ; though the term was very
naturally afterwards applied to the difeafe. A
fimilar derivation is to be obferved in the French
name of rage, Ariftotle ^ is the firft writer
who exprefsly mentions the difeafe. He fays
that all animals belides man, were infedled by
the bite of a mad dog 5 and that it proved fatal
to every animal except man. imperfedt

ftate of his knowledge is a proof, that in his
time the difeafe was recent. It has been
remarked before, that a fmall proportion only
of thofe of the human fpecies who are bitten,
are feized with the difeafe j; and Ariftotle
might have feen feveral who received no in-r
jury from the bite of a mad dog. Again, the
difeafe not appearing till long after the in-
fedtion, and. the fymptoms in man differing
greatly from thofe in the dog kind, in which
there is no difficulty pr averfion to fwallow
cither liquids or folids, fome tinic might
elapfe, and many cafes of hydrophobia occur,
before it was referred to its true fource. But

f- ' N. '.V

a period of no great length of time muft have
been fufficient to clear up all thefe doubtful
points; and when we advert to the total

* De HiiT:or, Animal. lib. viii. cap. zi.

iilence

[ 329 ]

filence of Hippocrates, the Imperfeft know¬
ledge of Ariftotle, and the familiar manner
in which fubfequent writers fpeak of the dif-
eafe, we are tempted to conclude that canine
madnefs did not exift in Greece till a- fhort
time before the days of Ariftotle, that is,
about two thoufand one hundred years ago.

* i ‘

XVIII.

[ 330 ]

3CVIII. So7ne Obfervations on Wcers* By

Everard Home, Efq-, F.R.S, AJjiJlant

Surgeon to St. George's^ Hofpital.

)

As the management of ulcers is one of the
moft common offices of furgeiy, the appli¬
cations employed for that purpofe, are almoft
without number. Yet the ufual modes of
treating fuch complaints, when fituated on
the flower extremities, have been fo unfuc-
cefsful, that they are regarded, not unjuftly,
as the opprobrium of the art.

Ulcers generally confidered, vary in many
refpedls, according to the conftitution of the
patient, and the parts on which they are
fituated; the modes of treating them can,
therefore, be collected only from a field of
pradice of confiderable extent, and form a
topic of enquiry, much too various and im¬
portant, for the limits of this paper. It i§
not my intention at prefent to enter minutely
into the fubjed ; a few obfervations pn the
treatment of fuch fores as are of no fpecific
nature, but from weaknefs, indolence, or
long habit, have no difpofition to ficin, will
be all that I fhall now bring forward.

The

' ' [ 331 ] '

The ufual mode. of treating ulcers of this
kind is by ftimulating, or by fedative appli¬
cations ; when neither of thefe are thought
neceffary, dry lint is commonly applied to
the furface of the fore, to abforb the mat¬
ter, and fome uniSuous covering is laid over
it, to prevent evaporation, and more readily
admit of the removal of the dreffings.

Stimulating medicines are commonly mixed
up with fome of the exprefled oils, and ap¬
plied in the form of an ointment ; but thofe
applications that are intended to adl as feda-
tives, are ufually combined with water, and
made ufe of in the form of fomentations and
poultices,

' Both thefe modes of applying medicines to
an ulcer, experience has proved to be im¬
proper as a general pradlice. Undtuous drelT-
ings are found not unfrequently to difagree
with the furrounding Ikin, and, when brought
in contadl with the furface of an ulcer, be¬
come extremely irritating. W atery dreffings,
from the weight which is neceflary for their
conflant application, are in many inftances
. f)oth inconvenient and hurtful ; and, when
ong continued, give the granulations a difpo*^
^ion to be luxuriant aud flai^by.

Froim

[ 33^ ]

From the knowledge of thefe fadts, which
are I belive fufiiciently eftabliflied, furgeons
have, for fome years paft, applied their minds
to ftrike out fome improvement ; and various
fubftances in the form of powder have been
propofed, as fubftitutes for the comnion
dreffings.

In the courfe of thefe laft fourteen years,'!
have had frequent opportunities of attending
to cafes of this kind, and have made ufe of a
variety of fubftances, in different forms, as
external applications. I have not only tried
thofe powders recommended by others, but
have ufed fome which had not before been
thought of. Of the latter kind, a few ap¬
pear to me to defervc particular attention^
my experiments and obfervations upon which,
I have thrown together in this paper.

As the application of powders to ulcers in
general is a pradice not yet much known, it
may not be improper firft to mention the re-
fult of my experiments on fuch fubftances as
have not been found to anfwer, that others
may not lofe time in ufelefs trials.

Tartar emetic, in the form of powder, has
been recommended, and I have ufed it in a
variety of inftance*'s ^ in fomp it produced no

vifible

[ 333 ]

yifihle effefts, and in others fuch as evidently
were unfavourable ; nor in any cafe could I
effedt a cure, by perfifting in the ufe of it*

Chalk has had its advocates, but experiejU:e
does not authorife me to give my teftimony
in its favour; it may anfwer in fuperficial
fores, where nothing in fadt is neceflary to
be done. This powder, when firft applied,
does not feem to produce the fmalleft irrita¬
tion ; but if it be long continued, the fore
in general, although not alaways, becomes
foul.

Plaifter of paris is an application I was led
to niake ufe of feveral years ago, from an idea
that it would abforb the matter of a fuperfi¬
cial fore as faft as it was fecreted, and forna
a cruft, which, fimilar to a fcab, would in¬
duce the parts underneath to ikin over ; ex¬
perience, however, proves that this is not
the cafe, and the edges of the fore, in many
inftanccs, are much irritated by this applica¬
tion.

Lapis caliminaris, in the form of powder,
has had a character with feveral furgeons for
having the power of difpofing fuperficial fores
to ikin over ; I therefore thought it deferving
of a trial. I ufed it in a great many in-

9 ftances.

t 334 ]

fiances, arid no one circumftance lias occiitrcA
from which I could conclude in favour of its

effiacv. '

•/

That each of thefe four fubftances has
been found, in particular inftances, to fuc-
ceed, I am very ffeady to believe ; but, as far
as my own obfervations lead me, I am in¬
clined to think that ^ they are- not to be fet
down as applications on which dependence
can be placed in the cure of ulcers.

- - The ufe of thefe mineral fubftances in pow-^
der having proved unfuccefsful, I was led
to confider^how far the vegetable medicines
could be applied in that form with advan¬
tage; and I was encouraged in this enquiry
from having, in many inftances, experienced
the good effefts of the carrot and caftada poul¬
tices which are nothing more than the
powder of thofe roots in a moift ftate. ;

During the laft war, Twas eight months
in* the.iiland of St.^Lucia, in the Weft-In¬
dies, where ulcers on the the legs of the worft
kind - were exceedingly numerous ; and the
application from 'which they appeared to de¬
rive the greateft benefit, was the caffada- root
grated into a powder, and moiftened with

* The calTada is- the fafropha manihot of Linnaeus.

^ watei%

t 335 ]

Water. It did not at that time occur to me,
tliat it might be ufed in a dry ftate.

As rhubarb has confid^rable powers in ill- ^
mulatirig the villou^" internal furface of the
llomach and iiiteftines, which in appearance
is not very diffimilar to that of a granulating
fore, I made choice of this powder as an ex¬
ternal application.

I began my e]i?:perlments by covering the
furfaces of feveral ulcers with the powder of
rhubarb, very thinly fpread over them, and
afterwards dreffing them with a pledget of
common ointment. Thefe applications were
renewed once in twenty-four hours. Under
this treatment the fores mended for feveral
days, and then feemed to be at a itand, al¬
though they retained a healing appearance.
This circumftance was not readily accounted
for, but as the pledget was exceedingly greafy,
and came in contadl with the edges, and many
other parts of the fore, it was attributed to
that caufe, and a piece of lint v/as therefore
interpofed between the powder and the unc¬
tuous covering, after which the granulations
became difpofed to form Ikin, and the fores
were gradually healed.

Encouraged

t 336 ]

Encouraged by thefe trials, I made ufe of
this powder under a variety of circumftances,
with a fimilar refult. In fome cafes it ap¬
peared, after being continued fome time, to
lofe its efFed: upon the ulcer. But even in
thefe inftances, the applying it twice in the
fame day was fufficient to reftore the firft ef-
fed. In other cafes the rhubarb feemed to
be too violent an application, in fome degree
difpofing the granulations to ulcerate; this
effed was however prevented, by adding to
it the powder of opium, in the proportion of
a drachm to an ounce. By thefe means the
application of this medicine may be adapted
to the degree of indolence or irritability in
the fore to which it is applied.

' Having afeertained the eiFeds of what is
commonly called Indian rhubarb, I made

comparative trials With that imported from
Turkey, but could not difeover any difference
that appeared material. Rhubarb in the form
of ^ tindure did not by any means produce
limilar efFeds ; on the contrary, the fores to
which it was applied, when irritable in their

* The tindure ufed in thefe experiments, was made by pour¬
ing proof fpirits upon the powder of rhubarb, and, after letting
it remain three or four days without adding any other ingre¬
dient, the tindure w^s feparated for ufc.

nature.

[ 337 3

nature, put on a foul appearance ; when in¬
dolent they were lefs aifefled, but did not
acquire the fame healing difpofition that the
powder ufually produced.

After confining my experiments to rhu¬
barb, and having this fuccefs, I was natu¬
rally led to try the effedts of other vegetable
powders. It feemed neceflary to determine
whether this healing property was peculiar
to rhubarb, or, if it be in other vegetable
fubftances, in which of thefe it exifted in
moft perfedtion.

With 'this view I feledled the following
powders, as proper fubjedls for my experi¬
ments, and {hall {late, in as few words aa
poflible, the refult of my obfervations upon
them.

Ipecacuanha appeared to irritate the gra¬
nulations to which it was applied, giving the
fore a foul appearance

The flour of muilard, applied by itfelf,
not only irritated the granulations, but exco¬
riated the furrounding {kin ; to prevent thefe
effedls, it was mixed with the farina of lint-
feed meal in different proportions. Thus

■* Equal parts of ipecacuanha and rhubarb make an ufefuj
jnild efcharotic for deftroying warts.

weakened

. [ 338 ]

weakened I applied it to feveral fores, but
did not find its general efFedls fufficiently fa¬
vourable to induce me to continue this ap¬
plication.

The gentian and chamomile were ufed
feparately, in a variety of cafes. The fores
under this treatment went on tolerably well,

and the granulations put on a florid and heal-
ing appearance ; but the procefs of forming
new fkin was extremely flow, when com¬
pared with the cfledls of rhubarb. Compa¬
rative trials of thefe powders with rhubarb
on the fame fore, afforded fufiicient evidence
of the inferiority of their powers in difpofing
ulcers to heal.

The powder of the columba-root appears,
from its effects, to bear a greater refemblance
to the rhubarb than any of the other fubftances
which were made trial of. In feveral cafes
where the fores had become ftationary under
the application of the rhubarb, changing it
for the columba produced a difpofition to heal,
which continued till the fores got well. This
certainly is in favour of the columba, but is
no prcof of its fuperiority, fince all medi¬
cines lofe their effeds from being long con¬
tinued, and, when that happens. Amply
1 leaving

[ 339 ]

leaving them off may produce a cure, of dif-
pofe the parts to get well under applications
which before had failed.

My experience of the effedls of this medi¬
cine being lefs extenfive than of thofe of rhu¬
barb, I am unwilling to fay more refpedling
it ; but in ufing columba, the granulations
fometimes rife above the furface, a circum-
flance which does not occur when the rhu¬
barb is ufed.

It will hardly be necelfary to mention here
the difficulties which muft occur to every me¬
dical pradlitioner, in afcertaloing the effects
of a medicine ; the only fatisfaftory mode of
doing which, is to compare a number of re-
fults, obtained under different circumftances,,
deducing our conclufions from the aggregate.

In determining the effeds of local appli-

cations, the furgeon is often milled by fome
circumftances which are not, I believe, fuf-
ficiently attended to ; thefe, therefore, I (hall
briefly mention.

It fhould be obferved, in the firfl: place,
that almoft all fores appear for a time to re¬
ceive benefit Amply from a change in the
dreffing, although the new application be by
no means better than the former. In the

Z 2 fecond>

[ 34° ]

fecond, that all local applications lofe their
effcd's upon a fore^, whatever they may be,
after long continuance.

The circum fiances of the patient are alfo
to be taken into the account, before we can
well afcertain the effects of our treatment. A
man who has been fuifering all the diftreffes
of poverty, when taken into an hofpital,
where he is kept quiet, and well taken care
of, will mend under any treatment ; and in
many inftances would get well without the
affiftance of medicine. In all ulcers, on the
lower extremities particularly, reft alone is of

the utmoft benefit. To thefe and fimilar cir-

cumftances, attention muft be ftridtly paid,
with due allowance for their natural effedls,
in all experiments that are attempted on this
fubjeft.

Having given a general view of the effedts
of rhubarb as an application to ulcers, and
' compared them with thofe of other vegetable
and mineral powders ; I fhall add only a few
obfervations upon the particular ' changes
which moft commonly occur in fores while
under this treatment.

In mentioning rhubarb as a dreffing, it is
not meant to bring it forward as one that will
5 in

' [ 341 ]

in every cafe fucceed ; but only to introduce
it into pradlice, as a mode of treatment fu-
perior to fome now in ufe : as one which will
be found riot unfrequently to give the granu¬
lations a healing difpofition, and, when they
have arrived at the external furface, difpofe
them to form {kin.

In the courfe of the lad; twelve months I
have ufed this drefiing almoft conftantly in
St. George’s Hofpital, in a large infirmary,
where ulcers in the legs are very numerous,
and in private practice. From the different
cafes which have occurred in thefe fituations,
I have been led to make the following re¬
marks upon the effedls of this medicine.

When the rhubarb is firfl applied, the fore
is commonly more painful than it was before,
and the whole furface becomes of an uniform
red colour. In foul ulcers, where the mat¬
ter is principally compofed of coagulable
lymph, adhering to the furfiice, a change is
produced in the difcliarge ; it becomes more
like true pus, which feparates from the fur¬
face, and expefes the granulations to our
view.

In fores where the granulations are large^
fpongy, and femitranfparent, under this treat-

Z 3 meat

i; 342 ]

ment they become fmall, firm, very pointed
at the furface, and of a florid colour; they
are alfo fenfible to the touch, making the
fore extremely tender.

The granulations, as foon as they have
rifen to the level of the fl^in, feem to have a
Ifop put to their growth ; and thofe that are
next to the furrounding cutis lofe their irre¬
gular pointed appearance, become fmooth,
fhining, and of a more florid colour than the
refl: of the fore. In this way a margin is
formed, about one- eighth of an inch broad,
which is afterwards covered by a cuticle, con¬
tracting the fize of the fore ; and this procefs
goes on till the whole is fkinned over.

This circumftance of the granulations be¬
coming ftationary when arrived at the level
of the flcin, is fo general an effect, that in
an hundred cafes, many of thefe fores nearly
equal to fix inches fquare, no one inftance ’
to the contrary has occurred.

When the fore is beginning to heal, or has
in part fkinned over, the powder adheres firmly
to the edges, and fometimes to the furface
of the granulations, forming a crufl over
thefe parts. This fhould be carefully removed
at each dreffing, as it confines the matter,

which

■ [ 343 ]

which is often produdlive of mifchief, and
always retards the progrefs of the cure. •
From thefe fadls, which have been afcer-
tained by experiments too frequently repeated
to admit of much fallacy, I venture to re¬
commend the rhubarb as an application,
which will be found ufeful in the treatment
of ulcers ; leaving it to a further and more
complete experience to determine the exadl
place it is to hold among the applications
now in ufe.

Z 4 INDEX.

IWIWi

I N D E X.

N »

Abscess of the internal coat of the veins.
Page 1 8

Aneurifm, obfervations on, 120, 123, 131, 139

" ■ ■ - popliteal, Mr. Hunter's method of operating

in, 138, 158

■■■■ — ■■ operations for, 172, 174, 178

. . cured wifhnut an operation, 756

— ■ of the femoral artery, operation for, 166

Ani, prolapfus, remarks on, 112, note
Antimony, tartarifed, mode of preparing of uniform
ftrength, 32

not a good application for ulcers^

332

: - - i-

B;.. i ■ -

Bark, Peruvian. Bee Cinchona
Bladder, urinary, fnigular ftru^lure of an, 189
Blood, death perhaps occafioned by pus mixing with the,
24, 26

- - obfervations on the, 230, 284

Blood-veflels, lingular appearances of difeafes in, 119

- 'v - - on the obliteration of, 125

■ ' . . . . offification of, 133

'■■■ ■■ capable of fecreting air, 206

Bone,

INDEX.

Bone, fracSlured, want of difpofition to unite in, Page 233
Brain, unufual formation of a part of the, 212

)

Canine rriadnefs, obfervations on, 294
Carotid arteries, poffibility of living without any circula¬
tion through a part of the main trunks of both, ‘124
Cartilages, loofe, found in joints, remarks on, 229
Caffada poultice, utility of, in ulcers of the legs, 334i
Chalk of little ufe as an application for ulcers, 333
Camomile powder applied to ulcers, 338
Cinchona, bark of, utility of, in eryfipelatous inflamma¬
tion, 290

Columba root, powdered^ utility of, applied to ulcers,

338

Contagion, remaiks on, 1 1

.■> -'r' ■ ; V

^ . i '

Day, in n(i^icine, ' on the! proper time of -beg4 lining- the,
286

Deglutition, palfy of the mufcles of, cured, 182

- - - on difHcuIty of, Wd,

Difeafe, uncommon appearances of, in blood-veflels, 119

Difeafes, advantages of remarking Angular appearances

in, ibid. ^ ■ " ' : \ -

- — . ’direiSlionsi for drawing- up hiftories of, * 244

- - - epidemic, remarks on, 262, 269

. ■■ ■— on the occafiohal caufes of, 278

. . — ^ time of commencement of, 288

> -■ . — - new, appear to be ail ftridtly infedtious, 326

Dogs, hydrophobia feldom if ever generated fpontaneoufly

ill, 294'

Dogs,

(

I N D E X,

Dog5, fym'ptoms of hydrophobia' in, Page 296
Dyfentery, obfervations on, 263 ' ^

Emphyfema not proceeding from local injury, caufes of, '
.202, 208 . ,

Epidemic difeafes, remarks on, 262, 269 ^

Eryfipelatous inflammation, remarks on, 290
Evidence, medical, , attempt to improve, 243

Fallopian tube, fatal haemorrhage from laceration of the,

215 \ . ■

Fever, obfervations on, il

- epidemic remittent, of “Buflbrah, cafe of, 53

Foetus, extrauterine, cafe of, 216

- - membrana decidua of the, formed in the uterus,

222

Fra6lures,‘ compound, ^remarks bn, 29 ' * •

- - - - peculiar circumftances attending, 233

G J ^

Generation, organs of, cafe of extraordinary flru£!Ure of
the, 189

- - — . . — remarks on the, 223 >

Gentian powder applied to ulcers, 338

Heat, intenfe, at BulTorah, 57

Hemorrhage, fatal, from a laceration of the Fallopian
jtube, 215

Hydatids

INDEX.

Hydatids' between the re6lum and neck of the bladder,
cafe of, Page 34

~ on the growth of, 39

- different kinds of, 41, 49

— . — — mercurials recommended in cafes of, 47

Hydrophobia, on the generation of the poifon of, 294,
302 '

■ . . fymptoms of, in dogs, 296

■ . . — . — - the human fpecies, 306

- - - precautions to be taken againff, 298, 314

* ■ ■■ - how communicated, 299

I' . . . -- effe£ls of the poifon of, on the human fpe-

cies, 303

- - - on the prevention of, 312

- - - - treatment of, 319

. . . . . . antiquity of, 326

; I.

Inflammation of the internal coat of the veins, 18

- - -a-, after venefedlion, remarks on, 20

. — remarks on, 26

_ eryfipelatous, obfervations on, 290

Inoculation of fmall-pox, remarks on, i
. . . .1 - - - beft mode of performing, 8

_ _ ~ . . . does not communicate other

difeafes, lO.

Infanity, peculiar kind of, 88
Introfufception, obfervations on, 103

■M — - cafes of, 107, 108, 1 15

- - - - - treatment of, 1 1 3

Ipecacuanha powder, efcharotic, 337

Joint, new, formed in confequence of fradlure, 235

Joints, on the loofe cartilages found in, 229

INDEX.

Knee, operation for extrading loofe cartilages from the.
Page 239

Lapis calaminaris of little ufe applied in powder to ulcers,

333 • ‘

London, medical topography of, 247

Medicine, attempt to improve the evidence of, 243
Mercurials recommended in cafes of hydatids, 47

— - - ufelefs in hydrophobia, 320

Muflard, flour of, applied to ulcers, 337

Opium of no eiHcacy In hydrophobia, 32®
- efleds of, externally applied, 336

Palfy of the mufcles of deglutition cured, 182
Pericardium, inftance of the want of, 91
Peruvian bark. See Cinchona ^ .

Plafter of Paris not a good application to ulcers, 333
Pregnancy, remarks on ficknefs during, 224'
Preparation, remarks on, 9
Prolapfus ani, remarks on, 112, note
Pus mixing with the blood perhaps a cau^e of death, 24,
26

INDEX;

RheumatiTm, obfervations on, Page 269
Rhubarb, powdered, beneficial efFedls of, applied t®
ulcers, 335, 339, 340

9 '

•S

Sheep, hydatids of, 49

— - - difeafe called the Jlaggers in, produced by hydatids,

Small-pox, on inoculation for the, i

- - violence of, proportionate to quantity- of

matter abforbed, 6 '

Stomach, artificial mode of conveying food into the,
j86 ' ,

Structure of organs may be confiderably varied without
injury to their fundtions, 214
Suicide, inclination to, fymptom of a fever in Turkey,
,62, 86

Tartar, emetic. Bee Antimony tartar ifed
Temperament, obfervations on, 272
Tunica decidua formed in the uterus, 222

Ulcers, obfervations on, 330, 339
— on the application of various powders to, 332
'Urinary bladder, extraordinary ftrudlure of an, 189 •

Urine,

INDEX.

Urine fuppreilion, fatal cafe of, P^e 34
Uterus, tunica decidua formed in the, v*'hen no foetu-s
prefent in it, 222 ,

■ - - V

« I

Veins, internal coat of, liable to inflammation and abfcefs-^

^ • *

- - inftance of offification of, 134.

Vena cava inferior, changed into a ligamentous fubHancc-,;
127

- - azygos, double, 128

Venefedtion, inflammation after, 20'' ' ' ‘

- - directions for performing, 27

> ♦

W ' '

* ■ * r -

Warts, good efcharotic for> 337. mU

F I N I S.

• • ‘

V '

)

(

. ' ERRATA,

' } .

f» 93. 1. 8. f, b. for fai r. foi,'

' 1. 9. f. t. far on r. in.

I ' ' ' f

127. 1. 5. dele in.

142, note, 1, 1 1, f. h,for fteddying r, /teadylhg,
364. I. 2. f. for cacrfully r, carefully.

191. laft line, for glands, r. glans.

J94. 1. 9.yor mufcular r. vafcular,

>212. I.,4. f. \t. for falceform r. falciform. '
220. 1. 2. f. h, for inrpregnated r. unimpregnated
301. 1. y. f. b.y^r when r.. where.

317, note, 1. 6. from b. for ridge r, bridge.

331 1, 2. f. h.forong r. long
333,1^ II. f. t, for alaways r. always.

], y. f. b. for Caliminaris r, Calaminari*.
334, note, yor fatropha r, jatropha. . ^

C A S E I.

Cilmate

' London'.

Preceffion of the feafons

[two very long and' cold winters, followed by fummers alfo cold, but mikf autumns, particularly the laft.-

Prefent temperature

Epidemics

Temperament

Peculiarities

Mode of living

Times and contingencies

Ocfcalional caufes

1787

Jan.

6 p. m.

T'p.m.

Boon

day

Pulfe.

dif-

eafe.

between

1 Sc 2

80 and

- 14

Sun.

zSc 3

about

1 00

}

3^4

•>

about

1 10

. 16

1 24

'• W.

“ 5

•c

Jry

irequent inflammations of the Ikin, or red eruptions, fometimes accompanied withxrifypelatous fore throat,- fornetimes without ; they particularly affedfed that part of the town,
rather fmall- in ftature, and delicate. Her pulfe in health fmall and weak, and eafily rendered frequent. , i

as women of a middle rank; regular as to hour of fleeping.

aged 29 ; menflrua regular, not much in quantity ; had been married four years without being pregnant; fhe had been affefted two years before with a nervous fever, which continued nearly four weeks,

.none apparent. -

I by the
Ther¬
mome¬
ter un¬
der the
I tongue.

105

moifl

and

natural

100

Heat feel

Heat on

.Mnfcles*

Eyes.

Tongue.

Mouth &

Refpira- j
tion.

Stomach,

Food and

[nteftines. 1

Urine. (

Sleep.

of the

touching

throat.

drink..

patient.

the Ikin

3v the

phyfician.

•

}

' ■!

began to

appetite

refrained

feel the

not loft

Tom ani-

^ !

uvula.

mal food

not hot

•

throat

natural

appetite

tea and

natural

not ob-

difturbed

•» —

fore

oft

water-

evacua-

erved

gruel

tion in the

morning

not hot .

foul

fore, red.

rather af-

lick

beef-tea.

no evacu-

ditto

verylittle.

and be-

fefted

barley-

ation

drow fy

ginning

water.

■

flpughs

•

&c.

hot

■

' \ t

jj:-. •

; .

fouler

floughs

not m.uch

naufea

the fame

evacua-

ditto

the fame

increafed

affedled

tion in the

morning

hot

moderate

in noways

dull

a thick

flough of

not per-

naufea.

fago, pa-

evacua-

fomewhat

dofing

and

tenfe

yellowilh

an a(h co-

fedlly eafy

which fhe

nada, &c.

tion as

of a whey

; -

brown

lour CO-

from the

aferibes

with '

ufual in

appear-

drowfy

mucus

vered the

afleition

to the me-

wine.

the morn-

ance

formed a

whole

of the

dicines

lemonade

ing

triangle,

right ton-

throat

the bafe

fil, round

• ^

to the

which the

■

throat

membrane

wasnotred

temperate

moderate

natural

brighter

mucus ■
crufl; lefs

membrane
red about

more dif¬
ficult

naufea
gone, but

the fame

higher co¬
loured,

:ftill dofing
and

the edge

from the

no appe-

r *

with a

drowfy

N. .

of the

throat

kite

cloud

flough^

which be-

*•

•

gins to
fepargte

•

Mifceilaneous Obfervations,

excepting for the feel of the
uvula no complaint

felt generally difordered

Medicines.

linimentum volatile guttura

pul vis jacobi- vefperer

miflura falina c, tart, emet;-
gr. i fextis horis

I faw her for the firH time in
this difeafe

th:! flougli fell off th^ evening
of the 1 8th, and fhe recovered

R cort, Peruv, 9iji tertiis hof.-
tii^. myrrh. 3ij. mel. rofar,-
^ij. aquas puras Jviij. m. fub-'
inde utendum pro gargifmate’

R aq. menthi vulg. Jjfs. core.
Per. pulv. 33*. fp. lavend. c.-
3j. ft. hauit fecunda q hora-
fum.

R ol. olivar.' Jij. alkal. volat.-
c. jij. pro liniment, guttur^'
applicandum
R tinduras rofar. |vj,
myrrh. |ij. pro garg.

medicines continued-

Internet Archive Audio

Featured

Top

Images

Featured

Top

Software

Featured

Top

Books

Featured

Top

Video

Featured

Top

Mobile Apps

Browser Extensions

Archive-It Subscription

Save Page Now

Full text of "Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge. Volume 1, 1793."

See other formats