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M E

THE

D I C

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Hi::';:;

AND '

CHIRURGICAL

REVIEW;

CONTAINING

A COPIOUS ACCOUNT

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OF THE

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VARIOUS PUBLICATIONS

IN DIFFERENT LANGUAGES,

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MEDICINE AND SURGERY.

Vol. V.

From MAY 1798, to MAY 1 799-

y - 1 • .1

- - QUJE NON FECIMUS IPSI

vix ea nostPlA yoco - - - - OvidL

LONDON :

PRINTED FOR THE EDITORS J AND SOLD BY T. BOOSEYj BROA©

street; and w* gilbert, dublin»

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CONTENTS

OF THE

FIFTH VOLUME.

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164,

Page.

26
40
101
67
81:
82
87

93
118

208
148
221
182

184
186

MEMOIRS of the Manchefter Society, p. 1, V. 5. -

Baillies Appendix to Morbid Anatomy
Bree on Difordered Refpiration -

Cavallo’s Medicinal Properties of Factious Airs
Duncan’s Annals of Medicine for 1797 - - 52,

Ware on the Fiftula Lachrymalis, Sec.

Lagrange’s Cours d’Etude Pharmaceutique, &c.

Foot’s Cafes of Veficas Lotura
Wallis’s Eflay on the Gout -

Curry on Apparent Death from Drowning, ,&c.

Saumarez’s New Syftemof Phyfiology
Fordyce’s Third DifFertation on Fever
Blair’s Eflays on the V enereal Difeale
Ferriar’s Medical Hiflories and Refledions
Alibert’s Confiderations fur les Odeurs, &c.

Dumas’s Syfteme Methodique - -

Haflam’s Obferrations on Infanity, Sec.

Examen fait fur l’Exiflence d’un Fluide Aqueux dans les Cavites

Cerebrales, & c. - - - 198

Caillau’s Premieres Lignes de Nofologie Infantile, ou Eflai fur

la Did ribution des Maladies des Enfans en Clafles, &c. 1 99

Lombard’s Inftrudion furl’ Art des Panfemens, Sec, - ibid.

Turton’s Medical Glofiary - 200

Memoires de la Societe Medicale d’ Emulation - - 201

Jenner’s Inquiry into the Variolas Vaccinse - - 236

Crowther on the Difeafes of the Joints, See, - - 245

Stuart’s Medical Difcipline - - 256

JPerkins on the Influence of Metallic Trailers, Sec. - 258

Beddoes’ Ledures, Sec. on the Human Body - - 278

Turnbull’s Rules and Inftrudions on Ruptures - - 284

Weikard’s Medicine Simplified, Sec. - * - 285

Soemmering De Corporis Humani Fabrica - 286

Pearfon on Inflammatory Diathefis in Hydrophobia - 29!

Philofophical Tranfadions of the Royal Society of London,

part 1, for 1798 - 301

Cullen’s Clinical Ledures - - * 318, 420

Blfoard on the large Blood- veflels, Sec. * - 337

Contents .

Crichton on Mental Derangement, &c.

Rumball on the Nature and Caufe of the Pulfe, &c.
Willan on Cutaneous Difeafes, &c»

Hamilton on Hydrophobia;

Sue fur la Vitaiite *>

Report on Galvanifm -

Philofophical Tranfa&ions of the Royal Society of
part 2, for 1 798 -

White on the Broad-leaved Willow Barb
Medical Records and Refearches
Ruffell’s Account of Indian Serpents
Simmons on the Casfarian Operation, &c.

Coindet’s Obfervations on Animal Fat, &c.

Rollons Cafes of the Diabetes Mellitus, &c.

Pearfon’s Inquiry into the Cow-Pox
Beddoes on the Venereal Difeafe
Bell’s Syftem of Diifedions *

Bell’s Anatomia Brittannica

Hamilton on the Duties of a Regimental Surgeon

Hooper’s Medical Di&ionary

Horn’s Treatife on Leeches -

The Medical Diary for 1799 * * -

Brown on Scrophulous Difeafes « -

Leidenfroft Opufcula Phyfico-Chemica, See .

S^vigny’s Coile&ion of Engravings •» *

Page.

- 343* 436

358

361
376, 451

394> 495

L.ta 557
401
’ 467

468, 5IO
478, JOI
489

- 498

- |Z4

544

535

565

568

57i

* “ 573

574
•? ibid.

575

576

- 579

PREFACE

■' J

PREFACE

ROM the length of time which has

elapfed fince the firft publication
of the Medical and Chirurical
Review, there are few fubje&s, it is
prefumed, in any way connected with
Medicine, or with Medical Philofo-
phy, which have not undergone dif-
cuflion, and which, confequently,
have not found admiffion, into the
prefent work. Many matters, indeed,
of high importance, have fprung up,
and many new and powerful remedies
been difcovered, within the period al¬
luded to. Concentrated views of thefe

have, no doubt, their value, as tending
more widely and Ipeedily to diffufe
ufeful and important truths. Such

was

PREFACE.

was the end the Editors had In
view in their undertaking ; and they
truft their object has been attained.
To the Medical and Chirurgical Re¬
view, they, with forae confidence, re¬
fer, as a compendium of the prefent
ftate of Medicine, and of the moft
material improvements which have
taken place with regard to it, for
-the laH ten years,

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THE

No. XXV.

THE

MEDICAL and CHIRURGICAL

A .. V ' ,'W /

REVIEW.

JULY, 1798.

IIWI— Mil millMBSlilMniUP' TOI,P>

Art, L Memoirs of the Literary and Philofophical
Society of Manchefler. Vol. 5 , part 1. 06lavo>
318 pages, price 6s, Cadell and Davies,
London, 1798.

THE firft paper in the prefent eftimable colleftion*
that bears any relation to our fubjedt, is by
Mr. John Dalton, and contains fome extraordinary
fafts relating to the vifion of colours. It has been
obferved, he remarks, that our ideas of colours*
founds, taftes, &c. excited by the fame objeft, may
be very different in themfelves, without our being
aware of it ; and that we may neverthelefs converfe
intelligibly concerning fuch obje6ts, as if we were
certain the impreffion made by them on our minds
were exactly fimilar. All, indeed, that is required
for this purpofe, is, that the fame obje£t fliould uni¬
formly make the fame impreffion on each mind , and
that objetts which appear different to one fhould be
equally fo to others. It would, however, fcarcely
be fuppofed, that any two objefts, which . are every
day before us, Ihould appear hardly diflinguiihable to
one perfon, and very different to another, without
the circumftance immediately fuggefting a difference
VOL, v. B

2 Memoirs of the Manchejler Society } part 1, pot. 5,

In their faculties of vifion; yet fuch is the fa6l, not
only with regard to the author of the paper before us,
but to many others alfo. The following are hated
as the characleriftic facts of the vifion of thefe per-
fons :

c 1. In the folar fp eft rum three colours appear,
yellow, blue, and purple. The two former make a
contrail ; the two latter feem to differ more in degree
than in kind.

c 2. Pink appears, by day-light, to be fky-blue a
little faded; by candle-light it affuines an orange or
yellQwifh appearance, which forms a Itrong contrail
to blue.

4 3. Crimfon appears a muddy blue by day; and
crimfon woollen yarn is much the fame as dark blue.

c 4. Red and Scarlet have a more vivid and flaming
appearance by candle-light than by day-light.

c 5. There is not much difference in colour between
a flick of red iealing wax and grafs, by day.

c 6, Dark green woollen cloth feems a muddy red,
much darker than grafs, and of a very different co¬
lour.

‘ 7. The colour of a florid complexion is dufky
blue.

* 8. Coats, gowns, &c. appear to us frequently to
be badly matched with linings, when others fay they
are not. On the other hand, we fhould match crim-
lons with claret or mud; pinks with light blues;
browns with reds,; and drabs with greens.

( 9. In all points where we differ from other per¬
sons, the difference is much lefs by candle-light than
by day-light.’

The author has been informed of nearly twenty*
perlons in the predicament here flated : feveral of
which were of the fame family: it is remarkable that
he has not heard of one female fubjedl to this pecu¬
liar, ty. None of them were aware of their actually
feeing colours different from other people; but

imagined

Memoirs of the Manchejler Society , part 1 yvoL 5: 3

imagined there was great perplexity in the nam.es
aferibed to particular colours.

‘ Obfervations tending to point but the caufe of this
anomalous vi/iom . The firfi time I was enabled to form
a plaulible idea of the caufe of our vifion, was after
obferving that a fky-blue tranfparent liquid modified
the light of a candle fo as to make it fimilar to day-?
light; and, of courfe, reifored to pink its proper
colour by day, namely, light blue. This was an im¬
portant obfervation. At the fame time that it exhi¬
bited the effect of a tranfparent coloured medium in
the modification of colours, it feerned to indicate
the analogy of folar light to that refulting from cone
bullion; and that the former is modified by the tranf¬
parent blue atmofphere, as the latter is by the
tranfparent blue liquid. Now the effect of a tranf¬
parent coloured medium, as Mr. Delayal has proved,
is to tranfmit more, and consequently imbibe fewer
of the r&ys of its own colour, than of thofe of other
colours; Refle6fing upon thefe fafts, I was led to
conjecture that one of the humours of my eye muff be
a tranfparent, but coloured i medium, fo conftituted
as to abforb red and green rays principally, becaufe
I obtain no proper ideas of thefe in the folar fpeCtrum;
and to tranfmit blue and other colours more perfectly*
What feerned to make againft this opinion, however,
was, that I thought red bodies, fuch as vermilion,
Ihould appear black to me, which was contrary to
fact. How this difficulty was obviated will be un¬
de rffood from what follows.

f Newton has fufficiently afeertairied, that opake
bodies are of a particular colour from their reflecting
the rays of light of that colour more copioufly than
thofe of the other colours ; the unrefieCteci rays being
abforbed by the bodies. Adopting this fa£t, we are
infenfibly led to conclude, that the more rays of any¬
one colour a body reflects, and the fewer of every
other colour, the more perfeCt will be the colour.
This conclusion* however, is certainly erroneous.

B 2 Splendid

4 Memoirs of the Manchejler Society , part 1, vol. 5*

Splendid coloured bodies reflect light of every colour
copioufly ; but that of their own mod fo. Accord¬
ingly we find, that bodies of all colours, when placed
in homogeneal light of any colour, appear of that
particular colour. Hence a body that is red may
appear of any other colour to an eye that does not
trail fruit red, according as thofe other colours are
more copioully reflected from the body, or tranfmitted
through the humours of the eye.

« ‘ It appears, therefore, almod beyond a doubt, that
one of the humours of my eye, and of the eyes of my
fellows, is a coloured medium, probably fome modi¬
fication of blue. I fuppofe it muff be the vitreous
humour 5 otherwife I apprehend it might be difeo-
vered by infpeftion, which has not been done. It
is the province of phyfiologifts to explain in what
manner the humours of the eye may be coloured,
and to them I fhall leave it ; and proceed to drew
that the hypothesis will explain the fafts dated in the
conclufion of the fecond part.

c 1. This needs no' further illuftration.

* 2. Pink is known to be a mixture of red and
blue ; that is, thefe two colours are re fie ft ed in ex-
cefs. Our eyes only tranfm.it the blue excels, which
Caufes it to appear blue ; a few red rays pervading
the eye may Serve to give the colour that faded ap¬
pearance. In candle-light, red and orange, or fome
Other of the higher colours, are known to abound
more proportionably than in day-light. The orange
light reflefted may therefore exceed the blue, and
the compound colour con fid of red and orange.
Now, the red being mod copioufly reflefted, the
colour will be recognized by a common eye under
this bn all modification ; but the red not appearing to
us, we fee chiefly the orange excefs : it is confequent-
ly to us not a modification but a new colour.

4 3. By a fimilar method of reafoning, crimfov ,
'being compounded of red and dark blue, mud aflame
the appearances I have deferibed.

* 4. Bodies

Memoirs of the Manchejier Society , part i, vol. 5. 5

€ 4. Bodies that are red and fcarlet probably relief
orange and yellow in greateft plenty, next after red.
The orange and yellow, mixed wjth a few red rays,
will give us our idea of red, which is heightened by
candle-light, becaufe the orange is then more,
abundant.

‘ 5. Grafs-green is probably compounded of green,
yellow, and orange, with more or lefs blue. Our
idea of it will then be obtained principally from the
yellow and orange mixed with a few green rays.
It appears, therefore, that red and green to us will
be nearly alike. I do not, however, underhand,
why the greens (hould affume a blueilh appearance
to us, and to every body elfe, by candle-light, when
it (hould feem that candle-light is deficient in blue.

* 6. The green rays not being perceived by us, the
remaining rays may, for aught that is known, com¬
pound a muddy red.

c 7. The obfervations upon the phenomena of
pink and crimfon, will explain this fa ft.

c 8. Suppofe a body to refle£t red rays as the num¬
ber 8, orange rays as the number 6, and blue as .5 ;
and another body red 8, orange 6, and blue 6: then
it is evident that a common eye, attending princi¬
pally to the red, would fee little difference in-thofe
colours; but we, who form our ideas of the colours
from the orange and blue, (hould perceive the latter
to be bluer than the former.

‘ 9. From the whole of this paper it is evident,
that our eyes admit blue rays in greater proportion
than thofe of other people ; therefore when any kind
of light is lefs abundant in blue, as is the cafe with
candle-light compared to day-light, our eyes ferve in
fome degree to temper that light, fo as to reduce it
nearly to the common ftandard. This feems to be
the reafon why colours appear to us by candle-light,
almofl as they do to others by day-light.

c I (hall conclude this paper by obferving, that it
appears to me extremely probable, that the fun’s

B 3 light:

6 Memoirs of the Manchejkr. Society , part I, vol. 5.

light and candle-light, or that which we commonly
obtain from combudion, are originally conftituted
alike; and that the earth's atmofphere is properly
a blue fluid. , and modifies the fun’s light to as to
occafion the commonly perceived differenced

Account of' a remarkable Change of Colour in a
Negro . By Miers Fifher.— Extract of a Letter from.
Mr. James Pemberton to Mr. Thomas Wilkinfon.

Philadelphia, September 13th, 1796.

4 This day Henry Mofs, of African defcent, vifited
me ; and produced a certificate, of which the follow¬
ing is a copy:

c I do hereby certify, that I have been well ac¬
quainted with Henry Mofs, who is the bearer hereof,
upwards of thirty years, during the whole of which
time he fupported an honed, character. In the late
war he inlided with me in the continental army as a
foldier, and behaved well as fuch. From the firft
of my acquaintance with him, till within two or three
years pad, he was of as dark a complexion as any
African, which has changed without any known
caufe to what it is at prefent. He was free-born,
and ferved his time with Major Brent, late of Charlotte
county. 1 -

4 Given under my hand the 2d day of September,
]794- Joseph Holt, Bedford County}

4 Henry Mofs has all tne features common to the.
African race, though not ftrongly impreffed. He'
is forty-two years of age, and five feet fix inches
high. The borders of his face, at the roots of the
hair on the finciput and defcending by the rHht
ear, are, for nearly an inch in breadth, of a perfea
European complexion. This ftripe, fomewhat en¬
larged in its dimenfions, is continued under the chin,
and rifes, on the left cheek to within two inches of
the ear, where it is intercepted by an irregular
blotch or the negro fkin, about an inch broad, which
detaches it from a correfponding ftripe on the left

fide

Memoirs of the Manchejter Society , part 1, vol. 5* 7

fide of his face. It paffes down the neck of the left
fide about three inches, and is there two inches wide.
Its margin is irregularly indented, refembiing iflands
and peninfulas as reprefented on the chart of a fea-
coaft. The back of the neck, the breaft, arms, and
legs (as far as thefe could be expofed with decency
in a mixed company) are of a clear complexion, in¬
ter fper fed with fmall fpecks of African colour, not
unlike the freckles which appear on the fkin of a fair
woman in fummer. The African complexion is
completely difcharged from the upper eyelids.
There is a fmall white freak under the right eye;
and a larger one, nearly half an inch broad, with a
margin irregularly defined, under the left. A white
lift paffes round the mouth, fhaded by one of his na¬
tive hue reaching nearly to the chin, below which
he has a very fair complexion. The back and palm
of the hands are perfectly fair; yet ftripes of his for¬
mer colour pafs from the wrift along the fides of his
hands to the ends of his fingers; and appear on the
outfides of all his fingers. But in general on his
limbs, where they are covered by clothing, or where
fkin meets fkin, the tranfm illation is complete. The
whole area of negro fkin would not, I am perfuaded,
if properly meafured, exceed a fquare foot. His hair
js1 undergoing a correfpondcnt change ; and whenever
a white fpot can be difcovered, it appears foft like
that of an European, and may be drawn out with
eafe to a length of feveral inches: where the fkin re¬
tains its priftine hue, it is crifp like wool. On
preffmg his fkin with my finger, the part which I
preffed appeared white ; and, on removing my finger,
it was fuffufed with red, as happens in Europeans.
I examined the borders pf tfie black and white fkin,
with a glafs which magnified confiderably, and which
is known in Ireland by the name of a linen-teller.
It was evident that the change was not external, or
occafioned by the calling off of the epidermis; but
that it was owing tp an affeftion of the corpus miico ■*

B 4 jinn .

8 Memoirs of the Manchejter Society , part I, voL 5.

fam. No fiffures were difcernible, but I perceived
that there was a fmall and gradual elevation where
the white and black portions met, without any dif-
continuity on the external iurface.

c He gave the following account of his genealogy.
His paternal grandfather was bora in Africa, and
married a native Indian of this country. His father
married a Mulatto, born of an African father and an
Irifh mother His maternal grandfather was born in
Africa.

£ He was firft fenfible of a change of colour in his
fkin in February 1792. It commenced at the roots
of his finger nails, extended to the firft joints, and
went no further at the time. Two months after¬
wards the back of his neck underwent the fame
change, which proceeded along the body, and gra¬
dually defcended to molt parts ufually covered by his
clothes. The progrefs was flow in the firft, but more
rapid in- the enfuing )ears. The alteration was made
chiefly in fummer or warm weather; and could not
be feen to make any progrefs in the cold months.
He fays, he came to this city on the 26th of July:
and that the remains of African complexion on his
face and hands has fenfibly diminifhed fince his arri¬
val. This account is confirmed by Stephen Pafchal
and others, who faw him twice, at an interval 'of
thirteen days, in which time the difference was abun¬
dantly manifeft. He was this morning fhaved by a
barber ; who fays, that he felt no obftru&ion to the
razor, when it paffed over the white to the black
part of his face, or on its return, which muft hare
been experienced if thefe had been feparated by any
difconti unity of the fkin.

c Since the change of complexion took place, he
has been more fenfible of variations in the tempera¬
ture of the air ; and has had blifters and freckles in
every part of his body, which was expofed to the
fun by holes in clothes.

€ I put

Baillle’s Appendix to Morbid Anatomy.

* I put many queftions to him concerning his diet
and mode of life, the ftate of his health, the dif-
eafes to which he had been fubjeft, and the remedies
employed for their removal; but nothing could be
extrafled from his replies, which had the leaft ten*
dency to folve this curious phenomenon.

* November 22d, Henry Mofs vifited me again. I
examined his face, hands, breaft, legs, and thighs.
The black parts are conflderably diminifhed fiiice
I faw him laft. Hence I entertain no doubt that the
change is gradually proceeding; and, fhould he live
another fummer or two, that it will be complete.

* Miers Fisher/

Art. II. An Appendix to the Firft Edition of the Morbid
Anatomy offome of the mofi important P arts of the
Human Body. By Matthew Bailli e, M. D.
F.R S. Fellow of the Boyal College of Phyfteians,
and Phyjician to St. George’s Hofpital. Oftavo,
162 pages, price 2s. 6d. Johnson, London, 1798.

THE greater part of our readers are no doubt
acquainted with the treatife of Dr. Baillie on
the fubjeft of Morbid Anatomy ; a work intejefting
both in its nature and execution. The fecond edition
having lately appeared with confiderable enlargement,
the author thought it but juft to thofe who had pur-
chafed copies of the firft edition, tojmblifh a feparate
Appendix to it feparatelyl This not only, he ob-
ferves, comprehends what is new in the fecond edi¬
tion, but alio whatever has undergone any confidera¬
ble alteration fince the publication of the firft, in
confequence either of better opportunities of obferva-
tion, or of more reflection.

With refpeft to the fecond edition of the Morbid
Anatomy, the author obferves, that befides additions
furnifhed from his own ftores, fome are derived from

the.

JO BailhVs Appendix to Morbid Anatomy .

the obfervations of others, and efpecially from thofe
vt Dr. Soemmering, Profelfor of Medicine in the Unh
yeriity of Mayence, one of the moft diftinguifhed
anatomifls of Germany. To the morbid appearances
Dr. Baillie has fubjoined the fymptoms connected with
them: but this part of the work is attended with many
difficulties, and he feels it neceffary to befpeak in¬
dulgence on this head,

‘ The difficulties which attend an attempt to afcer-
tain the fymptoms of difeafes, are derived fro pi vari¬
ous fources. The fame fymptoms are not uniformly
connected with the fame morbid changes of Itrufture
in the body. — in many cafes, too, the fymptoms are
nearly the fame, where the morbid changes of ftruc-
ture are very different.— This is particularly exempli¬
fied in difeafes of the brain and of the heart, — Patients
often explain very imperfectly their feelings, partly
from the natural deficiency of language, and partly
from being milled by preconceived opinions about
the nature of their complaints.— Medical men alfo,
in examining into the fymptoms of difeafes, fome-
times put their queftions inaccurately, and not unfre-
quently miflead patients into a falfe defcription, from
feme opinion about the difeafe which they have too
haftily adopted. All of thefe are formidable difficul¬
ties, which obftruft the progrefs of our knowledge
of the fymptoms of difeafes; but the accumulated
obiervations of many individuals will probably, pt
length, in a great meafure overcome them.’

Many difeafed appearances are deferibed in the
prefect woik, to which there are added no corre-
fponding fymptoms and this depends upon different
caufes. I he frit is, that there are many morbid
changes of ff.ru cl u re in the body, the correfponding
fymptoms of which are not afeertained. The fecond
is, that many morbid changes of flriuffure are pro¬
duced by caufes which difturb the conffitution fo
iitdc, as to be attended with fymptoms top fhghtly
inarxed for oofervation. The third and laft is, that

the

• /

Bai'llie?s Appendix to Morbid Anatomy. 1 1

the fymptoms belonging to fome difeafecl appearances
fall to immediately under the cognizance of the eye,
or of the touch, as to be included in a description of
the difeafed appearances themfelves, and to render
any further account of them Superfluous.

From the following heads, our readers will fee
what they are to expebf in the Appendix before us.
From the whole we Shall afterwards feleft a few of
thofe which appear moft interesting, or which have
the greatest practical tendency. Of many, the bare
enumeration will Suffice.

The pericardium wanting. — A Singular mal-forma-
tion of fhe heart. — The pleura almoft dry. — Water
accumulated in the Subftance of the lungs. — Air-
yeffels attached to the edge of the lungs.— Inflamma¬
tion of the thyroid gland.— Bronchocele. — Schirrus of
the thyroid gland. — The thyroid gland converted into
bone. — -The cartilages of the larynx converted into
bone. — Ulcers in the cavity of the larynx. — Scrofulous
Swelling in the pharynx. — Difeafed appearances of the
thymus gland.— Steatomatous tumours adhering to
the peritonaeum. — Air in the cavity of the abdomen. — •
Calculi in the Stomach. — Taenia folium. — Taenia lata.
— Trichuris. — Coats of the liver converted into car¬
tilage. — Cyil in the liver containing an earthy mat¬
ter. — Rupture of the liver. — Ulcers in the gall-blad¬
der.— The gall-bladder wanting. — The fpleen rup¬
tured. — Several Small Spleens. — The fpleen Said to be
-wanting. — Scrofulous tubercles in the kidneys.—
State of the kidneys in diabetes. — Hydatids of the
kidneys. — Renal capfules fcrofulous and cartilaginous.
— Little (tones in the renal capfules. — Polypus of the
bladder. — Cyfts communicating with the bladder. —
The bladder divided into two chambers.— Calculi. —
Loofe cartilages in the tunica vaginalis teflis. — Malig¬
nant ulcer of the uterus. — Schirrous enlargement of
the uterus. — An hermaphrodite in the human lpecies.
- — A part of the pia mater bony. — Bony tumours
preffing upon the brain.— Bony ridges irritating the

brain.

12 Baillie’s Appendix to Morbid Anatomy .

brain.* — Hydrocephalus. — Cavities in the brain con¬
taining a ferous fluid. — Aneuryfm of the internal
carotid arteries on the fide of the fella turcica. — Lit¬
tle bags in the plexus choroides. — Round tumours
adhering to the plexus choroides.— Difeafed appear¬
ances of the pituitary gland.

Such are the general contents of this valuable vo¬
lume. — The part which we flrft feledt relates to dif¬
eafed appearances of the ftomach.

c Appearances in Hydrophobia. On opening the
bodies of perfons who have died from hydrophobia,
the inner membrane of the ftomach is frequently
found inflamed at the cardia, and its great end. The
inner membrane of the pharynx and the cefophagus
is alfo inflamed. The membrane is not thickened
by the inflammation, but the inflammation fpreads as
in eryfipelas, (hewing in fome places a diftindt line of
boundary. This inflammation is commonly, I be¬
lieve, not very great.’

c Calculi in the Stomach. Calculi with different
appearances have been defcribed as being occafton-
ally found in the ftomach. They have never come
under my own ohfervation, and are to be reckoned
very uncommon* Moft of thefe calculi have been
found upon examination to be biliary, and had been
conveyed from the duodenum into the ftomach by
an antiperiftaltic motion of this part of the fmall in-
teftines.’

c Symptoms connected with the difeafed appearances ,
In inflammation of the ftomach, the following lym-
toms are obferved to take place; viz. pain in the
epigaftric region, which is increafed when any thing
has been fwallowed, vomiting, often hickup, a pulfe
fmall, frequent, and hard, heafo thirft, and a feeling
of great debility.

‘ The fymptoms which are produced by fwallowing
arfenic, are the fame with thofe which take place in
a very violent inflammation of the ftomach; for arfe-

* 4 Vid. Lieutaud, Tom. I. p. iyd

Baillie’s Appendix to Morbid Anatomy . 13

nic a£ts upon that organ in no other way than by ex¬
citing in it a very high degree of inflammation.

‘ Hydrophobia is fufficiently characterized by the
horror which the patient expreifes at the fight of any
fluid that is offered to him, by the great difficulty
experienced in fvvallowing, and by the flrong aliena¬
tion of mind which accompanies this dreadful difeafe.

* I have reafon to believe that ulcers in the fto-
mach are often flow in their progrefs. They are at¬
tended with pain, or an uneafy feeling in the ftomach,
and what is fwallowed is commonly rejected by vo¬
miting. This ftate becomes gradually worfe, and is
very little relieved by medicine ; which may ferve as
fome ground of diftinCtion between this complaint
and a temporary deranged aCtion of the ftomach.

£ Cancer of the ftomach is attended with a fenfe of
pain in that organ, which varies a good deal in its
degree in different individuals. What is fwallowed
is almoft conftantly rejected by vomiting, and there is
frequently thrown up alio a dark coloured fluid,
which has fometimes been compared to coffee
grounds. Ti e patient commonly becomes emaciated,
and the countenance fallow; the pulfe is frequent,
and heftic fymptoms are formed.

c I am not acquainted with the fymptoms which
are produced by a partial thickening of the ftomach
unattended with ulceration.

‘ The accumulation of air in the ftomach is ac¬
companied with an unpleafant feeling of diftenfion,
and a fvveiling may be felt externally in the epigaftric
region ; wind paffes up by the defophagus, and there
are occaftonal pains in the ftomach, produced by a

fpafmodic contraction of fome part of its mufcular
coat/

The next chapter contains the difeafed appear¬
ances of the inteftines.

Tama . The taenia which is moft commonly
found in the human inteftines, is of two kinds, viz,
the tania folium, and the tania latad

Tania

14 Baillie’s Appendix to Morbid Anatomy,

c Tcenia folium. This taenia is frequently bred ifi
the in te hi nes of the inhabitants of Germany, and ocA
calionally, but rarely, in thofe of the inhabitants of
Great Britain. It confifls of a great many diftinCf.
portions, which are connected together fo as to put
on a jointed appearance ; thefe joints are commonly
of a very white colour* but are occafionally brownifb,
which depends on a fluid or this colour which is
found in their veffels. The worm is ufually very
long, extending often many yards, and feldom paffes
entire from the bowels. This circumftance has pre¬
vented the extremities of the tcenia from being often
feen.

c The head of this taenia is fomewhat of a fquare
form, with a narrowed projection forwards; in the
middle of this projecting part, there is a diflinCl Gr~
cular aperture, around the edge of which grow curved
fharp procefies. Near the angles of the fquare edge
of the head, are fituated four round projecting aper¬
tures, at equal diftances from each other; this head
is placed upon a narrow jointed portion of the worm,
of confiderable length, and which gradually fpreads
itfelf into the broader joints, of which the body of the
worm is compofed.

c The body of the taenia confifis of thin, flat, pretty
long joints, on one edge of which there is a projec-’
lion, with a very obvious aperture. In the fame
worm fome of thefe joints appear confiderably longer
than others ; this probably depends on one joint be¬
ing contracted, while another is relaxed. The aper¬
tures which we have juft mentioned, are generally
placed on the alternate edges of the contiguous joints :
but this is not uniformly the cafe ; they are fometimes
placed on the fame edges of two, or even feveral
contiguous joints. When thefe joints are examined
attentively, there are frequently feen, in each of them,
veffels filled with a brownifb fluid, and difpofed in an
arboryfeent form. Aroui.d the edges of each joint,

' . there

Baillie’s Appendix to Morbid Anatomy. 3 5

there is alfo a diftindt Terpentine canal.* The laft
joint of a taenia refembles very much a common
joint rounded off at its extremity, but without any
aperture..’

c Tania lata. The taenia lata is bred very com¬
monly in the inteftines of the inhabitants of Switzer¬
land, but very rarely in thofe of the inhabitants of
Great Britain. The joints of which it is compofed
are fhort and broad, and the aperture is not upon the
edge of each joint, as in the folium, but in the mid¬
dle of its flattened furface. I have not feen either the
head or the pofterior extremity of this taenia; but I
prefume that they differ little from thofe of the folium.

‘ Other taenia have occafionally been found in the
human inteftines, but they occur very rarely, and
have not fallen under my own obfervation. - They
would feem all to be formed upon 'one general plan.

‘ Trichuris . This worm has been occafionally
found in the great inteftines of man, and more efpe-
cially the c cecum. It refembles a good deal the
afcaris, but is confiderably larger, and has a very
long tranfparent tail To the heads of fome of them
is attached a procefs or horn.’

_ Of Diabetes , Dr. Baillie obferves, that c opportu¬
nities do not frequently occur of examining the ftate
of the kidneys m this difeafe. I have once, however
been able to make this examination f in a fatisfa&orv

* e This, as well as theveflels difpofed in an arborefcent form, is
very difnnUly feen injected in fome preparations which have been made,
and given to me by an ingenious young burgeon, Mr. Carlifled

f The topical affe&ion of the kidneys in diabetes is apparent, not
only from this, but from other examinations made after death. It ap^
pears to us, therefore, that the change in the condition of the urine fn
this difeafe admits of a ready explanation, without recurring to the

theory of Dr. Rollo; — [See Medical Review, vol. 4, page 190) _ for

this would be needlefsly to multiply caufes. The ftomach and inteftinejt
were to all appearance found : fo that there does not feem to be any

foundation *or Dr. jBaillie s opinion, of an imperfect formation of the
chyle.

> manner*

16 Bailiie's Appendix to Morbid Anatomy .

manner, where a perfon had been long affected with
diabetes, and had been a patient under my care at
St. George’s 'Hofpital. In both kidneys the fuperfi-
cial veins were much fuller of blood than ufual, form¬
ing upon their furface a moll beautiful net-work of
veffels, the larger branches of which exhibited an
arborefcent appearance. The whole fu bilance of the
kidneys was much more vafcular than in a healthy
hate, approaching a good deal in appearance to what
takes place in inflammation. In both of them there
was a very fmall quantity of a whitifh fluid, fome-
w hat refembling pus, which was fqueezecLout through
one or two infundibula ; but there was no appearance
of ulceration whatever. The artery, the vein, the
lymphatic veffels, and the nerves of both kidneys were
in their natural ftate, The liver, at the fame time,
I examined with care, becaufe it has been thought
by fome to be the chief fource of difeafe in diabetic
patients, but it was perfectly found. The ftomach
and inteftines were alfo examined with attention, but
no appearances occurred intthem which are not very
common. From the ftate of the kidneys upon exa¬
mination, it feemed to me probable that diabetes
depends, in a conftderable degree, upon a deranged
fiftion of the fecretory ftrufture of the kidneys, by
which the blood there is difpofed to new combina¬
tions. The effeCt of thefe combinations is the pro¬
duction of a faccharine matter. I think it probable,
at the fame time, that the chyle may be fo imper¬
fectly formed, as to make the blood be more readily
changed into a faccharine fubftance, by the aCtion of
the kidneys. This opinion, however, is propofed
with much diffidence.’

c An Hermaphrodite in the Human Species Exam-

fles of what have been called hermaphrodites in the
uman fpecies have, when ftriCtly examined, been
hitherto found to belong to the male or the female
fex} but Dr. Storer of Nottingham has favoured me

Baillie’s Appendix to Morbid Anatomy. 17

\ *

with an account of a perfon fo ftrongly marked as an
hermaphrodite, that no doubt can, I think, be rea-
fonably entertained of this being the cafe. The per¬
fon to whom this Angular monftrofity belongs, is {till
alive, and has been carefully examined by Dr. Storer
and other medical gentlemen, very able to judge con¬
cerning it ; I ill all therefore take the liberty of infert-
ing here, the account which Dr. Storer was fo
obliging as to fend me.

c The perfon bears a woman’s name, and wears the
apparel of a woman. She has a remarkably mafcu-
line look, wTith plain features, Tut no beard. She had
never menftruated ; and on this account fhe was de-
fired by the lady with whom the lived as fervant, to
become an out patient at the Nottingham HofpitaL
At this time (he was twenty-four years of age, and
had not been fenfible of any bad health, but only
came to the hofpital in order to comply with the
withes of her miftrefs. V arious medicines were tried
without effedf, which led to the fufpicion of the hy¬
men being imperforated, and the menftrual blood
having accumulated behind it. She was, therefore,
examined by Mr. Wright, one of the furgeons to the
hofpital, and by Dr. Storer.

6 The vagina was found to terminate in a cul-de-
fac, two inches from the external furface of the labia.
The head of the clitoris, and the external orifice
of the meatus urinae, appeared as in the natural frac¬
ture of a female, but there were no nymphax The
labia were more pendulous than ufual, and contained
each of them a body refembling a tefticle of a mode¬
rate lize, with its chord. The mammae refembled
thofe of a woman. The perfon had no defire of par¬
tiality whatever for either fexfi

The remarks on the difeafed appearances of the
brain and its membranes, are too important to be
palled over.

vol. v. C 4 A pari

18 Baillie's Appendix to Morbid Anatomy .

c A part of the pia mater bony . It occafionally
happens, although I believe very feldom, that a por¬
tion of the pia mater is converted into bone. It has
not occurred to me to obferve fuch a change of flruc-
ture n this membrane, but Dr. Soemmering men¬
tions that a fpecimen of this difeafe is preferved in his
cohesion.

f The brain very firm. The brain is fometimes
found to be confiderably firmer than in a healthy
date, to be tougher, and to have a greater degree of
elafticity than ufual ; it will bear to be pulled out with
fome force, and will readily re-aft fo as to reliore it-
felf, or when preffed will recover its former lhape.
Under fuch circiunftances the ventricles are fome¬
times found enlarged in fize, and full of water. The
brain has even been faid to become fo hard and dry
as to be friable between the fingers j and the medul¬
lary fuhftance, in thefe cafes, is reprefented as being
much lighter than in a natural ft ate. It is probable,
however, that thefe accounts are a good deal exag¬
gerated. It has been remarked that the cerebellum
is very often unaftefted.

c Bony tumours pi (fifing upon the brain. Bony tu¬
mours are fometimes formed in the cranium, which
prefs upon a part of the brain. They mod commonly
confift of an irregular mafs, which is formed of bony
proheffes, with a fleiliy fubflance filling up the inter¬
faces between them. Of this fort of tumour there
are feveral examples in Dr, Hunter’s collection.

e It has fometimes happened, but very rarely, that
all the bones of the cranium have become extremely
thickened, and have encroached, by their growth,
upon the cavity which contains the brain. Of this
there is a remarkable fpecimen in Mr. Hunter’s col-
leftion, where the bones of the cranium are at leaf!
three times as thick as in the natural hate. They ar<j
alio, in the cafe to which I allude, much more
fpongy than ufual in their texture.

* A nodule

Bailiie’s Appendix to Morbid Anatomy. 19

c A nodule of a fubftance having the appearance of
ivory, has alfo been known to be tormed in the bones
of the cranium, and to protrude confiderably into its
cavity. This too occurs very rarely, but a fpecimen
of it is preferved in Mr. Hunter’s cohesion. What¬
ever may be the variety in the morbid proceffes, which
produce thefe changes of ftru&ure in the bones of the
cranium, yet their effefts upon the functions of the
brain mu ft be nearly the fame, as they form a perma¬
nent caufe of comprefiion.

c Bony ridges irritating the brain . Upon the inner
furface of the bafis of the cranium there is always
fome irregularity. This confifts in numerous ridges
and fmali eminences with depreffed lurfaces inter-
pofed between them. It happens occafionally that
there is a morbid growth of thefe eminences and
ridges, forming fharp fpicula and (harp edges of bone.
Thefe run into the brain, and irritate very violently
the nervous fyftem.

* Hydrocephalus. One of the mod common ap¬
pearances of difeafe in the brain, is the accumulation
of water in its ventricles ;* this generally takes place
■when a child is very young, and even fometimes be¬
fore birth. The water is accumulated in greater or
lefs quantities in different cafes. It fometimes amounts
only to a few ounces, and occafionally to many pints.
When the quantity of water is very confiderable, the
fornix is raifed at its anterior extremity in confe-
quence of its accumulation, and an immediate
opening of communication is thereby formed be¬
tween the lateral ventricles.*)* From this caufe too

a part

* c Mr. Home has known an inftance where water was accumulated
in large quantity in the third ventricle, and had forced its way between
the fine laminae of the medullary fubftance which compofe the feptum
lucidum, without efcaping into either of the lateral ventricles. This
may be faid to be a new htuation of hydrocephalus, and is of very rare
occurrence. y

f 6 A diftinguifhed author has, in a late publication, infilled very
ftrongly upon the exiftence of a communication between the two lateral

C 2 ventricles

20 BaillieV Appendix to Morbid Anatomy .

a part of the water paffes very readily into the third
ventricle, and from thence into the fourth. The wa¬
ter is of a purer colour, and more limpid, than what
is found in dropfy of the thorax or abdomen. It ap¬
pears, however, to be generally of the fame nature
with the water that is accumulated in both of thofe
large cavities. In fome trials which I have made, it
partly coagulated upon the application of the com¬
mon acids, exalUy like the water in hydrothorax and
afcites, or like the ferum of the blood.* But there
is much variety in the quantity of the coagulable
matter. In fome inftances the water in hydrocepha¬
lus contains a very fmall proportion of coagulable
matter, and in others it is entirely free from it. This
variety may probably depend upon foriie difference in
the aftion of the fmall blood- veffels which pour the
fluid out.

f When water is accumulated in the ventricles to
a very large quantity, the fubftance of the brain,
efpecially upon the lides and at the upper furface,
appears almoft to be a fort of pulpy bag, containing

ventricles of the brain, and has expreffed great furprize that it has been
denied by feveral teachers of anatomy in London. Without entering
into any difpute about this matter, which in itfelf is of no great import¬
ance, I fha.ll briefly mention what appears to me to be the real date
of the circumdances. The fornix at its exterior extremity lies loofe
trpon a part of the thalami nervorum opticorum, and there is a fmall
chink on each fide of the fornix leading obliquely downwards from the
lateral ventricles to the anterior extremity of the third ventricle. While
the fornix is allowed to remain in its natural duration, there feems to
me to be no immediate communication between the lateral ventricles.
But when the fornix is elevated (which maybe very eafily done), then
the lateral ventricles communicate with each other; and the communi¬
cation is more or lefs according to the degree of the elevation. It may
be laid, that the lateral ventricles dill communicate together by means
of the third ventricle. This, however, does not feem to me to be
properly a communication between the two lateral ventricles, unlefs any
two cavities which communicate with a third, may be properly laid
to communicate with each other.*

* 4 In one indance, lately, I found that the water of hydrocephalus
depofited no coagulable matter whatever upon the application of con¬
centrated vitriolic acid.*

a fluid.

Bailiie’s Appendix to Morbid Anatomy * 21

a fluid. The corpus callofum is at the fame time
burft, fo that a part of the water lies in immediate
contaff with the dura mater which lines the infide of
the upper part of the cranium. "I he fcull too, upon
fuch occafions, is very much enlarged in fize, and al¬
tered in its fhape The cranium is exceedingly large
in proportion to the fize of the face, ihe projections
are very conliderable at the centres of offification,
from whence the frontal, parietal, and occipital bones
wTere originally formed, and the membranous divifions
between thefe feveral bones are very wide. When
the fcalp is removed, fo as to give an opportunity of
looking immediately upon the cranium, the bones are
found to be very thin, often not thicker than a (hil¬
ling, and there are frequently broad fpots of mem¬
brane in the bone. The reafon of this lad appearance

is, that offification takes place in many points of the
membrane in fuch cafes in order to make a quicker
progrefs, but the water accumulates too rapidly for

it, fo that fpots of membrane are left not converted
into bone. When fuch appearances take place in
hydrocephalus, the difeafe has been of long continu¬
ance, occafionally for fome years.

c Cavities in the brain containing a ferous fluid .
Cavities containing a ferous fluid are fometimes ob-
ferved in the fuhftance of the brain. They aimed
conftantly occur in the medullary part of the hemif-
pheres, and are generally lined with a tough fub-
flance or membrane. They would appear to be the
remains of the cavities formed by extravafated blood,
in cafes of apoplexy, where the patients have not
been cut off immediately, but have lived afterwards
for fome months or years. The extravafated blood
would feem in fuch cafes to be diffolved, and taken
up by abforption; but the injury is not repaired, and
a cavity remains afterwards tilled with a ferous fluid. *

* Aneuryfm

* 4 I had an opportunity of obferving, lately, a well marked cafe of
this fort, in a perfon who had had federal attacks of apoplexy, and at

C 3 length

22 Baillie’s Appendix to Morbid Anatomy *

c Aneuryfm of the internal carotid arteries on the
fide of the fella turcica. The internal carotid arteries
are very apt, in perfons of an advanced age, to be¬
come offified, and the fame morbid change may be
traced along their branches. It occurs, however,
very rarely that they are diftended at any part into an
aneurylmal hack, like the arteries in fame other parts
of the body. I have been informed of an inftance of
this kind, where both the internal carotid arteries,
on the fide of the fella turcica, were diftended into a
little aneuryfm.* One of thefe aneuryfms was about
the ftze of a cherry, and the other was fomewhat
fm alter. It is remarkable that in the only two in¬
stances which have come to my knowledge, of aneu-
rifms being formed in the arteries of the head and
brain, there has been an aneuryfm in both arteries
in the fame fituation, and at the fame time. I once
met with an aneuryfm in the two carotid arteries at
the origin of the internal carotids, and in the cafe juft
defcribed, there was an aneuryfm in the two internal
carotid arteries upon the fide of the fella turcica,

‘ Difeafed appearances of the plexus choroides.—
Little bags in the plexus choroides , The rnoft com¬
mon difeafed appearance of the plexus choroides is
that of little round tranfparent bags, which adhere
to it, and which have commonly been called hyda¬
tids. Thefe are generally about the fize of a garden
pea, but fometimes they have been feen as large as
a goofeberry. From feveral examinations which I
have made of them, they would teem to be formed
by a diftenfon of the vein which runs along the edge
of the plexus choroides. I have been able to diftend
them fully with air, by making an opening into this
vein, and inflating air into it through a fmall blow¬
pipe.

length was cut off by one of them. Dr. John Hunter has obferved &
good many inftances of it, and a cafe occurred fome years ago to Mr.
vv ilfon, lecturer on furgery, whofe anatomical accuracy is well known*
where the cavity which remained was of a very large fized
f 1 owe my acquaintance with this cafe to Dr* Blanc.’

f Round

Baillie’s Appendix to Morbid Anatomy.

‘ Round tumours adhering to the plexus choroutes.
Tumours fometimes adhere to the plexus choroiaes
They -are fmall in their fize, are commonly ahnoit
globular in their fhape, and occur but rarely. 1 1 ey
feem to be of the fame kind with the round tumours
which are fometimes found imbedded m the brain,

and I believe are fcrofulous.

‘ Difeafed appearances of the pituitary glaitd.

This gland is very little liable to be aped by dif-
eafe. It has only occurred to me to obferve in it one
morbid change. It was, m that care, ^ enlarged to
twice its natural fize, and was converted into a iuo-
fiance, poffeffing an obfcurely fibrous ftructure.

« Symptoms connected with the difeafed appearances.
Inflammation of the dura mater is not diftmguifoed
by any peculiar fymptoms. The fymptoms which
belong to it, are the fame with thoie wmch a.! r.d
inflammation of the other membranes, and even oiaer
but little from the fymptoms which take place m m*-
flammation of the brain itfelf. The fymptoms are,
pain in the head, delirium, fymptomatic rever, and

fometimes convulfive motions. . f

‘ When tumours have been found ache ring to the

dura mater, or the other membranes of the brain, a
long continued pain in the head has commonly been
remarked, fometimes delirium, fometimes convul-
fions, and fometimes, it has been faid, the ordinary

fymptoms of apoplexy. . , ,

' ‘ Where bony matter has been formed m the aura

mater, with (harp precedes growing from it, convul¬
five motions have very commonly occurred m various
parts of the body, often a continued pain m the head,

and fometimes delirium. . ,

< In cafes where the veins of the pia mater hav$

been found turgid with blood, ftupor has very fre¬
quently occurred, fometimes delirium, and fometimes,
it has been faid, even apoplexy m its perteft form.

< The fymptoms of inflammation in the pia mater
are the fame with thofe which attend inflammation or
the dura mater, and they have been already noticed.

C 4

*24

Baillie’s Appendix to Morbid Anatomy ,

c In inflammation of the fubftance of the brain,
there is pain in the head, delirium, fymptomatic fe¬
ver, and fometimes coma.

c Where an abfcefs has been formed in the brain;
pain, delirium, and coma, have been remarked,
fometimes a paralyfis of a part of the body, and fome¬
times convulfion§. The left fymptom has been ob¬
served moil frequently to occur when the abfcefs has
been formed in the tuberculum annulare, or in the
medulla oblongata, or in the neighbourhood of thefe
ftruftures, fo that the pus could air eft them by its
preffure.

‘ The brain has been fometimes found more firm
and elaftic than is natural in cafes of mania. I have-
been informed, however, lately, from the beft autho¬
rity, that this ftate of brain is not common in maniacs;
and that in them it is generally not more firm, nor
more elaftic, than in people whole minds have always
been found.

s The fymptoms which have been ob ferved to at¬
tend the, formation of folid, or encyfted tumours in
the brain, are a permanent uneafinefs or pain in the
head, fometimes delirium, fometimes convulfions,
and fometimes, it has been faid, the common fymp¬
toms of apoplexy. It is worthy of remark here, that
when tumours of any kind prefs upon the thalami
nervorum opticorpm, or the optic nerves themfelves,
within the cranium, vifion becomes impaired in va¬
rious ways ; and that when tumours prefs upon the
tuberculum annulare, or the medulla oblongata, con¬
vulfions are very apt to occur.

‘ The fymptoms of hydrocephalus, are a pain in
the head, ftupor, convulfive motions, picking of the
nofe, grinding of the teeth during fieep, occafional
flufhings of the face, a dilatation of the pupils, and
towards the latter end of the difeafe, fquinting. The
ftomach is commonly affefted with ficknefs, and the
bowels are with difficulty afted upon by purgative
medicines. In the beginning of this difeafe, the pulfe

Baillie’s Appendix to Morbid Anatomy .

is frequent but regular; when the difeafe has made
a further progrefs, it is flower and irregujar ; and to¬
wards the latter end of the difeafe, it becomes again
regular and frequent. Where the progrefs of the
difeafe has been very gradual, and the patient has
continued to live for fome months, or even years, the
functions of the brain have been found, in many in-
trances, to be lefs impaired than might have been
expefted, till near its clofe.

4 Where blood has been e flu fed upon any of the
membranes of the brain, the patient is more or lefs
in a comatofe date, according to the degree of the
effufion, or the different fufceptibiiity of the brain in
different individuals to be affefted by preflure. In¬
numerable inftances (hew, that the brain will have
its functions impaired in very different degrees, from
the fame apparent degree of injury.

‘ When blood is effufed into the fubftance of the
brain, apoplexy is produced, which is attended with
the following fymptoms, viz. coma ; often ftertorous
breathing ; a paralyfis, commonly of one half of the
body; and often corn/ ul five . motions. The pulfe is
flow, full, and generally very ftrong. When the pa¬
tient is not cut off at once, but live6 for fome time
after the attack, the hemiplegia, which is aimed con-
ftantly an effedt of this difeafe, is upon the oppofite
fide of the body from that of the brain, in which the
eff ufion of blood has taken place. This would feern
to fhew, that the right fide of the body derives its
nervous influence from the left fide of the brain, and
the left fide of the body its nervous influence from the
right fide of the brain,’*

* e Dr. John Hunter has made fome very accurate diffedions relative
to apoplexy, and its conl'equences, which formed the fubjed of the
Guldonian ledures, read by him, 1796, before the College of Phyh-
cians. By thefe ledures, I have been enabled to give a more fatisfac-
tory account of the appearances ednneded with this difeafe, than I
Ihouid have been otherwifed

( 26 )

% * X.

4 . , » ' ...

Art. IIL A Practical Inquiry on Uifordered Ref
piration , <8ft\ By Robert Bree, M . D>

[Continued from voL 4, page 548.)

\ , ■ f •

JN our laft number we entered at fome length on
the nature and caufes of the convulfive althma,
and are now to follow the ingenious author in the
treatment, founded on his dodlrine of the difeafe.
On this head, he remarks on the little encourage¬
ment afforded by former writers of great authority,
who treated on the fubjedt ; and he attributes their
want of fuccefs to the erroneous opinions entertained
by them on the caufe of the difeafe. From this
fource he traces the falfe indications they followed
in attempting a cure. c It is time/ he fays, c that other
indications fhould be purfued than thofe of relieving
fpafmodic conftridtions of the bronchia and efferve-'
fcences of the blood ; or let us rather become em¬
pirics, and take the chance of benefit from cafual
experiment, and the happy fuccefs of blunder, than
rely on diredfions which confeffedly do not point to
the objedl of our wiflres, and may poffihly lead us
to error.’

The author having experienced the difeafe himfelf
with great feverity, was furni fired with the oppor¬
tunity of making trials, of which he appears to
have availed himfelf with induftry and fuccefs. The
juvantia and Icedentia were here ineflimable guides,
as they always will be in medical inveftigation.

The ftates of difeafe in afthma are limited by a
diftindt application of terms as follows:

c A Paroxyjm of Convulfive Afthma, is that ftatc of*
the difeafe which has an Exacerbation at night as
long as it lafts. Wfterr the intermiffion takes place,
Afthma is not cured, and though the paroxyfm is
generally attended by at leaf! Three Exacerbations ,
it fometimes is extended through many more, nor is

there

Bree on Difordered Refpiration , &

there any certain limit to their number. If it does
not embrace fo many as three, benefit may be faid
to be derived from fome operation of art or nature,
when the patient has a confirmed predifpofition to
the diforder; but we can never affent to the pro¬
priety of claiming an advantage over the paroxyfm,
if the exacerbations are renewed as often as was
cuftomary in former fits, or oftener than three times,
if the difeafe is new. Much lefs can the word
Cure be admitted to clofe the phyfician’s labour, or
enhance the character of his fagacity, unlefs an entire
change in the habit of his patient, comprehending
vigorous digeftion, and eafy refpiration, fhould be
well efrablifhed after the paroxyfm has been long
overcome.’

The general effefts of the different claffes of me-

dicines are next given.

Cathartics are commonly injurious, and in fome
inftances have brought on a paroxyfm.

Emetics are ufeful in three fpecies, but in the
fourth, which depends on habit, they are to be
avoided.

On blood-letting, the author obferves, . that,
* many doubts occur on the propriety of bleeding in
Afthma, in any fpecies of the difeafe. Before the
pulmonary veffels have attempted to relieve them-
felves by their exhaling orifices, blood may poffibly
be drawn with advantage, but when effufiqn has
taken place, a certain debility is indicated, and a
lofs of contractile power in the coats of the veffels,
which prudence will rather fubmit to during the
ft, and attempt to remedy in the intermiffiom In
this flate of the difeafe, nature purfues the path
bed: adapted to her circumftances ; the efcape or
ferous fluid gradually relieves the veffels, and ref¬
piration and abforption muff be relied on, with a
falutary cough, to clear the air cells of the lymph.
If evacuations of blood are dire&ed, the fudden
depletion of the veffels will leave their coats without

the

i i

28 Bree on D {/ordered Befpiraiion> <Su\

the ftimulus neceffary to produce a contraction, equal
to the fpace which the blood had occupied; the
heart will participate in the injury* and will alfo be
deficient in vigour of contraction. If, therefore,
blood is to be taken* it ihould be drawn from the
vefiels at intervals, and in fmall portions, which
would allow of the contradtile power being exerted,
in proportion as the veflel lofes its contents, and
would not finally take fo much fluid away, as would
leave it without the ftimulus of detention, fo effential
to its return of health.

c But bleeding is an imprudent operation in every
fpecies of Afthma, unlefs it be the fecond. In the
firft fpecies I have repeatedly direfted it, but have
never had reafon to think that the paroxyfm was
fhortened an hour by the lofs of blood, and I have
often been convinced that expe&oration was de¬
layed, and more dyfpncea remained in the intermif-
fion, than was common after . former paroxyfms.
In old people who have been ufed to the diforder,
it is certainly injurious. In the fecond fpecies there
are occaflonal topical inflammations, which this
operation may relieve, but if it is carried far, there
is the ftrongeft reafon to apprehend, that the pa¬
tient maybe plunged into afthma of the firft fpecies/

Sudorifics and diuretics are not of polltive ad¬
vantage. In complicated cafes of old people, iffues
are ufefuh

Antifpalmodics may be expeHed to flop the fit
in the firft Ipecies, if we attend to the hypothefis of
a fpafmodie conftriction of the bronchia., but indica¬
tions from this theory are not to be depended upon.

4 Antifpafmcdic medicines,5 the author oblerves,

* have no certain efficacy in fhortening the paroxyfm
of the firft fpecies of this difeafe. Exceptions may
be made to this general remark, but they are not
founded upon precife lines of diftindijon of the dif¬
ferent fpecies.

‘ In

Bree on D if ordered Refpiration , 8£c. 29

e In the fourth fpecies, which often appears in
afthmatics, who may alfo be fubjeded to exciting
caufes, occafioning one or other of the three former.,
antifpafmodics will not deceive the phyfician.
Opium hands firft, but its value is frequently en¬
hanced by the addition ot aether. If thefe valuable
medicines had been applied with proper difcrimi-
nation of different fpecies of afthma, the practice
would not have been fo frequently difgraced by
failure in the expectations of relief from their ufes.

{ In the accefs of a paroxyfm of the firft fpecies,
R. B. took four grains of folid opium, which pro¬
duced nearly an apopleCtic ftupor for two days.
After a few hours, the moil debilitating ficknefs
came on, with inceffant efforts to puke. The la¬
bour of the refpiratory mufcles was abated, but
the wheezing evidently increafed ; a countenance
more turgid than ufual, and intenfe head-ache at¬
tended. The pulfe was increafed in ftrength and
quicknefs for a few hours, but then funk into great
weaknefs.

c The paroxyfm fhewed itfelf four hours earlier
than ufual the next day, and two grains more were
taken when it was perceived to commence ; refpi¬
ratory labour feemed again to abate, but the anxiety
encreafed to an alarming degree, as the ftupor be¬
came fo me thing lefs. The pulfe was now weaker,
and frequently irregular. Loofe motions fucceeded,
and a general fvveat. The energy of the paroxyfm
then revived with exquifite diftrefs. A medical
friend, who attended with great care to the progrefs
of thefe trials, became alarmed, and endeavoured to
promote puking, without effect. Biifters were ap¬
plied, and draughts of vinegar and ' pepper were
given, interpofed with ftrong coffee and muftard.
The patient was at laft brought back to a ftate more
ufual in former paroxyfms, but with every care, the
exacerbations were no fewer than nine, before ex-
peroration, becoming gradually more copious, in¬
cluded

30 Bree on Difordered Rcfpiration , Kc,

eluded the fit. Notwithstanding the bad fuccefs of
this experiment, opium was ufed in another pa-
roxyfm after an active vomit, and bad confequences
ftili enfued, though not fo extenfive. In the latter ex¬
periment, the extraordinary fymptom of a moft painful
ftrangury came on, which continued feveral hours.’

Of expectorants he prefers ipecacohan, ammo¬
niac and fquill, and avoids oily demulcents as in¬
jurious. Heating expedlorants are to be corredted
by their combination with other ingredients. Afa-
foetida is condemned.

Of pneumatic remedies Dr. Bree fpeaks with
little confidence, as to their efficacy in curing aflhma.
He, however, propofes oxygen as an ally, with other
means' of relief in the firii fpecies from mucous irri¬
tation. The authority which he appears chiefly to
have confulted is, the reports of profeffors of this
pradtice. We fliould have been better fatisfied with
the refult of his own accurate experience; for furely
the negledt which the pradtice feems to have fallen
into, is a ftrong argument againft„ depending upon
the vague cafes which have been brought forward in
recommendation of the ufe of the gaffes.

It would be definable to know if the author had
ever really obferved the miraculous effedt which
oxygen has been affirmed to produce in aflhma, by
Dr. Beddoes : ‘ No fooner,’ fays he, c does it touch
the lungs, than the livid colour of the countenance
difappears, the laborious refpiration ceafes, and the
fun diions of all the thoracic organs go on eafily and
pleafantly again !’

In the dry afthma, oxygen was obferved to be pofi-
tively hurtful ; and hydrogen and hydrocarbonate were
tried without benefit, by Dr. Thomas Bree, who had
paid attention to this pradtice. The phyfiological rea-
fons which Dr. Bree gives for the ufe of oxygen in the
firff fpecies, viz. that excels of mucus in the air bladders
makes its natural combination with the blood diffi¬
cult, are ingenious, and account in a feemingly fa-

tisfactory

Bree on Diforclei'ed R&fpiratioti, <Sfc. 31

tisfaftory manner for the good effed of this air upon
afthmatics, if, in fad, they do perceive relief from
infpiring it.

Stomachics are coniidered as abfolutely neceffary.
Of thefe he recommends abforbents and vinegar
feparatelv exhibited — Both eminently counteract the
flatulence and diftention of the ftomach.

Chalk is recommended in ftrong terms as a means
of cure in the third fpecies ; but this is not very
readily difcriminated from the firft, and chalk may
poflibly be more extenftvely applied where dyfpepfia
is fo predominant as in general cafes of afthma. *
The fuccefs which attends its ufe is only to be ac¬
counted for, by conli dering the influence which a
morbid ftate of the ftomach may have on the adions
of the refpiratory mufcles in this difeafe. This in¬
fluence is placed by Dr. Bree on juft principles in
the 14th feed ion of his inquiry. And the correfpon-
dence of the external mufcles with the irritated or¬
gan which they attempt to relieve, is a pathological
fad which we deem highly important, as eftablifh-
ing the greateft improvement which has been yet
given in treating the difeafe.

Stimulants are injurious till after the third day
in the paroxyfm, and we are cautioned againft their
abufe. c I have never yet feen/ he fays c aether
give eafe in the acme of the paroxyfm of the flrft
fpec les. In many trials, the anxiety and the energy
of refpiratory labour were certainly encreafeef/
Cold bathing is ftrongly advifed between the fits.
Dr. Bree entirely coincides with the teftimony of
Dr. Ryan as to the great benefit of this pradice, but
found it manifeftly injurious in the paroxyfm.

Tonics are the grand means of cure, not exhibited
in the paroxyfm, but in the intermiflion. Prepara¬
tions of iron are preferred. On this fubjeef he fpeaks
as follows :

Ionic medicines, if we feparate a clafs of fto-
machics from this general head, are not expeded to

2 be

52 Bree on Dlf ordered Rcjpiration^ <Sfc\

be ufeful in the paroxyfm of afthma. They have
been applied partially, and abandoned capriciouily,
by molt practitioners, in cafes of afthma during the

intervals. .

4 But a defideratum has always been a proper
diftmbiion of Ipecific caufes. If tonics are given in
cafes of difordered refpiration arifmg from fecret vo-
. micae, fmall .tubercles, adhefions of the pleura, and
.many other caufes of continued afthma, .what conic-
quenee can be expected, but encreafe of difeafe,
and accumulated mifchie.fr The recollection of every
practitioner wall enable him to allow, that inflances
of this complicated kind, have been confounded
more or left with convulsive afthma of nofologifts,
and when iron, or peruvian bark have been ex¬
hibited, thefe valuable medicines have met with
unmerited difgrace.

4 But, befid.es this caufe for the rejeftion of tonics,
the want of firmnefs in continuing the ufe of them,
when properly indicated, is a great fource of their
di (credit

4 A febrile affeftion comes on during a courfe of
fteel or mineral w^ater, and the medicine is dift
carded never to be refumed.

4 Peruvian bark loads the ftomach, and brings on
dyfpnoea in one preparation, and it is abandoned
without trying another of lighter digeftion, and
more divided parts.

4 I can affirm, that in the intervals of the paroxyfms
of the firft, third, and fourth fpecies of afthma, tonics
are generally beneficial, and that a temporary incon¬
venience from the ufe of one form, fhouid incite the
phyfician to find another, and apply it, never aban¬
doning the general intention.

4 In the fecond fpecies their advantage is more
doubtful, and their exhibition muft be decided upon,
by careful attention to remote caufes.’

After this general account of the effeCl of medi¬
cines, the author propofes the indications which are

* to

Bree o?i Difordered Refpiratiori , 8(c,

to be followed in treating the paroxyfm. Thefe are
fuch as are naturally deduced from the caufes of
the dibindf fpecies. They deferve great attention,
as leading to confiderable relief of the diftreffing
fymptoms ; but, excepting in that fpecies which is de¬
pendant on habit, the author profeffes only to im¬
prove the pradlice in the paroxyfm, by giving more
certain data, founded on his numerous experiments.
It is the intermiffion which appears to afford the op¬
portunity of eradicating the diforder, and by a rule
of pradtice fimilar to that purfued in the iliorter in-
termiffions of a quartan ague, by corroborating the
fydem of the patient. It is only by removing the
predifpofition that the difeafe can be cured, a confide-
ration hitherto but little followed in pradtice, how¬
ever important.

‘ It is our duty/ fays the author, c to urge the ne~
ceffity of counteracting exciting caufes, and to fhew
what condition of body it is, in which thefe caufes
are buffered to operate their effedts. Unlefs this
honed folicitude of the phyfician is anfwered by the
firm fubmiffion of the patient, the latter cannot be¬
come impervious to the future attacks of aithma,
though a paroxyfm has terminated in the mod per-
fedt intermiffion.

‘ In the Firft Species it is obvious, that the proper
indications are to be only anfwered by the ufe of
medicines, which can give a contradtile tone to the
pulmonary capillaries, encreafe the power of the
domach and bowels, and promote abforption and
drength through the whole habit.

c Peruvian bark, iron, cold bathing, exercife,
change of air, oxygen, bitters, abforption, and acids,
thefe are the means, which, diverffied according to
their effedfs, will prevent the recurrence of pa~
roxyfms, by curing the condition ot body in which
they are excited.’

c We mud continue abforbents from the clofe of
the paroxyfm, making ufe of magnefia when the

vol, v, D body

34 Rree on Dif ordered FeJ1 piralion,

body is coftive, but preferring chalk in common in-
fiances. This medicine, given in bitter infufions,
will oppofe dyfpepfia as a temporary relief, but muff:
not be relied upon for a more extenfive advantage.
The preparations of iron are to be given at firft in
fmall doles, and afterwards increafmg the quantity.
If heat, or pain, occafionally attend, we muft fubmit,
during thefe fymptoms, to fufpend their ufe, and fub-
ftitute faline draughts with opium.

c In the Second Species , exhalation fhould be pro-
moted from the veffels of the lungs, by the ufe of
diaphoretics. Small dofes of opium are ufefully con¬
joined, and the patient fhould not be fubjeCted to the
influence of irritating caufes, fuch as are known to
exift in towns and manufactories.

‘ The Third Species is to be cured by the means
pfopofed in the firft, but with a more free ufe of ab-
forbents, and a more rigid attention to diet. Chalk
and opium will aftonilh the afthmatic, by the excel¬
lence of their effeCts, when the irritation proceeds
from dyfpepfia of the firft paflages only.

‘ The Fourth Species is cured by antifpaftnodics,
which abate a fenfe of irritation from trivial caufes
that cannot be avoided, and by a change of ideas
and manner of life : by thefe means the habit of con-
vulfive mufcular contractions is finally overcome, if
thefe had not ceafed with the offending caufe which
excited them.’

Some cafes are given which elucidate the princi¬
ples, and confirm the propriety of the author’s prac¬
tice. The moft ftriking will doubtlefs be confidered
his own cafe, which, as wil! be feen below, appears
to embrace the firft, fecond, and laft fpecies of the
difeafe, in its fuccefiive periods. A cure was obtain¬
ed by arduous perfeverance in corroborating means,
and attentive obfervation of the effeCts of medicines.

R. B. enjoyed general health in various fituations
until 1783 ; when dyfpepfia firft attacked him at
twenty-five years of aae. The fymptoms increafed

gradually

Bree on Di/ordered Befpiration 3 &'c. -35

gradually for four years. He was hypochondriac,
fleepy after meals, and had conftant pains in the in-
tercoftal mufcles.'

1788„ — Reading was painful, his eyes conftantly
inflamed; ftupor came on every night, and apoplexy
was apprehended. He had lived upon a very weak
and fluid diet, and taken faline medicines very inju-
dicioufly.

In the fummer, after awaking in the morning, he
perceived fome wheezing in his expirations, but no
dyfpncea.

In the autumn, after a catarrh, and fatigue in
riding, he was feized in the ufual manner, with a
paroxyfm of convulfive afthma of the firft fpecies.

In the winter, he had feveral paroxyfms, and pur*
fued the means of alleviating them pointed out in
the preceding feftions. His experiments frequently
prolonged their duration, and the inter mifficins were
neglefted.

For four years this difeafe preferved its character,
and was remarkably excited by the following remote
caufe. — The elevated flat of Solyhull is the higheft
part of Warwickfliire, from which rivulets defcend
to the eaftern and weftern oceans. The foil is gra¬
velly, but always moift with fprings ; the air is light,
and continual evaporations make it cold. He W7as
frequently called to this fpot by the ties of family, or
motives of bufinefs, from a refidence forty miles dis¬
tant, and two hundred feet nearer to the level of the
fea. In his firft vifit, after he had fuftained the afthma,
he was feized with a very fevere paroxyfm on the
evening of his arrival. He was laid up during his
ftay, and the fymptoms had not fubfided when he
purfued his road back. As he defcended from the
high country into the rich paftures of Leicefterfhire,
the dyfpnoea gradually went off, notwithftanding great
fatigue. During four years he repeated this vifit in
warm and cold weather, and under all c ire urn franc es,

D 2 feven

36 Bree pn D If order eel Refplration , &c.

feven times, but with the fame bad fuccefs in ever?
attempt.

1792. — He had tried the effect of numerous reme¬
dies in the paroxyfm, and had attained fome advan¬
tage over it: dyfpepfia was lefs, and his general
health improved, but he had not yet fucceeded in
lengthening the intervals.

H e now purfued, more vigoroufly, the plan which
he had adopted. He took iron in3 large dofes, and
in all preparations, but preferred the ruft, which cor¬
rected dyfpepfia moft powerfully. He went into the
cold bath every other morning, and took abforbent
earths frequently, with bitter infufions, and rhubarb.

In the fummer, dyfpepfia was greatly abated, and
the intermiffions became longer. In October, he
went to Bath, and drank the water a few weeks with
great benefit. Upon his return he refumed his tonics,
and trufted chiefly to the ruft of iron, taking chalk
more feldom. The cold bath was fufpended in the
winter.

1793. — Some boils had appeared in the laft year,
and they were now more frequent upon his face and
body. The paroxyfm s did not come on fo often, but
were excited by fatigue or cold, and by profeffional
bufinefs, which he now determined to abandon ra¬
ther than his hopes of a perfect cure.

1794. — In the winter he was very free from diforder-
ed re fpi ration, which he attributed to excurlions and a
change of ideas in new purfuits. In the fpring he had
two fevere returns, excited by duft of oats and hair pow¬
der, which revived dyfpepfia and gloomy profpefis.
But he expectorated little, although dyfpnoea fub-
fided with the paroxylm. His difeafe now approach¬
ed the character of the fecond fpecies, and the change
was conlidered favourable. He alfo applied the
principles of feCtion XV. to thefe attacks, and fecretly
determined to oppofe a future invalion by fedatives,
which he had long difearded as ufeleis in this in¬
tention.

Bree on Difordcred liefpirationl We, 37

An opportunity occurred twenty days after, when
he completely flopped theparoxyfm at ^.commence¬
ment, by two grains of opium diifolved in vinegar
with aether. He enjoyed a good night, and arofe in
the morning without dyfpnoea or expectoration. He
was now prompted to fee the event of a journey into
W arwickfhire, but here the paroxyfm came as ufual
on the evening of his arrival, when his mind was oc¬
cupied by the perceptions which he had before ex¬
perienced in the fame place, and which he had great
anxiety to avoid. When he perceived the fympt'oms,
he withdrew from company, and took a draught of
cold water and vinegar, with forty drops of tinCt.
opii. Relief foon came, but not extended to a per¬
fect removal of the affeCtion, which he attributed to
the ftrength of influences operating upon habit,

The dofe of opium was repeated, and he had a
good night, but no deep; in the morning, dyfpnoea
without wheezing Further reflection ftrengthened
his opinion that he was now under the dominion of a
fecondary difeafe eftablithed in habit, and he deter¬
mined to anfwer the new indications , at any expence
of effort which circumftances might demand. He
recollected the aphorifm of Hippocrates on the con-
vulfive difeafe of epilepfy, which had been dilated
in the doctrines of many modern writers, applied to
cuffom or habit, but not with the force which has
been ffnce exhibited by the author of Zoonomia.

Military bufmefs was moft oppoffte to his former
habits, and moft likely to turn the current of his
ideas to diffever the chain of links bv which they
revived old fenfations, or to obliterate their influence.
Exercife near the fea, where the denfity of the air
might co-operate with other means of cure, and the
opportunity of bending his mind to the principles of a
new fcience, were his motives for taking a company
in a regiment ot militia, commanded by excellent of¬
ficers, who were his friends.

At the end of June he joined his regiment, en¬
camped upon a dry common, elevated above the

D 3 • plain.

38 Bree on D if ordered Refpiration , 8£c,

■ ■ ■ •

plain* and Hoping towards the fea at a few miles dif-
tance, The colonel of His regiment is a father to his
officers, and He permitted him to occupy lodgings,
with his family, in the vicinity of the camp. He at
firft avoided, with great care, errors in diet, which
are exciting caufes copiouily provided at military
tables. But after a few weeks he found great cau¬
tion was unneceffary, an accidental excefs having no
bad confequence, He foon gave his whole attention
to the fcene before him, and attempted to fill his
mind with the images which it pre feinted. A new
fyftem of taffies being ordered for practice of the
regiment in camp, he employed himfelf in affiduous
ftudy of its principles, and their application to aftive
fervice.

During the fummer, and until late in the autumn,
he had uninterrupted health. The vigorous fpring
of elaftic youth again animated his frame, and was
attended by fatisfaffion and ferenity of mind, which
the capricious tyranny of his diforder had denied him
for the preceding ten years. He generally arofe at
four in the morning, and frequently marched fix
miles, in the duft of two brigades of infantry, to be
reviewed under a burning fun, and was on foot until
noon before he returned to camp. When this duty
was not executed, exercife was purfued in the camp
ground, become equally dufty as the read, but nei¬
ther cough nor dyfpncea was excited. Dyfpnoea and
hypocondriacifm were equally overcome; liberties
were taken with every fpecies of diet ; no exertion
feemed too confiderable, and fatigue was never felt.
At the clofe of the campaign he flept conftantly in
camp, and torrents of rain, which filled the tents
with wet, and flowed through a Knightfbridge houfe,
which he was favoured with, produced no alteration
for the worfe.

1795.— The regiment was cantoned in the towns
of Cambridgeffiire during the winter, and he had no
return of afthma,

Bree on Difordertd Refpiration, 39

\ v*. - - \ ^ ■■■$— . '•3'^ ’J' • <.? • < iVi!

In March, he had orders to take three companies
under his command, and to follow other divifions of
the regiment to Hull. He was now fo confirmed in
health, as to determine upon flnilhing his military ex¬
periments when this duty was difcharged.

Yet at Huntingdon, having taken cold and drunk
bad wine, he had the terrentia of his difeafe, but .
the progrefs of the lymptoms was fufpended by opium,
and finally carried off in a bilious diarrhea.

At the end of the month, fully fatisfied with the
fuccefs of an uncommon experiment, he refumed his
regular profeffion, and to the prefent period, (July,
1797) has felt no fymptom of his former complaint.
A flight dyfpncea came on with unufual exercife and
heat laft September, and went off in a bilious diarrhoea,
without taking the form of afthma. But what are
the proofs of a perfect cure in this difeafe capable
offo long intermiffions?

He has refided in Birmingham fince A u guff, 1795,
a fituation of nearly equal altitude to that where he
always met with a paroxyfm fince he knew the dif¬
eafe, and only feven miles from it.

The air is much rarified by numerous fires, and a
population of 80,000 inhabitants, with particles of
duff perpetually boating from the manufactories. He
is, however, not fo imprudent as to abandon pre¬
ventive means.

In the fummer he ufes the cold bath frequently.
If flatulence difturbs his ftomach, he oppofes the firft
lymptoms of growing diforder by abforbents and
bitters, always concluding this occafional plan by
fteel, for feveral days, though the lymptoms foon
leave him. After a catarrh, he takes the fame care
to recover the tone of the pulmonary veffels and fto¬
mach: and with thefe attentions he has no apprehen-
fion of the difeafe returning, although the exciting
caufes are fo ready to aft.

' D 4

40 Cavaliers MedicinalBroperiies of Factitious Airs .

We have now gone: through the contents of this
interefting volume, not more valuable for the mode
of cure it inculcates, than for the information it con¬
veys of the inefficacy of many fafhionable remedies.
It exhibits a much defer connexion between the
practice recommended, and the theory on which it
is founded, than any of the other publications on the
fame fubjech We cannot, therefore, but recommend
it to the attentive notice of our readers,
ft ■ ' .

Art. IV. An Fffay on the Medicinal Properties of
lute titious Airs, with an Appendix on the Nature
of Blood. By Tiberitjs Cavallo, F. jR. S.
Octavo, 256 pages, price 4s. Di lly, London,
•..1798. . ;

I:T is not quite forty years fince the artificial aerial
fluids began to be adminiffered as remedies to the
human body. The uncertainty, and the errors of the
eany applications, rendered the progrefs of the prac~
tice how and doubtful ; nor ha> the experience or
the fuccefs of recent and more numerous praffitioners
been, fufficient to determine the precife power of the
aerial fluids,; or to diffipate the doubts which are fHh
entertained concerning their ufe. A defire of extri¬
cating the fubjeff from the conflux of contrary opi-
pions,:reftabliHied prejudices, and oppofite interefts,
induced the author to publifh the prefent work. To
exhibit, a concife. view of afeertained faffs, to fepa-
rete them from fuppofitions and hypothefes, and to
P uiit out the ways of inveftigating tne farther ufes of
iaefitious airs, has been his principal aim in the com¬
pilation of the prefent effay.

i he full chapter treats of the principal properties
of tlipfe airs, or permanently elaftic fluids, which have
been applied as remedies to the human body, and of
the beft; means of obtaining them for praffical ufe.

Cavallo’s Medicinal Properties of Factitious Ai rs. 4 1

In the fecond, the author relates "the generally-known
eircumftances refpe£ling the refpiration of co nmon,
and of oxygen air. The exhilarating effefts attri¬
buted to diluted oxygen air, or, as it has been termed,
improved atmofpherical air, which has been fa id to
produce a florid colour in the face, to conciliate
Jleep, to ftrengthen the organs of digeftion, to pro¬
mote circulation, to ftrengthen the pulfe, &c. are
fuppofed to admit of explanation, on a comparifoa
with the effects experienced by a fhort excurfion out
of a town, or of a houfe, after confinement: yet it
may be doubted whether there be any clofe analogy
in this cafe ; for the fuperior purity of the country
air, above that of the town, is fo fmali, as not to
equal that which is produced by mixing common air
with even- one-twentieth of its bulk of oxygen air;
whilffc it is manifeft that there are many other circum^
ifances to which the effe&s may be afcribed.

The third chapter treats of the phenomena arifing
from breathing other aerial fluids, befides the common
and the oxygen airs. The fubje&s of this and the
preceding chapters have already been amply difcuffed
in different parts of our Review.

Chap. 4. Phenomena arifing from the application
of the elaftic fluids to other parts of the animal body
beiides the lungs. It has been found that the pores
of the fkin imbibe and expel a fmali quantity of air,
and it is faid that in equal times they will abforb a
much greater quantity of oxygen, than of common,
or of any other, air. Different forts of elaftic fluid
were feparately injefted into the cellular membrane
of animals, through incifions made in the fkin, and
the apertures were clofed immediately after. The
appearances obferved were in general as follow :

Common air fwelled or puffed the animal, render¬
ed it uneafy for a day or two, after which the fwell-
ing began to decreafe, and vanilhed entirely at the
end of about three weeks.

tmi&tde Oxygen

42 Cavalkfts Medicinal P roper ties. of F petitions Airs.

Oxygen air fw.elled the animal, and rendered if
fornewhat uneafy for a ihort time ; the uneafmefs,
however, foon vaniflied, the animal became unufu-
ally lively, and the fwdling difappeared much fooner
than in the cafe where common air had been ufed.

Azotic gas fwelled the animal, and rendered it dull,
by fuperinducing a fort of ftupor, which in a few
days time degenerated into convulfions, and at laft
killed the animal.

Carbonic acid gas was rapidly abforbed, and fel-
dom produced any flight and temporary uneafmefs.

Hydrogen gas fwelled the animal, produced heavb
nets and fbiverings; but the fwelling difappeared
fooner than in the cafe of common air.

Mr. Girtanner is faid to have injected azotic gas
into the jugular vein of a dog, in confequence of
which the animal died at the end of twenty feconds.
On opening the thorax, the pericardium, and the
heart, the right auricle and right ventricle, were filled
with black blood ; the left ventricle was of its ordi¬
nary dark colour; the heart had loft its irritability
almoft entirely. A fimilar experiment being made
with carbonic acid gas, inftead of azotic gas, nearly
the fame phenomena took place.

In the fifth chapter, the author gives the modem
Theory of Refpiration, and the Nature of Aerial
Fluids. c It is entertaining to perufe the works of
authors previous to the late difeoveries, and to ob-
ferve how near the ideas of fome of them approached
the modern theory of refpiration. Hippocrates con-
ftdered air as one of the aliments of the body. Dr.
Mayow afferts, that fome nitre, or aerial fpkit of
nitre, enters the body through the lungs, and fur-
nifties the animal fpirits at the fame time that it conn
nmnicates heat to the blood.*

^ ‘ 'C'e.e his work, printed at Oxford in the year 1674, under the
title of 'Tract at us qumqu-e Medico-PhyJiclC

Cavallo’ s Medicinal Properties of Factitious Airs . 43

‘ Dr. White fuppofed that the Simulating quality
of the air is neceffary to keep the heart in motion.
Mr. Hewfon, obferving that the blood has a more
florid red appearance in the left, than in the right,
auricle of the heart, concludes with faying, that as
the change of colour in blood out of the body is oc-
cafioned by the contact of air, fo it may be prefumed
that the fame change within the body is occafioned
by air alio, and that the change takes place in the
lungs.’

Chap. 6. A general idea of the application of
aerial fluids in different diforders incident to the hu¬
man body.

Chap. 7. Of the particular adminiftration of aerial
fluids in different diforders. The difeafes in which the
aerial remedies have been ufefully applied are here
arranged in alphabetical order.

The next contains an account of Several cafes in
which thefe fluids were administered. Thefe cafes
have been either extracted from other publications,
or have been communicated by the author’s intel¬
ligent friends. Of moll of the former we have al¬
ready taken notice on different oecafions. This is a
part of his talk which we cannot deem the author by
any means competent to fulfil. To enable a perfon
to judge of the effects of applications to the living
body, with any degree of certainty or precifion, an
acquaintance with the fubjeCt in all its various rela¬
tions, is required. This can be expeCted from pro-
feffional men alone ; and experience thews us, that of
thefe even the number is few on which any great re¬
liance can be placed. The various nature of indivi¬
duals, the imperfeCt and contradictory accounts which
have, been given, and the frequent adminiflration of
other remedies, in conjunction with the aerial fluids,
render our knowledge of their powers in a high de¬
gree precarious and unfafisfaCtory. For thefe reafons
we decline following the author in the ftrifitly medical
parts of his work.

The

44 Cavalkfs Medicinal Properties of Factitious Airs*

The ninth and laft chapter contains practical re¬
marks concerning the production of factitious airs,
and the means of preferring them. c In particular
fituations,’ the author obferves, 4 the difficulty of pro¬
curing proper materials and proper tools may prevent
the poffibility of adopting the molt expeditious, or,
upon the whole, the molt advantageous, methods of
procuring the aerial fluids ; and when that is the cafe,
the praCtitioner mult confult the firlt chapter of this
effay, for the method which may be more fuitable to
the circumiiances of his fituation. But when there
is the opportunity of procuring both materials and
inltruments, it is then proper to follow7 the plan which
may appear lefs exceptionable.

4 The cheapcft article for the production of oxygen
air is the mineral called manganefe , which is found
plentifully in many parts of this ifland, and elfewhere.
A very good fort of it is found near Exeter. It ought
to be free from extraneous, and particularly noxious,
minerals; but it frequently contains a confiderable
proportion of calcareous matter, which may be de¬
tected by powdering a little of the mineral, and pour¬
ing fome nitrous acid upon the powder ; for this will
produce an effervefcence proportionate to the quan¬
tity of calcareous matter. It muft not, however, be
expeCted to find manganefe perfectly free from it ;
for though this may be the cafe with filial! pieces of
that mineral, yet in confiderably large quantities of it,
fuch as are required for the production of oxygen air,
fome calcareous earth is almoft alw7ays contained ; but
the only ejteCt which arifes from it, is the production
of carbonic acid gas, together with the oxygen air,
the former of wffiich is eafily feparated from the latter
by the wTell-knowm method of wTaffiing in lime-water.

< The greateft quantity of oxygen air is extricated
from manganefe merely by the aCtion of a full red
heat ; it is, therefore, neceffiary to put that mineral
in a veffel ca pable of refitting the aCtion of fuch a de¬
gree of heat. Earthen-ware, and certain metals, are

the

Cavallo’s Medicinal Properties of Factitious Ain . 45

the materials fit for the conftruftion of fuch veffels.
The former is certainly unexceptionable in point of
purity ; but it is not managed very eafily for this pur-
pofe, and befides, the ufe of it is attended with com
liderable expence, for a velfel of that fort will hardly
ever ferve more than once, as on cooling after the firft
experiment it generally breaks; and indeed it fre¬
quently breaks in the courfe of the experiment. ^ Of
the metals, gold or platina vefiels would be the fitted:
for the purpofe, did not their value offer a material
objection. Thofe metals excepted, iron is the bell ;
for though the ufe of a velfel of this metal he attend-
ed with evident objedtions, yet, when managed with
care and attention, the oxygen air may be produced
of fuch a degree of purity, as to be more than jfuffici-
ently ufeful for medicinal purpofes.

‘ It is neceffary to remark, that in all cafes, but
efpecially wThen an iron velfel is ufed, the manganefe,
as well as the velfel in which it is contained, and the
pipe or tube which conveys the air from it to the re¬
ceiver, mull be quite free from animal or vegetable
matter, and perfectly dry, otherwife the el. attic fluid,
which is produced, may be injured in point of purity,
and it may even degenerate into a noxious fluid.

6 When thofe particulars are attended to, the oxy¬
gen air will principally contain a certain proportion
of carbolic acid gas, and fome light powder of man¬
ganefe, the former of which is to be feparated by
means of lime, and the latter will be depofited by
Handing, in about ten or fourteen hours time.

6 The fpecies of inflammable gas moldy in ufe are
extrafted by means of diluted vitriolic acid from zinc
or iron, and by palling the fleam of water over the
furface of red hot zinc, or iron, or charcoal,

c The gas, extracted by means of diluted acid,
holds in fufpenfion fmall particles of the metals con¬
cerned, viz. of the zinc or irhn, the latter of which in
particular may be rendered marufeft by burning the
gas in a bottle full of it, in which yafe fome fmall par¬
ticles

46 Cavallo’s Medicinal Properties of Factitious Airs*

tides of a dark red light will be difcerned within the
pale flame of the gas, which are the ferrugineous par¬
ticles ; for thofe minute red fparks are not to be feen
in the inflammable gas which is obtained from pond
water, or putrid matter, or, in fhort, from fuch fub-
ftances as do not contain any metallic fubftance.

c The gas obtained by pafling the fleam of water
over red hot zinc, holds in fufpenflon a confiderable
quantity of the flowers of zinc, which it depofits in
about a day’s time.

£ The gas obtained in a fmiilar manner from iron
is the rnoft abundant, and of courfe the cheapeft.

s For the produflion of the heavy inflammable
gas, or hydrocarbonate, Mr. Watt recommends to ufe
“ charcoal made of the twigs of fofter woods, fuch as
willow, poplar, hazle, birch, or fycamore, avoiding
fuch as have reflnous or aftringent juices. Prepare
£C the charcoal by heating it to full ignition in an open
“ fire, arid quenching it in clean water, or by filling a
“ crucible with it, covering it with clean fand, and
expofing it to a ftrong heat in an air furnace, and
“ then buffering it to cool. In either of thefe cafes it
will be found free from any bituminous matter,
“ which might contaminate the air, as generally
tc happens with common charcoal.”

* Mr. Watt likewife mentions, amongft other forts
of inflammable gas, that which is extracted from a.
mixture of charcoal powder and flaked lime, which,
on account of its peculiar properties feems likely to
prove very ufeful : cc In refpetl,” fays he, to the
<c medicinal properties, all I know is, that the in-
cc flammable air from charcoal and lime contained no
fixed air feparable by waffling with quick lime and
water,, and that it did hot caufe the vertigo when
u inhaled pure.”

‘ One or other of thofe fpecies of inflammable gas
may be preferred in particular cafes, and it is not only
likely, but in great meafure proved by a final expe¬
riment, that the particles of iron, or other matter,
4 which

Cavallo’s Medicinal 'Properties of Facti tious Ai r’s: 47

which are fufpended in a particular fort of gas, may
be peculiarly ufeful in certain difeafes.

c In the production of inflammable gas. the intro¬
duction ot any extraneous matter, and efpecially of
vegetable or animal fubftances, and of minerals that
contain acids, fhould be carefully guarded again!!.—
It is like wife advifabie, for a very obvious reafon, not
to conduCt this procefs by candle light.

‘ The carbonic acid gas may be extracted from
chalk in Mr. Watt’s apparatus, according to the di¬
rections given with the laid apparatus ; but when no
extraordinary large quantity of it is required, it is far
more commodious to extraCt it from chalk or marble
powder, and diluted vitriolic acid, in a gl-afs veflel.
The difference between chalk and marble in this
refpeCt is, that the former gives out the gas quicker,
but is foon exhaufted ; whereas the latter gives it out
more gradually, and for a greater length of time ;
hence, in fome cafes, the former, and in others, the
latter, may be preferred.

4 Concerning the Preferyalim of Aerial Fluids.
Oxygen air is not contaminated by keeping in glafs
receivers, or in fuch veffels as do not communicate

any thing to it, nor does the contaCt of pure water
injure it ; but in wooden veffels, or veffels painted
with oil paint; and when a confiderable quantity of
common river water is in contaCl with it, the oxygen
air will be contaminated more or lefs.

4 The various ipeeies of inflammable gas are apt to
degenerate in procefs of time, efpecially if they be
kept mixed with common or with oxygen air. The
hydrocarbonate, in particular, is vaftly more powerful
when frefli made, than two or three days after. Due
allowance, therefore, mu ft be made for the lofs of
power in the adminiftration of thofe airs.

W hen- oxygen air, or inflammable gas, is to be
taken out of an air-holder or bottle, &c. by putting
water in the veflel after the ufua] manner, it is ad-
vifable -to ufe lime-water .5 for the’ Jirtje will not only

abforb

48 Cavallo’s Medicinal Properties ofF actitiousAirs <

abforb any carbonic acid gas that may be mixed with
thofe airs, but will alfo prevent the putrefaction of
the water.

* For this purpofe there is no occafion to filtrate
the lime-water, as is practifed in the ufual manner of
preparing it ; but it will be fufficient to mix the quick
lime with the water, and after leaving it at reft for an
hour or two, to feparate the fluid and ufeful part from
the fediment, by decanting it gently.

‘ The carbonic acid gas is not contaminated by
keeping ; but as it is abforbed by moft fluids, it
fhould not be kept in contaft with much water. In
moft cafes it will be better to produce it afrefh every
time it is wanted.’

An Appendix is fubjoined to the volume on the
Nature of Blood. The intimate connection between
refpiration, and the ftate of the blood, the neceftary
dependence of animal life on the oxygen part of the
atmofphere, through the intermediation of that fluid,
undoubtedly render an account of its nature highly
neceftary, in a general inveftigation of the adtion of
aerial fluids on the human body. The account of
the chemical properties of the blood here given, is
chiefly extracted from Fourcroy’s late chemical works,
and contains nothing that is not known to the genera*
lily of our readers.

The configuration of the red particles of the blood,
as determinable by the microfcope, has given rife to
much controverfy. ‘ Luenhoeck thought that each
red particle confifted of, and was refolvible into, fix
fmaller globules, and that every one of thefe fecon-
dary globules confifted of other fmaller particles. —
Hewfon took them for bladders which contained a
nucleus or central body that feemed to roll from one
fide of the bag to the other. Torre faw them like
rings 5 viz. confifting of an internal and an external
circle, and this ring appeared to be divided, or to
confift of parts joined together like the rim of a com¬
mon coach wheel. Falconer confidered them as flat

- V'T V

- -

<Lgt "

Cavallo’s Medicinal Properties of Factitious Air s . 49

> 1 P ® ^ > > :'V s

•5 ry y- p> r o c*

i JE* ,

V- "

or fphcroidicai bodies; for he thought he tome times
faw them Tideways. “ The red globules^’ fays the
late Mr. J. Hunter, “ are always nearly of the fame
tf fize in the fame animal, and when in the ferum do
<c not run into one another as oil does when divided
“ into fmall globules in water. This form, therefore,
“ does not arife limply from their not uniting with the
4C ferum, but they have really a determined lhape
£c and fize. This is fimilar to what is obferved of

“ the globules in milk ; for milk being oily, its glp-
cc bules are not foluble in water ; neither do they cqn-
¥ fill of fuch pure oil as to run into each other ; nor

wrill they diffolve in oil. I lufpeft, therefore, that
£‘ they are regular bodies, fo that two of them could
££ not unite and form one Dr. Wells is of opi¬
nion, that the red globules confift of two parts, one
within the other, and that the outer, being in foluble
in ferum or dilute folutions of neutral falts, defends
the inner from the aft ion of thofe fluids fd

By employing the minute glafs globules invented
by the Abbe Torre, the author thinks he has in many
points confirmed the Abbe's obfervations. £ I have
repeatedly meafured,’ fays he, £ the diameters of the
red particles, both by means of my mother-of-pearl *
micrometer in a compound microfcope, and likewife
by looking at them with one eye through a Angle
lens, and referring their image to a fcale properly
divided, and viewed with the other eye out of the
microfcope.

£ In perfons of nearly the fame age the mean fize of
the particles differs very little indeed. In the fame
perfon they differ a little, and their figure is not very
circular. This deviation from the circle is not fuch
as a fiat circular furface would affume in its different
inclinations to the axis of vifion ; for, according to
the rules of orthographic projeftion, the flat circular
furface muft appear either circular, or elliptical, or as

_ ■ < ■: ... v. ... .

* Treatife on the Blood, p. 41. f Phil. Tranf. P. II. for 1797.
vol. v . E a ilraight

50 Cavallo’s Medicinal Properties of Factitious Airs,

a ftraight line ; whereas I never faw the particles
of blood as ftraight lines, viz. edge wife, and the
elliptical figure, which they fometimes affume, is
by no means regular.

c In an adult of the human fpecies, the diameters
of the red particles run from about 0,0003 to about
0,0004 parts of an inch, and I very feldom faw one
fmaller or larger than thofe limits. If, therefore, we
take the fmalleft particles and fet them in a row, we
fhall find that about 3334 of them will equal one inch,
and if we take the largeft, about 2500 of them will
meafure one inch.

c When the particles are magnified more than 40
or 50 times, and lefs than 80 (meaning always in
diameter), they appear like colourlefs transparent fpots
inclofed within dark circles.

4 When magnified more than 80 times, and lefs
than about 160, a dark fpot, like a dot made with
ink on paper, appears in the middle of each particle.

c If the reflector which illumines the particles, in-
ftead of being fituated ftraight before the objeft, be
fet on one fide of the axis of vifion, fo as to throw the
light obliquely on the objedt, then the half of the dark
circle of each particle difappears, viz. that half which
is on the fide oppofite to the refleftor. The central
fpot does at the fame time appear to change its place.

£ When the particles are magnified above 200
times, the central fpot appears converted into a cir¬
cle inclofing a tranfparent fpace. The diameter of
this inner circle is about the half of that of the ex¬
ternal one ; but the proportion of thefe diameters, or
the fize of the internal circle, may be caufed to in-
creafe or decreafe by the leaft alteration of the dis¬
tance between the objeft and the microfcopical lens ,
and by the fame, means the fpace within the inner cir¬
cle may be rendered clearer or darker than that be¬
tween the two circles. The pofition of the inner
circle is changed by the direftion of the light ; for if
the particle of blood be viewed through a microfco-
4 pical

Oavallo’s Medicinal Properties ofF actitiousAirs . 5 1

pical globule, directly facing the flame of a candle,
without the intermediation of any lens or reflector,
the inner circle will appear concentric with the outer
one ; but if the candle be moved a little to one fide,
fo that the light may fall obliquely on the particle of
blood, then the inner circle will be obferved to move
towards the oppofite fide, and to acquire an elliptical
fhape.

c When the particles of blood are magnified above
400 times, an imperfect image of the candle, which is
placed before the microfcope, may be feen within the
inner circle of each particle.

‘ Through a glafs globule of 0,018 of an inch in
diameter, I have feen the red particles of blood mag¬
nified about 900 limes* in which cafe the image of
the flame of the candle could be feen within the
inner circle of each particle very clearly, at leaf! fo as
to fhew to which fide the motion of the air in the *
room inclined it.

f Notwithftanding this great magnifying power,
the annulus or fpace between the two circles did
not appear to be divided, excepting fome accidental
fraftures, which now and then could be feen in a few
of the particles.

‘ Thefe obfervations feem to prove, that the red
particles of blood are not perforated, but that they
are globular, and of fome uniform fubftance much
lefs tranfparent than glafs. They likewife fhew that
Mr. Hewfon’s idea of their containing a central body
or nucleus, moveable within the external fliell, arofe
from the apparent change of place which the various
direction of the light produces on the central fpot or
inner circle of each particle.’ — — -

Where fuch contradictory ftatements appear, and
where the difficulty of making microfcopical obferva¬
tions is confefledly fo great, and the refult liable to
iuch uncertainty, it is impoffible to have any reliance
on the accounts which have been given refpecling the
ultimate ftrufture of the red globules of the blood :

52 Duncans'' Annals of Medicine for 1797.

and we lliall probably remain in our prefent date of
ignorance, on this fubjeft at lead, till we have better
means of increafing our power of vifion than we are
yet acquainted with.

Art. V. Annals of Medicine for the Year 1191 ;
exhibiting a concife View of the lateft and moji
important Difcoveries in Medicine and Medical
Philofopny . 1 By Andrew Duncan, Sen. and

Andrew Duncan, Jun. M. D. D . &c. Vol. 2,

Oftavo, 470 pages, price 7s. Edinburgh, Mudie!
1798. b

^T^HE prefent volume is not lefs interefting, either
in reipefct to the fele£lions, or to the original
matter which it contains, than any of the preceding
ones from the pen of Dr. Duncan. It commences,
as ufual, with an analyfis of books. The firft re¬
view is of Dr. Ruffel’s valuable and fplendid treatife
on the ferpents of India, with experiments and re¬
marks on their feveral poifons. We fhall pafs this
over for the prefent, in the hope of thortly gratifying

our readers with a full and particular account from
the original work.

The fecond article contains an account of fome
newly-difcovered fads in the ltrufture of the retina of
the eye, by Profeffor Reil, of Halle, in Germany. *
lhe firft difeovery is attributable to Dr. Soemmering,
In the bottom of the eye, clofe by the entrance of
tne optic nerve, towards the outfide, and exaHly in
the axis of the eye, there is a yellow fpot in the re-
tma, of an oval flrape, about one line and a half, or
two lines in horizontal diameter, and one perpendi¬
cular. Fhe colour is molt faturated in the center.
I owards the edges it is paler and unequal. A plait,

Arcbiv fur die Phyfidogie. II Band. 1797.

which

Duncans’ Annals of Medicine for 1797. 53

\ *

which is in the middle, gives it there a cloudy ap¬
pearance. This yellow fpot may be obferved in the
eye of every healthy perfon after birth. It has many
varieties with refpebt to fize and depth of colour, but
its fituation is always the fame.

f At this place there is alfo a plait of the retina,
which is folded in towards the cavity of the eye. It
lies horizontally between the optic nerve and the ex¬
ternal angle. It commences at the nerve with a fine
point, becomes gradually broader, extends in length
about a line and a halt, and terminates abruptly. It
is fubjedt, however, to many varieties. Sometimes it
is a fingle fimple plait, which entirely conceals the
tranfparent portion of the retina ; fome'times it is di¬
vided, and at other times entirely wanting.

‘ There is, befides, exactly in the axis of the eye,
about two lines on the outficle of the optic nerve, a
thin, tranfparent, oval portion of the retina, whofe
diameter is nearly one fourth of a line, and greatefl
horizontally. Its edges are not ragged, but it ap¬
pears as if cut wdth a lharp inftrument. It lies in the
plait, which conceals it more or lefs, and is furround-
ed wdth the above-mentioned yellow fpot. Soem¬
mering takes it to be a real hole; Buzzi, on the
contrary, thinks that it is merely a tranfparent and
thin portion of the retina.' Michaelis feems to agree
with him ; and our author admits that they may
be right, although his own obfervations, as wTell as
MeckeTs, are rather in favour of the exigence of an
adfual hole.

c Michaelis faw the plait more diflincfly in foetufes
of feven or eight months than in adults, and the tranf-
parent portion lay concealed within it ; but the yel¬
low fpot wras wanting. Nor is it to be obferved in the
eyes of newdy-born children. After the firft year, it
becomes fomewhat yellow, and the depth of the co¬
lour increafes with the age of the fubjeft. Soem¬
mering fays, that this fpot is pale in children, bright
yellow in young people, and becomes again pale in

E % " old

54 Duncan's Annals of Medicine for 1797.

old age. Its degree of faturation feems to be inti¬
mately connected with the hate of vifion. It con-
ftantly diminifhes in proportion as vifion is obftrudted.
Where one eye only is difeafed, in it the yellow fpot
is wanting, and the plait is frnall and wrinkled; while
in the found one they are rather more diftindt than
ufualf— -Thefe are the appearances ; but they have
not as yet led to any improvement in phyfiological
fcience.

Art. 3* Allgemeine Gefchichte der Natnr und Artz
Artzneikunde Erzaehlt. i. e. IJniverfal Hiflory of Me¬
dicine and Phyfics. By An gull us Frederick Hecker,
Vol. 1, Odfavo. Leipfic. I his is too copious a fub~
jedl to be brought within the limits of analyfis.

Art . 4. Ideen fur Diagnoftick , &c. i. e. Hints
for a Syftem of Diagnoftics , communicated to reflect¬
ing Phyjicians. By J. E. Wichmann, Phyfician in
Ordinary to the King of Great Britain , and F. JR. A

• Gottingen , & c. Vol. 1, Odtavo. Hanover, 1794ft _

The importance of a juft and accurate diagnofis in
the practice of medicine can hardly be rated too high :
yet it is perhaps the moil difficult part of the art, and
the one therefore that is the moil imperfedt. Defini¬
tions in medicine are of little ufe : the charadter of
difeafes can only be underftood by a thorough invef-
tigation of all the phenomena. It is the intention of
the learned author of the prefent effay, to enable us to
become acquainted with the marks which conftitute
the diftinguifhing charadter of difeafes, by comparing
and examining thofe which are fimilar in many of their
appearances. The difeafes which are thus brought
together and compared with each other, in the pre¬
fent volume, are ; the crufla lacfea , and another erup¬
tion, fomewhat fimilar, which the author terms crnfla
ferpiginofa . Zona , eryflpelas veficulofum, eryfipelas a
veneno , pemphigus , and fehris bullojd , are next com¬
pared and diftinguifhed from each other. In the next
effay, Dr. Wichmann endeavours to eftablifh a juft
diagnofis between the different dwellings off the neck,

Duncan's Annals of Medicine for 1797. 55

as frunuiy fcrofula, bronchocele , and mumps: chorea ,
and raphania , are then compared ; and, laftly, the
author concludes this firft volume with remarks on
fome caufes of chronic vomiting, and the means of

diftinguifhing them.

• • • ; ✓ - - ' <

The three next articles give an account of Dr.
Monro’s Treatife on the Brain, Eye, and Ear j Dr.
Rollo’s on Diabetes ; and Mr. Cruickfhank’s on the
Ufe of Acids and other Subftances in Lues Venerea.
For a full account of each of thefe, we refer to the laft
volume of our review.

Art . 8. Obfervations on the Medical Effects of Com-
prejjion by the Tourniquet. By George Kellie, Sur¬
geon in the Navy. 061avo. Edinburgh, 1797. The
obfervations of the author on the fubje6t of compref-
fion by the Tourniquet, were firft prefented to the
public in the year 1794, and appeared in the Medical
Commentaries for that year. * The prefent volume
contains thefe, and likewife many new obfervations,
the refult of fubfequent experience. Mr. Kellie firft:
relates fome experiments tending more exactly (:o
afcertain the influence of compreffion on the human
body in a healthful ftate. ‘ If,’ he obfervesc 6 we ob»

Aru 61 the circulation in two or more extremities, by

*•

the tourniquet, the pulfe at firft increafes in frequency,
and becomes at the fame time fuller and ftronger ; but
foon after, the frequency diminifhes, fo as even to be
lefs than before the comprefiion was made. Some
increafe of heat is foon difcovered, efpecially in the
face and bread. Anxiety, and a fenfe of fullnefs
about the prascordia, are perceived, which gradually
increafe till the perfon becomes faint and vertiginous.
The countenance appears tuigid, and, in fome expe¬
riments, the temporal and jugular veins were obferv-
ed fuller, and more diftended, than they were before
the compreffion was made.

* See alfo an account of other experiments on the fame fubjeft. — •

ivied. Rev. Vol. p« 12.

56 Duncan’s Annals of Medicine for 1767.

c If the compreffion he continued for twenty
minutes, or half an hour, the viiion becomes fome-
what confufed, objects appear double or clouded, and
imall black fpedtra are feen floating paft the eyes.
Drops of fweat now Hand on the face, neck, and
break, and the increaflng vertigo, fleknefs, and ten¬
dency to deliquium, demand the removal of the tour¬
niquets.

f On reftoring the circulation, thefe fymptoms al-
moft immediately vanilh, a coldnefs about the prae-
cordia, and chilnefs of the whole body, is then per¬
ceived, attended fometimes with lhudderings and
yawnings ; the blood flows with a painful heat
through the veffels which had been comprefled ; the
whole limb is fuftufed with a glow ; and this is fucceed-
ed by a fenfation of prickling. The pulfe continues
flow, and generally becomes flower than it was before
the compreflions were removed, beating, at the fame
time, full and foft.

c If the circulation be obftrudted in one arm for
fifteen minutes, or half an hour, the pulfe, after the
removal of the corn predion, will, Mr. K ellie obferves,
be found fuller and ftronger in this than in the other

arm.

s If the tourniquets be properly applied, fo as in-
ftantly and completely to comprefs the artery, the veins
of the comprefled limb do not fwell, and the limb itfelf
feels foft and flaccid, rather than hard. But if the
artery be not completely comprefled, or if any time
be loft in ferewing the tourniquet, the veins are firft
comprefled, and allowed to fill, before the communi¬
cation between the heart and arties is deftroyed.- —
Hence they appear turgid, and thfe limb feels hard
and painful from diftenfion.

* When the circulation is completely obftru&ed in
an extremity, if a vein be opened below the tourni¬
quet, the blood will flow, and the comprefled veffels
may be thus entirely drained of their contents.

Duncans’ Annals of Medicine for 1797* 57

* If, after compreffion has been continued for fome
time, a vein be opened below the tourniquet, by
gently preffing the arm, it will discharge to the ex¬
tent of two or three ounces of blood, of an uncom¬
monly dark colour. When the blood-veffels have
thus been emptied, if the compreffion be removed
from the artery, and continued on the vein, blood will
again flow from the orifice, but very different in ap¬
pearance, being now thinner and more florid. With
refpeCt: to coagulation, that which was drawn from
the vein while the arteries were compreffed, coagu¬
lates fooner than the other, and never fliews any
buffy coat ; although in that which was drawn from
the fame orifice, after the reftoration of the circula¬
tion, it may be very confpicuous.

‘ After thefe general obfervations on the effefts of
compreffion, confirmed by different experiments, of
which Mr. Kellie has here given a diftmCt relation,
he next proceeds to give an account of the effects of
compreffion in fome difeafes.

‘ In intermittents, to which Mr. Kellie’s obferva¬
tions in his former letters principally referred, he has
found, that if the two iliacs, or one iliac, and one
fubclavian, be compreffed, about the time of an ex¬
pected paroxyfm, and the compreffion continued till
the ufual period of attack be fully elapfed, the fit will
be prevented or poftponed. If the cold ftage have
taken place before the compreffion be made, in three
or four minutes the fenfations of cold and the rigors
will ceafe ; the pulfe from being frequent, fmall, and
weak, will become fuller and ftronger, and, after
fome time, lefs frequent. The pain of the loins, and
afterwards the head-ach, will go off ; the naufea,
anxiety, and third, will be relieved, and the hot fit
will thus be induced, with milder fymptoms than
before.

c The compreffion, Mr. Kellie tells us, ought ge¬
nerally to be continued ten or fifteen minutes, for the
fymptoms of the hot ftage will thus be moderated ;

but

58 Duncans" Annals of Medicine for 1797.

but ought feldom, he thinks, to be continued much
longer ; for he has obferved, that when this has been
done, the pulfe, which had become fuller, ftronger,
and flower, has again been rendered fmaller and more
frequent, and when the tourniquets were removed,
the rigors and fuccuffions returned.

c In confirmation of thefe affertions, we are here
prefented with a particular detail of three cafes of in-
termittents, which have occurred to Mr. Kellie fince
his former letter.

c From obferving the effects of compreflion in inter-
mittents, Mr. Kellie wras induced to make trial of it
in other febrile difeafes. In the incipient ffages of
thefe, he has found compreflion by the tourniquet
very ferviceable. The pulfe has become fuller, ftrong¬
er, and flower ; and if the patient was affedfed with
coldnefs and rigor, he became warmer, the pain of
the loins and head-ach vanifhed, anxiety, naufea, and
third, were relieved, and, in fome cafes, the fymp-
toms thus carried off never returned. And from thir¬
teen different cafes, which are here particularly relat¬
ed, he concludes, 1//, That compreflion by the tour¬
niquet, in the incipient ftages of pyrexia, will forne-
times, like emetics, prevent the farther prbgrefs of the
difeafe, 2 dly, That in other and more advanced
ffages of pyrexia, compreflion may be employed to
moderate the fymptoms, and reduce the frequency of
of the pulfe. 3 dly, That when employed in acute
rheumatifins, the vigour of the circulation, heat and
pains, are for a few minutes increafed. 4 thly> That
in from five to fifteeti minutes, the pains are totally
removed 5 in fifteen or twenty minutes, the heat di-
mini flies, and the pulfe decreafes in velocity. 5 thly>
That, on reftoring the circulation, the pulfe becomes
flower, and the temperature lefs. 6 th ty, That thefe
fymptoms, thus relieved or removed, feldom return
for fever at hours after, fometimes not for a whole
day, and that the following attacks are lefs fevere
than the preceding ones. 7 lhty9 That if the compref-

fion

Duncans' Annals of Medicine for 1797.

fion be continued for half an hour, or longer, drew-
fmefs, vertigo, anxiety, and tendency to deliquium,
are induced ; but that, though thefe effefts are to
be avoided in the cold ftage of intermittents, in the
incipient ftage of pyrexia, and in all cafes of arterial
debility, they yet appear ferviceabie in acute rheuma-
tifms, and in all cafes where inflammatory diathefts
exifts. §thly , That in acute rheumatifms, the tour¬
niquets fliould be applied on the affedted extremities.
And, lafhjy That rheumatic pains, without fever,
may be thus certainly removed or relieved.

c To thefe obfervations, deduced from aflual prac¬
tice, and careful experiment, Mr. Kellie has fubjoin-
ed, in the third fedtion, home conjectures refpeCting
the manner in which compreftion may be fuppofed to
operate. It is, he obferves, well known to phyfto-
logifts, that the proportions of circulating fluids differ
very conftderably in the fame veffels at different times,
and that fuch changes in the diftribution of the blood
are often occafioned by flight caufes, while at the
fame time they produce very conftderable effects*
It is however certain, that the compreffton of one or
more large arterial trunks, muft occaiion, in every
other part of the fyftem, what has been termed by
phyftologifts Plethora ad fpatium. This plethora will
take place in a greater degree in fome parts of the
fyftem than others, according to the parts which are
comprefled. Thus, by compreftion of the fubclavian,
a greater quantity of blood will be circulated through
the head. Hence the patient then fooner complains
of drowfinefs and vertigo ; and hence different fpecies
of head-achs are foon removed by this compreftion,
thofe efpecially which depend on defeft of ftimula-
tion. On the contrary, when the compreftion is made
on the external iliacs, the plethora will exift chiefly
in the branches of the internal iliacs, the cceliac, me*
lenteric, and emulgent arteries ; and hence lumbago
and pain of the loins, in the cold ftage of fever, are

60 Duncans’ Annals- of Medicine for 1797.

moft eflfedtually and fpeedily removed when tourni¬
quets are applied to the lower extremities.

4 As by compreffion plethora is induced, Mr. Kel¬
lie infers, that a greater quantity of blood muft pafs
through the heart and lungs in a given time, and a
larger fupply muft be lent to the brain and other vif-
cera. Thefe organs, therefore, muft, he thinks, be
ftimulated into greater exertions ; and hence the ef¬
fects of compreflion are, increafed vigour of circula¬
tion, and th,e removal of atony.

c But as the long- continued operation of any fti-
mulus, at length produces an inert or quiefcent ftate
of the fyftem ; fo, if compreflion be too long conti¬
nued, the pulfe, which was at ftrft excited into more
energetic adiion, becomes again flower. and fofter. — -
And on this principle Mr. Kellie thinks we are able
to explain the feemingly oppofite eftedts of compref¬
fion, in intermittents and acute rhenmaiifm. In the
cold ftage of intermittents, the compreflion fliould not
be continued any longer than is fufficient to cftablifh
an increafed excitement, and ten or fifteen minutes
will commonly be found long enough. But where
the phlogiftic diathefis exifts, the compreflion, Mi.
Kellie thinks, fliould be continued till vertigo and
tendency to deliquium be induced, and the violence
of the adiion of the heart and arteries will then be
found much dimmiftied. For ail ftimulants, by their
violent and continued operation, produce firft increaf¬
ed, then decreafed exertion, and, finally, quiefcence
of the moving fibre. And fuch appear to be the ef~
fedls of compreflion.

4 There is, Mr. Kellie thinks, ftill another way in
which the fyftem may be a tie died by compreflion. — -
Though the energy of the brain would feem to de¬
pend much on a certain fullnefs of its blood-veflels,
yet, where the fulnefs is increafed beyond this, inftead
of an increafe of excitement, that vifcus will in fome
degree be itfelf compreffed, and a kind of apopledlic
ftate induced. Dr. Darwin, in his Zoonomia, has

propofed

I-

Duncans5 Annals of Medicine for 1797. 61

propofed to ftill the violent aftion of the heart and
arteries in inflammatory fever, by gently compreffing
the brain ; and this he thinks might ealily be done,
by fufpending a bed, fo as to whirl the patient round,
with his head mod diflant from the centre of motion,
as if he lay acrofs a millftone. But in all cafes where
compreffion of the brain may feem to be indicated,
Mr. Kellie propofes, that the two fubclavian arteries
ihould be comprefled, as they pafs over the firft rib.
While fuch compreflion is without danger, of eafy
execution, and can at all times be effected without
the removal or difturbance of the patient, it will, Mr.
Kellie affiires us, if continued from fifteen minutes to
half an hour, have the defired effects.

‘ In the laft place, Mr. Kellie obferves, that when
the circulation is obftruffed in any extremity, the
parts below the tourniquet become quiefeent, the
arteries ceafe to a£t, and the blood accumulates in
the veins. The blood, thus detained in the compreff-
ed extremity, would feem, by its differing farther dif-
oxygenation, to become lefs ftimulating. And if,
while the arteries are comprefled, a vein be opened
below the ligature, and the blood be drawn off,
the vafcular fyflem of the limb will be lefs ftimulated.
On this principle he explains the effects of compref¬
fion, in thofe pains of the joints and limbs which are
caufed by the increafed exertion or activity of the
veffels of the inflamed ligament. Thefe pains ceafe,
when, by compreflion, the inflamed veffels are render¬
ed quiefeent ; and the tumefaction of an inflamed part
is reduced, when the comprefled veffels are drained of
their contents, by opening a vein below the tourni¬
quet. And Mr. Kellie is difpofed to think, that
inflammations of the extremities might be fpeedily
cured, by compreffing the arteries, fupplying the af-
fefted parts, and then emptying the inflamed veffels,
by opening a correfpondent vein, or by fcarifying the
inflamed furface. Such a practice might,, he imagines,

62 Duncans" Annals of Medicine for 1797.

be very ufeful in the incipient flate of white fwellings,
and in acute inflammations of the joints.

c After giving a diftinct account of the fuccefsful
effefts of compreffion, Mr. Keflie concludes the pre-
fent treat ife by candidly acknowledging, that he has
fometimes been difappointed, and that compreffion,
as a remedy, is, like all others, precarious and va¬
riable in its effects. Thus, in a cafe of intermittent,
though the rigors were fufpended, they returned, after
feveral trials, on removing the compreffion ; nor was
the pulfe ever altered. In a cafe of incipient py¬
rexia, on the application of a tourniquet to an arm
and thigh, the patient alnioft immediately became
vertiginous, and vomited ; and in a cafe of pain of
the loins, he found the affection much aggravated by
compreffion of the iliacs. Such variety of effefts,
however, will, he thinks, rather be expe£ted by
every one acquainted with the animal economy, than
be matter of furprife to him. And we cannot help
thinking, that from Mr. Kellie’s experiments and ob-
fervations, unqueftionable evidence is afforded, that
compreffion by the tourniquet affords us a very pow¬
erful agent in the practice of medicine.’

The other publications reviewed in this part of the
Annals are, Dr. J. Hamilton’s on the Seats arid
Caufes of Difeafes ; Drs. Clark and M’Lean’s on
the Yellow Fever; and Dr. Beddoes’s Reports on the
Nitrous Acid ; all of which have been fully noticed
by us.

This brings; .us to the fecond part of the work, or
that containing Medical Obfervations. The firfl: of
thefe is a hiftory of a lingular cafe of petechiae line
febre, accompanied with exceffive haemorrhages, ter¬
minating favourably under the ufe of the vitriolic
acid : related by Mr. John Walker, Surgeon, in
Edinburgh. The fubject of this cafe was a boy five
years of age. The complaint came on during the

hooping

Duncans’ Annals of Medicine for 179’

hooping cough, and fee. ms to us to have been a very
aggravated cafe of fcurvy ; produced very probably
by a free indulgence in the ufe of fugar. We ob-
ferve, like wife, that the author exhibited within the
lpace of a very few days, about three bottles of Port
wine , and many pounds of fugar, probably as antifep-
tics. Under this treatment it does not feem very
furprifing that the difeafe fhould gain ground ; that
the whole infide of the lips and fauces fhould be co-
covered with petechias, with a profufe difcharge of
blood from the centre of the larged: ones : and that
there fhould be a fucceffion of livid blotches and
petechias on the fkin. The cure was fpeedily effeCt-
ed by five drops of the diluted vitriolic acid given
every hour or two,

2. The Iliftory of a Cafe of Venereal Ulcer , effec¬
tually cure a l by the topical Ufe of an Arfenical Cor -
rofive Application : by Mr. Thomas Morifon, Surgeon,
Dublin. The cafe was a recent chancre, and the ap¬
plication confided of equal parts of arfenic and red
precipitate, continued till a hough took place, fol¬
lowed by a healthy ulcer. We obferve nothing very
Uncommon in this practice.

3. Hijtory of an inveterate Cafe of Tinea Capitis ,
fiiccefsfully treated by the Application of an adheftve
Pafte : by the fame. In this cafe, which had re¬
filled various attempts to relieve it, 6 the whole fcalp
was entirely covered with that honey-comb appear-'
ance, not unfrequently met with by practitioners*
and it emitted, at the fame time, a very offenfivc
fetor. His habit of body was evidently difpofed to
fcrophula ; and there were certain marks of approach¬
ing debility, attended with a fufpenfion of the ufual
aCtions of the ftomach and inteftinal canal. I ordered
his head to be carefully fhaved, and an emollient
poultice to be applied over the whole affeCted parts,
with directions that he fhould call upon me. the fol¬
lowing morning..

c He

64 Duncans* Annals of Medicine for 1797.

4 He accordingly paid me a vifit. I faw that the
poultice had effected the purpofe, fo far as to render
foft this remarkable incruftation. I alfo perceived
fmall and indolent tumours on the pofterior part of
the head, near to the origin of the occipital mufcle.
The cervical glands were enlarged, and fhewed a
fcrophulous diathefis. He was ordered the Peruvian
bark in fmall and repeated dofes, with an increafed
quantity of nutriment ; and I alfo direfted that a little
wine fhould be given. As an external application, I
direfted the following adhefive pafte to be prepared.

c Take two pounds of common ale, and fix ounces
of the fineft flour ; mix them intimately ; and having
fet them over a very brilk fire, add four ounces of
yellow refin, ftirring them conflantly until they be
perfeftly incorporated, and take on a fmooth gela¬
tinous appearance.

c On the 23d of March, 1795, I applied this pafte,
fpread lightly on ftrips of linen, and deflred the lad to
attend me regularly every morning, until recovered
from his deplorable difeafe. I accordingly removed,
next morning, the pafte, ftrip by ftrip, which gave
him fome degree of pain and uneafmefs. It was alfo
attended with a temporary effufton of blood. But he
told me his head was much ealier after its removal,
than he had remembered it for four years, which was
nearly the date of the commencement of the difeafe.
I cautioufly and regularly, for fifteen fucceflive morn¬
ings, removed and applied the pafte, obferving that
my patient gradually became lefs concerned about the
pain of its removal. I alfo, with a pair of fciflars,
cut off the hair which began to grow, and fuch fcabs
as might prevent the application of the pafte.

s From the firft application to that period when I
could prognofticate a perfect cure, there was a gra¬
dual diminution of the effufion of blood, which had at
firft iffued from the fores, on the removal of the pafte ;
and all other appearances proceeded equally favour¬
ably.

< The

Duncans' Annals of Medicine for 1797, 65

The fubjeft of this important cafe continues now
perfeftly free from the difagreeable complaint to
which he was before fubjefted, and has acquired
a copious crop of fine hair. I have treated feveral
other cafes in the fame manner, with fimilar fuccefs*

< 4. Hiftory of a Cafe , in which a Wound of the
Head , with confiderahle Deprejjion of the Cranium ,
terminated in complete Recovery , without any Opera¬
tion : by Mr. John Mackie, Surgeon in Antigua. A
negro boy, aged fourteen, received a kick on the fore¬
head from a mule on the 2d of June, 1795, and was
carried home in a ftate of infenfibility. On vifiting
him foon after the accident, I found an extenfive la¬
cerated wound on his forehead. The bone was com¬
pletely denuded, and a confiderable portion of it de-
preffed, immediately above the longitudinal finus. I
wifhed to have been able to elevate the deprefted part
immediately, but the danger attending an operation
for that purpofe induced me to delay it, till I fliould
fee the (ituation of the patient next morning. I di¬
re ft ed, therefore, a poultice to be applied over the
wound. I adminiftered an opiate to the patient, and
ordered that his regimen ihould be ftriftly antiphlo-
gillie. On the night after the accident, he was faid
to have had fome delirium, and to have fpoken fre¬
quently incoherently. But in the morning I found
his pulfe at feventy-two, and of moderate ftrength*
His appetite was good, and he had no giddinefs or
uneafinefs whatever. The wound difeharged a lim¬
pid fanies, the quantity of which was but inconfider-
able. I did not, after this, again examine the wound
till the feventh, when I found matters nearly as be¬
fore, his pulfe continuing at feventy-two, and foft,
the depreffion remaining in the fame ftate as when it
was firft examined.

c On the 10th he was vifited by Dr. Emmert ; and
as we both agreed on the impropriety of having re-
courfe to a very dangerous operation, when no urgent
appearance required it, all thoughts of performing
vol. v. F the

66 Duncans’ Annals of Medicine for 1797.

the operation of the trepan were for the prefent
laid alide ; and nothing farther was done than dref-
ling the wound, which now difcharged purulent mat¬
ter, with digeftive ointment.

c On the 20th, I found that the palpebral were af-
fefted with a confiderable fwelling, but without pain.
Other circumftanees continued nearly the fame as be¬
fore ; his pulfe was feventy, and full, but not hard.
On the 30th, a frnall portion of bone was thrown off,
which however did not weigh more than half a grain.
The wound now difcharged laudable pus ; the depref-
lion continued as before.

c On the 6th of July, as the edges of the wound
had affiumed rather a fungous appearance, diredfions
were given for their being walked three or four times
a-day with a folution of blue vitriol. On the 12th, I
found the wound looking much better, and the fun¬
gous excrefcences greatly diminifhed. By the 16th the
wound was nearly healed. The depreffion continued
as before ; but he was able to walk about, and had
no complaint.

c On the 26th, I found him at work, in good
health, the wound being completely healed, though
there was dill a very confiderable obvious depreffion,
as well as a large cicatrix. And as he has now con¬
tinued to the prefent day, July 13, 1796, free from
any complaint, 1 think there is every reafon to con¬
clude, that the depreffion will not be productive of
any bad confequencesd

The remainder of the volume will be noticed in our
next number.

Art.

Art. VI. R cm arks on the Fijlula La chry malts ;
with the Description of an Operation confiderably
different from that commonly ufed ; and Cafes
annexed in Proof of its Utility: to which are
added , Obf creations on Hemorrhoids ; and Addi¬
tional Bemarks on the Opthalmy. By James
Ware, Surgeon . Octavo, 150 pages* price 3s 6cL

THE difeafe termed Fiftula Lachrymalis, though
trifling in its apparent magnitude, acquires no
fmall degree of importance from the deformity it often
occafions, and from the trouble and uneafinefs to
which it generally gives rife. It is, therefore* an
object defervedly of conflderable attention amongft
practitioners, although it has not hitherto been treat¬
ed with that fuccefs which might have been wifhed.
The operations which have been employed for its cure
have fometimes fucceeded, but are attended wdth
much pain and inconvenience, and, which is worfe*
have very frequently failed altogether. A mode of
treatment, more Ample in execution, and more fuc-
cefsful in its termination, than thofe which have*
hitherto been employed, muff doubtlefs be highly
definable : and fuch, there is reafon to hope, promifes
to be that, winch is now recommended, by the inge¬
nious author of the prefent ellay.

The method of treatment which has of late gene¬
rally prevailed, has been that of inferting a tube,
either in the natural duft leading from the lachrymal
fac to the cavity of the noftril, or in an artificial open¬
ing made through the os unguis into the fame part.
From different caufes thefe have frequently failed of
giving permanent relief. Sometimes the failure has
been owing to the tube having been improperly
placed, or from its having made its way out at the
corner of the eye, or through into the nofe : fome¬
times the cavity of the tube has become entirely ob~
firucted by infpiffated mucus. The operation which

F 2 Mr.

( 67 )

68 Ware on the Fijiula Lachrymalis , Kc.

Mr. Ware has adopted in place of this is, in general,
fo eafy to be performed, and has in many inftances fo
fpeedily and effectually accomplifhed a cure of the
diforder, that its defcription will no doubt be highly
acceptable. The following is the mode in which it

is directed to be performed.

‘ If the difeafe has not occafioned an aperture in
the lachrymal fac, or if this aperture be not fituated
in a right line with the longitudinal direftion of the
nafal duff, a puncture fhould be made into the fac,
at a fmall diftance from the internal juncture of the
palpebrse, nearly in a line drawn horizontally from
this juncture towards the nofe. The blunt end of a
filve;* probe, of a fize rather fmaller than the probes that
are commonly ufed by furgeons, fhould then be intro¬
duced through the wound, and gently, but fteadily, be
pufhed on in the direction of the nafal duct, with a force
fufficient to overcome the obftru£tion in this canal,
and until there is reafon to believe that it has freely
entered into the cavity of the nofe. The polition or
the probe, when thus introduced, will be nearly per¬
pendicular ; its fide will touch the upper edge of the
orbit ; and the fpace betwen its bulbous end in the
nofe and the wound in the fkin, will ufually be found,
in a full grown perfon, to be about an inch and a
quarter, or an inch and three eighths. The probe is
then to be withdrawn, and a filver ftyle of a fize
nearly fimilar to that of the probe, but rather fmaller,
about an inch and three eighths in length, with a flat
head like that of a nail, but placed obliquely, that it
may fit clofe on the fkin, is to be introduced through
the du£t, in place of the probe, and to be left con-
ftantly in it. For the firffc day or two after the ftyle
has been introduced, it is fometimes advifable to
wafli the eye with a weak faturnine lotion, in order
to obviate any tendency to inflammation which may
have been excited by the operation : but this in ge¬
neral is fo flight, that I have rarely had occafion to
ufe any application to remove it. The ftyle fhould
be withdrawn once every day for about a week, and

after

Ware on the Fifiula Lachrymalis, & (c.

afterwards every fecond or third day, fome warm water
fhould each time be injefted through the duft into
the nofe, and the inftrument be afterwards replaced
in the fame manner as before. I formerly ufed to
cover the head of the ftyle with a piece of diachylon
plafter fpread on black filk : but have of late obviat¬
ed the necefiity for applying any plafter, by blacken¬
ing the head of the ftyle with fealing-wax.

* The effeft: produced by the ftyle, when intro¬
duced in the way above-mentioned, at firft gave me
much furprife. It was employed with a view fimilar
to that with which Mr. Pott recommends the intro¬
duction of a bougie ; viz. to open and dilate the nafal
du£t, and thus to eftablifti a paftage, through which
the tears might afterwards be conveyed from the eye
to the nofe. I expected, however, that whilft the
ftyle continued in the duff, the obftruction would re¬
main ; and of courfe that the watering of the eve,
and the weaknefs of the fight, would prove as trou-
blefome as they had been before the inftrument was
introduced. I did not imagine that any effential be¬
nefit could refult from the operation until the ftyle
wras removed, and the paftage thereby opened. It
was an agreeable difappointment to me to find, that the
amendment was much more expeditious. The water¬
ing of the eye almoft wholly ceafed as foon as the
ftyle was introduced ; and in proportion as the pa¬
tient amended in this refpeef, his fight alfo became
more ftrong and ufeful. The ftyle, therefore, feems
to a£t in a two-fold capacity ; firft, it dilates the ob-
ftrufted paftage ; and then, by an attraction, forne-
what fimilar to that of a capillary tube, it guides the
tears through the du£t into the nofe.

c The wound that I ufually make into the fac, if
the fuppurative procefs has not formed a fuitable
aperture in this part, is no longer than is juft fuf-
ficient to admit the end of the probe or ftyle ; and this
in general, in a little time, becomes a fiftulous orifice,
through which the ftyle is paffed, without occafioning
4 . F 3 the

Ware on the Fijtula Lachrymalis , Stc.

the fmalleft degree of pain. The accumulation of
matter in the lachrymal fac, which, previous to the
operation, is often copious, ufuallv abates foon after
the operation has been performed, and, in about a
week or ten days, the treatment of the cafe becomes
fo eafy, that the patient himfelf, or fome friend or
fprVfint who is conftantly with him, is fully competent
to do the whole that is neceffary. It confifts folely in
withdrawing the ftyle two or three times in the week,
occafionally injefting fome warm water, and then re¬
placing the inftrument in the fame way in which it
was done before.

‘ It is not eafy to afcertain the exact length of time
that the ftyle fhould be continued in the du£t. Some
have worn it many years, and, not finding any incon¬
venience from the inftrument, are ftill afraid and un¬
willing to part from it. Others, on the contrary,
have difufed it at the end of about a month or fix
weeks, and have not had the fmalleft return of the
obftruclion afterwards.

‘ The troublefome ulcerations, which are fometimes
formed over the lachrymal fac, heal, in general, as
foon as an opening is eftablifked through which the
tears may pafs into the nofe. But in two inftances
which lately came under my care, in which the pa¬
tients had occafionally been fubject to cutaneous erup¬
tions, thefe wounds did not heal fo foon as I expect¬
ed ; and a conftderable quantity of purulent matter
was difeharged through the aperture that had been
fnacle to admit the ftyle, feveral days after the opera¬
tion was performed. Both thefe cafes were evidently
relieved by adminiftering internally a weak folution
of the hydrargyrus muriatus, together with a light
preparation of the Peruvian bark ; and by purfuing
the ufe of thefe medicines, the wounds in a fhort
time clofed ; the aperture which had been made with
the lancet contracted into a fiftulous orifice, juft large
enough to admit the end of the ftyle, and the purulent
difeharge wholly ceafed.

‘ The

Ware on the Fiftula JLachry mails , &V. 71

f The pofition, both of the probe and ftyle, is very
nearly the fame, whether they be palled through the
natural nafal duel, or through a perforation in the thin
part of the os unguis ; and 1 have reafon to believe,
that it does not effentially fignify in which of thefe
ways the operation is performed. It may be proper,
however, to point out a few circumllances in which
the two operations appear to differ. One is, that in
confequence of the nafal duel being lined with a
frnooth membrane, the i n fir u merit ufually paffes
through it with facility ; and its paffage is unac¬
companied with that fenfation of a forcible breach,
which is perceived by the operator when it makes its
way for the firft time through the fubftance of the os
unguis. Another is, that when the inlf rumen t has
palled through the nafal duff, it has nearly a perpen¬
dicular pofition with refpecl to the ufual pofture of
the body ; whereas, when it has palled through the
os unguis, it has an oblique direction downward and
inward. A third difference is, that in the former in-
ftance, the inllrument is more firmly fixed than it is in
the latter, in which it often has an unfteadv motion
when touched with the linger. By an attention to
thefe hints, I think it may be difeovered with tolera¬
ble certainty, in which of the two ways the inllru¬
ment has paffed ; and, i believe, 1 may venture to
add, that whether the ftyle be introduced in the
former or latter of thefe directions, it is equally able
to condufl the tears into the nofe, and to accomplilh
a cure of the d iforder.

c In thofe cafes where the nafal du61 is fo com¬
pletely obfir acted that the blunt end of a probe can¬
not be made to pafs through it, there does not appear
to me to be any way of obtaining a paffage for the
tears from the eye to the nofe, fo ealy, or fo effectual,
as that of making a perforation through the thin part
of the os unguis. When this part of the operation is
accompliilied, the perforating inllrument fhould be
withdrawn, and a nail-headed ftyle, about an inch

F 4 long,

72 Ware on the Fijtula Lachrymalis , 8(c.

long, be introduced through the aperture in the fame
way in which it is introduced through the nafal dufit
in thofe cafes where the obflrufilion is not fo great
as to prevent its pafling in this direftion ; and it may
remain here with as much fafety as in this laft-men-
tioned inftance, for as long a time as its continuance
may be thought neceffary to eftablifh the freedom of
the communication. It may be proper to obferve, that
when the ftyle is carried through a perforation in the
os unguis, the length of an inch is fufficient to allow
its end to reach the open fpace that lies between the
os fpongiofum fuperius, and the os fpongiofum infe-
rius. But when it is carried through the natural
nafal du£I, its length mull not be lefs in an adult
perfon than an inch and a quarter, or an inch and
three eighths, in order to allow it to pafs completely
through the du6l into the nofed

Ten cafes are added, feledted from a confiderable
number, in proof of the advantage arifing from this
mode of operating. One or two of thefe will give
our readers a fufiicient idea of its nature and utility.

4 Cafe 1. An Obf ruction in the Lachrymal Canal ,
of feveral years' continuance , perfectly and f pee dily
cured by the introduction of a nail-headed Style
through the Nafal Duct. A young lady of Oxford,
who, for upwards of three years, had been fubje£l to
an almoft continual watering of one of her eyes, ac¬
companied at different times with a trouhlefome in¬
flammation of the tunica conjunffiva, was introduced
to me on the 8th of July, 1796, by Mr. Curtis, Sur¬
geon, at Iflington. Prior to my being confulted, the
tears had frequently been mixed with a fmall portion
of infpiffated mucus, which at thofe times made the
eye feel ftiff and uneafy ; and the eyelids were ufually
gummed together when fhe awoke in the morning.
On examining the eye, an excoriation was perceived
on the edges, both of the upper and lower lids, and
on gently preffing my finger on the lachrymal fac,
which appeared fuller than in its natural ftate, a few

fmall

Ware on the Fijlula Lachry malls, Kc.

fxnall particles of infpiffated mucus were difcharged
through the punfta lachrymalia, and fpread over the
eye. I endeavoured to injeft fome warm water
through the inferior punftum into the nofe ; but
the obftru£tion in the nafal duft was fo great, that
none would pafs, the whole of the liquor returning
immediately through the fuperior punffum. A little
of the unguentum hydrergyri nitrati was applied with
a camel’s hair pencil to the excoriated edges of the
eyelids, and a weak vitriolic collyrium was directed
to be ufed three or four times in the courfe of the
day. The injedtion of warm water, together with
the application of the ointment, were repeated feveral
days in fucceffion. On the 1 1th, the watering of the
eye was lefs troublefome. On the 15th, a part of the
injefted liquor evidently paffed both into the nofe and
throat, as it did alfo on the three following days ; the
flow of tears over the cheek being conflderably dimi-
nifhed. On the 19th, the patient caught cold at the
Opera; in confequence of which, the epiphora imme¬
diately returned, and was accompanied with a fmall
degree of inflammation on the ball of the eye. The
next day no part of the injedled liquor would pafs
through the duct. 1 fcarified the fchneiderian mem¬
brane, on the infide of the nofe, writh the point of a
lancet, and took away two or three tea-fpoonfuls of
blood ; an opening medicine was adminiftered ; and a
faturnine lotion applied to the eyes. On the 2 iff,
the inflammation of the eye was removed ; but ft ill
none of the injected liquor would go down. I intro¬
duced the end of a fmall gold probe through the fu¬
perior punftum lachrymale, and gently pulhed it on,
in the direction of the du£t, but it would not pafs.
On the 22d, I repeated the attempt, and it now went
freely into the nofe ; after which fome warm water,
injected through the inferior punftum, alfo paffed. — -
The watering of the eye gave very little trouble for
feveral days after this time : but in about a week the
obftruftion to the tears returned, together with an

inflammation

74 Ware on f he Fift ula 'Lachfijma Us, Sc.

inflammation on the ball of the eve, and a fmall
tumefaction in the lachrymal fac. Both the patient
and myfelf were much difcouraged by this relapfe ;
and I now propofed to her to allow me to make a
punfture into the fac, and to introduce a ftyle, in the
way that has been defcribed in the preceding pages.
Agreeably to this advice the operation was performed
on the 7th of Auguft ; and, with very little pain or
difficulty, a probe was flrft introduced, and aftem
wards a nail-headed ftyle, an inch and three-eighths
in length, through the nafal duft into themofe. Au¬
guft 8th, the young lady had not experienced any
pain, and the inflammation of the eye was abated.
Auguft 9th, I withdrew the ftyle, and injected fome
warm water through the wound. It paffed freely into
the nofe ; alter which the ftyle was replaced with as
much eafe as it had been at flrft introduced. Auguft
10th, the watering of the eye, in every refpedt, much
more ealy than it had been for many months before
the operation. The ftyle was withdrawn, and re¬
placed every day for about a week, and afterwards
every fecond or third day, until the 30th of the fame
month, when the patient left London, being perfefllly
able to manage the operation ; which the repeated
every four or flve days, in order to keep the ftyle clean
and the paffage clear.

‘On the 16th of Auguft, 1797, fhe informed me,
by a letter, “ That her eye had been effeCfually re¬
lieved by the introduClion of the ftvle ; that (lie had
then worn it without the fmalleft inconvenience above
a year ; and that fhe fhould certainly continue it until
fhe had an opportunity of feeing me.”

‘ Cafe 2. An Epiphora, produced by an old oh -
ftruction in the l achrymal Canal , which , like the
former , was fpeedily cured by the introduction of a
nail headed Style through the Nafal Duel. The
daughter of L P., thirteen years of age, was recom¬
mended to me Auguft 14-th, 1797, by Mr. Moore,
apothecary, in Norfolk- ftreet. Strand, on account of

a com

Ware on the Fijlula Lachrpmalis ,

a conftant watering of the right eye. It had been
troublefome to her ten years, and began during the
time flie had the fmall pox 3 which diforder had pro¬
duced a violent inflammation in both her eyes. When
I firft faw her, the edges of the lids of both eyes,
and particularly of the right, were conliderably ex¬
coriated ; and her fight was fo extremely weak, that
flie had long been unable either to react, or to work
with her needle. The right lachrymal fac was dif-
tended with a confiderable quantity of thick mucus,
which oftened returned through the pun ft a lachry-
nialia over the eye ; and not unfrequently flie was
obliged to difcharge it by the preffure of her finger.
I injeQed fome warm water through the inferior punc¬
tual, but could not obferve that any of it paffed into
the nofe. The obftruffion was fo compleat, and it
had continued fo long, that it appeared to me in vain
to attempt to clear the duff by a continuance of this
mode of treatment. I, therefore, propofed to the
mother of the girl, to permit me to punflure the fac
WTith a fpear-pointed lancet, as had been done in the
preceding cafe, and to introduce a nail-headed flyle.
The mother and daughter acceding to the propofal,
the operation w as performed the fame day, and a flyle
was introduced without any difficulty, through the
duff into the nofe. The head of the inftrument be¬
ing b acked with fealing wax, no dreffimg was ne-
ceffary over it; and the eye was no othenvife defended
from the light than by the ufe of a common (bade.
Auguft 15th, the eye was not in the leaft inflamed,
and the patient had not fuffered any pain fince the
time of the operation. A little ot the Unguentum
Hydrargyri Nitrati Rubri was applied with my finger
to the excoriated edges of the eyelids, and was wip¬
ed off immediately afterwards. Auguft 16, I with¬
drew the flyle, and injeffed fome warm water through
the aperture ; the whole of which paffed at once
either into the nofe or throat ; after which the flyle
was introduced again as before. This operation was

repeated

76 Ware on the Fijiula Lachrymalis , Kc.

repeated daily, until Auguft 23d, when the water!
ing of the eye had wholly ceafed, and the fight of
the patient was become as flrong as that of other per-
fons. The ftvle was continued in the du£l until the
2d of Oftober, being retrafted only once or twice in
the week, in order to inje£t fome water through the
paffage. At this time it appeared to me that the
lachrymal paffage was fufficiently eftablifhed to allow
the indrument to be withdrawn entirely. This was
accordingly now done, and the wound fuffered to
clofe ; after which the Epiphora did not return, and
the fight continued perfectly flrong and ufeful.’

The fubje6t which next engages the author's at¬
tention is, Haemorrhoidal AAe6tions. The nature
of thefe, their effects on the general health of the
body, and the ordinary means of relief, are fuff
fieiently known. In general, the difeafe is of fo little
importance, and fo fleeting in its duration, as to
render unneceffary any particular interference of art.
Occafionally, however, the pain and irritation are fo
great as to produce an inability to perform the com¬
mon offices of life. In fuch cafes, it becomes indiff
penfably neceflary to have recourfe to extraordinary
modes of abidance, fuch as extirpation of the offend¬
ing parts, either by cutting them off with a fcalpel or
fciffars ; or by tying a tight ligature round their bads,
in order to deprive them of nourilhment, and thus to
caufe them to die and fall off.

Mr. Ware obferves, that though the number of
haemorrhoidal tumours protruded through the anus is
often conflderable, yet the pain which the patient
fuffers is not produced equally by all of thefe. If an
accurate inquiry be made, it will often be found, that
the patient will point to one, or at mod to two, of the
tumours, from whence all his pain proceeds. When
thefe are examined, it will be difcovered, that they
are much harder and more inflamed than the red ;
and generally they are alfo fmailer and lefs promi¬
nent £

w are on the Fifiula Lacrhymalis , <Su\

nent ; protruding but juft low enough to be compreff-
ed be the fphyncfter ani.

If this be a juft defcription of the ftate of the dis¬
order, it follows that the operation of cutting off the
whole number of haemorrhoids with a Scalpel or SciS-
Sars, and that of tying a ligature round them, are
alike unneceffary. Inftead of having recourfe to thefe
Severe remedies, we have only to direft our attention
to the hard inflamed tumour, which is the caufe of
the pain, and which is not unfrequently Situated in
the center of the reft. This is often no larger than
the end of the little finger, and the removal of it
almoft inftantly abates the pain, and, in a ihort time,
caufes the reft of the tumors to collapfe and disap¬
pear. The mode which Mr. Ware has purfued, con-
fiftently with thefe principles, is, to take hold of the
moft painful of the tumours with a differing hook or
forceps, and fnip it off as clofe to its bafts as poffible,
with a (harp pair of curved fciffars. Several cafes are
adduced in Support of this mode of treatment.

€ Cafe 1 . A gentleman in Birchin Lane applied to
me, about three years ago, on account of an hemor¬
rhoidal diforder to which he had been Subject many
years. For the laft twelve months Several large tu¬
mours were protruded through the fphyn&er ani
whenever he had a ftool, and afterwards they not only
bled, but he was often for hours in fo much pain, that
he was unable to attend to any bufinefs. Many medi¬
cines had been given him, and different applications
employed, but without affording him any afliftance.
On an examination I found a confiderable number
of haemorrhoids protruded through the anus, all of
which appeared to be in a ftate of inflammation ; but
one in particular was exceffively tender, and felt quite
hard when touched with the finger.* I ftated to the

patient

* It has been obferved above, that hemorrhoidal tumours are not
unfrequently occafioned by a thickning of one or more of the plicae or
folds in the membrane which lines the inferior part of the inteftine rec¬
tum.

Ware on the Fijtula Lackrymalis 5 <Sfc.

patient my opinion, that this hard pile was the caufe
of the pain he endured, and that the removal of it
was a highly probable means of giving him eafe, and
caufmg the other tumours to collapfe. On the fubfe-
quent day I performed the operation in the following
manner. Having fecured the hard haemorrhoid with
a differing hook, and drawing it forward, I cut it off,
with a curved pair of fciffars, as clofe to its bafis as I
was able. The remainder of the tumours inflantly
collapfed, and withdrew within the fphyndter ; and,
as they were quite foft, I did not think it neceffary to
fearch further for them. The pain the operation oc-
cauoned was much lefs than the patient had. experi¬
enced for a long time after every motion. No haemor¬
rhage followed. I applied a comprefs dipped in a
faturnine lotion over the anus, and bound it on with
the ufual T bandage. An uneafy fenfation was ex-
perienced in the redtum during the whole of the firft
day, but the patient flept well in the night, and the
following day was perfectly eafy. On the third day
he took a gently opening medicine, which procured
him two loofe motions. Thefe were mixed with a
fmall quantity of blood \ but gave him very little pain
as they came away, and were followed with a very
flight protrufion of the gut, which went back, imme¬
diately on the application of the finger. He had not
any occafion to take medicines afterwards. The
bowels in a fhort time performed their proper office
without pain or protrufion, and he became quite well
in every refpeft. For a year and a half he continued
free from any uneafmefs of the haemorrhoid al kind ,
but then the gut began to have a flight tendency to
protrude whenever he had a coftive Fool. He took
particular care to avoid this by an attention to his
diet, and by the ufe of gently purgative medicines.

turn. I have reafon to believe that this is much more frequently the
Caufe of thefe tumours, than a varicous enlargement of any large blood
veffel that is htuated in this part.

Ware on the Fiji id a Lachrymalis > Kc,

As this, however, did not hinder the gut from occa-
fionally coming down, he was advifed to take the fize
of a nutmeg of Ward’s Paile every morning and even¬
ing. Fie had not taken this medicine long before the
tendency to a prolapfus entirely went off, and for the
lafl two years he has not had the lead unealinefs in
this part.

c Cafe 6. Mrs. FL, about four years ago, had occa-
fion to take a purgative medicine, which unexpect¬
edly operated with great violence. In confequehce
of this, whenever die had a llool afterwards, a part of
the internal membrane of the refilum was protruded
through the fphynfiler ani, requiring the application
of the fingers to return it to its proper pofition ; and
in a fhort time the gut became fo weak, that it came
down whenever the walked the diflance of a hundred
yards. She was not unfrequently alfo troubled with
a confiderable haemorrhage from this part, which
fometimes came on fuddenly, and occafioned her
great diflrefs. Many remedies, both external and
internal, had been made ufe of, but without afford¬
ing her any relief. I at fir 11 fufpe filed that this was
one of the common cafes of haemorrhoids ; and, as
the patient was conilituiionally colli ve, I direfiled her
to take the fize of a nutmeg of an electuary compofed
of fulphur and cream of tartar mixed with lenitive
elefituary, once or twice every day, according as the
Hate of her bowels made it neceffary. An ointment
compofed of equal parts of the powder of pak galls
and elder ointment was alfo prefcribed to be applied,
morning and evening, to the protruded gut. Thefe
remedies, however, did not produce any good effefit.
She was then advifed to introduce up the gut the end
of a fmall candle, about two inches long, and as thick
as the little finger, once or twice every day,, in order
by its preffure to hinder the protrufion, and, in this
way, to give ltrength to the weakened part. A thick
comprefs at the fame time was confined on the anus
by a T bandage, which was bound on the part as

tight

BO Ware on the Fijlula Lachryvtatis , t('c.

tight as it could be borne, without giving pain, Thefe
applications feemed at firft to have a good effect in
keeping up the gut ; but in a fhort time, the benefit
they afforded ceafed, and the introduction of the
candle, and wearing the bandage, became a work of
fo much fatigue, that the patient could not be pre¬
vailed on to continue the ufe of them. 1 was now
permitted to examine the feat of the difeafe, and I
found the pofterior and inferior part of the reftum
protruded through the fphyn&er ani, about the fize of
the firft joint of the little finger. There did not ap¬
pear to be any diftinft tumor in the part, that could
properly be denominated an haemorrhoid j but the re-
femblance between the two diforders wTas fo ftrong,
and the diftrefs of the patient fo great, that l thought
myfelf fully juftified in recommending the excifion of
the protruded part, in the fame way in which I would
remove an inflamed haemorrhoid. The patient giving
her confent, I performed the operation on the follow¬
ing day. Having fecured the moil prominent part of
the tumor wuth a hook, I cut it off in the ufual way
with a curved pair of fciffars. The haemorrhage that
enfued was very inconfiderable and the gut imme¬
diately returned to its proper pofition, I covered the
part wuth a cold faturnine lotion, and bound it on
wuth a T bandage. About two hours after the ope¬
ration, the patient felt an uneafinefs in the reftum, as
if Die fhould have a ftool ; and fhortly afterwards a
large quantity of thick blood was brought away. —
This much alarmed both the patient and her friends*,
and occafioned them to fend in hafte for me ; their
alarm being increafed by a return of the haemorrhage
before I arrived. I immediately applied a doflil of
lint dipped in a ftrong vitriolic lotion to the wound,
and repeated the ufe of a thick comprefs dipped in a
cold faturnine lotion to the external part ot the anus.
A bolus containing five grains of dragon’s blood, and
an equal quantity of alum was given every tw7o hours ;
the weight of the bed cloaths was leffened ; and hot

drinks

Lagrange’s C'oitrs IP Etude Phcirmaceutique. 81

drinks of every kind were carefully avoided. No
haemorrhage of any conlequence took place after this
plan was adopted It was fteadily continued for
twenty-four hours ; the comprefs being frequently
dipped, during this time, in the cold faturnine lotion.
The boluffes were afterwards given every four hours
for another day. On the third the patient took lome
caftor oil, which brought away a loofe itool with a
fmall mixture of blood, but without any protruflon of
the gut. She had a flight fenfe of forenefs in the
wound lor about a month ; but then the pain wholly
went off ; and from that rime to the prefent, which is
Upwards of three years, fhe has enjoyed her health
perfectly in every refpefl.’

The laft part of the volume contains additional re¬
marks on the Ophthalmy : but they are of too mifceh
laneous a nature to allow of abridgement here : one
of the chief purpofesy however, is to enforce the ule
of the tinctura thebaica , as an external application,
in the manner recommended in the author’s treatife
on this fubject ; and to diffuade from the ufe of the
tinct. opii of the new pharmacopoeia ; the effefls of
which are very different. A ftribt compliance with
the mode of application pointed out is likewife en¬
joined.

Art. VII. Co urs D'Elude Fharmciceutique. Par
B. Lagrange, Pharmacien de Paris, &c. In 4
Vols. Offavo, price 20s. Imported by Booset.5
London, 1798.

THIS work is divided into four parts ; the firft
contains the elements of phyflcs, the general
laws of nature, the properties of bodies, their mo¬
tion, gravity, the theory of mechanics, hydroftatics^

Q w and

82 Foot's Cafes of V efiae Lotnra , & (c.

and capillary tubes ; the nature of aerial fluids ; op¬
tics in general ; the laws of light, eleCtricity, mag-
netifm, acouftics, &c. ; thefe form the fubjeCt of
the fir ft volume.

The fecond contains the materia medica , or the
lift of Ample medicines; divided into the three
kingdoms, vegetable, animal, and mineral.

The third part contains botany, and commences
with the principles of that fcience, followed by the
fyftems of Linnaeus and Tournefort ; laftly, the bo¬
tanical demonftration of a conflderable number of
plants, according to the method of Tournefort.

The fourth volume contains pharmacy, or phar¬
maceutic chemiftry.

The general nature of the work may hence be un~
derftood. It profefles to have nothing original, but
the arrangement. The vaft number of Amples in¬
troduced, the multiform compounds, and the almoft
indifcriminate aflignment of virtues, give it a cha¬
racter that ill accords with the prefent advanced ftate
of medical fcience.

1====^=== - _ . — . — - — .

Art. VIII. Cafes of the Succefsful Practice of
VefiCiC Lotura in the Cure of Difeafed Bladders.
By Jesse Foot, Surgeon. OCtavo, 42 pages,
price Is 6d. Becket, London, 1798.

rTpHE author profefles himfelf indebted to a cafe
£ related by Le Dran, for the firft hint of the
praCtice he here recommends. He thinks it not a
little extraordinary, that a praCtice fuccefsfully pur-
fued by a man of fuch eminence, fhould have been
hitherto wholly difcontinued, and attributes it to the
want of an inftrument fo well adapted to the purpofe
as the elaftic catheter*. Four cafes only are related

* See a cafe of this kind, Med. Rev Vol. 3, p. 1.

Foot's Cafes of Vcfcce Lot ufa, 8£c.t

of this mode of practice. By trariferibing one of thefe*
our readers will be enabled to judge of the reft.

‘ Cafe 3. A gentleman, of the Excife Office, went
down to Harrowgate, for the benefit of its water, but
was compleatly difappointed. He there met a friend
of mine, and it was in confequence of his recom¬
mendation, that he applied to me, in the fpring of
the year 1796.

* He was about 56 years of age, tall, but not cor¬
pulent, of a ruddy complexion, not that fort indica¬
tive of high health, but fuch a one as thofe have, who
have been at fea, and have lived freely • when the
hands and the face have a tendency to a livid ap¬
pearance ; a fort of weather-beaten face. I queftion-
ed him as to his manner of living, and though, as I
fufpedted, fpirituous liquors did make a portion in his
drink, yet I am inclined to believe, that he did not
take it to a degree of intoxication ; and that he did
not abufe his conftitution more, by that privileged
poifon, than other moderate fubjefts do, who have
yielded to the fpontaneous habit of conftantly taking
it, or who have been driven to it, as a fubftitute for
wine, fince fuch a duty has been exafted upon that
moft neceffary article of life ; and lince not even a
drawback upon it, has been allowed for the poor in
a work-houfe. Nothing is more common, and no¬
thing can be more prejudicial, than for perfons af¬
flicted with bladder complaints, to take to gin ; and
nothing is more common, when once they have taken
to it, than for them to like the difeafe for the fake
of the remedy.

£ This patient's complaint, when I firft faw him,
was a frequent difcharge of his urine, over which he
rarely had any command. Sometimes it flowed from
him as he walked about, involuntarily ; and fome-
times, when he knew his bladder was charged with
a largifli portion, he could not urine at all. At other

C 2 times.

Foot’s Cafes of Vejicce Lotura, 8C c.

times, his urine would fuddenly ceafe to flow,. during
the aft of urining 3 and upon thefe laid occalions, his
efforts would be encreafed, and his pain acute 3 pro-
Fufe fweats would build forth 3 and if he was then
taking his walk, as he was confdantly in the habit of
doing from the office to his houfe at Iflington, he
was forced to lean tor fome time, where he could find
a place, and by drifting his pofdure, he generally fuc-
ceeded in obtaining an evacuation, and confequently
procuring eafe.

c The fymptoms of his cafe pointed out fo plainly
the nature of his complaint, that it did not require
much confideralion to determine it to be, either gra¬
vel or ldone, but mold probably the former. Upon
introducing a bougie of a middling lize, I found the
capacity of the urethra extremely narrow, towards the
neck of the bladder 3 and the patient then informed
me, that he frequently found clots of blood come
forth with his urine. I afcertained another faft by
enquiry, namely, that the capacity of his bladder was
not leffened, or at leafd to no great degree. Thinking
that the fiid thing to be done was to diftend the
urethra, I began the cafe wdth palling bougies for
that intention, wdth recommending a fomentation of
the decoftion of poppies to be applied in the direc¬
tion of the urethra, and with prelcribing then, a de¬
co cdi on of bark with elixir of vitriol, to be taken fre¬
quently in the ufual dofes, but foon changed it for
lim e -water.

‘ My patient went on thus till the month of
Auguft, without the fmalleft abatement of fymp¬
toms. Having about this time experienced the ad¬
vantage of the veficae lotura, I concluded that it was
expedient at leafl, to throw lime-water directly into
the bladder, in Head of fending it circuitoufl'y there,
through the conftitution 3 and more expedient than by
the fliort paffage even, invented and defigned by Dr.
Darwin.' In order to be able to effeft this, i pafled
the largeft bougie I could get, to procure a paffage

Foot's Cafes of Vefica Lotiira, Cc.

for the catheter, as I had hitherto been foiled when-
ever I attempted topafs it.

c This idea opened to me a very enlarged train of
refleftion ; and my reading an excellent paper by Dr.
Whytt, in the Medical Obfervations of a Society at
Edinburgh, encouraged and enhanced the value of it
to that degree, that it was impoffible for me to refill
the defign. Nothing b elides the want of proper in¬
ftruments was the obftacle, at the time Dr. Whytt
Wrote his> paper, to the practice then; and this has
been the obftacle ever fince, to this felf-evident pro-
cefs. A furgeon ought always, in order to reafon
fairly upon what has been done by former furgeons,
to afeertain what inftruments were known at the
time they puhlifhed their cafes, and bv that deter¬
mine the degree of improvement at leaft; fo far as
inftruments have a concern in the advancement ot the
art. Dr. Langrifh has encouraged the fame idea,
but to his fuccefs alfo, the want or proper inftruments
was the obftacle that rendered the practice imprac¬
ticable, at leaft upon the human bladder of a male
fubjedl.

I fucceeded in palling the elaftick catheter, but not
on the firft attempt, injedted lime water diluted with
warm water, and found what f was not at all fur-
prifed at, that the bladder would contain and retain
more than eight ounces. I went on thus not every
day for a month ; the bladder was able to hold the
i.njefted fluid, and the patient departed with it.

‘ During the praftice of the veficae lotura upon

, © . 1 .... . r •

him, the patient regained his continence ot urine,
and fcarcely ever called without bringing with him
fragments of gravel which he had difeharged, and
fome with the greateft difficulty, of an irregular figure.
I recommended him kill to keep his urethra open
with the largeft bougies that the urethra would admit,
during the procefs of injection. Whilft he was in-
jefiting, it very frequently happened, after the bladder
had been fully difiended by the repetition of the in-

G 3 jedlion

Foot's Cafes ofVefae Lotura , -8Ce,

je&ion, that the water would Hop all of a hidden;
but then palling a bougie to diflodge the piece of gra*»
vel from the neck of the bladder, it would flow out
again, until the bladder was empty. It was con¬
cluded upon the ceflation of this fymptom, that there
was no more gravel to come awray ; and this was
judged to be a proper criterion to decide upon, when
the procefs ought to be difcontinued, For as the
bladder could be completely filled, and repeatedly
filled, the preffure of the full bladder in the expulfon
of its contents, eonftantly brought the gravel within,
to the neck of the bladder, when it either fuck fall,
and thereby flopped the current of the fluid, or came
forth through the urethra with the current.

4 dhefe equivocal fymptoms having totally ceafed,
I difcontinued the injection, leaving it to the patient
to keep the urethra open with bpugies. For as I
could not take upon me to fay, that more gravel may
or may not hereafter be formed, I thought it right for
him to be prepared, with the only poihble power of
procuring the difcharge out of the bladder, of what¬
ever extraneous fubftance might haye been hereaf¬
ter collefted within it. And as this gentleman left
me perfectly fatisfied and at cafe, l rely upon it, that
if he had ever fince experienced any return of his
complaint, I muft have heard from him, or have feen
him again.

c I fhall not take upon me to affirm which of the
three remedies I applied was the caufe of diflodging
the gravel, rcfloring the continence of urine, and giv¬
ing eafe to the patient, If enlarging the paflage of
the urethra could have flngly done it, an opportunity
for that was given for months, without any viflbje
alteration, and whilft at the fame time the patient was
drinking lime water. Whereas the fact is, that it
was not until the application of the veficre lotura had
been repeated, that the patient either regained his
continence of urine, or evacuated the grayel from the
bladder, or found eafed

Wallis’s EJfay on the Gold . 87

It is proper to obferve, that tne other were
cafes of difeafed bladder, not depending on calcu¬
lous concretion ; and the author feems to attribute
the good effects of the injection to its power of di¬
lating the bladder, as well as to its diluent and de-
fenlive properties. But there appears to be a (iudied
obfcurity in the author’s manner of writing, which
leads one to imagine he thinks himfelf the molt ^pro¬
per to direct and fuperintend the operation. I his
may, perhaps, be a neceffary hint to patients.

We confefs our expectations of relief from this
plan of treatment fall tar ffiort of thofe of Mr. Foot.

Art. IX. An Efay on the Gout , in which is intro¬
duced a Candid Examination , and a Refutation
attempted , of Dr. Latham's Principles, lately pub-
lifted on this Subject , and others advanced, deduced
from Facts occurring in the Author's own Cafe , and
from his Practical Experience of many years. By
George Wallis, M. I) . 8vo. 203 pages, price
4s, Robinson, London, 1798.

FEW difeafes have more frequently been the fub-
ject of medical writings, than the one which
we are now to notice : but with how little fuccefs,
both in theory and practice, may be gathered from
the various and contradictory hypothefes which have
prevailed from the earlieft ages of medicine to the
prefent day, and from the glarfng inefficacy of every
mode of treatment which has been hitherto adopted.
How far the author has fucceeded in removing any
of the difficulties which encompafs the fubjeft, will
appear as we proceed in our account ot his effay.

In the firft feCtion, the author exhibits the opi¬
nions of different authors reipefting the caufe and
feat of the gout. In the fecond, that of Dr. La¬
tham is examined, and its refutation attempted : a

G 4 talk

Wallis’s Effdy on the Gout.

'talk of no great difficulty, as will appear, we pre~
fume, from ,the account we have already given of
this hypothecs.*

Dr. Wallis next narrates his own cafe, from
whence he deduces his opinion of the nature of
this -difeafe : which is, that it is a nervous affec¬
tion : but as this is a term of very extensive im¬
port, it is neceffary that we ffiould follow him in his
elucidation of the matter.

c And fir ft/ he fays, c the fymptoms which mani-
fefted themfelves before the pain of my foot became
violent, as enumerated in pages 35, 36, and 37,
are evidently of the nervous kind ; which, on ex¬
amination, we (hall find fimilar to thofe by which
people are oppreffed who labour under a flow fever,
and brought on in the following manner. We muff,
however, previoufly obferve, that the nerves them¬
felves are univer tally allowed to be the inftruments
of all fenfation, by whofe influence many parts are
put into, and all parts continued in motion ; which
motion is quick, or flow, ftrong, weak, &c. accord¬
ing to the energy, or debility of that fyftem by
which it is created. It is certain, alfo, that flow
fevers will arife from any caufe which can debilitate
the addon of the nervous fyftem, fuch as great fa¬
tigue, mental or corporeal; excefs of venery ; fevere
fiudy ; uneqfinefs of mind long continued ; great eva¬
cuations , whether of blood or other fluids of the
machine ; morbid matter received into, or generated
in the habit, & c. &c. &c. We know, likewife, that
the fymptoms which are the confequences of tbefe
caufes, arife from a torpor of the nervous fyflem ;
by which means the excretions of the whole habit
are made in too fmall quantities, and feme of the
excretories almoft entirely clofed ; on which ac¬
count a very large proportion of excrementiticus
matter, that fliould be conftantly palling out of the

* See Med. Rev. vol. 4, page 40.

habit,

Wallis’s EJfay on the Gout . 8 9

habit, is retained, and acrimony of different natures
generated within.

‘ Now, by this acrimony, a different train of fymp-
toms occurs, according to the different parts affeCted,
till nature, or the powers of the conftitution, are
roufed to free themfelves from thefe oppreflive af¬
fections, and either corrects, affimilates, ejeCts, or
other wile conquers the primary offending caufe ;
which done, the nerves begin to affume their pro¬
per and natural actions, all the different parts depend¬
ant thereon perform their ufual functions, and the
whole machine reaffumes its wonted regularity in
aCtion and accuftomed vigour.

c Thele faCts being indifputable, allowed by au¬
thorities of the fuff eminence, and obvious to any
difcriminating practitioner, it will be fome fat is fac¬
tion to fee how they quadrate with thofe fvmptoms,
confidered as precurfors of the gouty paroxyfm.

f The firft appearances manifefiing themfelves, I
have faid were, general languor and lajji tilde, fatigue
from trifling exercife , debility of the whole fyjiem ,
load and heavinejs at my jtomach after eating , cof-
tivenefs, pallid urine , dulnefs of hearing, founds in my
ears now and then, fimilar to the found of a Jiroke from
a bell ; dimnefs of fight , as if objects at a finall dif-
tance were enveloped in a miff, &c. &c. &c.

‘ Now, it muff be allowed, that where any parts
depend upon another for the promotion or continu¬
ance of their aCtion, any defeCt in that aCtion may
naturally be attributed to fomething defective in the
-moving caufe ; and that moving caufe re tides in the
nerves : tor if the branch of a nerve ferving any part
be divided, that part will lofe its power, and become
paralytic in a given time, if not inliantaneoufly ; nor
can the total iofs be attributed to any other caufe.
J hat the defeCt relides in the nervous fyftem, 1 hold
certainly to be the cafe, when the motions of the va¬
rious parts ot the fyltem are confidered in general :
for 1 am well aware, where a particular part is only

affected

Wallis’s Eflcnj on the Gout.

affefcled in the manner here defcribed, that defeft
may be, and often is, owing to fome derangement or
other in the organic ftru&ure of the part, or incapa¬
bility of the part, from fome accidental caufe, feeling
the influence of the nerves, though they themfelves
retain their full power.

‘ The fymptoms above enumerated appear evi¬
dently to arife from want of power in the parts af-
fefted to perform their offices in a manner confident
with a date of health. Hence the mufcles of the
machine perform their motions weakly ; the circula¬
tion of the blood becomes languid ; the domach and
intedines are fluggifh and torpid in their adtion ; the or¬
gans ofhearing imperfeft in their feeling ; as well as the
eyes lofing, in fome degree, the clearnefs and acute-
nefs of their vifion ; and all this from fome caufe af-
fedling thofe inftruments of aftion or motion, upon
which the perceptive and moving powers of thefe
parts depend. And that this mud be the cafe, is
obvious ; becaufe, previous to the attack of this difi-
eafe, thefe organs experienced in themfelves no de-
feft, but were performing their functions with eafe
and freedom.

‘Now, this caufe I take to be, the aril untie or gouty
matter exercifnvg a fedative power upon the nervous
fyjlem in the flrfl injtance ; whence a torpor in the
action of all the parts /abject to their influence is occa~
floned , by which means the fluids, which ought to
circulate freely to the external parts of the machine,
are conveyed too fparingly, and hence the larger
veffels of the habit experience an oppreffive pleni¬
tude, till, by their increafed action, acquired by the
natural Airnulus of the habit, that is, the matter of
heat inherent in the blood being there collefted, in-
creafes their power, and occafions the blood to be
puflied forward more freely; by which increafe of
power the morbid offending matter is thrown from
the more internal parts of the fydem, feparated by a
law of nature from the circulating fluids, and depo-

fited

Wallis’s EJfay on the Gout . 9 1

fited by the fame law on the extremities, and thofe
chiefly of the fmall joints moft diftantly removed from
the heart and larger arteries, where the moft forcible
circulatory powers refide, and to which the fmaller
veflels of the fame order are fubfervient ; the offend¬
ing matter fo depoftted, then, from its acrimony,
begins to irritate the minute fibrous expanjions of the
nervous fyftem , creating acute pain, and that very
often inftantaneoufly $ by this means the fluids are
folicited to the parts, fpafms in the cutaneous veflels
take place, tenfion and fwelling fucceed, with in¬
flammation externally, till the arthritic matter, fepa-
rated from the habit, lofes its power, and is partly
thrown out of the conftitution by the cutaneous
pores, partly re.-abforbed and eliminated by feme of
the other excretories, particularly the kidneys and
urinary paflages 5 and this appears to be the mode of
which nature makes ufe to free the machine from
matters fo offenfive. Nor does it feem improbable,
that nature employs this pain as her inftrument of
relief to the conftitution in general ; for we find, upon
its acceffion, which forms the fecond ftage of the
gout, the various affections under which the confti¬
tution previouflv laboured, vanifli, and fymptoms of
an oppofite nature fucceed : the febrile affections be¬
gin to put on a difference appearance; the pulfe
grows ftrong and full, though lefs frequent ; the coun¬
tenance affumes a florid hue ; general heat is diffufed
over the body ; there comes on a greater thirft, and
a ftronger defire for diluting and fub-acid drinks • the
urine grows^ higher coloured ; and other fymptoms,
more indicative of continued inflammatory fever, take
place, with exacerbations in the evening ; and things
continue in this ftate till the abatement of the pain ;
and then the violence gradually decreafes, and at laft
goes off, leaving the part affeCted, fwelled, red, and
extremely weak : which are only mere effeCfs brought
on by the preceding gouty irritation/

92 Wallis’s EJfay on the Gout, ,

Upon tbs whole, the author concludes, that the
caufe of the regular gout is ftimulus in the firft in-
ftance, independent or fpafm or diftenfion, inducing
immediate pain, fixing, by a law' of the animal oeco-
nomy, on the fmall joints and ligaments furrounding
them, of the extremities, having fpafm and diftenfion
for its affociates, which produce fwelling, inflamma¬
tion, and pain as their confequences:

c That all this depends upon an acrimonious hu¬
mour, called arthritic from its eflfedts, firft exercifing
a fedative power on the nervous fyftem whilft circu¬
lating in the mafs of fluids ; when feparated, a ftirnu-
lating power on the fibrillous expanfion of the nervous
fyftem, in conftitutions previously difpofed to favour
fuch a depofition, and feel its effedts :

c That the gout, when mifplaced , depends upon
predifpofition of the parts affedled to receive the
arthritic acrimony, and feel its power ; when retroce¬
dent , upon conftitutional debility, incapable of retain¬
ing the arthritic acrimony in the fituation where it
firft fixes ; or it arifes from accident or mifmanage-
ment ; then it frequently puts on the appearance of
mifplaced gout ; all which diversified appearances
originate from the fame caufe as thofe of the regular
gout, placed under different conftitutional or acci¬
dental circumflances.,

When gouty people are attacked fuddenly by apo¬
plexy, it is accounted for, by the gouty acrimony
producing a highly fedative effedt, like the eledtric
matter upon the nervous fyftem, by which its power
is totally deftroyed.

Thus it appears that the author has loft fight of his
firft principle. Inftead of being a nervous affedlion,
as we were informed, it turns out to be an acrimoni¬
ous ftate of the fluids, capable, it would feem, of
exerting very oppofite effe&s. Firft, the arthritic or
gouty matter exercifes a fedative power upon the ner¬
vous fyftem, whence a torpor in the larger veffels of

the

Curry on Apparent Death from Drowning , 8(c. 93

the habit ; thefe being oppreffed by plenitude, are
roufed to increafed action, and the fluids are thrown
forwards to the extremities, where the morbid offend¬
ing matter, by fome law of nature beft known to the
author, is feparated from the circulating fluids, and
depolited on the minute fibrous expanfions of the
nervous fyftem. Inflead of acting with a fedative
power here, producing torpor, &c. it irritates violently,
creating acute pain, and that very often inftantane-
oufly, followed by tenfion and fwelling, and inflam¬
mation. Such are the inconfiftencies which hypothefis
gives rife to. The nature and progrefs, entrance and
exit, of this arthritic acrimony are as clearly and pre-
cifely marked, as if it had been a matter cognizable
by the fenfes, and its exiftence fliewn by ocular
proof. But we have not room for all the remarks
which offer themfelves on this occafion. We trufl,
however, that a formal refutation of fuch arguments
is altogether uhneceffary.

Art. X. Obferoations on Apparent Death from
D 7 ’ owning , Suffocation , Ate. with an Account of the
Means to he employed for Recovery ; drawn up at
the Defire of the No rth amptonjh ire Prefervative
Society . By James Curry, M. D. Phyjkian at
Ketterton. Odtavo, 113 pages, price 2s. 6d.
Johnson, London.

THE time is within the recollection of many
now living, the author obferves, when it was
almoft univerfally believed, that life quitted the body
in a very few minutes after the perfon had oeafed to
breathe. Remarkable examples to the contrary were
indeed upon record ; but thefe, befides being ex¬
tremely rare, were generally cafes wherein the fuf-
penfion, as well as the recovery of life, had occurred
fpontaneoufly \ they were therefore beheld with alto-

niikment.

§ 4 Curry on Apparent Death from Drowning,

niffunent, as particular inftances of divine interpofition*
and afforded no ground to hope, that human means
could prove at all ufeful under timilar circumftances.
Such a view of the matter neceffarily checked any
rational and premeditated attempt to recovery, even
in thofe cafes where the appearance of death was
evidently occafioned by the operation of external and
alh gn able caufes.

That there is an effential difference between abfo«
lute and apparent death, is, however, fufficiently aff
certained j and it is one part of Dr. Curry’s plan to
point out the marks by which thofe two hates may be
diftinguifhed : on the one hand, that ufelefs efforts
may not be made ; and, on the other, that no means
may be left untried as long as there is a poffibility,
or a hope, of effecting recovery.

Although medical men are, from the nature of
their ffudies and profeffion, particularly qualified for
being ufeful on fuch occafions, it by no means fob
lows that they are exclufively fo. Intelligent perfons
of every defcription, may readily acquire fufficient
information on the fubjeft, to enable them to a 61
with propriety and fuccefs ; and it is chiefly with a
view to the inffruftion of fuch perfons, that the ob-
fervations before us have been drawn up. Technical
words and phrafes, therefore, are properly rejefted,
as far as poffible.

Although there is nothing new in the fa61s or fpe-
culations which calls for particular notice, we cannot
difmifs the prefent article without exprefifing our
opinion, that it is exceedingly well calculated to am*
fwer the purpofes intended by its author.

Art-.

Saumarez’s New Syftem of Phyfiology .

A r t. XI. A New Syftem of Phyjiology. By Richard

Saumarez, Su rgeo n .

(Continued from Vol. 4, page 568.)

WE concluded our former account of Mr. Sauma¬
rez’s work with his remarks on the Brunonian
Dodtrine of Medicine. That of Dr. Darwin he pro-
feiies not to comprehend, and, of courfe, naffes it
by without a comment. 1

The author next gives a view of the proceffion of
living beings, and endeavours to prove, from their
greater prefervative and procreative powers, their
longevity, &c. that vegetables are more perfedi in
their frame than brutes— brutes more perfeft than
the human fpecies. The reafon of this he fuppofes
to arife from the difference in the final caufe of their
exigence, which in vegetables is dated to be the pro¬
pagation of the fpecies merely, as means of affording
fupport to beings of a higher clafs : in brutes, the
gratification of the appetite , and the propagation of
the fpecies ; whilft in man, the final caufe of his exig¬
ence is, befides thofe which belongto him in common
with inferior beings, and which are only fecondarv
the perfection of his mind. '

Author, in the next place, treats of the means
by which the final caufe of human exiffence is at¬
tained ; and this leads him to fpeak of univerfities in
general, and of the College of Phyficians, and the
Corporation of Surgeons. The neceffity of fuch effa-
bhfhments, he obferves,ffs not fo great in arts and
fciences, as it is in theology. In theology, the ob-
)eti is to preferve, not to improve the doctrine f it is
to make men learn wrhat has already been proclaimed
and not to .invent a new fyftem. On the contrary, in
arts and fciences, the objedf is not only to learn what
zs already known, but to improve upon that know*

ledge.

96 Saumarezx New Syftem of Phyfiotogy.

ledge, to explore new branches of fcience, and
bring the whole to a hate of perfection. At the time
when thefe colleges were founded, the hate of fci¬
ence was totally different from what it is now ; they
poffeffea a perfect monopoly of knowledge, and there
were no ehablifhments formed in London, or other
parts of England. At this prefent time the cafe is
completely reverted ; there is a monopoly of know¬
ledge in London, and a perfect hate of herility in the
colleges, efpecially with refpeCt to our profehion.
Notwithftanding this condition of things, the fellows
who have the controul over the affairs of the college,
inhead of admitting the meritorious to participate in
the dignity attached to the eftabliihment to which
they belong, monopolize the whole advantages to
themfelves, and damp the ardour of purfuit, by ex¬
cluding men from attaining profeffional honours by
means of profeffional merit.

c The College of Phyhcians, by virtue of its charter,
has not only the privilege of examining medical men,
members of the different univerhties of Oxford and
Cambridge, with refpeCf to their qualification in their
profehion ; but they have a right alfo to fummon any
members of foreign univerhties, and prevent them
from pra&ifing in London, or within the bills of
mortality, if upon examination they are found defi¬
cient, in profeffional knowledge. The charter that
granted the college thefe important privileges, had
for its objeft, the prevention of empyrics from the
praCfice of medicine, and the laudable defife, that
every one ffiould give proper tehs of his acquirements
before he was allowed to praftife.

* At this period the art of medicine was in the moft
■barbarous hate that can be conceived , but after the
college was eftabliffied, and certain tehs made requi-
iite to enable phyhcians to pradfife, an inducement
was held out for men of dignity and abilities to en¬
gage in the hudy of it ; the hoh of empyrics coiife*
qmently dimimfhed, and almoft difappeared, and the

advantages

Saumarez’s New Syftem of Phyfiology * ; 97

advantages were very foon felt and acknowledged.
It was about this time that the immortal Harvey dis¬
covered that the blood was in a conftant ftate of cir¬
culation, in the living fyftem. Inftead of Englifh
fludents emigrating to foreign univerfities for the pur-
pofe of being taught firft principles that were falfe,
viz. that the blood was dead and ftagnant ; foreign
fludents came to England with a view of learning
principles that were true.

4 The increafe of practitioners foon began to excite
fome degree of jealoufy in the fellows of the college •
they not only found a competition, but a diminution,
of revenue ; they therefore applied to, and obtained
from, parliament* the power of making certain bye¬
laws, not in oppofition to the Spirit of the original
charter, but with a view of extending its operation.
So far, however, from adhering to this principle, the
fellows have multiplied the bye-laws of the college in
fuch a manner, that, inftead of profeffional merit be¬
ing the road to profeffional honour, profeffional
honours are now the real and true attributes of pro¬
feffional ignorance,

c After feeing what knowledge it is that disqualifies
a man to become either a fellow or a licentiate of the
college, it remains to fay, what are the eflentiai attri¬
butes by which that exalted and diftinguifhed honour
is to be obtained. A man muft have ftudied, or at
leaft palled, two years at one of the foreign univer¬
sities, Edinburgh, Glafgow, &c. (London is not con-
fidered an univerfity) before he can be permitted to
offer himfelf for examination as a licentiate ; ‘and
finally, it is neceflary that he ffiould have regularly
matriculated at either of thofe fountains of medical
wifdom, Oxford or Cambridge, for the nominal pe¬
riod of fourteen years, before he can be admitted
within the pale of a fellowlhip, in the Royal College
of Phyficians in London It is very true, that with
the exception of young gentlemen who are natives of
thofe cities, ftudents occalionally refort there only for

H the

98 Saumarez’s New Syjlem of Phyfiology

the purpofe of keeping terms ; and many abridge
their period of fervitude from fourteen nominal years,
to three of abfolute attendance. Keeping terms in
this way is called term-trotting , and the graduates
themfelves have received the appellation of term-
trotters. This is the period thought neceffary before
apprentices to furgeons and apothecaries are deemed
qualified either to bleed, or adminifter an enema to a
patient ; whilft, on the contrary, the matriculated
ftudents of Oxford and Cambridge, who have learnt
anatomy without diffe&ion, ftudied medicine by fee¬
ing the healthy, and the practice of it without vifiting
the lick, are deemed bona fide alone qualified to be
at the head of our profeffion. is jt then furprifing
that the College of Phyficians is dwindled to nothing,
and the only dignity attached to the fellows of it but
a name ; that whilft they are flattering and compli¬
menting each other in their orations, they are abuling
the licentiates, and holding at a diftance men of fu-
perior medical knowledge to themfelves ?

‘ Motives of perfonal regard prevent me from dif-
cufling the abilities of the different fellows. It has
been thought that the publication in France of the
Lime Rouge y zvith Notes , was very inftrumental in
exciting the contempt of the nation againft the Haute
Noblefle. If the profeflional abilities of the fellows
of the college were fcrutinized, it is very probable
that a fimilar lot would befall them.

‘The great leviathan of the college, ********5
before his death, is reported to have declared, that
there was no good in phyfic, although he realized
eight or ten thoufand guineas annually by the admi-
niftration of it. But here I jjpp for the prefent. J
(hall merely conclude by applying to thefe gentlemen
the memorable word* (hat came from the elegant pen
of Junius, upon a former occafion : 66 The feathers
that adorn the college bird fupport his flight : ftrip
him of his plumage, and you fix him to the earth/

Some

Saumarez’s New Syfiem of Phyfology, 99r

Some obfervations, equally fevere and juft, follow,
on the conduit of the Corporation of Surgeons: but
this is a fubjeft that we have repeatedly handled.

'• > * •> i »

c As to the Apothecaries Company, it muft be con-
fidered as a company deligned for traffic and mer-
chandife, rather than for fcience. The good it does
(and that good is certainly great) extends to the im¬
portation of the belt medicines, which it vends to
the public at an equitable price. It does not however
appear that the exertions of this company have con¬
tributed in any confiderable degree either to the per¬
fection of the practical part of chemiftry, or to meli¬
orating the pharmaceutic department ; it may rather
be confidered as a difpenfary to the fellows of the
College of Phyficians, and as more immediately
under their controul.

f After having expofed the errors of thefe different
eftabliffiments, it may perhaps be expeCted that I
fhould point out the means by which they can be
amended. The eftabliffiments of themfelves are good,
and it is the conduCt of thofe only who fuperintend
them which is bad. Inftead of afting conformably to
the principles of the inftitutions, they live in conftant
violation of their precepts. It is not new laws that
are wanted, fo much as the proper execution of the
old. The evils that exift are evils of omiffion more
perhaps than of commiffion. Let thofe who have
the management of the Surgeons’ Company aft with
diligence and zeal ; and notwithftanding the impaired
and impoveriffied ftate of its finances, we Humid
foon fee it have leftures without a theatre, books
without a library, committee-rooms without dining-
parlours, and a full purfe for the indigent and needy,
inftead of an empty one.

‘ When men are animated with a laudable fpirit to
further the end of the inftitution to which they be¬
long, we frequently behold great objefts attained by
means apparently inadequate and infufficient : on the

contrary

I' ' " __ <H

10D 6atimarez5sArac Syjiem of Phyfiology*

contrary, inftead of looking forward to the attainment
of the final caufe, they do not think of it ; they ge¬
nerally employ the means to perfonai purpofes inftead
of general ones ; to private advantage inftead of pub¬
lic good. x .

< Animated as I feel myfelf to be with the love of
my profeffion, and deeply interefted in its welfare,
I fincerely hope to fee the government of it placed on
a refpe&able eftabliftiment, and the governors of it
refpeftable men : it is then, and then only that we
may hope to fee it attain the end for which it was
defigned.

< It is however vain to hope that public adminiftra-
lions can be well managed whilft the conduft of in¬
dividuals of which they are compofed is bad. If the
parts of a building are defeftive, it is impoflible that
the whole can be good ; it is therefore a reformation
in private morals that mnft be firft attempted, before
we can expe£t to fee large maffes of men a£ting and
co-operating together in the acquifition of knowledge,
and in the general diffufion of it. The means how¬
ever are evidently the fame in both, and confift in
education and iriftru&ion/

; : .•*p • «•>*-. . ' , ■’ t!t

(To be continued

No. XXVI.

THE

MEDICAL and CHIRURGICAL

REVIEW.

SEPTEMBER, 1798.

Art. XII, Duncan's Annals of Medicine, Vol. IL

for the Year 1797.

(Continued from page 66.)

The next paper in the prefent colle&ion which
we are to notice, is by Mr. George Kellie*
Surgeon in the Navy, on the EffeQs of the Nitrous
Acid in the cure of Syphilis. Mr. Kellie employed
this fubftance in five inftances. The firft was a cafe
of chancre, cured by the acid, after fourteen days
ufe. This patient continued well three months af¬
terwards. The quantity of the acid was gradually
increafed to half an ounce daily.

The fecond was alfo a cafe of recent chancre,
which got well within ten days ; the quantity of
acid employed, half a drachm daily.

The third a cafe of bubo, cured in about eight
'Wreeks : acid from one to two drachms daily.

The next was a cafe of fecondary fymptoms, with
heftic, and general health much impaired. The ef¬
fects of the acid not remarkable in this cafe, though
continued for fix weeks.
vol. v.

Cafe

102 Duncans’ Annals of Medicine for 1191 <

Cafe 5, was of a boy, who had a phagedenic ulcer
of the leg. After refilling various means, it gave
way to the nitric acid.

The fenfible effects of the acid in the cafes above
mentioned were, increafed flow of faliva, without foe-
tor of the breath, or forenefs of the mouth ; and in¬
creafed perfpi ration.

I v V

Art . 6. The Hijlory of a Cafe , in which , after a
complete Inverjioii of the Uterus , a. favourable ter mi -
nation took place . By Mr. Thomas Brown, Surgeon
in Muf el burgh.

Art . 7. Hijlory of a Cafe terminating fuccef fully,
after Amputation at the Shoulder Joint. By Mr.
William Rurd, Surgeon in the Navy. — Thefe cafes
afford nothing remarkably new in practice.

Art. 8. The Hijlory of a Cafe in which a Tape
Worm zvas difcharged from the Stomach, upon the ufe
of an Emetic. By Mr. William White, Surgeon in
Donaghadee. — The fymptoms attributed to worms in
the alimentary canal are very equivocal. In the fol¬
lowing cafe, however, by Mr. White, they feem to
have been pretty clearly afcertained.

f Hugh Smith, a glover here, aged about thirty-fix
years, applied to me lately for advice with refpedt to
his health. He laid that he had, been in a bad (late
" of health for twenty ve-ars pail; that when he was
young, he had a very large belly ; that of late years
he had a very fevere ftomach complaint, and a molt
offenfive breath ; and that his appetite could never be
fatisfled with food. He had frequent pains of his
ftomach, and a very peculiar feeling, as he faid,
about the top of bis throat, as if lorn e thing were
coming up ^ fometimes tickling, with a fenfe of full-
nefs, and fometimes like to choke him. He had alfo
frequent headach.

‘ He was of a very dull and melancholic clifpofi-
fion ; lean, and a very bad colour. He had applied,

for

Duncans* Annals of Medicine for 1797. 10 $

for medical advice • and had taken many medicines*
without any effect.

‘ He fufpefted he had worms* as he paffed fome
fliort worms, of a fiat form, a number of years ago.

< From the above fymptoms I was led to fuppofe;
that there were worms in his ftomach. But the chief
fymptom which induced me to think fo, was the pe¬
culiar feeling and fenfation in the upper part of the

throat. f1

c I remember the cafe of a lady, who had been
long under a ftomach-complaint, had been long under
the care of a phyfician, and had taken many medb
cines without benefit. With her* the mod: trouble^
fome fymptom was a tickling, and the fenfe of fome-
thing, as it were, twifting about the top of the gullet.
In this cafe, I recommended an emetic, referring the
fenfation to fomething offenfive in the flomach. But
my advice was not taken. Some time afterwards, the
lady vomited a worm, fpontaneoufly, ox the lumbri-
cous kind, and was immediately relieved from the
fenfation; and never had any return of her ftomach-
complaint afterwards.

< Smith’s cafe was exactly fimilar to the lady’s*
with refpeft to the peculiar fenfation in his throat.
And there were other undoubted proofs of the exift-
ence of worms, viz. his having tome years ago paffed
fome joints of taenia ; and alio, the voracious appe¬
tite ; which, I think, is diagnoftic of the tape worm,
as, on account of its prodigious length, it requires
proportionate nourifhment, and, probably, abforbs at
every joint the chyle, and digefted part of our aliment.
There can fcarcely be any doubt but that it is nourifh-
ed in this way, as it exifts after it is broken into fe»
parate portions in the human body.

c Having formed this opinion of Smith’s cafe, I
gave him a very ftrong emetic of tartarifed antimony ;
and, as foon as he began to vomit, he threw up the
end of a tape worm, which his wife took hold of, and
coiled away, wThen it broke. But new efforts of vo-

I 2 uniting

104 Duncans’ Annals of Medicine for 1797.

rniting brought away the reft ; and his wife, being
greatly alarmed (as the thought that he had vomited
fome of his bowels), fent for me. And, to my afto-
niftnnent, I found he had vomited a tape worm,
which meafured eighteen yards in length. The end
laft vomited was: alive when difcharged, as his wife
informed me.

5 It was very narrow at both ends, and the joints
very fhort; but it was about half an inch broad about
its middle, and the joints rather more than an inch
long.

4 The worm is preferved, and in my poffeffion ;
and the man is now in perfe£t health.’

Art. 9. The Hiftory of a remarkable Cafe of Ty¬
phus Fever , immediately fucceeded by Meajles , ter nil
nating fuccefsf, Lilly . By Dr. George Mo Oman, Brad¬
ford, Yorkjhire . — The fubject of this cafe was a boy
twelve years of age: The plan of treatment adopted
during the fever wTas ftimulant in the higheft degree.
Tinffure of opium, caftor, and ferpentaria, were given
every hour in Port wine ; and equal parts of brandy
and water for common drink. A bottle and a half of
old Port, and half a bottle of brandy, were confumed
in twenty-four hours ! Who of our readers will
wonder, at being informed, that at the end of a
week from the commencement of this treatment, no
advantage fhould have been gained : that the pulfe
lhould have been at 144 in the minute, the tongue
black, and the ftupor fo great, that the pupils were
infenfible of the approach of a lighted candle, and the
noftrils of volatile falts ? It was not till the frequent
application of cold water to the extremities had been
made, that the pulfe began to diminifti in frequency,
and figns of amendment to take place. The author
feems, however, to have purfued his fiery ordeal to
the laft, and probably congratulates himlelf on the
fuccefs of his praftice !

The fymptoms of the mealies fhewed themfelves a
day or two after the typhus declined, and the ftimu¬
lant

Duncans’ Annals of Medicine for 1797. 105

lant plan was here again applied. The patient did
recover.

Art . 10. Hijtory of a long-continued Cafe of Con-
jtipatian , terminating fatally ; with the Appearances
on Direction . By the fame. — The patient lived two
months without evacuation. On diffeffion, the caufe
of the difeafe was found to be a fchirrous thickening
and contraction of the colon, near the beginning of
the reftum. .<

Art. 11. Extraordinary Cafe of Extra-Uterine
F'cetuSy voided through an Abfcefs in the Cavity of
the Abomen. By Mr. J. M. Wilfon, Ho uJe-Su rgeon
to the Weftminfter Hofpital.

Art . 12. Cafe of Phthifis Pulmonalis completely
cured , from the Patient breathing Mephitic Air. By
Mr. James Howifon, Surgeon.— There were in this
cafe all the fyrnptoms characterizing pulmonary con-
fumption. The following is the account of the cafe
during the cure, as given by the author. After Hat¬
ing it as the opinion of all the medical gentlemen .
who faw the patient, (Captain Roper) that he could
not furvive a month, Mr. Howifon obferves, c A
Merchantman being on the point of failing from the
Prince of Wales’s liland for Bengal, on which I had
taken my palfage, his going in her was notwithftand-
ing recommended, as, about the expefted time of our
arrival there, the healthy feafon would be felting in,
fo that if then alive, he might reap the advantages
of it.

6 All medicine had for fome time been laid afide,
except about fixty drops of the paregoric elixir, which,
he took at night, for the purpofe of affording him a
temporary relief from his teazing cough. •

‘ Upon our going on board, as it was expeCted he
would be moftly confined to bed, he had an apart¬
ment of about feven feet fquare allotted him, which ,
was lituated direCtly oppofite to the door of the great <
cabin, where I was accommodated. Our cargo con-,
lifted chiefly of raw fugars, the drainings of which,

1 3 mixing

106 Duncans" Annals of Medicine for 1797.

mixing with the bilge-water, produced fo intolerable
a fetor, that, notwithftanding fix windows, and two
large doors, opened into our apartment, I was under
the neceflity of fpending a great part of my time upon
deck.

‘ Captain Roper was, as I then thought, worfe
fituated, having the hatchway, from whence this dis¬
agreeable effluvia ifflued, immediately under the only
door he had to his cabin. In the evenings before I
went to deep, I have obferved his candle to give a
very dim light, and frequently to go out, which I at
the time afcribed to the impurity of the air ; but as he
did not complain, and as there was no other apart¬
ment vacant, I gave no notice of that circumftance to
him.

c The two firft nights wre were on board, he thought
he had Spent with more comfort than any for Some time
preceding. During the third, fourth, and fifth days
and nights, he evidently coughed lets, and kept bet¬
ter. By the 10th he had got a tolerable appetite, and
fcarcely awakened during the whole night, while his
cough and Spitting were much decreaied, and the
pain of the fide a! molt gone.

‘ His health continued improving rapidly, until
our arrival in Bengal, which was in twenty -five days,
from our leaving Prince of Wales’s ifiand. A little
of his cough Sill remained, but there was no Spit mg
of blood, and the fetid breath, and pain of the fide
were entirely gone.

* For Some time previous to our arrival, he Sept fo
very found, that the difficulty we had in awaking him,
when called to breakfaft, was remarked by every per-
fon, as Something extraordinary, his pulfe at the time
being uncommonly foft and flow.

e In the courfe of eight days after our arrival, the
remainder of his complaint entirely left him, and I had
the pleafure of feeing him fourteen months after in
perfedt health/

Art,

Duncans5 Annals of Medicine for 1797. 107

. Art. 13. Hiftory of a Cafe of imperforate llymen%
fuccefsfully removed by Operation. By Mr. John
Lucie Smith, Surgeon , Barbadoes.

Art. 14. Obfiervations on Mr. Baynton' s Method
of treating Ulcers of the Legs. By Mr. W. Sim¬
mons, Surgeon to the Manchejter Infirmary . — Mr.
Simmons approves highly of the employment of ad-
hefive plafters, as recommended by Mr. Raynton, in
his ingenious treatife on the fubjeft ; though he differs
fomewhat from Mr. Baynton as to the modus operandi
of the remedy.

c It not uncommonly happens,’ Mr. Wilfon ob-
ferves, c that a combination of the different kinds
of ulcer takes place, and that the callous is attended
with a fpecific morbid action. The latter may be
removed, and yet the ulcer may be intractable, from
affuming the former character. Whatever plan of
treatment be adopted, it appears evidently the inten¬
tion to reduce it to the (late of a fimple ulcer. And
in this form, or when attended with callous edges, the
plan of treatment recommended by Mr. Baynton, will,
I apprehend, be extremely proper. The author has
not referred it to any particular fpecies of ulcer.

c For fome years i have been endeavouring to form
a ground of preference, in the choice of remedies ap¬
plicable to this common kind of ulcer ; and after a
trial of all of them, the plan of Wife-man, of apply¬
ing precipitate and light bandages, has gained a de¬
cided preference. When the granulations rife above
the level of the fkin, the vitriol of copper has been
fubflituted as reprefling them, and leaving the furface
more difpofed for cicatrization. Rhubarb, fo ftrongly
recommended by Mr. Home, is feeble in its powers
when compared with precipitate. But the admirable
plan of applying adhefive plafters, as directed by Mr.
Baynton, frees the furgeon from farther difficulty in
his choice of means. The principle of their opera¬
tion is exemplified in the application of fheet-lead, as

I 4 approved

■f,

108 Duncans* Annals of Medicine for 1797.

approved by the late Mr. Elfe ; which, from nicety
in its application, has fallen into difufe.

c Mr. Baynton obferves, that the efficacy of this
plan depends on the endeavour to bring the divided
parts nearer together. But whoever attends to its
effect, on an extenfive old ulcer, on the anterior part
of the leg for example, will fee the impoffibility of
bringing the original fkin to approximate. Admitting
his facts, the benefit may be produced in two ways,
firf by acting as a bandage, giving tone and remov¬
ing induration ; an d,fecondly, by keeping the ulcerat¬
ed furface level with the furrounding fkin. The uti¬
lity of bandaging is generally allowed, and it would
feem that a bandage of fuch materials is preferable,
by making a more fteady and uniform preffure than a
common roller. The procefs of fkinning refembles
the freezing of water, or the cryftallization of falts,
both of which are facilitated by an even furface,
which is effential to the due configuration of the
cryftals. On the fame principle it is, that the adhe-
five plafters are fo efficacious.

c In an old hollow ulcer, with hard callous edges,
the cure is accomplifhed by the filling up of the ca¬
vity with new granulations, and the fubfidence of the
neighbouring parts. Whilft the former is going on,
the latter is effefted by preffure inducing the abforp-
tion of the thickened and indurated integuments, oc-
cafioned by interftitial depofition. Thefe two points
being attained, cicatrization, or the cryftallization of
fkin, will be greatly affified by keeping the furface
level. This ft age of the healing procefs takes place,
in a beautiful and rapid manner, under this treatment.
But fliould the granulations be fuffered to rife above
the level of the adjoining fkin, an immediate obftacle
prefents itfelf, and the fkinning is impeded. That
there is an extenfive produflion of new fkin, may
be afcertained by admeafurement from day to day,
c Viewing the introdu&ion of this practice, as one
of the greatefl improvements in modern furgery, I

have

Duncans’ Annals of Medicine for 1797. 109

have thus attempted an explication of the principles
on which it a£ts, in a manner fomewhat different from
its inventor, hoping thereby to extend its utility. I
now apply it in all cafes where there has been a de¬
finition of common integument, and I find that it
does more in one week, than could be accompliihed
in feveral, according to the old method. In perfons
of an irritable fkin, the emplaftrum lithargyri, anfwers
equally well, and is not liable to excite excoriation.’

This concludes the original articles in the volume.
The third fetion is devoted, as ufual, to Medical
News. The line of diftin£tion, however, is not ac¬
curately drawn between this and the former part.
We have firft a paper refpefting the difeafes rnoft
common among the troops in the Weft Indies, by Dr.
Wright. The obfervations here furnifhed, though im¬
portant, do not materially differ from thofe given by
the fame author in the feventh volume of the Me¬
dical Fa£ts and Obfervations*.

The next article is furnifhed by Dr. Withering of
Birmingham, and relates to the cure and prevention
of the plague, by fri6tions of the whole furface of the
body with olive oil. This method is faid to have
been firft propofed by George Baldwin, Efquire, his
Britannic Majefty’s Agent, and Coniul-General at
Alexandria, in Egypt. The dire6tions are fimplv
thefe. ;

c Immediately after a perfon is perceived to be in¬
fected with the plague, he muft be taken into a clofe
room, and over a brazier of hot coals, with a clean
fponge dipt in warm olive-oil, his body muft be very
brifkly rubbed all over, for the purpofe of producing
a profufe fweat. During the friction, fugar and ju¬
niper berries muft be burnt in the fire, which raife a
denfe and hot frnoke, that contributes to the effe£t.

* See Med. Rev. vol. 4, page 250.

( The

110 Duncans* Annals of Medicine for 179T.

The fri&ion ought not to be continued more than
four minutes, and a pint of oil is enough to be ufed at
each time.

‘ In general, the firft rubbing is followed by a very
copious perfpiration 5 but lhould it fail of this effedl,
the operation may be repeated, hi ft wiping the body
with a warm dry cloth 5 and in order ftill farther to
promote perfpiration, the patient may take any warm
fudorific drink, fuch as elder-flower-tea, &c.

c It is not neceftary to touch the eyes ; and other
tender parts of the body may be rubbed more gently.

‘ Every poffibie precaution rnuft be made ufe of, to
prevent the patient taking cold, fuch as keeping co¬
vered thofe parts of the body not dire fitly under the
operation ; nor muft the linen be changed till the per¬
fpiration has entirely fubfided. The operation lhould
be repeated once a-day, until evident fymptoms of re¬
covery begin tc. appear.

c If there are already tumours on the body, they
fhould be gently and more frequently rubbed, till
they appear to be in a ftate of fuppuration, when they
may be dreffed with the ufual plafters.

6 The operation ought to be begun on the firft ap¬
pearance ot the fymptoms of the difeafe; if negle£ied
till the nerves and the mafs of blood are affefted, or a
diarrhoea has commenced, little hopes can be enter¬
tained of cure ; but ftill the patient lhould not .be de-
fpaired of, as, by an aftiduous application of the means
propofed, fome few have recovered even after diar¬
rhoea had commenced.

c During the firft four or five days, the patient rnuft
obferve a very abftemious diet; the author allows only
a final] quantity of vermicelli, Amply boiled in water.
Nor muft any thing be taken for the fpace of thirty or
forty days, except very light food ; as, he fays, an in-
digeftion in any ftage of the diforder might be ex¬
tremely dangerous. He does not alloy/ the ufe of
wine till the expiration of forty days*

* There

Duncans* Annals of Medicine for 1797. Ill

c There is no inliance of the perfon rubbing a pa¬
tient having taken the infection. He fflould previ-
oufly anoint himfelf all over with oil, and muff avoid
receiving the breath of the infected perfon into his
mouth and noftrils. The prevention to be ufed, in
all circumftances, is that of carefully anointing the
body, and living upon light and eafily digeftible food.

4 One of the molt ingenious obfervations made by
Mr. Baldwin is, that among upwards of a million of
inhabitants carried off by the plague, in Upper and
Lower Egypt, during the fpace of four years, he
could not difcover a tingle oilman, or dealer in oil*

It appears to us, that the evidence here adduced is
more fatisfadtory as to the preventive powers of the
application, than to its fanative ones, alter the difeafe
has once taken place.

An intereffmg account is given by Mr. William
Simmons, Surgeon at Manchefter, refpedting the ufe
of arfenic in the hooping cough, a diforder that feems
hitherto to have baffled all the efforts of practitioners.
‘ For upwards of three years,5 Mr. Simmons obferves,
* I have given arfenic in the hooping cough, with
the mo ft falutary effedt. In general, it has put a flop
to the difeafe in about a fortnight ; and it has never
failed to moderate it in a few davs. I have admin iff

tered it in one unfuccefsful cafe only, and even then
it afforded considerable relief*, and had I been called
in earlier, or had I been permitted to pay the atten¬
tion the cafe required, I am of opinion it would have
fucceeded in that alfo. I have ufed it in the form of
the mineral folution of Dr. Fowler, and in the dofes,
and with the precautions recommended by him in his
work on intermittents, &c. Children of a year old
may take it with fafety. Previous to, and during its
ufe, bleeding, blifters, and emetics, may be. employed
according to the indications, particularly the latter.
It fflould he continued till the difeafe be fubdued, and
then leaving it off for a week, it fhould again be had

recourfe

112 Duncans' Annals of Medicine for 1797.

recourfe to for a week, to prevent a return. Should
expofure to cold occafion a relapfe, it has hitherto put
a flop to it, on being taken for a few days.

‘ Under thefe precautions, and with thefe regula¬
tions, I apprehend it will generally be exhibited with
fuccefs 5 and I recommend it with confidence to the
profeffion.’

Memoir on the Nature and Treatment of Rachitis,
by Citizen Bonhomme of Paris. According to the
author of this memoir, the nature of the rachitic dis¬
order arifes, on the one hand, from the developement
of an acid, approaching in its properties to the vege¬
table acids, particularly the oxalic ; and, on the other,
from the defeft of phofphoric acid, of which the com¬
bination with animal calcareous earth, forms the na¬
tural balis of the bones, and gives them their folidity.
From this opinion he infers, that the proper treatment
of rachitis muff turn on two principal points, viz. to
prevent the developement of the oxalic acid, and to
re-eftablith the combination of the phofphoric with
the bafis of the bones. Thefe intentions may, he
thinks, be often accomplifhed, by the internal ufe of
phofphate of lime, and phofphate orfoda, and by the
external ufe of alkaline lotions. Several cafes are re¬
corded, in which thefe pradlices were apparently at¬
tended with the belt effe&s. A powder was formed,
of equal parts of phofphate of lime and phofphate of
foda, and taken by infants twice a-day, to the extent
of a fcruple for a dofe. The alkaline folution was
made, by diffolving half an ounce of common potafh,
or fait of tartar, in a pound of very pure fpring water.
When this folution is to be ufed, the (kin mult firft he
rubbed with a dry cloth, or a piece of fine flannel.
After this precaution, the difeafed parts are to be
wafhed carefully with the warm folution, and at length
wiped, fo as to leave no trace of moifture. This walk¬
ing muft be repeated, at leaft, twice a-day.

He affirms, that he has feen various inftances of
children cured of their difpofltion to rachitis, merely.

Duncans* Annals of M edicifie for 1797, 11 S

by wa filing with the alkaline liquid; but in mod; cafes
he has thought it neceflary to fecure the firft fuccefs
by other remedies. The alkaline lotion is a remedy
the more preferable, as it is not at all difgufting, and
fcarcely in any refpeft troublefome to children. But
the internal remedies, he confiders as pofleffing fupe-
rior efficacy.

He contends, that the calcareous phofphate, taken
internally, is really tranfmitted by the lymphatic paf-
fages, and contributes to oflification ; and that the
internal ufe of the calcareous phofphate, whether alone
or combined with the phofphate of foda, powerfully
contributes to reftore the natural proportions in the
fubftances of the bones, and accelerate the cure of
rachitis. In proof of thefe opinions, he relates various
experiments made on young fowls, fome of which
took a proportion of calcareous phofphate with their
food. After an exaCt comparifon, there could, he.
tells us, be no doubt of the efficacy of calcareous phof¬
phate, in favouring the progrefs of offification.

Dr. j. Harnefs, Phylician to the Britifh fleet in the
Mediterranean, gives an account of the good effects
of the gaftric fluid of graminivorous animals in the
cure of ulcers. The application of this fubftance in*
fcorbutic ulcers, and thofe where there is a tendency
to mortification, feems, in a great number of inftances,
to have been productive of the happieft confequences,
after the failure of other remedies.

A letter is given from Mr. Hammick, Jun. Affiftant
Surgeon to the Royal Hofpital at Plymouth, giving
an account of the benefit obtained from the external
ufe of hops, in the cure of large fordid ulcers. A
large handful of hops are directed to be boiled with
a quart of water, till a ftrong decoction is formed.
Oat-meal, with lard or oil, is then to be mixed with
the hops and the deception, till the poultice becomes
of a proper confidence. It is then applied to the ulcer
without any intervening lint. Previoufly to this ap¬
plication, the ulcers are to be well fomented with the

decoftion.

114 Duncans* Annals of Medicine for 1191,

decoftion. The pain proceeding from the ulcers is
faid to be foon alleviated, and the ulcers themfelves
foon ceafe to fpread. They become clean, and in a
Hate to be dreffed with lint or any foft ointment.

Dr. John Wilfon, Phyfician at Spalding in Lincoln^
ihire, gives his teftimony in favour of the argentum
nitratum as a remedy in epilepfy. He employs it in
dofes of two grains and a half, three times a-day.

Dr. Thomas Garnett, Profeffor of Phyfics in An--
derfon’s Inftitution, Glafgow, gives the following ac¬
count of the benefit he has obferved from the oxygen¬
ated muriate of potaih, employed as a medicine. € I
have for foriie years,’ he fays, c entertained an idea
which I have repeatedly mentioned in my chemical
leftures, that when a deficiency of oxygen occurs in
the fyftem, that principle might be better fupplied by
means of the oxygenated muriate of potafh, than by
any other method with which we are acquainted.

‘ For fome time I had no opportunity of fubje<fring
my theory to the teft of experiment. But, during the
laft fu turner, a cafe fell in my way, which feemed to
offer a fair opportunity of trying it.

c A lady in the north of England, aged about
thirty-three years, of a delicate habit, had for feveral
years been affeSted with fymptoms of fcurvy. Her
gums bled frequently, and her fkin was covered with
livid blotches and petcchim, fome of which were as
large as the palm of the hand, or even larger ; while
others did not much exceed in fize the point of a pin,
Thefe appearances were always worft during the pe¬
riod of menftruation ; and the periodical difcharge
was always very profufe. She complained of great
coldnefs, and was at thofe times almoft incapable of
the leaf; exertion. She naufeated her food, but had
a great defire for frefli vegetables. Her countenance
was very fallow, and her pulfe weak and feeble. —
The complaint was always wor-fe in the autumn than
at any other time of the year. She had tried a va¬
riety of remedies, without any permanent relief. Ve¬
getable

Duncans’ Annals of Medicine for 1797, 115

getable acids, and the elixir of vitriol, afforded fome
alleviation of the complaint, and Ihe thought Ihe re¬
ceived fo much benefit from the ufe of the cold bath,
that Ihe bathed almoft conftantly, both during fummer

and winter.

c I had for fome time intended to advife her to in-
hale oxygen gas ; but as an apparatus for that purpofe
could not ealily be procured, I determined to try the
e thefts of the oxygenated muriate of potafh. She was
direfted to take" three grains of it, four times a-day, in
a little water. As this produced no uneafmefs, the
dole was increafed to double that quantity. She foon
found the fmaller fpots difappear, and the larger ones
become lefs. Her ftrength became greater than for
years ; her countenance grew much clearer,^ and ihe
was able to take a good deal of exercife ; betides this,
the mendrual difeharge was not, by any means, fo
profufe. In thort, the efFefts produced by this fait
exceeded my mod tanguine expectations ; and though
fome of the fymptoms returned in fome degree, when
tire had one day fatigued herfeif very much with walk¬
ing, yet I really hope, that, by means of this medi¬
cine/ the may be perfeftly rfttored to health. She
has now begun to try the inhalation of oxygen gas, as
well as the oxygenated muriate of potafh.

It is well known, that about feventy-five cubic
inches of extremely pure oxygen gas may be pro¬
cured from an hundred grain's of this fait, by means
of heat. The oxygen is fo loofely attached,, that. it
is difengaged even by the light of the fun. It is rapid¬
ly difengaged, and combines with combudible fub-
dances, as is evident from its detonation with fulphur ;
which detonation is dill more violent with phofphorus.
We may therefore conclude, it would be readily de~
compofed by the carbon and hydrogen in the blood,
and would diminiih the quantity of thefe principles,
or increafe the proportion of oxygen.

c As the oxygenated muriate of potafh has, in this
country, been "hitherto prepared as a matter of curio-

iity

116 Duncans’ Annals of Medicine for 1797.

fity only, its price was very high.. But when I began
to hope that it might be ufed in medicine, I requeued
Mr. Hoyle, an ingenious bleacher and dyer in Man-
chefter, to try if he could form it at the fame time
that he prepared the bleaching liquor. He has fuc-
ceeded perfectly, and can now fupply druggifts and
apothecaries at a reafonable price.’

An account has been drawn up, and printed, of
the women delivered, and children bom, in the Bri-
tifh Lying-in Hofpital of London ; and alfo of the
twins, ftill-births, and deaths, from the time of its
inftitution, in November 1749, to the end of the year
1796. This account, wrhich, we are informed, is
drawn up by Dr. Combe, Phyfician to the above
inftitution, contains interefting information refpefting
different particulars. It appears that the whole num¬
ber of women delivered, during that period, amounted
to 24,079 ; that of thefe 281 had twins, fo that the
number of children born amounted to 24,360; of
thefe, 12,531 were boys, and 11,828 were girls;
that 978 children were ftill-born ; that 766 died foon
after birth ; and that 385 women died foon after de¬
livery,

‘ The proportion of deaths, both of the women and
children, appears to have been much greater during
the firft periods of the inftitution, than during the
latter periods ; as is manifeft from the following ab«
ftraft.

From 1749 to

Death of

worn.

Death of chil.

1759,

1 in

42,

15.

From 1759 to

1769,

1 in

50,

.20.

From 1769 to

1779,

1 in

53,

42.

From 1779 to

1789,

1 in

60,

44.

From 1789 to

1797,

1 in 304,

84.

The following remarks of Mr. Benjamin Bell, of
Edinburgh, occur in the fecond edition, lately pub¬
lished, of his Treatife on the Gonorrhasa Virulenta,
and Lues Venerea. RefpeHing the ufe of the nitrous
acid in fyphilitic complaints, Mr. Bell informs us.

Duncans’ Annals of Medicine for 1797. 117

that in every trial which he has made with this
acid in the cure of fyphilis, it has completely and en¬
tirely failed ; infomuch that he is now clearly of opi¬
nion, that no dependence fhould be placed on it.
And whether mercury has been given or not, it ap¬
pears to him to be equally inefficacious. The favour¬
able opinion which fome have been induced to form
of the nitric acid, in the cure of fyphilis, Mr. Bell
fuppofes to have arifen from chancres, and other
fymptoms of the difeafe, having difappeared, while
this acid was the only remedy employed for them.
But from frequent opportunities for observation, he af-
ferts, though contrary to the generally received opi¬
nion, that chancres, as well as fome other fymptoms
of 1 ues venerea, will occafionally difappear, whether
any remedy be employed for them or not. In fome
inftances thefe will never recur again, as he has repeat¬
edly found to happen, even with nodes. But moft
commonly, venereal fymptoms afterwards again ap¬
pear with more violence in fome other form.

This being the cafe, and the moft diftrefsful confe-
quences having enfued in all the inftances in which he
has known this acid to be depended upon for a cure,
the difeafe having rapidly gained ground in all of
them, by which much blame was thrown upon the
praftitioner, for advifing what at beft muft be confi-
dered as a very doubtful remedy, when another,
which rarely or never fails, was in his power; Mr,
Bell confiders it as hazardous and improper in any
degree to truft to it. He is afraid that much mifchief
is likely to enfue from the frequent trials which are
now making with this acid, in many inftances, per¬
haps, without any dread of the failures which are
likely to occur from it.

Mr. Bell has never found, that the nitric acid,
whether given internally, or applied as a walk, has
proved more ufeful in the cure of niters of any de-
fcription, than the acid of vitriol, or the muriatic acid ;
while none of them have a£ied with fuch certainty in

vol. v. K cleanfing

1 18 Saumarez’s New Syftem of Phyjiology.

cleanfing fores, and thus reducing them to a healing
flate, as the different varieties of the vegetable acid,,
whether common vinegar, lemon-juice, or the acid of
forreh

Some other articles of inferior moment might have
been noticed, had our limits permitted, The volume
concludes, as ufual, with an account of deaths of
eminent practitioners, and a lift of new books.

f \

< j

-Art* XIII. A New Syjlem of Phyfiology. By
Richard Saumarez, Surgeon.

(Concluded from page 100.^

OUR account of the prefent wrork has been car¬
ried to a confiderable length : both becaufe of
the extent and variety of the fubjeCf ; and becaufe it
contains* in the manner of its execution, no inconfi-
derable portion of originality.

The remainder of the firft part is occupied by an
inquiry into the means by which individuals attain
the final caufe of their exiftence : into the relation
which man bears to the Deity • and that which the
Deity bears to man.

In the fecond part of the work, the author treats of
the organs, as the inftruments through which animat¬
ed beings fulfil the final caufe of their exiftence. The
three firft chapters are employed in explaining the
anatomical ftrufture of the vegetable fyftem ; its de-
compofition, and death ; and the circumftances re-
fpeCling vegetable temperature.

Chap. 4, treats of the mode of propagation in dif¬
ferent animal fyftems, from the moft fimple to the more
complicated. In the lower order it is obferved to be
more regular, and more extenfive, than in the higher.

• • . cThe

Saumarez’s New Syfiem of Phyjio logy , 119

The experiments of Mr. Cruikfhank and Dr. Haigh-
ton * are adduced to prove that corpora lutea do not
conditute the ted of impregnation, as thefe have been
found to exid when it cannot have taken place, as
where the fallopian tube has been previoufly divided.
The oedrum, or excitement of the ovafia, which is the
confequence, mud therefore be fuppofed adequate to
occadon an evolution of the ova to a certain degree.
In the amphibia and dfh it is fhewn that fexual inter-
courfe is unnecedary ; whilft in quadrupeds, fecunda¬
tion can take place by that mean alone.

In the fifth chapter the peculiarities in the mode of
generation in the kanguroo are pointed out : but thefe
we have before noticed f.

The dxth chapter treats of the proximate caufe of
cedrum, which is fuppofed to depend on a fenfe of
Want in the generating organs* and does not take
place till thefe are fully evolved. (Edrum exids in
thofe fydems that have generative organs, but are def-
titute of fexual, in a higher degree than in thofe fyf-
tems that poflefs both.

The following chapters treat of the mode of pro¬
pagation in the human fpecies, of mendruation, and
of the generating organs of the male. — This concludes
the drd volume.

The fecond volume commences with an account of
the procefs of evolution in the human foetus.- — Chap*
2. Of predifpqfition in general . The difference be¬
tween the foetal date and the adult confifts in this,
that the diderent organs in the former are in a padive
date, podeding only a capacity to act , and requiring
proper fubjecfs on which that capacity may be ex¬
erted, and difplayed in the production of addion. It
is this capacity of action, of the eye to fee, of the ear
to hear, of the tongue to tafte, of the nerves to feel,

* See Med. Rev. vol. 4, pages 321, 332.
f Ibid, vol. 3, page 193,

K 2

120 Saumarez’s New SijJiem of Phyjiology .

of the lungs to refpire, of the ftomach to digeft, &cf
&c. which is denominated predifpojition. it is in this
power which the fyftem altogether, or the different
organs in particular feverally poffefs, either of operat-
ing upon, or in refilling the operation of external fub-
Itances, that the fyftem may be faid to poffefs a pre-
difpofition to healths and fome conftitutions poffefs
this in fo eminent a degree, that they pafs through
the courfe of a long life in the undifturbed enjoyment
of it. So long as the proper relation fubfifts, of power
in the organs, and aptitude in the fubjeCt matter,
health is preferved and difeafe prevented.

The power to aft therefore exifted before that
power was abfolutely exerted, in the fame manner
as the predifpofition to aft in the lungs, &c. exifted
before action took place : it only took place when
the fubjeCt matter (air) fitted for their aCtion was ap¬
plied ; and fo of the other organs. The power,
•therefore, or capacity, is refident within. The means
by which that power is called forth into energy comes
from without s the refult of which is the production
of organic action ,

The aCtion produced is not the "caufe of life, as has
been erroneoufly fuppofed, but merely an effect of it.
Life may and does fubfift. without organic aCtion,
although organic aflion cannot fubfift without the
exiftence of life. 4 Life had a prior exiftence to the
organization, and organization itfelf to the action pro¬
duced. Life is the primary and efficient caufe, of
which organization is the fecondary or inftrumental
caufe ; and organic aCtion itfelf is the final caufe,
which proceeds from the living power of the organs
a Cling upon fubftances foreign to themfelves, when
they poffefs a proper aptitude to be afted upon. So
long as this relation continues to fubfift, of power in
the organ, and aptitude in . the fubjeCt matter, the
fyftem receives the fupply it perpetually demands ;
the fenfation of health and of ftrength, fo delightful
and agreeable, may be then faid to ex ill ; on the con¬
trary,

121

Saumarez’s New Syjtern of Phyfology.

trarv, when there Is a mal-conformation of the organs,
or the fubjeft matter applied to them is either im¬
proper from excefs or defeft, or from the nature of
its fenfible qualities, difeafe takes place/

On the lubje£I of predifpolition to difeafe, the
author obferves, that fuch is the conltrudlion of all
generated beings, that whilft their powers of prefer-
vation and refiftance are limited, the celeterious caufes
by which they may be affailed, are aim oil infinite both
in number and power; fo that in the lull enjoyment
of health and of ftrength, all are eonftantiv predihoof-
ed to the operation of morbid caufes, by which difeafe
is produced.

The fyftem is predifpofed to difeafe from accidents,
becaufe the organization is not diffidently drong to
refill the operation of the mechanical powers to which
it is expofed, and by which it is often affailed. it is
predifpofed to difeafe, from the operation of fubllances
whofe powers do not refide fo much in their me¬
chanical as in their fpecific or chemical qualities, as
the different fpecies of poifon, natural and morbid.—
Finally, it is predifpofed to difeafe from the operation
of the fenfible qualities of chemical bodies — of fire
in a fenfible form, of lightning, of various caufdcs of
an acid and of an alkaline nature.

The following obfervations occur on the Rrunonian
doftrine of predifpolition. c It appears that Dr. John
Brown’s ideas ot predifpofition were very different
from thofe I have endeavoured to explain. Predif¬
pofition he defines to be tc a ft ate intermediate betwixt
health and difeafe : the powers producing it are the
fame with thofe that produce difeafe p. 59. This
nonfenfe would be of itfelf perfectly, unintelligible,
were it not for the imperfect explanation which the
context affords. The context fays, that cc predifpo¬
fition arifes from the fame exciting powers ailing
upon the fame excitability from which both health
and difeafe arife, and is an intermediate Hate between
both.” So far from this opinion being true, that a

K 2 llatt

122 Saumarez’s New Syflem of Phyjiology .

ftate of prfedifpofition arifes from the fame exciting
powers addng upon the fame excitability from whence
both health and difeafe arife, and is an intermediate
Hate between both, that a date of predifpofition, pro¬
perly defined, can only exift before the exciting pow¬
ers have been applied, or before they have produced
any addon upon the excitability. Predifpofition, as
we have feen, really and truly exifts in the fetal ftate
altogether ; it exifts in the collapfed lungs ; in the
fetal ftomach before it has received any food ; in the
organs of generation, and in various other parts. On
the contrary, according to him (and, I may add, molt
others alfo), at ftate of predifpofition is a ftate of pof -
difpofition : it is predifpofition ended, and addon be¬
gun ; it is the origin of difeafe before the morbid ac¬
tions of the fyftem have had their full fwing. It evi¬
dently appears, that Dr. Brown had no knowledge
whatever of the condition of the fetal ftate, of the
ftate of predifpofition in which it then exifts 3 of the
capacity of addng which it pofl'efies, and of the power
by which addon is ultimately produced.

* In every fyftem whatever there is a tendency to
evolution and health, before the tendency to difeafe
and death. There is a period allotted to both : when
perfeddon is attained, it ends, and the tendency to
dififolution begins. It would be far otherwife, if life
were the forced ftate he fuppofes 3 if it were true,
“ that the tendency of animals every moment is to
diffolution 3 that they are kept from it not by any
powers in themf elves , but by foreign powers, and
even by thefe with difficulty, and only for a time 3
and then, from the neceffity of their fate, they yield
to death.” If life were the forced ftate he fuppofes
it to be, the proper application of his exciting powers
would perpetuate animal life ad infinitum : inftead of
animals being forced to die, they would be forced to
live 3 and he might as eafily refufcitate a dead animal
by means of his ftimuli, as excite motion in a paffive
top by the addon of a whip. The whip may be com¬
pared

Saumarez’s New Syftem of Phyjiology. 123

pared to his exciting powers ; the top to the fub fiance
in which excitability refides ; and the motion pro¬
duced by the combined agency of the whip and
top together, is exaftly analogous to excitement or
life, which is forced and whipped out by the opera¬
tion of his exciting powers aCting on his excitability.
It is very obvious indeed, that Dr. Brown grounded
his fyftem upon the phenomena be beheld common
matter difplay ; he faw excitement produced in the
fyftem by the introduction of different fubftances of
brandy, wine, &c. he therefore referred excitement
to the brandy as its caufe, in the fame manner as the
motion produced in the top by the action of the whip.
Both cafes, however, are totally oppofite and diftinCt :
in the one cafe, the top is totally paffive, and yields to
the moving power which the whip communicates : in
the other cafe, the animated fyftem conftitutes the
power which acts upon the brandy ; the fyftem is
the caufe exciting, the brandy, the thing excited
upon ; and in this effort it is by which aCtion is
produced.

* A neceffity evidently fubfifts, that the food intro¬
duced ftiould correfpond to the ftrength or weaknefH
of the fyftem. In atonic difeafes, where the fpecific
power of the aftimilating organs is extremely weak,
the ordinary kinds of aliment become unfit to be in¬
troduced ; and we are obliged to refort to food that
poffeffes the ftrongeft poffible aptitude to be aCted
upon, in order that it may be digefted : inftead, there¬
fore, of giving folid, liquid food is preferred ; and we
are taught by experience that fermented liquors and
animal juices poffefs a ftronger aptitude to be afted
upon by the ftomach than cold water, or acid or other
fubftances of the fame clafs. In proportion, therefore,
as the ftrength of the fyftem decreafes, the aptitude in
the aliment ought to increafe : hence arifes the necef¬
fity of giving in the latter periods of low fevers wine
and brandy, when every other fpecies of aliment is
rejefted unaltered and undigefted.

K 4 ‘ It

124 Saumarez’s New Syflem of Fhyjiology .

c It is owing to the total confufion of ideas, to the
total ignorance of phyfiological knowledge, that Dr,
Brown, in the very onfet of his book, chap. i. art. 1.
under the title of what he calls Explanations, but
which are really and truly axioms, (hews himfelf ig¬
norant alfo of the difinftion that fubfiffs between
medicine and diet. Expl. 1. “ Medicine is the fcience
ofpreferving the good, and preventing and curing the
ill health of animals.” This proportion, I maintain
it, is falfe : the means by which the good health of
animals is preferved, is not a fcience, neither does it
belong to any branch of medical knowledge : it be¬
longs to the dietetic branch, arifing from experience
alone, and in which men totally ignorant of medicine
are perfectly converfant. This knowledge extends to
the whole range of the brute and even vegetable
creation, amongf which the fcience of medicine does
not yet appear to have made any progrefs. On the
contrary, the praftice of medicine is the art (not the
fcience : our knowledge of its operation, and the fub-
jeft on which it operates, is as yet too imperfect to
bring it to any fcientific rule) by which difeafe is
cured, and health refored ; and medicine itfelf is
the mean bv which the end is attained,

c Although it is the fyfEm which in general pof-
feffes the power by which health is preferved, and
difeaie prevented, or difeafe cured after it aftually
fubfiffs, there are various complaints which arife from
the application of fpecific poifons, and which can only
be cured by fuch remedies as have the fpecific power
of uniting with and defraying the fenfible properties
which thofe poifons po fiefs : — mercury for the lues,
fulphur for the itch, & c. &c. Thefe remedies, like
thofe poifons, are taken up into the blood, or aft
upon the poifon in the part, and produce their bene¬
ficial effefts by eliminating and defraying the fenfible
qualities thofe poifons contain. So totally defeftive,
however, is the Brunonian fyfem, that it does not
provide at all for the fpecific aftion of fpecific poifons :

the *

Saumarez’s New Syftem of Phyjio logy. 125

the author, therefore, gets rid of the fubjeft thus, p. 63.
“ The only cure for poifons is their early difcharge
from the fyftem ; and if, as often happens, others, by
wounding an organ neceffary to lire, are fatal, the
effefts of both are foreign from our prefent purpofe,
and ought to be referred to local difeafes.” Aware
of the deleterious effects which poifons produce, he
confequently recommends their early difcharge from
the fyftem : he, notwithftanding this acknowledgment,
fays, <c that it is excitement atone through its varying
degrees , that produces either health , difeafe , or reco¬
very ; it alone governs both univerfal arid local difeafes ,
neither of which ever arife from faults in the fo lids or
fluids , but always either from increafed or diminijhtd
excitement : hence the cure is never to be directed to
the fate of the fo lids or fluids, but only to the dimi¬
nution or the increaje of excitement” p. 50.

c Thus, then, has Dr. Brown, with one ftroke of
his pen, deftroyed the diftindtion that the wifeft and
bell Phyfiologifts have ever made, of difeafes that
were merely accompanied by an increafe or decreafe
of the action, either of particular parts, or of the fyf¬
tem altogether, from thofe that were accompanied,
not merely by an adtion too high or too low, but
where the action was totally altered from the healthy
ftate, conftituting a certain peculiarity in the nature of
the difeafe itfelf, known by the appellation of 'fpecific.
Thefe fpecific difeafes evidently arife from the fpecific
quality and adtive powers of the poifon, and the weak-
nefs of the fyftem in refifting their operation. When
thefe poifons therefore produce their effects upon the
fyftem, fometimes deftroying its adtion in a few hours,
or in a few moments, they ought, in fuch cafes, to be
called fedatives. Shall it be denied, when the ftrongeft
men are fuddenly deftroyed by the inhalation of a few
draughts of mephitic gas, that the operation of it is
not diredtly fedative ? When the poifon of the ti~
cunas, of lauro-cerafus, and efpecially of different
ferpents, which Dr. Ruffel, in his late molt fplendid

work.

3 26 Saumarez's New Syfiem of Phyfiology.

work, has decidedly proved, deftroy different animals
in twenty or thirty minutes, without producing, in
many inftances, any fenfible aft ion from the time the
poifon is received, to the diffolution of the animal,- —
Shall it be pretended that death is not produced by a
fedative effeft upon the fyftem ? It required the ar¬
rogance of Dr. Brown himfelf to deny the'exiftence
of fe datives,' — to deny the fpecific mode of their ope¬
ration, — to deny the fpecific nature of the difeafe they
produce, or that the matter which is in confequence
evolved, is capable of producing the fame poifon upon
another fubjeft. Thus it is we have the poifon of
plague producing plague, but not fmall-pox ; the
poifon of final! pox producing fmall-pox, but not
mealies-; the poifon of the itch producing the itch,
but not Syphilis. But, according to the Brunonian
Syfiem, all thefe fubffances are one and the fame in
their nature : the only difference there is between
them, confifts in the different degrees of flimulant
properties they poffefs, and in the different proportion
of excitement they produce ; fo that the pox and the
itch, typhus fever, and the plague, &c. &c. may be
cured by the fame means, the nature of the ftimulus
alone varying in degree. It might indeed be further
Hated, that the caufe producing the difeafe, and the
medicine effecting the cure, are, according to him, in
their nature, one and the feme ; the only difference
between them confining in the degree of ftimulating
power they Severally poffefs. Hence he fays, that
“ whether the matter of contagion act by a flimulant
or a debilitating operation, its operation is the fame
with that of the ordinary power , that is to fay, the
caufe of difeafe is the fame ; and if, as Sometimes
happens, no general affeftion follows the application
of contagion ; if no undue excefs or defect: of excite¬
ment is the confequence, the affeftion is altogether
local, and foreign to this place.” So far from the
affertion being true, that the operation of morbid
poifons on the fyftem arifes from the ftimulus they

produce.

Saumarez’s New Syjlem of Phyjiology. 127

produce, being merely in excels or clefeft ; and that
the effeCt produced on the fyftem is the fame in kind
as the nature of the caufe, whether it be above or
below par $ fo that an high ftimulus (hall produce in-
creafed excitement, and a low ftimulus a weak degree
of it, it is often totally otherwife.

‘ If this were the cafe, the atonic fymptoms, in
atonic difeafes, ought to manifeft themfelves more
eminently after the poifon has been applied * at the
time when it was in the plenitude of its power, adting
upon the excitability in the aggregate, without abate¬
ment or divifion, than it is found to do at the latter
period of the difeafe. If this were true, the fymp¬
toms of debility, of putrefadiion, and of death itfelf,
ought to manifeft themfelves as foon as this imperfect
ftimulus is received. Thefe atonic fymptoms ought
progreffively to go off, in proportion as the effefts are
abated by the introduction of adequate ftimuli, and
the poifon itfelf weakened by divifion and feparation.
If this were the cafe, typhus fever would invariably
begin with fymptoms of putrefaction, and terminate
with thofe of inflammation ; inftead of the difeafe be¬
ginning, as it frequently does, with fymptoms of in¬
flammation, and terminating with thofe of putrefac¬
tion. It certainly is within tile knowledge of raoft
practitioners, that fome of the worft fpecies of typhus
frequently qpme on with fymptoms of ftrong and in-
creafed aCtion, which demand a ftrift antiphlogiftic
diet : any other regimen only tends to hurry on the
fymptoms of inflammation, to induce local determina¬
tions, either to the head, in producing phrenitis ; to
the lungs, in producing peripneumonia ; or to the in-
teftines efpecially, in producing enteritis. It is only
at the latter period of the fever, that the real fymp¬
toms manifeft themfelves, when one and the fame
poifon which produced inflammation at flrfr, is the
remote caufe of inducing at laft the ftate of putrefac¬
tion.

< The

128 Saumarez's New Sijftem of Phyjiology. *

c The beft praflitioners that have written on the
plague, recommend bleeding and early evacuation as
the moil effectual means of cure ; and it is now found,
by the general teftimony of the French phylicians who
have long refided in the Well Indies, and by our own
furgeons at this time, that if bleeding and evacuations
are immediately employed on the very firft onfet of the
yellow fever, the patient generally recovers; and it is
found that the admimftration of mercury itfelf, fo as to
produce ptyalifm, feerns to have almoft a fpecific ef-
left in operating a cure. To expatiate oil the cala¬
mities which this pernicious Brunonian do&rine has
produced in its application to practice, will not fatisfy
the humanity it has offended : it will not reftore the
children to the parent, the parent to his children, and
a multitude of brave and deferving fubjefts to their
country ; thoufands, and tens of thoufands, have
fallen victims to it. The yellow fever, in the Weft
Indies, amongft the Englilh, was called bv the native
French furgeons the brandy and madeira fever, from
the quantity of fpirituous liquors that were adminis¬
tered. W hi I ft our brave foldiers uniformly died by
this mode, the French, by adopting the antiphlogiftic
plan in the ftriCteft poffible degree, generally reco~
vexed.

‘ Equally falfe are his opinions with refpeft to the
different dates of excitement that often exift in dif¬
ferent parts of the fame fydem : it is notorious to
every man of common obfervation, that enteritis and
phrenitis frequently come on, and are attendant on
typhus fever; and the author of thefe pages can fay
with confidence and truth, that he has been the means
of faving the life of feveral patients, by taking blood
from the temporal artery, at a time when there was
a brown tongue, a quick pulfe, and the other fymp-
toms of low fever. On the contrary. Dr. Brown
thought, p. 44, “ that every a flection of a part, that
occurs in general difeafes, however formidable, is to
be confidered only as a part of the affection inherent

r ' *

Saumarez’s New Syfiem oj Phyfiology . V2S

■ in the whole body, and the remedies are not to be
direfted to a part, as if the whole d if cafe lurked there,
and was only to be removed thence ; but to the whole
body, all which it affefts.”

The next chapter is on the fubjeft of the blood.
Inftead of acceding to the opinion of Mr. Hunter,
that the coagulation of the blood arofe from an exer¬
tion of the living power which it contained, fmiilar to
the contraftion of a mufcle, the author fuppofes it to
proceed from a diminution or deprivation of life ; that
it is an aft of dying, or of death itfelf.

Chap. 4. On infpiration. Before parturition, the
different organs of fenfe and fenfation are in a paf*
five ftate, owin£ to the harmony that fubhfts between

O m ft

them and the medium in which they are placed.
After parturition, the irritation they fufiain from ex¬
ternal caufes excites them to aft. Thus, the mufcles
of refpiration are thrown into aftion, the internal ca¬
pacity of the chefl is enlarged, the mouth is opened
by the mufcles of the face, and the air rufhes into the
lungs through the medium of the trachea. And thus
infpiration is firfl performed. The effefts of air on the
blood are next inveftigated.

Chap . 5, treats of the means by which the blood
is diflributed from the lungs to the different parts of
the fyffem ; of the arterial fyftem 5 of the brain and
nerves ; and of mufcular motion.

Chap. 6, of the Linnzean claffification of the animal
kingdom.

Chap. 7, and following ones, treat of the means by
which the blood is fupplied from the wafte it fuflains:
the different fpecies of aliment that are employed by
different animated fyftems pointed out; the organs of
rnanducation and digeftion defcribed.

Refpefting the ufe of the fpleen, a point which has
hitherto puzzled all anatomifts, the author has a pe¬
culiar notion. He fuppofes it to be fubfervient to di-
gefiion in this way. When the ftomach becomes dis¬
tended

ISO Saumarez’s New Syjlem of Pho/io login

tended by a full meal, the left or great curvature be*
comes approximated to the fpleen, on which it pro¬
duces a confiderable degree of compreffion, although
it is too remote to produce fuch an effeft when empty.
This preflfure on the fpleen tends to diminifh the ca¬
pacity of the vefiels with which it is fupplied, and an
accumulation takes place in the fplenic trunks. The
blood confequently flows into other channels through
which it can obtain admiffion. Tbefe channels con-
fill: in the larger branches which the fplenic trunk
gives to the ftomach, called gaftrica finiftra, through
the five fmaller branches called vafa brevia, and
through the feveral branches which the fplenic artery
diftributes to the pancreas.

The increafed quantity of blood which thefe organs
in confequence receive, enables them to fecrete a
larger proportion of the gaftric and pancreatic juice,
at a time when the diftenfion which the ftomach fuf-
tains from the plenitude of food renders the fupply of
gaftric juice more effentially necefiary, or when the
accumulation of chyme in the duodenum demands a
more abundant quantity of pancreatic.— Such is the
hypothefis of the author on this obfcure queftion. To
us, we confefs, it appears too mechanical.

Mr. Saumarez next treats of the powers by which
chyle is abforbed, and blood fupplied : viz. the lac¬
teal and lymphatic abforbent vefiels. A criticifm
here occurs on the late Mr. Hunter, which is cer¬
tainly ill-founded. From the changes in magnitude
and form in many parts, which are taking place dur¬
ing the growth of the fyftem, and which changes are
e fiddled by the power of the abforbing vefiels, Mr.
Hunter called thefe the modellers of the fyftem. —
But Mr. Saumarez, from finding them deftined to
remove dead and fuperfluous parts, will not allow
them any fhare in perfecting the form of the body.
Mr. Hunter certainly did not fuppofe, as Mr. Sau¬
marez imagines, that the abforbents laid the enamell¬
ed

Saumarez’s New Syfiem of Phyfiology . 181

td far face of the teeth ; it is diffident that they ffiould
be able to remove irregularities, to produce ultimately
the fame effeft. A model may furely be perfected as
well by fubtradion, as by addition of parts : whence
otherwise the art of the fculptor r

Refpe&ing the produdion of animal heat, the au¬
thor obferves, that in proportion as the blood changes
from a pure and healthy Hate, to an impure and a
difeafed one ; in proportion as the florid colour of the
blood decreafes, and the black colour increafes, it
appears from experiment there is a progreiiive in-
creafe of fenfible heat, fo that the blood in the right
fide of the heart is much hotter than the blood on the
left. ‘ If the caufe of animal heat depended, as is
generally fuppofed, on the quantity of caloric that is
abforbed, the temperature of the fyftem at the period
of manhood, would be far lower than it is found to be -
during the period of infancy ; becaufe the compara¬
tive magnitude of the lungs in particular, with refped
to the lize of the fyftem altogether, is much lefs in
the one than it is in the other. In infancy, the lungs
have attained their fqlnefs of growth, when the fyf¬
tem is not half evolved. Great therefore muft be the
quantity of caloric feparated and abforbed. How
immenfely high then ought to be the temperature
of the infant frame ! And finally, that animal heat
does not altogether depend on the quantity of caloric
which is abforbed by the lungs, is further proved by
fafts which every praftitioner muft often have beheld
—of the continued and exceffive quantities of fenfible
heat which are evolved from different patients labour¬
ing under phthifis pulmonalis, at thole times, when
the difeafe of the lungs muft weaken, or altogether
bereave them of the powrer of .aft-in g. I have feen a
fcorching and a burning heat iffue from the furface of
the (kin of thofe, whofe lungs,, after death, I have
found eroded and alrnoft totally wafted, the bronchia
jffienffelves plugged up and abounding with purulent

matter.

132 Saumarez’s New Syjlem of Phyfiology.

matter, and when the quantity of caloric abforbed
mu ft confequently have been very fmall. So far in¬
deed is the abforption of caloric from producing heat
in the part by which it is received, that it tends to
abate the temperature of the blood. It produces, it
is true, an increafe of fluidity and a melioration of
colour. It changes blood from a coagulating or ropy
confidence to a fluid one, — from a black to a florid
colour, and from a higher degree of heat to a lower
one.

4 If the lungs were the immediate agents by which
animal heat was produced, and the production of
animal zvarmth the final caufe of their aftion, the
effefts would be immediately rendered fenfible by the
temperature of the blood by which that warmth was
received ; fo that the blood of the pulmonary veins*
inftead of being cooler, would be much hotter than
the blood in the pulmonary artery. We may there¬
fore conclude, that the atmofpheric matter which the*
blood immediately receives through the medium of
the lungs* does not aft by the production of fenfible
heat (or warmth), but by meliorating the quality of
the blood, efpecially with refpeft to fluidity and
colour, — conditions of the blood which are known
to be molt favourable for its ufe.

f That the lungs are not the immediate fources of
animal heat, is further proved from the low tempera¬
ture of the blood of thofe who infpired air of a de¬
gree of temperature far exceeding the heat of the
blood/

Animal heat, therefore, arifes, in the author’s opi¬
nion, from a ftate of decompofition which takes place
between the dying parts of a living animal; and the
decompofition which the blood has fuftained, is the
caufe why there are two degrees of difference in the
temperature of the good and of the bad blopd, —
between that which proceeds from the lungs, and
that which returns to them ; between that which is

florid!

Saumarez’s New Syjlem of Phyjio logy « 133

florid and fluid, and that which is black and has a
tendency to coagulate.

The author is next led to conflder the means by
which this carbonaceous and other matter, the pro
du£t of the animal combuftion, are expelled the fyl
tern ; viz. the different excretory organs of the body
as the kidneys, the exhalant veffels of the fkin, and
thofe of the lungs.

It is almofi: univerfally fuppofed, that the diaphragm
is a principal organ of infpiration. Mr. Saumarez,
however, maintains a very different opinion. e The
natural condition of the diaphragm,’ he obferves, c is
to be convex towards the lungs, and concave towards
the abdomen, as it is found to be in the foetal date.

c On the contrary, in the adult date, when infpira¬
tion has taken place, it is forced from this relaxed
condition, by the didendon which the lungs fudain
from the air they receive ; fo that its mufcular fibres
contraft, and by thefe means it becomes altered from
a curve upwards to a plane. As foon, however, as
this air becomes diminilhed, either from abforption,
or from the lofs of its elafticity, the didenfion which
the bronchice had fudained progreffively goes off, the
diaphragm returns into its original date, and, in this
a£t, the internal capacity of the thorax is diminifned
in a longitudinal direction.

c The action which the diaphragm performs feems
to be independent of the will, and goes on during
deep as perfeSily as during a date of watchfulnefs.
The diaphragm appears to be an organ not neceffary
to the procefs of infpiration, but of expiration only*
In its natural date it mud ever impede the procefs of
infpiration ; and it is only by the impetus of the air
when it ruflies into the bronchiae from without, that
this natural condition of the diaphragm is overcome^
a contraction of its mufcular fibres produced, and the
longitudinal direction of the thorax confequently en¬
larged.’

If this were the faCt, we may afk, of what ufe is
the drong mufcular druCture of the diaphragm? Does
vol. v, L it

134 Fordyce’s Third Differ tation on Fever .

it ever, in the deeped inspiration, attain a plane fur-
face ? It appears evident, even to demonilration, that
its contraction can have no other effeCt, than that of
ipcreafing the diameter of the thorax longitudinally,

\ i

The living fyftem has now been traced from its cm-
bryon date to that of its final termination, or death.
The means by which this is naturally produced con-
fid in the action of the excretory organs being dronger
than that of the incretory. The mode of the bodies’
fubfidence on things from without, continues for the
moft part the fame. The aCtions of the different or¬
gans which are more immediately fubfervient to the
evolution and prefervation of the fyffem, lofe the energy
they poffeffed : whild, on the contrary, the actions of
the excretory organs in general continue in full force.
It is by the weaknefs of the one, and power of the
other, that natural death is produced.

Three chapters are added, which conclude the
work, and in which the author treats of matter,
and its different combinations and arrangements, as
forming the various fpecies which we behold around
us. But we cannot follow him here.

Art. XIV. A Third Differtation on Fever. Part
I. Containing the lliftory and Method of Treatment
of a regular continued Fever , Juppofing it is left to
purfue its ordinary courfe. By George For-
dyce, M D. F R S. Senior Phyfician to St. Tho¬
mas's Hofpital , &c. OCtavo, 260 pages, price 4s.
London, 1798. Johnson.

A CONSIDERABLE interval has elapfed fince
the appearance of the author's Fird and Second
Diilertations on Fever,* and we fhould be difpofed
to augur ill of the continuation and conclufion of the

* See Med. Rev. vol. 2, page 426.

work,

Fordyce*s Third Dijertation on Fever . 135

work, had we not reafon to know, that the matter*
of which they will be competed, is in much forward-
nefs, wanting little more than arrangement to prepare
it for the prefs. We fhould deem it a ferious iofs to
the public, to be deprived of any part of the valuable
obfervations of Dr. Fordyce, on a fubje£t which, for
a great number of years, has engaged his clofe and
unremitting attention. Theories of fever are daily
fhooting forth from the hot-beds of imagination. And
they betray all the luxuriancy and all the weaknefs of
fuch produ£tions. Whilfl the obfervations before us*
founded as they are on nature and experience alone*
mud, and will, hand the tell of ages.

The author’s firft object in the prefent differtation
is, to diftinguilh a regular continued fever from other
difeafes with which it has frequently been confound¬
ed. A fever which continues for three, four, five
weeks, or even longer, without any marked crifis, and
afterwards goes off by degrees, one critical fymptom
happening after another, is only, in the author’s opi¬
nion, a repetition of ephemerae or fingle paroxyfms of
fever, where the fubfequent paroxyfm begins before
the crifis of the former has begun to take place.

One criterion of a regular continued fever is, that
it encreafes for a certain time from its beginning, re¬
mains for fome time in its greateft degree or acme,
then, without any apparent caufe, gradually dimi-
niffies and terminates in health. Or otherwife, a
crifis takes place during its progrefs, and carries off
the difeafe ; or the crifis converts it into an inter¬
mittent ; or in its progrefs it produces topical inflam¬
mation ; or kills the patient. Any difeafe, not having
thefe properties, is not a regular continued fever.

The tendency to go off fpontaneoufly, though not
peculiar to fever, yet ferves to diftinguifh it from
heftic fever, and fome other affections. HeCtic agrees
with regular continued fever, in fometimes arifing
without apparent caufe ; but it commonly arifes from,
and is kept up by the conffant application of an ap-

L 2 parent

]S 6 Forclyce's 'Third Dijfertation on Fever .

parent caufe. It wants tills effential property of re*
gular fever, that where it does not arife from an ap¬
parent caufe, and often when its caufe is removed, it
has no difpofition to go off’ of itfelf, but remains until
it deftroys the patient.

That affeftion of the fyftem which attends phleg¬
monous inflammation has commonly been termed

fever, but improperly, in the author’s opinion. It
differs from fever in being kept up by a conffant ap¬
parent caufe, with which it like wife goes off. Similar
appearances take place in rheumatifm, and gout, but
depend entirely upon their apparent caufe.

Should eryffpelatous inflammation arife on the
lkin,_it often happens, after the inflammation has
taken place, that the pujfe becomes frequent to 120
ffrokes in a minute or upwards ; the ftrength of the
patient is univerfally depreffed, there is head-ach,
foulnefs of the tongue, lofs of appetite, naufea ; the
fenfe of heat is very much increafed, as alfo the de¬
gree of heat to 100°, or 103°, or 104°; there is dry-
nefs of the fkin, and obftruftion of the pulfe. Thefe
fymptoms are all very much increafed in the evening;
and there is fome degree of relaxation of them in the
morning. This difeafe is extremely ffinilar to fever,
yet it is to be excluded from that difeafe by its total
dependance upon its caufe, the eryfipelatous inflam¬
mation of the fkin ; for if that be removed by applb *
cation of alkohol, diluted with water, to the inflamed
part only, all thefe affections of the fyftem generally
go off.

Should an eryfipelatous inflammation arife in the.,
throat, producing whitiffi Houghs in it, limilar fympr-
toms appear in the fyftem ; but if the inflammation be
carried off by the exhibition of large quantities of the
bark of the cinchona, and the whitiffi Houghs be made
to fall off, fo that all difeafe fliall be removed from the
mucous membrane of the throat, the affedlion offthe
fyftem generally ceafes. This affection of the fyftem,
therefore, cannot be ranked among fevers, according

Fordyce’s Third Differtation on Fever . 137

to the rule, which excludes from fevers diieafes de¬
pending on the conftant application of their came.

Should phlegmonous inflammation take^ place in
any part of the duodenum, jejunum or ilium ; and
after the inflammation has taken place, as [hewn ny
the pain, if the ftreng.th be greatly depreifed, if the
pulfe fhould become hard, frequent to 120 ftrokes in
a minute or. upwards, and much contracted ; if there
fhould be a thick brown fur upon the tongue, great
fenfe of heat, head-ach, palenefs, and contraction of
the Ik in, naulea and vomiting ; if there fhould even
be delirium ; let the inflammation of the inteftines be^
cured by copious bleeding from the arm and fkin of
the abdomen, by the application of fedative and re¬
laxing fomentations to the abdomen ; all thefe fymp-
toms 'in the fyftem generally will fubfide and go oh,
and therefore cannot form a difeafe which ought to
be included in the clafs of fevers.

One objedl in view, the author obferves, in laying
down the above diflindtions, is to difcriminate be¬
tween difeafe s where it is only neceflaiy to remove
their caufe to cure the patient, and thofe where other
circumftances of the dueate are of moment. Thus in
phlegmonous inflammation it is fufficient in general
to attend to the local difeafe. The affedtion of the
fyftem, indeed, or general inflammation, is fometimes
fo great as to endanger the patient, and in this cafe
requires attention; but the means of relief are for the
molt part the fame as for the topical difeafe, and to¬
tally different from thofe that fhould be employed to
take off fever.

An important remark occurs here on the fubjedl of
rheumatifm. When it was the pradlice to bleed
largely in acute rheumatifm, metaftafis frequently
took place to the interior parts of the body, and
deftroyed the patient. This accident in the author’s
pra&ice during the laft fifteen years has rarely hap¬
pened. In this period he has entirely left off bleed¬
ing in acute rheumatifm, and has not loit above two

L 3 or

138

Fordyce’s Third Dijfertaiion on 'Fever .

or three patients, although he has treated feveral
hundreds in this difeafe.

Continued fevers fometimes begin at once exa£t-
ly with the fame fymptoms as an ephemera. At
times, however, there arifes immediately upon applh
cation of the caufe of difeafe, particularly if it fhould
be expofure to cold, putrefaction, or infection, fome
derangement of the fyftem, but no complete paroxyfm
of fever. Thefe derangements confift of languor, the
patient’s feeling himfelf not perfectly well, and being
unable to exert the powers of his body or his mind,
whether for bufmefs or amufement, lb perfectly as
when in abfolute health. Sometimes his deep is dif-
turbed ; he does not go to deep readily ; his deep
during the night is broken, and he is not refrefhed
fo much as ufuab It happens fometimes that thefe
fymptoms go off in a few days ; fometimes they all at
once increafe very confiderably, and form a paroxyfm,
which is the beginning of the fever.

When a continued fever is produced, fometimes
when the caufe of the difeafe is applied, there is not
the lead appearance of fever, or any apparent altera¬
tion from health for many days, until all at once a
complete paroxyfm of fever comes on. Sometimes,
when the caufe of lever is applied, fome dight febrile
appearances take place, and continue till a perfeCt at¬
tack of fever arifes, which comes on at once, and its
fird paroxyfm is eafily afcertained ; now and then they
gradually diminidr and go off, without any permanent
fever arifing, When fuch dighter febrile fymptoms
take place, they do not increafe gradually, fo as to
conditute a fever, but the patient goes on with his
ordinary occupations ; not well indeed, but not fo as
to be confined, until all at once a paroxyfm, fuch as
has been defcribed in the diflertation on the ephemera
fimplex, takes place, fo that the patient can almoft
always mark the very hour in which the attack comes
on, Sometimes a complete paroxyfm of fever is pro*
duced immediately upon application of the caufe*

Fordyce’s Third DiJJertation on Fever . 139

If none of the fymptoms of fever happen between
the time of the application of the caufe and that of
the firft paroxyfm, a itrong attack takes place at once,
and begins often with a fenfe of coldnefs, horror, and
rigour; the cold is followed by a fenfation of heat,
which is fucceeded again by a fenfe of coldnefs, and
fo alternately for the firft twenty-four hours. Some¬
times there is no fenfe of coldnefs, but the patient
feels from the beginning very hot. Whether there
be a fenfe of coldnefs or a fenfe of heat, the thermo¬
meter under the tongue rifes to about one hundred,
or from that to one hundred and five degrees of Fah¬
renheit’s fcale, excepting at the very firft beginning of
the attack. Whether there be fenfe of cold or of
heat, there is always great depreffion of ftrength, both
in the powers of the body and the mind, which is
generally according to the degree of fever, fometimes
fo great as to render the patient unable to fupport
himfelf in an ereft pofture ; fometimes not fo con-
liderable as to prevent him from doing his ordinary
bufinefs, if he makes extraordinary exertions.

It has unluckily often happened, that phyficians
have been too apt to go on attending their patients
for a day or two after a paroxyfm has adlually taken
place, and unfortunately have been by that means fo
exhaufted, as not to be able to go through the remain¬
ing part of the difeafe, but have been cut off.

The depreffion of ftrength is in all degrees, be¬
tween thefe extremes. The pulfe, during the firft
twenty-four hours, beats feldom lefs than ninety
times in a minute, and very feldom more than one
hundred and five in a minute ; whereas in an ephe¬
mera, or in the firft paroxyfm of an intermittent, it
very often rifes to one hundred and twenty or thirty
pulfations. It is fometimes full and ftrong, always
obftrufted, fometimes fmall and particularly foft, fome¬
times of the natural fulnefs, but with a particular de¬
gree of foftnefs ; when this is the cafe, it indicates a

L 4 ' fever

140 Fordyce’s Third Differtation on Fever .

fever which will be very violent, efpecially in refpeSt
to the depreffion of ftrength.

The author gives the following explanation of his
terms with regard, to the pulfe. 4 Great numbers of
practitioners/ he obferves, 4 have called obftruftion
hardnefs, freedom foftnefs of the pulfe.

4 The feelings of the organs of the fenfes are often
different in different men. The ear, for example, of
one perfon, can diftinguifh accurately the different
notes on the mufical fcale ; the ear of another can
diftinguifh nothing but that the found is louder or lefs
loud. In like manner, the fingers of fome are only
capable of diftinguifhing whether the pulfe is more or
lefs frequent, and that by comparing it w7ith fome
other meafure of time. It is neceffary, therefore, that
we fhould have fome other criterion of the differences
of pulfation than the feel of the practitioner, in order
to be able to teach young practitioners how to dis¬
cover if they have any power of feeling different fen-
fations, and diftinguifhing them.

4 When the pulfe is hard, whether it be ftrong or
not, the blood is long in coagulating ; the confequence
of which is, that if the blood flow from a vein in a
large ftrearn through the air, into a veftel nearly the
feCfion of a fphere, the red particles will fall down
towards the bottom of the blood, and leave the upper
furface of the coagulum colourlefs after the blood has
coagulated ; whereas if the pulfe be ftrong, without
any hardnefs, the blood will coagulate much fooner
under the fame circumftances, fo as not to give time
for the red particles to fall clown from the upper fur-
face of the coagulum, which will therefore be red.

4 In like manner, if the pulfe be obftruCfed and not
hard, the coagulum will be red on the upper furface.

4 This then is a criterion by which ftrength and
obftruCfion may be diftinguifhed from hardnefs, viz.
when the pulfe ms hard, the upper furface of the
coagulum is not red,

4 It

Fordyce’s Third Differ tuition on Fever. 141

c It is neceffary that the praftitioner thould make
himfelf mafter of the feel of the pulfation under thefe
different circumftances. r. This may be done by feeling
the pulfe of a patient affe&ed with an intermittent, in
which there is often ftrength, fulnefs, and obftruflion,
but no hardnefs, and in which cafe a quantity of
blood may be taken away without any detriment
to the patient ; and again, in a pleurify, where there
is ftrength and hardnefs, and in which blood is taken
away with great propriety,

‘ By thefe means any man with the faculty of feel¬
ing, fo as to diftinguifh the different fenfations arifing
from pulfations, may make himfelf mafter of the dif¬
ference between hardnefs and ftrength, or obftru&ion,
which, as will be fhewn afterwards, is very effential
in the management of fever, obftruftion being an ef-
fential fymptom of fever. Hardnefs is an irregularity,
and confequently is to be referred to that treatife,
in which irregular fevers are to be confideredd

The caufes which reproduce fever are apparently
two, one that reproduces a remittent and intermittent
fever at the expiration of a certain period of time 5 1
the other the natural evening paroxyfm, or that
change in the fyflem which may be obferved in
health to take place between five and fix o’clock
in the evening, as quicknefs of pulfe and deprefhon
of ftrength : it is this which reproduces a continued
fever : both of thefe, as far as the fcience of medicine
has hitherto been inveftigated, are perfeftly incompre-
■henfible.

Thefe different caufes ferve to diftinguifh between
an intermittent and remittent on the one hand, and
a continued fever on the other. For if we find, in
the fir ft days of a fever, when there is no perfetf in-
termiftion, that the exacerbation takes place between
five and fix o’clock in the evening, or a little later,
we may conclude that the difeafe is a continued fever;
but if the exacerbations take place at any other time

142 Fordyee’s Third Differ tail on on Fever.

in the twenty four hours, that it will terminate in an
intermittent or remittent fever.

The firft paroxyfrn of a continued fever is irregular,
with a greater or lefs degree of violence, feldom, how¬
ever, fo violent as the fubfequent paroxyfrn. The
fecond paroxyfrn is generally regular. The third pa-
roxyfm is more fevere than the fecond, and fo every
evening the difeafe continues to increafe for the firft
week.

Sir John Pringle and many other practitioners,
being attracted by the appearance of putrefaction
which takes place in fevers where the ftrength is
greatly depreflfed, have fuppofed that the difeafe de¬
pends on putrefaCtion of the fluids, and not the pu¬
trefaCtion of the fluids upon the difeafe. It appears
to the author in a very different light. If the putre¬
faction of the fluids is fubfequent to the depreflion of
ftrength, and if a certain degree of depreflion of
ftrength takes place in all fevers, in that cafe certainly
the putrefaftion of the fluids cannot be confidered
either as the eifeCt of putrefaCtion, but as the effeCts
of depreflion of ftrength.

The following are given by the author as figns
denoting what has been called putrid fever. c The
fymptoms of putrefaCtion, when they firft take place*
are alterations in the appearance ol the fecretions.
The urine firft has a more vifeid appearance than
common; is frothy, browner, and not abfolutely tranf-
parent, although there is no cloud or fediment. If
the putrefaCtion is (till greater, it becomes of a dark
brown, and lofes its tranfparency, and fometimes a
dark brown fediment falls to the bottom of the vefFel,
after it has flood an hour or twTo. The faeces begin
to be foetid, and at laft have a very putrid fee tor,
which, however, is to be diftinguilhed from the foe-
tor of the inflammable air, which is often difeharged,
and is very foetid, although there be no putrefac¬
tion. The foeces are alfo not uncommonly black and
liquid. The fweafc, if there fhould be any, tinges the

s linen

143

Fordyce’s Third Differtation on Fever .

linen with a dilute ichorous appearance. The cruft
which forms upon the tongue appears browner and
more clammy • as the fever goes on it grows browner
and browner, until at laft it is quite black; the teeth*
rubbing it off from the tongue, become as it were
buried in a black ffime ; this hardly takes place be¬
fore the end of the firft week of the difeafe; the
breath alfo becomes foetid.

There fometimes appears upon the fkin, but not
excepting the putrefaction has arifen to a confiderable
degree, a kind of difcoiouration, fimilar to the ap¬
pearances which we find in polifhed marble, not
purely white, which are called bluffi veins. When
the degree of putrefaction is more confiderable, dark
purple fpots, of various fizes, are formed in the fkin j
if the putrefaftion be ftill more confiderable, the fkin
becomes all over of a dark purple colour.

€ At the beginning, when the putretaCtion has not
gone to any great length, if blood fhould have hap¬
pened to hate been taken from the arm, the coagu-
lum is loofe and eafily broken, the ferum being hardly
of a browner colour than common. Sometimes
when the depreffion of ftrength is not very great, the
blood retains this appearance during the whole courfe
of the difeafe. Should the patient become fo weak,
as to be carried off by the weaknefs, this appearance
is not altered, for it is depreffion of ftrength, not
weaknefs, which produces putrefaftion.

c If there is greater depreffion of ftrength, and by
confequence putrefaftion is in a greater degree, the
ferum becomes of a browner colour. In a ftill fur¬
ther degree it is red : in this cafe, on examining the
red particles with a microfcope, many of them are
found diminiffied in fize, and not regular fpheres,
or oblate fpheroids; fome have the appearance of
being broken in two, and look like half moons : but
moft of them retain their healthy appearance. If the
putrefaftion goes on ftill further, there is hardly any
diftinftion between ferum and coagulum,; if ftill fur¬
ther, the coagulable lymph forms a kind of bag,

leaving

144 Fordyce’s Third Difleriation on Fever.

leaving the ferum on the outfide diftinCt. In the
fubftance oi the bag itfelf, there is no intermixture
of red particles, fo that it looks like the buff, which
is on the furface of the coaguhim in cafes of general
inflammation; but within this bag a red fluid is con¬
tained, which,’ upon being examined with a micro-
fcope, fhew s the red particles of a variety of forms.

e All thefe appearances the author has feen. There
are feme cafes upon record in which it is ftated, that
the blood was abfolutely foetid ; and a practitioner of
perfect credit, who praCtffied a confiderable time in
hot climates, told me he had feen feveral cafes, where
the blood taken from the arm was actually foetid.

c As depreffion of ftrength produces putrefaCtion
of the fluids, fo, on the other hand, putrefaCtion of the
fluids. occafions greater depreffion of flrength, fome-
times in a degree that proves fatal : in this cafe the
pulfe often towards the end beats tatter than can be
counted.

4 It happens more frequently that hemorrhage
arifes, almoft indiferiminately, from any of the cavi¬
ties which open externally: thefe hemorrhages are
very dangerous, and often fatal.’

c At particular times it is very rare that any great
mark of putrefaCtion takes place ; at other times it
is more frequent. It was common enough in Lon¬
don, from one thoufand feven hundred and fifty, to
one thoufand feven hundred and lixty-five; from that
time the feverer fymptoms of putrefaCtion have been
feldomer feen ; and from one thoufand feven hundred
and feventy-five to this period, one thoufand feven
hundred and ninety-feven, they have been very rarely
feen indeed in fevers,’

Among the fymptoms of the difeafe, which gra-
dually encreafe from the fecond exacerbation to the

end of the firft week, or fometimes a little longer, is
delirium. Ot this there are two fpecies obfervable,
one without any material afleCtion of the brain, the

other

Fordyce’s Third Dijfertation on Fever . 145

other with fulnefs of the veffels of the brain. The
Appearances dharatterifing theie different fpecies are
pointed out at considerable length.

Whether it be that the fever is gradually incieafing,
and delirium along with it, or that^ delirium is the
occahon or the increafe of it, the lever goes on in
proportion With the delirium. If, the deiiiium con¬
tinuing confiderable, the patient refpires witn mi-
iiculty, or hardly at all, or if the deglutition be almoft
totally prevented, or if in attempting it, it throws
the patient into con vulfive contractions, he larely re¬
covers. On the other hand, although the other Symp¬
toms of the difeafe abate, it the delirium continues,
without Itupor or deafnefs, and the other marks of
fulnefs of the veffels ot the brain, in fuch cafe, not¬
withstanding the practitioner and the by-dander are
flattered, the patient is frequently cut off.

Thus the fever continues to increafe from the^ be¬
ginning of the fir ft, Sometimes to the middle or the
fecond week of the difeafe, and continues in tfle
fame degree, unlefs it fhould be carried off in a crifis.
Crifis much feldomer takes place in cold than in hot
climates. In London, the author obierves, not above
one third part of the fevers which happen, terminate
in this way.

c The appearances, then, in the fecond week are
fome, times frequency of the pulfe, to perhaps an
hundred, or an hundred and five, in the evening; and
in the morning from ninety-five to an hundred, in
many cafes of fever the pulfe is much more frequent,
but this will be defcribed as an irregularity in a future
differtation.

‘ The tongue is covered with a brownifh fur, which
is not Hi my, excepting when putrefaction takes place,
as has already been defcribed. When the difeafe is Se¬
vere, it is not uncommon for the middle or the tongue
efpeeially to lofe this fur, and appear, when moift,
cleaner and rawer than it is in its natural ftate, and,

when

146 Fordyce’s Third Differ tat ion on Fever .

when dry, with a degree of polifh, as if it were
gkzed over.

c The eyes have always, provided the fever be
regular, a degree of confufion ; but it is greater or
lefs as there is more delirium, as has already been
defcribed. The fkin is of a dirty dulky colour; this
fymptom is in a greater or lefs degree, according to
the violence of the difeafe.

« The head-ach is often lefs complained of by the
patient, but this appears rather to depend upon the
confufion of the mind than on the head's being ac¬
tually relieved.

c The appetite is often totally loft. The patient
frequently complains lefs of thirft during the fecond
than during the firft week ; but this want of thirft
feems rather to be from the confufion of the mind ;
for fometimes, efpecially when the fever is very vio¬
lent, he will drink a great quantity at once, and at
other times, in the fame circumftances, will hardly
drink an ounce. The fkin continues very dry and
parched, that is, feels very hot and dry to the bv-
ftander.

‘ The urine continues perfeftly tranfparent, as has
been defcribed.

4 There are flatulencies in the inteftines, generally
with coftivenefs ; but now and then there are one or
two thin and very foetid evacuations in twenty-four
hours, even when there is no other appearance of pu¬
trefaction .

c The deep, when the patient gets any, is more or
lefs quiet, partly according to the delirium, and partly
according to the general reftlefsnefs.

c If the fever fhould be flight, and perfectly regular;
if the practitioner has patience, and does not prefs the
patient with improper remedies, nor the by-ftanders
with improper nourifhment, this ftage of the difeafe
pafles over with tolerable tranquillity. On the other
hand, if the delirium, and other fymptoms of fever,
be very violent, it proceeds with the utmoft anxiety
to the praftitiouer and danger to the patient. This

happens

Fordyce’s Third Dijertation on Fever , 14*!

happens in all gradations, from the moil fevere and
fatal to the flighteft.

c Provided there has not been fuch a depreffion of
ffrength as to occalion putrefadtion of the fluids, and
by that means to deftroy the patient, and that nei-
ther of the kinds of delirium which have been de~
fcribed fhould prove fatal; or provided the patient
fhould not be deftroyed, by ftrong fymptoms of fever
taking place at the beginning of a critical paroxyfm ;
and the delirium, if of the firft fpecies defcribed,
keeps pace with the other fymptoms of the firft ftage ;
or provided it be of the fecond fpecies, if it begins to
be converted into deafnefs and ftupor; and provided,
that the fever was of itfelf perfectly regular, and,
laftly, that it has not been rendered irregular by im¬
proper treatment, it rarely happens that it is danger¬
ous after the fecond week/

c On the fifteenth day, and often fooner, the fymp¬
toms of the difeafe begin to abate. The firft ap¬
pearance of this abatement is not uncommonly a
cleannefs and healthy look about the edges of the
tongue ; or fometimes the fkin becomes of a more
natural colour; fometimes, although not very gene¬
rally, a fweating takes place all over the body, and the
fkin afterwards continues moift. The delirium, if it
be of the firft kind, abates in the day-time, and re¬
turns at night ; if of the fecond kind, the patient is
deaf and ftupid, with little difference in the twenty-
four hours; and this deafnefs and ftupor remain until
the whole of the difeafe has difappeared/

The eruptions which take place at this period, as
petechiae and marbling of the fkin, are faid not
to influence the progrefs of the difeafe.

c In the third week, the urine depofits fometimes a
copious lateritious fediment for a day or two, and af¬
terwards returns to its natural appearance. Sometimes
there is a copious lateritious fediment in the urine made
in the night time, and a mucous one in that made in
the day time. The coftivenefs goes off, and the foeces
return to their ordinary appearance. The eyes, unlefs

when

148 Blair’s Effays on the Venereal Difeafe .

when the delirium has ended in ftupor, begin to have
a more healthy appearance, are more compofed, and
exprefs a greater attention to the objects around them.
All the fecretions become gradually increafed, notf
equally, but fometimes one more and fometimes ano¬
ther. The fleep returns, but not equally, the patient
fometimes palling a tolerable, at others, a reftlefs
night. There is fometimes a greater degree of thirft
than was exprelfed in the fecond week. The appe¬
tite returns, although feldom regularly ; fometimes it
is voracious, but the patient is notwithstanding fatis-
fled with a very fmall quantity of food ; in other cafes
it returns very flow ly. The depreflion of ftrengthi
fometimes goes off almoft at once, and what is lin¬
gular, leaves the patient with a greater feel of w7eak-
nefs. Thus the difeafe goes off, and the patient re¬
covers his ftrength very quickly.’

The author comes now' to the treatment of a regu¬
lar continued fever: but our account of this muff
be referved for a future number.

Art. XV. Effays on the Venereal Difeafe , and its
concomitant affections , illujirated by a variety off
cafes. Effay /, Parti . On the Antivenereal Effects
of Nitrous acid, oxygenated muriate of Potaffi, and
fever al analogous remedies , which have been lately
propofed as fubftitutes for Mercury . By William
Blair, A, M. Surgeon of the Lock Hofpitaf
and of the Old Finfbury Difpenfary . 8vo, 252 pages. ,i
price 4s. London, 1798. Johnson.. 1

THREE centuries have elapfed,’ Mr. Blair ob-
ferves, c fince the introduction of mercury for the
cure of the Venereal Difeafe ; during which period, a
variety of other remedies have been propofed, as fub¬
ftitutes for that mineral. Among thefe, certain vege¬
table productions have gained the greateft number of

advocates y

Blair’s EJfays on the Venereal Difeafe. 149

advocates; but, on making a fair and extenfive trial of
their comparative virtues, mankind are aimed univerfab
ly perfuaded, that, at prefent, we are in poffeffion of no
antivenereal remedy fo efficacious as mercury. The
inconveniencies, however, which fome times arife from
the injudicious adminiitration of this medicine, have
left room for a reafonable wiffi that we could obtain
a milder antidote againft the fyphilitic virus.

‘ A new fpecific has lately been offered to the world,
which (if we may believe its adherents) is not only
lefs noxious to the conftitution of our patients, but
even more certain and more expeditious in producing
its good effefts, than mercury itfelf; and which, com
fequently, is found to be in all refpefts its fuperior.
In a few years’’ (fays one of thefe gentlemen) “ I
think that mercury, as a remedy for lues venerea,
will be banilhed by the nitric acid ; and that the
5C poifon of fyphilis may, in a great meafure, be ex-
" tinguiffied over the face of the earth.”

c We have been’ continues the author, c fo fre¬
quently amufed and deceived with the cry of cc a
new fpecific that, while I join heartily in the gene¬
ral wiffi for one in the venereal difeafe, I cannot
forbear fuggefting the probable mifehief which, a
pretenfion of this kind muff occafion, before its fal¬
lacy be detected ; efpecially if men of reputation and
known talents combine in extolling an uncertain re¬
medy, while we are in the actual poffeffion of an ah
moft infallible one.

c The ufe of opium as a fpecific in the venereal dif¬
eafe, was much infilled on, by feveral practitioners of
eminence, about eighteen years ago. Opium was
then faid to have performed wonders, where mer¬
cury had never been ufed, and in various ftages of the
diforder. Although its fuccefs was not abfolutely
certain, the proportion of fuccefsful cafes to thofe
in which this remedy did not effeCf a cure, was re¬
lated to be as three to one ; and among thofe in
which it failed, there were many wherein mercury
vol. v. M proved

150 Blairs EJhys on the Venereal JJifeafe .

proved equally ineffectual. Numerous inftances of
reputed cures are ftill on record, and may therefore
be examined in all their circumftances. Nor were
thefe merely temporary effeCts ; for, after a long
period of time, numbers of patients experienced no
relapfe ; and, confequentlv, there was the higheft pro¬
bability of their having been perfectly cured. — What
can be faid to all this ? 1 hat opium is a fpecifc ? Or,
that medical men joined in propagating wilful falfe-
hoods P No, furely : but, that gentlemen were not fuf-
ficiently accurate in conducting their experiments,
and in feleCting the fubjeCts of them ; fo that al¬
though they publifhed only what they believed to
be ftriCtly true, mankind were obliged, by contrary
evidence and farther examination, to rejeCt the re¬
medy, as totally inadequate in a genuine fyphilis.

The mode lately recommended, of curing the
venereal difeafe by means of acids, although it com¬
monly paffes for a modern difcovery, is not fo new
as is generally believed. Without infilling on a paf-
fage of Fracajtorins , in the fecond book of his ele¬
gant poem/ where he ftrongly recommends the ufe
of lemons, I may fugged that acids were employed
externally for the cure of fyphilis, by fome of the
oldeft writers on this diforder $ and they were given,
internally, for the fame purpofe, about the beginning
of the prefent century, if not earlier.

‘ Dr. Daniel Turner, in his tc PraCfical Differta-

tion on the Venereal Difeafe/’ mentions the following

44 * Sed neque carminibus negledta (ilebere noftris
5S Pleiperidum decus, & Medarmn gloria citre
Sylvarum: fi forte facris cantata poetis
Parte quoque hac medicam non dedignabere Mulam.
u Sic tibi (it semper viridis coma, femper opaca,
c" Semper flore novo redolens, (ic femper honefta
a Per viridem pomis fylvam pendentibus aureis. l * '

44 Ergo, ubinitendum eft cascis te opponere morbi
44 Seminibus, m nura arbor Cithereia prajlat*

Qqippe illam Citherea, fuum dum plorat Adonirn,

44 Munere donavit multo, & virtutibus auxit.’*

cafe

Blair’s EJJays on the Venereal Difeafe . 151

cafe of a patient who had been treated by a courfe
ot vegetable acids. cc Being at one time in com-
pany with that excellent practitioner Mr. Charles
Bernard, a gentleman came into his dudy, as I
u had reafon to believe, upon fome private bulinefs *
cc upon which I retired into another room, when, in
a few minutes, he came to me, and defired me to
<c come and fee the effeCts of a new method of curing
“ the pox. The patient had been for two months
“ under the care of a noted Philo-acidus , who placed
<c the caufe of this (and i think moil other difeafes)
*c in an alkaiy, for a light infection therefrom: in
tx order to eradicate which, he was advifed to eat
“ half a dozen of the larged lemons he could get,
" daily, befides good ftore of verjuice at his meals,
which method (after fome other preferiptions) was
<c to be continued for a month ; by which time, in-
dead of his cure, he found himfelf cruded over
“ with inveterate fcabs and other pudules ; yet was
“ told that he was well, and that thefe would fcale
“ away of themfelves ; which he was ordered by the
“ gentleman he now came to confult, that he would
ic make trial of ; as he did a little while, till fome
“ ulcers growing corrofive, and eating farther in, by
“ reafon of the acrimony of the humours underneath,
<c forced him to comply with a mercurial ptyalifm,
“ under this artist’s care, by which his cure was foon
<f completed.”

c The fame author likewife notices an oppofite feCt
of practitioners, the Mifo-acidi , whofe theory led
them to the ufe of alcaline remedies in the lues ve-
nera : he then fuggeds, that “ by being obftinately
“ wedded to fome mere hypotheds, or affeCting a
“ chymical philofophic babbling, fubjeCting medi-
“ cine (which is incompatible) to a mathematick
“ dandard, and amufing the patient with a jargon
ec of hard words, you may very probably do mif-
** chief, if not utterly dedroy him.”

M 2

* The

152 Blair’s Effays on the Venereal Difeafe .

< The illudrious Chancellor Bacon, in his maderly
work De Augmentis Scientiarum, mentions it as one?
of the difeafes of authors, that they “ often infe6t
their fpeeulations and dodlrines with lome peculiar
tc opinions they happen to be fond of, or the partic-u-
“ lar fciences to which they have mod applied.”
Hence, the mechanical phyhcians have had their
day, and the chymids are again affuming tlm right of
combating difeafe upon their own peculiar principles.

c Though the nonfenfe of Paracelfus and Van
Helmont is fuperfeded by the phrafeology of modem
illumination, it may be queftioned, perhaps, whether
either of them have facilitated the cure of difeafes.

I am very far from mfinuating that experimental chy-
midry has been ufelefs in the praftice of medicine ;
but I would guard young pradlitioners againd that
licentious fpirit of innovation which has bewitched
fome of our fpeculative enquirers after knowledge A
Nihil magis a vera morborum cognitione men tern
cc retrahit, quam effrsenis ilia fpeculandi difputan-
cc dique licentia, cui in ipfa praxi adeo indulfere me*
" dici Arabes, et quotquot pod eos fuere Galenici.”
This judicious remark of Baglivi deferves attention
in the prefent inquidtive age.

Having made thefe preliminary obfervations, the
author proceeds, in the drd place, to give a fum-
mary view of the attedations which have hitherto
been borne to the efficacy of the new remedies.
This is done with much candour, but at the fame
time, with occalional and jud dritfures on the
evidence, and on the conclufions which have been
drawn from it. This part of the work we have
already prefented in fubdance to our readers at dif¬
ferent times.

In the next chapter, the author gives the unfa¬
vourable reports concerning the new remedies, with
occalional animadverfions. On this occafion alfo we
have, for the mod part, anticipated him. We proceed,
therefore, to his own experience of the fubje£t.

The

Blair’s Effays on the Venereal Difeafe* IB%

The firft feclion contains an account of twenty-four
trials of the acid of nitre, the citric acid, and the
oxygenated muriate of potaili, in primary fymptoms.
In the fecond feHion twenty-fix cafes of confirmed
fyphilis are given, wherein the acid of nitre was ex¬
hibited. And in the third, eleven trials with the
oxygenated muriate of potaih, in advanced ftages
of the difeafe. — Thefe conflitute the extent of Mr.
Blair’s own expedience of the new remedies. His
general remarks and conciufions are referred for the
fucceeding part of his effays. We (hall now prefent
our readers with a few of the mod finking cafes ad¬
duced, under the different heads above enumerated.

Sect. 1. Primary fymptoms . 4 The firft cafe in

which I tried the nitrous acid was that of George
Kelly, aged thirty ; who was admitted into the Lock
Hofpital on the 30th of March, 1797, with a glan¬
dular fwelling in his right groin, which feemed in¬
clined to fuppurate. He contradled the venereal dif-
eafe two months before ; and, at that time, had chan¬
cres : but, when he applied to me the) were healed ;
his mouth was alfo affefted by mercurial medicines,
which he had previoufly taken. — April the 4th. I pre-
fcribed him three meafured drams of the common
fuming acid, in a concentrated ftate, diluted with
a quart of water. This quantity was ordered to be
drank, by a cupful at a time, every twenty-four hours.
— On the 6th. I encreafed the acid to four drams a
day, as it agreed perfectly well. His gums, which
before were rather fwelled and tender, had now re¬
turned to a natural ftate ; and the fize of his bubo was
a little reduced.— 10th. The tumour had nearly dii ap¬
peared. The acid was continued in the fame propor¬
tion. He complained of a tendernefs in his cheeks,,
which probably arofe from the local effects of the
acid ; but he had no inclination to a ptyalifm. — 13th.
His mouth in the fame ftate ; and the bubo quite
gone. — 17th. The acid now gave him violent pain
in his bowels : I therefore directed one grain of opium

M 3 , to

1 54 Blair’s EJjays on the Venereal Difeafe*

to be taken occafionally. — 20th. The add was Hill
continued without interruption, and was not omitted
till the 24th.— I difmiffed him, apparently cured, on
the 27th ; and have not heard of him fince.

4 Cafe 4. George Hughes, aged twenty-two, con-
traded the venereal difeafe about the middle of Sep¬
tember 1797 ; at which time he had a glandular fwell-
ing in each groin. The fame tumours remained on
the 12th of October, when he was admitted into
the hofpital ; but, they had burft, and were covered
with fcabs. A warm linfeed poultice was applied to
the buboes, and the nitrous drink was adminiftered as
in the former cafe. — 19th. The buboes feemed to
be a little amended.: — November 2nd. No material
change has taken place thefe few laft days. — 9th.
Confiderably better. The acid continued as before.
- — 20th. The fwellings ftill d'iminifli. The fcabs hav¬
ing fallen off, I ordered the fores underneath to be
dreffed with fimple cerate.- — 27th. The fores nearly
healed — December 4th. The groins ulcerating again,
and do not yield good pus. The fimple cerate and
acid continued. — 6th. Having made no farther pro-
grefs, I left off the acid, and ordered mercurial oint-
ment to be rubbed into bis thighs every night. — 1 1th.
Getting much better. — 14th. The fores are fcabbed
over, but indurated glands remain. — January the 8th.
No hardnefs in the groins. Perfectly cicatrized.—
13 th. Difmiffed cured. • — He ufed, in the whole, fifty-
nine drams of the ointment, containing a third part of
mercury ; which is full as much as is commonly re¬
quired in fimilar cafes, where the acid has not been
given.

* Cafe 5. W. 7B. confulted me on the 13th of
0£tober, with a chancre under the meatus urethrae,
and a phymofis, of three weeks duration. At that
time I relied more on the favourable reports which
had been given of the nitrous acid, than upon my
own experience : I was therefore tempted to prefcribe
the acid mixture, with a faturnine lotion and cata-

iapfm.

Blair's EJfays on the Venereal Difeafe . 155

plafm. — -18th. Fie had diligently employed the means
dire&ed, and found himfelf conliderably amended.
The fame plan was purfued till the 24th , when he
called upon me, and was rapidly improving.—- No¬
vember the 4th. The phymofis was quite gone, and
the ulcer under the glans ftill healing : but on tetrad!-
ing the prepuce, a frefh ulceration was perceived upon
the corona glandis. The acid was continued; but,
the daily quantity of it was now encreafed to three
drams. — 11th. The phymofis has in fome meaiure re¬
turned, with an oedematous date of the prepuce, and
inflammation of the glans, and a worfe appearance of
the ulcers. A decoftion of poppy heads and cha¬
momile flowers was ordered to be mixed with Iin?
feed meal, and applied warm twice a day. — 15th.
Frefh ulcerations are breaking out on different parts
of the glans, and the old fores are fpreading. I now
directed the acid to be left oft, and calomel pills to
be taken daily : but, the patient having by fome
means difcovered that I was making trial of a new
medicine, told the Apothecary to whom he had
taken my prefcriptions that he was diffatisfied. Fie
afterwards did not chufe to confult me any more. —
I cannot tell what was the fequel of this cafe ; but
there is no reafon to felicitate the philo-acidi on its
progrefs, to the 15 th of November. This was the
firft (and will probably be the laft) private patient
with whom I have ventured to hazard my reputation,
by trufting to a new-fangled fcheme.

‘ Cafe 12. John Williams, in the twentieth year
of his age, was received as a patient upon the 23rd
Cf laft November. Flis original complaints, which he
contra&ed fix months previous to his admiffion, were
chancres : he endeavoured to get rid of thefe, by fome
trifling means ; but had taken nothing for three months
before 1 faw him. Fie then had chancres on the
middle and upper part of the penis, with indurated
glands in each groin.- — I put him on the ufe of the
nitrous medicine, two drams of the acid daily, and

M 4 ordered

156 Blair's EJfays on the Venereal Difeafe.

ordered his fores to be drefied with a Ample ointment.
—The acid did not at all difagree with him 5 fo that
he was able to continue it without any intermiffion,
or diminution of the quantity, till I defired him to
deftft. — No change of confequence occurred before
the 10th or 11th of December, at which time his
ch ancre-s were nearly healed, and the inguinal tumors
diminhhed : there remained, however, a thickened
fkin, and a hard bale around the cicatrized parts. — -
Scarce any alteration took place in the groins, for ten
days longer: at which time he complained greatly or
pains in his joints.— December the 28th. The buboes
not fo much tumefied, and unattended with inflamma¬
tion.— January the 1ft. They have leffened fafter than
ufual thefe three days. — 4th. The acid has thrown
out very fmall whitifn pimples, with black points in
their centre, accompanied with an itching fenfation,
all over his body.— 8th. His groins are very little
fwelled now : the medicine was continued for three
days more. — 1 1th. Difcharged from the holpital ; after
having taken 96 meafured drams of the acid, equal
to above 156 drams by weight.

- c On the 19th of February he returned to me, with
numerous, broad, fyphilitic blotches, on his breaft and
face ; alio a venereal farcocele, and an ill looking
ulcer on one tonfil. He faid his throat became fore
a month ago ; but that his eruption had appeared
only a week.- — I immediately ordered the mercurial
inunClion.— On the fecond day after his re -ad million,
upon infpeCtmg his throat very carefully, I difcovered
that both his tonfils were ulcerating, and likewife the
pofterior fauces. Fie was now direCled to fumigate
twice a day with factitious cinnabar, and rub in the
mercurial ointment every night. — By the 5th of March
all his ulcerations, and likewife the farcocele, were
entirely well : moil of the fpots had alfo difappeared.
—April 26. Fie left the hofpital, and promifed to re¬
turn if any relapfe fliould occur. I have not heard of
him fm.ce.

* Nothing

157

Blair’s Ejfiays on the Venereal Difeafe.

c Nothing worthy of peculiar notice happened dur¬
ing the mercurial courfe ; nor could I perceive that
the previous treatment, by nitrous acid, had occafion-
ed any difference in the time or facility of his cure :
but it fhould be hinted, that one dram of the oint¬
ment, containing a fcruple of mercury, was as much
as he could bear in 24 hours.

Se£t. 2. Acid of Nitre in confirmed Syphilis.—
* Cafe 6. Robert Chace, twenty-five years of age,
was admitted under my care, October the 26th. He
contrafled the venereal difeafe four months before :
his firft fymptoms were chancres ; which he got rid
of in a week, by taking eighteen pills. He has now
loft his uvula and part of the foft palate, by an ulce¬
ration of two months continuance. — The acid mixture
was adminiftered immediately : he went twice into
the warm bath, without my order.- — November the
6th. He told me he had an ulceration near the verge
of the anus, which had been there two months ; and
likewife pains in his arms. No alteration was made
in his treatment, except that a faturnine lotion wTas
applied to the anus frequently. — 9th. He ufed for¬
merly to complain of a pain in his throat ; but it is

now removed : his appetite has improved lately. _ _

13th. I this day perceived an ulcer on the pofterior
part of the fauces : the palate looks cleaner than be¬
fore, and the ulceration near the fundament is better.

6th. His throat is a little healed over. — 20th.
Much amendment in his palate and fauces; but a
fiftula lachrymals has juft appeared.— 23rd. The fif-
tula gets worfe ; the fauces better. He takes three
drams oi the acid daily. — 29th. Getting better in his
throat daily : he begins to loath his medicine.— De¬
cember the 4th. Vefications appear on the palate and
cheeks, likewife ulcerations upon his lips, from the
immediate application of the acid ; his gums alfo are
tender, but not fwelied, and the enamel on his teeth
*s c°nfiderably eroded: I am informed that he has had
a ialivation tome time. The ulcers are healed in his

. ■ r * throat ;

158

Blair’s Effays on the Venereal Difeafe .

throat ; but puftular eruptions have juft broken out on
his face. I directed him in future to drink the acid
mixture through a tube, to prevent its touching his
teeth and cheeks, likewUe to diminifh the daily quan¬
tity of it to two drams. — -1-1 th,. Not yet better of his
lips and mouth : the falivation has encreafed to three
pints a day : the fpots continue on his face. — 18th.
A bad ozcena has come on, with great pain, and a
difcharge of purulent matter from his nofe : the fif-
tula lachrv mails is going. In other refpedts, he is
much the fame as on the eleventh. — 21ft. I now
again ordered three drams of the acid to be taken
daily : his mouth, &c. is better ; and he only fpits
one pint in twenty-four hours. — 28th. His fpitting has
ceafed entirely. The ozcena and puriforrn difcharge
continue. The eruptions on his face are of a dubious
nature ; but I begin to fufpeft they are venereal . — -
January the 1ft, 1798. A Angle fcabby eruption has
come upon one leg. He ftill takes three drams of the
acid ; and, it agrees very well. His general health is
good. — 4th. The fcab on his leg has enlarged ; and he
fhews me more puftular eruptions upon his arms, like
thofe which appeared nearly five weeks ago in his
face. 1 he complaint in his nofe is much the fame.

- — He has already taken one hundred and Jixty-five
meajured drams of the acid; zvhich are ccjmil to
upwards of tzvo hundred and eighty-nine drams by
weight /—Some of his recent complaints feemed to
be venereal ; although the fymptoms for which he
firft came under my care had entirely difappeared : J
was therefore difpofed to watch the progrefs of this
curious cafe, and to defift from the new mode of treat¬
ment. — January the 5th. Omit the acid, and take
Pilulae ex mica panis bis in die. — 11th. The fcab on
his leg encreafes in its dimenlions. The man gets
fat, and has a very keen appetite : in other refpedis he
remains as before. I now made him an out-patient,
and defired him to continue the pills till I faw him
again.— 22nd. He had no fpitting when he left the

Blair’s Kff'ays on the Venereal Difeafe . 159

hofpital ; but, a falivation has fince recurred : his
front teeth are covered with tartar, and much in¬
jured by the acid : his gums are very painful ; but
not fpongy, as if he had ufed mercury ; nor is his
breath at all fetid. The other fymptoms of difeafe
remain fiationary. Perftet in ufu pilularum micas
panis. — 29th I difeovered a deep and foul ulcer in
the lower part of his pofierior fauces. He continues
to fpit very much. — February the 5th. The ulcer has
become as large as half a crown. I defired to fee him
again in three days. — 8th. The ulcer has not got
larger ; but is very filthy in its afpeft, and clearly
venereal : fome of the fpots on his face now appear
to be well marked fyphilitic eruptions : I conclude
that his ozasna is alfo venereal ; efpecially as it has
become much worfe than before. Nothing would
have juftified my continuing the new specific af¬
ter this decifive trial : mercury was the only refovree ;
and it was well I had fuch an efficacious remedy to
flee to.

c On the 8th of February he rubbed a dram of
mercurial ointment into his thighs, morning and
evening. — He repeated the fame quantity on the
10th, 12rh, 13th, and 14th ; after which he ufed it
once a day till the 25th. — Fie was, by this time, ma¬
terially relieved. The mercury having caufed a co¬
pious difeharge of faliva, and his gums being now
tumefied, he rubbed in only a dram every alternate
evening. — March the 3rd. His throat is perfe£tly heal¬
ed : his fpots are all vanithed : the ulcer in his nofe
is much better : but, the lachrymal fac has lately dif-
tended and inflamed as it did before. — 8th. The fif-
tula lachrymalis ruptured, and is healing again. — 15th.
His nofe, &c. quite well. The mercurial friction was
regularly continued till the 20th of April ; at which
time he had employed about feventy drams of the
ointment. I now gave him five grains of the quick-
filver pill, night and morning ; and on< the 30th made
him an out-patient.— May the 12th. He returned to

me.

160 Blair's EJays on the Venereal Difeafe.

me, and had more pills : they lafted him till the thirty-
firft ; whem he came to the hofpjtaj and returned
thanks for his cure, faying “ he was as ftrong and
hearty as ever." — If there were no other cafe on
record hejide this , who could he fit ate a moment in
giving the preference to mercury f What can

BE MORE CONCLUSIVE?

c Cafe 17. Elizabeth Scarborough, in the twenty-
fecond year of her age, contracted the lues venerea
in July 1797. Four months after this, fhe became my
patient; at which time die had ulcerations on the alas
mad and on one dioulder. — -I ordered her the nitrous
potion : it agreed very well, and afforded her a little
relief by the 2nd of November.— Nothing remarkable
occurred during this ftage of her treatment : fhe went
on gradually mending till the 16th, when the ulcera¬
tions on her dioulder and nofe were alrdoft healed :
They had been dreffed with dimple white cerate. —
Four days afterwards, while the fores were ftill dimi-
nifhing on the external parts of the alas nab, they fpr'ead
inwards, and ulcerated the noftrils : nocturnal pains
in the tibiae, at the fame time difturbedher night’s reft;
but the dioulder had now quite healed. — 27th. The
pains in her dims are extremely tormenting : the nofe
gets worfe internally ; and an opthalmia has affected
her eyes. — 30th. In addition to the other aggravations
of her diforder, venereal blotches have broken out
upon her face and boforn. — Experience now fuggefted
the necedity ot a different plan: the acid was relin-
quidied, and mercurial friction adopted. — December
the 6th. All her venereal fymptoms were going awray
rapidly. — 14th. Perfectly well — 29th. She eloped
from the hofpital, before i propofed to difcharge her.

‘ Cafe 25. Elizabeth Turner, twenty years old, was
admitted April the 28th. She contracted the lues
venerea fix months before: her firft fympton was a
gonorrhrea, which was fucceeded by a bubo ; after¬
wards eruptions appeared about her body. For this
•complaint fhe underwent a mercurial courfe, at Guy's

Hofpital*

161

Blair’s Ejjays on the Venereal Dijeafe*

Hofpital, under the care of Mr. Cooper: but, in the
iixth week alter her difcharge, the eruptions returned.
In this ilate (he applied to me. — I gave her a dram
and a half of the nitric acid, prepared by Mr. Seaton,
diluted with two pints of water, and without any fy~
.rup. It occafioned pains in her flomach at firft; but,
by adding fome tindhire of Opium to the drink, and
giving a grain of opium at night, ihe was enabled to
continue its ufe with regularity. — March the 7th.
Two drams of the acid were taken daily, from this
time.-— 10th. The fpots are going off, but the gonor¬
rhea is greatly encreafed. Patients with a gonorrhea
have in general employed a vitriolic injection ; but

this woman did not ufe any thing for that fymptom. _ -

13th. Numerous frefli eruptions have come out on
her forehead ; and the acid occafions a diftreffing op-
preffion on the brain, with giddinefs, head-ach,° and
paininher flomach. — She now debited from the acid^
upon which the complaint in her head went off, and the
venereal fpots remained flationary till I put her upon
a courfe of mercurial inundtion.— Nine drams of the
ointment difperfed the eruptions. She is now continu¬
ing the treatment with mercury ; and was this day
(June the 7th) going on. perfedily well.

Sect. 3. € Cafe 9. John Gibbins became my patient at
the Finfbury Difpenfary, in the autumn of 1797. He
had been feme time under the care of my colleague. Dr.
Wells s but, a venereal eruption having broke out on
his face and body, the dpetor transferred him to me,
I treated him in the ordinary manner, with mercury,
till the fpots had nearly difappeared ; and then, to try
whether the nitrous acid was capable of effecting a
complete cure, I gave him two drams (from Apothe¬
caries Hall) to be taken in a pint and a half of wrat^er
daily. — This patient was one of the moft fit fubjedls
poflible for a courfe of experiments: he was perfedl-
ly conformable to every direct ion ; be had the fulled
confidence in my judgment: he lived in a fituation
where he was provided for, and where I could vifit

him

162 Blair’s Effays on the Venereal Difeafe .

him from time to time: in fhort, he was one of the
molt traftable and patient beings imaginable. 1 have
mentioned this, becaufe the progrefs of his cafe is ex¬
traordinary, and it may aflift in giving weight to what
I fhall add of his hiftory. — He fieadily perfevered in
taking the acid, without having any appearance of
the lues or any unpleafant effeCt from the remedy, till
the 7th of November 5 when a falivation came on.™
17th. Frefh eruptions were difcovered upon his legs.
Having now exhibited the acid forty -two days , I dif-
continued it, and watched for the fubfequent fymp-
toms. — 28th. Violent pains have attacked one of his
arms, and a fwelling has come on the left ulna. I
amufed him, and at the fame time improved his gene¬
ral health, by ordering the daily ufe of a decoftion of
calcarilla. — Next day, he called to fhew me a tumor
on his right tibia, which was extremely tender. I di¬
rected fifteen grains of the compound powder of ipe-
cacuan to be taken at bed-time, four fuccefiive nights.
- — December the 6th. His pains were better. The

;owder was repeated for fix nights more. — -
anuary the 20th. Iwent on till this time, that the
cafe might be in fo diftinCt and unequivocal a form
as to be fit for the oxygenated muriate of potalh. In
addition to the nodes, eruptions, and noClurnal pains,
a lardaceous ulcer has made its appearance on the left
tonfil. He began to take twenty grains of the kali
in a cup of water four times a day.— 25th. The dofe
is augmented to thirty grains. No good e fie 61 is pro¬
duced : his ftomach and intefiines are uneafy from the
medicine. — 30th. It has agreed lately, and he has
even encreafed the quantity to forty grains : but, to
prevent his bowels from being affeCted, I ordered an
opium pill every night at bed-time. — February the 6th.
The opium is repeated, and the potafii is hereafter to
be taken, /fee times a day , in the dofe of forty grains .
— 10th. He ha? continued it in the fame dofe ; but
the lues venerea feems fiill in progrefiion, and the
tonfil is more ulcerated : his appetite fails him; his
Urine diminifhes in quantity ; he has a conftant third:

and

163

Blair's EJj'ays on the Venereal Difeafe,

and dry fkin ; his bowels are griped and very hot; a
cold fhivering comes over him when he takes the kali;
and he has a llight falivation, with a pain in his jaws,
but not fpongy gums. — February 14th. The tonfil is
very deeply ulcerated, and fpreads wider; the fpots
are encreafmg in number; the nodes much more
painful; his gums are red and tender, but his breath
is not fetid: the medicine now produces a univerfal
tremor when he takes it, and has caufed a languid in¬
termitting pulfe.— 16th. He protefts he has never yet
miffed taking his potaffi ; but, the third dofe to-day
occafioned fuch excruciating pain on one fide of his
abdomen, accompanied with a trembling motion of
the heart, that tie could not move his body from the
fpot where he lay, during the fpace of feven hours : at
the end of that time, he was relieved by a diarrhea
and vomiting. — He has had a defective fecretion by
the kidneys till within the two laft days, when he
voided a confiderable quantity of urine : his tongue
has been furred and white, as in the former cafes.
His venereal fpots are at length rather oaler than they
were ; but the nodes are as large as c f>re, and pain¬
ful almoft to diflraftion : the ulcerated tonfil is ah

moil deftroved.

This was an experimentum crucis. He had taken
the acid forty-two days, and likewife employed about

SEVENTY-SIX DRAMS OF THE OXYGENATED MU¬
RIATE OF POTASH. It was high time, after this

decifive trial, to treat the man by other means. _ On

the 17th of February, I directed him to begin with
the mercurial ointment, and to gargle his throat with
a weak folutionof muriated mercury. His fymptoms
yielded in ten days : The eruptions, the fore throat,
bus noQurnal pains, and one of the nodes, difappear-
ed foon afterwards.— -This patient being often ex do fed
to the cold air, and finding the ointment to be abforbed
with great difficulty, was advifed to perievere in the
nfe or mercury till the end of May.— He is at pre-
fent in good health, and does not appear to have been
much debiliated by fio tedious aprocefs/

The

164 Ferriars Medical Hijiories and Reflections .

The fuccefs of the new remedies in the cafes we
have quoted above, is frnall indeed ; and the remain¬
der do not afford a more favourable refult. But we
forbear at prefent to draw general conclusions, as the
author promifes a further fupply of evidence.

Art. XVI. Medical Hijiories and Reflections. VoL
IIL By J ohn Ferriar, M. I). Phyjician to the
M anchejler Infirmary , Sic. Stic. Odtavo, 232 pages,
price 4s. London, 1798. Cabell and Davies/

THE method purfued by the ingenious author in
the volume at prefent before us, is fimilar to
that employed in the preceding ones, of which we
have heretofore given a fufficiently full account*. He
does not profefs to treat fyftematically on any of the
fubjefts which have engaged his attention : his aim
being merely, to fupply fome deficiency in the hif-
torv, or fome elucidation of the treatment of parti¬
cular difeafes.

_ The fubjeff of the firft effay is Rabies Canlna.
The diffeflion of two cafes of the difeafe which
fell under Dr. Ferriar’s notice, is related. On open¬
ing the head, he obferves, there was found an effii-
lion of fluid between the pia mater and tunica arach-
noides, which diftended the former f confiderably.—
There was not more water than ufual in the ven¬
tricles. In the thorax there were fome adhefions on
the right fide : the left lobe of the lungs was fo com¬
pletely filled with blood, as to have acquired confi-
derable weight and folidity. This appearance is laid
great ftrefs on in the fequel.

# Vide Med. Rev. vol. 2, pages 199 and 299.
f A fmall miftake occurs here : the tunica arachnoides is external
lo the pi a mater ; the pia mater, therefore, could not have been dif¬
tended by an efrufion between: it and the tunica arachnoides.

Fer bar's Medical Hiftories and Reflections . 165

In the abdomen, the liver was changed in colour,
and ftreaked with white fpots. (The patient had
been intemperate.) The external furface of the
ftomach was much inflamed, efpecially on the great
curvature. The oefophagus was completely found*
The villous coat of the ftomach was found to be ge¬
nerally inflamed in irregular points, and there was an
appearance of abrafion. Dr. Ferriar was led by thefe
appearances to inquire, whether the dread of water,
in cafes of rabies produced by the bite of mad ani¬
mals, has been accompanied by inflammation of the
internal coat of the ftomach or oefophagus in other in-,
fiances, and to examine how far the dread of water
is effential to conftitute the exiftence of rabies ; as
cafes are faid to have occurred, in which neither this
fymptom during life, nor inflammation after death had
been obferved.

Many cafes of rabies are mentioned by authors, in
which, on diffection, inflammation of the ftomach and
oefophagus was obferved. Lietaud, Hoffman, Van
Swieten, and Sauvages, are adduced in proof. Some
have mentioned a ftate of the lungs fimilar to that ob¬
ferved by Dr. Ferriar : and wdiilft hydrophobia, or a
dread of water, has been wanting in many cafes of
rabies, this fymptom has taken place in many other
affections, wuthout the moft diftant fufpicion of rabid
poifon.

The ufe which the author makes of the fa61s ob¬
ferved in diffeCtion will appear from the following
train of reafoning. c The application of the term hy¬
drophobia he obferves, c to an acceffory fymptom,
fupervening to fuch a variety of difeafes, evidently
tends only to miflead, by directing the attention of.
practitioners to fuppofed analogies, which have no
other foundation than the abufe of a word. To be
correct, we muft preferve the diftinftion between
rabies, and difeafes wffich are effentially different
from it in their ufual appearance, and which only ac¬
quire an adventitious refemblance to it under uncom-

vol. v, N moiii

166 Ferriar’s Medical Hijlories and Reflections.

mon circumftances. Several cafes have been defcrib-
ed, of late years, under the title of, Spontaneous hydro¬
phobia. I think it very evident, from the view I have
Exhibited, that no fuch difeafe ever exifts. If t-hofe:
cafes be analyzed, they will be found to belong to
the clafs of hyfterical, febrile, mental, or fpafmodic
diforders, and by ranking them under their proper
titles, we fhali at once clear this fubjedl from a great
and accumulating mafs of error. By confidering the
matter in this point of view, we are alfo enabled to
explain the contradiftory reports, hitherto fo perplex¬
ing, on the eflfedts of remedies in rabies. It is eafy to
perceive, that evacuant and antifpafmodic remedies
would remove a difficulty in fwallowing, occafioned
by inflammation or fpafm in the ftomach or oefopha-
gws ; that bark and wine would cure it in cafes of
typhus, or of low mania ; and that opium and the
cold bath would be fuccefsful, when it accompanied
tetanus.

‘ When thefe falfe cafes are fet afide, perhaps we
gain fomething refpedting the ratio fymptomatum ,
and the pradlice, in rabies. The difficulty of fwal¬
lowing, in this difeafe, is probably almoft always at¬
tended with inflammation of the flomach or oefopha-
gus : we cannot, therefore, hefltate to bleed, and to
apply rubefacients of the mo ft active kind to the Ik in,
as near the feat of inflammation as poffible, whenever
this fymptom appears in a clearly-marked cafe of ra¬
bies. It is of fome advantage, that wre can nearly
afcertain the duration of the difeafe ; for, if the prac¬
titioner be confulted early, he can determine with
precifton, whether a fucceffion of blifters, or of ftimu-
lants quicker in their operation, be better adapted to
the remaining portion of time. But the mode of ap¬
plying thefe remedies may alfo be varied, by atten¬
tion to the view of the difeafe next to be mentioned.

‘ It has been remarked in many of the difledlions,
that the lungs have been loaded with blood, to fuch
a degree, that fome part of them has appeared almoft

a folid

Ferriar’s Medical Hiflories and Reflections. 167

a folid maf$, exactly refembling the phenomena
which occur, when blood has been effufed into
the fubftance of the lungs in pneumonic inflamma¬
tion. The only queftion upon this point is, whether
this happens fo frequently as to conftitute an effential
part of the difeafe, I am inclined to fufpeCf that it
does. It is true, that in my firft patient, Johnfon,
there was no particular difeafe viflble in the lungs,
which furprifed me more, as he had fathered repeated
attacks of pain in the breaft and tides, and of cough,
previous to the acceffion of the rabies. But the ap¬
pearance of effuflon in my fecond patient was fo ftrik>
ing, and the phenomenon is mentioned fo frequently,
without reference to theory, by authors, that it is
allowable to direct the attention of practitioners to
this circumftance.

c This ftate of the lungs is obvioufly a fufficient
caufe of death, and when it is detected, affords a
folution of our doubts on that head. If it be fup-
pofed, that congeftion of the lungs takes place in the
firft inftance, the affeCtion of the brain, and the ap¬
pearances of effuflon or congeftion difeovered in it,
receive alio a full explanation. And that this fuppo-
lition is not improbable, appears from the great
anxiety and oppreftion at the breaft, of which the
fick fo generally complain, which Dr. J. Hunter
fuppofes to depend on an affection of the heart, but
which the review of diffeCtions inclines me to refer to
the lungs. Symptoms of compreffion of the brain are
fufficiently remarkable, in the ordinary courfe of the
difeafe, fuch as the delirium, and the convulfions,
which are frequently of the epileptic type ; but, in
fome cafes, the appearances have been ftill more de-
cifive. In a patient of Dr. Mead’s, a paralytic af-
fe&ion of the right arm fupervened, and the patient
complained of mift before his eyes. A patient of
Dr. Howman’s, who was feized with rabies in con-
fequence of a recent bite, was affefted, at the very
commencement of the difeafe, with palfy of the right

N 2, arm,

168 Ferriar’s Medical Hifiories and Reflections .

arm, and intermiffion of the pulfe at the wrift of that
arm. The difficulty of fwallowing did not take place
till the third night; and the paralytic complaint com
tinued to encreafe till death.

‘ If future diffedtions fhould prove, that congeftion
in the lungs generally appears in thofe who die of
rabies, I confefs that I fhould be difpofed to confider
this difeafe as dependent on the obftrudiion of circu¬
lation in that important organ. Accumulation of
blood in the head, and compreffion of the brain,
muft be the confequence of fuch an obftrudlion,
rapidly formed. The quick, panting refpiration,
anxiety and fudden debility, may be referred to the.
fame caufe. In fadl, we find a fimilar degree of
tremor attendant on the croup, which confifts in in¬
flammation of the trachea, and deftroys by fuffocation.
That degree of inflammation in the ftomach or oefo-
phagus, which produces the difficulty of fwallowing
liquids, may not only arife from fympathy, but the
fymptom itfelf may occ'ur in confequence of the ftate
of the lungs alone. This will appear from the fol¬
lowing cafe, given by Ronetus.

“ Quidam voraciffimus enteroceles moleftias decli-
naturus, caftrationi fe fubmifit, feliciter peradtae. Om¬
nia rite fe habebant, cum poft tres feptimanas diffl -■
cult ate deglutiendi et difilcili refpiratione prehenditur, ,
Tertia die lingua erat carbone nigrior, urgebat deglu--
tiendi et refpirandi difficultas. Nil in hac anginas:
fpecie, nec intus nec extra apparebat, fi linguae ni-
grorem exceperis.

<c Mortui aperto corpore, falva reperta eft trachea'
arteria, et omnis phlegmonis expers. Thymus intu-
muerat, et atro fanguine fcatens tracheam premebat.
Pulmones fe praebent inflammati, et creberrimis ma-
culis nigris confpersi cum gangrsenae fignis eviden-
tibus.,,

4 It will appear, on reference to Lietaud, under the
title, Lcejiones Pectoris , how frequently inflammation

Ferriar’s Medical Hiflories and Reflections. 169

of the higher part of the abdominal vifcera, accom¬
panies pneumonic inflammation.

c To all thefe confederations we muft add, the fud-
dennefs with which death takes place, and the re¬
markable fluidity of the blood, fo commonly obferved
in diffedtions ; circumflances which cannot be fatis-
fadtorily explained, without attending4 to. the date of
the lungs, which I fuppofe to exift.

c Thefe conclufions, it muft be owned, are uncer¬
tain, becaufe the facts from which they are drawn are
incomplete. I offer them only as conjectures, which
may give a new direction to farther enquiries, on a
fubjedt equally important and obfcure.

c In the mean time, it cannot be uninterefting to
conftder, what mode of pradtice this view of the dif-
eafe would determine us to adopt. Repeated blifter-
ing would certainly be advifeable, if the period of the
difeafe fhould admit this remedy ; and the application
fhould be made to the head, as well as to the cheft
and fpine. Blood fhould be drawn from the jugular
veins, and perhaps the head and lungs would be beft
relieved by the repetition of bleedings. The ftate of
the pulfe, and the apparent degree of debility, fhould
not deter the practitioner from ufing this remedy, on
my fuppofition. Thofe fymptoms may be confidered
as the neceffary confequence of impeded circulation
in the lungs. Dr. Nugent’s cafe of rabies was cured
by large, and repeated general bleedings. In the
prefent ftate of knowledge, little will be attributed to
the mufk which he exhibited. Great attention fhould,
undoubtedly be paid to the ftate of the pulfe, while
the blood flows from the vein, efpecially after the firfl
bleeding. The fame cautions apply here, which have
been given by pradtical writers, on the fubjedl of re¬
peated bleeding in peripneumony. In fadf, there is
no difeafe which is accompanied by more ftriking
marks of debility, at its firfl appearance, than peri¬
pneumony. If, however, the pradfitioner fhould be
alarmed at the idea of frequent general bleeding,

N % leeches

170 Ferriar’s Medical Hiftories and Reflections,

leeches may be applied to the temples. With the
view of relieving the lungs from congeftion, by ftimu-
lating the exhalents, and of exftinguiffiing the exifting
difeafe, by producing another lefs dangerous, the fuc-
cefs faid to have attended the free ufe of mercury is
perfectly reconcileable. 1 fhould join opium, in pretty
large dofes, with this procefs. Calomel with opium
may be given internally, while the mercurial friCtion
is applied to the limbs : I believe that the mouth w ill
be fooner affected in this manner ; and, confide ring
the fhort duration of the difeafe, it is of the higheft
importance to excite a ptyalifm early.

c So greatly would this hypotheiis alter my views
of the indications ot cure, from opinions which I have
formerly expreffed, that it wmuld induce me to pro¬
hibit entirely the ufe of the cold ba h, and of bark,
during the exigence of the fymptoms,

c Refpetring the ufe of oil, I ffiould be more un¬
certain. Dr. Shadwell’s cafe appears to favour it*
yet there was fomething very ur.uf il in that cafe,
both m the mode of attack, wffiich refembled phrenzy
more than rabies, and in the duration of the difeafe ;
for eleven days elapfed from the firft fymptoms of ill-
nefs, and nine from the phrenitic attack, before the
difficulty of fwallowing, and dread of cold air left the
patient. If oil were given, i fhould not allow it to
fuperfede the mercurial courfe.

c As it is abfolutelv neceffary to choofe among the
contradictory methods of treatment, recommended in
rabies, I have thus ventured to ftate the plan upon
which I fhall proceed, if any other cafes occur to me ;
but with a deep conviction, that the grounds of pre¬
ference are not yet Efficiently afcertained. This is a
fubjeCt, concerning wffiich the mind of the medical
philofopher cannot remain at reft. It is allowable to
hope, that careful diffeCtions, and accurate difcrimi-
nation of fymptoms, will at fome future period, afford
the power of removing this hitherto intractable difeafe/

Ferriar's Medical Hifiories and Reflections . 171

It appears to us that objedtions of no inconfiderable
weight might be darted againd much of this reafon-
ing. The inflamed ftate of the ftomach and oefopha-
gus has not always been obferved, where the hydro¬
phobia veas prefect, nor, if it had, would it explain
the peculiar date of mind which accompanies this
fymptom. The condition of the lungs obferved by
the author has a (till lefs claim to confideration, as
explanatory of the fymptom s of the difeafe ; for it
has been yet more rarely obferved to accompany it.
We may obferve ot this alfo, that it would be wholly
infufflcient to account for the fymptoms ; for who has
obferved peripneumony attended with the date of
mind peculiar to rabies ? or has the mode of dying
been at all flmilar ? In fadt, it is in vain to compare
the phenomena excited by peculiar poifons in the
fydem, with thofe which arife from other caufes.
There is neither analogy in the fymptoms, nor in the
method of cure. Obfervation mud point out the one,
and experience alone can fugged the other.

The fecond efiay contains an account of the Edab-
lifhment of Fever Wards in Mancheder. In the twro
preceding volumes, the author pointed out the mifery
and havock, produced by the prevalence of infedtious
fevers, among the poor in manufadturing towns. The
object of the prefent efl'ay is of a more agreeable na¬
ture $ it is, to explain the meafures which have been
adopted, for remedying thofe evils, and the fuccefs
attending them, which has exceeded all expedtation.
A board, or committee, was formed for the purpofe
of fuperintending the health of the poor in Mancheder
and Salford, whofe objedt was to inquire into the
caufes of the rapid fpreading of infedtion, and the
means by which it might be bed obviated. The
principal fources of fever among the poor appear to
be, lodging-houfes, cellars, cotton-mills, and the in¬
cautious intercourle of the poor with each other, in
places infected.

N 4

The

172 Ferriar’s Medical Iliftorks and Reflections .

The moll eligible mode of remedying thefe evils
appeared to be, the appropriation of a building, to
the particular reception of patients ill of fever ; and a
houfe was accordingly provided, and named I he
Houfe of Recovery. The following are the regu¬
lations which were adopted in its management.

< 1. Every patient on admiihon, fhall change his
infeflious, for clehn linen ; the face and hands fhall
be wafhed clean with lukewarm water, and the lower
extremities fomented.

‘ 2. The clothes brought into the houfe by pa¬
tients, fhall be properly purified and aired.

• ‘ 3. Ail linen and bed-clothes, immediately on
being removed from the bodies of the patients, fhall
be immerfed in cold water, before they are carried
down flairs.

‘ 4. All difcharges from the patients fhall be re¬
moved from the wards, without delay.

c 5. The floors of the wards fhall be carefully wafh¬
ed twice a week, and near the beds every day.

c 6. Fumigations with nitre and concentrated vi¬
triolic acid, which have been lately employed with
fuch fuccefs in his Majefly’s military and navy hos¬
pitals, as an antidote to contagion, fhall be ufed, ac¬
cording to the directions of Dr. Smyth, twice daily in
all the wards of the Houfe of Recovery. The walls
fhall be frequently wafhed with quick-lime, frefh
flaked in water, and whilfl it continues bubbling
and hot.

6 7. No relation or acquaintance fhall be permitted
to vifit the wards, without a written order from one
- of the phyficians.

c 8. No flrangers {hall be admitted into the wards ;
and the nurfes fhall be itri&dy enjoined not to receive
unneceffary vifits.

‘ 9. No linen or clothes fhall be removed from the
Houfe of Recovery, till they have been wafhed, aired,
and freed from infection.

* 10. No

EerriaFs Medical Hiflories and Reflections. I7S

* 10. No convalescents {hall be difcharged from
the houfe, without a confultation of the phyficians.

4 11. The nurfes and Servants of the houfe Shall
have no direct communication with the Infirmary;
but Shall receive the medicines, in the room already
appropriated to meflengers from the home-patients.

4 12. The committee of the Strangers’ Friend So-
ciety (hall be requeded to undertake the office of in¬
specting the Houfe of Recovery.

4 1 3. A weekly report of the patients admitted and
difcharged, (hall be publiffied in the Manchester news¬
papers.

4 14. When a patient dies in the wards, the bodv
(hall be removed as Soon as poffible, into a room ap¬
propriated to that ufe ; it Shall then be WTapt in a
pitched cloth, and the friends (hall be defired to pro¬
ceed to the interment, as early as is confident with
propriety.

4 15.. All provisions and attendance for the patients
in the Houfe of Recovery, Shall be provided from the
funds of this inftitution, without any communication
with the Infirmary.

The rooms on the ground-floor wmre appropriated
to the fervants, and the convalefcents. The establish¬
ment of Servants, confided of a head-nurfe, who was
expeCted to Superintend the domedic concerns of the
houfe, and three ordinary nurfes, a number fuppofed
to be equal to the general exigencies of the institu¬
tion. On emergencies, it was propofed to hire oc¬
casional nurSes, while the temporary preflure might
render their affidance neceflary. The wards were
furniflied with iron beddeads, without curtains, and
with ticks filled with draw, which was changed at
proper periods.

The mode of removing the fick from their own
dwellings, adopted by the committee, was that of
conveying them in a fedan-chair, purchafed for the

ufe

174 Ferriar’s Medical Hi fi ones and Reflections.

•+ V .

life of the fever-ward, and kept in the out-building,
for that foie purpofe.

f Part of a vacant piece of ground, adjoining to
the houfes, was enclofed with a wall, for the purpofe
of wafhing and airing the clothes of the patients’.

The fuccefs of this eftablifhment has much ex¬
ceeded expectation. An idea of it may be formed
from the following comparative view of the number
of patients ill of fever at different periods in certain
ftreets of Manchester.

‘ From September 20, 174$, to May 20, 1794,
(a period of eight months , felected on account of the
ufual prevalence of fever) number of fever-patients
in thefe ftreets, 400.

‘ From September 20, 1794, to May 1795, num¬
ber of fever-patients in thefe ftreets, 389.

‘ From September 20, 1795, to May 20, 1796,
number of fever-patients in thefe ftreets, 267.

* From July 13, 1796, to March 13, 1797 (being
a period of eight months ftnce the opening of the
Houfe of Recovery), number of fever-patients in thefe
ftreets, 25.

* In July la ft, five.

‘ In Auguft laft, one.

c In September laft, none.

c From the 4th to the 23d of February laft, two.

f The bills of mortality for 1796 fhew, that there
has been a decreafe in the burials, amounting nearly
to 400.

‘ From the opening of the Houfe of Recovery on
the 19th of May, 1796, to February 3d, 1798, 623
patients have been admitted: of thefe 53 have died;
15 remain in the houfe. The number of deaths,
ftnce the beginning of May, 1797, to Feb. 3, 1798,
has been only 13, though the houfe has been gene¬
rally full, during the whole period. The moft itrik-
ing proof of the benefit which the public derive from

this

Ferriar’s Medical Hifiories acid Reflections . 175

this inftitution, refults from obferving the diminution
in the number of the home-patients of the infirmary:
the number of home-patients, from June 1795, to
June 1796, was 2880; from June 1796, (immediately
after the opening of the Houfe of Recovery,) to June
1797, the number of home-patients was 1759; that
is, the illnefs of 1121 perfons has probably been pre¬
vented by this inftitution, in one year; for the home-
patient’s lift has generally encreafed every year.’

The number of cures effected in the Houfe of Re¬
covery, it is well obferved, muft be principally af-
cribed to the attendance, and the comforts experi¬
enced by the patients. A clean bed, a quiet ward,
an attentive nurfe, and the frequent vilxts of the phy-
fician, are fo many medicines to a poor creature, who
has been languilhing in a cold, damp cellar, or in a
garret expofed to the injuries of the weather, a-
midft the neglecl and confufion of a wretched
family, clamorous from hunger, or brutal from de¬
bauchery.

£ In the practice of the Houfe,’ Dr. Ferriar ob~
ferves, c there is nothing peculiar, excepting the ufe
of cold bathing, which I introduced among the home-
patients in 1791, and which I have employed very
fuccefsfully in the fever wards. I h^ve not ufed it
in the firft days of fever, as danger is frequently to
be apprehended from the tendency to congeftion,
particularly in the head. Perhaps the fcrophulous
conftitution of a large manufaHuring town, may ren¬
der fuppuration in the brain more frequent, in fixa¬
tions refembling ours. The fevere cough, which fo
often attends our fynochus and typhus, from their firft:
appearance, alfo ftrongly contra-indicates this prac¬
tice with us, at the beginning of the difeafe. But
when the fever runs on to a great length, without any
particular affeftion of the head or lungs, when com¬
mon ftimulants lofe their effeft, and when the extreme

debility

(

17 6 Fer.riar’s Medical Ilifiories and Bejlections .

debility of the patient takes away all hope of re*
florin g him by ordinary means, I find the cold bath
eminently ferviceable. Among the home-patients, I
was frequently under the rieceffity of employing
fimple ablution with cold water, from the want of
conveniencies : in the Home of Recovery we ufe the
flipper-bath, and immerfe the patient. I have never
known any injurious effebt produced; on the con¬
trary, patients have often declared, that they felt
themfelves agreeably refreshed by it. In fome cafes*
where great ftupor accompanied the other bad fyrop-
toms, and where I was not without fufpicions re-
fpebling the hate of the brain, I have yet ventured
on the ufe of the cold bath, after applying leeches,
or cupping-glades, to the temples, and I have had
the fatisfaction of feeing the patient recover, from a
hate little ihort of death. Immerfion generally brings
on very quiet and falutary deep, in the cowrie of an
hour or two. One of my patients, in whom the
effebis of the bath appeared to go off towards even¬
ing, wTas bathed twice a day. The patient’s drink
was commonly adrainiflered cold.

6 In cafes of typhus, which begin with diarrhoea,
when the ftomach becomes fo irritable as to rejebt
medicines, wine, and other kinds of fuftenance, I
depend upon repeated dofes of opium in fubdance,
fometimes combined with aromatics, frequently given
alone. I have cured feveral cafes of this kind, when
the fever run on for four or five weeks, without giv¬
ing a fmgle dofe of bark. In thefe circumflances,
when there is no fixed pain in the bowels, I join the
ufe of the cold bath wdth that of opium, wdth great
advantage. Aflringent gliders, adminidered cold,
have a powerful effebt in checking febrile diarrhoea.
In one cafe, when large quantities of laudanum
thrown up, combined with ftrong aflringents, were
inftantly returned, and fmall loofe dools wrere dis¬
charged almoft every half hour, I direbted three

ounces

Ferriar s Medical lliftories and Reflections* 1 77

ounces of a flrong decoftion of galls to be injected
cold ; the effect was, that the patient had no return of
diarrhoea for four hours, and then parted with a fi¬
gured ftool. The naufea, which is always a formi¬
dable fymptom, may fometimes be relieved by giving,
repeatedly, fmall quantities of milk and water ; in ge¬
neral, it yields to the ufe of opium, and burnt brandy.
1 find, that obftinate coftivenefs, which fometimes be¬
comes as troublefome as the oppofite date of the
bowels, is belt relieved by calomel. Five or fix
grains commonly operate very gently with an adult,
in this (late.

* When patients are admitted into the houfie, a
flannel drefs is provided for them, and their own
cloaths are carried into the yard, to be wafhed,
fcoured, or ventilated. During their convalefcence,
they wear the drefs of thehoufe; which confifts of a
jacket and trowfers for the men, and of a wrapping1
gown and petticoat for the women. At the time of
/difeharging patients, their own cloaths are returned
to them perfectly clean, and they rejoin their fami¬
lies, and refume their occupations, without the ha¬
zard of communicating infection to others.’

We have thus entered fully into the account of
this inffitution, for the purpofe of rendering its eftab-
lifhment and fuccefs as generally known as was in
our power. There is not a town, as the author ob¬
serves, containing four thoiifand inhabitants, which
would not be benefited by the adoption of a fimiiar
plan. Abufes and errors prevail every where among
the lower dalles of fociety, which require both in-
druction and afliftance from the more enlightened.
Much mifery, much actual differing, are unavoidable,
in all dates of fociety; yet when the important inte-
refts of the poor are properly watched over, their ca¬
lamities admit of great alleviation.

The title of the next efifay is, An affection of the
lymphatic vej/els, hitherto mifunderjlood. It has been

long

178 Ferriar’s Medical Hiflories and Reflections*

long known, that irritation may be propagated along;
a lymphatic veffel, from its extremity, to its entrance
into one of the larger conglobate glands. But prac¬
titioners do not feem to have been aware, the author
obferves, that all the lymphatics of a large limb
may take on a difpofition to inflammation, from in¬
ternal caufes, though fuch an occurrence might have
been expected a priori . The following cafe, he
thinks, ferves to demonftrate this faft, and to furniffl
an explanation of cafes, which have been deferibed,
but not wellunderftood, by former writers,

* A gentleman of an irritable habit, fubjeft to fe^
vere bilious attacks, to hasmorrhoidal difeharges, and
fometimes to a conflderable degree of rheumatifm,
was affe£ted with pain, ftiflfnefs, and fwelling, in the
left leg and thigh. The pain and fwelling began in
the foot, and extended up to the groin. When I faw
him, the fwelling was uniform, tenfe, and fhining,
without difcolouration of the Ikin. Upon applying
my hand, I felt great hardnefs and enlargement in
the glands of the groin, and in thofe of the ham ;
the patient complained mo ft of pain in the ham.
The veflels could be felt much enlarged and harden¬
ed, for a little way above the ham, but the extreme
tenfion of the Ikin prevented me from tracing them
to any conflderable diftance.

* A bilious fit had preceded this attack, and the
ftomach was ftill weak, full of flatulence, and eafily
excited to vomiting. The patient had alfo been ex¬
po fed to the aftion of cold and moifture.

* About two years before, this patient had under¬
gone a variety of complaints, arifing from an accu¬
mulation of bile, and had difeharged a conflderable
quantity of hasmorrhoidal blood. After this, the left
arm had become fwelled and painful, but not to a
degree equal to the diforder which I have defcribed.
The difeafe in the arm was at that time removed, by
the application of a blifter below the elbow-joint.
After the difappearance of the fwelling, an acute

pain

Ferriar’s Medical Hijtories and Reflections. 179

pain in the right fide fupervened, accompanied with
tenfion of the abdomen, and obftinate coftivenefs,
Thefe fymptoms continued with great fe verity, during
three days, and were carried off by the brifk aft ion
of fenna and rochelle fait.

‘ In confidering the affeftion of the leg and thigh,
I conceived that there were fufficient marks, to indi¬
cate a general inflammatory ftate of the abforbents
of the limb. Thofe fymptoms from which we con¬
clude a Angle lymphatic to be inflamed, wTere diftin-
guifhable in all the fuperficial lymphatics, and in the
conglobate glands of the part., I determined, there¬
fore, to try the effeft of topical bleeding, and I
direfted feveral leeches to be applied to the leg,
juft under the knee, as the pain and ftiffnefs were
moft confiderable in the ham. Almoft immediate
relief was obtained from the action of the leeches,
"Next day there was an evident decreafe of the fw el-
ling, and I could diftinftly trace the fuperficial lym¬
phatics, entwifted like bundles of cord, through the
whole courfe of the limb. The inguinal glands on
the left fide were ft ill much enlarged, and very pain¬
ful, but the affeftion feemed to flop there, for no
pain or diftention was felt in the abdomen.

c The difeafe gradually leffened from day to day,
while the patient’s bowels were kept open by gentle
cathartics, and in the courfe of a week or two little
inconvenience remained.

‘ The tenfe fwelling of the limb/ the author ob~
ferves, ‘ clearly marked the diftinftion between the
clafs of veffels affefted, and thofe of the fanguiferous
fyftem. The abforbents were rendered incapable of
performing their funftions, by the thickening of the
veffels, and the obftruftion of the glands ; but the
arteries being in a found ftate, the exhalents con¬
tinued to pour out their fluid, which, not being ab-
forbed, muft ftagnate in the cellular membrane.
The theory and the faft accord perfeftly with each
other. The difference between this ftate of accumu-

. , lation

1 80 Ferrier’s Medical II [ft cries and Reflections,

lation, and that of common dropfy, feems to be this ;
that when the lymphatics are generally inflamed, ab~
forption ceafes entirely for the time ; but that in cafes
of oedema, or anasarca, abforption goes on, though
imperfectly, while there is any vigour in the habit.
At length, abforption is flopped, in dropfical cafes,
and the integuments give way : but before this event
takes place, I have generally found the fwellings af-
fume the tenfe, fhining appearance, accompanying
the lymphatic inflammation.’

A difeafe, refembling that which has now been
defcribed, has been mentioned by feveral writers on
midwifery. They have fuppofed it to be peculiar
to women in the puerperal flate, and in general have
attributed it to a rupture of fome lymphatic in the
groin, byr the preffure of the child’s head againfl the
brim of the pelvis, during labour. Dr. Ferriar, how¬
ever, explains it on the principle above mentioned,
of inflammation of the abforbent veffels and glands
of the limb.

* Little can be known’, the author obferves, 4 re-
fpeding the remote caufes of a difeafe, which has
been co'rreftly obferved in fo fewT inftances. In my
patient, it was apparently produced by the aftion of
cold and moifture, and it has probably been occa-
iioned by fimilar caufes, in thofe cafes where it ap¬
peared feveral weeks after delivery. But there are
circumflances preceding delivery, which may ope¬
rate as remote caufes, and from which the frequency
of its occurrence, in the puerperal ftate, may per¬
haps be explained.

4 It is an acknowledged faft, that during the lafl
months of geflation, a confiderable interruption is
given to the return of blood, by the veins of the
lower extremities, in confequence of the preffure of
the loaded uterus, on the contained parts of the
pelvis. The exigence of venous plethora, under
fuch circumflances, is proved by the varicous Hate
of the fuperficial veins, which repeated pregnancies
fo often occafiom By the laws of the conflitution,

which

Ferriar’s Medical Hiflories and Reflections . 181

which it is unneceffary for me to repeat to patholo¬
gical readers, this ftate of plethora in the veins, muft
be followed by encreafed effufion from the exhalent
veffels, and the encreafe of exhalation muft produce
encreafed adlion in the abforbents. In habits pre-
dispofed to the difeafe, occasional caufes may rea¬
dily excite inflammation, in a clafs of veffels thus
extraordinarily ftimulated. To this confideration we
muft join another; that much irritability in the lower
extremities is evident, in the laft months of preg¬
nancy, from the frequency of cramps in the legs,
during that period. The objection to this opinion is
obvious ; that the difeafe occurs after delivery . But
I have fhewed that the difeafe may exift, indepen¬
dently of every circumftance regarding parturition,
and I do not think it impoffible, though at prefent
I cannot prove, that it may take place before deli¬
very. Future obfervations muft decide this quef-
tion. But the violent preffure on the internal iliacs,
and the accompanying veins and nerves, wdftch takes
place during delivery, muft undoubtedly be confider-
ed as a powerful occaflonal caufe of lymphatic in¬
flammation, fufticient to account for the phenomena,
wdthout the fuppofition of a rupture of veffels.

c It muft alfo be conftdered, that the conftitution
is much more irritable, more liable to frebrile and
inflammatory complaints, after, than before delivery.
The balance of the circulating fluids is fuddenly and
violently changed ; there are new determinations,
new fympathies produced, in a ftate of great debility,
agitation, and anxiety. It cannot furprife us, that in
circumftances fo peculiar, a fet of veffels, commonly
exempted from inflammatory affe&ions, fliould take
on an unufual difpofttion.

£ From thefe views of the diforder, the method
of treatment is eafily deduced. As no inflammatory
affection of the arterial fyftem exifts, and as the in¬
flammation of the lymphatics is a local difeafe, topi¬
cal bleeding is evidently beft adapted to remove the

vol. v. O fymptoms >

182 Alibert’s Confederations fur les Odours , Sic.

fymptoms; it is a remedy which proved remarkably
ufeful in the cafe which I have related, and I fhould
expedt great advantages from its repeated application,
upon any fimilar occalion that may occur in future.
A fucceffion of blitters will be a valuable addition to
this courfe, and it will be proper to exhibit internally,
gentle cathartics ; perhaps cream of tartar, which ap¬
pears to operate fo powerfully on the abforbent fyf-
tem, in cafes of dropfy, may be better adapted to this
purpofe than moft other remedies of this clafs. By
this method, the difeafe will probably be removed in
two or three weeks, inftead of continuing feveral
months, which is the duration generally afligned to
it, by writers on midwifery.5

Whether Dr. Ferriar’s view of this diforder be per-
perfedlly corredl and fatisfadtory in theory, we fliall
not determine. It has, however, led him to adopt a
mode of pra£tice which appears to have been attend¬
ed with ftriking advantage.

(To be continued.)

Art. XVII. Confederations Philojophiques fur les
Qdeurs , et fur leur Elnploi comme Medicament :
i. e. Philofophicat Confederations on Odours , and
on their Employment in Medicine. By J. L.

A LIBERT. Magazin Encyclopedique, 1797 .

INDEPENDENT of the importance of the fenfe
of fine 11 in g, as one of the fafeguards of our ex-
iftence, and the fource oi many of our pleafures, it
merits ample confideration in its relation to difeafe
and the healing art. Who is ignorant of the effefts
of applications to this fenfe, in thofe faintings where
the living principle, as it were, remains fufpe'nded for
a time ? Strong odours which adt with energy on the
brain, are efpecially advantageous in thofe affedtions
which belong to the nervous fyflem. Aretoeus makes

mention

Alibert’s Conji derations fur les Odeitrsy fife. 183

mention of the efficacy of ammoniacal vapours on
certain epileptics. Morgagni gives an inftance of
the approach of epilepfy being arrefted, or prevented,
by the application of the fluor volatile alkali to the
noftrils. M. Pinel, Profeffor at Paris, witneffed a
fimilar fa ft. We daily obferve hyfterical attacks
yield to the fame remedy. Chambon makes an in-
terefting remark relative to the effects of odours, on
women who are frequently affailed with nervous
fymptoms. Agreeable aromatic fubftances, he ob-
ferves, enable us to diftinguiffi whether the affeftion
proceeds from a laefion of the uterine fyftem, or from
an unnatural condition of the nervous principle • they
are highly falutary when the uterus is affefted ; in the
other cafe they afford no relief. He adds, that hyf¬
terical women, expofed to the aftion of acrid fetid
effluvia, experience relief, whilit the purely hypo¬
chondriacal are rendered worle by them.

M. Alibert fuppofes, that in a variety of cafes we
might fubftitute odours, for medicines which are in¬
terdicted by particular idofyncrafies or antipathies.
Haller remarks with truth, that there are many ex¬
amples of perfons being purged by merely inhaling
the effluvia of hellebore, rhubarb, or coloqumtida.
The odour of faffron fometimes induces deep. Might
not opium be advantageoufly employed in vapour ?

Odours afford another fertile refource, but which
has been much neglefted by praftitioners in medicine.
The author alludes to the relief derived from fuch
fweet and grateful fcents under various calamities
and misfortunes. Montaigne avers, that they ope¬
rated on him the happieff effects ; and wonders that
phyficians have not oftener profited by them, to calm
and foothe the ills of human life. Long before him,
Ariftotle obferved, that the balmy vapours which
exhale from gardens and meadows, were not lefs
efficacious in re-eftablifhing the health, than in the
recreation afforded by them to the fenfes. The author
himfelf experienced the good effects arifing from this
fource.

O 2

184 Dumas's Syfieme Methodique.

It muft not be diffembled at the fame time that ill
confcquences may enfue, from the improper ufe of
thefe means. There are, in certain individuals, par¬
ticular and inherent antipathies, the caufes of which
cannot be afligned, but which call for . the greateft
attention. We fee perfons thrown into convul-
fions from odours the moft Ample and natural —
Tiffot, in his treatife on nervous difeafes, cites the
example of a woman, in whom fainting was induced
by the odour of Hoffman’s Anodyne Liquor : he mem
tions another, on whom the perfume of lavender pro¬
duced a fimilar effeft ; and a third in whom ftcknefs
and vomiting was occafioned by the fcent of the Eau
de Cologne .* The books of art contain a thoufand
fimilar faffs. Travellers fubjeff to epileptic attacks
have been fuddenly cured or relieved, by refpiring
the perfumed air of Arabia : others, it is true, have
been incommoded by the fame. The influence of
odours on the nervous fyllem is neverthelefs apparent.

Thefe faffs prove, inconteftibly, the relation that
fubfifts between odours, and various morbid ftates
of the fyftem. The ufe that may be made of this
knowledge, by the praffical phyfician, is too evident
to need particularly pointing out.

Art. XVIII. Syfieme Methodique de Nomenclature
et de Clajjification des Mufcles du Corps Humain :
i. e. A Methodical Syfiem of Nomenclature and
Clajjification of the Mufcles of the Human Body .
By C. L. Dumas, Prof ef or of Anatomy and Phy -

fiology, 8£c. at Montpellier . Quarto. 1797.

Magazin Encyclopedique,

✓

THE prefent work has three diftinft objeffs. As
a fyftem of nomenclature, it points out the
changes which have taken place in the ancient de¬
nominations of the mufcles, and explains the method

185

Dumas's Syfteme Methodique.

in which the language of anatomy has been formed.
As a fyfte.m of clafiincation, it eftablithes an exact
distribution of the mufcles, by arranging them under
feparate and diftiridt claffes. finally, it prelents5 oy
tables neatly executed, the defcription of the mufcles,
placing each in the clafs to which it properly belongs.

Prole {for Chauffer has treated the fir ft object, and
rendered, by his labours, a hgnal Service to anatomy.
M. Dumas propofes a nomenclature, differing but
little from that of M. Chauffer, but which is be¬

lieved to be more complete and exadf.

The author firft treats of the general principles of
language, and afterwards gives a view of the .progref-
five advances of the fciences, compared with thofe of
their language, die afterwards points out the vices
of anatomical language, and the means of reforming
it. The objects of anatomy, little complicated in
themfelves, are capable of fimple and clear deno¬
minations. Neverthelefs, the further we purfue the
ftudy of this art, the more we thali be convinced, that
its language is vitiated bv an innumerable multitude
of infignificant and improper terms ; which, having
little or no relation to the things intended to be ex-
preffed by them, can afford only tulle and erroneous
ideas. The method 'which M. Dumas propofes for

correcting and improving the ancient nomenclature,
confifts in attaching clear and diftindt ideas to words ;
in proscribing thofe which convey no particular idea ;
in drawing the denominations from the bofom of ana¬
tomy itfelf ; in employing conflantly the fame terms
in the fame fenfe ; in fine, in constructing a nomen¬
clature which, by the compohtion of words, by their
terminations, and by their mutual correfpondence,
may be fubmitted to general and invariable rules.

An hiftorical inquiry into the caufes which have
impeded the progrefs of anatomy, and deformed its
language : critical obfervations on the nomenclature
proper to each part of anatomy, and efpecially to
myology : the bafis on which his new nomenclature

O 3 is

186 FI ail am ’s Obfervations on Infanity, <SfC.

is founded : thefe are the principal points which en¬
gage the author's attention in the prefent eftay.

Art. XIX. Obfervations on Inf inity : with prac¬
tical Remarks on the Difeafe , and an Account of
the Morbid Appearances on Hi faction. By John
Has lam, late of Pembroke Hall , Cambridge ,
Member of the Corporation of Surgeons, and
Apothecary to Bethlem Hof pit at. Octavo, ' 147
pages, price Ss. 6d. London, 1798. Riving-
tons.

OF the maladies “ which flefh is heir to,” mental
derangement is fureiy to be ranked among the
molt deplorable. No fubjeft is more likely to have
attracted the particular attention of practitioners; and
it might have been expected, we fhould, by this time,
have been in poffefiion of Satisfactory doCtrines re-*
Speeding it, and of a method of cure, at lead certain
and determinate, however fmall its fuccefs. But it is
tar other wife. It has unaccountably happened, that
thole, whofe Situation leads them aim oft exclusively
to the treatment of mental diforders, whofe oppor¬
tunities, therefore, of acquiring knowledge is necef-
farily great, have yet withheld their obfervations from
the public ; fo that we have almoft wholly loft the be¬
nefit which their opportunities and experience might
have afforded us. It is with peculiar Satisfaction, there¬
fore, that m the prefent, we meet with a performance,
calculated, both from the filiation the author holds,
and from the proofs of attentive obfervation and
found judgment it difplays, to throw conliderable
light on a very important, though obfeure, fubjedl.

in treating it the author confines himfelf to a
fimple range ; deferibing merely what he has ob¬
served, and fug.geft.ing a treatment which is pointed
out by experience alone. The Subtleties of meta-

phyfics

Haflam’s Obfervations on Infanity ,

l¥f

phyfics he has, with great propriety, avoided : for
to what good pra£Hcal purpofe has the difquilitiou
into mind and its faculties hitherto led ?

We are but little indebted, the author obferves, to
thofe who have been moft capable of affording us m-
ftruclion with regard to mental alienation ; foi if we
except the late Dr. John Monro’s Reply to Dr. Bat-
tie’s Treatife on Madnefs,. there is no work on the
fubjedt which has been delivered on the authority ot

extend ve obfervation and practice. .

The firft chapter relates to the definition of infanity.
Rejecting that which has been given by Dr. Mead,
and alfo that of Dr. Ferriar, his own character of the
difeafe is, an incorrect affociation of familiar ideas ,
which is independent of the prejudices of education,
and is always accompanied, with implicit belief , and
generally with either violent or ^ depreffing paffions *.
He ftrongly oppofes the common idea, of mania and
melancholy being oppofite in their nature^ In. both
thefe hates of infanity, he obferves, the aUociation of
ideas is equally ineorrea, and they appear to differ
only, from the different pailions which accompany
them. On direction, the ftate of the brain does not
fhew any appearances peculiar to melancholy ; nor is
the treatment which is obferved to be molt fucceinful,
different from that which is employed in mania.

In the fecond chapter the fymptoms of infanity are
detailed. In no two patients is tne difeafe ufhered
in, or continued, with precisely the fame appearances.
The different propenfities and habits of different pa¬
tients lead, of necelfity, to a difference 01 idea, and of
expreffion, in each. It would oe endlefs lo enu¬
merate all the varieties. Among tne bodily particu¬
larities, however, which mark this difeafe, may be
obferved, the protruded, and often gliftening eye, and
a peculiar caff of countenance, which cannot be de¬
ferred. In feme, the author obferves, an appearance
takes place, which has not hitherto been noticed by
authors. This is a relaxation of the integuments of

O 4

the

188 HaflamV Obfervations on Infanity, Xc,

the cranium, by means of which they may be wrin¬
kled, or rather gathered up by the hand to a con-
fiderable degree It is generally rnoft remarkable on
the pofterior part of the fcalp ; and has frequently
been accompanied with contraction of the iris. As
far as the author has obferved, it does not take place
in the beginning of the difeafe, but after a raving
paroxyfm of fome continuance.

The author was induced to afcertain the prevailing
complexion qnd colour of the hair in infane people.
Out of 265 who were examined, 205 were of a
fwarthy complexion, with dark, or black hair ; the
remaining 60 were of a fair fkin, and light, brown,
or red haired. It would be defirable to afcertain,
what connexion this proportion may have with the
complexion and colour of the hair of the people of
this country in general.

Of the power which maniacs poffefs of refitting
cold the belief is general, and the hiftories which
are on record are truly wmnderful. In Bethlem Hof*
pital however, the author obferves, the patients poffefs
no fuch exemption from the effeCts of fevere cold.
They are particularly fubjeCt to mortifications of . the
feet ; and this faCt is fo well eftablifhed from former
accidents, that there is an exprefs order of the houfe,
that every patient under ftriCt confinement, flrall have
his feet examined morning and evening by the keeper,
and alfo have them conftantly wrapped in flannel. —
Thofe patients who are permitted to go about, are
always to be found as near to the fire as they can get,
during the winter feafon.

The author next gives a hiflory of the appearances
which he has noticed on opening the heads of feveral
maniacs, who have died in Bethlem Hofpital. Twenty-
nine cafes are given, in all of which there were marks
of previous inflammation, fuch as thickening and opa¬
city of the tunica arachnoides and pia mater. In the
greater number there was effufion of water into the

cavities

Haflam’s Obfervations on Inf unity , tsc. 189

cavities of the brain. Several died apoplectic and
paralytic. In one inftance only was there any pre¬
ternatural hardnefs of the fubftance of the brain, an
appearance which has been much infilled on by fe-

veral writers.

►

Chap. 3 inquires into the caufes of infanity. The
caufes which the author has been able moll certainly
to afcertain, may be divided into phyfical and moral.
Under the firft are comprehended repeated intoxica¬
tion 5 blows received upon the head ; fever, particu¬
larly when accompanied with delirium ; mercury
largely or nnjudicioufly employed ; the fuppreffion
of periodical or occalional difcharges and fecretions ;
hereditary difpofition, and paralytic affedtions.

Of the moral clafs of caufes, are the long en¬
durance of grief, ardent and ungratified defires, re¬
ligious terror, the difappointment of pride, fudden
fright, fits of anger, profperity humbled by misfor¬
tunes : in a word, the frequent and uncurbed indul¬
gence of any palhon or emotion, and any fudden and
violent affedtion of the mind.

Of the more immediate, or, as it is generally term¬
ed, the proximate caufe of this difeafe, the author
profefifes to know nothing. Whenever the functions
of the brain lhall be fully underftood, and the ufe of
its different parts afcertained, we may then be enabled
to judge, how far difeafe, attacking any of th'efe,
parts, may increafe, diminifh, or otherwife alter its
functions. But this appears a degree of knowledge
which we are not likely foon to attain.

From the diffedtions of infane perfons here ad¬
duced, it may be inferred, that madnefs has always
been connected with difeafe of the brain, and of its
membranes. And it is much in favour of them, that
they have not been feledted from a number of others,
which would have rendered them liable to fufpicion,
but comprize the entire number which have fallen
under the author’s obfervation.

190 Haflam's Obfervations on Infanity , SCc.

- 6 It may be a matter affording much diverfity of
opinion/ the author obferves, * whether thefe morbid
appearances of the brain be the caufe or the effedt of
raadnefs : it may be obferved, that they have been
found in all dates of the difeafe. When the brain
has been injured from external violence, its functions
have been generally impaired, if inflammation of its
fubftance, or more delicate membranes has enfuech
The fame appearances have for the rnoft part been
detected when patients have died of phrenitis, or in
the delirium of fever : in thefe inftances the derange¬
ment of the intellectual functions appears evidently
to have been caufed by the inflammation. If in ma¬
nia the fame appearances be found, there will be no
neceffity of calling in the aid of other caufes to ac¬
count for the effedt ; indeed it would be difficult to
difeover them. Thofe who entertain an oppoftte opi¬
nion, are obliged to fuppofe, a difeafe of the mind .
Such a morbid affection, from the limited nature of
my powers perhaps, I have never been able to con¬
ceive. Poflefling, however, little knowledge of me-
taphyncal controverfy, I fl i all only offer a few remarks
upon this part of the fubjedt, and beg pardon for
having at all touched it.

‘ Perhaps it is not more difficult to fuppofe that
matter peculiarly arranged may think , than to con¬
ceive the union of an immaterial being with a cor¬
poreal fubftance. It is queftioning the infinite wif-
dom and power of the Deity to fay, that he does not,
or cannot arrange and organize matter fo that it fhall
think. When we find infanity, as far as has hitherto
been obferved, uniformly accompanied with difeafe of
the brain, is it not more juft to conclude, that fuch
organic affedt ion has produced this incorrect affocia-
tion or ideas, than that a Being, which is immaterial,
incorruptible and immortal, fhould be fubjedt to the
grofs and fubordinate changes which matter tieceffa-
rily undergoes ? /yvffi | ’ -|rf£

( Bui

Haflam’s Obf croat Ions on Infanity, $c. 191

* But let us imagine a difeafe of ideas. In what
manner are we to effeCt a cure ? To this fubtle fpijit
the doctor can apply no medicines. But though fo
refined as to elude the force of material remedies,
fome may however think that it may be reafoned
with. The good effects which have refulted from
exhibiting logic as a remedy for madnefs, mud be
fufficiently known to every one who has converfed
with infane perfons, and muft be confidered as time
very judicioufly employed : fpeaking more gravely, it
will readily be acknowledged, by perfons acquainted
with this difeafe, that if infanity be a difeafe of ideas,
we poffefs no corporeal remedies for it : and that to
endeavour to convince madmen of their errors, by
reafoning, is folly in thofe who attempt it, fmce there
is always in madnefs the firmed conviction of the truth
of what is falfe, and which the cleared and mod cir~
cumdantial evidence cannot removed

Mr. Haflam next adverts to the prognodic In
cafes of infanity. c In our own climate,5 he ob~
ferves, 4 women are more frequently affeCled with
infanity than men. Several perfons who fuperintend
private mad-houfes have adored me, that the number
of females brought in annually confiderably exceeds
that of the males. From the year 1748, to 1794,
comprizing a period of forty-bx years, there have
been admitted into Bethlem Hofpital 4832 women,
and 4042 men. The natural proceiies which women
undergo, of mendruatioh, parturition, and of pi soar¬
ing nutriment for the infant, together with the difeafes
to which they are fubject at thefe periods, and which
are frequently remote caufes of infanity, may, per¬
haps, ferve to explain their greater difpofition to this
malady. As to the proportion in which' they recover,
compared with males, it may be dated, that of 4832
women affe&ed, 1402 were difcharged cured; and
that of the 4042 men, 1155 recovered. It is proper
here to mention, that in general we know but little

192 Ha flam's Obfervations on Infanity , Kc.

of what becomes of thofe vcho are difcharged, a cer¬
tain number of thofe cured occafionally relapfe ; and
fome of thofe who are difcharged uncured afterwards
recover : perhaps in the majority of inflances, where
they relapfe, they are fent back to Bethlem. To give
fome idea of the number fo r'e-admitted, it may be
mentioned, that, during the laft two years, there have
been admitted 389 patients, 53 of whom had at fome

former time been in the houfe. There are fuch a
variety of circumftances, which, fuppofmg they did
relapfe, might prevent them from returning, that it
can only be hated, with confidence, that within
twelve months (the time allowed as a trial of cure)
fo many have been difcharged perfectly well.

4 To fhew how frequently infanity fupervenes on
parturition, it may be remarked, that, from the year
1784 to 1794 inclufive, 80 patients have been admitt¬
ed, whofe diforder {portly followed the puerperal hate.
Women affected from this caufe recover in a larger
proportion than patients of any other defcription of
the fame age. Of thefe 80, 50 have perfectly reco¬
vered. The frit fymptom of the approach of this
difeafe, after delivery, is want of fleep ; the milk is
afterwards fecreted in lefs quantity, and, when the
mind becomes more violently difordered, it is totally
fupp re fifed.

4 From whatever caufe this difeafe may be produced
in women, it is conhdered as very unfavourable to re¬
covery, if they are worfe at the period of menftruation,
or have their catamenia in very fmall or immoderate
quantities.

4 At the firft attack of the difeafe, and for fome
months afterwards, during its continuance, females
mofl commonly labour under amenorrboea. The na¬
tural and healthy return of this difcharge generally
precedes convalefcence.*

It appears, from an eftimate of feveral years, that
infane perfons recover in proportion to their youth.
When the difeafe attacks perfons advanced in life,
. the

193

Haflam’s Ohfervntions on Inf unity , <Su\

the profpeCi of recovery is but fmall. The chance of
cure, likewife, appears to be lefs, in propbrtion to the
length of time which the diforder fliall have continued.

‘ When the reader contrails the preceding ftate-
ment with the account recorded in the report of the
committee, appointed to examine the phylicians who
have attended his Majefly, &c. he will then either be
inclined to deplore the unlkilfulnefs or mifmanage-
ment which has prevailed among thofe medical per-
fons who have directed the treatment of mania in the
largell public inftitution, in this kingdom, of its kind,
compared with the fuccefs which has attended the
private praCtice of an individual ; or, to require fame
other evidence , than the hare ajjertions of the man
pretending to have performed fuch cures . It was de~
pofed by that reverend and celebrated phylician, that
of patients placed under his care within three months
after the attack of the difeafe, nine out of ten had re¬
covered ; and alfo, that the age was of no fignifica-
tion, unlefs the patient had been affliCted before with
the fame malady.

‘ How little foever I might be difpofed to doubt
fuch a bold, unprecedented, and marvellous account,
yet, I mull acknowledge, that my mind would have
been much more fatisfied as to the truth of that affer-
tion, had it been plaufibly made out, or had the cir-
cumftances been otherwise than feebly recollected by
that very fuccefsful pra&itioner. Medicine has gene¬
rally been elleemed a progrefiive fcience, in which
its profelfors have confeiTed themfelves indebted to a
great preparatory ftudy, and. long fubfequent expe¬
rience, tor the knowledge they have acquired ; but,
in the cafe to wThich we are now alluding, the outfet
of the doCtor’s praCtice was marked with fuch fplendid
fuccefs, that time and obfervation have been unable
to increafe it.

c This aftoniihing number of cures has been effect¬
ed by the vigorous agency of remedies, which others
have not hitherto been fo fortunate as to difcover ; by

remedies

194 BaflanTs Obfervations on Infanity, 8(c.

remedies which, when remote caufes have been ope¬
rating for twenty-feven years, fuch as weighty bufi-
nefs, fevere exercife, too great abftemioufnefs, and
little reft, are poffeffed of adequate power direftly
to meet and counteract fuch caufes. 4

c It will be feen by the table that a greater number
of patients have been admitted between the age of
thirty and forty, than during any other equal period
of life. There may be fome reafons affrgned for the
increafed proportion of infane perfons at this age.

4 Although I have made no exadt calculation, yet,
from a great number of cafes, it appears to be the
time, when the hereditary difpofition is moft frequent¬
ly called into aftion ; or, to fpeak more plainly, it is
that ftage of life when perfons, whofe families have
been infane, are moft liable to become mad. If it
can be made to appear, that at this period people are
more fubjeft to be adted upon by the remote caufes
of the difeafe, or that a greater number of fuch caufes
are then applied, we may be enabled fatisfaftorily to
explain it. At this age people are generally efta-
blifhed in their different occupations, are married,
and have families ; their habits are more ftrongly
formed, and the interruptions of them are, come-
quently, attended with greater anxiety and regret.
Under thefe circumftances, they feel the misfortunes
of life more exquifttely. Adverfity does not deprefs
the individual for himfelf alone, but as involving his
partner and his offspring in wretchednefs and ruin.
In youth, we feel defrrous only of prefent good; at
the . middle age, we become more provident and
anxious for the future; the mind affumes a ferious
charadter, and religion, as it is juftly or improperly
impreffed, imparts comfort, or excites apprehenfion
and terror.

c By misfortunes the habits of intoxication are
readily formed. Thofe, who in their youth have
fhaken off calamity as a fuperficial incumbrance, at
the middle age feel it corrode and penetrate : and

when

Haflam’s Obfermtions on Inf unity, S (c.

when fermented liquors have once difpelled the gloom
ol defpondency, and taught the mind either to excite
a temporary affemblage of cheerful fcenes, or to dif-
dain the terror of impending mifery, it is natural to
recur to the fame, though deftru&ive caufe, to re¬
produce the effeCt.

c Patients, who are in a furious (late, recover in a
larger proportion than thofe who are depreffed and
melancholick. An hundred violent, and the fame
number of melancholick cafes wmre felected. Of the
former, fixty-two were difcharged well ; of the latter,
only twTenty-feven. When the furious ftate is fucceed-
ed by melancholy, and after this {hall have continued
a fhort time, the violent paroxyfm returns, the hope
of recovery is very flight. Indeed, whenever thefe
hates of the difeafe frequently change, fuch alterna-
nation may be confidered as unfavourable.

c Where the complaint has been induced from re¬
mote phyiical caufes,- the proportion of thofe who re¬
cover is confiderably greater, than where it has arifen
from caufes of a moral nature. In thofe inftances
where infanity has been produced by a train of un¬
avoidable misfortunes, as where the father of a lar^e
family, with the moft laborious exertions, ineffectually
druggies to maintain it, the number who recover is
very frnall indeed.

Paralytic affections are a much more frequent
caufe of infanity than has been commonly fupppfed.
In thofe affefted from this caufe, we are, on enquirv,
enabled to trace a hidden affeCtion, or fit, tQ have
preceded the difeafe. Thefe patients ufualfy bear
marks of fuch affeftion, independent of their infanity ■:
the fpeech is impeded, and the mouth drawn afide ;
an arm,' or leg, is more or lefs deprived of its capacity
of being moved by the will : and in by far the greateff
number of thefe cafes the memory is particularly af¬
fected. . Very few of thefe cafes have received any
benefit in the hofpital ; and from the enquiries I -have
been able to make at the private houfes, where they

* have

196 Haflanfls Obfervations on Infanity , Sfc\

have been afterwards confined, it has appeared, that
they have either died fuddenly from apoplexy, or have
had repeated fits, from the efledls of which they have
funk into a ftupid Hate, and have gradually dwindled

away.

‘ When the natural fmall-pox attacks infane per*
fons, it moft commonly proves fatal.

6 When infanity fupervenes on epilepfy, or where
the latter difeafe is induced by infanity, a cure is very
feldom effedled : from my own obfervation, 1 do not
recoiled! a tingle cafe of recovery.

When patients during their convalefcence be¬
come more corpulent than they were before, it is
a favourable fymptom ; and, as far as I have remark¬
ed, fuch perfons have very feldom relapfedd

i . -

The method of cure is divided by the author into
management , and treatment by medicine. The for¬
mer, perhaps, is of much the greater confequence. —
Coercion is recommended only, for the purpofe of
avoiding danger to the patient and his attendants.
Mild treatment, with great regularity in all the addons
performed by the patient, is particularly enforced. — ■
By gentlenefs of manner, and kindnefs of treatment,
the author obferves, he has never failed to obtain the
confidence, and conciliate the efteem of infane .per¬
fons ; and has fucceeded by thefe means in procuring
from them refpedl and obedience. There are cer¬
tainly fome patients who are not to be trufied, and
in whom malevolence forms the prominent feature in
their charadter : fuch perfons fliould always be kept
under a certain refrraint ; but this is not incompatible
with mildriefs and humanity.

Infane patients fliould be made to rife, take exer-
cife, and food, at hated times. Independently of
fuch regularity contributing to health, it alfo renders
them much more eafily manageable. Change of fitu-
ation, and removal from friends, are amongft the
riieans particularly recommended.

HaflanVs Qbfervations on Inf unity, <Sfc. 19?

As to medicines, fome remarks occur on bleeding
purging, vomiting, camphor, cold-bathing, blitters,,
and opium, Bleeding, the author obferves, he has
found the moft beneficial remedy that has been em¬
ployed, where the patient is ftrong and of a plethoric
habit, and where the diforder has not been of any long
continuance. The melancholic cafes have been equal¬
ly relieved with the maniacal by this evacuation. A
buffy coat has feldom been obferved on the blood.

An opinion has long prevailed, that mad people are
particularly conftipated, and extremely difficult to be
purged. From the author’s obfervations, however, it
would appear, that infane patients are of very delicate
and irritable bowels, and readily purged by the com¬
mon cathartics. The common complaints with which
they are attested, are diarrhoea and dyfentery. Ca¬
thartic medicines, it -appears from very ample expe¬
rience, are of the greateft benefit in the treatment of
infanity.

Vomiting is not fpoken of favourably. In many
inftances, it feems to have induced paralytic affeftions
by determining to the head. Camphor feems to have
been ufelefs, but the author has witneffed its trial in
ten cafes only. Cold-bathing appears to have done
harm as frequently as fervice. Blitters and other
drains have been found ineffectual.

Of opium it is obferved, that whenever it has been
exhibited during a violent paroxyfm, it has hardly
ever procured fleep ; but, on the contrary, has ren¬
dered thofe who have taken it much more furious
and, where it has for a fhort time produced reft, the
patient has, after its operation, awoke in a ftate of
increafed violence.

■ • -• ‘l ' ' ' ' ■ " ’ X'" -' ""

VOL. ¥•

Ait.

( 198 )

Art. XX. Examen fait fur V Exigence dhin Fliiide
Aqueux dans les Cavites Cerebrates , <S (c. i. e. An
Inquiry into the Existence of an Aqueous Fluid in
the Cavities of the Brain.

Magazin Encyclopedique, 1797*

MANY have fuppofed, that the ventricles of the
brain in their natural hate contain a quantity
of fluid 5 and M. Soemmering has gone fo far, as to
imagine this fluid to be the organ of the foul. We
fee, in this inflance, how prone the mind of man is
to build hypothefes ; and on how perifhable a balls
they are often ereffed, will appear from the following
ftatement. A man, of the name of Kuhne, was
beheaded ,at Brunfwick, on the third of January
1797 : the head was carried as fpeedily as poflible,
to the anatomical theatre, and differed immediately,
in prefence of Meflfs. Sommer, Roofe, Wiedman,
Himly, Schoenyan, Cramer, Fricke, & c. &c. Pro-
feffors of Medicine. The following were the ap¬
pearances obferved.

The membranes of the brain were frill full of blood.
~Five and twenty minutes after the execution, they
began to make horizontal incifions into the fubftance
of the brain, which was ftill warm and humid. Long
before this, not the leaft trace of motion in the retina
on expofing it to the light could be obferved, nor any
other mark of fenfation. — Thirty minutes after execu¬
tion, the cavity of the left ventricle was laid open from
above, but no traces of watery fluid were obfervable.
It was the fame with the right ventricle.

At thirty-three minutes, they opened the cavity of
the third ventricle $ and at thirty-fix minutes, that of
the fourth. In none of thefe parts was the fmalleft
drop of water to be obferved, nor even in the calamus
fcriptorius . As the cavities of the brain have no
communication with the channel of the fpine, it can¬
not be fuppofed, that by the feparation of the fourth

from

• , . H. ■ ' \

Lombard’s Lift ruction fur V Art des Panfemens, Sc. 199

from the fifth vertebra, the efcape of any fluid, before
contained within the ventricles* could take place.

Thus, then, the queftion refpeCting the exiftence of
an aqueous fluid in the brain, in the natural ftate,
may be confidered as determined : if, indeed, any
fuch proof were needed. . '

Art. XXI. Premieres Lignes de Nofo logic Infan-
tile, ou EJfai fur la Diftribution des Maladies des
Enfans en Clajfes , Sc. i. e. Fir ft Lines of Infantile
Nofo logy ; an Ejfay on the Diftribution of the
Difeafes of Children into Claftcs , Genera , and
Species. By J. M* Caillau, Member of the
Philanthropic Society of Health at Bourdeaux , 8s c.
Twelves. Magazin Encyclopedique.

MACBRIDE, in his introduction to the theory
and practice of medicine, eftablifhed four
great claffes of difeafes. He divided them into
1ft. univerfal, 2d. local, Sd. fexual, and 4th. infantile,
Death prevented his fulfilling more than the firft part
of his talk. The laft clafs forms the fubjeCt of the
prefent eflay.

The number of treatifes on infantile diforders is
fufficiently great: but in none are they clafled, in- the
opinion of M. Caillau, with fufficient precifion. To
fupply this deficiency is the objeCt of his endeavours.

Art. XXII. Inftruction Sommaire fur V Art des
P anfemens , a I'Ufage des Etudians en Chirurgie ,
Sc. i. e. Brief Inft ructions on the Art of Dr effing
Wounds, for the Ufe of Students in the Military
Hofpitals . By Lombard, Confidting-Surgeon of
the Army , Sc. Sc. OCtavo. Strajbourg.

THE prefent treatife contains fummary directions,
refpeCting the different circumffances relative to

P 2 wounds.

200 Tilrton’s Me diced Glojjary »

wounds* * and their management. Lint* and its various
ufes* bolfters* tents* felons, injections, fomentations,
cataplafms, plaflers * the application of different to-
t4picals in the cure of wounds and ulcers ; comprefs
and bandage ; thefe are the objedts of the author’s
attention. The filiation of M. Lombard with the
army, qualifies him in an eminent degree for the
tafk he has undertaken, and his mftruSlons are the
more neceffary, as the great deman \ for military bur¬
geons has introduced many into the inferior offices of
hofpitals, without education and the requifite infor¬
mation. In the execution of the work, more im¬
portance, perhaps, is beflowed on minute circum-
ftances, than will be thought neceffary by the gene¬
rality of Britifh furgeons.

M I Wii ■gfgrn I ■»■■ mmnm . . ji

• -• - ,-s - • • .V .

i H . * . ^

Art. XXIII. A Medical Glojjary , in which the
Words in the Various Branches of Medicine are
Deduced from their Original Languages , properly
Accented and Explained . By W. Turton, M.Dl
Quarto, 622 pages, price ll Is. Johnson, 1797.

OF the utility of a work of this kind, no doubt
can be entertained, and it is only requifite that
its execution fhould be equal to its defign. That it
is fo we may venture to liate.

.••r

No. XXVII.

THE

* t

MEDICAL and CHIRURGICAL

' *'<

REVIEW.

NOVEMBER, 1798.

— ' v ~ '•» l- ^ " 4 f * -

Art. XXIV. Memoir es de la Societe Medicate
U Emulation, He. : i. e. Memoirs of the Medical
Society of Emulation , held at the School of Me¬
dicine of Paris. Octavo., 537 pages. Paris, 1798.

THE volume before us contains the firft fruits of
a fociety, eftablifhed for the laudable purpofe
of promoting and extending the different branches of
medicine. Though firft inftituted by the pupils of
the various claffes, the lift of members has been ho¬
noured by the names of feveral of the firft profeffors
in Paris, and who have contributed their labours to¬
wards the formation of the prefent collection. We
hardly need fay, therefore, that it is in many refpefts
highly interefting, as containing valuable practical in¬
formation, and much found reafoning. We flia.ll pre¬
fent our readers with a general account of its contents,
and a more particular one of fuch parts, as appear moft
novel or important.

A *■ *. • ,i

The work is divided into the different heads of
Medicine, Surgery, Materia Medina., Phyfiology,
and Medical Philofophy.

vol. v. Q The

202 Memoires die la Societe Medicate Dy Emulation*

The fir ft article under the clafs of Medicine con¬
tains, Obfervations on the Danger of Cutting the
Hair in fome Acute Difeafes, By P. Lanoix, M D.

Art. 2. Medical Obfervations, extracted from
Authors not of the Medical Profeffion, applied to
the Defcription of Fevers of the Intercurrent kind,
intended as part of a larger Work. By Roufdle -
Chamfer u .

3. Inquify by M. Hitffon , whether Ample Ter¬
tians fliould be left to themfelves till after the Seventh
Faroxyfm, according to the Aphorifm of Hippocrates,
Tertiana exquifita feptem circuitibus iitplurimum ju¬
dicature — This queftion the author determines in the
affirmative, but allows, at the fame time, that parti¬
cular cafes may call for the interference of art.

The two following papers we have already noticed,
in an extract from the Magazin Ency elope digue.

6. Is there a real Difference between Difeafes of
the fame kind, when they arife in Armies encamped
in elevated Situations, and in marfhy Grounds ? By
J- Roques. — This queftion too has often been deter¬
mined affirmatively.

7. Obfervations on a fudden Suppreffion of the
Menfes, occalioned by a mental Affeftion, and the
confequences which enfued. By P. J. Chevalier.

8. Reflections on the Modifications which Educa¬
tion and Habit occafioned in the developement of the
affeCtion termed Nqftalgia , during the late War. By
R. P. Beauchamp.

9. Obfervation on a cutaneous Apoplexy. By B.
A. Godefroy-Coutanceau. — There feems to us no
ground for the name which the author beftows on
the prefent affeCtion. It had no fymptom of apo¬
plexy, and appeared to have been merely a variety of
Scarlatina. 1 he veffels of the head were found dif-
tended with blood.

^ 1.0. Obfervations on certain AffeSions of the V oice.
Jby M. Portal. — I he firft cafe recited by the author,
is of a woman, 43 years of age, and of an irritable

, • temperament.

Memo ires de la Societe Medic ale D' Emulation \ 203

temperament. She had loft the power of fpeaking at
will ; Hie made fruitlefs efforts to fpeak for fome
minutes, but having once begun, found it equally
difficult to reftrain herfelf. She often uttered invo-
luntarily uncommon founds ; and efpecially when
clofely occupied by any idea, found it impoffible to
avoid expreffing it in fpeech. But in this citfe, in-
ftead of the ordinary monotonous tone of converfation,
ffie uttered the moft difcordant founds, p ailing rapidly
from the ffiarpeft to the lowed; tone, often with an
intermediate and continued found ; fo that her voice
refembled at times the barking of a dog, or the howl
of a wolf.

M. Portal attributed this uncommon affeftion to a
convulfion of the mufcles of the voice and fpeech, and
prefcribed cooling and relaxing drinks, and antifpaf-
modics. After feveral months, the voice returned
gradually to its natural ftate.

In another cafe of fuppreffion of the voice, the caufe
was fuppofed to be a paralytic affediion of the mufcles
of the larynx, and an appropriate treatment adopted
with fuccefs. The remaining cafes have lefs of pecu^
liarity.

11. Memoir on periodical or intermittent Mania,
By M. Pinel. — This paper contains many valuable re¬
marks, but hardly admits of abridgement. We find
in it a confirmation of many of the remarks of Mr.
Haflam, whofe Treatife on Infanity was noticed in
our laft number.

Under the head of Surgery, the firft paper is, On
the Inconveniences which the Invagination of the In-
tefline prefents. By M. P. F. Ray tigers, of Holland,
— By this term is underftood, the operation for uniting
the two extremities of a divided inteftine. From a
view of the difficulties and danger which neceffarily
relult from an operation of this kind, the author
thinks it ought never to be practifed in the human
body. He advifes only that care fhould be taken to

Q 2 retain

1 J ' V •»

204 Memoircs de la Societe Medicate U Emulation,

retain the divided ends at the edges of the wound*
which wili thus often gradually clofe, and preferve
the continuity of the canal.

2. Opinion on the Signs of the Elaftic Gum Ca¬
theter having penetrated into the (Efophagus or
Larynx. By J. S. F. Worbe.

3. Cafe of Luxation of the Tarfus. By M.
Be an fils.

4. Obfervations on a Cancerous Ulcer. By Mb
Salmade. — The ulcer was lituated on the infide of the
arm, and fucceeded fome fchirrous lumps in the breaft.
The appearances feem clearly to indicate the real
nature of the complaint* which refilled the ordinary
modes of treatment. It was afterwards cured by
repeated applications of the cauftic powder ot Rouf-
felot*, made into a palle with water, and laid on the
furface of the ulcer for four and twenty hours at a
time. It was repeated, after the interval of a few
days, till the fungous dilpolition was deflroyed, and
the fore put on a healthy appearance.

5. Obfervations on a Mufcle ruptured by the
violence of its Contraction. — This accident happened
to the pfoas mufcle, from lifting a heavy weight. It
was followed by lumbar abfcefs which proved fatal.
On diftection, the mufcle was found to have fufiered a.
confiderahle rupture.

6. Obfervation of a voluminous Tumour of the
Knee, the exa£l Nature of which could not be de-»
termined, even by infpeCtion after Death. By Le-
pecq de la Cloture .

\ ■ <s ’• I V

Section 3. Materia Medica. The fir ft paper in
this part of the volume contains fome interefting Re-

V I ' V

* The compofition of this powder is as follows ;

R Sulphur of Mercury *,

Dragons Blood, - -

o ^ ►

Oxyd of Arfenic, - zX

(* Qu. Cinnabar.) i

marks

Memoir es de la Sociele Medicate JDy Emulation. 205

marks on the Effe£ts of Phofphorus, employed as an
internal Remedy. By M. Alphonfe he hoy. This
fubftance, M. Le Roy ohferves, he has very often had
occafton to employ, and he thus defcribes the circum-
ftance which firft led him to adopt it. Being called
in the year 1778, to a woman who was nearly ex-
haufted from a long previous illnefs, and apparently
within a few hours of her laft, having no other remedy
at hand, he took fome water from a flafk, in which
pieces of phofphorus had been long kept, and gave
the patient a draught of it. The next day the patient
was fenfibly better, and was preferved from death,
the author thinks, for a fortnight afterwards, by a
continuance of the fame remedy.

He found on inquiry, that fome German praSti-
tioners had given phofphorus inwardly, mixed with
confections, in malignant fevers, and, as was faid, in
dofes of twelve grains. On taking, however, fo fma.ll
a quantity as three grains in theriaca , M. Le Roy
was in danger of falling a victim to his imprudence s
, for heated phofphorus needs no more air to inflame
it, than the ftomach is frequently found to contain.
He found himfelf exceedingly incommoded for fome
hours, and drank frequent draughts of very cold
water. The urine, he obferves, became exceedingly
red. The next day his mufcular powers were amaz¬
ingly increafed, and he felt an almoft iniupportable
venereal irritation.

He afterwards gave the fame remedy to a young
man, in the laft ftage of a malignant fever, without
hope of recovery ; and with the beft effects. Since
this time, M. Le Roy and fome of his pupils have fo
often employed it, and in luch various forms, eipe-
daily in malignant fevers, that he is convinced it is
.one of the greateft refources in the hands of the phy~
ftcian.

It has been given in different ways, fometimes in
that of a linftus. The difficulty is to bruife it with¬
out inflaming it. To effect this, he melts it in hot

Q 3 water.

206 Memoir 6 s de la Societc Medicate £>’ Emulation .

water, and agitates the phial violently, till the phof-
phorus is divided into an infinite number of globules,
like oil : on adding cold water, the phofphorus is pre¬
cipitated in the form of a powder. One or two grains
of this is mixed with fugar, a drop or two of oil, and
the yolk of an egg, and rubbed in a glafs mortar,
placed in ice or extremely cold water, till the lindtus
is completed. A quarter of a grain of phofphorus
taken daily, M. Le Roy obferves, is fufficient to pro¬
duce conflderable effedl.

Kunkel exhibited phofphorus, in England, in a
folid form. He made luminous pills, which he gave
in obftinate chronic complaints. M. Le Roy has dis¬
covered the method of forming thefe ; but has with¬
held it from the public, convinced, from his own ex¬
perience, of the danger of the remedy when not fuf-
ficiently diffolved. Each pill contains an eighth of a
grain of phofphorus. They poffefs, he fays, a foporific
and quieting power. He has often employed them
in rheumatifm, and a number of nervous affections, in
pituitous difeafes, acute as well as chronic, and in
rheumatic gout.

The phofphoric acid appears to the author an equal¬
ly valuable remedy. Taken as a kind of lemonade,
lie fays, it is ufed by many perfons, and thought by
them to contribute to the prefervation of health, and
even to prolong life.

From its effects in exciting the venereal appetite,
M. Le Roy thinks phoiphorus one of the moil pow¬
erful and fpeedy reftoratives in nature. Of almofl in¬
finite divifibilitv, he thinks, from its analogy to light,
it bears a firong relation to the nervous fluid. Of
all fubftances, perhaps, it is the moft proper to be
tranfmuted in the animal oeccnomy into the eleftric
vital fluid, its adtion is clearly marked on the organs
of generation, and its relation to the fpermatic fluid is
evident.

The body of a woman who had taken a Angle
grain of phofphorus., and who had been recovered

Memoircs dc la Societe Medicate D' Emulation. 207

by it from a putrid fever, but who foon after died
fuddenly from fome imprudence, was obferved to be
entirely phofphoric, and luminous in all parts. I he
hands of the anatomift who diiTe&ed the body, even
after being wafhed, were ftill luminous.

M. Le Roy promifes a continuation of his remarks
on this interefting fubjeft.

2. Obfervations and Experiments on certain pur¬
gative, diuretic, and febrifuge Medicines, applied ex¬
ternally. By M. Alibert.— Already noticed by us. .

3. On the utility of certain indigenous Plants in
the Treatment of many fpecies of intermittent Fever*
and more efpecially in thofe accompanied by Stupor*
By M. J. P." J off r ion. — The obfervations on this fub-
l’eft are of too general a nature to admit of abridge¬
ment here.

4. ExtraSl of a Memoir on the antivenerea! and
antipforic Properties of Oxygene. By M. Alyon. —
It has long been prefumed, that mercury and its pre¬
parations owe their medicinal properties in fome way
to oxygene : the fimple metal may be taken in any
quantities with little or no effedt. At prefent when
it is known that mercury, of all the metals, is the moft
oxydable ; that agitation in the air is alone fufficient
to combine it with oxygene, and, on the other hand,
that it readily abandons this principle : when the fa¬
cility with which oxygene unites with animal fub-
ftances, and the tendency thefe have to extract it
from acids and oxyds, are attentively conlidered, we
may form a ready conception, the author obferves, in
what way all the mercurial preparations a 61. Know¬
ing thefe fadts, he obferves, to find a powerful anti-
venereal remedy, an adfive ftimulant, it is only necei-
fary to take a fubllance containing a large proportion
of oxygene, and which readily parts with it to animal
fubffances. On thefe principles he has been able to
obtain many combinations of oxygene without mer¬
cury, and which he has employed with the greateft
fuccefs. Thus by axunge and the nitric acid, is

Q 4 * formed

508 Fordyce’s Third Differtation on Fever.

• \ * * •

formed an ointment fuperior to the Neapolitan ; and
thus he has employed the folution of the oxygenated
muriate of potafb, to cicatrize chancres and venereal
ulcers, with effedt far fuperior to mercurial prepara¬
tions. By augmenting the dofes of the oxygenated
ointment, and by the internal ufe of water acidulated
with the nitric acid, M. Alyon obferves, he has pro¬
duced falivation, the fwelling of the amygdalae, and
the other effects which refult from exceffive mercurial
fridtions. The detail of his experiments are foon to
be laid before the public.

Art. XXV. A Third Differtation on Fever. Part
I. By George Fordyce, M. D. Sic.

( Con tinned from page 148,y

IN otir laft number, we followed the learned author
through the Hiftory and Progrefs of a regular con¬
tinued Fever, and are now to notice the mode of treat¬
ment to be purfued. It has already been dated that
the prefent part contains only the method of treat¬
ment, iuppofing the difeafe is left to purfue its re¬
gular courfe. The next point of inquiry will be,,
whether means have been found out to fhorten the’
fever by producing a cribs, or otherwdfe, fo that the
patient iliall be reftored to health. But this will form:
the fubjedt of the fecond part, and which we are told!
Is in much forwardnefs.

The hilt attention is to be paid to the iituation of
the patient. A man afledted with fever, the author
obferves, has the powers of his fyftem depreffed, and
therefore cannot defend himfelf againft the cold of the
atmofphere. Befides, a degree of cold greater than
a man has been accuftomed to, contracts all the ex¬
ternal veffels, and therefore prevents that relaxation

which.

Fordyce's Third Differtation on Fever . 209

which ought to take place in the crifis, and of con-
Fequence tends to prevent crifis from taking place.
It alfo tends to render the diminution of the difeafe in
the morning lefs confiderable. On thefe accounts, a
man in a fever fhould not be fuffered to remain in too
cold an atmofphere, or any other medium of too fmali
a degree of heat.

A fmali part only of the body is expofed to the heat
of the atmofphere ; this therefore may be colder than
the bodies which immediately furround him. In this
country, the author obferves, the heat of bodies im¬
mediately furrounding the patients fhould never be
lefs than feventy-hve in winter, or eighty degrees in
fummer. The different wrays of regulating the tem¬
perature are pointed out at confiderable length, bu
do not require our detailing them.

In fever, a patient fhould avoid all extraordinary
exertions ; he fhould be placed, therefore, in a hori¬
zontal pofition, or as nearly fo as he is accuftomed to
when in health ; in this pofition he is fupported every
where by the bed, and is not obliged to exert any of
his mufcles, as he is when in an upright pofture, to
keep the parts in equilibrium. At the fame time,
great care fhould be taken that his mind be kept free
from all exertions whatever, and efpecially all fuch as
produce anxiety.

In regular continued fever, when fevere, the patient
is not able to judge of any thing truly 3 the mind can¬
not arrange the arguments on each fide of a queftion,
fo as to draw from them any perfedt conclufion, much
lefs can it form a rule for any action ; nor, when it has
formed an opinion of what is to be done, can it ima¬
gine the mode in which the effect is to be produced.
No advantage can, therefore, be gained, by exciting,
his attention to his affairs ; the force of the fyftern is
only exhaufted by fruitlefs attempts. If a regular con¬
tinued fever fhould be lefs violent in its beginning,
although a man might attend to his affairs with forne
effcdt, yet any advantage gained by fuch attention

4 would

210 Fordyce’s Third Differtation on Fever «

would be much overbalanced by exerting the force
of the fyfrem. As foon, therefore, as a patient is feiz-
ed with a febrile attack, he ffiould immediately be
put to bed, and left under the care of one attendant
only, and every thing that can call into addon the
operations of the mind is to be avoided.

The quality of the atmofphere which the patient
breathes is next to be attended to : and here the
author remarks, that the proportion of pure air in the
atmofphere in different fituations is very nearly the
fame, provided the air does not ftagnate ; in a room
in a private houfe, or in the ward of an hofpital in the
center of fuch a city as London. It is only neceffary,
therefore, that the air fhould not ftagnate.

The queftion, whether a different proportion of
pure air would be better adapted to the refpiration
of a patient in a fever, than that proportion which is
found commonly, is thus critically difeuffed. When¬
ever any new and feemingly important fadi has been
difeovered, and efpecially if it cannot immediately be
applied to any advantageous purpofe in mechanical
or chemical arts, mankind in general, and very of ten
even praddtioners in medicine, conceive it muff be
applicable to feme medicinal purpofe. juft as an
infant, allured by any thing which glitters in its eye,
applies it to its mouth, fuppofing it mull be likewife
exquifite food ; fo infants in medicine are dazzled
with any furprifing difeovery, and immediately em¬
ploy it for the cure of difeafes, not confidering how
extremely difficult an art medicine is ; how fallacious
experiments made in it often are, as has been obferv-
ed long ago by Hippocrates, and by what flow de¬
grees valuable medicines have had their powers in-
veftigated ; how long it Avas before the effedls of the
bark of the cinchona, of mercury, of antimony, were
brought to light, as far as they are already known.

I he author, therefore, conceives, that in fever it
certainly is not at all known, whether the fever will
go through its ordinary courfe better or worfe for the

patient’s

Fordyce’s Third Di/fertation on Fever. 2 LI

patient’s breathing an atmofphere having a larger or
3efs proportion of pure air. The other vapours which
conftitute the remaining three-fourths of the atmof¬
phere, may fome of them be noxious, and others of
them may be breathed along with the proper propor¬
tion of pure air, without any detriment.

As the vapours which conftitute the atmofphere are
extremely vifcid, they fufpend innumerable fine par¬
ticles of various folids, and alfo innumerable drops of
fluids, which are principally water, the effedts of
which laft have already been attended to. Many
fuch fubftances may be very noxious and very im¬
proper for the patient to breathe in health, and ftil!
more noxious in difeafe. That they are very noxious
in many difeafes is eafily feen from what happens in
hofpitals, in almoft all kinds of wounds and ulcers,
inflammations and fuppurations, in all affedlions of
any of the parts employed in refpiration. In all thefe
difeafes the patients in hofpitals recover much more
feldom than in the air even of London, a town at
leaft feven miles long and three in breadth ; and in
fuch a town thefe difeafes go on much worfe than
they do in the country at the diftance of ten miles
from it.

What are the noxious particles, or vapours, mixed
with the atmofphere, which render it fo hurtful in
thefe difeafes, has not been inveftigated. The breath
arifmg from the lungs of animals, the vapours which
ante from their bodies, the vapour ariftng from the
immenfe quantity of matter which is conftantly pu¬
trefying, the vapour which has ferved for the inflam¬
mation of fuel, & c. are all improper for refpiration.
The particles of foot, afhes, horfe-dung, gravel, and
a vaft variety of other bodies, floating in the air of a
large town, render it undoubtedly improper for ref¬
piration ; but which of all thefe fmail particles, va¬
pours, fluids, or folids, are hurtful in the difeafes
which have been enumerated, has by no means been

inveftigated

f 12 Fordyce's Third Di/fertation on Fever .

Inveftigated by experiment* the only means of inves¬
tigation which can in the lead be depended upon.

However noxious thefe vapours* which ordinarily
contaminate the atmofphere of an hofpital, or large
town, are in the difeafe s which have been enumerat¬
ed, they do not feem to have very bad effefts in a
regular continued fever. A patient, in a regular
continued fever, goes through its courfe under ex¬
actly the fame treatment, as fafely in St. Thomas's
Hofpital as he does in the country, or in an air in
which no noxious particles are known to exifh It is
undoubtedly true, that vapour arifmg from putrid fub-
ftances depreffes the Strength, and in fo far muft be
noxious in fever ; but when care is taken to avoid
fuch putrefaftion, and by a proper circulation to keep
a due proportion of pure air ; infectious vapour, and
mod: other noxious fubftances, do not feem, from ex¬
perience, to have much effedi in regular continued
fever.

The food and drink which Should be employed dur¬
ing the progrefs of the difeafe are next inquired into.
The rules which have been laid down in a regular ter-

« a t O

tian are by no means applicable in a regular conti¬
nued fever, for there is no time in which the patient
is free from the difeafe. In a regular continued fe¬
ver, be it ever fo flight, no Solid animal food ought
ever to be employed, whether quadrupeds, birds,
reptiles, or infects. Solid animal food, in a regular
continued fever, during its digeftion, greatly increafes
the heat to the feel of the patient. Still more to the
feel of the by-ftander, and frequently, though not al¬
ways, to the thermometer. It produces great reft-
leffnefs and fenle of uneafinefs, and an increafe of de-
preflion of lbrength in the patient, during the time
that it remains in the Stomach and inteStines. it
totally deranges the fever. It often produces the ap¬
pearance of a frefh paroxyfm. If it be made ufe of
about noon, or before the next evening exacerbation,
this is almoft always rendered more violent. It is

true,

Pordyce’s Third Differlation on Fever ... 2 IS

true, indeed, that if an error be committed, and
folid animal food be employed, after it Jias palled
through the inteftinal canals, the fyftem generally re¬
covers itfelf, the patient only being weakened by the
extraordinary exertion, and rendered lefs able to {up-
port himfelf during the remainder of the difeafe. if
the fame kind of food be perfifted in, it increafes the
evening exacerbations extremely, brings on delirium
much falter, and in a much greater degree than it
would otherwife arife, and prevents the fever from
being worn out by its own progrefs, as it otherwife
would be. All folid animal food is therefore in every
cafe to be rejected throughout the whole progrefs of
the difeafe.

Even after the difeafe has been terminated by a crifis,
animal food in a folid Hate fhould be rejected, there be¬
ing no caufe which has produced relapfes, as far as the
author’s obfervation has gone, fo frequently, as uiing
this too foon. The fame objections arife againfl the
ufe of fuch animal fluids as are coagulated by the
juices of the ftomach ; fuch as ferum, eggs, &c. — -
Green vegetables are like wife improper, from their
difpofition to run into the vinous and acetous fermen¬
tation.

The food confidered by the author as molt proper
in fever is, the farinaceous part of vegetables coagu¬
lated by heat, and diffolved* wholly or partially in
water ; fuch are barley water, panada, fago, and the;
like. Among!! fruits, grapes, figs, and dates, are
confidered the bell : apples and pears likewife, boil¬
ed, baked, or roafted. The author is inclined to think,
that it is never neceffary or proper for the patient to
ufe animal food of any kind in a regular continued
fever. If the prejudices of the patient or the attend¬
ants require, that animal food fhould be employed, it
fhould be in folution in water, but never folid. The
following are the obfervations of the author refpe Cl¬
ing milk.

Milk

3514 Fordyee’s Third DijTerlation on Fever .

Milk is a fluid that always coagulates in the
ftomach, but does not coagulate in the heat of
boiling water. It has been generally thought, that
this fluid ought not to be made ufe of in continued
fevers. In one part of the works of Hippocrates, it
is faid fimply, that it is bad. In another part, that
it ought not to be given, unlefs the fever is very long.
Sometimes the author has feen it coagulate in the
ftomach fo firmly, as to render the patient fick, which
ficknefs brought on vomiting, during which the coa~
gulum was thrown up refembling a tendon. In fuch
cafes milk is undoubtedly a very improper food.

Milk confifts of a folution of a mucilaginous fub-
fiance in water, expreffed oil, and fugar ; there is per¬
haps likewife a little of the neutral falts of the blood
in it. The fugar contained in it corrects any putref-
cency that might take place in the chyle, rather dif-
pofing it to be acefcent ; and the expreffed oil being
every where mixed with it, prevents it, when it coa¬
gulates, from forming fo firm a inafs, fo that although
it be always coagulated in the ftomachs of children,
it digeft$ eafier than almoft any kind of food, at the
fame time that it gives them greater nourifhment.
This would tempt us to employ it in fever, as an
animal food of at leaft eafy digeftion ; and the author
is not certain that, notwithftanding it has been con¬
demned by Hippocrates, and the few cafes he has
feen where it has difagreed with the ffomach, that it
is not very fit to be employed if any animal food is
given.

The next object of the author’s attention is thirjl.
The opinions of practitioners, he obferves, have differ¬
ed very much with regard to the quantity as well &s
quality of the fluid to be made ufe of for drink. The.
ancient Greek phyficians thought it improper that the
patient fhould drink any thing at all during at leaft
part of the difeafe, as they conceived that any kind of
drink increafed the fever, and occafioned greater thirft,
even water alone. Modern praftitioners, with a view
•of rendering the blood thinner, have forced the pa¬
tient

Fordycc's Third Differ tat ion on Fever. 2 IS

tient to drink a much larger quantity of water, or
watery fluids, than he would of his own accord.

That the blood is thick, and in confequence ob-
ftruCts the fmall vedels in fever, was a doCtrine form¬
ed by authors, who were not acquainted with the fub-
dances of which the blood condds. They did not
know that its mod effential parts are red particles, coa-
gulable lymph, and ferum; that there is befdes thefe a
folutionof mucilaginous fubftance, fimilar to that which
is formed where putrefaction has taken place, that there
was a folution of natron muriatum, ammonia muriata,
and ammonia phofphorata ; befides other neutral and
earthy falts ; and that befides all thefe fubdances
there is alfo water, not in a date of chemical combi¬
nation with any fubdance, but diffufed through them.
There is, therefore, a larger quantity of water already
in the blood-veffels than is neceffary to didolve or com¬
bine with any of them.

That it is true that there is water not chemically
combined is fhewn by this, that when the blood is
expofed to fome of the fine dlters in the body, fuch
as the pores of the fkin or the kidneys, water is
filtered off, fometimes perfectly pure ; but filtration is
a procefs which never feparates two fubdances che¬
mically combined ; water then, fo filtered off, is not
in combination with any of the fubdances from whence
it is filtered.

If more fuperfluous matter were thrown into the
, blood than is already in it, it would not render any of
J the parts of the blood thinner, or capable of pading
through vedels it could not pafs through before ; the
only effeCf of it would be, that when blood came to a
vedel fo fmall as not to let any other part of the blood
pals through, the water would pafs through, and leave
tire other parts of the blood behind. Throwing, there¬
fore, a larger quantity of water into the blood-veffels
would not thin any part of the blood that was too
vifcid, fo as to make it pafs through vedels that it
could not pafs through before on account of its vif-

ciditv.

216 Fordyce’s Third Differtation on Fever .

cidity. It is not neceffary, therefore, to force the
patient to drink more water than he choofes for the
purpofe of thinning the blood, as no fuch effedf arifes
from throwing in a larger quantity.

As it is not neceffary or ufeful to give a quantity
of water greater than the patient choofes to drink, fo
on the other hand, the not giving a fufficient quantity,
according to the third;, leems to have arifen, as far as
can be judged, from that fuperftition, which has in¬
duced mankind to refrain from things agreeable, to
produce fome falutary effedl ; juft as men think they
will go to heaven, by not eating animal food tor two
days in the week. The author conceives, therefore,
that the patient fhould be allowed to drink as much
as he detires ; nor does he conceive it to be of any ufe
to prevent him from drinking it of the degree of heat
that he likes beft.

With refpedt to quality, mucilaginous drinks are
preferred to fimple water, as not running off fo quick¬
ly by the excretories.

At the attack of fever, there is ufually a quantity
of indigefted food in th<? ftomach : an emetic, there¬
fore, is generally proper at the commencement of the
difeafe. On the fame ground, it is neceffary to eva¬
cuate the inteftinal canal.

We pafs over feveral points relative to the choice
of purgatives, and the employment of glyfters, which,
though no doubt interefting to young pradfitioners,
may be difpenfed with here. We come next to the
important article of Jleep.

With refpedt to opium, fo ufeful in procuring a
quiet, eafy, and refrelhing fleep, when a man is ex-
haufted by labour, or weakened by evacuations, if
exhibited, it is obferved, in the quantity of from half
a grain to a grain in regular continued fever, it often
produces fleep, but that fleep is difturbed : the pa¬
tient is often diftradfed with various incoherent, and
frequently difagreeable dreams ; and he often wakes
in the morning with a conviction that he has not flept

Fordyce’s Third Dijjhrtation on Fever. 2 If

at all. Inftead of a relaxation of the fever taking
place in the morning, the head-ach is greater, he has
more third, and the appetite is lefs : deep, therefore,
fo procured is fo far different from that reft which
gives time for the powers of the body to he recruit-
ed, that they are more exhaufted during it than they
would have been it the patient had not ilept at alh
No fubftances which have been conjoined with the
opium in fuch doles, have the e fie 61 of depriving it
of thefe qualities.

About five and twenty year's ago there arofe a
practice in St. Thomas’s Mofpital of exhibiting opium
in a much lefs quantity, to wit, in the quantity of a
quarter of a grain for a dofe, and repeating it at the
end of every fix or eight hours. When given in fuch
dofes it produces no immediate effect, but by degrees
the patient falls into a ftupor which gradually in-
cre'&fes ; and although this ftupor does not end in a
complete ileep, yet it grows in a day or two into that
kind of ftupor that we find, when the delirium from
the fever, with apparent fulnefs of the veflels of the
brain, begins to diminilh. It is true, indeed, that
this dofe of opium is obtained by adding a few drops
of laudanum to that mixture which is called mith-
ridate, but the author has often employed the opium
in his private practice, with ten grains of caftor, with
equal or rather better effe£f.

Lately many practitioners have exhibited opium
three or four times in the twenty-four hours in fe¬
vers, having borrowed their practice probably from
that which has been purfued in St. Thomas’s Hof-
pita!, the practice of the Hofpital being open to the
mipectiori or many pupils. Thefe practitioners have
not learned, however, that it is the fmallnefs of the
dofe that produces beneficial effects ; if the dofe be
increafed fo far as half a grain, the fame reftleflhefs,
the fame difturbed deep, dreams, &c. as have been
noticed, are brought on.

vol. Y. R The?

218 Fordyce’s Third Differtation on Fever .

The author has not ventured to employ opium in
the firft week of the difeafe : after this, it considerably
abates the delirium, and efpecially that increafe of it
which arifes in the evening. Other remedies have
been employed with the fame intentions, as muik,
camphor, and aether, Hoffman’s Anodyne Liquor
often has the effeft, but is very uncertain in its ope¬
ration.

When a regular continued fever is left to purfue
its ordinary courfe, the efforts that take place in the
fever, and the want of fufficient nourifhment and
ileep, frequently weaken the patient towards the
end of the difeafe to fuch a degree as to be dan¬
gerous, and even in fome cafes fatal. Weaknefs,
therefore, becomes an objedl of attention to the prac¬
titioner. If fuch a degree of weaknefs fhould take
place at the end of a regular continued fever, as to
endanger the life of the patient, the force of the body-
may in fome degree be kept up, by employing me¬
dicines which will induce the powers of the fyftem
to with all their force, until the fever ihall fo far
diminifh as to allow of the flomach digefting food of
better nourifhment, or the powers of the body to be
recruited by found and refrefhing ileep. The prac¬
tice of exciting the body to a£f with all its powers,
until the fever is fo far gone off, depends upon the
following principle.

Let a patient ill of a regular continued fever be
ever fo weak at the time of the crifis, or at the time
when the difeafe has gradually worn itfelf out ; as
foon as the fever is entirely terminated, provided the
patient is allowed to be perfectly at reft, and if pro¬
per nouriftiment is exhibited to him, to wit, fuch as
he can digeft, the powers of the body begin inftantly
to be on the increafe ; therefore the patient will be
gradually reftored to his health again.

Although there may be confiderable power in the
fyftem, yet there may be a want of exertion of tha
power j fo that the patient may fink and die from

weaknefs.

Fordyce’s Third Dijfertation on Fever . 219

weak nefs, though there are hill in the body powers,
which if they had been exerted might have kept the
patient alive. By employing medicines to make the
body exert thefe powers until the fever is gone off,
the patient will be preferved, and afterwards gra¬
dually recover his ftrength.

If this was not the cafe, all ftimulants employed in
fever would evidently be extremely hurtful, for every
extraordinary exertion tends to weaken the fyftem,
and to exhauft the powers that it brings into action
and therefore if all the powers in the body were
already in aftion, the increafmg that aftion would
weaken the fyftem much more, and render the weak-
nefs more fatal, inftead of preventing the patient from
being deftroyed by it. The ftimulant employed muft
roufe the dormant powers, in order to have good
effects.

Firft, many praftitioners have endeavoured to ex¬
cite the dormant powers of the body, for it is thefe
only, the author obferves, that can be excited to ad¬
vantage, by producing inflammation of the fkin by the
application of various ftimulants. But both phleg¬
monous inflammation and inflammation of the Ikin
have occafioned greater frequency of the pulfe, have
rendered it weaker and fmaller, and, as in health,
have prevented fleep, and the patient taking the fame
quantity of nourilhment, and have depreffed and de¬
ranged the whole fyftem. The author therefore con¬
cludes, that producing fuch inflammation does not
keep up the ftrength, or make any dormant power
aft, but that on the contrary it weakens the patient.

The fpices have been much employed, but impro¬
perly in the author’s opinion, unlefs to correft flatu¬
lency, as they render the pulfe much more frequent,
fmaller, and weaker.

Wine feerns to be the only remedy that is of ufe
to excite the dormant ftrength of the fyftem, when
weaknefs takes place towards the end of continued
fevers. It tends to increafe the force of the fyftem,

R 2 without

2 20

Fordyce’s Third Dijfcriation on Fever .

without increafing the frequency of the aftion of the
heard and on this ground it may be more fafely em¬
ployed than any other ftimulant. It has alfo a nar¬
cotic power.

Wine fhould be employed in moderate quantity ;
when exhibited in large quantity it produces intoxi¬
cation, the effefts of which every man who has drunk
it in fuck quantity very eafily perceives. The fto-
mach, after the intoxication is gone off, is difordered,
fpafmodic contractions take place in it, and it is not
capable of digefting food, which laid effeft would
render the patient weaker from want of receiving
fufficient nourifnment ; it fhould be ufed, therefore,
fparingly, and not in the leak to intoxicate.

It ought only to be employed, when the weaknefs
has juft become confiderable, in moderate quantity ;
for if we exhibit it in greater quantity than is fuffi-
cient to make fuck part of the dormant ftrength of
the fyftem, as is required, to be exerted, it will ex-
hauft that dormant ftrength, and not leave a fufficient
quantity to fupport the patient during the remaining
part of the difeafe.

When wine is firft employed by perfons not accus¬
tomed to ufe it, where it becomes neceffary to em¬
ploy it from weaknefs, four ounces is a fufficient:

quantity or wine of the ftrength of Fort wine. The
ftrength of wines can hardly be tranfmitted to pof-
terity by any permanent mark, for the ftrength does
not depend on the alcohol they contain, but like wife1
On the quantity of a vapour, which was called hr
V an Helm on t gas filveftre, probably different from)
that vapour which he called gas limply, and which
has lince been called fixed air and carbonic acid,,
although the author thinks thefe improper names p
that, however, is foreign to -the purpofe of this differ-
tatiom

The author has alfo to obferve, that in patients
who have been accuitomed to drink wine even in

ge quant it
exhibited

les, three half pints are quite fufficient ta>
in twenty-four hours.'

Art

{ 221 )

Art. XXV L Medical Hiftories and Reflections .

Vol. III. % J. Ferriar, M.D . Sic.

( Continued from page IS2.J

r fubjecl next treated of by Dr. Ferriar is

jj the Croup. It is of great importance, he ob~
ferves, to form an accurate opinion refpefting the
treatment of this difeafe, which is very fhort in its
duration, and attended with extreme danger. It has
been his lot, not only to have met with feveral iii-
ftances of this difeafe in practice, but to have un¬
dergone it repeatedly in his youth, and to have feen
a great deal of it in his family. From fuch opportu¬
nities, therefore, we may expect to derive much in¬
formation, and it is with much fatisfadfion we find
him fpeak fo decidedly of a method of cure, which
he has found invariably to fucceed, when employed
fufficiently early in the diforder.

We give the author’s very accurate defcription of
the fymptoms, becaufe an early detection of the dif¬
eafe is a point of the firft importance : fo much fo,
that Dr. Ferriar remarks, if the alarming fymptoms
are not mitigated during the firft fix hours, the dif-
cafe will generally prove fatal.

c Some days before the appearance of the croup,
the child is fretful, inactive, and drowfy : the eyes are
fomewhat fuffufed and blood-fhot, and the complexion
is muddy, or rather livid. There is fome degree of
cough, which generally refembles that attending a
common cold, but fometimes has the peculiar thrill
found, even from the firft. This cough, in the courfe
of two or three days, becomes violent and Irouble-
fome, and it is then neceffary to watch the patient,
with great attention. The dangerous- attack is com¬
monly made in the night, fometimes foon after the
child is put to bed, but more frequently about mid¬
night. The cough, on the approach of danger, has

R 3 a thrill.

222 Ferriar’s Medical Hiflories and Reflections „

a fhrill, barking found, and returns in redoubled fits,
the firft of which, though very violent, is fucceeded in
a few minutes by a fecond, longer, and yet more
violent. Every fit of coughing agitates the patient,
to an extreme degree : the face is (welled and fiuih-
ed ; the eyes are protruded ; a general tremor takes
place, and there is a kind of convulfive fixuggle to
renew refpiration, at the clofe of each fit. There is
no expectoration, at this period of the difeafe. As
the complaint encreafes, the coughing fits are fome-
times more troublefome, fometimes they become lefs
frequent 3 but an incefifant difficulty of breathing comes
on, accompanied by fwelling cf the throat, about the
place of the larynx : the head is thrown back, in the
agony of attempting to efcape fuffocation, and the
whole extenfors of the trunk, and of the legs, are
fometimes thrown fuddenly into aftion, to ailift the
effort, fo that the whole body is bent backwards, as
in tetanus ; in this attitude, and in this effort, the pa¬
tient expires. I once attended the infpeCfion of a
fine boy, who had died of the croup, and I obferved,
his druggies had been fo violent, that the corpfe reti¬
ed, in a great meafure, on the hind head and the
heels.

c There is not only an unufual found produced by
the Co- gh, fomething between the yelping and bark¬
ing of a dog, which it is impoffihle to defcribe, but
refpiration is performed with a hifhng noife, as if the
trachea were nearly clofed up, by feme light, fpongy
fubllance. The expreffion of the countenance is alto
appropriate, and will alone betray the difeafe, to an
experienced obferver. There is much diltenfion, the
bloom of the cheeks is greatly heightened, the eyes
are fwelled up, watery, and exhibit great figns of fuf-
fering. The trembling, hurry, and reftleffnefs, though
accompanied with heavy deep, proceed to an excef-
five degree as the difeafe advances, and the heart and
arteries are thrown into violent palpitations. Refpi¬
ration becomes more ilridulous, is repeated at longer

efforts,

Ferriar’s Medical Hiftories and Reflections. 22

efforts, and with greater exertion? till it ceafes en¬
tirely. Spontaneous vomiting fometimes comes on,
in the ccurfe of the difeafe, and a quantity of vifcid
mucus is difcharged, but without much relief. Chil¬
dren who are fubjeCI to attacks of the croup, are
fometimes feized with the deep, barking cough,
which will encreafe to fuch a degree as to create
much alarm, about the ufual time of the dangerous
exacerbation, yet it will decreafe again, and at length
go entirely off, without any other remedies than com¬
mon demulcents. Cafes of this kind, I fufpeCt, have
been defcribed as genuine paroxyfms of croup ; and
very trifling methods of cure have been recommended,
in confequence of their apparent effiacy in the fpu-
rious croup, which always cures itfelf. The diagnofis
of this particular cafe, is to be drawn from the follow¬
ing circumftances.

* 1. In the fpurious croup, the cough has not the
fhrill, whining found, which marks it in genuine cafes .
It is hoarfer, and the intervals are longer.

‘ 2. Refpiration is not fo much affeCted in the fpu¬
rious croup, even when the cough becomes alarming¬
ly violent ; and the obftru&ion does not produce the
fibilation peculiar to croup, but refembles more a
common dyfpnoea.

* 3. The fpurious croup is not attended with the
reftleffnefs, trembling, and palpitation of the arteries,
which characterize the other.

c I muff obferve, however, that thefe diftin&ions
are only to be learned, from much attention fo the
different cafes of the difeafe ; for the found of the
cough is fo fimilar in both, as to infpire even the moil
experienced with fome degree of doubt. I have fat
by the child’s bedfide repeatedly, watching for the
moment of danger, while the cough was encreafing
m violence ; and have been only undeceived, by find¬
ing that no tremor or palpitation cajme on towards
midnight, that the reftleffnefs abated, and that fleep
feemed to become more com poled.

R 4 c I have

524 Fe mar’s Medical Hi dories and Rejections.

s I have feen children affefted with this difeafe^
almoft at all ages, under nine. In large families,
if one child is feized with croup, mod of the others
generally begin, about the fame time, to have fymp¬
toms of the fpurious croup. I have never found rea-
fon to believe it infectious, and it appears very doubt¬
ful whether the difpolition to it be hereditary. 1 have
known it appear in families, to whom the fymptoms
were totally new.’

From the fymptoms, and from the appearances on
diffeCtion, there can be no doubt, the author obferves,
that the genuine croup is a difeafe highly inflamma¬
tory, and on this principle is the treatment founded.
In all the cafes of croup which he has feen, he has
found it neceffary to bleed immediately, and when
he has feen the patient fufficiently early to entertain
hopes of faving them, he has directed the evacuation
to be continued, fo as nearly to produce fainting.—
This is the effential point of the cure, without which
no relief can be effected. Evep it the patient fhould
not be feen till the day fucceeding the attack, it is
proper to bleed ad deliquium , if the fuhjeet be ple¬
thoric, and the difficulty of breathing and reftleffnefs
be great.

A -large bleeding generally produces an inftanta-
neous abatement of the fymptoms ; hut this is not fuf-
ficient for the fafety of the patient. A blifter mud at
the fame time be applied to the bread, or between
the (boulders, and ought to be made larger than ufuah
In the cafe of very young children, we mud almoft
defpair, for it is extremely difficult to procure any
blood from them by the lancet, and leeches afford a
very inadequate mode of depletion. Children above
two years of age may have blood drawn trom the
hands or feet in tolerable quantity. The operator
mud not be nice, refpefting the appearance of man¬
gling, in circumftances fo dreadful.

Betides the blood-letting and binders which have
juft been mentioned, the author advifes next to pro¬
duce

Ferriar’s Medical Uijiories and Reflections . 12525

dace full vomiting. Confiderable quantities of ropy
mucus are thus brought off, but he has not feen the
inflammatory exudation thrown up in the form of a
membrane.

It the firft bleeding and emetic do not effeftually
relieve the cough, and difficulty of breathing, it be¬
comes neceffary to repeat the bleeding ; and the eva¬
cuation in this cafe muff again be carried as far as the
patient’s ftrength will permit. A repetition of the
emetic, after the fecond bleeding, often puts an end
to the difeafe ; but if this fhould fail, we have nothing
to hope from medicine.

The ufe of the warm bath and demulcents may be
conjoined with this plan, but they are not confidered
as forming a very effential part of the treatment.

The operation of bronchotomy has been propof-
ed as a laid refource, but the author thinks, from
the appearances on diffedtion, it would be com¬
pletely ufelefs. The upper part of the hardened
membranous fubftance might be extracted with
the forceps, but the fluid portion, which fills the
lower part of the trachea and the bronchia, 'and
which could not be removed, would ftill occafion a
powerful obftacle to respiration, and the inflammation
ftill exifting, would certainly not be diminifhed by the
operation.

Some remarks next occur on the Hooping-Cough.
With refpeH to remedies in this complaint, bark,
cicuta, tinflure of cantfcarides, the author obferves,
are ail recommended by the experience of fome prac-
tioners. He believes that they may all have fucceed-
ed equally, for they have generally been tried about
the height, or in the decline of a difeafe, which in
moft cafes will cure itfelf. The only queftion is,
whether it be pofftble to cut fhort the progrefs of
hooping-cough, or whether it mull be left to run its
eourfe,

* in

■I

226 Ferriars Medical Hijories and Rejections.

s In the beginning of the difeafe, when it is ac¬
companied by fymptoms of fever and inflammation,
bleeding is fometimes neceffary. Blifters are more
frequently neceffary, and Dr. Armftrong’s plan of ex¬
hibiting tartarized antimony, in dofes which prove
gently emetic, is undoubtedly very ufeful : chiefly,
perhaps, by fupplying the means of expefloration to
very young children. But after thefe preliminary
fteps are taken, I believe that the only remedy,
which promifes to fhorten the diforder effectually,
is the folution of white arfenic. I have employed
this medicine, in feveral cafes of Infirmary-patients,
with tolerable fuccefs 3 and I have occafionally given
it in private praCtice, with fo much advantage, that
I think it deferving of farther trials. The dofe with
which I generally begin, is one drop daily, for an
infant ; and for children under feven, two drops, re¬
peated according to the date of the fymptoms. it re¬
quires fome caution, to avoid the accumulated aCtion
of this medicine. The exhibition of the folution
fhouid be fufpended occafionally, for a day or more,
and the bowels fhouid be gently opened, by means
of a little calomel.’

Of the life of the Nitric Acid in Syphilis , and fome
other Difeafes. The very contradictory accounts
which have appeared with regard to the powers
of this fubftance, make it defirable for us to poflfefs
the teftimony of many and various practitioners on
the fubjeCt. Somewhere there mult be error or ex¬
aggeration, for it is impoffible that ftatements fo very
inconfiflent with each other, can be true. Dr. Fer-
riar’s trials, on the whole, afford a refult favourable to
the new remedies, as will appear from what follows.
Eight cafes are narrated wherein the nitric acid was
employed. The flrft was one of thofe obflinate cafes
of the venereal difeafe, which now and then refill the
aCtion of mercury, or which at leaf! are only partially
removed by it. The acid was employed in this cafe,

feemingly

O 4

Ferriar’s Medical Hijlories and Reflections . 227

feemingly with advantage, but its good effefts were
not very decided.

The fymptoms in the fecond cafe had recurred re¬
peatedly, it would appear, from too flight a ufe of
mercury. The acid produced a favourable change,
but the cure was completed by mercury. The third
was a cafe of paralyfis of the lower extremities, from
diftortion of the fpine. Iffues had been ineffectually
tifed for feveral months. A recovery took place
under the exhibition of the nitrous acid. A cafe
of fciatica was alfo luccefsfuHy treated by the fame
remedy.

In cafe 5th, an old fyphilitic affection, the pains
feem to have been relieved by the acid. In the iixth
cafe (fyphilis) the acid had little effect. The com¬
plaint yielded, at length, to mercury. In the feventh
the pain arifing from nodes of long handing, was ap¬
parently relieved by the acid. In the eighth cafe, a
venereal one, the acid produced no evident advan¬
tage, the diforder, however, feemed to yield more ra¬
pidly afterwards to the ufe of mercury.

To thefe cafes the following remarks are fubjoined.
e Belides the cafes which I have thus mentioned at
length, I have ufed the nitric acid in a variety of
venereal complaints, in conjunction with mercury. I
have not perceived, that by this combination, a
fmaller quantity of mercury was fufficient to era¬
dicate the difeafe, nor have I found that the fenfible
aftion of mercury on the falivary glands, was at all
promoted, by the ufe of the acid.

* My obfervations would rather lead me to fup«
pofe, that the acid leffens the irritability of the fyf-
tem, and prevents the extent, to which the mercurial
difeafe ufually proceeds. In fpeaking of immediate
deductions from faCts, I fet the chemical pathology
afide.

4 It appears from the faCts I have mentioned, that
the fpecific power of the nitrous acid, in venereal com¬
plaints, is limited, to certain fymptoms, in the advanc¬
ed

. \ r

228 Ferriar’s Medical Hijfories and Reflections.

ed ftages. It feems to remove the pains of the long
bones, and to aft on the fuperficial ulcers of the third
ftage, but I fhould hardly be inclined to truft the cure
of any well-afcertained venereal affeftion, to the acid
alone. Mr. Simmons's trials of this remedy, which
will be found in the Appendix, fhew that the acid
is capable of extinguifliing the fymptoms, in a recent
cafe.

c I have never been able to afcertain clearly, that
the forenefs of the gums, and flight falivation, of
which patients certainly complain fome times, while
they are ufing the acid, depend on a general aftion
on the fall vary glands. When the acid mixture is
not fucked through a quill, or a glafs tube, the gums
are. affefted by the direft application of the acid ; and
patients have obferved to me, that even with the pre¬
caution of ufing glafs tubes, they ftill felt, that every
dofe of the acid affefted the teeth and gums. I can
positively after t* that I have known the acid taken in
large quantities, for a considerable length of time, in
conjunftion with the free ufe of mercury, without
producing any ulceration of the gums, or encreafe
of faliva ; yet with the effeft of defraying every ve¬
nereal appearance, in well-marked cafes.

c -I do not undertake to explain th-efe contradiftions
to the principles, on which the ufe of the nitric acid
has been introduced, in this diforder. Of the fafts
related by Mr. Scott, whom I feel a pride in mention¬
ing, as one of my earlieft, and moil valued friends, I
cannot entertain a doubt. And if my experience
differs, in any refpect, from his, I hope the variation
may be more owing, to the great difference between
the climates, in which we have refpeftively ufed the
medicine, than to inaccuracy on my part.

/ Suppofmg the efficacy of the nitric acid, in this
difeafe, to be ascertained, an important queftion will
remain to be decided : how far the fuiphuric, and
muriatic acids are capable of afting in a fimilar man¬
ner. 1 he operation of thefe three acids has, hitherto,

beem

Ferriar's Medical Hijlories and Reflections . 229

been confidered as nearly identical. We have ufed
them indifcriminately, as tonics, and they have all
produced thofe effefts on the fyftern, which the
chemical phyficians afcribe, at prefent, to the action
of oxygen. The muriatic acid, in particular, has
been much employed by me, both in private and
hofpital pra&ice, for reftoring the ftrength of the
moving^ fibre, in cafes of ferophula, of phthifis, of
dyfpepfia, or of general debility ; and 1 have always
found its effe&s to be, an acceleration of the pulfe,
an agreeable, glowing fenfation in the ffomach, a
feeling of encreafed vigour and alacrity, and a height¬
ening of the complexion. It has proved, in many
- inlfances, an ufeful fubftitute for bark, ft eel, and bit¬
ters, by the fmallnefs of its dofe, and by its freedom
from the difagreeable tafte of fome of thofe remedies.

‘ The reader muft have perceived, that in one or
two of the preceding cafes, the effect of the muriatic
acid was flightly tried. Perhaps, in the progrefs of
this enquiry, more accurate diftinftions may be eftab-
lifhed, refpefting the relative power of thefe different
acids. At prefent, the nitric acid appears to be the
more valuable.

4 After my fuccefs with the nitric acid, in chronic
rheumatifm, I was induced to employ it in forae cafes
of general debility, and great irritation of the nervous
fyftern, and I have derived as much advantage from it,
as could have attended the ufe of the rnoft powerful
tonics. I am perfuaded, that in many irritable, bi¬
lious habits, it may be ufed with great benefit, in
place of bark, and the other ufual remedies In
typhus, it will probably be found an excellent tonic,
mftead of bark, efpecially when the bowels are irri¬
table, and when the muriatic acid would be apt to
produce, or encourage diarrhoea. From the great en-
creafe in the dofe, upon which we now venture we
may expefl an action, nearly adequate to all theVur-
pofes of tonics, in fever, with the advantage of a re¬
medy lefs offenfive to the palate, and more effectual

230 Fe rriar’s Medical Hiftories and Reflections .

In relieving thirlh The only cafe of typhus, in which
this medicine can be contra-indicated, is, where there
Is much diarrhoea, or tendency to active inflamma¬
tion, or to haemorrhage. Yet even under thefe cir-
cumftances, I conceive that the full dofe only is pro¬
hibited ; in conjun&ion with opiates, it may be mo¬
derately ufed, with advantage.

c In giving the diluted acid, with opium, it may
be proper to obferve, that the opium fhould be added
to it in fubflance. The addition of a drachm of
laudanum, to an ounce or two of the diluted acid,
will fome times produce an explofion, efpecially if the
phial be agitated.

c Upon the whole, I think we may conclude, that
the nitric acid has a powerful effeft in certain ftages
of the venereal difeafe, but that neither the extent,
nor the permanency of this effe£t is yet afcertained.
That we have acquired, at lead, a valuable auxiliary
to mercury, an ufeful remedy again!! chronic rheu-
matifm, and, what was much wanted, a palatable
tonic.’

Refpefting the oxygenated muriate of potafh, the
author obferves, that he has found it efficacious in
the true fcurvy. In fyphilitic complaints, he has feen
no remarkable advantage derived from it. In cafes
of general debility it has not fucceeded. It proved

diuretic in one only of feveral cafes.

; ■ ' ) ■ * -

Some very interefting obfervations next occur, re-
fpeQing the Treatment of the Dying. The author
endeavours to fhew, that the terrors which fo gene¬
rally attend the idea of death, are not founded on
the aftual fufferings of the dying perfon, but are
altogether the fruits of imagination. In obferving
patients in this fituation, he has always been impreffi-
ed with an idea, that the approach of aftual death
produces a fenfation fimilar to that of falling afleep.
The difturbance of refpiration is the only appareiit
fource of uneafinefs to the dying, and fenfibility feems

Ferriar's Medical Hiflories and Reflections . 23 1

to be impaired, in exa£l proportion to the decreafe of
that function.

Many abfurd and inhuman practices of nurfes and
attendants are pointed out and judly reprobated. — -
5 It is a prevalent opinion/ Dr. Ferriar remarks,

* among nurfes and fervants, that a patient, wh'ofe
death is lingering, cannot quit life while he remains
on a common bed, and that it is neceflary to drag the
bed away, and to place him on the mattrefs. This
piece of cruelty is often praftifed, when the attend¬
ants are left to themfelves. A hill more hazardous
practice has been very prevalent in France and Ger¬
many, and, I am afraid, is not unknown in this coun¬
try. When the patient is fuppofed by the nurfes to
be nearly in a dying hate, they withdraw the pillows,
and bolder from beneath his head ; fometimes with
fitch violence, as to throw the head back, and to add
greatly to the difficulty of refpiration. A full ac¬
count of this inhuman cuftom, may be feen, in a
tract preferved by Valent ini, drawn up by a
German lawyer, in which he afferts, that patients
have been repeatedly fuffocated in this manner,
when there was no reafon to expert death from the
fymptoms of the difeafe. As the avowed motive for
this barbarity, is a defire to put the patient out of pain,
that is, to put him to death, it is incumbent on his
friends to preferve him from the hands of thofe exe¬
cutioners.

‘ Another improper pra&ice, is the precipitation
with which the attendants lay out the body, imme¬
diately after death appears to have taken place. I
have known them drip the body, in very cold, dormy
weather, wrap it in cold linen, throwing a Angle ffieet
over it, and opening the doors and windows of the
apartment, in little more than half an hour, after a
patient had died fuddenly.

c There is, indeed, a lingular indance recorded by
Sydenham, of the revival of a patient thus ufed.

232 Fernar’s Medical Hiflories and Reflections.

during the prevalence of the fiery treatment of fm all¬
pox. 3 A young man, having gone to Briftol, was
feizecl with the fmall-pox, and became delirious.
During the abfence of his nurfe, the attendants
fuppofing him to be dead, and on account of the
heat of the feafon, and the patient’s corpulency, took
the body out of bed, and laid it naked on a table,
merely throwing a (beet over it. The patient, thus
cooled, began to revive. His nurfe, on her return,
perceived ligns of life in him ; he recovered, and,
feveral years afterwards, told this fiery to Dr. Syden¬
ham. But the rough treatment of the body, and the
fudden alteration from the temperate warmth of the
bed, to the rigorous cold of a winter’s night, have*
perhaps, in fome cafes, extinguifhed the feeble re¬
mains of life, which might have been cherifhed by
more gentle methods.

6 It is too certain, that the helplefs patient feels all
thefe cruelties, after he has become unable to exprefs
his fenfati'ons diftinftly. The teftimony of perfons*
who have recovered from apparent death, leaves no
doubt on this head. Perhaps a more deplorable con¬
dition can fcafcelv he conceived, than that of the
expiring mailer of a family, transferred from the
foo thing care of his friends, to the officious folly, or
rugged indifference of fervants. This is a flate of
fuffering to which we are all expofed, and if it were
unavoidable, I fhould be far from deliring to unveil
fo afflifting a profpeft. But the means of prevention
are fo eafy, that 1 cannot forbear to folicit the public
attention to them.

c When the toffing of the arms, which I have de¬
fended, the rattling noife in refpiration, and difficulty
of fwallowing have come on, .all unneceffary noife and
buttle about the dying perfon fhould be prohibited.
The bed-curtains fhould be drawn nearly clofe, and
unlefs the patient -fhould place himfelf in a pofture
evidently uneafy, he fhould be left undifturbed. Ex-

4 clamations

Ferriaf s Medical Hiflories and Reflections. 233

cfamations of grief, and the crowding of the family
round the bed, only ferve to harrafs him :

c The common practice, of plying him with liquors
of different kinds, and of forcing them into his mouth,
when he cannot fwallow, fhould be totally abftained
from.

c When he no longer breathes, one perfon only
fhould remain in the room, who fhould take care
that no alteration be made in the hate of the bed.
Every thing fhould be condufted, as if he were in a
tranfitory fieep. If the weather be hot, the windows
of the room may be opened, and the bed-curtains un¬
drawn, in the courfe.of two or three hours. In win*
ter, it will be fufficient to withdraw the curtains
within that time.

* There can be no juft reafon for the hafte, with
which it is ufual to lay out the body. Seyerai hours
may be very properly fuffered to elapfe, before this is
done ; for the joints do not commonly become rigid
for a confiderable time. At the end of that- period,
the body will be completely cold, and all remains of
fenfibiiity will have been extinguifhedd

In an Appendix, No. I. are contained fome ufeful
rules for the prefervation of the poor from contagious
fevers, drawn up for the purpofe of being diftributed
by the Board of Health. The languageds very pro¬
perly accommodated to the perfons for whofe benefit
it was deftgned. Much may doubtlefs be effected by
the conduct of the lower claffes, and we may hope
that information is only wanting to induce them to
purfue their own intereft and welfare.

No. II. is a Letter to Dr. Ferriar, from Mr. Sim¬
mons, Surgeon to the Manchefter Infirmary* on dif¬
ferent profeflional fubjefls.

1. On the Ufe of the Kali Furufti, as a Cauftic in
Hydrophobia & For twenty years, Mr. Simmons ob¬
serves, he has had experience of the fuccefs attendant

vol. v, i S on

234 Ferriar’s Medical Uijlories and Reflections .

on applying this cauflic, in wounds inflifted by the
bite of mad animals, or of animals fuppofed to be
mad ; and in no one inftance has hydrophobia follow¬
ed its ufe. It has been ufed at the Manchefter In¬
firmary ever fince its foundation, now near fifty years,
with uniform fuccefs. Although the difeafe would
not have appeared in many of the inftance s in which
the kali purum was employed, it is highly probable
that it would have fhewn itfelf in fome ot them, for it
can fcarcely be conceived that the poifon fhould
efcape being infufed in fuch a multiplicity of in-
fiances*.

Two cafes of the Venereal Difeafe are next recited,
wherein the nitric acid was employed. Without de¬
tailing thefe, it will be fufficient to give Mr. Sim¬
mons’s general obfervations on the fubjeft.

c The firft cafe fhews, that the nitric acid will cure
the primary fymptoms of lues venerea, and the fecond
proves, that though it is capable of relieving ulcers of
the tonfils, by its direft aclion, yet it fails in perma¬
nently removing fecond ary fymptoms, whatever tem¬
porary relief it may afford, in fuch dofes as can be
taken, when there are ulcers in the throat. I have
given the common nitrous acid of the fhops, in this
dileafe, under a variety of circumllances, and in
primary and fecondary fymptoms : the refult corref-
ponds with the above recited cafes.

c It requires neither confinement, particular mode
of diet, nor hindrance of bufinefs. Whether the
hoarfenefs, in the firft cafe, was owing to the acid,
I cannot determine ; probably a much larger dofe
was given than is abfolutely necelfary in primary

* In the Debate on the Dog Tax, in the Houfe of Commons, in the
year 1796, Mr. Dent mentioned, that forty cafes of hydrophobia had
occurred at the Manchefter Infirmary, within a fortnight. Happily*
however, for the individuals, Mr. Simmons obferves, not one cafe of
hydrophobia occurred at the time alluded to, but a conliderable num¬
ber applied, who had been bitten by mad dogs.

fymptoms.

Ferriai^s Medical Hiftories and Reflections . 235

fymptoms, but I was defirous to know to what ex¬
tent it might be adminiftered, as it was then meafured
with precifion, and taken with the utmoft regularity.
When not fufficiently diluted, it has excited vomiting,
and pain in the ftomach. It would appear, that the
affection of the gums, and confequent falivation, is
owing folely to its direct action on them, and may
be avoided by fucking it through a quill, ftraw, or
glafs tube.

4 Although it has failed me in fecondary fymp-
toms, when the conftitution has been much exhaust¬
ed by previous difeafe, and a long courfe of mercury,
it has had a fpeedy and permanent effect in reftoring
the health and ftrength, Under circumftances v/here
a mercurial courfe cannot be entered on, it arreits the
progrefs of the difeafe. An example of this may be
taken from a perfon labouring under lues venerea,
being feized with typhus— the venereal adlion is fuff
pended during the fever, and is again renewred on its
termination ; in this cafe, mercury mult be of doubt¬
ful propriety : the acid, however, will not only relieve
the venereal affedtion, but reftore the patient’s ftrength,
and coincides admirably with any tonic plan, that may
be adopted.

4 In ulcers, remaining after a mercurial courfe,
and which, though for a time relieved, are aggra¬
vated by the further ufe of mercury, I have derived
much benefit from it.

4 Such is the refult of my experience of this re¬
medy. I am little folicitous to know how the falu-
tary changes are induced, and cannot at prefent ac~
quiefce in the dodtrine of oxygenation of the fluids,
either by means of the nitric acid, or of mercury ;
and it muft be admitted, that opium, laurel-water,
and other powerful narcotics, do not adt by any
known elective attradliond

( 236 )

Art. XXVII. An Inquiry into the Caufes and Ef¬
fects of the Variola Vaccina , a Difeafe difcovered
in fame of the Wejtem Counties in England , parti¬
cularly Glance fterjkire , and known by the name of
the Cow Pox. By Edward Jenner, M. D
F.B.S. He. Quarto, 75 pages, with Four co¬
loured Plates. Price 7s 6d. Law, &c. London,
1798.

■ . ' u

ideas which prevail amongfl praftitioners
§ and others, refpedling the very Angular difeafe
which makes the fubje£l of the prefent effay, are fo
vague and indeterminate, that the public are much
indebted to the author for his careful and accurate
inveftigation of the matter. The deviation of man,
he obferves, from the ltate in which he was originally
placed by nature, feems to have proved to him a pro¬
lific fource of difeafes. From the love of lplendor,
from the indulgences of luxury, and from his fond-
nefs for amufement, he has familiarized himfelf with
a great number of animals, which may not originally
have been intended for his affociates. Hence, pro¬
bably, are derived, many of the maladies, which,
from time to time, fpring up in fociety, and which
are not at all found in a hate of nature.

There is a difeafe to which the horfe, from his
ftate of domeftication, is frequently fubjedh The
farriers have termed it the greafe. It is an inflam¬
mation and (welling in the heel, from which iffues
matter poffeffing properties of a very peculiar kind,
which feems capable of generating a difeafe in the
human body (after it has undergone the modification
which I fhali presently lpeak of], which bears fo
Prong a refemblance to the fm all-pox, that I think
I high y probable it may be the fource of that difeafe.

‘ In this dairy country a great number of cows are
kept, and the office of milking is performed indiferi-
mim.tely by men and maid-fervants. One of the

former

Jenner’s Inquiry into the Variohe Vaccines, 23 7

former having been appointed to apply dreflings to
the heels of a horfe affefted with the greafe, and not
paying due attention to cleanlinefs, incautioufly bears
his part in milking the cows, with forne particles or
the infectious matter adhering to his fingers. When
this is the cafe, it commonly happens that a difeafe
is communicated to the cows, and trom the cows to
the dairy-maids, which ipreads through the farm un¬
til moft of the cattle and domeftics feel its unpleafant
confequences. This dileafe has obtained the name
of the Cow Pox. It appears on the nipples of the
cows in the form of irregular pullules. At their firft
appearance they are commonly of a palifh blue, or
rather of a colour fomewhat approaching to livid, and
are furrounded by an eryfipelatous inflammation.—*
Thefe puftules, unlefs a timely remedy be applied,
frequently degenerate into phagedenic ulcers, which
prove extremely troublefome. The animals become
indifpofed, and the fecretion of milk is much leffened.
Inflamed fpots now begin to appear on different parts
of the hands of the domeftics employed in milking,
and fometimes on the \y rifts, which quickly run on to
fuppuration, firft affuming the appearance of the fmall
vefications produced by a burn. Moft commonly
they appear about the joints ot the fingers, and at
their extremities ; but whatever parts are affefled, if
the fituation will admit, thefe fuperficial fuppurations
put on a circular form, with their edges more elevated
than their centre, and of a colour diftantly approach¬
ing to blue. Abforption takes place,. and tumours
appear in each axilla. The fyftem becomes affected,
the pulfe is quickened ; and Ihiverings, with general
laftitude and pains about the loins and limbs, with
vomiting, come on. The head is painful, and the
patient is now and then even a defied with delirium.
Thefe fymptoms, varying in their degrees of violence,
generally continue from one day to three or four,
leaving ulcerated fores about the hands, which, from
the fenfibility of the parts, are very troublefome, and

S 3 commonly

238 Jenner’s Inquiry into the Voriohs Vaccina *.

commonly heal flowly, frequently becoming phage¬
denic, like thofe from whence they fprung. The
lips, noftrils, eyelids, and other parts of the body, are
fometiraes affected with fores; but thefe evidently
arife from their being needleffly rubbed or feratched
with the patient’s infecled fingers. No eruptions of
the fkin have followed the decline of the feverifh
fymptoms in any infiance that has come under my
infpeftion, one only excepted, and in this cafe a very
few appeared on the arms : they were very minute,
of a vivid red colour, and foon died away without ad¬
vancing to maturation : fo that I cannot determine
whether they had any connexion with the preceding
fymptoms.

c Thus the cdifeafe makes its progrefs from the
horfe to the nipple of the cow, and from the cow
to the human fubjeft.

c Morbid matter of various kinds, when abforbed
into the fyfiem, may produce effects in feme degree
fimilar f but what renders the cove pox virus fo ex~
tremely fingular, is, that the perfon who has been
thus affected is for ever after fecure from the infec¬
tion of the frn all-pox ; neither expofure to the vario¬
lous effluvia, nor the infertion of the matter into the
fkin, producing this clrftemper.’

A great uutpber of inftances are adduced in fup-
port of this extraordinary faff:* a few of which we
ihall tranferibe.

* Cafe

i # It is neceflary to obferve, that puftulous fores frequently appear
fpontaneoufly on the nipples oi cows, and inftances have occurred,
though very rarely, of the hands of the fervants employed in milking
being affected with fores in confequence, ar..d even of their feeling an
indifpofition from abforption. Thefe puftules are of a much milder
nature than thofe wnich arife from that contagion whicn conftitutes
the true cow pox. They are always free from the bluifh or livid tint
fo confpicuous in that difeafe. No eryfipelas attends them, nor do
they the w any phagedenic difpofttion as in the other cafe, but quickly
terminate in afcab, without creating any apparent difdrder in the cow.
"1 his complaint appears at various feafons of the year, but moft com¬
monly in the fpnng, when the cows are firft taken from their winter
food and fed with grafs. It is very apt to appear alfo when they are

duckling

Jenner’s Inquiry into the Vctriohe T accuice* 239

c Cafe 2. Sarah Portlock, of this place *, was in-
fefted with the cow pox, when a fervant at a far¬
mer’s in the neighbourhood, twenty-feven years ago.

« In the year 1792, conceiving herfejf, from this
circumftance, fecure from the infection of the fmall-
pox, the nurfed one of her own children who had
accidentally caught the difeafe, but no indiipofition
enfued. During the time (he remained in the in-
feffled room, variolous matter was inferted into both
her arms, but without any further* efte£f than local
inflammation.’

c Cafe 4. Mary Barge, of Woodford, in this parifh,
was inoculated with variolous matter in the year 1791.
An efflorefcence of a palifh-red colour foon appeared
about the parts where the matter was inferted, and
fpread itfelf rather extenflvely, but died away in a
few days without producing any variolous fymptoms.
She has fmce been repeatedly employed as a nurfe to
fmall-pox patients, without experiencing any ill con-
fequences. This woman had the cow pox when file
lived in the fervice of a farmer in this parifh, thirty-
one years before.’

Several cafes are next given which fhew, that thole
who have had the fmall-pox either efcape the cow
pox, or are difpofed to have it (lightly. Some varia¬
tion, however, is found in this refpect.

The teftimony here adduced in fupport of the tail,
that the cow pox protefts the human conftitution
from the infection of the imall-pox, is ample and
fatisfactory ; and the ftatements are confirmed by the
concurring teftimony of Mr. Dolland, a Surgeon re¬
dding in a dairy country remote trom that where the
prefent obfervations were made. c With refpect to

fuckling their young. But this difeafe is not to be confjde-red as
fimilar m any refpeCt to that of which I am. treating, as it is incapable
of producing any fpecific effects on the human conftitution. However,
it is of the greatefl confequence to point it out here, left the want of
difcrimination fhould occafion an idea of fecurity trom the infection of
the fmall-pox, which might prove delufive.’

* Berkeley, in Gloucefterfhire,

S 4 > ' the

240 Jenner’s Inquiry into the Variola Vaccina,

the opinion adduced/ the author obferves, c that the
fource of the infection is a peculiar xnotbid matter
arifing in the horfe/ although I have not been able
to prove it from afitual experiments conducted imme¬
diately under my own eye, yet the evidence I have ad¬
duced appears to eftablifh it.

4 They who are not in the habit of conducing ex¬
periments may not be aware of the coincidence of
circumftances neceffary for their being managed, fo
as to prove perfectly decilive ; nor how often men en¬
gaged in profeffional purfuits are liable to interrup¬
tions which difappoint them almolt: at the inftant of
their being accomplifhed : however, I feel no room
for hefitation refpefting the common origin of the dif-
eafe, being well convinced that it never appears
among the cows (except it can be traced to a cow
introduced among the general herd w7hich has been
previously infefted,) or to an infeQed fervant, unlefs
they have been milked by forne one who, at the fame
time, has the care of a horfe affe&ed with difeafed
heels.

c The fpring of the year 1797, which I intended
particularly to have devoted to the completion of this
inyeftigation, proved, from its drynefs, remarkably
adverfe to my withes ; for it frequently happens,
while the farmers horfes are expofed to thy cold rains
which fall at that feafon, that their heels become
difeafed, and no cow pox then appeared in the
neighbourhood.

‘ The active quality of the virus from the horfes*
heels is greatly increafed after it has a£ted on the
nipples of the cow, as it rarely happens that the horfe
aftects his drefler with fores, and as rarely that a milk
maid efcapes the infection wThen the milks infected
cows. It is moil aftive at the commencement of the
difeafe, even before it has acquired a pus-like ap¬
pearance ; indeed I am not confident whether this
property in the matter does not entirely ceafe as foon
as it is fecreted in the form of pus. I am induced to

think.

JenneBs Inquiry into the Variola Vaccina. \ 241

think it does ceafe*, and that it is the thin darkifti-
looking fluid only, oozing from the newly-formed
cracks in the heels, fimilar to what fometimes appears
from eryfipelatous blifters, which gives the difeafe.
Nor am I certain that the nipples of the cows are
at all times in a ft ate to receive the infection . — •
The appearance of the difeafe in the fpring and the
early part of the fummer, when they are difpofed to
be affedted with fpontaneous eruptions fo much more
frequently than at other feafons, induces me to think,
that the virus from the horfe muft be received upon
them when they are in this Hate, in order to produce
effedts : experiments, however, muft determine thefe
points. But it is clear that when the cow pox virus
is once generated, that the cows cannot refill the con¬
tagion, in whatever ftate their nipples may chance to
be, if they are milked with an infedted hand.

‘ Whether the matter, either from the cow or the
horfe, will affedt the found fkin of the human body,
I cannot positively determine ; probably it will not,
unlefs on thofe parts where the cuticle is extremely
thin, as on the lips, for example. I have known an
inftance of a poor girl who produced an ulceration
on her lip by frequently holding her finger to her
mouth to cool the raging of a cow pox fore by blow¬
ing upon it. The hands of the farmers’ fervants here,
from the nature of their employments, are conftantly
expofed to thofe injuries which occafion abrafions of
the cuticle, to punctures from thorns and fuch like
accidents ; fo that they are always in a ftate to feel
the confequences of expofure to infedlious matter.

e It is lingular to obferve that the cow pox virus,
although it renders the conftitution unfufceptible of
the variolous', ihould neverthelefs, leave it unchanged
with refpedf to its own adtion. It is curious alfo to

* * It is very eafy to procure pus from old fores on the heels of
horfes. This I have often inferted into fcratches made with a lancet,
on the found nipples of cows, and have feen no other effect from it
than fimple inflammation. *

obferve.

242 jennefes Inquiry into the VarioLe Vaccinct.

obferve, that the vims, which with refpedf to its ef¬
fects is undetermined and uncertain previoufly to its
palling from the horfe through the medium of the
cow, fhould then not only become more active, but
fhould invariably and completely poffefs thofe fpecific
properties which induce in the human conftitution
fymptoms fimilar to thofe of the variolous fever,
and eftedt in it that peculiar change which for ever
renders it unfufceptible of the variolous contagion.

c May it not, then, be reafonably conjectured/ the
author afks, f that the fource of the final 1-pox is mor¬
bid matter of a peculiar kind, generated by a difeafe
in the horfe, and that accidental circumftances may
have again and again arifen, {till working new
changes upon it, until it has acquired the conta¬
gious and malignant form under which we now
commonly fee it making its devaftations amonglt
us ? And, from a consideration of the change which
the infedlious matter undergoes from producing a dif¬
eafe on the cow, may w7e not conceive that many
contagious difeafes, now prevalent amonglt us, may
owe their prefcnt appearance not to a fimple, but to
a compound origin ? For example, is it difficult to
imagine that the mealies, the fcarlet fever, and the
ulcerous lore throat with a fpotted fkin, have all
fprung from the fame fource, affuming feme variety
in their forms according- to the nature of their new
combinations ? The fame queftion will apply re-
fpecling the origin of many other contagious dif¬
eafes, which bear a ftrong analogy to each other/

Some obfervations next occur, but not immediately
connedled with the prefent fubjedt, relative to the
fmall-pox. The author mentions the inftance of a
practitioner who had been accu homed to preferve the
variolous matter in a warm pocket 3 a fituation favour¬
able for producing putrefadtion in it. This matter
when inferted wras found to produce inflammation,
dwelling's of the axillary glands, fever and fome times

eruptions $

Jenner’s Inquiry into the Variola Vaccina. 243

eruptions ; but not of the variolous kind, as patients
thus inoculated were found ftill fufceptible of the
fmall-pox contagion. The author further obferves,
that 1 he has the ftrongeft reafons to believe, that if
either the punctures or incifions in inoculation be
made fo deep as to go through the fkin, and wound
the adipole membrane, that the rifk of bringing on a
violent difeafe is greatly increafed. Several fadts are
adduced in fupport of this opinion.

Refpefting the origin of the cow pox, the following
obfervations are made. c At what period the cow-
pox was fir ft noticed here, is not upon record. Our
oldeft farmers were not unacquainted with it in their
earlieft days, when it appeared among their farms
without any deviation from the phenomena which it
now exhibits. Its connection with the fmall-pox
feerns to have been unknown to them. Probably
the general introduction of inoculation firft occalion-
ed the difcovery. Its rife in this country may not
have been of very remote date, as the practice of
milking cow~s might formerly have been in the hands
of women only ; which I believe is the cafe now in
fome other dairy countries, and, confequently, that
the cows might not in former times have been expof-
ed to the contagious matter brought by the men fer-
vants from the heels of horfes. Indeed a knowledge
of the fource of the infection is new in the minds of
moft of the farmers in this neighbourhood, but it has
at length produced good confequences 3 and it feems
probable from the precautions they are now difpofed
to adopt, that the appearance of the cow pox here
may either be entirely extinguished, or become ex¬
tremely rare/

The inquiry which makes the fubjedl of the prefent
eiTay is undoubtedly of conftderable importance ; for
notwithftanding the happy effects of inoculation,
with all the improvements which the practice has

received

244 Jenner’s Inquiry into the Variola Vaccina.

received fince its firft introduftion into this country,
it not very unfrequently produces deformity of the
fkin, and fometimes, under the be ft management,
proves fatal. But as fatal effects have not been
known to arife from the cow pox, even when im-
prelfed in the moft unfavourable manner, producing
extenfive inflammations and ulcerations on the hands ;
and as it clearly appears that this difeafe leaves the
conftitution in a date of perfeft fecurity from the in-
feftion of the fmall-pox, we may infer, the author
thinks, that a mode of inoculation may be introduced
preferable to that at prefent adopted, efpecially among
thofe families, which, from previous circumftances,
we may judge to be predifpofed to have the difeafe
unfavourably.

Many facts concur to fhew, that the cow pox can-
not be propagated by effluvia. Perfons have often
flept in the fame bed with thofe aftefted with the dif¬
eafe, without themfelv.es receiving the inflexion.-— -
And the following cafe renders it highly probable
that not only the heels of the horfe, but other parts
of the body of that animal, are capable of generating
the virus which produces the cow pox.

€ An extenfive inflammation of the eryfipelatous
kind appeared without any apparent caufe upon
the upper part of the thigh of a fucking colt, the
property of Mr. Millet, a Farmer at Rockhampton,
a village near Berkeley. The inflammation conti¬
nued feveral weeks, and at length terminated in
the formation of three or four fmall abfcefles. The
inflamed parts were fomented, and dreflings were ap¬
plied by fome of the fame perfons who were employ¬
ed in milking the cows. The number of cows milk¬
ed was twenty-four, and the whole of them had the
cow pox. The milkers, confiding of the farmer's
wife, a man, and a maid fervant, were infected by
the cows. The man fervant had previoufly gone
through the fmall-pox, and felt but little of the cow
pox. The fervant maid had fome years before been

infected

Crowther on the Difeafe of the Joints , Wc* 245

mfefted with the cow pox, and fhe alfo felt it now in
a flight degree : but the farmer’s wife, who never had
gone through either of thefe difeafes, felt its effedts
very feverely. That the difeafe produced upon the
cows by the colt, and from thence conveyed to thofe
who milked them, was the true and not the fpurious
cow pox, there can be fcarcely any room for fufpi-
cion ; yet it would have been more completely fatis-
fadtorv, had the effedts of variolous matter been afcer-
tained on the farmer’s wife ; but there was a pecu¬
liarity in her fituation which prevented my making
the experiment/

The plates which accompany the work are finely
executed, and highly defcriptive of the appearance
of the cow pox puftules.

Art. XXVIIL Practical Qbfervations on the Dif-
eafe of the Joints , commonly called White-Swelling ;
with fame Remarks on Scrofulous Ahfcejjes. By
Bryan Crowther, Surgeon to Bridewell and
Bethlem Hofpitals . Od lavo, 122 pages, price 3s,
London. Robinsons, 1797.

THE author in the firft place endeavours to fhew,
that the white-fwelling, as it is called, is a bru¬
mous affedtion : he is led to this opinion from having
obferved, that mob of the patients affedted with this
diforder were defcended from parents of a fcrophu-
lous habit, and that many of their families have been
deftroyed by phthifis pulmonalis.

The bones in this complaint, Mr. Crowther re¬
marks, are affedted in two ways : in the one they
are affected primarily from difeafe in their interior
itru&ure ; in the other they are affedted fecondarily,
by their articulating furfaces becoming difeafed, in
confequence of the previous affection of the internal

furface

246 Crowther on the Difeafe of the Joints , Kc,

' \ ' \ ')

furface of the joint. Exfoliation is a rare occurrence
in fhefe difeafe s : and of courfe the practice of dilat¬
ing the wound, and the application of the adtual
cautery, both of which were formerly much in ufe,
are not only unneceffary but pernicious.

We need not follow the author in his remarks on
the ordinary treatment of thefe diforders, for its ineffi¬
cacy is too well attefted. We proceed, therefore, to
the mode of cure particularly infifted upon in the
prefent work.

c It is now more than four years,’ Mr, Crowther
obferves, c fince I recommended the cauffic to be
applied on the integuments covering the difeafed
joint, from an opinion, that i flues would prove more
effectual, the nearer they were made to the feat of
the difeafe.

£ I then Hated, that this opinion had fomething
more than probable conje&ure to recommend itfelf,
and, indeed, fubfequent experience has fully confirm¬
ed me in the belief, that the failure of the cauftic in
difeafed joints, was not owing, according to Dr. Auf-
tin, to the difiance of the part affefted from the
trunk, but from the discharge not being procured
fo near the complaint as might be effedted : however,
the reader will of courfe form his own opinion from
the comparative fuccefs attending the more diftant, or
clofer application of the remedy.

c The mode I firft purfued in maintaining an arti¬
ficial drain in thefe cafes, was, by making a large
efchar, of a circular form, on each fide of the joint,
and keeping the fores open by a layer of fponge
dipped in the emplqfirum certe compofitum , of the
fame ffiape as the fores, but of a fize rather lefs, fo
as to allow fuffi cient room for the granulations at the
edges to rife above the furface of the plaftered fponge,
which was further feeured in its place by crofs flips
of adhefve plafter, and the affiftance of a roller.

£ f hough this method has fucceeded in the cure of
confirmed white-fwellings, fome of which were at-
4 tended

Crowther on the Difeafe of the Joints , 8(c. 247

tended with caries, yet the application of the cauftic
is frequently hazardous, from the thinnefs of the inte¬
guments in fome cafes ; for inftances have occurred
where the cauftic has penetrated fo far as to produce
a Houghing of the tendinous expansion of the mufcles ;
but the furgeon may avoid injuring the ligaments of
the joint, by making the efchars at a diftance fuf-
ficently remote, as he can afterwards drift the fore
higher or lower, more on one fide or the other, by
preffing the fponge againft its edge in the direction of
that part from whence he may wifh to procure a dis¬
charge. Notwithftanding the fuccefs which attended
the application of the cauftic, yet thefe inconveniences
as well as the very minute attention it requires, made
me apprehenfive that it would never be generally-
adopted. I was of courfe led to the trial of different
efcharotic applications, in the form of ointment :
among ft others, I was induced, from obferving the
effects of powdered favine in the removal of verruca?,
to try it alfo. Some of the powder was firft mixed
with white cerate, and applied as a dreffing to a part
that had been bliftered ; but the ointment ran off,
leaving the powder dry upon the fore, and no effeft
was produced. I next * infpiffated a decoQion of
favine, and mixed the extraft with the ointment,
which fucceeded better, for it produced a great and
permanent difcharge : and at laft, after various trials,
I was led to prefer a preparation analogous to the
unguentum jambuci, P. L. and give the following
formula, as anfwering every purpofe which my willies
could have fuggeftecl :

CERATUM SABIM.

R Sabina, recentis conlujie.

Cerce fiavcz, Jingularum , libram unam .

Adipis fuilla, libras quatnor.

Adipe et cerd liquefactis incoque fabinam et
cola.

f I have made many experiments refpefting this
cerate, and at one time imagined, that its prepara¬
tion

248 Crowther on the Difeafe of the Joints , Kc.

tion in a copper veflel might have influenced its e£
fe£t. Its deep green colour does appear to depend
upon this circumftance $ for where it is prepared in
tin veflels, it is of a much paler green tinge, nearly
approaching to a yellow, but its effect is the fame*
The prefence of a fmall quantity of copper, in an ex¬
ternal application, cannot be of any confequence,
and in this cafe, notwithftanding the modification
of its colour, the quantity is fo fmall as not to be dis¬
coverable by any chemical tell.

c The ceratum fabinae has been tried very largely
in the medical pradlice of a large hofpital, for the
production of permanent difcharges, and it is pre¬
ferable in this view to the unguentum cantharidis,
becaufe it produces no flrangury, and becaufe the
quantity of difcharge is much greater. There are
fome particular conftitutions where its ufe is attended
with great irritation, and when fuch occur it fhould
be lowered by the addition of unguentum cerae.

c It is to be underflood that a blifter is to be pre-
vioufly applied over the anterior and lateral parts of
the joint, and when the cuticle is removed, the fore
is to be drefled with the ceratum fabinae, taking care
at every dreffing, to keep the part clean.

c Simplicity attending any mode of treatment, muft
certainly be confidered as a recommendation in its
favour ^ and I have not known this method of main¬
taining a drain in the leak inferior to that by the
cauftic, and from its fuccefs, it has feemed to me to
merit a preference, particularly in thofe cafes where
the difeaie in the joint is more extenlive, of courfe
the pain and fwelling more diffufive, for the cauftic
cannot be well applied to a furface fo large as from
experience feems requifite for the accomplifhment of
a cure.

c The fuccefs of this kind of treatment is always
proportionate to the quantity of difcharge which is
procured, and not the depth of furface from whence
it is derived. The ingenuity of furgeons has been

employed*

Crowther on the Difeafe of the Joints , 8fc. 249

employed, to explain in what manner the cauftics are
beneficial in complaints of this nature, one imagining
it is the irritation, another the difeharge, and fome in
order, as they think, to be nearer the truth, have fup~
pofed the efficacy to exift in both.

A difference of opinion, when it does not in-
fluence us in the treatment of a difeafe, cannot be
productive of harm, and therefore I fhould have con¬
tented myfelf, in merely bringing forward cafes to
prove the efficacy of the practice I with to recom¬
mend ; but when the contrary appears, and the feel¬
ings as well as the recovery of the patient, are involved
in a theoretical controversy, the difference of opinion
then becomes ferious, and fhould be determined as
foon as poflible ; but this can be effected only by the
criterion of practical experience.

* It pay be faid in favour of the irritation which
immediately attends the cauftic, that it is fometimes ef¬
fectual (for it is not uniformly fo) in reducing the fuell¬
ing and confequently mitigating the pain $ but thefe
are only fymptoms of the difeafe, and not the difeafe
itfelf; and we have not (as I know of) a tingle in-
fiance of a confirmed whitedwelling being cured by
the mere effeCt of irritation, and thofe cafes in which
it feemed to me to produce any effeCt, the joint was
in a ftate of a great tenfion, and further than this the
complaint did not receive any amendment until an
abfolute drain had been eftablifhed for fome time.

* Mr. Pott attributed the fuccefs of the cauftic to
the difeharge, and I am confirmed in that opinion
from fubfequent experience ; and it appears to me
very doubtful that the greatest advocate for irritation,
has ever known it capable of arrefting the progrefs of
caries, healing fores, difperfmg abfeeffes and collec¬
tions of fluid, which are attendant on white-fwelling :
but that fuch effeCts do refult from the kind of treat¬
ment we have been recommending, is beyond all
doubt ; but the reader, I truft, will be able to fatisfy
himfelf with refpect to this point, by a perufal of cafes

vol. v,. T which

250 Growth er on the Difeafe of the Joints,

which arc brought forward, not with a view of flip*-
porting this or that particular opinion, but merely to
record a plain matter of fact : viz. that white-fwellings
of the joints have recovered after making a fore fur-
face, and procuring from thence a confiderable per¬
manent difcharged

The author has found this method of exciting arti¬
ficial drains efficacious in difcuffing collections of
fluids and even abfceffies in other parts of the body $
feverai inftances of which are adduced.

Upwards of thirty cafes of difeafed joints are
brought forward in proof of the utility of the plan
recommended. From thefe we iliall felect a few' of
the molt linking.

« ^ * Cafe 1. I was defired to vifit a man, about twenty-
feven years of age, who had been affli&ed with "a
white-fwelling of his knee for more than twelve
months. He differed great pain within the articula¬
tion, before the joint appeared to enlarge, and his cafe
was treated as a rheumatifm ; however, inilead of re¬
ceiving benefit, he gradually grew worfe, and was ad¬
mitted into an hofpital, where he was firft falivated,-
with not the fmalleft advantage. A blifier was alfo
applied to the joint, and repeated every other day,
for the fpace of a fortnight. He Hated, that this
method procured him confiderable eafe, with feme
reduction of the fwelling. When I faw him, he was
in a confirmed Hate of heClic $ had been troubled with
rigours ; the joint was much enlarged, and very pain¬
ful, particularly in one part, where the Ikin was thin
and inflamed. Indeed, both from the appearances
and the examination, I was fully fatisfied that matter
had formed. . I advifed him, on account of his health,

Ao part with the limb ; but he declined the operation,
telling me he quitted the hofpital, as nothing farther
was propofed.

f I made a large efehar on each fide of the joint, by
rubbing th t kali purum on the part, and the fores
were kept difeharging, by means of prepared fponge.

6 In

Crowther on the Difeafe of the Joints , &V. 25 1

In this cafe, no eafe was derived from the Stimulus
of the cauftic ; but after the fores had difcharged
freely for fome time, his pains were mitigated, and
his health improved.

‘ The previous painful date of the part, prevented,
before, a minute examination, which would have as¬
certained that the ends of the bones were deprived of
their cartilaginous covering, by the grating noife that
was occafioned upon moving the joint. By the con¬
tinuance of this drain, for nearly eighteen months, his
knee got perfedlly well ; its motion was unimpaired,
nor was the grating found any longer perceivable
upon ufing the joint,

‘ This man had alfo a Similar affe&ion of his ankle
joint, attended with ulcerations and extenfive caries*
on which account, he Submitted to amputation $ and
though the knee had remained well a twelvemonth,
and was So at the time of the operation, yet it was
considered right to amputate above it 5 and I very
much regret, I had not the opportunity of examining
the difeafed parts.'

c Cafe 2. S. G. a child, about the age of Seven,
had an indolent white-fwelling, for upwards of two
years 5 the whole joint was greatly Swelled, and the
inner condyle of the thigh-bone appeared enlarged.

c She appeared to be very consumptive, breathed
with difficulty ; her fkin was yellow, dry, hot, and
Scurfy 5 and ffie made little, and Sometimes no water
in the courfe of the day 3 her belly was alfo Swollen*
and the glands of the neck enlarged. In confequence
of the weak flate the child was in, a Sore was made
by the cauftic, only on the infide of the joint, that
part being mod difeafed, and was kept open by the
prepared Sponge, and when it had difcharged only a few*
weeks, her fkin became cool and perfpirable ; her ap¬
petite was improved, and her breathing relieved 3 She
became eafy, and her lleep was uninterrupted by thofe
fpafms of the affe6led limb, with which She had been
before troubled.

T 2 ‘In

$52 Crowtlier on the Difeafe of the Joints ,

* In every refpeCt fhe was mending, until, unfom
tunately, fhe caught cold, by fitting at the window,
to view the flames from the fire at RatclifFe, which
imprudence produced a fever, and a large deep-
feated abfcefs formed on the outfide of the knee, I
afcertained that the fever was not fymptomatic of the
abfcefs, but that the abfcefs depended on the fever,
from the mother’s account, who informed me, that
the child had for two days been very feverifh, before
any alteration in the joint took place, or fhe had com¬
plained of any pain. It was pretty certain, that if the
abfcefs had burfted, or been opened, the child would
probably have been drained to death ; but the joint
having been confiderably reduced in fize by the firffc:
application of the cauftic, I wras tempted to apply it
again, on that part of the fkin which immediately^
covered the abfcefs, taking the greateft care that it:
did not penetrate into the tumour. After the efchar
had feparated, and the fore had difcharged freely, the:1
child became eafier, and the abfcefs gradually difperf—
ed. The iffues wrere kept open, firft by the fponge,
and afterwards by the favine cerate, for upwards of:
two years, at the end of which time fhe was in every
refpeCt healthy, and the joint appeared free from any
difeafe, though there remained a flight enlargement of
the inner condyle ; however, probably fhe will be
obliged to wear a lift to her fhoe, in confequence
of the contracted ftate of the knee.’

* Cafe 8. l\ B. about fix years old, had been af¬
flicted with a white-fwelling of his elbow, above eight!
months, and it was then ulcerated in feven places ; he
had alfo a ftrumouS afleCtion of his great toe on the
left foot, a fcrofulous abfcefs, and two fores on the
right leg, befides a flrumous ophthalmia which had
fubfifted from the fourth year of his age. On account
of the inflamed Hate of the elbow, fix leeches were
applied, and cloths wrung out of the fatnrnine lotion ,
were kept to the part, and renewed when dry.—
Though this treatment in a degree relieved the in¬
flammation,

urowtner on the Difeafe of the Joints, 25$

flamrriation, yet the fores did not indicate the fmalleft
difpofition to heal. A large cauftic was applied
above the elbow-joint, the ulcers preventing its
nearer application, the iffue was kept open for about
ten months, when the ulcers formed by the difeafe
had completely healed, and the joint recovered.

* This cafe affords a very ilriking iriftance of the
conftitutional effect of artificial drains ; as under this
treatment, he entirely got the better of all the com¬
plaints which have been enumerated. On account
of his difpofition to fcrofula, before the fore made
by the cauftic was healed, I cut him an iffue in the
arm.

c I have aim oft daily opportunity of feeing this boy*
as he lives in my neighbourhood, and he has not fmce
had any complaint, though a period of nearly three
years has elapfedd

4 Cafe 1 1 . A young lady felt a pain in her knee*
three years before I faw her, which was exafperated
by walking, long (landing, or any kind of fatigue ;
the joint was contracted, much enlarged, and the in¬
teguments were in a thickened, puffy date, and of a
pallid appearance, though not oedematous. She de~
fcribed her pain as particularly fevere in the inner
condyle, and under the ligaments of the knee-pan,
fhooting from thence into the joint. The part was at
different times, cupped or leeched, and a large blifter
applied. As the cafe occurred before my knowledge
of the effeCts of favine, I employed the wig. cantha -
ridis to keep up the difcharge, which produced great
pain and ftrangury. I therefore applied the cauftic
on each fide of the joint, and kept the fores open by
the plaftered fponge. I with particularly to remark,
that flie always expreffed herfelf relieved in propor¬
tion to the quantity of difcharge. This patient con¬
tinued under my care for two years, and nearly the
whole of that time, a drain was maintained, either by
the prepared fponge, or by the favine cerate, a blifter
being previoufly applied. Her knee is perfectly re-

T 3 covered*

\ \ '

254 Crowther on the Lifeafe of the Joints, 8Cc.

' \

covered;, flie can ftraighten or bend the joint without
pain, and her health, which had buffered very con-
iiderably, is now completely re-eftablifhed. I cannot
futficiently commend the patience with which the
lady who is the fubjeft of the prefent cafe, has
borne her fuherings. Indeed, the circumftances were
particularly unfavourable : for a very near relation had
fallen a viciim to the fame diforder, and but for a
vifible improvement in her general health, I Ihould
frequently have propofed amputation of the limb, as
preferable to the mifery flie endured. To fecure her
from a relapfe, and as fhe had been troubled with
fwel lings of the glands of her neck, I cut an iffue
above the knee.*

Cafe 20. A boy, aged feven years, had a difeafed
knee and afikle-joint of the fame limb, which had fo
impaired his health, that amputation was thought ad¬
visable, but to which the parents would not confent.
The knee-joint having been firft affefted, and ad¬
vancing fail: to a date of fuppuration, it was bliftered,
and the part was every day dreffed with the favine
cerate, for above fix months \ this treatment produced
£ reduftion of the fwelling of the foft parts, a re¬
moval of the pain occafioned by the difeafe, and
a complete abforption of the fluid, with which the
different parts of the joint were diftended.

Tne Knee is capable of every funftion, though
the condyles of the thigh-bone remain confiderably
enlarged.

‘ From the improvement of the boy’s health, and
the amendment of his knee, I recommended -the
ankle-joint to be treated in the fame way ; but
with what advantage, I have not yet heard, as he
r elides in the country.’

from the cates adduced, the author is certainly
warranted in his conclufions :

1 hat long continued difcharges, artificially ex-
cited, are highly beneficial in every flage of white*
fwelling, and in other modifications of fcrofula.

’« That

Crowtner on the Difeafe of the Joints , Sic. 255

* That caries has been arretted, and fometimes
cured $ that collections of fluid within the cavities
of joints, or exterior to them, have been removed ;
that fores connected with the local affeCtion have
been permanently healed, and a repetition of them
prevented ; that the general health of every patient
has been ftrikingly improved, and that where this
treatment has been adopted in confequence of the
difeafed joint, other ferofulous appearances in diftant
parts have alfo yielded to it.

€ That the bed method of producing fuch difcharge,
is the application of a common blitter in the firft in-
fiance, and when the cuticle is removed, in dreffing
the part with the fa vine cerate ; and that the ufe of
this preparation may be beneficially extended to a
great variety of cafes, where a copious local difcharge
may be thought advifable.

£ That an blue in any part of the body, may be
fuccefsfully employed as a conftitutional remedy, in
all cafes of fcrofula, and may probably be fufficiently
powerful when it is applied in time, to prevent an
attack of this difeafe, in eonftitutions predifpofed to it,

€ And finally, that we are not to be depreffed by
the obftinate refinance of the complaint, or lofe the
neceffary confidence in our mode of treatment, al¬
though months fhould pafs without much apparent
advantage ; for it has principally been owing to a
fleady perfeverance, that I have fucceeded in reftor-
ing fome patients, labouring under unfortunate and
almoft defperate cafes* to the full enjoyment of their
health.5

The application of iffues and other drains, in the
vicinity of difeafed joints, is by no means a novel
praCtice ; yet it feems of late to have retained lefs
confidence, than its importance and utility entitle it
to. The public are therefore indebted to Mr. Crow-
ther for. recalling our attention to the fubjeCl, and
letting its advantages in a new and ftriking point
of view,

T 4 Art,

( 256 )

Art. XXIX. Medical DifcipUne ; or, Rules and
Regulations for the more effectual Prefervation of
Health on board the Honourable E aft- India Com¬
pany s Ships . In a Letter addreffed to the Court
of Directors , and publijhed with their Approbation.
By Alexander Stuart, Surgeon in Southwark,
and formerly of the Earl Talbot and General God¬
dard Eajt Indiamen . Twelves, 107 pages, price
2s 6dL London, 1798. Murray and Highley,,

A COURSE of four voyages, comprizing a‘ pe¬
riod of nearly ten years, in the fervice above
alluded to, has enabled the author, in his fituation of
furgeon, to obferve, collect, and arrange, a number
of taCls on different matters relative to the important
interefts of health on board fhips, in their voyages to
and from India. It is a well known and melancholy
truth, the author obferves, that thefe voyages, when
protracted beyond the ufual length of time, from war,
or other caufes, have hitherto been generally attended
with great ficknefs and mortality : the fcurvy, fluxes,
and malignant fevers, have frequently made dreadful
ravages amongfl the crews.

1 he fuccefsful experience of the late celebrated
and humane navigator. Captain Cook, has happily
evinced how much it is in the power of well-direCted
management to preferve the bleffmg of health, in the
longeft voyage, through every variety of climate. His
fuccefs, together with flmilar inftances, warrant the
averting with confidence, that ficknefs and mortality,
to the deplorable extent they have fo frequently oc¬
curred in voyages to hot climates, are by no means
t0 J36 confidered as evils unavoidable. The means
which have been employed to fo defirable an end,
need only to be pointed out, it is hoped, in order to
their general adoption.

1 he regulations here propofed refpeft the important
articles of cleanlinefs, air, diet, .reft, exercife, and

clothing.

257

Stuart’s Medical Difcipline ,

clothing. We tranfcribe the following remarks on
the pernicious ufe of fpirits, when employed unmix¬
ed ; and on the advantages of them, when given in
combination with the vegetable acid.

* The only mode, it appears to me, in which liquor
can be daily allowed to advantage, is in form of
punch, made with either the frelh or preferved acid
of vegetables, as lemon, lime, or orange-juice. When
the liquor is in this manner blended with the acid and
fugar, and a large proportion of water, many of its
bad qualities are corrected, and the acid and fugar
are given in a pleafant, palatable form, with infinite
advantage. In this frate it counteracts the bad ef~
fe£ts of a fea diet, and powerfully prevents fcurvy.

c An ordinary allowance of punch daily, given at
dinner, is, perhaps, among the moft effectual antif-
corbutics that can be ufed at fea. We have inftances
on record where this pra6tice, in a long voyage, faved
whole crews, even from the flighted fymptoms of
fcurvy ; whilft other fhips in the fame fleet, and
expofed only to the fame caufes, were daily burying
men, cut off by this dreadful malady.

c But of the virtues of this acid, (on which thofe of
punch chiefly depend) both in the cure and preven¬
tion of fcurvy, I can decidedly fpeak from my own
immediate obfervation and experience.

‘ On board the General Goddard, during the
voyage of 1792, feveral cafes of fcurvy occurred
among the foldiers, in recovering from a contagious
fever that raged univerfally for a time amongft them,
which were all fpeedily and effe&ually cured by the
liberal ufe of preferved lime-juice. And I have every
reafon to think, that the difeafe was prevented in a
great many others, by the daily ufe of a fmall quan¬
tity of the acid, mixed with water, and the addition
of a little wine and fugar.

c Indeed, I confider this acid, in its frefh or pre¬
ferved ftate, to be as effeftual in curing and prevent¬
ing fcurvy, as the bark and mercury are in curing the
ague and fyphilis ; and a large quantity of it as necefl

fary

258 Perkin^ on the Influence of Metallic Tractors , SCc*

fary to be laid in by fhips at every place it can be
procured.

* I have therefore firongly to recommend, , that a
frefn quantity be always purchafed at every port a
Ihip touches at on the voyage ; and alfo that a part
of the (hip’s flock of liquor be made into fhrub, that
is to fay, that a certain quantity of acid and fugar be
mixed with a certain proportion of fpirits, to be kept
and daily ferved out to the men during their contb
nuance at fea,

£ It were moft truly and earneftly to be wi fired,
that the Honourable Company’s fhips fliould always
be fupplied, on their fitting out, with a quantity of
their liquor made previouily into fhrub, which would
only require a proportion of water to make punch.
That the ufe of punch in a moderate degree, fliould
become general ; that drams fhould never be given
unlefs in fuch inftances of expofure as I have already
mentioned ; and that grog fliould be ufed as feldom as
poffible. In my mind the beneficial effefts that would
arife from fuch praftices, would be great indeed.*

Art. XXX. The Influence of Metallic Tractors on
the Human Body, in Removing various painful In -
flammatory Di ('cafes, fuch as Rheumatifm , Pleurify%
fame Gouty Affections , & (c. fc. lately I) if covered by
Dr. Perkins, of North America ; and demon -
Jirated in a femes of Experiments and Obfervations ,
by ProfeJfors Meigs, Woodward, Rogers, &c,
&cf by which the Importance of the Dijcovery is
fully Af certained. , and a new Field of Inquiry
opened in the Modern Science of Galvanifm, or
Animal Eleftricity. By Benjamin Douglas
Perkins, A. M. Son to the Difcoverer. Ofilavo,
99 pages, price 2s 6d, London, 1798. Johnson,

THE fubjeft of the effay before us is probably new
to the greater part of our readers ; but a cir-
cumftance we learn from it, viz, that the Metallic

Tractors

P erkin s on the Influence of Metallic Tractors , 8Cc. 259

Tractors are vended by the author and difcoverer,
at the price oi five guineas the fet, favours, at firft
fight, too much of modern empiricifm, to induce us
to go particularly into the contents of the work.—
Yet the evidence adduced, refpeCting the powers
of the remedy here recommended, is apparently fo
ftrong, both in nature and extent, that no inconfider-
able degree of importance attaches to the fubjeft,
and we are led to give a more extended account of
it, than we might otherwife, perhaps, have deemed
neceffary.

The origin of the difcovery is thus defcribed.— .

Perkins, of Connecticut, m TSF orth America,
for many years entertained the opinion that metals
poftefled an influence on the human body, which had
hitherto efcaped the fcrutinizing eyes of phyfiologifts.
This opinion was the refult of fome phenomena,
which in the courfe of his extend ve praCtice had
accidentally arretted his attention. The firft remark¬
able incident that prefented itfelf to the notice of Dr.
Perkins, was the hidden contraction of a mufcle, when
he was performing a chirurgical operation. This he
obferved regularly took place whenever the point of
the metallic inftrument was put in contaCf with the
mufcle. Struck with tne novelty or the appearance, he
was induced to try the points of wood, and other
fubftances ; and no contraction taking place on thefe
experiments, he thence inferred that the phenomena
could be afcribed only to the influence of the metal.

* About the fame time he obferved, that in one or
two cafes, a ceffation of pain had enfued when a
knife or lancet was applied to feparate the gum
from a tooth, preparatory to extracting it ; and in the
fame year he difcovered, that momentary eafe was
given in a few inftances, by the accidental applica¬
tion of a metallic inftrument to inflamed and painful
tumours, previous to any incifion.

While thefe and a few other cafes of a fimilar
nature,^ in which the perfectly tranquil ftate of the
patient s mind^ with every attending circumftance,

precluded

260 Perkins on the Influence of Metallic Tractors , 8Cc,

precluded the poffibility of a fallacy,. were engaging
his attention, the news of the late important difco-
very of Galvani, the celebrate-d Profeffor at Bologna,
relative to the furprizing effeCts of metals on the nerve
and mufcular fibre, confirmed him in his hypothefis.
From this period he began to turn his attention to this
his favourite purfuit, and fought with eagernefs for
fubjeCts which might enable him to afcertain the
power of metallic influence when applied to difeafes
of the human body.

c He proceeded to make infiruments of what are call¬
ed the perfeCt metals as well as of the bafe ones, and
likewife of various compound metals, and tried them
all, fometimes with lefs and fometimes with more fuc-
cefs, than he had ever hoped or expected. Thefe ex¬
periments he continued for feveral years ; convinced
from what he had already noticed that he was right
in his principle, and ardently hoping that further ex¬
periments and obfervations would enable him to ap¬
ply it to the alleviation of human affliction, and the
general benefit of mankind.

c The refult corroborated and indeed exceeded his
moft fanguine expectations ; for he difcovered that,
by drawing over the parts affeCted in particular direc¬
tions, certain infiruments which he formed from me¬
tallic fubftances into certain fhapes, he could remove
chronic rheumatifm, feme gouty affeCtions, pleurifies,
inflammations in the eyes, eryfipelas, and tetters ; vio¬
lent fpafmodic convulfions, as epileptic fits ; the lock¬
ed jaw; the pain and fwelling attending contufions ;
inflammatory tumours ; the violent pains occafioned
by a recent fprain ; the painful effeCts of a burn or
feald ; pains in the head, teeth, ears, breaft, fide,
back, and limbs ; and indeed moft kinds of painful
topical affeCtions, which came under his care and ob-
fervation. The infiruments producing thefe effeCts
are termed TRACTORS.

4 The fubjeCt by this time began to excite public
attention and general curiofity. By thofe only who

had

Perkins on the Influence of Metallic Tractors , Xc. 26 1

had feen or experienced the effefts of the tractors
were they credited, while thofe who judged only
from rumour, confidered the metallic operation as a
renewal of Mefmers treatment, and the fhafts of ri¬
dicule were thrown at the difcoverer, as the reviver
of his exploded practice. With thefe men Dr. Per¬
kins was fuppofed to have loll his fenfes; and his hy¬
pothecs, which they have fince honourably acknow¬
ledged to be tounded on reaion, and fupported by
experiment, was then efteemed the delufive dream of
chimerical projection !

‘ Shortly after the adjournment of the Medical
Convention, to which I have juft referred, Dr.
Perkins, influenced by the advice of his friends,
and delirous of being fituated in a more extenllve
field for exhibiting his difcovery, repaired to Phila¬
delphia. The public hofpitals, alms-houfes, infirma¬
ries, and other inftitutions which ornament that po¬
pulous city, and do honour to its inhabitants, pre-
fented excellent opportunities ‘for making experi¬
ments on a variety of new cafes, and fubjeCting
his hypothefis to a feverer teft. As Congrefs was
now in feftion, he performed his operations, not only in
the prefence of the moft eminent phyficians, but alfo
before the moft diftinguifhed perfonages of the Union.
General Washington, then President of the
United States, convinced of the importance of the
difeovery from experiments in his own family, avail- ,
ed himfelf of its advantages by purchafing a fet of
the tractors for their ufe.

c The Chief Justice of the United States, fe-
veral of the Senators and Reprefentatives in Congrefs,
and other literary characters, honoured the difcoverer
with their attendance at a great variety of his expe¬
riments, as well as the medical gentlemen of Phi¬
ladelphia and its neighbourhood.

c In the prefence of fuch honourable and accom-
plifhed judges. Dr. Perkins operated at the hofpitals,
on patients afflicted with pains and inflammations

262 Perkins on the Influence of Metallic Tractors, SCc*

in almoft all their variety, and I believe I may fay
to the general fatisfaflion and furprife of the Ypec-
tators. Difeafes of the rnoft obftinate nature, which
had baffled medical art, were removed by the metaltic
tractors : and many perfons of an advanced age, who
had been crippled for years with the chronic rheu-
xnatifm, were, in feveral inftances, perfectly cured.’

The author next gives an account of the opposition
which the metallic tractors met with from different
quarters 5 much of this, however, it appears, gave
way to a candid inveftigation of faffs, and the tefti-
monies adduced" in their fupport are at lead: honour¬
able, if not decifive. Many fuppofed the tractors to
a£t on the fame principle as the exploded practice of
animal magnetifm, and, in faff, to be merely a re¬
vival of that impofition. But the reality of this was
brought into queftion, from the following comparative
observations on the two. Several members of the
Medical Society of Connefticut turned their atten¬
tion to this objeft, and endeavoured to difeover, if
any affinity or refemblance could be found between
the operations of Dr. Perkins, and the treatment of
Mefmer. •

‘ After almoft innumerable experiments, which
were made on fubje&s of all descriptions, as it re-
fpe&s their difeafes, ages, or ftations in life, and, in
Short, diversified with every variety which occurred to
them ; it was acknowledged that there could be no
refemblance found, either in the modes of applica¬
tion, or in the effects which were produced, between
the operation of the tractors and animal magnetifm.
It was obferved, that the author of the difeovery of
the metallic influence, always fought opportunities
for performing his operations in the prefence of phi-
lofophers and men of Science, <c who fhould be com¬
petent to deteft a fallacy, if there was one; and, on
the other hand, to extend the improvement, if, in
faft, a new principle is discovered.

€ It

Perkins on the Influence of Metallic Tractors, Sic. 263

c It was found that the difeafes, in which the ope-
ration of the metallic influence was moft fuccefsful,
are diredtly oppofed to, or very different from, thofe
in which animal magnetifm had produced effefls. —
Highly nervous complaints, attended with debility, in
which the latter chiefly appeared effective, have rarely
been relieved by the former ; alfo none of thofe dan¬
gerous or ridiculous fymptoms, which in animal mag¬
netifm were faid to be preparatory to a crifis, took
place here ; nor any thing which bore the le aft refem-
blance to the crifis itfelf. The pains, inftead of re¬
quiring an operation of two hours or more, as was the
cafe in Mefmer’s treatment, are generally removed bv
the . tractors in the courfe of twelve minutes ; and
inftead 6f their being fuccefsful only among the lower
daffies of mankind, who are moft fubjeft to credulity
and impofition, they have hitherto been chiefly ufed
among men of fcience and refpedability, who have
often been difpofed, at firft, to treat them with ridi¬
cule and contempt, from a perfuafion that the opera¬
tions were all a fallacy.

c The circumftances under which the tractors pro¬
duce no eflfedt, alone fufficiently prove that a phyflcal
caufe, independent of the power of imagination, is
concerned in the operations ; as for inftance, relief
from pain has never been procured by them, on parts
of the body to which any* oily application, or where
any adipofe fubflances have bepn recently employed,

* The obftacies which oil prefents in exciting mufcular motion, or
the animal electricity, is particularly mentioned by Galvani, the dif»
coverer of that influence. ( De Viribus El. in m . m. p. zz.)

Dr. Fowler alfo, whole ingenious experiments on the fame in-
fluence have fucceeded thofe of Galvani, has the following remarks.
(Exp. and ObJ', on Anim. EleEf. p . is.)

** Oils of all kinds are fo tar from conducing, that if the fingers of
the perfon holding either the probe or the zinc have perlpired much,
even this operates as a complete obftrudhon to the pallage of the in¬
fluence. The inftant the perfpired matter has been wiped away, and

the fingers have been dipped in water, it again excites contractions. _

When the inteftines of a frog are removed, and its abdomen is filled
with oil, no contractions can be excited by placing one metal upon its
fciatic nerves, and bringing another in contact with it, either above or
below the furface of the oil.’*

* Indeed,

264 Perkins on the Influence of Metallic Tractors , Kc0

c Indeed, perfpiration itfelf is fo efteQual a barrier
to the metallic influence, that the tractors have never
been ufed to fo much advantage in the warm fummer
of America, when the hands oi the operator, and the
fkin of the patient, are generally covered with it. — -
But if the part be thoroughly wafhed, and the oil,
adipofe, or perfpirable matter be perfeftly removed,
relief will be immediately obtained. Chronic pains,
after an injudicious ufe of mercury, or old pains, which
are the effe&s of a venereal complaint, even where no
mercury has been ufed, have never been radically re¬
moved by the metallic influence.

* Another Angular phenomenon occurred, viz. That
in fome inftances the metallic influence, when excited
by different perfons, produced different effefls. This
fa£t, however extraordinary it appeared, and however
ffrenuoufly it was at firft: oppofed, is now universally
acknowledged. Experiments were made to afcertain
this point with fuch accuracy, as to preclude the pof-
fibiiity of a fallacy ; and the refult proved, that there
were perfons who might ufe the tractors for any
length of time, in difeafes which were fuitable for
the operation, and produce no perceptible effeft ;
when by placing them in the hands of another per-
fon, who fliould perform the operation precifely in the
fame manner as before, the pain or inflammation
would be removed diredtly. It is true, this lin¬
gular property is charafleriftic but of few, yet among
the great number who have purchafed the tractors in
America, there are fome who have never performed
a cure. Thefe gentlemen, whenever an operation is
required, put the tractors in the hands of a bye-
ffander, who applies them under their direction, and
the ufual falutary effefts are the immediate confe-
qucnce.

c This curious fa£t has been mentioned, by the
writers on the philofophy of the metallic influence,,

Perkins on the Influence of Metallic Tractors , 263

as a proof of its analogy* to the influence difcovered
by Galvani.

• c I fliali next enumerate feme of the difeafes which
were found to be fuitable fubjeCts for the metallic
operation ; and thofe who have experienced or un-
'derftand them, will eafily judge whether the imagina¬
tion can have any influence in their cure. Can the
imagination cure a gout f — remove, almoft inftanta-
neouflv, the fpafms of an epileptic fit, when the pa¬
tient is diverted of every exercife of reafon ? or the
contractions of a locked-jazv f — Can imagination re¬
move the pains and inflammations j* of the eyes f — -
reduce tumours , as the quincy , biles , and whitlows , if
applied before a fuppuration has taken place? — re¬
move the fevere inflammations , pains , and tumours of
the flings and bites of poifonous infeCts ? — or of burns
and fc aids, and thofe on an infant ? — or inflammations
of ringworms, tetters , and eryjipelas t Or can ima¬
gination cure the lamenefs of a brute J? Thefe are
fome of the afflictions which the tractors, generally
cure.

4 It

* * See the experiments of profefTor Volta, relating to the various;
effects of the metals when applied to the fenfe of tajie.

1 Cavallo, alfo, when fpeaking of the influence of metallic applica¬
tions, which are rendered fufceptible to the tajie and fight, has the fol¬
lowing remarks, “ Different perfons are varioufly affebted by this ex¬
periment.” [ Application of •zinc and filler to the tongue . ] *•* W ith

fome the fenfation or tajie is very (lightly or net at all perceived, whilft
with others it is very flrong, and even difagreeable. Some think it a.
mere pungency and not a tafte.” ** When the experiment was applied
to the fenfe of fight,” he fays, “ this phenomenon is hot alike perceiv¬
ed by every perfon, fome being hardly fenfible of it, whilft otners ob~
ferve a very ft rong flafh.

“ In performing both of the above-mentioned experiments, vilz*
that which produces the tafle, and the other which produces the flafh
©f light, fome perfons imagine to feel a gentle warmth diffufe itfelf
over the tongue from its root to the very apex.” Can) alt o s Complete
Treatife on Eleft . 'vol. Hi. page 58. , .

4 f See the effects of Galvanifm on inflammations, in Fonjjlet s Exp*
& Obf. on Ani?n. EleFt . page 87 , and 1 ’,8, 129. .

‘ f; I once faw a horfe, which, in confequence of a drain in the pal-
tern, had become exceedingly lame, and from the intenfe heat 01 the
hoof on that foot, and the actions of the animal, was iuppofed to be in
great pain, completely relieved in the courfe ot ten minutes by the

IT operation

VOL. V. W * j.

266 Perkins on the Influence of Metallic Tractors ,

* It may be naturally conceived, that the evidence
exhibited muft have been powerful and conclufive,
to induce the members of the Connefticut Medical
Society, individually, to come forward and declare
their fentiments to the world in favour of the opera¬
tion of the tractors , when they thereby openly violat¬
ed an aft of their fociety, and hazarded the ftigma of
an expulfionft

The experiments are next given which ferve to
authenticate the difcovery of the metallic influence.
Many of the testimonies come from perfons not of the
medical profeffion, but who, neverthelefs, feem com¬
petent on the prefent occafion ; for the fubjeft is, for
the moft part, an appeal to the common fenfes. — *
Others of the fafts are vouched for by members of
the medical profeffion of high and diftinguiffied cha-
rafter. A few of thefe we ffiall lay before our
readers.

Experiments 4. — Doftors Baker, Hall, Lord, and
Brewfter, Reprefentatives of the County of Wind¬
ham in the Connecticut Medical Convention , and
Fellows of the Con . Med. Soc.

Windham County, Aug. 16, 1796.

From a variety of cafes which have occurred,
not only in our own praftice but in that of our neigh¬
bouring phyficians, we ar e fully convinced of the uti¬
lity of the metallic traftors, in removing various pains,
^ • " • . ■ ■

operation of the traftors ; the hot hoof bpcoming of the fame tempera¬
ture ds that of the other. From being fcarcely able to put his foot to
the ground, he became fo much better inabout twelve minutes from
the time the metallic inftruments were firft applied, that a gentleman
mounted him and rode away, being but juft able to perceive his
lamenefs. -

( I have heard of other ftmilar inftances, but this is the only one
which has come under my perfonal obfervation.

* I have frequently, however, heard of the little painful fwellings on
the back, generally termed faddle biles, being cured by the operation
of the metallic influence/

Jpafmodit\

Perkins on the Influence of Metallic Tractors , Sic. 267

fpafmodic , and inflammatory affections from the hu¬
man body ; and that the difcovery is of importance to
the healing art.”

Experiments 8. — Dr. Rufus Johnfon , of Canterbury >
Member of the Connecticut Medical Society,

w;. . - ^ Auguft 11th, 1796.

£C In the courfe of my practice a few months
pall, I have made frequent experiments with the me-f
tallic tractors , and have, with but very few excep¬
tions, mcceeded to my furprife in removing rheumatic
pains , head-achs, pains in the face ,fpafmodic affections ,
and inflammatory fwellings of the throat .

“ The pains after being once eafed, have in fome
infiances returned ; and then, by a repetition of the
applications, have been wholly removed.

“ From my own practice , and what I know of the
praftice of others, I conceive this method of remov¬
ing pains a very important and ufeful difcovery in the
healing art ; and I earneftly with that the tractors may
be generally difperfed, that mankind at large may
have it in their power, by thefe innocent means, to
eafe themfelves of many difeafes which baffle the ef¬
forts of medicine.”

Experiments 9. — Dr. Thomas Backus, of Plainfield ,
Member of the Connecticut Medical Society.

Auguft 9th, 1796.

“ I was called, on the 4th ult. to attend a patient,
by the name of James Crawfon, who, for about five
years, has been frequently troubled with a fpecies of
epileptic fits . When I firft faw him he had experi¬
enced, in the courfe of the day, twelve, each of which
held him about fifteen minutes. I took from him.
fourteen ounces of blood ; but difcovering no happy
effefts, I applied the tractors to his right leg, in
which he ufually experienced the firft attack of his

D 2 fits.

268 Perkins on the Influence of Metallic Tractors, Xc.

fits. The whole limb immediately became limber
and free from fpafm, and he foon revived without dif¬
fering a general convulfion.

“ About twenty minutes after, I being out of his
room, was informed that the fymptoms of another fit
appeared, and before I could operate on him he was
univerfallv convulfed, with an entire lofs of reafon.
I then drew the tractors over his right leg again, fix
or eight times, when the fpafms immediately ceafed,
and his reafon was inftantly redo-red.

“ In about half an hour he was feized with ano¬
ther, which w as removed very much in the manner of
the lait, the indruments not being applied until a ge¬
neral convulfion had taken place. I then feated my-
felf on his bed, that I might be enabled to apply the
means more feafonably. Here I foon difcovered the
fymptoms again, but by applying the tractors , imme¬
diately the fymptoms difappeared. Several others, at
intervals, commenced with their ufual fymptoms, fo
contra&ing and cramping the right leg, that the ut-

. • C it n ♦ 1 •

mod exertions ot twro men were unable to ftraighten it.

each of which were in lefs than a minute removed by
five or fix lirokes of the tractors , before the fpafm
had extended to the other parts of his body: the leg
almod inftantaneoufly becoming perfectly lax.

By the requeft of a number of gentlemen, who
by this time had convened to behold this fingular
phenomenon, when the fymptoms of a fit appeared I.
ceafed to ufe the tractors , that we might determine,
whether the above operations had prevented the ge¬
neral convulfions, which before their application had
always fucceeded the attack in his leg. Immediately
he fell into a very fevere fit, which appeared in one
univerfal fpafm. in this fituation I fuffered him to

Continue a few minutes, which was long enough for

the experiment, when, by applying the tractors
to his leg again, in lefs— than one minute he was.
entirely five from every kind of fpafm, and in-
dantly regained his reafon. I dill continued by his

fide*.

Perkins on the Influence of Metallic Tractors , Site. 269

fide, and prevented feveral other general attacks, by
operating at the beginning of the fymptoms.

fC About one hour and an half after the fir ft: appli¬
cation of the tractors , the fits entirely fubfided. He
became very eafy, and experienced none of thofe
difagreeable fenfations, which he ever had after for¬
mer attacks of this kind. He had ufuallv been af-

fli&ed with thefe fits, except at a few intervals, of
twelve or fifteen minutes each, about twenty-four
hours from the time they firft commenced. It is
therefore evident, that the influence of the tractors
not only fhortened the fits, but leffened their number,
as at this time they continued not more than nine or
ten hours from their firft commencement, and about
an hour and an half after the firft experiment. He
has difeovered none of that debility which has ufually
fucceeded his former attacks, and continues to this
day enjoying better health than ufual.”

Experiments 13. — James Gofs, M. 1). of Gloucefler ■,

MaJJ'achufets .

{C I this day faw your tractors applied with fuc-
cefs on a child of Mr. James Smith, fifteen months
old, which had been, about an hour before the ap¬
plication, very feverely fc aided , by falling into boil¬
ing fat with one hand and arm, on which large blis¬
ters were raifed. After a few minutes operation, the
rednefs and inflammation was almofi wholly removed,
and the child appeared to be eafed of pain.”

Experiment 17. — Communicated bp James Burrill, Efq.

Attorney General for the State of Ilk ode //land.

“ My fon had for nine years been afflicted with
the rheumatifm to fuch a degree, that he could not
walk without crutches, nor at many times drefs or
undrefs himfelf. Dr. Perkins, by applying his tractors*
gave him immediate relief, fo that he walked with eafe

U 3 unaflifte

270 Perkins on the Influence of Metallic Tractors 8(c.

unaffifted by any fupport. For nine years preceding
this period, the diforder was fo violent that he was
almoft conftantly in pain, which at night was fo
fevere as often to prevent deep. Soon after the ope¬
ration of the metallic influence, he was wholly freed
from pain, and the dwelling of his joints fubfided.
Since that time, when the fame fort of pains recurred,
of which there have been but few inflances, they have
always been eafily removed by the fame application.

“ Jofeph Bradford.’ 1

<<r Mr. Bradford is a neighbour of mine, and I have
knowledge of his fon’s having been for a great nura-
bet of years feverely afflicted with the rheumatifm to
fuch a degree that he always appeared to walk with
great difficulty ; and that, fince your metallic appli¬
cation, to which I was an eye-witnefs, he has walked
with apparent eafe, and in every appearance is much
amended. 1 have had knowledge of the fuccefs of
your tractors in many other inllances, and have the
firmed belief in their general efficacy.”

Experiment 20. — James Glover, Efq. County of Tioga ,

State of New York ,

<c Your tractors , which I lately purchafed to ufe
in my family, I have applied with great fuccefs, upon
a perfon fcalded with boiling lye. A man by the
name of Welch , who was at work in my pot-afhery,
when boiling down the lye fome of it flew into one
of his eyes, which foon became very much inflamed,
and fwelled to fuch a degree that he could not open
it, and remained in that fituation for the fpace of
three days. After the tractors had been ufed a few
minutes, he was able to open it, and with two ap¬
plications only, his eye was entirely free from pain
and inflammation, and in a fhort time was perfectly
well, although fo badly fcalded, that he had defpaired
of its ever recovering.”

Experiment

Perkins on the Influence of Metallic Tractors , & u\ 27 1

Experiment 23. — Rev. Samuel Spring, D. D, of New¬
bury Port , S'/u/e of M a ffachufe its, Author of“ Re¬
ligious Tracts 9” Sic. 8(c.

February 24th, 1797.

C€ Give me leave to congratulate you in the view
of the ample fuccefs with which your difcovery has
been crowned. To afcertain its. utility in any new
cafe, will, to you no doubt, be particularly grateful.
Let me then remark, that they have proved fuccefsful
in removing the rickets . In my congregation at New¬
bury Port, there is a young gentleman, who, previous
to the application of the' tractors, had not, for fixteen
years, been able to bend his body fufficiently to reach
the floor with his hand ; but whofe pains," in a few
minutes afterwards, were not only removed, but he
was alfo able to reach the floor with facility. I have
not the lead doubt but many affiidled children, and
young perfons, might in a fliort time be relieved from
the burden of fuch complaints, by a feafonable and
proper ufe of the metallic tractors ..

“ In confequence of your invaluable difcovery for
removing many pains of the human body, I with you,
dear Sir, the mod ample fuccefs, and the grateful
notice and encouragement of your fellow-citizens.”

Experiment 26. — Communicated by the Rev. Samuel
Hopkins, D. D . of Newport, Rhode Ifland , Author
of“ The Sy Jl em of Divinity fl Sic. Ec.

Auguft 17th, 1796.

For twelve or fourteen years Captain William
Land, of Newport, had been frequently afflifled with
fevere paroxyfms of the gout. In the fall of 1795 he
had a violent attack of this diforder, which had con¬
fined him to his room for five or fix days. At this
time, when his foot was very much fwelled, inflamed,
and in fuch extreme pain, efpecially his great toe,
that he could not walk, nor fet his foot on the floor,

C 4 I called

272 Perkins on the Influence of Metallic Tractors , 8(c.

I called upon him, and operated on his foot with the
metallic tractors according to Dr. Perkins's direc¬
tions. Within five minutes the pain and inflammar
tion ceafed, fo that he walked with eafe. The fwell-
ing within twenty-four hours fubfided, fo that he put
on his fhoe ; and this foot in two davs became as well
as the other. The pain has twice returned fince, but
has been foon removed by the fame application. I
have information of other perfons being cured of pain,
by the fame paeans, in this city."

.. * p

Experiments 28. — Rev. Thomas Barnard, D. D. of
Salem , State of Mqjfaclnifetts.

December 6th, 1796,

u A p ad y of between fixty and fe veuty years of
age had one of her fingers contracted for feven years,
which the was unable to open without the affirmance
of the other hand. About the firfl of November lafifc
I applied your metallic tractors. The difficulty was
removed, fo that the opened it as her other fingers. I
have had direct information from her three weeks
imce the operation, and her finger continued well.
At the fame time I cured a whitlow on one of her
thumbs with one trial. From what I have done,
feen, and heard, I am fully fatisfied that the difcovery
is important to the healing art."

^ With refpeCt to the theory which is to explain the
fads above fpecified, we are informed, that Dr. Per¬
kins has not yet brought any forwards. Dr. V aughan,
an ingenious friend of the difcoverer, in a differtation
on the fubjeCt of Animal Electricity, lately publifhed,
attempts to account for the effeCt of the trafilors on
the principle of the newly-difcovered influence of
Gal van b f [ have frequently,’ he obferves, c taken
out the hearts of frogs, turtles, &c. and obferved at¬
tentively their actions. They will contrafit and dilate
fua fponte for fome time, and then ceafe, when they
may be again excited to contract by lacerating them

with

Perkins on the Influence of Metallic Tractors , &rc. 273

with a wooden or other pointed inftrument But when
they become no longer excitable by thefe means,
they may be re-excited to contrafl by the irritation of
a metallic inftrument. I once obferved a fmgular
phenomenon in an amputated limb. One of the
crural mufcles contracted upon being irritated with
the point of a fcalpel. The experiment was then
tried with a pointed wooden inftrument, but to no
effe£t ; yet on irritating it a fecond time with the
fcalpel, it contracted once or twice. Hence the appli¬
cation of metals is one of the belt and moft delicate
tefts for afcertaining the ieaft poffible degree of muf-
cular irritability. After having been wholly infenfible
to the impreffions of all other flimuli , they may be
re-excited, on the application of their native ftimulus.

“ Although we cannot with precifion fay why
hominal eleftricity fliould be fufceptible of metals
only, yet the faff is inconteftible, and fanClioned by
the experiments of thofe gentlemen afore-mentioned,
whofe veracity is unqueftionable. It is alfo further
fubftantiated by the difcovery of Dr. Perkins’s me¬
tallic tractors for removing pains and topical affec¬
tions. The DoCtor obferved to me that he had made
trial of ail the various metals, but none are fo effec¬
tual as thofe of which his tractors are competed.™
This difcovery is as important in the healing art, as it
is novel in the fcience of phyfiology, and all that re¬
mains, to illuftrate its efficacy, is a rational and phi-
lofophical demonftration of the principle itfelf, and an
explanation of the modus eperandi on the eftabliflied
laws of the animal oeconomy. This, however, is con-
fidered problematical by tome, and by others it is
pofitively difearded. Yet to ceafe from enquiry be-
caufe we are fometimes miftaken, is no greater proof
of wifdom than to defift from walking becaufe we
fometimes ftumble.

<£ And if we only take an impartial view of the
operations of nature herfelf, and attend diligently to
the analytical inveftigations of the afore-mentioned

experimen-

274 Perkins on the Influence of Metallic Tractors , <$V.

experimentalifls on this fublime fubjeft, I think the
fceptic himfelf muft admit, that the principle of ner¬
vous energy, is a modification of electricity. As fen-
fation is dependent upon this energy, a pleafurable
fenfation, or what may be termed a natural or healthy
degree thereof ; then certainly pain, or fuperfenfation,
can only depend on an accumulation of the electroid
fluid, or extra degree of energy in the part affeCfed.
On this principle the problem admits of an eafy fo-
lution ; namely, that the metals being fufceptible of
this fluid, condudt the extra degree of energy to parts
where it is diminifhed, or out of the fyftem altogether*
reltoring the native law of eleCtric equilibrium.

The particular affeCtions in which this operation
is the molt effectual are, chronic rheumatifms, as lum¬
bago, fciatica, &c. odontalgia, otalgia cephalalgia,
phlegmons, cynanchies, opthalmias, pleuritic pains,
fpafmodic cholics, burns and fcalds, paronychia?, con-
tulions, atonic gout, fpontaneous hcemorrhages, herpes,
eryfipelas, &c. with many other topical affeCtions
which might be enumerated if neceffary. The trac¬
tors fhouid be carried to feme diftance from the part
affected, along the courfe of the larger nerves ; and in
obftinate and fixed pains of long Handing, the opera¬
tion fhouid be continued until a flight inflammation
is excited ; but in eryfipelas, and other fuperficial in¬
flammations, the operation fhouid be very light on the
inflamed part, and principally confined to the edges
of the tumour. In removing pains from the head, the
hair fhouid be perfectly free from pomatum, or other
adipofe fubftances ; and all parts on which the trac¬
tors are ufed fhouid be free from fweat, oils, &c.
In pleurifies, cholics, . &c. a diaphorefis not unfre-
quently fucceeds their operation, and fometimes
faintnefs is produced, by the fudden abftraCfion of
nervous energy. In a cafe of cephalalgia, if the pain
is confined to the fore part of the head, it is imma¬
terial whether the hair is pomatumed or not. A few
days fmee I awoke with a moft rending head-ach,

unaecom-

Perkins on the Influence of Metallic Tractors , 275

unaccompanied with fever ; I delayed the operation
fome hours, on account of my hair being pomatumed,
but the pain became fo infupportable (and the ufual
applications failing) that I refolved to make trial of
the tractors , as the pain was for the moil part in my
forehead. After the operation had been continued a
few minutes on my forehead, and the back of my
neck, I was perfectly relieved from pain, and have re¬
mained fo ever fince.

“ It is argued by fome (who are oppofed to the
metallic operation) that the efficacy of the tractors
depends merely on a counter irritation produced by
friction. I would afk thofe dogmatics how metallic
friftion cures burns or topical inflammations ? Does
not the leaf! impreffion on an inflamed part produce
pain, and wTould not friction augment the evil ? —
Phlegmons, and fome other topical inflammations,
may often be removed by exciting a counter irrita-
tation with bliffers, 8cc. which reftore the equilibrium
of the nervous fluid. But blifters feldom anfwer any
valuable purpofe in local inflammations, accompanied
with exceflive a£tion of the arterial fyftem, until the
fever is previoufly diminifhed. Neither will the me¬
tallic procefs fucceed fo well in the acute as in the
chronic rheumatifm, while the febrile action remains
inordinate. This fliews a correfponden.ee in efteCt,
but the modes of operation are diametrically oppo-
lite. The former is by an indirect organic procefs i
the latter by a dire£t and fpecific operation ; and all
pretenfions towards identity are precluded by the di-
verfity of their effe£ts on burns and phlegmons, as
before mentioned. Phlegmons, and other topical af¬
fections, are owing to an internal or external irritation
on the nerves of a particular part, by means of which
the veflels of the part are alfo brought into action, and
not unfrequently the whole vafcular fyftem a£ts in
concert, from a fympathetic harmony prinrawally
eftahiifhed.

“ Spoilt a-

276 Perkins on the Influence of Metallic Tractors y Sic,

“ Spontaneous Hemorrhages are thofe which de¬
pend on a local excefs of tone or eleffricity, deno¬
minated (by the illuftrious Cullen) a Hemorrhagic
effort.

Herpes are the produff of a morbid or exceffive
excitement in the veffels of the cutis ; the incruftation
is formed by exceffive aftion. The metals remove
this inordinate a&ion by abftradling the extra degree
of electricity ; corrohve lotions deffroy the morbid ac¬
tion by corrofion, and induce or reftore the condition
for healthy a ft ion.

Burns . — The ftimulus of heat produces inflam¬
mation, by exciting and accumulating the eleftric
fluid.

&c Epilepfij is owing to an irregular; diftribution of
the nervous fluid, and an accumulation thereof in the
muffles affected with fpafm. That this is the faff, is
obvious from the preternatural ftrength of epileptics.

“ Pain is merely an accumulation of eleffricity, in
a particular part ; and the fubfequent ftate of eafe is
obtained by abftrafting the extra degree of fenfibility.
Hence the frequent faintings in parturition, cholics,
&c. are to be imputed to a diminution of nervous
energy. In chronic pains, conneffed with idiofyn-
crafy, or dependant on habit, fo that the orgafm of
the part is injured, or a mal-conformation induced by
nature or accident, the metallic procefs cannot be ex-
peffed to fucceed.

t6 When fuppuration has taken place, the tractors
-mu ft be confldered as mere palliatives. They fhould
never be ufed on the back, during the exigence of
the catamenia. Befldes thofe cafes in which they
have already been found fuccefsful, future experience
will probably develope many others, in which they
will prove equally efficacious.

<£ The tractors will alfo, in all probability, fucceed
better in the hands of fome perfons than others. For
example : — Many people are remarkable for an ex¬
treme luftre in their eyes 5 fome are fo much eleff rifled

4 naturally

Perkins on the Influence of Metallic Tractors, Sfc. 21 v.

naturally as to (hew evident figns of it when a fenfible
electrometer has been applied to them ; and others
have manifefted an extreme fenlibility of even the
fmalleft degree of eledricity, infomuch that they
would be affeded by a hath of lightning, though fo
remote that the thunder could not be heard. All
this evinces that eledricity, fo far from being noxious,
bears a very aCtive and falutary part in the animal
ceconomy, which will probably lead to more im¬
portant refearches on this interefting fubjed, and
incite future travellers to explore the remaining terra
incognita

We have thus thought it our duty to go much at
large into the evidence which has been brought for¬
ward, in fupport of the alledged power of the me¬
tallic traders; for, unquellionabfy, if there be no er¬
ror or mifconception of fads, the importance of the
difeovery is great indeed. There is, certainly, much
in the reports that will ftartle the cautious and feep*
tical inquirer, who does not, on flight and trivial
grounds, admit fads which fo far outrun his ordinary
experience and comprehenfion. Yet where the
proofs are fo many and fo ftrong, it would be unrea-
fonable to queftion them on any other grounds, than
cautious and fair experiment. To this tell, the mat¬
ter will, no doubt, foon be brought. Not having
wrtneffed the application of the metallic traders, we
can of eourfe offer no opinion on the fubjed. We
may date, however, on report, that a few trials
which have been made in one of the London hofpk
tals, have not added to the confidence which the
prefent pamphlet is well calculated to infpire.

Arx.

( 278 )

Art. XXXI. A Lecture introductory to a Courfe of
popular Infractions on the Confiitution and Ma¬
nagement of the Human Body. By Thomas
Beddoes, M. D. O cl a vo, 72 pages, price Is. 6cL
Johnson. London, 1797.

WE have, on many occafions, declared our-
felves advocates for the diffufion of medical
knowledge amongfl the public at large, convinced
that it would contribute no lefs to the benefit of fo-
ciety, than to the honour and refpefl ability of the
members of the medical profeffion. It is with plea-
Lire, therefore, that we find the fubjecl taken up by
fo able a hand.

The origin of the defign here announced is thus
defcribed. c A practitioner in furgery accidentally
informed me many months ago, that he was defirous
of giving a courfe of anatomical ledtures in BriftoL
To furnifh individuals with fo much knowledge of
themfelves as fhould enable them to guard againft
habitual licknefs, and a variety of ferious diforders,
had been long an objedt of contemplation with me.

I therefore propofed that the courfe fhould be mo¬
delled according to this idea. I remarked, that a dif-
tindt exhibition of the larger lines of anatomy and
phyliology would be alfo the mode of infirudfion bed
adapted to young Undents in medicine ; much ob-
fervation of ledtures having convinced me that ex¬
treme minutenefs is only perplexing to beginners.

I bis, joined to fome other confiderations, prevailed.
'The perfon in queftion has devoted much of his fpare
time to the providing of proper preparations, and he
has affociated in the undertaking a fellow pradfi-
tjoner, who poffefles a valuable anatomical collec¬
tion. For my own part, I fhall contribute my ut-
moft a ili fiance to the defign, in whatever way that
afliftance fliall, upon refledfion, appear moft likely
to be effeffual. The purpofe of the courfe will be

. to

Beddoes" Lecture, Sc. on the Human Body. 279

to exhibit the ftrufture of the human body, in a man-
ner neither fuperficial nor tedious, to explain the
furidlions of the parts as far as they have hitherto
been inveftigated, to illuftrate by fpecimens the
principal deviations of thefe parts from their healthy
conformation, and to interfperfe fuch reflections as
may be ufeful in phyfical education, and the whole
conduft of life/

It is added, that MeiTrs. Bowles and Smith, who
undertook the courfe, were more ntmieroufly at¬
tended than they expected. As fuccefs, therefore,
has crowned the tirft attempt, it is a natural with
that its publication may produce fimilar undertakings
elfewhere. — A few extrafls will convey an idea of
the ftyle and manner of execution of the prefent lec¬
ture.

‘ You are already/ Dr. Beddoes obferves, f in ge¬
neral apprized of the object of thefe leisures. The
principle by which they are to be regulated, was ex¬
plicitly fet forth to the public ; and you muff be
prepared for a courfe eiTentially different from fuch as
are ufually delivered in the fchools of medicine.
Difregarding the profeffion in which you may be
adlually engaged, or may hereafter defign to engage,
we purpoie, in the firft place, to lay open to you,
your own phyfical conftitution. We are aware that,
before a mixed affembly, fuch a fubjedf can alone be
properly treated, according to a meafure and me¬
thod, difficult at once to feize. At thefe, however,
we fh all aim. If we ftiould attain to be perfpicuous,
it does not follow that we mult be inaccurate or
flight.

/ Oar explanation of the great doftrines of anatomy
will, it wre can realize our own ideas, anfwer every
demand of liberal curiofity upon the flock of in¬
formation hitherto accumulated. With me, how¬
ever, immediate gratification is a very fubordinate
confideration. Many detached points of moment will,
no doubt, be elucidated, while the parts are before

vqu

r ' |

280 Beddoes* Lecture , Sic. on the Human Body.
vou, becaufe the elucidation can then be mod dlf-

m J

tindlly underftood. But I lay principal ftrefs upon the
demonftrations, as neceflary for furnifhing data to¬
wards that fpecies of knowledge to which the con¬
cluding lectures will be dedicated. On this head I
fhall, in a few moments, freely enlarge. An effay
on the means of fecuring health can be indifferent
to no man, who has feared for himfelf, or pitied in
another, thofe evils, by which daily life is mod cru¬
elly infefted.

‘ Beyond the limits which I have thus loofely af-
figned, it is prefumed that the majority of this au¬
dience will not ftretch their expectations. But we
have, among us, fome of the medical pupils of the
city : and before I difmifs the little i have to fay on
the firft part of the courfe, it may be proper to add
a word for their fatisfaction. I take it for granted
that they have not overlooked an intimation in the
profpedtus, defigned for them ; and I hope they are
difpofed to admit its juftnefs, till the contrary fhall
appear. It requires, indeed, but little fagacity to
difcover that individuals, whatever be their difference
in other refpecis, are pretty nearly on an equal foot¬
ing in relation to our defign, if the/e have fcarce en¬
tered upon the circle ot medical feience, and thofe
have devoted themfelves to different purfuits. A
plan calculated effectually to inftrudl the one, bids
fair to prefent to the other as much information as
moft perfons may be capable of receiving: at one
time.

Some of your number may painfully anticipate
the details of anatomy, I can enter into the tremors
of the moft apprehenfive. I have had them in full
force myfelr. But thofe who have courage to rifque
the firft encounter, may be fure of conquering the
principal portion of their falfe alarm, which will
very foon fubftde and be altogether forgotten. By
help of the difcoveries of modern chemiftry, the
uuifance of putrid fmells may, I believe, be abated;

and

)

Beddoes* Lecture, &c. on the Human Body. 2$1

imd were the ingenious called upon by the public
voice, models fufficient for every purpofe of popm
lar demonftration might be contrived. Thefe models
would imperceptibly fubdue the averfion of the de¬
licate, and prepare them for witn effing an exhibit
tion of the parts themfelves without difguft. By con¬
ciliating the mind to images which it is worfe than
Folly to confider as loathfome, more would be ef¬
fected. than the bare removal of a great impediment
to the moft important and moft curious of all hu¬
man ftudies. For it is a well-known obftruftion to
eveiy branch of the healing art, and by confequence
a public misfortune, that we are all, in early youth,
made or fuffered to acquire this abhorrence towards
the objects of anatomy. Ffence, I fuppofe, in part
originates that frequent, (and according to my expe¬
rience, aim oft condant) refufal of permiffion to exa¬
mine the bodies o! the dead. It is alio, I am aware,
in great part to be afcribed to falfe tendernefs.
However it may originate, I reckon, among the
probable advantages of our undertaking, the "dimi¬
nution of an evil that daily leaves in uncertainty,
points of the higheft confequence to the living. I
trud that even though you may have previoufly fuc-
ceeded in breaking thefe pernicious affociations in
yourfelves, you will hereafter be more in earned to
foften the cruelty your acquaintances may unthink¬
ingly harbour. For cruelty is the proper name of
every fentiment which oppofes the good of fome, by

enjoining or impeding what would not be injurious
to any.

‘ Deeming it important that you ffiouid fully com¬
prehend how the diffemination of medical knowledge
is to enrich medicine, I fhall a little unfold what has-
been already intimated. Since the immortal Syden¬
ham, the region of human maladies has been more
accurately explored. Many landmarks have been
fixed j and what is termed the hijlory of difeafes
has been compofed witn infinitely fuperior fidelity.

VOL. V. x -But

282 Beddoes' Lecture, $V. cw th& Human Body.

But much is yet wanting in cafes of very gradual de¬
viation, to fill up the fpace between the ftate of per¬
fect health, and the ftate regarded as full-formed dift
eafe. If you corifider how rarely medical men are
called upon to examine the various intervening con¬
ditions, and how unfavourable their fugitive vifits
rauft be to examination, you will not deem it ah-
furd to fuppofe that the interval will long remain a
blank, unlefs dorp'eftic come in aid to profeffional ob-
fervers. Important circumftances or fymptoms arife
without notice, and pafs away without leaving any
certain trace. They are often loft to the fcience :
they are loft, with their poffibly beneficial indications,
to the patient. And wherefore, but becaufe the eye
of the fpedfator has not been taught to fee ? Hence
the phyfician, who is to determine on the evidence,
cannot confide in the report of the witnefs 3 nor can
the witnefs confide in himfelf.

* I fhall truft to your fagacity for the detection of
fome inferior benefits, which would be enfured by
rendering thefe purfuits popular 3 and but point out
the moft remote perhaps, though certainly the greateft
of all 3 indeed the refult and confummation towards
which whatever elfe we gain is but preparatory.-—
By the joint efforts of the intelligent in the profeffion
and out of it, the genuine preventive or prophy¬
lactic medicine would be at length eftablifhed.
I am aware that medicine is ufually defined the art of
preventing and curing difeafes. Both thefe preten¬
tions it often realifes. But preventive medicine , the
deftined guardian of infancy, youth, manhood, and
old age, adapted to the interior of families, has yet
no exiftence,

c I do not conceive-that you can defire a more de¬
tailed account of the fupplemental lectures, tor which
the hope of being ufeful has induced me to engage.
There is, indeed, another head which I fhould not
like to leave unndticed. You will find that there^
are grounds for improvement in medicine, upon

which

Beddoes* Lecture , Kc. on the Human Body, 28 S

which the graduated and non-graduated regulars have
feldom had the courage to proceed. In truth, not-
withftanding the hourly failure of all our ufual re-
fources, in the moft reputable hands, upon youthful
fuhjefts, utter inattention to felf-knowledge has here¬
tofore maintained a public feeling, favouring the
triumph of intrigue over ability, and by every fort
of indirect menace, deterring the ordinary prafti-
tioner of medicine from aiming at great difcoveries.
But there exifts a fraternity , which, by boafting of
remedies for our word maladies, and by holding
them at the fame time concealed, becomes the fpon-
taneous outcaft from humanity. If you afk why its
members, whom no concern for character reftrains,
do not ftrike out ufeful inventions, I (hall readily own
my inability to anfwer fatisfadlorily, unlefs I may
fuppofe them deftitute of information and of genius*
not lefs than of Hi a me.

‘ That you may be able to refolve the queftion for
vourfelves, I could wifli to introduce you into the
bufy recedes of quackery, where pharmaceutical
compofitions, new and old, are firft disfigured, like
children kidnapped by gypfies, and then baptized by
the moft ludicrous names. But they impofe ; and
the difgraceful tribute levied by the proprietors, is
a handing premium for fraud. What is fingular, it
does not avail you to fee through the artifice. You
may as well pay with the good grace of a dupe*
The felicitation of feme friend of the family is fure
to extort your fhare of the general contribution. I
have fcarcely known a confumptive perfon upon
whom, whether willing or unwilling, a certain public
medicine , not lefs contemptible than the meaneft of
its fellows, has not at feme period been forced/

( 284 )

■ \ " ' '

Art, XXXII. A few general Rules and Infractions ^
very necejfary to be attended to by thofe of both
Sexes who are afflicted with Ruptures. By Wil¬
liam Turnbull, A. M. Surgeon to the Eajlern
Difpenfary and the Society for the Relief of the
ruptured Poor . Twelves, 46 pages, price Is,
London, 1798. Boosey, &c.

IN the courfe of his attendance on the ruptured
patients committed to his care, the author found
many inconveniences had arifen from the want of
feme general rules and inftruclions, which might
enable them, in molt cafes, to manage the trufs,
and conduct themfelves during their abfence from
the practitioner. To remedy an evil which fre¬
quently retarded and fometimes prevented a cure,
he has now printed what he conceives will anfwer
this falutary purpofe.

A general outline of the difeafe is fir ft given, di~
veiled as much as poffible of technical phrafeology.
By this an idea may be formed of the nature and
caufes of ruptures in general, as well as of the prin¬
ciples on which the cure is founded. The different
kinds of rupture are next deferibed, with the marks
and fymptoms peculiar to each ; and, laffly, the
treatment, efpecially the ufe of the trufs, is explain¬
ed, with fome general cautions and inltruCtions, ne¬
ed! ary to be attended to by thofe who are afflicted
with this malady.

In a work like the prefent, nothing will be ex¬
pected that is novel to the profeffional reader. In
this age of patents and difeoveries, however, it may
be well to give the author’s tellimony refpefting the
patent elajiic trufs , the merits of which, he mull be-
fuppofed well qualified to determine. 4 Much,’ he
obferves, c has been lately faid refpeCting the advan¬
tages that would arife from the ufe of patent
Elastic trusses j and the inventors of this trilling

novelty

WeikarcTs Medicine Amplified , Sc. 285

novelty have not fpared either trouble or expence in
promulgating their utility. But, as I am convinced
that any trufs of this defcription, made without the
circular fteel band, can never anfwer any beneficial
purpofe, but, on the contrary, may prove, in many
infrances, extremely injurious, I think it neceffary to
deliver a decided negative as to their general ufe.

My chief reafons are, that they do not prefs fuffi-
ciently on the aperture through which the gut paffes ;
and, likewife, that they have no fixed point of fup-
port, as they bear irregularly on the parts, and con-
fequently their compreffion muft be always unequal
and uncertain. In cafes of flight and recent hernia,
they may occafionally fucceed ; but no trufs can be
depended on, unlefs it is made with the circular fteel
fpring, which, from its producing an equal preffure,
and bearing directly on the opening, renders it more
eafy and convenient to the patient, and effectual in v *
its operation.’

Art. XXXIII. Methode medicate Jimplifiee cVapres
les Principe s de Brown , Sc. i. e. Medicine Am¬
plified on the Principles of the Brunonian Syjiem,
illufi rated and confirmed by M. Weikard.
Twelves, 3s. 6d. Imported by Boo set. London,
1798.

HiHHE advocates of the Element a Medicine, there
1 is reafon to believe, have confiderably dimi-
niihed in number in this country, fince the death of
their celebrated author. Time has, in a great mea-
fure, reduced the enthufiafm which this performance
once infpired, and given to it its proper eftimation.
To deny its claim to genius and originality, would
be to do it injuftice ; but its infufficiency, as a ge¬
neral balis of theoretical and practical knowledge,

X 3 has

28 6 Soemmering's Be Corporis humani Fabric a.

has, we trull, on many occafions in our work, been
amply and fatisfaClorily expofed.

The firm hold which the humoral pathology has
obtained, and indeed ’{till obtains, in the fchools on
the continent, mull have occafioned tfie work of
Dr. Brown to have been received with' avidity, eh
peciaily by the younger part of the profeffion, from
its novel and bold attack on eltablifhed principles :
and we are not furprized at being informed, that it is
ftudied at prefent with all the ardour, which its
originality, and mode of execution, are well calcu¬
lated to excite. Its merits will not probably foon
be fairly appreciated!

Art. XXXIV. S. T. H. Soemmering Be corpo¬
ris hujnani fabric a. Ofitavo, vol. 4, 366 pages,
price, 5s. Imported by T. Boosey.

IN feme former numbers of our review,* we had
occafion to notice the firft, fecond, and third vo¬
lumes of this refpecfable writer on the anatomy of
the human body. The opinion we then entertained
of the merits of the performance, has fuffered no di¬
minution by our perufa! of the prefent part. The
author commences, as ufual, with a catalogue of the
bell writers, on the fobiefii of which he treats, viz.
the brain and nerves , he then proceeds to the ana¬
tomy of the dead human brain* and with his ufual
arrangement and perfpicuity, invefligates this very
important vifeus. The volume is replete with inte-
refling phyfiological reafoning, and minute anatomi¬
cal defeription, worthy the attention both of the
practitioner and fludent : and we are happy to find
the profeffor invefligating chemically, the nature and
properties of an organ, whofe compofitioii and ana^

* See Med„ Rev, v. ii. p. *50, and v. iv. p. 276,

- 1 J ty

Soemmering’s De Corporis humani Fabric a « 287

fyfis have been, hitherto, little attended to by anato-
mifts in general.

The Brain examined by the Micro/cope .

The cineritious and medullary portions of the
brain, he obferves, appear to be compofed, according
to the teftimony of many obfervers, of tenacious,
glutinous, and feme what pellucid globules, cohering
together : nevertheless

1. It is not yet determined, whether the cineri-

tious portion be com poled of larger and the medul¬
lary portion of fmaller globules ; the medulla of the
fpinal marrow of fmaller globules, than that of the
brain ; and the nerves of the leaft of all ; nor, whe¬
ther the more remote the globules are from the ci¬
neritious portion, the more fubtle they become; nor
whether there is any difference between the cineri¬
tious portion and the medulla; nor, whether the
globules are of different fizes, one with regard to
another. v a

2. Nor is it clear, whether thefe globules float in
a pellucid fluid; which becomes more denfe the
farther it recedes from the cineritious portion, fo
that the globules move freely one amongft another,
or whether they are united together by a peculiar
ilender and appropriate cellular ftru&ure, or only by ;
veffels.

3. Nor is it afeertained, that the globules are
placed in right lines along the nerves, for they can¬
not be fufficiently cleanfed, fo as to be diffinftly feen
by the microfcope.

4. Nor is the fize of the globules clearly dem.o.h-
ftrated ; for fome authors affert, that they are lefs
than the globules of the blood.

The chemical Analyfts of l he Brain .

A pound of human brain, expofed to the chemical
analyfis, yielded, befides a great quantity of water,

X 4 two

•T5

'288 $oemniering*s De Corporis humani Fabrica .

two drams of fpirit of ammoniac, one ounce and a
half of rancid oil, and forty grains of a volatile
oil.

Sixteen ounces pf well wafhed brain, entirely freed
from blood, and reduced by degrees into allies, ex¬
hibited not the leaf! mark of iron. The remaining
part immerfed in vitriolic acid, and mixed with the
fait of Turldfh galls, produced a purple or reddiih
colour, not in the leaf; tending to black.

Nor was the leaf; appearance of iron detected by
phlogifticated alkali.

A great quantity of the acid of fugar was, how¬
ever, obtained ; four ounces of which, mixed gradu¬
ally with a fufficient quantity of dephlogifticated acid
of nitre, produced three drams and ten grains of ex¬
cellent cryftals.

The brain is diffolved into a milky mafs by the
fpirit of fait or of urine,

Pyrophorus can be procured from the human
brain, when expofed to the adtion of fire with alum.

Befides a kind of animal matter, more like the al¬
bumen of eggs than foap, the acid of phofphorus,
terra calcis, foda, and ammoniac, may be obtained.

The greater part of the contents of the fcull , and
the fpinal canal , does not appear to be effential to
life and the energy of the nerves i
For

1. There are many inftances of infants, born al-
mofl; without brain, and likewife without the fpinal
marrow, who neverthelefs have lived and become

fat

The calvaria, efpecially of foetufes, is often filled
with a pure water and no brain,* Infants without
my fpinal marrow have been feen to live.f Some-

.tr , _ . Element, ruyjiciog. torn. iy. p. 353, a fimilar example l
-fol xviT1 ' by Remnia m the racdical commeptaries of ^ipburgh,

t Memof?5 de Dijon, tom. ii. p. 22 5.

** 1 . * ■ 7 . ; .<

times

Soemmering's De Corpoi'is humani Fabric a. 289

times a foetus is brought into the world without any
head. *

2. Animals with fmall brains, poflfefs neverthelefs
great vigour, of which fiih are examples. There is no
animal of the fame fize as man which has a brain of
nearly the fame bulk : yet the nerves in man are
often as fmall or fmaller in proportion, than thofe of
other animals. If, therefore, fo fmall a portion of
cerebrum be fufficient to fuftain life and the energy
of the nerves in thefe animals, why not in man alfo ?

3. There have been inftances both of adult men
and beafts, whofe brain has been almoft wholly de¬
ft royed, or converted into pus, or abforbed, in com
frequence of the preffure of bony tumours ; and where
feveral ounces have been loft bv a blow or other
caufe • but who have neverthelefs continued in per*
feft vigour.

4. The foetus grows quickly in ntero , although the
brain be inert.

5. Life continues during fleep, when the natural
power of the brain is deprefled.

6. The vigour of life has continued perfe£t in ma«
ni’acs, notwithftanding the brain has been found al-
moft wholly corrupted.

The author next proceeds to the confideration of
the Tving human brain, in which the reader will find
every thing which has been hitherto faid on the fub-
jeft, with many pertinent and original obfervations of
the writer.

Under the head of organic vitia of the nerves is
cpnfidered their chemical analyfis.

Chemiftrv, the author obferves, extrafls from the
nerves a great quantity of water, impregnated with
ammoniacal fait* a little oil, and volatile alkali ; but
a greater quantity of inflammable air, which, expofed

* Banner's AnaiQmtJcbe Wahrnehmungen, Konifberg, 1769. Obf.

290 Soemmering’s De Corporis humani Fabrica.

to fire, fuftains a more vigorous and longer continued
flame, than that which is obtained from the other
parts of the body; and, laftly, a greater quantity
of oil than can be extracted from the mufcles.

The funfitions of the nerves are next in order:
arguments are employed to prove, that the nerves
are the inftruments of fenfe : — that the medullary por¬
tion of the nerves is fenfible, although their involuera
are not fo that the more the nerves are excited,
the greater the fenfation : — that an increafed commo¬
tion in a nerve induces pain : — that from a continued
Himulus the nerve becomes lefs fenfible : — and, that
a greater fenfation deftroys a lefier one.

The power which the nerves poffefs of inducing
mufcular contraction is a phenomenon well known.
It is inherent in the nerves of the mufcles only. The
motion which is requifite for that purpofe originates
in the brain, and is conveyed to the rnufcle through
the medium of the nerve. Senfation is firft carried
to the brain, then the power is exerted which in¬
duces the mufcles to contraCt. The tonic powder of
the nerves may be deftroyed, while the fentient powder
remains, and vice verfa. Is there then, the writer
afks, more than one kind of nerve ?

From the confent of the nerves, their power upon
the blood-vefiels and abforbents, and upon the dif¬
ferent fecretions, a very important queftion arifes,
viz. Whether the nerves contribute to the nourifh-
ment of the body, and whether they are concerned
in the production of animal heat ?

The ftruCture of the organs of fenfe, the author oh-
ferves, explains the reafon why the optic nerve ferves
for vifion, and the auditory nerves for hearing ; yet,
neverthelefs, nerves in other parts of the body, under
certain circumftances, have a peculiar mode of aftion ;
for tartar emetic produces vomiting, but does not dif-
turb the fenfe of tafte ; the crocus metallorum vomits,
but does not injure the eye ; pepper is agreeable to
the fiomach, but is hurtful to the eye ; the manner m

which

Fearfon on Inflammatory Diathejis in Hydrophobia. 29 i

which thefe different aftions are induced is not yet
known.

The next queltion, which is difcuffed, is. Whether
the nerves are hollow canals ? which leads the author
to the mode of aftion of the nerves, and the long
difputed do&rine of the exiftence of the nervous
fluid. The volume is then concluded with a very
excellent defcription of each nerve of the human
bodv.

A r t . X XXV. The Arguments in favour of an Inflam¬
matory Diathejis in Hydrophobia confidered ; with
fame. Reflections on the Nature and Treatment of this
Difeafe. By Richard Pearson, M. D. Phyfi ~
cian to the General Hofpital near Birmingham ,
Odtavo, 59 pages, price Is 6d. London, 1798'.
Seeley.

THE inflammatory nature of the hydrophobia or
rabies has been maintained by many refpedtable
writers on the difeafe, who have enjoined a plan of
treatment founded on this principle, confiding in
large and repeated blood-lettings, and other parts
of what is termed the antiphlogiftic plan. Diffatis-
fled with the arguments which lead to this hypo-
thefis, and ftill more, perhaps, from its infufficiency
as a guide to practice. Dr. Pearfon has been induced
to inquire into their validity, and' to attempt their
refutation.

The arguments which have been urged in fupport
of the inflammatory nature of hydrophobia from the
bite of a mad dog, are founded, 1ft. upon certain
fymptoms which attend the difeafe : 2d. upon ana¬
logy, or the occurrence of flmilar fymptoms in feme
other difeafes of a known inflammatory nature : 3d.
upon the appearances on diffeftion : and, laftly, upon
the, fuccefsful employment of venefe ftion in home

fuppofed

292 Pearfon on Inflammatory Diathefls in Hydrophobia *

fuppofed cafes of rabies.— Each of thefe is examin¬
ed in order.

Among the fymptoms which are faid to denote in¬
flammatory aftion in this diforder, the following are
the principal ; pain in the epigaftric region, and ardor
and oppreffion about the preecordia ; vomiting ; re fi¬
le ffnefs, third:, heat, and fever ; difficulty of fwallow-
ing liquids ; difficulty of breathing ; priapifm ; watch-
fulnefs, and furor. — Of thefe the author obferves, that
fame of them are merely accidental, others fcarcely
perceptible, and fome, even if prefent, would not
denote the difeafe to be of a nature requiring the
ufe of the lancet. The pain in the region of the
ftomach, not being conflant, is referred by the author
to a fpafmodic origin. The vomiting he fuppofes to
depend on a peculiar fympathy of the flomach with
the heart. The oppreffion about the praecordia is
probably owing to an affeftion of the heart, drongly
marked by the palpitations and irregular pulfe. The
difficulty of breathing comes on by fits, and is accom¬
panied with fighing, and is fuppofed to arife from
eonvulfive movements of the diaphragm and abdo¬
minal mufc'les. The difficulty of fwallowing liquids
is alfo referred to eonvulfive efforts. The re file fine fs
proves only an exquifite degree of fenfibility ; whilfl
the thirl! is the natural confequence of the abflinence
from liquids. The watchfulnefs and furor admit of
explanation on the fame principle.

2. Symptoms refembling thofe which occur in hy¬
drophobia have been faid to arife occafionally in
quinzy, gaftritis, and peripneumony ; but while their
appearance in thefe difeafes, is confelfed to be only
occafional, and whilft it is doubtful whether fome of
the cafes quoted were really inflammatory, there feems
no ground, for confidering them otherwife than as ac¬
cidental.

3. Great ftrefs has been laid, by thofe who contend
for the inflammatory nature of hydrophobia, on the
appearances on diffe&ion : thefe are, an unufual ari¬
dity oi the yifeera and other parts ; marks of inflam¬
mation

[

Pearfon on Inflammatory Dia thefts in Hydrophobia. 293

• i i

mation in the fauces, gula, and larynx 3 inflammatory
appearances in the flomach ; and accumulation or eff
fulion of blood in the lungs. The firft of thefe is not
a conllant occurrence, and therefore not effentiah—
The rednefs which has been often obferved in the
flomach and oefophagus, Dr. Pearfon fuppofes to arife
from an erythematous inflammation of the mem¬
branes, and not requiring the ufe of the lancet and
debilitating means. The accumulation or effuflon of
blood in the lungs has not been always obferved, and
appears to the author to be the termination of the
difeafe, and bv no means the difeafe itfelf. It feems
to have been moil confpicuous where the furious pa-
roxyfms were moil frequent and moil violent ; and.
on the other hand, to have been altogether wanting
where the patients (as has fome times happened) died
in a gradual, placid manner.

The fall argument in favour of the inflammatory
nature of the, difeafe refts on the fuccefsful employ¬
ment of venefeftion in fuppofed cafes of hydrophobia.
’But many of thefe cafes, the author obferves, are
doubtful and unfatisfaftory in their nature ; whilft
there are many, in which the progrefs of the difeafe
was not at all arreiled by the ufe of the lancet, and
are unexceptionable and decifive in the higheft de¬
gree. Blood-letting, too, has been equally ineffec¬
tual as a prophylactic.

The failure of blood-letting, added to the flight de¬
gree of febrile adlion, and the want of the buffy or
fizy appearance of the blood, together with the found
ffate in which the vifcera and other parts have been
frequently found, on opening the bodies after death —
all thefe fadls. Dr. Pearfon thinks, fully authorize the
conclusion, that the difeafe produced by the bite of a
mad dog, or other rabid animal, does not belong to
the clafs phlegmafise , in other words, that it is not
an inflammatory difeafe.

Having now gone over the ground of the author’s
arguments againft the inflammatory nature of the dif¬
eafe.

994 Pear fon on Inflammatory jJiatheJis in Hydrophobia 0

cafe, we come next to his own view of the fubjeQ,
and to the treatment which it fuggefts.

After the failure of blood-letting, the warm bath,
and the reft of the antiphlogiftic method, the tranft-
tlon was natural, the author obferves, to the tonic
plan. Dr. Ruffi, however, feems to have been led to
this, not fo much by a confideration of the unfuc-
cefsful employment of the remedies above mentioned,
as by a fancied analogy between tetanus and rabies.
* In tetanus from wounds, fractures, amputations,
and cold after expofure to heat, there is no poifon
acting upon the fyftern ; the mufcles are affected with
fpafms, and are not alternately convulfed and relaxed,
as in hydrophobia ; and in the former diforder there
is none of that preternatural fenftbility — none of that
intolerance of fluids, when applied to the furface of
the body — nor any of that irritability of mind, which
we obferve in rabies canina. I do not fee much ana¬
logy between them.

4 But, although the fymptoms are unlike, it does
not neceffarily follow that the fame, or nearly the
fame treatment may not be applicable to both. I
am inclined to think that one of the remedies recom¬
mended by Dr. Rnjh , may be given with good effeSl
in cafes of hydrophobia ; I mean wine ; and the more
fo, as we find from Dr. Ruffe! s account, that wine
in large quantities has been adminiftered with fuccefs
againit the bite of a venomous ferpent, between
which diforder and rabies there is, in feveral re-
fpefts, a much greater affinity than between rabies
and tetanus.

c As for the other remedy propofed by Dr. Rujh ,
viz. the cold bath, experience is againft it. In one
of Dr. Vaughan's patients it had a full trial, as well
as in a patient who died at the Birmingham Hofpital
fome years ago. The application of water, hot or
cold, feldom fails to excite convulfions, and only
ferves to aggravate the difeafe. It is time that bath¬
ing, which has been fo generally and fo unfuccefs-

fully'

Pearfon on Inflammatory Hiathefis in Hydrophobia. 295

fully employed in hydrophobia from the days of Cel-
jus to the prefent moment-, fhould be laid afidm

‘ I hope the confidence which molt praftitioners
have in mercury as a cure for rabies, is not mifplaced.
The progrefs of this difeafe, after its unequivocal fyrnp-
toms have appeared, is generally fo rapid, that there is
not fufiicient time for mercury to take effect ; and I
with I could not add that in fome well-authenticated
inftances, after this remedy had taken effeft and pro¬
duced a falivation, the difeafe terminated in the ulual
fatal manner. If it has ever been cured by mercury,
it has been in confequence of a coimter-imprejjiori
communicated to the whole fyftem, and not in con¬
fequence of the falivation ; for a falivation is a con-
ftant fymptom of the difeafe, fo that if it were curable
by a flow of fpittle, it would cure itfelf,

’ « If arfenic or lead have ever been of fervice in hy¬
drophobia, it mull have been by producing a fimilar
counter-impreflion.

‘ Confidering that the poifon of a rabid animal pro¬
duces an excejjwe increafe , or morbid alteration , of
the natural fenjibility — that (as Mead has remarked)
it is common to all who are bitten by a mad dog, that
they can ill bear the impreffion of objefts upon the
fenfes— that all feeling is painful— that the flighteft
touch or rubbing of the limbs hurts — that the lead
noife is offenfive ^ and the opening or fhutting of a
door affrights, as if the houfe was falling —that the
eyes fo ill bear the light, that even the light of any
thing white is intolerable — that in like manner, the
inward membranes are fo tender, that they cannot
fuffer their natural fenfation — that the common cool-
jnefs of frefh air is difagreeable to the lungs — that the
making of water gives uneafmefs in the urinary paf-
fages — and laftly, that there is a perpetual reftleffnefs

from the beginning of the attack to the end ; - con-

fidering that the poifon produces thefe effects, w q
thould, a priori, have pronounced opium to be the
remedy ; but experience has lhewn that it has here

298 Pearfon on Inflammatory Diathefls in Hydrophobia *

no curative power. It failed in Dr. Vaughan's trials ;
it failed in the inftance of the French woman under
the late Mr. John Hunter's care ; and it failed in the
cafes lately publifhed in the Medical Records and
Refearches. In fome of the firft mentioned trials, it
might be objeded that it was not adminiftered in
dofes fufficiently large, but this objedion will not
apply to the laft mentioned cafes, in one of which
(William Yates) it was given to the quantity of 180
grains in the fpace of 14 or 15 hours/

‘ From the failure of opium both in moderate and
in large dofes in this difeafe, it may be prefumed that
other narcotics, fuch as ftramonium, belladonna, nUx
vomica, or tobacco, will have no better effed. When*
ever they are given in hydrophobic cafes, it would
feem advifeable to combine them with powerful aro¬
matics ; indeed it may be doubted whether the aro¬
matics, given without the narcotics, might not anfwer
De(I > fo oppofite does the nature of this difeaie appear
to be to that of an inflammatory afFedion.

6 Dr. liiifk has fhewn that the provoking of fome
degree of inflammatory adion is necefiary to the cure
of tetanus. Now, although I do not fee with him the
dole analogy between this difeafe and rabies ; yet I
think it probable that the exciting of fome degree of
fever and inflammation may have a falutary eifeft in
cafes of hydrophobia. Indeed there is no example of
a perfon recovering from an animal poifon introduced
into the fyftem, without more or iefs inflammatory
adion. The poifon which produces the plague, is
often moft fatal when it is accompanied with the leafl:
degree of fever; and fwelling and inflammation of
the bitten part, together with encreafed heat over the
whole body, are the ufual forerunners of recovery in
cafes of viper-bites.

On thefe grounds, there is a reafonable prefumption,
that wine and aromatics may have a beneficial effed in
rabies, provided the averfion to liquids is not fo ftrong
as to render the exhibition of wine impradicable.

Perhaps

Pearfon on Inflammatory Diathefis in Hydrophobia, 297

Perhaps the nitrous acid , or other mineral acids, or
vinegar (as mentioned by Dr Ferriar) might be ad-
vantageoufly mixed with the wine.. The ace turn
aromaticum, Ph. Ed. feems preferable to common
vinegar. At the fame time, wine and vinegar may
be inje&ed up the return. Thefe things are to be
adminiftered on the ftrfl appearance of the fymp-
toms chara&eriftic of rabies; for as the difeafe ad¬
vances, neither wine nor any other liquid can be got
down the patient, in quantities fufficient to produce
a powerful effect ; and there is fometimes an equal
impediment to the adminiftration of clyfters. Yet
even in this ftate of things, we are not without re-
fource. Some of the concrete acids (fuch as the ef-
iential fait of tartar, the eflential fait of lemons, or
even the flores benzoes) may be given, joined with
about half as much powdered capficum or other ftrong
aromatic, and divided into fmall portions, to be in-
veloped in thick pafte made of flour and water, and
formed into fmall bolufles. Not lefs than 20 or 30
grains of the concrete acids, nor lefs than 8 or 10
grains of the capficum, fhould be given for a dofe.
In adminiftering remedies againfl: a difeafe fo rapid
in its progrefs, we muft exceed, and that confider-
ably, the ordinary meafured

‘ As ipecacuanha, in fmall dofes, proves fo fer-
viceable in fome fpafmodic diforders, it might per¬
haps be ad vantageoufly joined with the acids and
aromatics above-mentioned, in hydrophobia. Four
or five grains of the powdered root might be a fuffi¬
cient dofe. Some degree of naufea, and the confe-
quent perfpiration, would probably be of ufe ; but
it does not feem definable to provoke vomiting in
the beginning of the difeafe, as that would inter¬
fere with the operation of the other medicines.

' While thefe things are adminiflered int&rnally, to¬
pical applications are not to be neglefted. Where
the bite is in a part that will admit of it, a ligature,
as proDofed by Dr. Percivaf fhould be applied
above the cicatrized wound. This will prevent far-
v, ■ % Y ther

298 Pearfon on Inflammatory Diathejis in Hydrophobia .

ther abforption. At the fame time the bitten part
may be opened or deftroyed by the application of the
lunar cauftic, or concentrated mineral acids. In-

. . . Aft**

$ fiammation and ulceration excited in this manner
promife, from what we obferve in the inflance of

viper-bites, to be productive of the belt effefts Af¬
ter the corrofion of the cicatrized wTound, by the
means juft mentioned, the ligature which had been
paffed round the limb, fhouid be removed.’

c It would alfo be ufeful to excite inflammation
and ulceration in other places befides the bitten
part. With this intention, cauftics might be applied
to the arms, and perhaps the thighs. When the ur¬
gent fymptoms abate, and medicines and food can
be more eafily fwallowed, it will be no difficult
matter to fupport the ftrength of the patient under
the difcharge from the fores occasioned by the cau¬
ftics. In this ftage of the diforder, the Peruvian
bark may be given freely ; and to allay irritation,
opium occafionally in moderate dofes.*

In the pamphlet before us. Dr. Pearfon has cer¬
tainly fucceeded in proving, that the affeClion of the
fyftem in Hydrophobia is not the fame as that which
takes place in pleurify, or peripneumony, or the
other ftates of Ample inflammation, and of courfe
that a mode of treatment adapted to thefe is not ne~
ceflarily indicated in the former. It does not, how¬
ever, feem to follow, that the contrary ftate of the
fyftem muft be fuppofed, and debility furnifh the in¬
dications for its treatment. Stimulants may be ufe¬
ful, and may be the moft powerful remedies we are
in pofleffion of ; but whether they are fo, or not,
can only be determined on trial, and not on any
previous view of the nature of the difeafe which
theory may fuggeft. In fa£t, ther$ are no two poi-
fons which operate precifely the fame changes in the
fyftem, nor are they, probably, to be combated in
the. fame way. Experience is the only guide on
which we can rely.

CORRESPONDENCE.

THE Editors have to acknowledge the receipt of a Letter from Mr*,1
Boag of Stockport, containing i'ome remarks on their review of Dr.
Wallis’s Treatife on Gout *. Were it confident with the plan of this
work, the Editors would gladly infert the whole of Mr. Boag’s Letter*
but controverfy is not their object.

Mr. Boag obferves, that the theory which Dr. Wallis has employed
is by no means original, but that in its eflential parts it is derived from
Sydenham and the older phyficians: we cannot allow, however, that
this adds greatly to its probability. Though Sydenham will ever ftand
high, as an accurate obferver and good practitioner, his theories add
nothing to his fame, and are now indeed nearly and defervedly for¬
gotten. It is enough to fay of the gouty acrimony, that its exiftence
has never been proved. The inconfiftency of the hypothefis, as de¬
veloped and explained by Dr. Wallis, is allowed by Mr. Boag. It
has in no refpeCt illuftrated or improved the practice.

In anfwer to J. S. the Editors obferve, that all analytical accounts
pi new’ publications are thankfully received.

* See Med. Key. page 87, of th iprefent volume.

No. XXVIII.

THE

MEDICAL and CHIRURGICAL

REVIE W.

JANUARY, 1799.

Art, XXXVI. Philofophical Tran] actions of the
Royal Society of London. Part L for the Year
1798. Elmsley. London,

ART. 2. Experiments and Obfervatio?is, tending
to Jkezv the Compofition and Properties of Uri¬
nary Concretions. By George Pearson, M. D.
F. R. S. — Dr. Pearfon obferves, that urinary concre¬
tions have obtained their denominations, like other
things, from their obvious properties. Accordingly,
in our language, they are popularly known by the
names of Hone and gravel, or fand, from their refem-
blance to the Hates of earth fo named : and we
find names of the fame import in other lan gai ages,
fuch as (Aretams ;) XzQiaeig, (Coelius Aurelianus
ipappos, (Aretaeus ;) (various authors *) Calcuhis>

(Celfus and Pliny ;) Sahulum , (various authors.) In.
other languages, and efpecially in thofe now fpoken,
it is unneceffary to notice names which have the fame
meaning.

The notion very generally entertained of the na¬
ture ot urinary concretions, confifted with tjie terms,

vol, v. z till

502 PhHofophical Tranf actions of the Royal Society,

till the laft twenty years ; although the experiments
of Slare, Frederic Hoffman, and Hales, long before
fhewed, that thefe fubftances commonly confift of
animal matter. Galen indeed imagined that Cpfoy/xao
or vifeid animal matter, is the bafts of animal con¬
cretions ; but in his days, earth was believed to be
the bafis of animal matter. Alkaline medicines
were, however, employed by the Greek phyficians,
in difeafes from calculi.

c The experiments of the akhemifts alfo made it
appear, that earth was only a part of the matter of
concretions. It was probably the obfervation of the
difpofition and cryffallization of faline bodies, which
1'uggelted the notion of urinary calculi being of the
nature of tartar. Such was the opinion of Bafif
Valentine, and after him of Hochener, better known
by the name of Paracelfus ; but whether the latter
adopted the denomination Duelech from its import,
©r from caprice, has not been explained. Van Heb
mont, a century after his prototype Paracelfus, being
kruck with the experiment in which he difeovered
the concretion of falts in diftilled urine by alcohol,
was led to depart from his adored mailer’s opinion,
with refpedt to the nature of calculi; although he
acknowledges the merit of Paracelfus, in. having dif¬
eovered the folvent Indus, (a calcareous done alfo
called Jcptarium) which Van Helraont fays is pre¬
ferable to alkaline lixivium. He alfo fays, that when
the archeus fpirit of urine meets with a volatile earthy
fpirjh, and does not a£l in a due manner, a concretion
will be formed ; but,, in a healthy ftate, although all
urine contains the matter of urinary calculi, no con¬
cretion can take place, beeaufe the archeus, or vital
power of the bladder, counteracts its formation.

* As to the kind of earth composing calculi, the
only diftindtion of earths, till about the laft half cen¬
tury, was, into abforbent and non-abforbent ; but, <
fip.ee the abforbent earths were diftinguifhed into
calcareous, magnefia, and alumine or clay, the cab

(

. v it • 4 , * ■'V

Philofophical Tranfactions of the Royal Society, 303

careous was confidered to be the earth of urinary
concretions; apparently, however, for no other rea-
fon, but its obvious properties, and its extenfive dif-
fufion through the whole animal kingdom.

c At length, viz. in 1776, the experiments of the
wonderful Scheele were publifhed in Sweden, but
were fcarcely known in this country till 1785. Thefe
experiments exploded the opinion of the earthy na¬
ture of calculi, and fubftituted that of their confiding
of a peculiar acid, refembling the fuccinic, and of a
gelatinous matter, without any earth. Afterwards
about of their weights of lime wras found by
Bergman ; which, for a caufe now well known, had
eluded the acutenefs of Scheele. Although the ex¬
periments of Scheele were confeffedly unqueftionable,
and were ably fupported by the learned Bergman,
fome very eminent chemifts having obtained different
refults by their own experiments, adopted a different
opinion of the compolition of thefe concretions, he
immortal, and ever to be deplored, Lavoifier fup-
pofed thefe fubftances to confift of acidulous phof-
phate of lime and animal matter, many of them
being partially fufible ; but ftill it was the unrivalled
Scheele who difcovered, that the urine of healthy
perfons contains fuperphofphate, or acidulous phof
phate of lime ; and who alfo indicated the experiment
which verified his opinion, that pholphate of lime is
the bafis of bone.

f Experiments have been likewife made, for the
moft part in a rather defultory way, and moft of them
by perfons but little pra&iced in chemical inquiries,
which at lead afford evidence, that urinary concre¬
tions are very different, with refpeti to the proportion
of the ingredients in their compofition, and perhaps
alfo in kind. Mr. Fourcroy, who however muff not
be claffed with inexperienced chemifts, i believe firft
obtained pruffic acid by fire, and by nitric acid, from
thefe concretions : and (hewed that they fometimes
contain phofphate of ammoniac and of foda ; which.

Z 2 may

304 Philofophical Tran/actions of the Royal Society *

may be diffolved out of them by water. Mr. Four-
croy alfo fays, he found magnefia in the intedinal
calculus of a, horfe ; which calculus was a triple
combination of one part of phofphate of ammoniac,
of two parts of magnefia, and one of wafer, befides
traces of animal and vegetable matter.

; Dr. Link, in a very elaborate differtation, pub-
blifhed at Gottingen, in 1788, on urine and calculi,
concludes, that urinary concretions confift of phof-
phoric acid, lime, ammoniac, oil, the bafis of dif¬
ferent kinds of gaffes, together with the acid fub-
Innate of Scheele, although he did not fucceed in
obtaining it.

4 It is a proof of Dr. Black’s fagacity, that he
fliould have been able to perceive, from a few ex¬
periments, that urinary concretions confided of ani¬
mal matter and the earth of bone, before the com-
petition of this earth was demondrated by Gahn.

c In this hidorical (ketch it fhould be noticed, that
alkaline fubdances though ufed by the Greek phy¬
sicians, and afterwards by the alchemical phyficiaiis,
appear to have been laid afide by the regular prac¬
titioners, for a century or two preceding their revival,
by the famous Mrs, Stephens, in 1720. Her pre-
feription brought into vogue the theory of thefe
medicines operating by their caudicity. The fuccefs-
ful ufe, by Mr. Colborne, of potadi faturated with
carbonic acid, according to the difeovery of Bewly
and Bergman, and the dill further improvement in
practice, from the ufe of foda, as well as potadi fuper-
fat mated with carbonic acid, by the difeovery of a
peculiar method by Mr. Schweppe, have completely
refuted the theory of the agency of alkalies on the
principle of caudicity. ’

^ The obfervations of the learned author relate prin¬
cipally to a fubdance, which appears to be very ge¬
nerally a condituent of both urinary aad arthritic
concretions. It is obtained by diffolving it out of

thefe-

Philofophical Trarif actions of the Royal Society. 305

thefe concretions by lye of cauflic fixed alkali, and
precipitating it from the folution by acids. It ap¬
pears, likewife, to oe altogether a different fubflance
from the dcid fublimate of Scheele, and which in the
new fyflem of chemiflry, is termed lit hie acid.

It would carry us to much too great a length, were
we to follow the author in the detail of his exoeri-
rnents: we fliall content ourfelves, therefore, with
the conclusions wThich refult from them.

1. li appears, that at leafl one halt of the matter
of the urinary concretions fubjefted to the above ex¬
periments, united to cauflic foda, and was precipitat¬
ed from it by acids.

c 2. This precipitate does not indicate acidity to
the inoft delicate tefts : and, as it is inodorous, tafle-
leis, scarcely foluble in cold wrater, does not unite to
the alkali of carbonate of potafh, of foda, or of am¬
moniac, nor to oxide of mercury, nor to the lime of
lime water, nor decompofed foap, or pruffiate of iron,
and, as its combination with cauflic foda refembles
foap, more than any double fait known to confift of
an acid and alkali, this precipitate does not belong
to the genus acids. °

/ 3- As this precipitate could not be fuhlimed,
without being decompounded, like animal matter^
and alfo for the reafons mentioned in the lafl para¬
graph, it cannot be the fame thing as the acid fub¬
limate of Scheele, or the fuccinic acid.

c 4- As it does not appear to be putrefcible, nor
form a vifeid folution with water, it cannot be refer¬
red to the animal mucilages.

f 5. On account of its manner of burning in the
air, under the blowpipe, and its yielding on expofure
to fire in clofe veffels, the diftinguifhing products of
animal matter, (efpecially ammoniac and pruflic acid,')
as well as on account of its affording a foap-like
matter with cauflic foda, this precipitate may be
confidered as a fpecies of animal matter ; and, from
its compofition being analogous to that of the fui>

fiances

506 Fhilof&phical Tranfactions of the Royal Society.

fiances called, in the new fyftem of chemiftry, animal
oxides, it belongs to that genus. Its peculiar and
fpecific diftinguifhing properties are, imputrefcihility ,
facility of cryftallizatwn , hi fallibility in cold water,
and, that moft remarkable property of all others,
producing a pink or red matter , on evaporation of its
folution in nitric acid*'

Having found the precipitate above alluded to, to
be an oxide, and not, as is commonly fuppofed, an
acid, the author thought it probable that, like other
analogous oxides, it was acidifiable. In his endea¬
vours, however, to effect this, he was not fuccefsfuh
The part of the urinary concretions which remain¬
ed infoluble in the lye of cauftic foda, appeared, by
experiment, to confift of phofphate of lime. Three
hundred grains of calculus examined, appeared to
contain as follows.

Grains.

Peculiar animal oxide, - - - - - - 175

Phofphate of lime, ------- 96

Ammoniac (and moft probably phofpboric
acid united to the ammoniac,) water, and
common mucilage of urine, which were
not collefted, by eftimation - - - - 29

300

c If it be allowed/ Dr. Pearfon remarks, c that
this urinary animal oxide is totally different from the
acid fublimate of Scheele, it will be neceffary to give
it an appropriate name. Agreeably to the principles
of the new chemical nomenclature, the name fhould
be hthic oxide. But the term lit hie, is a grofs
iblecifm ; and I truft that philological critics will
find the name ounc or uric oxide perfectly appro¬
priate ; for, if it be thought objeftionable, on account
of the exiftence of the matter in arthritic as well as

urinary

Philofophical Tranf actions of the Royal Society . 307

urinary concretions, (till philology will allow its ad-
million, as in other limilar cafes, Kar ; it being

found in greater abundance, by far, in the urinary
p adages than in other fituations, and therefore fall¬
ing under common obfervation, as an ingredient of
the urine. If, however, the term lithic oxide, or
any other denomination, (hall obtain acceptance, I
fhall very willingly adopt it.

/ It requires no fagacity, in a perfon acquainted
with the tadts of the preceding experiments, to per¬
ceive that they are applicable to a variety of ufes in
chemical invedigation, and in the practice of phyfic.
The latter I of courfe take no notice of in this place :
but, relative to the former ufes, I fhall particularly
point out, that we are now able not only to deteft,
in the eafied manner, the prefence of the minuted
proportion of the above animal oxide in urinary con¬
cretions, and alfo in other fubftances, but even to de¬
termine its proportion to the other conftituent parts,
in the fpace of a few minutes, in mod cafes, and in
all in a very little time, without any other apparatus
than nitric acid, a round-bottomed mattrafs, or glafs
difh, and a lamp. By this method, I have, in a ge¬
neral way, examined above three hundred fpecimens
of concretions, of the human fubjeft and other ani¬
mals, principally urinary ones ; and alfo many from
other parts, particularly thofe from the joints/'

Out of two hundred fpecimens examined by the
author, not more than fix did not contain the animal
oxide above defcribed. The proportion of this oxide
was very different in the different fpecimens ; varying
from (exclufive of water) to .£§£ ; but, for" the
mod part, varying between and The

common animal mucilage of urine is frequently found
in concretions, in very different proportions ; but is
perhaps never a principal condituent part of them.
It appears alfo, that the animal oxide was not found
in the urinary, or any other, concretions, of any ani¬
mal but the human kind : ladly, that it was alfo

2 4 found

SOB Philofophical Tranfactions of the Royal Society .

found in human arthritic calculi, but not in thofe
pf the teeth, ftomach, inteftines, lungs, brain, &c.

The urinary concretion of a dog being examined,
appeared to confift principally of phofphate of lime,
phofphate of ammoniac, and animal matter. A like
concretion from the urinary bladder of a rabbit con-
lifted of carbonate of lime, with common animal
matter, with, perhaps, a very final 1 proportion of
phofphoric acid. A concretion, la; i to be from the
ftomach pf a monkey, afforded the fame refuits — -
Different fpecimens of renal calculus in the horfe,
afforded carbonate of lime and common animal mat¬
ter. One fpecimen, however, was found to contain
phofphate of lime, phofphate of ammoniac, and comb
xnon animal matter.

The difference in the conftitution of urinary con¬
cretions may depend on the difference of the urinary-
organs of different animals, on the food and drink,
and on the various difeafed and healthy Hates of the
urinary organs.

The author has not found the uric oxide in the
urinary concretions of any phytivorous animal ; but
whether it would be formed in the human animal
when nourifhed merely by vegetable matter, muff be
determined by future obfervations. In the mean time,
it is warrantable' to conclude, from analogy, that it
would not, and the application of this fadf to prac¬
tice is obvious. — We lhall be happy to fee Dr. Fear-
ion profecute this interefting fubjeff, with a view to
medical pradfice.

The next article which we are now to notice in
the prefent volume, contains an Inquiry concerning
the Source of the Heat which is excited by Fric¬
tion: by Benjamin Count Rumford, F. R. S. &c.—
This fubjedt is perhaps not, in ftridtnefs, applicable
to our purpofe. Yet. it is altogether fo important,

and

Philofophical Tranf actions of the Royal Society. 309

and the theory of heat has fo often been introduced
in medical fpeculations, that we have no doubt of
Handing excuted tor the notice here bellowed on it.

It frequently happens, Count Rmnford obferves,
that in the ordinary aifairs and occupations of life,
opportunities prefent themfelves of contemplating
fome of the mod curious operations of nature; and
yerv interefling philofophical experiments might often
De made aim oft without trouble or expence, by means
or machinery contrived tor the mere mechanical pur-
pofes of arts and manufactures. It was by accident
that the author was led to make the experiments
which form the fubjeCl of the prefent paper.

Being engaged in fuperintending "the boring of
cannon,, in the workfhops of the Military Arfenal
at Munich, he was ftruck with the very confiderable
degree of heat which a brafs gun acquires, in a lliort
time, in being bored ; and with the Hill more intenfe
heat (much greater than that of boiling water, as was
found by experiment) of the metallic chips feparated
from it by the borer. An inveftigation of thefe phe¬
nomena feemed to bid fair to give a farther inlight
into the hidden nature of heat; and to enable us to
form fome reafonahle conjectures refpecfing the ex¬
igence, or non-exiftence, of an igneous fluid : a fub-
jeSt on which the opinions of philofophers have, in
all ages, been much divided.

The particular points of inquiry, which fuggeHed
themfelves to the ingenious author, were : whence
comes the heat actually produced in the mechanical
operation above mentioned ? — Is it furniflied by the
metallic chips which are feparated by the borer from
the folid mafs of metal ? that is, according to the mo¬
dern do&rines of latent heat, and of caloric, is the
capacity for heat of the parts of the metal, fo re¬
duced to chips, fo changed as to account for the heat
produced? — On repeated trials it was found that the
capacities of the metallic chips, and of the folid block
of metal, were in no refpeft different.

310 Philofophical Trarif actions of the Royal Society.

It was next endeavoured to afcertain the quantity
of heat produced, and the rapidity of its produCtiom
In thirty minutes, the 113 pounds of gun-metal was
found to be heated to 130 degrees of Fahrenheit’s
fcale, by means of the friCtion occafioned by the
revolution of the cannon on the extremity of a blunt
borer.

If the heat, or any confiderable part of it, were
produced in confequence of a change in the capa¬
city for heat of a part of the metal, as fuch change
could be only fuperftciaU the metal would by degrees
be exhaiifled. But in fucceffive experiments, not the
fmalleft fign of exhaustion appeared, notwithstanding
the large quantities of heat actually given off.

The author next endeavoured to find out whether
the air contributes any thing in the generation of the
heat excited by friftion : and for this purpofe the ex¬
periment was made under water, where, therefore,
no air could have accefs. The generation of heat
was here equally great and rapid as before. In two
hours and a half, the water furrounding the apparatus
was actually made to boil. When the water was
Inhered to have free accefs to the metallic furfaces
where the heat was generated, the production of heat
was as great and as rapid as before.

The author concludes his experiments with the fol¬
lowing general remarks :

4 What is heat? — Is there any fuch thing as an
igneous fluid ? — Is there any thing that can with
propriety be called caloric ?

c We have feen that a very confiderable quantity
of heat may be excited in the friction of two me¬
tallic furfaces, and given off in a conftant ftream or
flux, in all directions , without interruption or inter-
miffion, and without any figns of diminution, or ex¬
hauftion.

c From whence came the heat which was con¬
tinually given off in this manner, in the foregoing
3 expert-

Philofophical Tranf actions of the Pioyal Society . 31i

experiments? — Was it furnifhed by the fmall par¬
ticles of metal, detached from the larger folid maffes,
on their being rubbed together ? — This, as we have
already feen, could not poffibly have been the cafe.

c Was it furnifhed by the air? — This could not
have been the cafe ; for, in three of thefe experiments,
the machinery being kept immerfed in water, the ac-
cefs of the air of the atmofphere was completely pre¬
vented.

c Was it furnifhed by the water which furrounded
the machinery ? — That this could not have been the
cafe is evident ; firji , becaufe this water was conti¬
nually receiving heat from the machinery, and could
not, at the fame time, be giving to , and receiving heat
from , the fame body; and Jecondly , becaufe there
was no chemical decompofition of any part of this
water. Had any fuch decompofition taken place,
(which indeed could not reafonably have been ex¬
pected,) one of its component elaftic fluids (moft pro¬
bably inflammable air) muff, at the fame time, have
been fet at liberty, and, in making its efcape into the
atmofphere, would have been detefted ; but though
I frequently examined the water, to fee if any air
bubbles rofe up through it, and had even made pre¬
parations for catching them, in order to examine
them, if any fhould appear, I could perceive none ;
nor was there any fign of decompofition of any kind
whatfoever, or other chemical procefs, going on in
the water.

‘ Is it poffible that the heat could have been fup-
plied by means of the iron bar to the end of which
the blunt fteel borer was fixed ? or by the fmall neck
of gun-metal by which the hollow cylinder was unit¬
ed to the cannon ? — Thefe fuppofitions appear more
improbable even than either of thofe before men¬
tioned : for heat was continually going off, or out
of the machinery , by both thefe paffagcs, during the
whole time the experiments lafled.

‘ And,

$12 PhUofophical Tranf actions of the Hoped Society .

< And, in reafoning on this fubjeft, we mu ft not
forget to coniider that moil remarkable circumftance,
that the fource cf the heat generated by fri&ion, in
thefe experiments, appeared evidently to be inex-

hauftible. m T

« It is hardly neceffary to add, that any thing
which any infulated body, or fyftem of bodies, can
continue to furnifh without limitation , cannot pof-
fibly be a material Jub fiance, and it appears to me
to be extremely difficult, if not quite i-mpoffible,. to
form any diftindf idea of any thing, capable or being
excited, and communicated in the manner the heat
was excited, and communicated in thefe experiments,
except it be motion.

* I am very far from pretending to know how, or
by what means, or mechanical contrivances, that par¬
ticular kind of motion in bodies which have been
fuppofed to conftitute heat, is excited, continued,
and propagated, and I (hall not prefume to trouble
the Society with mere conjectures ; particularly on a
fubjecl which, during fo many thoufand years, the
moil enlightened philosophers have endeavoured, but
in vain, to. comprehend.

6 But, although the mechanifm of heat fhould, in
fact, be one of thofe myfteries of nature which are
beyond the reach of human intelligence, this ought
by no means to difeourage us, or even leffen our
ardour, in our attempt to mveftigate the laws of its
operations. How far can we advance in any of the
paths which fcience has opened to us, before we find
ourfelves enveloped in thofe thick mills which, on
every fide, bound the horizon of the human intellect ?
But how ample, and how interefting, is the field that
is given us to explore 1

4 Nobody, furely, in his fober fenfes, has ever pre¬
tended to underhand the mechanifm of gravitation ;
and yet what fublime difeoveries was our immortal
Newton enabled to make, merely by the inveftigation
of the laws of its adtion 1

1 The

Phiiofophical Tran/ actions of the Royal Society . 313

c The effefts produced in the world by the agency
of heat, are probably juft as extenfive , and quite as
important, as thofe which are owing to the tendency
of the particles of matter towards each other ; and
there is no doubt but its operations are, in all cafes.*
determined by laws equally immutable/

Art. 5. Obfervations on the Foramina Thebefti of
the Heart : by Mr. John Abernethy. — There is a re¬
markable contrivance, Mr. Abernethy obferves, in
the blood-veffels which fupply the heart, not to be
met with in any other part of the body, and which is
of great ufe in the healthy functions of that organ,
but which is particularly ferviceable in preventing
difeafe of a part fo effential to life.

A diften.ded date of the blood-veffels muft always
impede their functions, and confequently be very de¬
trimental to the health of the part which they fup¬
ply ; but, as the cavities of the heart are naturally
receptacles of blood, a Angular opportunity is afford¬
ed to its nutrient veffels, to relieve themfelves when
furcharged, by pouring a part of their contents into
thofe cavities. Such appears to be the ufe of the
foramina, by which injections, thrown into the blood-
veffels of the heart, efcape into the cavities of that
organ ; and which were firft noticed by Yieuffens,
but, being more expreffly defcribed by Thebefius,
generally bear the name of the latter author.

Anatomifts appear to have been much perplexed
concerning the foramina Thebefti ; even Haller, Se-
nac, and Zinn, were fometirnes unable to difcover
them 5 which fuggefted an idea, that when an injec¬
tion was effufed into the cavities of the heart, the
veffels were torn, and that it did not efcape through
natural openings. When thefe foramina were in¬
jected, they were found under various circumftances,
as to their iize and fituation ; and Haller obferved,
that the injection, for the molt part, efcaped into the
cavities of the heart, it alfo remains unde¬
termined.

right

SI 4 Philofopkicat TrafiJ actions of the Royal Society ,

termined, whether thefe foramina belong to the arte¬
ries and veins, or re fp entirely to each fet of veffels.

, It is from an examination of thefe openings in dif-
eafed fubjef/ts, the author obferves, that a folution of
fuch difficulties may probably be obtained. Who¬
ever reflects on the circumftances under which the
principal coronary vein terminates in the right auricle
ot the heart, will perceive that an impediment to the
flow of blood through that veffiel mult occafionally
take place ; but the difficulty will be much increafech
when the right fide of the heart is more than ordi¬
narily diftended, in confequence of obftruflion to the
pulmonary circulation. Indeed it Teems probable,
that fuch an obftruflion, by occafioning a difiend-
ed Hate of the right fide of the heart, and thus im¬
peding the circulation in the nutrient veffels of that
organ, would as neceffarily occafion correfponding
dileafe in it, as an obftruflion to the circulation in
the liver, occalions difeafes in the other abdominal
vifcera, were it not for fome preventing circumftances.

Having been attentive to fome very bad cafes of
pulmonary confumption, from a defire to witnefs th®
effefls of breathing medicated air in that complaint,
the author was led to a more particular examination
of the heart of thofe patients who died. In thefe
cafes he found, 'that by throwing common coarfe
waxen injection into the arteries and veins of the
heart, it readily flowed into the cavities of that organ;
and that the left ventricle was in je fled in the firff
place, and moll completely. When the ventricle
was opened, and the eflufed injection removed, the
foramina Thebelii appeared both numerous and large,
and diftended with the different coloured wax which
had been impelled into the coronary arteries and
veins. Upon eight comparative trials, made by in-
je fling the veffels of hearts taken from fubjefls whofe
lungs were either much difeafed, or in a perfeftly
found flat e, it was found, that in the former, com¬
mon injection' readily flowed, in the manner which
v has

Pkilofop final Fran factions of the Royal Society, 315

has been defcribed, into all the cavities of the 'heart;
but principally into the left ventricle - whilft, in many
of the latter, he could not impel the leaft quantity of
fuch coarfe injection into that cavity.

I n is difference in the facility with which the ca-
\ities of the neart can be injected from its nutrient
veLels, was obferved by moft an a to mills- though thev
did not advert to^ the circumllances on which it de¬
pended. Haller’s teftimony on this head is here
adduced.

As it feems right, Mr. Abernethy obferves, that
the blood which had been diilributed by the coro¬
nary arteries, and which mull have loll, in a Greater
or lefs degree, the properties of arterial blood, fliould
npj- niixed with the arterial blood which is to be
diilributed to every part of the body, but ought
rather to be font again to the- lungs, in order that
it may re-acquire thofe properties ; we therefore per¬
ceive why, in a natural Hate of the heart, the prin¬
cipal foramina Fhebelii are to be found in the right
cavity of that organ. However, as even in a ftate’of
health, thofe cavities are liable to be uncommonly
amended, in confequence of mufcular exertion fome-
fomes forcing the venous blood into the heart falter
than it can be tranfmitted through the lungs, there
feems to arife a neceffity for fimilar openings on the
left fide; but thefe, in their natural Hate, though
capable of emitting blood, and of relieving the ple¬
thora of the coronary veffels, are not of fufficient ffze
to give paffage to common waxen injections. Yet,
when there is a diftended Hate of the right cavities
of the heart, which is almoH certainly nccafioned bv
a- difeafed Hate of the lungs, thefe foramina leading
into the left cavities then become enlarged, in the
manner that has been already defcribed ; and thus
:he plethoric Hate of the nutrient veffels of the heart,

ind the confequent difeafe of that important organ
are prevented. . o *

Ihe preceding remarks Efficiently explain, in the
tuth or s opinion, the caufe of the variety in the Hze

i * and

SI 6 Philofophical Tran/ actions of the Royal Society .

and fituation of thefe foramina, which alfo appear to
belong both to the arteries and veins ; becaufe, the
injeChon which was employed was too coarfe to pafs
from one fet of veffels to the other, and yet the dif¬
ferent coloured injeftions patfed into the cavities of
the heart un mixed.

There is yet another mode, Mr. Abernethy ob-
ferves, by which difeafes of the heart, that would
otherwife fo inevitably fucceed to obftruCiion in the
pulmonary veffels, are avoided. Having formerly
been much furprized to find the heart fo little af¬
fected, when the lungs were greatly difeafed, and
obferving in one or two inftances, that the foramen
ovale was open, he was led to pay more attention to
the (late of that part ; and he has found this to be
a! moil a conftant occurrence in thofe fubjeCt's where
pulmonary confumption had for feme time exifted
previous to the perfon’s difeafe. It was obfervecj
thirteen times in the courfe of one year : and, in
feveral inftances, the aperture was fufficiently large
to allow of a finger being paffed through it. As the
feptum auricularum is almoft conftantly perfect in
fubje&s whofe lungs are healthy, the author concludes
that the renewal of the foramen ovale is the effeCl of
difeafe : nor will the opinion appear, on reflection,
improbable.; for the opening becomes clofed by the
membranous fold growing from one edge of it, till
it overlaps the other, and their fmooth furfaces being
kept in clofe contaCi,, by the preffure of the blood in
the left auricle, they gradually grow together. But
fhould there be a -deficiency of blood in the left auricle,
and a redundance in the right, the preffure of the
latter on this membranous partition, will fo ftretch
and irritate the uniting medium, as to occafion its
removal ; and thus a renewal of the communication
between the auricles will again take place.

From thefe obfervations it is natural to fuppofe,
that in thofe men, or animals, who are accuftomed
to remain long under water, this opening will either

Philofophical Tmnf actions of the Royal Society . SIT

be maintained or renewed ; yet on this circumftance
alone the continuance of their life does not depend ;
for, we now have fufficient proof* that if the b^ood
is not oxygenated in the lungs* it is unlit to /Support
the animal powers. There is an experiment lelated
by Buffon, Mr. Abernethy obferves, which has not
been publicly controverted, * and which tends greatly
to milreprefent this fubject. He fays, that he caufed
a bitch to bring forth her puppies under warm water *
that he fuddenly removed them into a pail of warm
milk; that he kept them immerfed in milk for more
than half an hour ; and that when they were taken out
of it all the three were alive. He then allowed them
to .refpire about half an hour, and again immerfed
them in the warm milk* where they remained ano¬
ther half hour ; and, when taken out, two were
vigorous, but the third feemed to languifh : this
fubmerfion was again repeated, without apparent
injury to the animals.

This experiment is fo directly contrary, Mr. Aber¬
nethy obferves, to what we are led to believe from all
others, and alfo to the information derived from cafes
which frequently occur in the practice of midwifery, (in
which, an interruption to the circulation through the
umbilical chord occalions the death of the fetus) ^as
to make us fufpecft its truth : he was therefore in¬
duced to examine what would happen in a fimilar
experiment. He did not indeed caufe the bitch to
bring forth her puppies in water * but immerfed a
puppy, ftiortly after its birth, under water which was
of the animal temperature. It loft all power of flip-
porting itfelf in about fixty feconds, and would fhorfc-
ly have perifhed, had it not been removed into the
air. Neither could he, by repeating this experiment,
fo accuftom the animal to the circulation of unoxy-

* The fact related by Buffon was called in queftion by Mr. John
Bell, in the fecond volume of his Anatomy of the Human Body. See
Med. Rev. vol, 4, page 381.

yob. v. A a

seriated

SIB Cullen's Clinical Lectures .

genated bicod, as to lengthen the term of its exig¬
ence in fuch an unnatural fituation.

Ypung animals, indeed, retain their irritability for
a con/iderable time, fo that they move long after they
have been plunged beneath water; and may even,
on this account, recover after they are taken out
But the manner in which BufFon has related his
experiment, feems to imply, that the circulation of
the blood and other functions of life, were continued
after the animals had been excluded from the air;
but the author is convinced, that the doe* which was
the fubject of his experiment, would have been be¬
yond recovery in a few minutes.

Thofe animals which are accuftomed to remain
long under water, probably firft fill their lungs with
air, which may, in a partial manner, oxygenate their
blood during their fubinerfion. The true fiatement
of this fubjeft may probably be, that the circulation
of venous blood will deftroy moll animals in a very
fnort ipace ot time ; but that cut tom may enable
others to endure it, with very little change, for a
longer period.

Art. XXXVII. Clinical Lectures delivered in the
Years 1765 and 1766. By William Cullen,
■ • Y ' late P rofeffbr of the Practice of Phvjic in

the Uniyerjjty of Edinburgh, &c. Me. Taken in
‘ Short-nand by a Gentleman who attended. Oc¬
tavo, 338 pages, price 6s. Lee and Hurst.
London. 17.97.

I jl is tiuly obferved by the isditor oi the pages be¬
fore us, that the pofthumous works of the late
celebrated i lofcftor Cullen need no encomium j but
L any part deferves more attention than the reft, it is
thofe Clinical Leftures he read to his pupils, as il-
luftrations of his own practice ; compofed while his

m ind.

Cullen’s Clinical Lectures .

319

mind, matured by experience, retained all its native
vigour, and delivered where his doctrines were to be
confirmed or confuted by actual cafes, they muff be
invaluable. The correffnefs of this publication, it
is obferved, does not reft upon detached feraps,
whole defeats are fupplied from memory, being
printed from the manuscript of an eminent pbyftcian,
who attended thefe leftures, and took them down in
fhort-hand.

The fubjefts treated of in the prefent lectures are.
Nervous Diforders, and the Nervous Syftem, Tenfton
and Laxity, Sympathy, Hyfteria*, Hypochondriafis,
Falfy, Head-ach, Hydrophobia, the Acceleration of
the Puife, Rheumatifm, Eledricity as applicable to
the practice of medicine, Jaundice, Scrophula, Dy-
fentery, the Venereal Difeafe, and Intermittent Fe¬
vers.

On each of thefe topics many excellent remarks
will be found. It is greatly to be wiftied that a
complete copy of the lectures given by this celebrat¬
ed practitioner could be compiled from the notes of
his different hearers. An acquifttion of this kind
would be invaluable. We (hail prefent our readers
with fuch parts of the prefent volume, not as are moft
important, for they are all fo in a high degree, but
fuch as have been leaft noticed in the courfe of our
work, and which do not enter into the plan of the
author’s Firjl Lines.

Of Sympathy. c We have now fpoken in a brief
manner upon the tenfton and laxity of the animal
fyftem, and endeavoured to explain it by confidering
the tenfton of the mufcular and fanguiferous fyftems.
We have conftdered a particular part of the body,
which is upon a different footing from the reft, the
alimentary canal. We have fhewn that the great
varieties it undergoes in point of tenfton, are owing
to its unequal diftenftons, from the want of conftant
counterpoife ; in confequence of which, it is more
irritable, and depends more on the tonic power, than

A a 2 media-

S20

Cullen’s Clinical Lectures .

mechanical tenfion.' Still, however, that it has a
connexion with the tenfion of the whole fyftem,
we made apparent, from the e fife 61s of flatulency in
the primce vice, and the method taken to difperfe it.
This connexion, we obferved, was called fympathy.
As long as we have no idea on wdiat this conneftion
depends, the term may be ufed ; but if we can find
out its foundation, and the means of 'communication,
(which ought to be attempted), it will be no longer
proper. Thus it would be abfurd to talk of a fym¬
pathy between the pendulum of a clock, and a finger
that points the time ; becaufe here we underhand the
means of communication between them. In the fame
manner here, if a fentient principle is interpofed, if
the motions follow not indeed by a mechanical power,
as in a clock, but by a phyiical neceffity, all occafion
for fuppofing occult qualities, and conlequently ufmg
this term, immediately ceafes. A general fympathy
is now univerfally difclaimed : as to particular fym-
pathies, there is ftill fome doubt. With regard to
this, the very idea of fympathy fuppofes two corref-
ponding parts. If in confequence of an imprefifion
being made on any one part, and conveyed from it
to the fenforium commune , a motion is excited in the
moving powers, this motion muff either be general,
or determined to fome particular part.

c In the fir It cafe, no one thinks at all of a fym¬
pathy, as has beep juft faid ; but when a motion is.
excited by it in any particular part, this is commonly
called fympathy : but many of thefe feemingly parti¬
cular fympathies, are in reality general ones, and con-
fequently not to be looked upon at all as fympathies.
Dr. Whytt has, in his laft treatife, deftroyed the very
foundation of particular fympathies, by fhewing that
they are not owing to any communication of parti¬
cular nerves with one another, but that they come
through the intervention of the fenforium commune.
This defiroys the notion of particular fympathies, and
confequently of fympathies in general.

Cullen’s Clinical Lectures. 321

c If a blufh is excited at the fight of any thing in¬
decent, this is called a fympathy between the eye
and the cheek: but the idea, of which this blufh is
the effedf, might be received by the ear, the touch,
&c. So that the blufh on the cheek is not owing to
any particular confent between the eyes and it, and
confequently is not a particular fympathy. In the
fame manner, fear excites forne effects, which are
not produced by any particular fympathy between
thofe parts which receive the impreffion, and thofe
that are irritated. The motion of particular parts, in
confequence of thefe impreffions, depends only on the
intervention of the fenforium commune , and the par¬
ticular irritability of thofe parts. Thus, a perfon, on
looking from a precipice, had always a contraction
of the ere matter mufcles produced. This could not
be owing to any confent between the eye and the
cremaiters, but to the irritability of thefe mufcles,
and might have been produced by the fame idea ex¬
cited any other way. In this view fhoujd the fym¬
pathy between the ftomach and other parts of the
fyftem be conftdered. It is not owing to any com¬
munication between the nerves of thefe parts, but to
this circumftance.

4 Any affedtion of the ftomach will aftfedi the fen -
forium commune ; and this has a power of exciting a
motion in thofe parts, not in confequence of any con¬
fent of the ftomach with them, but of fome particular
irritability which they poftefs. This propofition is
convertible from thofe other parts of the fyftem to
the ftomach. We may now apply this general prin¬
ciple to the feveral confents obferved between the
ftomach and other parts : and firft of all, between it
and the head. This is not any particular confent,
but fuch as fubfifts between the fenforium commune ,
and every fentient part. What effect the ftate ot the
tenfton of the ftomach has on the ftate of the mind,
appears from hence ; that when it is in due tenfton,
the mind is poffeffed of vivacity, courage, clearnefs,

A a 3 and

522" Cullen’s C Tmical Lectured

ancl confiftency of thought : when it is otherwife, the
Hate of the mind is quite the reverfe. This might
moil probably be beft explained from the tendon of
the parts ; but leaving this, we fhall obferve that the
particular confent between the ftomach and head is
owing to this circumftance. When the fenforium is
afffedted by this or any other organ, the effedts are
firft felt in the parts neared: to the fenforium, as in
the eyes and ears. No wonder, then, that a vertigo,
affedtion of the eyes, & c. are gradual precedes to a
complete animi deliquium. In the fame manner, if
an impreffion on the ftomach has a tendency to pro¬
duce convulfions, it will probably firlt appear in the
mufcles of the eyes and vifage. To illuftrate this by
an example, if a nerve is pricked, it will fometimes
produce a tetanus ; or if in a lefs degree, a locked
jaw, this part being near to the fenforium commune .
This cannot be owing to any confent between the
pricked nerve and the nerve of the jaw, becaufe it
has the fame effedt whatever nerve is pricked. This
may be owing too, in fome meafure, to the number
of the levator mufcles there in proportion to the de-
preffors; and. in other parts too, the flexor mufcles
are more apt to be aftedted by it. On the whole,
then, this is not to be looked upon as a particular
confent between the head and ftomach 5 but it is to
be attributed to the ftomach having a great effedt
upon the fenforium commune , and the parts of the
head, as being neareft to the fenforium commune ,
being moil likely to be affedled by it.

c Another remarkable confent is obferved between
the ftomach and furface of the body. This is perhaps
owing to the furface of the body being the iargeft
organ of fenfe, having the greateft number of nerves,
and thefe too now ftripped of their covering mem¬
branes, which muft make it extremely fenftble. It is
therefore very likely to be affedled on any affedtion
of the fenforium commune. If then the ftomach af¬
fects the fenforium commune (as it was fhewn above

Cullen’s Clinical Lectures .

323

to do In a threat decree) this wftl affedt the furface of
the body, and vice ver/d : lo that here too there is no
particular confent between the parts, but it is to be
referred to the great fenftbihty of each. — Another
reafon why the furface ot the body is more liable
to be aftedted is, that it has a great number of blood*
veffels , and thefe are liable to be varied by any
change in the fyftem, as being far! hell from the
heart. But any variation in the ftate of the veffels
will alfo affect the nerves, which run over them ; and
thefe a min being aftedted, will in like manner affedt
the circulation*. A third reafon is, that this is a part
in oft fubjedt to the vicifti tudes of heat and cold,
which will affedt both the nervous and fanguiferous
fyftems. It muft therefore have a great effedt on the
fenforium commune, and, through it, on every fen-
fible part, and particularly the ftomach ; for every
confiderable change of the blood is particularly de¬
termined, either to the furface of the body or the
vifcera ; and thefe will mutually affedt each other.

‘ It is of great confequence to (hew how thefe are
mutually affedted by each other. Some of thefe phe¬
nomena may perhaps occur again, in fpeaking on
the circulation ; but either in that place or this, it
avails little to refer them to fympathy. It is worth
while to obferve in Sandtorius’s Aphorifms, how
greatly the ftate of the mind, and all the internal
functions, depend on the furface of the body. Ano¬
ther remarkable confent of the ftomach is with the
extremities, not confidered Amply as a furface ; but
as the parts moft remote from the heart and the fen¬
forium commune. It is eafy to ftiew how parts may
be affedted in confequence of this diftance ; but our
time doth not allow us. It particularly appears in
the gout. Whether there is any peculiar morbid
matter in this diforder, is not eafy to determine : but
it is evident that many of the phenomena attending
it muft be referred to the confent between the
ftomach and extremities, in confequence of their

A a 4 mutual

324 Cullen’s Clinical Lectures.

mutual degree of tenfion, and not to any tranflation
of morbid matter, On this principle if will be eafy
to explain, how a dram may drive the gout from the
ftomach to the extremities. Thefe are the confents
of the ftomach with the other parts of the fyftem,
which more particularly belong to our purpofe. The
alimentary canal itfelf was find mentioned with a view
to nervous diiorders , but there are other parts liable
to be affedted, which communicate their own hate of
tenfion to receive it from other parts of the fyftem.
Such are the- lungs and heart : the lungs are liable to
inequalities in diftending powers, though not fo much
as the ftomach ; and the heart, too, though one or the
moft adtive parts of the body, has a diftending power,
liable to fome irregularity ; confequently they are
both liable to various degrees of tenfion, which
may produce various effedts on thcmfelves, and upon
other parts. Thus a cafe is mentioned by Dr.
XX hytt, in his Treatife, page 21 6, of a nervous pa¬
tient, who had a cough, in confequence of changing
her pofture, or of a change of heat or cold : this can
only be explained from the ftate of tenfion in the
lungs being affedted by that in fome other part. The
eftecls of a change of pofture, in particular, can be
explained only from this variety of tenfion, and not
from any circumftance in the fanguiferous fyftem.
The ftomach, then, and alimentary canal, the heart,
lungs, and mufcular fyftem are, with the fenlorium
commune, moft liable to fpafmodic affedtions, and in
thefe parts do they generally appear. But there are
fome other paris, alfo, which have a great variety of
tenfion, and by that means may affedt thefe. Such
are the feminal veffels in men. This may be faid to
depend on a particular irritable matter produced
there • but its nature will perhaps he better ex¬
plained, from the different degrees of tenfion in
them. This opinion will be better fupported by ana¬
logy, if we confider fome of the particular effedts of
this affedtion, with regard to the ftate of the mind.

Cullen’s Clinical Lectures .

32 5

and the fenfation of pleafure it excites. The genitals
of women have alfo a conflderable influence this way :
thefe are varioufly affedted by a feries of conditions
they pafs through, as conception, geltation, bringing
forth, &c. But thefe affections can fcarcely be ac¬
counted for from any irritable matter, but rather from
the variety of tendons they are fubjedt to. Hence
there is a great difference in this refpedt between
men and women. In men, venery is chiefly to be
confidered ; but in the female organs, fomething very
different is neceffary to produce thefe changes. Thus
women who indulge themfelves mo ft in venery, if
they are barren, are not liable to the fame diforders
with thofe that bear children : the uterus has alfo a
great effect this way, as being fubjedt to periodical
hemorrhages, and thereby liable to a variety of ten¬
dons, fo as to influence the fyftem very much every
month. Some men too have periodical difcharges,
and thefe are liable to the fame affediions as women
with their menfes.

‘ Upon the wffiole, it appears, on a general view,
that many of thefe affediions may be explained from
-a general tenfion, every one part ferving as a balance
in this refpedt to another.’

The only other fubjedt we fhall extradt from this
valuable colledtion, is that of Head-ach ; a fubjedt of
great importance, both from its occaflonal feverity
and the frequency of its occurrence. It is one, at
the fame time, that has feldom been fatisfadlorily
treated of by authors.

‘ We fhail next fpeak of Ann Hood, labouring
under a violent head-ach. This is one of the molt
frequent fymptoms in pathology, and is of very dif¬
ferent natures. It may be diftinguiihed as being
either idiopathic or fympathic, that is, a diforder or
a fymptom. When it is to be looked upon as the
one, and wffien the other, is uncertain. We fhail at
prefent fpeak of it only as idiopathic. This is a very

difficult

326

Cullen's Clinical Lee lares.

difficult fubjeft, owing to the frequency of the dif¬
order, and the various circumftances and different
forms it appears in. Boerhaave has not given it a
place in his fyftem, nor mentioned it in his treatife
de nervorum mortis.

i In the firft place, we muff enquire what cafes of
the head-ach are properly idiopathic. Galen, Are-
tarns, and the followers of the ancients, and among
the moderns, particularly Stahl and his difciples,
have diftinguifbed thefe into four kinds, the cepha¬
lalgia, cephahva , clavus , and hemicrania . But they
have not made any ffieady diftindlion : fometimes dif-
tiriguifhing them merely by the degrees of violence
or duration, oftentimes by the place they occupy, and
often by the modification of the pain. But thefe we
fhall find to be no proper diftinctions. We could in¬
deed expeft them to be confidered in this light, only
iince phylicians began to examine more accurately
the various genera and fpecies of diforders, as has
been done particularly by Sauvages. He excludes
one of the genera eftablifhed by Galen, the clavUs,
and conftitutes only the other three. The great fault
of his works is, that he conftaritly enumerates fymp-
toms as fpecies ; and no where perhaps more impro¬
perly than in this diforder, of which he has made no
lefs than thirty different fpecies. Of thefe we muff

a y X

rejeft all tliofe that depend on feme primary diforder,
as the cephalalgia in fl animator ia, whether it be an
inflammation of the brain itfelf, or of its membranes.
On the fame footing we reject all thofe depending on
a fever, whether continual or intermittent, as the ce¬
phalalgia febrilis and inlermittens , ccphahea febri-
cq/d, and hemicrania lunatica. But we muft ob-
ferve here, that every exactly periodical head-ach is
not to be referred to the cephalalgia intermittens, and
doth not always depend on the fame caufe. It is
therefore doubtful whether Sauvages is right, in af-
figning the hemicrania lunatica to the general inter¬
mittent fevers.

Cullen’s Clinical Lectures .

327

c We like wife reject all thole arifing from a topical
inflammation of the contiguous parts, as the cephalal¬
gia catarrhalis, the hemicrania , odontalgica, Jinus ,
cory zee , purulent a , and a 6 infeeds . It is much that
he did not add, the otalgia to all thefe, as being of
the fame nature. Of this other fpecies, the cephahta
polonica or head-ach depending on the plica polonica
being improperly cut, is not to be admitted as he ex¬
plains it. We reject alfo all thofe which depend on
caufes not more peculiarly affecting the head than
any other part : this is the cafe in the cephakea fy~
phi Utica, which is no more a difeafe, than an affec¬
tion of the fkin from the fame caufe is ; as alfo in the
cephalzea ah acrimonid , proceeding from the feurvy.
Neither of thefe give any particular difeafe, much
lefs an idiopathic primary one.

c Under the cephalalgia inflammatoria , Sauvages
obferves, that this is of the fame nature with thofe
arifing ab ictu , mdnere , or any other external injury.
He has not made any diftinCt fpecies of thofe ; but if
he had, we muff: have rejected them ; perhaps, how¬
ever, thefe may occafion fuch a ftate of the brain as
may produce proper idiopathic head-achs. We have
now rejected about one half of the fpecies he eftab-
lifhes, but muft ftill proceed to rejeCt others, as the
cephalalgia pulfatilis , depending on a flight variation
in fymptoms only, and anemotropka , on a flight varia¬
tion in the caufe.

c It is not eafy to determine, how far we may
eftablifh fpecies from external or remote caufes ; but
if we admit this fpecies from a change of wind, we
muft alfo admit feveral others, as from the heat of the
fun, & c. Laftly, the cephaleca forafa is to be reject¬
ed, as being founded on internal, and not very evi¬
dent caufes. In the next place we muft obferve,
that it is yery doubtful how tar forne of his fpecies
are to be looked upon as diftinct from each other:
thus the cephalalgia plethorica , catamenialis , hccmor -
rhoidalis , feem to be all the fame fpecies ; and, per¬
haps.

S2S Cullen's Clinical Lectures.

haps, the cephalalgia gravidarum too is to be refers
red to the plethcrica . The hemicrania Jucmorrhoi-
dalis and cephalalgia hcemorrhoidalis are certainly
one fpecies only.

c It may be difputed too, whether the hemicrania
claims is a diftinct fpecies. Again, there is the fame
doubt with reipetf to another clafs, as the cephalalgia
hijft erica, cephahea arthritic a, hemicrania nephralgica ,
&c. Whether thefe and the others are diftinct fpe¬
cies, or whether they are all the fame fpecies, we
ihall confider hereafter.

£ At prefent we fliall fuppofe a fpecies properly
idiopathic, and one that feems moft general, and
give its hiflory, or at lead its general date. We ihall
be liable here to the fame inaccuracy which moft
phyficians are guilty of in defending genera rather
than fpecies ; and it is very difficult to avoid this.

c We ihall begin with obferving, the particular
temperament it is apt to affeft : this is the fanguine,
or rather the fanguineo-melancholic temperament.—
This may be diftinguilhed by the following marks; as
black hair; a more lean and firm habit; a ruddy, but
withal a brown complexion, with large veins, and
abftrafting from the ruddinefs of the cheeks ; with
a {kin pale, but frnooth and foft. This is diftinft
both bom the fanguineous and melancholic tempe¬
rament. The diforder frequently attacks the purely
fanguineous, and no lefs frequently the purely me¬
lancholic temperament; it affetls young perfons more
than old, but oftener about the acme than any other
time of life.

c It often continues a long time after, but feldom
arifes in elderly perfons : it is more frequent in. women
than men, in the proportion, perhaps, of ten to one.
As to the time of its attack, it is a diforder of all
feafons ; if it is more general in any one feafon than
the other, it is in the fpring. Such are the preaif-
pofing caufes of this diforder. As to its oceafional
caufes; it arifes in many perfons without any oh-

' . fervable

Cullen’s Clinical Lectures .

329

fervable ones ; and where it is exactly periodical, we
can fcarcely fuppofe any occafional caufe conftantly
recurring ; though, in the hemicrania lunatic a , the
ilate of the moon feems to be fuch a caufe. There,
are, perhaps, few diforders which aft by paroxyfms,
that do not depend on occafional caufes ; and though
the patient may not obferve thefe, they may be found
out by diligent inquiry. To find thefe out, is one of
the mo ft important things in prafiice ; and they really
exift always, though fometimes very difficult to be
difcovered. This is very obfervable in the head-
ach, where the flighted changes in diet, exereife,
temperature of the air, &c. are fufficient to bring on
the diforder. We can mark a great number of thefe
occafional caufes ; but it is difficult to enumerate
them, and frill more to arrange them in proper
order. The firfl: we (hall mention is the plethora
This is a frequent caufe, and fhould, indeed, have
been marked as a predifpofing caufe, as it was in
fact, when it was obferved that the diforder frequent¬
ly prevailed in a fanguine habit.

We mention it here, becaufe whatever increafes
it, may be an occafional caufe of the head-ach ; fuch
; as the fulnefs of diet, an obftruftion in any evacua¬
tion, either natural, as menftruation, &c. or fpon-
! taneousj as haemorrhages at the nofe, &c. Thus the
\ head-ach generally prevails at the beginning of meii-
:ftruation. To this article of increafed fulnefs in the
i body, we may add coflivenefs, which often accom-
! panies this diforder, and when extended to a great
( degree may produce it.

c Perhaps we may join here, cold applied to the
extremities, whereby perfpiration being obflrufted,
will excite fulnefs in the veffels, and particularly in
thofe of the head. Again, there are other caufes
which aft in producing a temporary turgefcence and
.rarefaftion, fuch as being kept in any great degree of
heat, and particularly, being expofed to a hot fun,
&c. or a change of weather from cold to hot, from

s heavy

330

Cullen’s Clinical Lectures .

heavy to light, and dry to mold ; alfo whatever dn-
creates the impetus of the blood, and quickens the
circulation, will have the fame effect as a diltenfion
of the veffels, and may be an occafional caufe, Such
is violent exercife, and fome of the paffions, particu¬
larly anger. Thofe exercifes too may be occafional
caufes, which do not excite an impetus of the blood
over the whole fyftem, but flop the reflux of the
blood from the head, by preventing its free paffage
through the lungs, and thereby cauling a regurgita¬
tion ; as much and loud fpeaking, violent laughter,
coughing, vomiting, &c. On the fame caufe, per¬
haps, but with a greater degree of obftru£lion, de¬
pends the head-ach, which commonly proceeds from
fits of the fpafmodic afthma.

c To thefe we may add another fet of occafional
caufes, quite different from the former, and, per¬
haps, direftly opposite. Of this kind are fudden
fear, fudden grief, and particularly any fubjeft of
anxiety. To thefe we may add excels of ftudy, not
only fuch as is keen and intenfe, but that which is
long protraQed and accompanied with watchings.
This laft is a frequent caufe ; and yet not lefs fre¬
quently the head-ach is occafioned by too much
lleep, and, in fome people, even by the ordinary
deep : fleeping at unufual hours, as in the afternoon,
is very apt to bring it on ; an abftemious way of life
is another caufe ; and we have known feveral in-
fiances of perfons cured of the head-ach by ufing a
fuller diet : it may alfo be occafioned by evacuations,
if too large and too long continued.

' c We mentioned above, that the head-ach fre¬
quently proceeded from obftru£lions of fome ufual
evacuations ; yet it arifes no lefs frequently from too
copious evacuations, and none are more fubje£t to it
than women with too copious a menftrual flux, or
men with an hemorrhoidal flux : in this cafe it at¬
tacks women at the going off of menftr nation, as in
the other it did in the beginning. In fliort, there

are

Cullen’s Clinical Lectures.

831

are inftances of its being occafioned by every thing
that weakens the body. One of the mod frequent
caufes is the application of cold, particularly to the
head, and this is relieved by warmth : to this we muft
add, riding in the wind 3 but whether this is merely
from the fame caufe is uncertain. Again, various
odours, whether fragrant or foetid, will forn.e times
produce the head-ach 3 wine too will have this ef¬
fect, either when taken in fuch a quantity only as to
heat the body, or after intoxication ; opium will, in
fome perfons, produce fimilar effects, and probably
other narcotics, and among thefe the metallic. This
is more evident in arfenic and mercury than any
other. All ftrong impreffions on any of the fenfes,
as violent noifes, ftrong light and odours, may alfo
be occalional caufes. There are fome other clrcum-
ftances more difficult to be explained. Thus, what¬
ever produces vertigo, as looking upon a ftream of
water, or from a great height, will often oecafion the
head-ach. Whether thefe oecafion flight temporary
head-achs only, or the proper idiopathic ones, is not
certain 3 but we fhould imagine, that the laft is the
cafe. We are next to (peak of the proper form, in
the feries and combination of its fymptoms. This is
commonly called the hiftory of the difeafe, though
that comprehends the predifpofing caufes, as alfo the
occalional and the remote, the fymptoms and effects
of them. The head-ach fometimes feizes fuddenly
and with great violence, but more commonly comes
on in a more gradual manner. In this laft cafe, it
often begins with a fenfe of weight, as if there was
a leaden cap on the patient’s head 3 oftentimes with
a fenfe of turgefcence and fullnefs 3 often too with a
ftiffnefs and conftriction about the head 3 frequently
there is a fenfe of cold about the head, or perhaps,
an affection of the ikin and hairs, which become
more or lefs briftly. The diforder beginning gene¬
rally with one or other of thefe fymptoms, changes
to a more formal and fixed pain : this, again, is°of

various

532 Cullen's Clinical Lectures *

various kinds ; frequently a kind of forenefs is felt
over the fkin of the head, fuch as is ufual after any
great fatigue, and what is called, by feme authors,
la [Jit u dp ulcer of a ; fometimes there is a fenfe of bli¬
nds, as if fomething was conftringing the head, or
violently diftending it. Thefe two are often con¬
founded together, as they fomewhat imitate each
other. Oftentimes there is a more piercing pain
or tenebrus, as if a nail was thru ft into fome parti¬
cular part. All thefe are attended with a ftrong pub
fation in the temporal arteries, and in the other parts,
and which is even perceptible by the eye. Thefe
different feelings of pain are again diftinguifhed as
they are more diffufed or definite ; generally they are
limited fo as to affeft one fide more than the other;
they are often fituated over one eyelid, as alfo upon
the fummit of the head, but more towards its ante-
terior part ; frequently they are confined to die tem¬
ples, or perhaps to the temporal mufcles ; wherever
they fix, they are more gentle at firft, but gradually
become very violent. This is commonly attended
with a fenfe of heat; often the face becomes turgid
and ruddy, but not with an uniform rednels, but
difcoloured with red fpots ; fometimes, however, it
is without any of this turgefcence, rednefs, or bloat-
ednefs, and the whole countenance is pale and cold.
When thefe pains are very fevere, and continue for a
long time, the eyelids fall, tears flow involuntarily,
the eye is fuffufed, and the albuginea more or lefs in¬
flamed, and vifion becomes obfeure, or is entirely
deftroyed. Commonly, there is more or lefs ver¬
tigo added to thefe fymptoms. The ears are alfo
affefted, as they have a fenfation of various noifes,
as of ftorms of wind, ruffling of waters, tinnitus, & c.

‘ Oftentimes too the fmell and tafte are affefted,
and almoft deftroyed. But wre muft obferve, that,
inftead of thefe fymptonts, there is frequently an in-
creafe of fenfibility, fo that the fmalleft light, or gent-
left noife, difturbs them. The internal fenfes are alfo

affedled.

Cullen’s Clinical Lectures . 333

affefted, the memory is impaired, the imagination
incoherent, and, from a want of attention, the judg¬
ment is difturbed. Sometimes it produces a deliquium
animi, though not very frequently. It often is at¬
tended with bilious vomitings, and commonly with a
coftive belly, and palenefs of urine. After all thefe
have continued for fome time, a ftupor and Deep come
on, which terminate the fit*

4 AS to the ftate of the pulfe, oftentimes, even in
violent and long-continued head-achs, it is not fen-
fibly altered from its ordinary ftate. In other cafes'
it is altered, and very varioufly, becoming not uncom¬
monly lefs frequent than before. In other cafes it is
not changed in its frequency, but becomes fuller dur¬
ing the paroxyfm, efpecially in the parts affected,
whence arifes the throbbing and perceptible pulfa-
tion, accompanying this diforder. But fometimes this
fulnefs is alfo accompanied with an increafe of fre¬
quency.

4 We mentioned the different ftates of the tempe¬
rature of the parts ; and the connexion between this
and the ftate of the pulfe is very difcernible. Thus,
where there is a fenfe of cold with a pale fkin, the
pulfe is either lefs frequent, or, at leaft, is not in-
creafed in that reipeft. Where there is a heat in
the part, frequently accompanied with fwelling, and
with more or lefs rednefs, the pulfe is more full and
frequent. We have now fpoken of the form of the
difeafe, and fhal.l only add a few general remarks
upon this form. The paroxyfms vary in the degrees
or violence, duration, and period. They come on at
different times of the day; as, in fome, in waking in
the morning ; in others, at noon, or foon after meals ;
frequently in the evening ; and in fome perfons, after
going to bed, and towards midnight. They differ
alfo greatly in their duration, continuing for fome
hours, fometimes for days. They have alrnoft always
a remiffion, and return at a certain interval, which in

vol. v. Bb fome

Cullen’s Clinical Lecturer

feme are exaft, in others very irregular. Of the exatF
intervals there is alfo a great variety, fome returning
daily, others in a tertian form-, fome monthly 5 others-
again, annually.

‘ The consequences of thefe head-achs, are fre¬
quently one or other of the various diforders of the
head, as oblivion, fatuity, and mania. Oftentimes
they end in the epiiepfy, .palfy, or apoplexy: fome-
iirnes they fall upon the exterior parts of the head,
affefting the lenfes and their peculiar organs, as the
eyes, with more or lefs fuffudori, and often with an
amaurojis or guild ferena ; and alfo the ears, impair¬
ing or de droving the fenfe of hearing. A common
effeCt, where the pain is htuated over one eyebrow,
is to leave that eyelid paralytic. Frequently the
temporal mufeles are affeCted with a palfy or atro¬
phy. Such are the chief effects of an idiopathic
head-ach. v ,

* The date of the body under this diforder, would
be bed learnt from examining it after death. But it
rarely happens that a perfon, dies after the head-ach,
without fome other diforder of the head fupervening,
as the palfy, epilepfy, ike, and then, upon examina¬
tion, we find the fame date of the parts as after thole
diforders. Thus we meet with topical affections, as
tumours, abfeeffes, various er olio ns, maj*ks of accu¬
mulation, dagnation and e fib don ot blood, and ferum
in the brain. It is not certain, whether thefe are
eaufes or effefls, exiding previoufly before the head-
ach, or both thefe ; and tho-fe fu p erven in g diforders
feeing the effects of the head-ach frequently recurring:.
Either of thefe is fufiiciently probable; and fome-
times one, fometim.es the other feems to take place.

c In head-achs of very long duration,, it is difficult
■to conceive any primary topical affeflion of the brain,
ib that thefe mud often be the effects of the head-ach :
yet inftances of fuch topical affections have been
found after accidental deaths, and fuch as were
-not immediately connected with the head-ach 3 which

feems

Cullen’s Clinical Lectures . 335

jfeenis to fhew; that they fometlmes exift before the
head-ach.

c In order to judge here what are the proximate
caufes of the head-ach, and how it may operate in
producing thefe topical affections* or the diforders
attending it, wTe mull; enter into the theory of the
difeafe.

f In the hr ft place, the head-ach may proceed from
fimple fulriefs, and the diftenfion occasioned thereby,
which gives the cephalalgia pletlionca. Thus we lee
it manifeftly arifing from all the caufes which pro¬
duce or encreafe a fulriefs of the blood-veffiels* which
occalion a temporary rarefaction, or which determine
the blood in a greater force, or in a large quantity to
the velfels of the head. This is fufficiently explained
by the occafional caufes of the diforder, which wre
have already mentioned : we fhall only illuftrate it by
a fingle inftance of a perfon wrno laboured under an.
afcitess founded on fteatomatous tumours, occupying
a large portion of the abdomen; this compreffing
the bloodweffels, produced many varicous fwelJings
in the velfels of the lower extremities, and a con-
ftant fulnefs in the veins of the head, fo as to oc ca¬
ll on violent head-achs ; in particular, any Hooping
brought on head-ach, dimnefs of fight, giddinefs,
flupor, partial paralytic afFeCtions, and fometimes
formal fits of the apoplexy, lading feveral hours.
This (hews how the head-ach may frequently be
produced by various inclinations of the head. This
is the mofl fimple view of the head-ach, as depend¬
ing on plethora, which is often flight and traniitory,
though there is a variety in this refpeCl according to
the caufe. Thus, even in this plethoric Hate, when
there is a greater tendency to heemorrhages, there are
more formal paroxyfms of the head-ach. Haemor¬
rhages are commonly faid to depend, on a fulnefs,
and increafed impetus of the blood in the fyftem,
and, perhaps, on a particular debility in thofe veffbls
In which the rupture takes place. But this notion

Bb 2 of

336

Cullen's Clinical Lectures .

of fpontaneous haemorrhages, is not cor re ft ; and to
explain the nature of them, we mult have recourfe
to Hoffman, who, in his chapter upon the haemor¬
rhages of the nofe, tells us, that they are begun by
a fpafm, or ftrifture of the veffels of the extremities,
whereby the impetus being inereafed in thefe vef¬
fels in the head, the blood burfts. But this will not
be underftood, without being acquainted with his
doftrine of fevers.

4 There is another cafe depending on a rheumatic
affection, or the fame with that occurring in rheu¬
matic affedtions of other parts. Here there is an
inereafed impetus in veffels not fuited to haemor¬
rhages, as being inclofed in the membrane of the
mufcles. To underhand this, we muft look into the
writings of the Stahlians, who tell us, that they are
conge ft a c ample la et incompleta , the former of which
anfwer to the proper haemorrhages, and the latter to
the rheumatic ; fo that in both they fuppofe there to
be the molimina hemorrhagica, and an inereafed
impetus.

4 This doftrine, with a little improvement, would
be very juft. What the difference in the liate of the
veffels is, we iliall not explain at prefent. B elides
this, there is, perhaps, fome difference alfo in the
caufes of each. But however this may be, it is cer¬
tain that there is a paroxyfm of the head-ach. of the
rheumatic kind : there is likewife another of the arth¬
ritic kind, which is alfo another of the congefta.—
How far this differs from the rheumatic in topical
affections-, is difficult to explain. It differs however
in this, that arthritic arifes from an interruption of
the ufuai determination of fuch arthritic affections,
and is. relieved by their return. There is a fourth
cafe depending on a topical fever.

c Intermittent fevers, during an epidemic period,
often operate folely in producing, head-achs. Per¬
haps then we have head-achs precifely in the fit na¬
tion of intermittent^ with this difference only, that
they are topical inflead of general. Whether there

are

337

Blizard on the large Blood-veJJels , Sc.

are not topical fevers of other kinds, which are the
foundations of various head-achs, is not determined,
but feems probable. Thefe four fpecies appearing
in paroxyfms, are all analogous ; and in proportion as
a perfon is acquainted with the doctrine of fevers, will
he underhand the hate of thefe head-achs, and their
proximate caufes. They begin with a cold fit, or
with fymptoms analogous to it ; fuch as, a general
horripilatio , and a fenfe of coklnefs in the part, which
is frequently fucceeded by a hot fit, firewing at leaft
an increafed impetus in the part itlelf. Sometimes
this is communicated to the reft of the fyftem, and
produces a more frequent pulfe. They terminate alfo
like levers, with hcemorrhages, fweatings either in the
part itfelf, or more generally ; and oftentimes tumours
of a particular part, as in the rheumatifm. Frequent¬
ly they are without any fenfible refolution ; but this
alfo happens in many fevers.’

We muft referve the conclufion of this intereftmg
fubject for our next number.

Art. XXXVIII. A Lecture on the Situation of the
large Blood-vejfels of the Extremities ; and the
Methods of making effectual Pre (jure on the Ar¬
teries , in Cafes of dangerous Effufions of Blood
from Wounds : delivered to the Scholars of the late
Maritime School at Chelfea ; and firft printed for
their life. Third Edition : to which is now added
a brief Explanation of the Nature of Wounds , more
particularly thofe received from Fire-arms. By
William Blizard , F. B. S. Twelves, 8 4 pages*
price 3s, London, 1798, Dilly,

LITTLE argument is wanting to prove the bene¬
ficial confequences which might refult to foci-
ety, were the knowledge of the lituation of the large
blood-veffels of the extremities, fo far as is necelfary

B b 3 fox

33S B lizard on the large Blood-vejels , &c.

for checking dangerous effufions of blood, and the
ufe of the tourniquet, more general % not confined
to the navy and army, but extended to colleges and
fchools, particularly to military and nautical aca¬
demies, manufactories, fipfpitals of every defcrip-
tion, prifons, plantations, fire-offices, the clergymen
pf parifhes in which no furgeons are refident, com¬
manders of merchantmen, miners, &c. The expe¬
rience of moll perfons, the author remarks, could af¬
ford inflances of danger or death through defeft of
this knowledge.

The defcriptions and inftruftions here given, are
fo clear and explicit, as to be readily comprehended
by any ordinary capacity 3 and though intended for
the ufe of the public only, are yet well calculated to
form a manual for the younger and more inexpe¬
rienced part of the profefliom A neat plate, which
is prefixed to the work, reprefenting the coupfe of the
principal veflels of the limbs, will no doubt add great¬
ly to the effefl and utility of the verbal defcriptiqn.

I he remarks on wounds contain every thing which
could be reafonably expefled within fo narrow a com-
pafs. Ihe moft prominent features are felefted, and
thofe^ only which have an immediate reference to
practice. Ihe following obfervations on amputation,
and the fecuring of veffels, will give our readers* a
favourable idea df the execution of this little tra6t.

Amputation is to be performed only under cir-
cumftances, unequivocally expreffing it to be pecef-
fary for the prefervation of life.

€ Events, in gun-fhpt wounds and compound frac¬
tures,^ feem tp juftify the aflertion, that fuccefs oftener
attends amputation after fuppuratipn, than when per¬
formed before that period.

Ihere are, however, occurrences in thefe and
Other ^ defcriptions of cafes that at once determine
their judgement as to the propriety of immediate am¬
putation 5 and, independently of the hurt, abftraftedly

confidered.

Blizard on the large Blood-vejfels, Me. ' 339

confidered, there are many things that will have great
weight in deciding upon the operation as the belt
expedient* even when* prima facie , the nature of
the injury may be fuch as, under more favourable
circumftances, might juftify a lefs fevere decifion, — *
The fituations of wounded people, in a crowded hof-
pital, in an airy plain, in the field of battle, in a
chamber of convenience and fecurity, in the anxious
moment of engagement, when in quiet poffeffion of
the field or the fea, during the hurry of a purfuit, the
alarm of a retreat, &c. are very different, and will
prefent reafons for afting differently in fimilar in¬
juries,

c General chirurgical principles, confirmed by ex¬
perience, mud, however, be adverted to, and fhould
be the guide upon every occafion.

c The more topical or limited the hurt, the more
proper, generally, will be immediate amputation ;
and, vice verfa, A wound, by a mufket-ball, in
the ancle-joint, and one in the thigh, with fracture,
from a cannon-ball, are cafes that illustrate this po¬
rtion. — It is the more neceffary that an inexperienced
perfon fhould well confider this rule, as the figns of
the greater extent and degree of violence might other-
wife be very likely to miflead his judgement.

* The operation ftiodld be done completely beyond
the feat of cmitnfion , as well as of fratture, &c. This
plain rule, alfo, is of great importance : the utmoft
care, therefore, is neceffary in determining upon the
nature and boundary of the injury.

‘ Gun-fhot wounds in the joints generally require

imputation.

< In every cafe of wound of a large artery, it is
fiafer to make a ligature upon each divided extremity,
than to truft to one only : branches may fupply the
lower portion, and continue or renew' haemorrhage.

‘ The period of feparation of contufed and dead
parts muff be religioufly watched. ihe alarm oi
bleeding may happen when not expected from any

B b 4 ftgn

340 Blizard on the large Blood-vejels, 8Cc.

fign of coDtiiiion ; and life will confequently depend
upon immediate affiftance. The retracing of a veffel,
or fainting, may fufpend hemorrhage, that may after-
wards occur, and prove fatal.

‘ Whenever ligature can be made in the cafe
of an opened artery, it ought to be done. Nothin o-
tluTi. bears the title or styptic is to be depended
upon. r

6 Men ^ould be wary how they give their fanaion
to dependence upon styptics in preference to cer¬
tain means of flopping haemorrhage. A little matter
will fom e times fuffice to reftrain a bleeding In an
amputation of the leg, below the knee, of a boy
eleven years of age, at the London Hofpital, all the
arteiies retradled fo much that not a ligature was
rnaae, and he was foon well. If any thin0" called
flyptic had been employed in this cafe, it would have
acquired unmerited reputation, and the lofs of many
valuable lives might have been the confeouence
.* Refiftance to a flow of blood may be made by
divers means, that may prove effeaual in bleedings
from fin all arteries; but are always to be regarded as
fallacious in divifions of large veffels. *

Mealy, and tender fibrous, fubftances, united
with the blood, may form a, relifting pafte. Acids,
iptrit of wine, &c. may coagulate the blood, and fo
occalion refiftance. Stimulating things may excite
the extremities of divided veflels to contract, and
retract, and thence refiftance may be caufed. Coagu¬
lation of the blood in the coats of a divided arteryf as
well asm the tube ltfelf, and, confequently, death of
the veil el, may happen from heat, and various things
< a.led caufhcs. Solutions of refins may be decom¬
pounded by the blood in the part, and' the 'refinous
coagulum may obftrua the divided velfels, as with
the compound tincture of gum-benjamin, tinaure of
myrrh, tcc. ; and fome of thefe properties may be
united m the fame article: but experience has de-
monftiated the fallibility of all fuch means.

'* Unhappily

Rlizard on the large Blood-veffels , Kc. 341

* Unhappily, however, there are occafions where
ligature cannot be made ; and it fometimes happens,
that the trial of a ftyptic may be admiffible, even in
cafes where ligature can be performed. Oil of tur¬
pentine, applied by buttons of lint, will generally
prove the mod: effectual article of the clafs of ftyptics :
being made hot, its ftyptical property becomes con*
fiderably augmented.

c Rut, molt of all, next to ligature, compression
is to be depended upon. This may be made by
means of compreffes of linen, lint, &c. either againit
the ends of the veffels, upon their Tides, or in both
ways. Sponge is admirably adapted for preffure $
but, when it is employed, the rationale of its ufe
fhould be remembered. The end purpofed will de¬
pend upon its elaflicity. It is, therefore, to be fo
preifed into, or upon, the part, as, when expanded,
to maintain a proper degree of preffure againft the
open veffels.

‘ Ligature may be made with the greateft proba¬
bility of fuccefs upon any artery of the upper extre¬
mity; and upon any artery, below the ham, of the
lower extremity : arid there is forne probability that
ligature may be fuccefsful below the large artery,
called arteria profunda , that goes off from the artery
in the groin: but no perfon is to be buffered to die
by haemorrhage that can be reftrained, from any vef-
jfel. What may pojlbly happen cannot be foretold.
The very order of things, in the diftribution of the
veffels in the part wounded, may be reverfed ; and
it fhould be remembered, that the nourifhment of the
parts below may be effectuated through the gradual
dilatation of myriads of communicating fmall veffels,
in the ratio of their diameters, where no large artery,
that can itfelf carry on the circulation, exifts.

c The difficulty of effectually fecuring bleeding vef¬
fels increafes much by the lofs of time ; efpccially, if
irritating ftyptics have been employed. The adhe¬
sions, thickening of cellular fubftance, & c. that fol¬
low.

$42 BJizard on the large Blood-vej}ehp

low, render it oftentimes no eaiy matter to afcertain^
and properly bring to view, the injured veffel : nor is
fuch a date fo favourable for the event of a ligature
as the condition before inflammation. Experience
has proved it a fafer general practice, in the cafe
of pun&ure or divifion of a large blood we fie!* at
once fo far to extend the wound as to allow of tying
the artery with eafe and proper effeft.

c The elaftic forceps are convenient for holding
veffels while ligatures are made upon them ; but,
in precarious fituations, it is fafer to ufe the needle
and ligature ; taking great care, however, to leave
out diftinguifhable nerves. The many-tailed flannel
bandage is the bed for the thigh after amputation.
By cutting oft one of the portions of a ligature, the
bulk of extraneous matter in a wound is favourably
Idfened. 1

c There is fometimes a date of dreadful apprehen¬
sion, concerning operations, even in perfons of urn
doubted courage. An occurrences fojne years fmces
at the London Hofpital, will exprefs this in a Striking
manner, and may convey* feme inftruflion. A fo¬
reigner was to have his leg amputated, on account
of a difeafe in it through which he was finking. He
was fo reduced, that it was determined to perform
the operation on his bed. At the moment of pro*
ceeding to the incifion, he fuddenly raifed himfelf,
fainted, and fell backwards. He thus continued
feme minutes, with a pulfe barely perceptible. He
then recovered a little, again darted up, afked, “ Is
my leg off?” and, upon being told it was not, faint*
ed again. It was judged, that he would inevitably
die without amputation ; that he would probably die
from repeated fainting ; that the operation, performed
with due care as to lofs of blood, would tend to
roufe, indead of weakening, the aft ion of the heart
and veffels ; and that, therefore, it ought to be per*
formed. It was done, with as much expedition as%
poffible.— 1 The operation was entirely finished, when

Crichton on Mental Derangement f fc 343

" %-j j •}'$ \ i* • i

J ** ft

he again raifed himfelf, and pot the queftion as be¬
fore. Being affured that his leg was removed, he
inftantly became cheerful, and fainted no more. He
left the hofpital perfectly well ; and always declared,
that he had not the lead painful fenfation from, or
confcioufnefs of, the operation.'

Art. XXXIX. An Inquiry into the Nature and
Origin of Mental Derangement ; comprehending a
concife Sijjiem of the Phyjiology and Pathology of
the Human Mind , and a Hijtory of the Paffions
and their Effects , By Alexander Crichton,
M,D. Phyfician to the Weftminjler Hofpital , and
Public Lecturer on the Theory and Practice of
JPhyJic , and on Chemijlry . 2 Vols. Oftavo, price 12s.
boards. London, 1798, Cadell and Davies.

r^pHE work, the author obferves in his preface,
I which is at prefent fubmitted to the judgment
oftlie public, is an attempt to reduce, under certain
fixed principles, a number of loofe faffs, which
abound in the writings of medical men, metaphy-
ficians, and philofophers of different ages and of
various countries. Many of thefe faffs have been
Jong known ; others, from the late period and foreign
languages in which they have been communicated,
it is prefumed, are only partially lo ; but although
they all relate to diforders which are common in
civilized nations, and are daily becoming more fre¬
quent, and are univerfally lamented, as conftituting
the greateft calamity to which mankind is fubjeft;
yet it is generally confeffed, that the attempts to
throw light on their real nature have been very few,
and thefe few have not been fuceefsfuh

If we except, Dr. Crichton remarks, Dr. Arnold
of Leicefter, no other author in this country has
written fully qn the fubjecf of mental derangement.

Monfieur

344 Crichton on Mental Derangement , 8Cc.

Monfieur Dufour is the only author, fince the time
of Sauvages, who has written on them fyltematically
in France ; and although the German prefs has fent
forth a vaft number of publications which relate to
difeafes of the human mind, yet they are only collec¬
tions of cafes, hiftories of individual difeafes, or ac-
* counts of new remedies ; for no author of that learned
nation has written either fully or fyltematically on
Vefanice ,

The method which the author has adopted through¬
out the whole of the work, is that of analyhs. This,
v he obferves, is the genuine touchftone of truth, not
only in matters of external fenfe, but alfo in obje&s
of abftraCt reafon ; for, as in conducting this mode of
inquiry, every conftituent or elementary part mult be
feparately examined, it is the fureft way of detecting
error j and as all complex ideas become clear, in
proportion as the individual parts of which they
are compofed are diftinCtly reprefented in the mind,
io it is the beft mode ot eftablifliing well-founded
refill ts.

When the work of analyfis is completed, the molt
ufetul and difficult part remains ; that of applying the
re full, or general principle, to explain and arrange
the individual faftsf It is this, indeed, which dif-
tinguithes the man of fcience from the mere fcholar.
It is, of all mental employments, the molt difficult, the
moft liable to. error, and yet the moft valuable when
w7ell accomplifhed. It is the abridgement of faCts.
and fimplification of all knowledge. Experience and
obfervation teach us a vaft crowd of fafts. We mul¬
tiply thefe by analyzing them ; in analyzing them we
generally obtain a knowledge of the caufes of a num¬
ber of their properties, and often of the caufe of their
production ; and we are thus enabled to reduce a
number of effeCts under a few general principles.
Hence the utility of this procets. But that it is a
procefs which is often dangerous, and even hurtful to
fcience, mult alio be admitted. It is dangerous when

Crichton on Mental Derangement , Sfc. 345

we try to reduce general principles under principles
{fill more general ; or, as it were, to find out the ulti¬
mate fource of all our knowledge ; for where are the
faffs to' guide us in fuch a refearch ? The ultimate
principles are excluded from human refearch, but,
unfortunately, not from human curiofity. It is hurt¬
ful to fcience when a man of genius attempts to re¬
duce the faffs of any branch of fcience under general
principles, while the faffs themfelves are too fcanty
to admit of juft conclufions being drawn, for then
wild hypothelis muff neceftarily arife.

The work is divided into three parts or books. In
the firft, the phyfical or corporeal caufes of delirium
and other derangements of mind— in the fecond,
the various morbid changes which each faculty of
the human mind is fubjeff to, either from an over-
ftraining, or from an original or acquired difpropor-
tionate activity, are inveftigated. In the laft book,
the Paffions are treated of.

Such is the general outline, and which leads to a
detail of vaft extent. It is not, however, to be fup-
pofed, that the fubjeff has here been purfued through
all its windings, and in all its minute ramifications*
Neither the life, nor- -the faculties of an individual,
would fuffice for this. As far as it goes, however,
the prefent work evinces long and laborious invef-
tigation in its author. We could have wifhed it had
been lefs defaced by verbal and typographical errors :
errors, which a little more attention, and a little lefs
hafte, might furely have prevented.

In the firft book, as has been already ftated, the
phyfical caufes of Delirium are inveftigated. The
firft chapter, here, is occupied on the iubjeff of the
principle of Irritability and its laws. Thefe are com¬
prized in the following axioms, which are partly new,
partly modifications of thofe of Fontana and Gir-
Xanner.

Axiom

346 Crichton on Menial Derangefnent , Sic*,

Axiom I. After every adrion in an irritable part,
a ftate of reft, or ceftation from motion, muft take
place betore the irritable part can be again incited
to action.

Axiom 2. Each irritable part has a certain portion
or quantity of the principle of irritability, which is
natural to it, part of which it lofes during addon, or
from the application of ftimuli.

Axiom 3. By a procefs wholly unknown to us, it
regains this loft quantity during its repofe or ftate of
reft.

Axiom 4. Each irritable part has ftimuli which
are peculiar to it, and which are intended to fup-
port its natural addon.

Axiom 5. Each irritable part differs from the reft
in regard 'to the quantity of irritability which it poft
feffes.

Axiom 6. All ftimuli produce addon in propor¬
tion to their irritating powers.

Axiom 7. The addon of every ftimultis is an in--
verfe ratio to the frequency of its application.

Axiom 8. The more the irritability of a part is
accumulated, the more that part is difpofed to be
adted upon.

Axiom 9. If the ftimuli which keep up the adtion
or any irritable body be withdrawn tor too great a
length of time, that procefs on which the formation
of the principle depends is gradually diminifhed, and
at laft entirely deftroyech

Thefe are the general laws agreeable, to which irri¬
tability feems to be regulated in producing its various
phenomena.^ The next queftion is, what is the nature
of this principle ?

Of late/ Dr. Crichton obferves, c a newr dodlrine
has arifen, which has been dignified with the refpedl-
able title of a theory. The proofs of its truth, however,
are fo fcanty, and fo many fadls remain unexplained
by it, that it cannot be allowed fuch an honour. Dr.

Girtanner

Crichton oil Mental Derangement , Kc. 347

Girtanner is the firft: who confiders irritability to be
nothing elfe than oxygene, the bails of pure air. — -
This opinion has been adopted by Dr. Beddoes, and
a few other pneumatic doCfors.

* In examining this hypothecs, it is impoffible for
any one who has a juft fenfe of the value of candour
in another, not to be hurt by the manner in which
Dr. Girtanner conceals difcoveries that have been
made, and conjectures that have been offered to the
public long before he wrote. There is a fpecies of
egotifm in fome authors which is fo powerful as to
make them hide not only the fources from which
they borrow their ideas, but often to afcribe to them*
ielves the merit of difcoveries to which they have no
kind of claim. The opinions of their opponents,
when eafily combated, are all brought forward, be-
caufe the refutation of thefe adds to their glory ; but
the combats of others who have fought fuceefsfully
before them in the fame field are not mentioned, for
fear that their fame fhould fuller diminution. Such
a conduct mull neceffarily occafion difguft, a fentb
ment always unfavourable to a wTriter, however great
his talents may be, for it prevents our doing him that
juftice to which he is other wife juftly entitled/

The faCt that oxygene combines with the venous
blood during refpiration, which is mentioned by Dr,
Girtanner as a difcovery of his own, is (hewn to be¬
long to Dr. Goodwin, who publifhed his experiments
long before the wrork of Dr. Girtanner made its ap¬
pearance. . *

The author contends with Dr. Beddoes that fcurvy,
fo far from being a difeafe of fuper-oxygenation, is
one in which the blood is not fufficiently oxygenated.
After bating, with great fairnefs, the arguments ufed
in fupport of this and the other branches of the pneu¬
matic hypothefis, Dr. Crichton goes on to obferve —
c In regard to this theory, (as it is called) I have to
obferve in the firft place, that the whole phenomena
of mechanical and mental ftimuli on the irritable

parts

348 Crichton on Mental Derangement, $Y.

parts of animals are not only left unexplained, but
really hand in direft contradiction to it. Does a
piece of rock-cryftal, a particle of fand, a thorn, or
the point of a pin, all of which ftimulate, draw oxy-
gene from a mufcle ? Can any proof whatever be
given of their having fuff'ered any chemical change
upon being applied to an irritable part ? Yet they
are all of them capable ol exciting inflammation,
when applied to naked veffels, or mufcles. The
fame queftions may be alked concerning our thoughts,
confidered as ftimuli. We choofe to walk, and ac¬
cordingly we get up and walk. In what manner
can the oxygene in our limbs be aflefted by Ample
volition ? The brain mu ft be fuppofed to be a che¬
mical laboratory, and the foul an operative chemift
who prepares agents which have a more powerful
attraction for oxygene than the mufcular fibre. — *
Thefe, it is to be imagined, are fent along the nerves
quickly or flowly, in large or fmall dofes, according
as a man choofes to dance, or to walk, to lift a
load, or to lift a feather.

It is a curious circumftance in regard to this
theory, that oxygene is confidered, not only as the
principle oi irritability, but alio as the agent that a£ts
on it. Dr. Girtanner, indeed, denies this, and fays,
that oxygene, and bodies which contain it in great
abundance, are only negative ffimuli, that is, they
yield it to the mufcular parts, and predifpofe them
to greater action. Cold, which is a negative ftimu-
lus, and hunger, it too long continued, gradually de»
Itroy life ltfelf, in the way in which all negative
ftimuli are fuppofed to produce their effect, that is,
by not fupporting adtion. If bodies which yield oxy¬
gene are to be confidered as negative ftimuli, they
ought,- therefore, to do the fame; but I appeal to
facts if this is the cafe. Does not red precipitate,
when applied to a fore, inftantly excite a violent
action in* the part? Do not corrolive fublimate (oxy¬
genated muriate of mercury,) and white arfenic (white

oxyde

Crichton on Mental Derangement, SCc. 349

oxyde of arfenic) aft in the fame manner? If thefe
fub (lances produce their effefts in no other way than
by cdufing an accumulation of the principle of irri¬
tability, where is the ftimulus which produces the
inflammation ? The oxygene which thefe bodies are
fuppofed to yield cannot be at the fame time the
principle of aftion, and the exciting caufe of aftion.
If a negative ftimulus of this kind were taken into
the ftomach, one would naturally imagine it would
caufe an accumulation of irritability in the whole of
that organ, and if any ftimulus were to aft on the
part, a general inflammation of that organ would
enfue. But how is this to be reconciled to the faft ?
When a perfon dies who has been poifoned bv ar-
ienic, is not the inflamed part limited to thefe places
with which the arfenic has been in contaft ? A
highly inflamed, and fometimes gangrenous fpot, not
larger than a (hilling, or a half-crown piece, is dis¬
covered. All the reft of the ftomach, except it be
thofe places immediately furrounding the fpot, are in
general but (lightly inflamed.

c The manner in which ftimuli aft, and produce
the contraftion of mufcular and other irritable
parts of the body, are phenomena which muft
awaken the fpirit of inquiry in every man who has
the flighted tinfture of it in his mental corapofition ;
but it is not by crude and baity conjeftures that wre
can arrive at a knowledge of thefe myfterious intri¬
cacies of nature. It is for this reafon, that the invef-
tigation of thefe fubjefts (hall be delayed until a
number of other phenomena have been examined.
The deeply learned Bacon, and Boyle, modeftly con¬
ceived, that, previous to the formation of general
principles, it was firft abfolutely necefiary to examine
with much caution, patience, and impartiality, every
faft connefted with the branch of fcience, to which
the general conclufi on related ; but this flow, yet
neceflary procefs, does not well fuit the temper of
the prefent times, Syftems are formed in a trice,
vol. v . C c an4

350 Crichton on Mental Derangement , gc.

and conftituted theories by the authority of one or
two individuals. We Amplify every thing in a moft
wonderful manner, and endeavour to approach the
facred fountain of truth by leaps and bounds, as if
we were fuddenly endowed with powers totally un¬
known to the philofophers of former ages. Man is
a fibre which bends itfelf into a ring, then becomes
a tube, and then an animal *. The principle of his
motions is oxygenef : ideas are motions of fibres J:
vegetables have ideas || : children may be begotten
of any fex, fhape, or feature, at the will of the male
parent §. The whole of living bodies are made up
of a few airs; and the great globe itfelf is only a
fplinter of a fradiured fun.^]7

In the fecond chapter the author treats on Senfa-
tion. After examining the opinions of different au¬
thors on the nature of this faculty. Dr. Crichton gives
the following, hypothefis on the fubjeft. c That the
particles of which bodies are compofed are not in a
ftate of perfect contaft, is a truth eftablifhed in phy-
iics ; for, independently of the repellent power with
which they are endowed, and which prevents their
complete union, a certain portion of heat is conftantly
prefent, which alfo keeps them feparate from each
other. A convincing proof of this pofition is, that
the moft folid body we know may be made to con-
trad! in all dimenfions by withdrawing heat from it,
and may be made to re-expand by giving it its former
temperature. The heat either combines itfelf with
the particles of the body, increafing their natural re¬
pellent power, or it infinuates itfelf between them,
forming atmofpheres for each particle ; and owing to
the great repulfive power which the particles of heat
have for each other, they keep thofe of the body

* Zoonomia, vol. i, fe£t. xxxix. f Girtanner on Irritability.
X Zoonomia, fe£t. iii. j| Same book, fe£l, xiii, $ Same book, leCt.
jfcxxix. J3ufFon’$ Theory of the Earth,

afunder*

Crichton on Mental Derangement, Xc. SSI

afunder. When it is afferted, then, that the me¬
dullary particles which compote our nerves are by
no means in a ftate of perfeft contaft, it is only at
ferting that they are poffeffed of a certain quality
which is common to all bodies. The vafcularity of
the cineritious part of the brain, and of the nerves
themfelves, their ioftnefs, pulpinefs, and natural hu¬
mid appearance, give reafon to believe, that between
the medullary particles of which they are principally
compofed, a fine fluid is conttantly fecreted, which
may be fitted to receive and tranfmit, even more rea¬
dily than other fluids do, all impreflions which are
made on it. I do not conceive that there is any ne-
ceffity for fuppofing it to be of a fupernatural degree
of fieenefs, fuch as the conje&ural sether of authors;
nor is it necefiary to confider the nerves as tubes in
which it circulates. It is a conftituent part of their
texture, lying between and furrounding the medullary
particles. The particles of this fluid, as well as the
medullary part ot the nerves, mull, in common with
ail matter, "have each of them their atmofpheres of
heat, which probably increafes their natural repel¬
lent powers. When any of the particles, then, of
this fluid are forcibly deranged from their natural
fituation, thofe which have been compreffed aft on
thofe neareft them, and thus the figure of impreffion
is tranfmitted to the brain or to other parts of the
nervous fyftem. Hence it follows as a necefiary de¬
duction, that what we confider to be the properties
of external bodies, are more properly fpeakmg, only
alterations of our own nerves. Thefe aie caufed,
indeed, by certain phyfical properties in the oodles ;
but our knowledge of theie properties is combined
with the affeftion oi our nerves. It is on this, that
is founded, in a great degree, the diverfity of tafies,
or judgments, which different people entertain about
the fame external objeffs. But trns view of the fub-
jefl will be more enlarged on in another part of the

Cc 2-

$52 Crichton on Mental Derangement, Ke«

* As the fluid, which conveys the impreffions of

external bodies to the brain, appears to be fecreted

from the fine veffels which fupply the nerves with

nouriftiment, fo it neceilarily follows, that they muft

be varioufly affefted by every thing which alters the

action of thefe veffels, & c.’

y »

Of this hypothecs, as the author modeftly and juftly
terms it, little need be faid. We fear it will go a
very little way in explaining the mode in which im¬
preffions are communicated to the brain. The veil
has not yet been withdrawn from this myfferious
fubjeft.

In the third and fourth chapters, the fubjeQ of
Senfation is continued, together with that of the or-,
gans which contribute to this faculty.

Chap. 5 leads more immediately to the main ob»
je£l of the work : it is entitled. Methodical Inquiry
into the Nature and Phyfical Caufes of Delirium, par¬
ticularly the Delirium of Lunatics.

The general exciting caufes of delirium are reduced
under the three following heads :

iff. Phyfical, or corporeal caufes ; fueh as too great
determination of blood to the head, as in fevers, or
intoxication, difeafed vifcera of the abdomen, poi-
fons, exceffive difcharges, &c.

2dly. Too great, or too long-continued exertion of
the mental faculties, as in the delirium which often
fucceeds long-continued and abftradt calculation ; and
the deliria to which men of genius are peculiarly
fubjech

3dly. Strong paffions, fuch as anger, grief, pride,
love, & c.

Of thefe different caufes, the modus operand i is
inveftigated at length. The following are the au¬
thor’s general deduftions from the different faffs
brought forward. *

* 1ft. We

Crichton on Mental Derangement, He. $5$

* 1ft. We obferve that a mere increafed determi¬
nation of blood to the head, provided the circulation
be fo free that a great congeftion does not arife, is
not the caufe of delirium, fmee in the cafes of fevere
exercife, and in many fevers, where the pulfe beats
120 in a minute, and the face is fluflied and full, no
fuch phenomenon takes place,

c 2dly. That an increafed quantity of blood fent to
the head, or the quicknefs with which it circulates
there, are not the immediate caufes of delirium, is
further evinced by this faff, that the delirium of
fevers, and many cafes of phrenzy, begin when there
is very little quicknefs of pulfe, and often continue
after that fymptom is greatly fubfided.

‘ 3dly. Diffedtions demonftrate in the cleared man¬
ner, that although a vaft variety of morbid appear¬
ances have been detedfed within the heads of deli¬
rious people, efpecially phrenitic patients, yet there
is no one which has been uniformly prefent in all
analogous cafes ; and therefore there is no reafon to
believe, that any one of them is to be conlidered as
the immediate caufe of the alienation of mind, but
rather as accidental effedts, arifmg from various caufes
'tMiich have occurred either previous to the com¬
mencement of the diforder, or during its attack.'
Tumors of various kinds, edifications of arteries and
the membranes envelloping the brain, hydatids, ftony
concretions, increafed vafcularity, diminifhed vafeu-
larity, coloured fpots, increafed denfity, increafed
fpecific gravity ; preternatural laxity, ulceration, rtq>
tured vefiels, extravafations of blood, lymph, and fe~
rum, not only on the furface, but in the cavities and
in the lubftance of the brain ; and independent of all
thefe appearances, a vaft variety in the form of the
fkull, have been detedled in various cafes. The chief
circumftance, however, which proves that they are
rather confequences than caufes of any particular dif-
eafe, is, that they have been found not only in phre-

C c 3 nitic

$5* Crichton on Mental Derangement, &c.

nltic patients, but alfo in idiots, melancholic patients,
hyfterical ones, paralytic ones, and epileptic people.

< 4thly. In all cafes of that peculiar kind of deli¬
rium called phrenzy, the firft phenomenon of difeafe
appears to be a difordered hate of fenforial feeling,
if the expreffion be permitted. All impreffions on
the brain are powerfully felt there. Thofe derived
from the external fenfes, if they are calculated to
excite any defire, or paffion, do fo in a moft uncom¬
mon degree ; and the reaftion of thefe mental impref¬
fions diforder the whole frame. The perfon acts as
if from an involuntary impulfe, which does not ad¬
mit of the operations of reafon. Hurry, uncommon
ftrength, buttle, and violence, characterize all the
actions and expreffions of the patient; every thing
creates an uncommon excitement of nervous energy
in him,

* We have had reafon to believe that the medium,
by means of which all impreffions, ah externa , are
conveyed to the mind, and ail thofe arifing in the
mind are communicated to the various parts of the
body, is a peculiar fluid fecreted, or at leaft formed
in the medullary fubtianee of the nerves. This re-
' fleftion, and the previous conclufions drawn from the
prernifes already laid down, naturally give rife to the
conjecture, that the principal caufe of fuch phrenzy
and deliria as have been defcribed, mult be a pecu¬
liar morbid action of the veifels which fecrete nervous
matter, efpecially the fluid in q'ueftion. . It may be
altered not only in quantity but quality. This idea
is much ftrengthened by the confideratfon that the
natural and healthy phenomena not only of the whole
body, but of Angle parts, and efpecially all fecreting
organs, are much affefled by difeafed vafcular afiion.
One fet of fymptoms proceed from the mere phyfical
derangement which the uncommon aftion of the vef-
fels produces on the folid particles in their neigh¬
bourhood. Another arifes from the changes in the

, fluids

Crichton on Mental Derangement , $c. 35*5

fields which circulate through them, and confequent-
Iy in the fecretions they perform.

c Although the force and quicknefs with which
the heart and arteries aft is extremely different in
different individuals, and probably alfo in different
parts of the fame individual, it is a fair conclusion to
fay that there is a peculiar one which fupports the
healthy aftion of each individual. The expreffion
difeafed , or morbid action , is one by which is meant,
in a general fenfe, all deviations from this healthy
aftion.

c It is impoffible for us to afcertain either the pe¬
culiar nature or number of all the difeafed aftions of
which the vafcular fyflem is fufceptible ; far lefs thofe
which happen to the veffels of particular parts in
various difeafes. The difference that.exifls in the
natural aftion of various parts, is by no means un¬
derflood. Of morbidly increafed arterial aftion, one
kind is peculiar to gout, another to acute rheumatifm,
another to venereal inflammation, another to fcrophu-
lous inflammation, another to eryfipelas, &c. Now,
although it is natural to fuppofe that in general the
adlion of the remote branches of the arterial fyflem
may be fuppofed to correfpond with that of the larger
arteries, yet we have undoubted proof that this is not
always the cafe. Their aclion is often altered in
many very remarkable degrees, without any corref-
ponding change of action in the heart, or fyflem of
larger blood-veffels. This is proved by cafes of to¬
pical inflammation of all kinds, in which the healthy
appearances of the part affefled are all changed, and
yet the circulation in general goes on as ufuaf. It is
alfo proved by many difeafes of the fkin, by fecon-
dary venereal fores, fcrophulous tumours, &c. In
many cafes, indeed, of topical difeafed arterial aftion,
the fyflem at large is deranged, but in fuch cafes it
is not owing to the difeafed acSlion becoming general,
but to a number of fecondary caufes ; that is to fay,
the topical difeafe, produces a certain number of

C c 4 events *

556 Crichton on Mental Derangement , 8Cc.

events; thefe become the caufe of others, and
thefe others of a third feries, and fo on. Thus, cer¬
tain difeafed actions of the veffels of the liver not only
produce uneafinefs there, but alfo caufe the bile to
be much changed from its healthy ftate, both in
quantity and quality; and hence a certain number
of morbid effefits, pain in the ftomach, naufea, vomit¬
ing, faulty digeftion, and lofs of appetite, colic pains,
and violent purging. Thefe, if they continue for
any length of time, produce head-ach, heat of fkin,
third, great languor, and reftleffnefs, and at laft,
cramps in the extremities, and convulfions, &c. So
the difeafed adb’on of the veffels of the brain, which
give rife to phrenzy, operate in a fimUar manner,
An altered date of feeling in the brain is evident in
the quicknefs and vividnefs of the eyes, the irafeibi-
lity and the difordered date of the mental faculties ;
the patient’s infenfibility to cold, and alfo his deprav¬
ed appetite, 8rc. Thefe, if they continue, produce
want of deep, flight febrile paroxyfms, a furious and
ungovernable conduft, wild and incoherent expref-
fions, and fo on.

c But if the aftion of the veffels which fecrete the
fentient principle, be greatly altered from their healthy
ftate, the fine fluid which is fecreted muft undergo
proportionate morbid changes. in order to prove
the effect which any unufual change of the fluids has
on the mental operations, I fliall infert a Angular fatly
mentioned by Dionis in the 498th page of his Conrs
(TOpet 'ations de Chirurgie , He fpeaks of a practice
which was at one time attempted to be introduced,
with a view not only of preventing, but curing many
difeafes.

ihe fadf he fpeaks of is the transfufion of blood,
from certain animals into man. The event, however,
was terrible ; for a great number of thofe on whom
the experiments were made became furioufly mad,
and loon died. The parliament of Paris having gain-
£d intelligence of thefe experiments, iflued a decree.

m :

Crichton on Mental Derangement , SCc. 357

by which it was forbidden, under the molt fevere
penalties, to repeat fuch experiments. His words
are thefe : “ Ils firent plufieurs de ces operations qui
<c devoient felon eux, avoir un fuccefs furprenant;
“ maix la fin funefte de ces malheureufes viftimes
(e de la nouveaute detruifit en un jour les hautes
“ idees quids avoient concues ; ils devinrent faux,

furieux et moururent enfuite. Le parlement in-
ce forme de ce que s’etoit pafle interpofa fon autorite,
€C et donna un arret par lequel il etoit defend u -foils
“ des rigoureufes peines de faire cette operation.”

f This fa ft is brought forward, not with a view of
infpiring the idea that the delirium of maniacs arifes
primarily from a vitiated ftate of the fluids, but merely
to prove that when the fluids are altered, no matter
what the caufe be, they ahvays change the aftion of
the vafcular fyflem,

* Upon the whole, I conclude that the delirium of
maniacs, when it has the peculiar charafter of that
which has been deferibed, always arifes from a fpe-
cific difeafed aftion of thofe fine veflels which fecrete
the nervous fluid in the brain. This difeafed aftion
appears to be one which, independent of its fpecific
nature, by w7hich it is diftinguifhed from common in¬
flammation, or fcrophula, is a preternaturally increaf-
ed one ; and this 1 think is proved by the quicknefs
of the external fenfes, the irafeibility of mind, the
heat of the fkin, the flufhed countenance, and un¬
common energy of body which maniacs evince. This
hypothefls explains the reafon alfo why it often has
periodical exacerbations, and remiffions. They who
believe that tumors, ulcers, and ofliflcations of the
brain, or increafed fpecific gravity, or increafed hard-
nefs of the fame, give birth to mania, mull necefiarily
be at a lofs to explain why the delirium ever ceafes
while fuch caufes exifl ; but if it arifes from difeafed
aftion, it mull ceafe, and may, or may not return, ac¬
cording as a variety of other circumfcances confpire
to its re-excitement/

The

358 Rumball on the Nature and Caufe of the Pulfe , $(c.

The fixth chapter, which concludes the firft book,
treats of Deliria from Morbid Nervous Impreffions.—
The hiftory of Hypochondriacs forms the principal
fubje£t of this chapter.

(To be continued.)

Art. XL. An Attempt to afcertain the Nature and
Caufe of the Pulfe , in a State of Health ; as far as
it depends on the contractile Power of the Heart
and Arteries , and the Mechanical Effect of the
Blood , by Diftenfion. By J . Rumball, Surgeon ,
Abingdon , Berks. Twelves, 49 pages, price Is. 6d.
London. 1797. Johnson.

WE have perufed thefe remarks, without having
been able very certainly to difeover, what it
was the author meant to inculcate. His chief poll-
lion feems to be, that the velocity of the pulfe is in
an inverfe ratio to its ftrength ; adopting the common
law in mechanics, cc that whatever is gained in power
is loft in timed' c As is the quantity or column of
the blood, fo will be its velocity, in an inverfe pro¬
portion to the momentum thereof ; that is, the greater
the quantity, the lefs the velocity, and vice verfa
ihus the force of circulation is fuppofed to be regu¬
lated in nearly the fame degree, both in a bate of
fulnefs, and depletion. In the flow pulfe, a power of
three is conceived to be operating with a motion of
one, for a given time ; in the other cafe, a power of
one adfing with a celerity of motion as three to one,
in the fame fpace of time ; thereby compenfating for
its moderation in degree, and producing ultimately
the fame effect.

# -All this appears to us too mechanical, and ineffi¬
cient to explain the different phenomena. The bates
of infancy and age, indeed, are mentioned as afford-

Rumball on the Nature and Canfe of the Pulfe, & c. 359

ing exceptions to the rule ; but there are others
innumerable.

The power of cold in exciting difeafe is thought,
by the author, to be in fome inftances analogous to
its operation on inanimate bodies. ‘ I have feen,*
he obferves, c an old wine decanter (previoufly heat¬
ed before the lire) fuddenly fiy to pieces only upon
pouring in the cold wine ; and the fame things hap¬
pens every day from the fad den application of heat
to a cold glafs ; but this is not owing to the degree
of heat, but to the fuddennefs of its application, or
the vivid tranlition from one extreme to the other,
bee a ufe the fame glafs, if gradually heated, would
bear heat enough to boil any fluid. To thefe hidden
changes, then, from one extreme to thfe other, fhould
I look for the common caufe of moil of the coughs,
colds, catarrhs, &c. in this variable climate of ours.’
—The fact is perhaps true, but the illuftration is but
a lame one.

Appended to thefe remarks, are two Cafes of
Small-pox during Pregnancy, which deferve to be
recorded.

‘ Cafe 1. On the 28th of April, 1796, Mary
Beckenham, of Sutton Courtney, in the County of
Berks, was attacked with thofe fymptoms which
ufually precede an eruptive fever ; and the natural
fmalf pox being then in the village, it was juftly fuf-
pedted that fhe was infedted with that difeafe ; and
accordingly in the ipace of a few days, an eruption
made its appearance, which from the attendant lymp-
toms during the progrefs of the difeafe, the regular
fuppuration of the puftules, the fubfequent infedtion
of the reft of the family, and the marks remaining
after her recovery, there could be no doubt of its
being the confluent fmall-pox.

< When firft taken ill, fhe was fuppofed to be
about four months advanced in pregnancy ; and from
the great confluence of the puftules, and the violence

$60 Rumball on the Nature and Caufe of the Pulfe, & (c.

of the fymptoms, it was hardly expecfted that fhe
could efcape with her life : however* fhe happily
recovered* and on the 26th of July following, was
fafely delivered, with very little of my affiftance, of
a live male child, bearing very diftinfl marks of its
having been affedted with the fame difeafe as that of
the mother. Now from the ulcerated fpots being
compleatly cicatrized, as well as the diftance of time
from the firft infection of the mother, I think I may
venture to conclude, that this patient had palled
through the difeafe in utero, and furvived it, fo far
at leaft : however, from the lize of the child, which
was rather below mediocrity, the diftance of time
from a certain affeftion of the mother, and the death
of the child in lefs than half an hour after its birth *.

I did alio conclude, that the mother could not be
much more than feven months gone, and that at
any rate the child could not be faid to have paffed
through the difeafe with impunity.’

c Cafe 2. Ann Pufey, of Abingdon, Berks, was
advanced in pregnancy about four months, when a
general inoculation took place through the town ; fhe
was accordingly advifed to remove till after her deli¬
very; but from the preffmg necefiities of her own
family, who were alfo under inoculation, and many
more very urgent reafons, fhe was obliged to remain,
and chofe to run all rilk, rather than be inoculated ;
lire was, however, prepared as for inoculation, and
caught the difeafe, which (he paffed through very
favourably, having but a moderate fprinkling, and
at the period of cuftomary calculation, was fafely de-
. livered of a daughter, without the leaft appearance
of the child ever having been infefted with the dif¬
eafe of the mother. — The child is now feven years of
age,, and I hope foon to have the pleafure of inocu¬
lating her, for the fatisfaftion of all concerned f.’

* This child is preferred by Dr. Pegge in the Anatomical Mufeum
at Oxford.

f When this trial has been made, we hope the author will find fome
means of communicating the refult. ,

Art.

v . . - i

( 361

Art. XLL Defcription and Treatment of Cutaneous*
Difeafes. Order I. Papulous Eruptions on the Skin ,
By Robert Willan, M. D. F. A S . Quarto,
110 pages, with Seven coloured Plates, price 15s.
London. 1798. Johnson.

THERE are few fuhjeCts relating to the fciencc
of medicine, of wriiich our knowledge is fo
limited, or which have been fo imperfeCtly handled,
as that of Cutaneous Affections. Thefe are alike im-
perfeft, in their hiftory, their diagnosis, and their
method of cure. Every attempt, therefore, to il~
luftrate fo obfcure, and, at the fame time, fo impor¬
tant a fubjeCt, merits a favourable reception from the
public. The prefent, however, has a higher claim
on public favour, from the induflry and attention,
which have evidently been bellowed on it, by its
ingenious author ; and from the very accurate repre-
fentations afforded by the plates ; a matter of the
greater import, as it promifes to afford a ftandard of
companion to future labourers in the fame field, the
deficiency of which has rendered much that has been
hitherto written on the fubjeCt in a great meafure
ufelels to us.

Little improvement. Dr. Willan remarks, has been
made in the fubjeCt at large, fmce the time of Avi¬
cenna. Later authors who profefs to treat of it ex-
preflly, do not always furnifh additional materials
from their own obfervation and experience. Their
principal objeCt has been to reconcile the defcription
of cutaneous complaints, given by the Greek and
Arabian phyficians, with each other, and alfo with
the forms of them obferved in this and the neigh¬
bouring countries ; an attempt which can fearcely be
deemed either rational or practicable. AffeCtions of
the fkin rnuft be fuppofed, as well as others, to vary
much in different climates. Is it therefore improper
to apply the fame names, or to eftablifh the identity

362 Willan on Cutaneous Difeafes ,

of difeafes, where the refemblance perhaps confifts in
only one or two circumftances of fmall importance ;
more efpecially, fince the obfcurity and want of pre-
cifion in the descriptions left us by the ancients fome-
times render it difficult to afcertain their meaning.

The Greek writers, the author obferves, afford a
tolerably diftinft account of phlegmone, eryfipelas,
herpes, and their varieties ; as alfo of feveral local
tumours, under the name of phyma, anthrax, phy-
gethlon, dothien, epinyftis, terminthus, jonthos, &c.
Of the formidable difeafe termed elephantiafis, they
have given a minute and elaborate defcription. Some
more ftriftly cutaneous affeftions they denote by the
terms cnefmos, lichenes, pfora, and lepra : which
though diffimilar in their form and progrefs, are
arranged under the fame genus, from a theoretical
notion refpefting their caufes. In like manner the
alphos, leuce, and melas, are defcribed as having a
clofe affinity with each other, whilft they really differ
in their principal charafteriftics.

The Greeks have been moil particular in defcribing
external affections of the head ; but miflead us, by
applying new names to the fame difeafe, in different
fituations, or in different ftages of its progrefs. This
will appear from comparing their accounts of pty-
riafis, ceria, achores, meliceris, melitagra; exanthe¬
mata, helcydria, and pfydracia capitis; fycofe, and
lichenofe tubercles of the chin ; madarofis, milphofis,
ptilofis, alopecia, and ophiafis. Of the difeafes^ of
the eyes, teeth, and gums ; alfo of apthai and. other
affedtions of the tongue; of polypi, oezena, &c, their
defcriptions are minutely accurate. Several external
blemifhes, not ranking as difeafes, are alfo mentioned
by them, as ephelides, phaci, chalazia, thymia, pe-
iiomata, celides, rhagades, tyli, myrmeeiac, acroch-
ordones, &c.

Many deficiences are, however, to be noted in
thefe authors : firft, they do not fufficiently defcribe
puftular difeafes, which are the moft numerous and

molt

\Villan on Cutaneous Difeajes , S63

mod important of all cutaneous complaints; nor do
they always diftinguifh puftules from papula and
exanthemata.

2. They give us no regular hiftory of proper ex-,
anthematous diieafes, or rallies : but are falls fed with
a loofe comparifon of their appearances to the efFefts
produced upon the Ok in by nettles and other ftinginy
plants, or by the bites of ideas, gnats, bugs, &c.\p-
plying feveral terms to denote them, as exanthif-
mata, blaftemata, eczefmata, &c. but without any
diftindtive characters, Their only material obferva-
tions are, that fome forms of the exanthemata are
permanent, while others appear and disappear irre¬
gularly . and fin the i, that tnofe or a purple or blade
colour are highly dangerous.

3* T hey fomctim.es employ the fame term to ex-
prefs different difeafes. This is particularly obfer-
vable in the ufe of the word pfora, which they apply
to a difeafe whofe charaCteriftic appearance is a dif-
tribution of fcales in various figures; to a puftular
complaint terminating in extenfive fuperficial ulcera¬
tions ; and alfo to a ciifeafe of the eyes or eyelids.

. 4- charades, or ftruma, their account is very
flight and partial.

Celfus, Pliny, Marcellas, and other Roman au¬
thors. have copied the Greek accounts of cutaneous
diforders, only changing fome of their terms, without
materially improving the fubjeet.

Under Impetigo, as a generic title, Celfus feems to
comprehend the ulcerated pfora, the fcaly pfora, and
perhaps the lepra ot the Greeks, along with fome
o tlier diflimilar affedlions. He conftitutes a genus
vitiligo, including the alphas, leuce, and melas :
under the titles of papula and ignis facer, he has
described the lichenes and herpes of the Greek
writers ; and he includes their alopecia and ophiafis
under the general term area. Celfus, however, is
the. firft who has given a particular account of the

fcabies.

$64 Willaft on Cutaneous Difeafes ,

fcabies, a difeafe mentioned indeed by the Greeks,,
but no where defcribed by them.

The Arabian phyficians are, on the whole, more
diftindt in their account of cutaneous difeafes than
either the Greeks or Latins ; but their fenfe has been
obfcured by very erroneous tranflations. They accu¬
rately defcribe external affedtions of the head ; dif-
tingui thing them into alraba (crufta ladiea), alavirati
(pityriafis), alfahera or the dry fahafati (porrigo),
'and refrengi, the moift or ulcerated fahafati (cerion),
of infants. Balkiati and alvatin they reprefen t as
obffinate forms of the fahafati extending to other
parts of the body. They have alfo particularly men¬
tioned the difeafes of the hair, and feveral fpecies of
baldnefs. Some difeafes affedting the tkin more ge¬
nerally are defcribed by them under the names of
black morphea, white morphea, alguada, black and
white albaras, ufagro, herifiati, and alcharifi, fee.

This multiplicity of terms has been produftive of
confufion ; and is the lefs neceffary, as many of
them do not exprefs different kinds of difeafe, but
rather apply to different degrees of the fame afieaion.
Thus the alguada and white morphea are defcribed
merely as luperficial and flight forms of the white
baras, which anfwers to the leuce ©f the Greeks.
The blacx baras feems to be the impetigo nigra of
Celfus : it is faid to be of the fame nature, and re¬
ferable to the fame caufes as the black morphea, but
to affedt the fiefh and even the bones, whereas the
morphea is confined to the fkin. The ufagro is like-
wife confounded with the black morphea and baras ;
and all of them are fometimes reprefented as appear¬
ances of a more general difeafe, the leprofy or ele-
phantiafis.

In the order of exanthemata, the Arabian writers
have defcribed the effera, and benat, or the plant of
night : tney diftinguifh the miliary rafli under the
title of hafef; and are the fuff authors who have ac¬
curately defcribed the mealies (alhalba). Among the

puffular

Willan on Cutaneous Difeafes, &C. 365 v

puftular difeafes they have alfo given the firft account
of the fmall-pox (algridi); and have defcribed an af-
feftion fimilar to the fcabies of Celfus, which, how¬
ever, is not properly diftinguifhed from the fahafati
and ufagro.

Their ufe of the term bothor renders this laft order
of difeafes very indefinite; lince bothor does not
with them fimply denote puftules, but alfo papula*,
wheals, warts, corns, and every fpecies of tubercle
on the fkin.

The Arabians have exactly copied the Greek ac¬
counts of the anthrax, herpes, and eryfipelas. They
term the laft almefire, and diftinguifh it with great
accuracy from phlegmonous inflammation. They de-
fcribe one form of herpes under the denomination of
Perfian fire ; and comprehend the phyma, phygeth-
Ion, bubon, and terminthus, of the Greeks under
a general term, althoin. The affe&ion denominated
fare feems to be the epiny&is. Their abdemenui
is the Greek dothien, or boil. Of the fcrofula they
have given a more accurate account than the Greek
writers ; and they mention the fwelling of the throat,
which arifes from an enlargement of the thyroid
gland, under the term botium.

Laftly, they have noticed a variety of local affec¬
tions, which it will be fufficient at prefent to men¬
tion ; baraffen (lentigines), alguaffem (livores) ; al-
cola (aphthae), alefirati (rhagades), alhafaph (inter¬
trigo), afec (tubera), alcoalib and iutefula (verruca)
mifmar (clavus), alcahas (paronychia), afalha (lupia),
and albedfanem, which comprehends red fpots of the
face, and ulcerations, from cold, on the extremities.

Of the modern authors on the fubjeft of cutaneous
difeafes, it is obferved, that they not only give va¬
rious interpretations of the accounts left us by the
ancients, but have perverted the fenfe of many paf-
• fages, in the Greek writers more particularly. They
"alfo make artificial arrangements by no means con¬
fident with each other ; feme reducing all the difeafes

vol. v. D d under

366 Willan on Cutaneous Difeafes, Kce

under two or three genera ; whilft others* too ftudious
of amplification, apply new names to different ftages
or appearances of the fame complaint. Thofe who
attempt to give theoretical views of the fubjeft at
large, are feldom clear and fatisfatfory : and there
feems a peculiar impropriety in clafhng the difeafes,
as fome have done, from hypothetical principles,
rather than from their obvious charafteriftic appear¬
ances.

Having given this hiftorical fiketcfi, Dr. Willan pro-
ceeds to affign the limits and natural divifion of his
fubjeft. The firfl point, therefore, is to fix the fenfe
of the terms employed, by proper definitions—: to
conftitute general divifions or orders of the difeafes,
from leading and peculiar circumfiances in their ap¬
pearance : to arrange them into diftinft genera: and
to defcribe at large their fpecific forms, or varieties— :
to claflify and give names to fuch as have not been
hitherto fufficiently diftinguifhed— : and laftly to fpe-
cify the mode of treatment for each difeafe.

Every genus is illuftrated by coloured engravings,
reprefenting fome of its molt finking varieties.

The prefent volume contains only, as is exprefled
in the title, the Order Papula * ; and of this the au¬
thor has conftituted three genera : viz. Strophulus,
Lichen, and Prurigo.

The Strophulus includes in it the Red, and White
Gum, the Tooth-rafh, and other eruptions peculiar to
Infancy. They are, for the moft part, mild affe&ions,
requiring little peculiarity of treatment.

The fecond genus is that of Lichen, a word which
has feldom been employed twice in the fame fenfe.
The following, however, is the definition affixed to it

* Definition . A very fmsll and acuminated elevation of the cuticle,
with an inflamed bate, not containing a fluid; not tending to fiippura-
ti«m : terminating, for the moft part, in fcurf.

' 4 v by

Willan on Cutaneous Difeafes , <Sfc. 367

by the author. “ An extenfive eruption of papufe
affeQing adults, connected with internal diforder,
ufually terminating in fcurf, recurrent, not conta¬
gious. v

The fpecies and varieties here are, lichen fimplex,
agrius, pilaris, lividus, and tropicus. The firft feems
to be what is in common language termed a critical
rath. It is often, at its commencement, miftaken for
meafles, fcarlatina, & c. and is fometimes confounded
with fcabies.

The lichen agrius appears to be an aggravated cafe
of the former. The following is an inftance of this
affeftion. The fubje£t of it was a lady 36 years of
age, with dark complexion, and coarfe fkin. * Dur¬
ing the year 1793, the had often complained of pains
in the head and ftomach, with a fenfe of depreflion
and faintnefs. Thefe fymptoms were occafionally
troublefome to her till the fpring of 1794, when
they were fuddenly relieved by an appearance of
numerous red, tingling papulae on the arms, and
wrifts. A fimilar eruption appeared about fix weeks
afterwards on the upper part of the breaft, and on
the back, extending to the loins. In all thefe fixa¬
tions, if any of the papulae fubfided, and became
fcurfy, frefh ones appeared : they were always mo ft
vivid, and tingling at night; in the morning itchy,
and lefs inflamed. The rednefs or inflammation
round the papulae was greateft, and moft diflufe in
the flexures of the elbows, where the fkin was alib
interfered with rhagades, or chops. After taking
powders compofed of cinnabar and nitre, with an
infufion of the tops of juniper, for twTo or three
weeks, the eruption wholly difappeared. It returned
however on the arms, within a month ; and in autumn
fome perfon perfuaded her to undergo a mercurial
courfe, which kept her in a ftate of falivation for a
confiderable time. During this procefs, her fkin was
free from the eruption ; but as foon as the effedls of
the mercury had fubfided, her arm was again covered

D d 2 with

$68 Willan on Cutaneous Difeafes> &V.

with numerous red papula?, more painful and tingling
than before. At the beginning of the year 1795, in
the fevere frofl, the eruption aflumed a puftular form ;
the puihiles were fm all, hard, inflamed, and in many
places confluent ; the ulcerations fucceedingthem were
partially covered with blackiih fcabs, but continued
to difcharge a watery fluid for feveral months, and
did not wholly heal till the end of the year. Since
that time the has been much affe&ed with pains of
the limbs, head-ach, languor, and indigeftion. Thefe
complaints are occafionally removed, in confequence
of the appearance of papula? on the arms, and other
parts of the body : but the eruption does not return
at any flated times, nor is fo permanent as formerly.

‘ It may be obferved, that women are much more
liable than men to the lichen agrius, and that the
complaint ufually affeCls thofe who have undergone
long continued fatigue, watching, and anxiety/

The peculiarity of the lichen pilaris is, that the
fmall tubercles or afperities appear only at the roots
of the hairs of the Ikin.

Lichen lividus. The puftules characterizing this
eruption are of a dark red, or livid hue, and more,
permanent than the foregoing. They appear chiefly
on the arms and legs ; and are not attended, nor pre¬
ceded by febrile fymptoms. It principally affeCfs per-
fons of a weak conflitution, who live on a poor diet,
and are engaged in laborious occupations. The
caufes fufflciently point out the cure.

By the lichen tropicus is meant the affection term¬
ed prickly heat , a papulous eruption almolf univer-
fally affefling Europeans fettled in tropical climates.
An account of the appearances in this difeafe, as
found on the Coaft of Africa, is here furnifhed by
Dr. T. M. Winterbottom, Phyfician to the Settle-
. nient at Sierra Leone. A vivid eruption of papulae
fomewhat analogous to the prickly heat, the author
#bferves, appears in our own climate, on the arms,

hands.

Willan on Cutaneous Difeafes , 8fc» 369

hands, face, and neck of labourers, and other perfons -
who ufe violent exercife during the hot months of
fummer. It produces a fenffition of tingling and
fmarting, more than of itching, and difappears in a
fhort time without any particular confluences.

The laft genus of this order, is Prurigo (gratelle
or univerfal itching of the fkim)

The fymptom of itching is common in a greater or
lefs degree to moll difeafes of the Ikin : but there are
fome cafes in which it occurs as the leading circum-
ftance, and is at the fame time accompanied with an
eruption of papular, the colour of which fcarcely ex¬
ceeds that of the adjoining cuticle, and with other
appearances fufficiently particular to conftitute a diP
tincf and independent genus of difeafe.

This difeafe, from its fuppofed affinities, has been
ranked with fcabies, lepra, or impetigo. Not being,
however, characterized, during its firft ftages, by an
eruption of puftules, nor by fcaiy crufts, it muft be fe-
parated from the above affeCtions, in an arrangement
made according to external appearances.

The prurigo, as it arifes from different caufes, or
at different periods of life, exhibits fome varieties in
its form, which are defcribed under the titles of pru¬
rigo mitis, formic ans, and fenilis. The prurigo mitis
appears generally in the fpring or beginning of fum¬
mer, and is characterized by foft and fmooth eleva¬
tions of the cuticle, retaining the ufual colour of the
ikin, unlefs irritated by fcratching. If cleanlinefs is
negleaed, it often changes to the itch; the acarus
fcabiei beginning to breed in the furrows of the
cuticle, the diforder becomes contagious. Frequent
wallring with tepid water is faid to be all that is
neceffary in the treatment.

The next fpecies is important, from its being often
accompanied with general affeCtion of the fyftem :
tor the purpofes of diagnolis we ffiall follow the

Dd 3 author

)

370 Willan on Cutaneous Difeafes , &c.

author in his defcription of the appearances and ac¬
companying fymptorns.

4 The prurigo forrnic.ans is a much more obftinate
apd troublefome difeafe than the foregoing. It ufually
affe6ts perfons of adult age ; commencing at all feafons
of the year indifferently; and its duration is from four
months to two or three years* with occafional lhort
intermiffions. hey are diftufed over the whole body,
except the face, feet, and palms of the hands ; they
appear, however, in greateft number on thofe parts
whicn from the ordinary mode of drefs are fubjeffed
to tight ligatures, as about the neck, loins, and
thighs.

y The itching is complicated with other fenfations,
which are varioufly defcribed by patients. They
fome times feel as if fmail mfefts were creepin°r
on the fkin; fometimes as if flung all over by ants**
fometimes as if hot needles were piercing the fkin
in divers places. On handing before a fire, on un-
dreffmg, and more particularly on getting into bed,
thefe fenfations become mod violent; and ufually
preclude all reft during the greateft part of the night.
When any part of the fkin is ftrongly rubbed, it be¬
comes red ; and large tubercles or wheals are ex¬
cited, which however fubfide as foon as the irritation
ceafes. The cuticle being abraded by the repeated
application of the nails to allay the troublefome fen¬
fations of itching, the furface of the body is every
where fpotted with fmail thin fcabs. This is in many
cafes the only appearance which the difeafe exhibits
to the eye, the papul<e being nearly ot the fame
colour with the fkin, and often indiftina from their
minutenefs.

Where the papula? are of the larger fize above
rne^.ioned, their eruption is preceded by head-ach,
fick ivTs, and pains of the ftomach ; and if they be
fuddenly repelled from the furface, the fame fymp-
tmns return in a violent degree. In other cafes, the
i-ffeaion of the fkin is not fo obvioufly conneaed

with

Wiflan on Cutaneous Difeafes, S(c. S7:I

with a diforder of the ftomach : neverthelefs it may
in general be faid, that this, fpeciefe of prurigo is at¬
tended with a ftate of ill health in the constitution ;
for thofe perfons are molt liable to Suffer frequently
from it, who are of a fallow complexion, who are
weak and fomewhat emaciated, or who labour under
obftruttions of the vifcera. The fame concluiion may
be deduced from the nature of the caufes, which ufu-
ally precede the difeafe : thefe, I have often had
occafion to obferve, are grief, watching, fatigue,
and a poor diet. However, as all perfons are not
equally affefted in the fame circumftances, fomething
mud neceftarily be referred to the original texture of
the {kin, or ftate of the cutaneous ' glands. With re-
fpe£t to this predifpofition, I have only been able to
remark, that the greater number of patients had a
more than ufual coarfenefs or roughnefs of the fkin,
which feemed often to have been communicated
hereditarily: and that when the itching and papulae
difappear at the termination of' the difeafe, the cu¬
ticle is left dry, fcaly, and thickened. This obfer-
v at ion is alfo made by Galen,

‘ To the occaftonal caufes above recited, I may
add the want of proper cleanlinefs, to which the ap¬
pearance of this diforder in the lower clafs of people
is often referable. Certain modes of diet have like-
wife a confiderable efteft in aggravating or exciting
the prurigo formic an s. Many perfons are affedted
with it, who in the fummer feafon live much upon
fifti, and other ftimulant animal food, at the fame
time drinking freely of wine or fpirituous liquors.
Some of the white Spanifh wines excite in particular
habits an eruption of itching papulae, which is excef-
iivelv rroublefome for many hours afterwards,, but
does not become permanent if the beverage be dis¬
continued^ I have feen the fame effeft produced by
wine made of the Mufcadine raifins ; a few giaffes of
it has occaftoned an univerfal itching of the fkin, and
precluded reft for twenty-four hours, or upwards,

D d 4 ‘ The

$72 Willan on Cutaneous Difeafes 5 6fc.

* The prurigo formicans is by m oft praQitioners
deemed contagious, and confounded with the itch:
in endeavouring' to afcertain the juftnefs of this opi¬
nion, i have been led to make the following remarks :
I ft. The eruption is, for the moft part, connected with
internal diforder, and arifes where no fource of infec¬
tion can be traced. 2dly. Perfons affefted may have
conftant intercourfe with feverai others, and yet never
communicate the difeafe to any of them 3dly. Se¬
veral perfons of one family may have the prurigo for¬
micans about the fame time : but I think this fhould
be referred rather to a common predifpofition than to
contagion : having obferved that individuals of a fa¬
mily are often fo affected at certain feafons of the
year, even wh^n they refide at a diftance from each
other.

c It is extremely difficult to relieve the prurigo
formicans, either by internal or external remedies.
Where it appears to be connected with general de¬
bility, or forne diforder of the abdominal vifeera,
thefe circumftances require a prior confideration, and
ffiould be removed by proper diet, exercife, or me¬
dicines adapted to the nature of the cafe. If the af¬
fection ot the fkin ftili continue after the patient’s
ftrength and appetite have been re-eftablifhed, which
is not unufual, it becomes neceffary to do fomething
further for his relief. In this attempt I have expe¬
rienced many difappointments, from the inefficacy of
medicines recommended on the heft authority. An-
timcnials and preparations of mercury, given fepa-
rately, or combined, produced no beneficial effetft:
the former indeed very generally aggravated the com¬
plaint. Neutral falts and other remedies adminifter-
cd as diaphoretics, were attended with as little fuc-
C^fs. T he diet-drinks ufually employed in cutaneous
difeafes contributed to allay the troublefome fenfation
of itching : as little difference was perceptible in their
refpehtive effefls, perhaps more may be attributed to
the watery vehicle than to the virtues of the impreg¬
nating

273

Will^n on Cutaneous Difectfes , 8tc,

nating ingredients. Vitriolic acid, fulphur, cCthiops
mineral, and cinnabar, I tried in a variety of cafes,
for a ccnliderable length of time, -without obferving
any permanent advantage from them.

6 Fixed alkali feemed to anfwer better than any of
the above remedies : I employed the natron preparatum
of the London Difpenfatory, fometimes alone, fome-
times in combination with fulphur : at the fame time an
infulion of fafafras or the tops of juniper was drunk
freely. Under this courfe the difagreeable fymptoms
were gradually alleviated, and the complaint difap-
peared in a month or fix weeks. The oleum tartar!
per deliquium, with a fmall proportion of the tindlure
of opium added to it, was equally efficacious.

c Moft of the writers on this fubjedt, recommend
itrong purgatives, adong with alterative medicines, in
order to expel from the blood and cutaneous glan ds
the vitiated humours, from which, as they fuppofe,
the complaint originates. Their theory is probably
erroneous; and the pradtice founded upon it, though
very ancient, will not bear the teft of experience.
I have, in general, found that purgatives frequently
repeated are injurious; as might indeed be expedted
from a previous confideration of the occafional caufes
inducing this complaint.

‘ With regard to external applications, it may be
obferved, that mercurial and lulphureous ointments
proved of little fervice : that decoctions of white hel¬
lebore, fo much commended by the ancients, were
without effect ; as alfo lime-water, or folutions of
white vitriol, and corrofive fublimate. It is neceffary
to keep the Ikin free from fordes, by frequent waffl¬
ing with warm water. The itching, however, is not
always allayed by this means, whence I was induced
to employ fome of the medicated baths recommended
by authors, and obferved confiderable advantage from
thole prepared with alkalized fulphur. Sea-bathing,
alfo, in fome cafes, entirely removed the complaint/

The

3-7 4 Willan on Cutaneous Difeafes, $*c.

The prurigo fenilis is not thought to differ effen-
tially, from the fpecies laft defcribed. It attacks ef-
pecially. perfons in advanced life, and is- exceedingly
Hard of removal.

The author next mentions feme pruriginous affec¬
tions which are merely local ; as thofe feated in the
podex, praeputium, urethra, pubes, fcrotum, and pu¬
dendum muliebre. The laft of thefe is often the
fource of great diftrefs : we Khali, therefore, tranfcribe
the author’s obfervations on the fubjeft.

I be prurigo pudendi muliebris is fomewhat ana¬
logous to the prurigo fcroti in men. It is often a
fymptomatic complaint in the lichen and lepra: it
like wife originates from afcarides irritating the rec¬
tum ; and is, in foine cafes, connected with a dis¬
charge of the floor albus.

€ A fimilar affecfion arifes in confequence of the
change of ftate in the genital organs at the time of
puberty, attended with a feries of moil diftrefling fil¬
iations. I (hall, however, confine my attention to one
cafe of this diforder, which may be confidered as idio¬
pathic, and which uiually affefts women foon after
the ceffation of the catamenia. - It chiefly occurs in
thofe who are of the phlegmatic temperament, and
inclined to corpulency. Its feat is the labia pudendi
and entrance of the vagina ; it is often accompanied
•“with an appearance of tenflon, or fulnefs in thofe
parts, and fometimes with inflamed itching papuke
on the labia and mons veneris. The diftrefs arifing
from a flrong and almoft perpetual itching in the
above fltuation, may be ealily imagined. In order
to allay it in feme degree, the fufterers have frequent
recourfe to friction, and to cooling applications ;
whence they are neceflitated to forego the enjoy¬
ment of tociety. An. excitement of venereal fenfa-
tions alfo takes place from the conftant direction of
the mind to the parts affedted, as well as from the
means employed to procure alleviation. The com¬
plicated

Willan on Cutaneous Difeafes,. 8(c. 375

plicated diftrefs thus arifing, renders exiftence almofl
infupportable ; and often produces a date of mind
bordering on phrenzy.

‘ Deep ulceration of the parts feldom takes place
in the prurigo pudendi ; but the appearance of apthae
on the labia and nymphae, is by no means unufuah
From intercourfe with females under thefe circum-
fiances, men are liable to be affefted with aphthous
ulcerations on the glans, and infide of the praepu-
tium, which prove troublefome for a length of time,
and often excite an alarm, being miftaken for chan¬
cres. They may however be removed by frequently
wafhing the parts with milk and water, and by ap¬
plying at bed time the unguent-urn ceruffe acetate.

f Women, after the fourth month of pregnancy,
often fuffer greatly from the prurigo pudendi, attend¬
ed with apthae. Thefe, in a few cafes, have been
fucceeded by extenfive ulcerations, which deftroyed
the nymphae, and produced a fatal hettic : fuch in-
ftances are however extremely rare. The complaint
has, in general, fome intervals or re millions ; and the
apthae ufually difappear foon after delivery, whether
at the full time, or by a mifcarriage. Saturnine lo¬
tions afford relief in {lighter degrees of the prurigo
pudendi, but cannot generally be depended upon.
Saline folutions, lime-water, vinegar, and oily emul-
fions prepared with fixed alkali, have aifo a tempo¬
rary good effeft. The mo ft certain remedy is a fo-
lution of corrofive fublimate in lime-water, half a
fcruple of the former being added to eight ounces
of the latter. The repeated application of it every
day has in fome cafes wholly removed the complaint.
Its ufe muff however be poftponed, if there are
rhagades, or painful fiffures of the. ikin, which often
occur, and require fome immediate palliation.

‘ Profeffor Lorry thinks the prurigo pudendi may
be moll effedlually relieved by the warm bath, or by
the application of the fleam of boiling water. He
adds fome proper cautions againft: the ufe of wine

376

Hamilton on Hydrophobia .

or flrong condiments ; as alfo again!! foft feats and
down beds, which are the means of exciting too
great a heat in the part affedled.

‘ I have employed for this complaint the regimen
and internal medicines formerly mentioned under the
heads of prurigo formicans, and prurigo podicis, with
various fuccefs ; and am forry to add, that the difeafe
has proved in feveral inftances fo inveterate, as to refill;
every plan hitherto recommended for it by medical
authors/

This, then, concludes our analyfis of the firft order
of cutaneous difeafes, as arranged by Dr. Willan.
The remaining orders, as defignated by Scales, Rallies,
Vehicles, Fuftules, Tubercles, and Macula?, will form
the fubjedt of the future volumes of this work.

Art. XLI. Remarks on Hydrophobia , or the Dif-
edfe produced by the Bite of a Mad Dog or other
Rabid Animat. By Robert Hamilton, M. D.
Member of the Royal College of Phyjicians , Lon¬
don y Sc. and late Phyjician to the Army. Gdhivo,
2 vols. Second Edition , with additions and correc -
- lions. Price 12s. London. 1798. Longman.

ORE than ten years have elapfed fince the
former edition of Dr. Hamilton’s work made
its appearance : fo many corrections and additions
have been made to it in this interval, that it deferves
rather the title of a new treatife, than that of a fecond
edition. Circumftances have of late befallen the au¬
thor which will doubtlefs forcibly call forth the fym*
pathy of the reader ; yet the pro fen t work needs no
foreign aid to excite an intereft in its perufal : its
merits amply entitle it to an attentive confideration.
Great pains have been taken to bring forward the
whole mafs of our knowledge on the important fub-

jea

‘II

$77

Hamilton on Hydrophobia .

ject of Hydrophobia, and to examine narrowly into
its nature and mode of cure. The refult of the in¬
quiry is, to withdraw our attention from frivolous ap¬
plications, under the aflumed name of fpecifics, and
to fix it on the preventive plan, the only one which
can at ail at prefent be relied on.

c The fhort time,5 fays the author, ‘ which I en¬
joyed the rank of Phyfician to the Army, fcarcely
warrants me to notice it in my title-page, two
months being its limits. A calamity into which
I fell about the time of my appointment, was the
means of depriving me of this rank. After a fevere-
and tedious fever I totally loft my fight, and was on
that account fuperfeded. It has not hitherro been
thought expedient to compenfate me for this mis¬
fortune, by any other appointment, either civil or
military. A few years of my life were formerly fpent
in the army, in a medical capacity, where the duties
of my humbler ftation were fcrupulo'ufly and confci-
entioufty difeharged ; but the fituation did not, on
leaving the army, entitle me to half-pay, and cuftom,
it feems, does not fanftion fuch a recompence for
that of phyfician, where the fervices have been fo
limited, whatever the circumftances of the cafe may
be. In the retirement, therefore, from bulinefs which
followed, I turned my attention to the revifal of a
Treatife formerly comppfed on Hydrophobia. 5

In the introduftion the author argues the poffibility
■ of the difeafe ariling in dogs from internal caufes, in¬
dependent of infection from the bite of another. —
That heat of weather is not a fufficient exciting caufe
is (hewn, from the infrequency of the difeafe in Ja¬
maica and other places in a hot climate. The fymp-
; toms are next deferibed as they take place in the
dog ; a point of material importance, as we are
thereby enabled to guard agamft accidents that might
other wife happen. In the early ltage, however, the
difference between this and other difeafes is not fo

obvious,

STS Hamilton on Hydrophobia .

obvious* for it has feveral fymptoms in common with
them.

The following fymptoms are mentioned as pecu¬
liar to and forming this malady in dogs.

‘ 1- A difinclination for his food. He does not*
it is true* refufe it ; but he takes it with an evident
indifference and liftleffnefs ; this indeed is not pecu¬
liar. F

‘ 2. He is melancholy. It is as eafy to mark this
fymptom in the dog as in the human fpecies. In
health he is frolickfome and playful; but now he
hangs his tail* and at the approach of his mailer or
any^other of the family* ffiews lefs of that joy with

which he was wont to welcome them on their" return
home.

c 3. His eyes appear mixed and dull. This may
be called the firll llage; yet there is fcarcelv any
thing pathognomonic here. It Ihould be obferved*
that in this llage he will Hill obey the call of his
mailer, and follow mm, nay* he will even fawn on
him when he approaches ; but his memory is lefs ac¬
curate and he occafionally forgets him. His irregular
peeviilmefs at this time points out he is greatly in-
difpofed. It becomes now highly proper to regard
our fafety, and not to truft him if he fnarls : nor oimhf
we to attempt to carefs him. §

As the firft llage of the difeafe is indiflincl and
marks nothing peculiar, we may be in danger from
want of fufpicion of the nature of the malady ; but
let the indifpofition of a dog be ever fo flight, pru¬
dence ought to direft us to treat it as of importance.

The fecond is more cliflinftly marked ; for in a
day or two he feeds with lefs avidity, though he does
not refufe, as has been faid, his vidluals ; authors have
affirmed, but erroneoufly, that at this tirme he refhfes
drink. He now ffiuns other dogs, and is equally
lhunned by them. Obfervation, I think, does not
confirm that the healthy limn the infe&ed in other

difeafes.

Hamilton on Hydrophobia . St#

difeafes, to which in common with other animals they
are liable.

< Now comes the laft ftage ; he lofes altogether his
recollection, quits his mailer’s houfe, runs forwards
he knows not where, and without any particular de¬
li gn, rufhes in his fury, and without barking, at every
animal that comes in his way, but turns not a fide to
bite any, and in the fpace of two days after, or left,
dies convulfed. If he is tied up he bites at his
chain in this ftage of the malady, and is furious
when approached.

c The fymptom of a drooping tail is more remark¬
able in this than in the former ftage ; another is like-
wife evident, viz. a convexity of the back, formed by
drawing his hinder towards his fore legs, an indica¬
tion of great uneaftnefs in the bowels. This is like-
wife accompanied by an extreme drynefs of the nofe*
c In all the different animals under hydrophobia
(the dog included) the difeafe attacks by exacerbation
and interval. — I can inftance this from good authority
and ocular infpeCtion.

* One thing is remarkable ; and in which among
others he materially differs from man under the fame
difeafe ; he never avoids water, having no fear of it ;
and as it would feem, feeling no inconvenience either
from drinking or touching it. I know from expe¬
rience, he laps whatever liquid food is let before
him, long after the poifen can be communicated by
his bite. Previous to his death fame fwellings about
his throat are f aid to have been obferved, and even
the tongue has been affeCted in the fame manner,
and dripping with flaver: fometimes it has been feeii
to loll out of his mouth. Such is the common pro-
grefs of the fufferings of a rabid dog, and fuch are the
chief fymptoms that diftinguifti it.’

s It is a fortunate cireumftance for man, that he is
not fo liable to be infedfed as the dog ; not more than
one, perphaps, in fixteen of the human fpecies, who
&tq bitten, take the difeafe. The fufceptibility of the

dog

380

Hamilton on Hydrophobia .

dog after a bite is difcovered to be much greater.
Four men and twelve dogs were bitten by the fame
rabid dog; all’the men efcaped, but every one of the
dogs died mad. In comparing inftances of this kind
in authors, many proofs corroborating this remark,
will be found. The men here ufed no other means
of prevention than what we every day fee fail. To
what can we attribute this? Scarcely, I think, to
the greater fen ability of the canine fyftem, rendering
it more eaiily inf Tied. It mull be to fome other law
in the ceconomy of his framed

The queftionrefpe&ing the mode of aftion of the
canine poifon is next difcuffed ; whether it afts by
abforption, or nervous irritation. The former opi¬
nion is that adopted by the author; but a detail of
arguments here, would carry us to much too great a
length. The queflion, however, is not likely to be
loon fettled fatisfadtorily.

Abforption, the author thinks, is proved by thofe
cafes of the difeafe where no wround has been infliS-
ed, but the poifon has been limply applied to the
found Ikin'. Of this feveral inftances are recorded,
both antient and modern, One of this kind is ad¬
duced by Dr. Bardlley, on the authority of Dr. Per-

• cival. A man living at Worral in Chefhire, having

• fallen alleep on the ground, while he was . in this
fituation, a mad dog accidentally came pall, licked
him about the mouth, then ran away, without doing
him farther injury. He was feized with the difeale
about the ufual time, and died in confequcnee.

Another inftance is afforded by the author on the
' authority of a competent witnefs. A young woman
hid her apron torn,; and Havered by a mad dog leap¬
ing on her and attempting to bite. Fortunately Hie
received no other injury from him, by the timely af~
fillance offered, and by the loofe part of her cloathing
which he laid hold of. But imprudently and without
proper refleftion, fhe began to mend the rent in her

apron

SB 1

Hamilton on Hydrophobia.

apron before the part was either wafhed or well dried 3
and as imprudently, or through habit, inftead of cut¬
ting the thread with fciffars, bit it off with her teeth.
In a few weeks fhe was feized with hydrophobia,
which proved fatal *.

Leaving, however, the opinions of local irritation ,
and abforption , to be further difcuffed by fuch patho¬
logies, as may conceive the arguments here adduced
inconclulive on either fide, the author proceeds to
confider the queftion, In what manner is the prac¬
titioner to conduct himfelf, in order to obviate the'
impending danger from rabid virus, either inferted in
a wound by the animal’s tuffs, or befmeared over
fome naked part of the body, thinly and delicately
covered with cuticle. Whatever may be the iffue of
the opinions refpefting primary irritation and abforp¬
tion, .the method proper to be purfued will be pre-
cifely the fame.

The author combats the opinion which has been
inculcated by fome, that the difeafe may commence
at any time, from the fir ft hour rill years after the bite.
The cafes of difeafe which have been given as fuc-
ceeding the bites of enraged animals, as cocks and*
other domeftic fowls, horfes, cows, apes, fwine, &c.
and which have often been called hydrophobia, are
confidered as cafes of tetanus, and not at all allied
to hydrophobia, -which, the author believes, feldom,
if ever, commences before the nineteenth day, or af¬
ter the eighteenth month.

The firft mode of prevention noticed is that by
fuftion of the wound. Some authors have recom¬
mended fucking the wounded part, and affirm that
no danger can attend the perfon who performs this
humane office, as the poifon muff be eje&ed with the
faliva by which the internal parts of the mouth are
conftantly bedewed, and which, as a further fecurity,

* For other inftances of the like kind fee Ephem. N. C. ann, 7.
obs. 1 21. — Coel. Aurel. De Morb. Acut. lib. 3. cap. 9. — Joh. Ma-
thaei Conful. No. 82.— Matthiola Opera.— Hildani Cent. j. obs. 86.
— Phil. Tranf. No. 277*

VOL. V.

ji. e

may

-382 Hamilton on Hydrophobia,

may be waflied out afterwards with water; Exam¬
ples are adduced in proof of the fuccefs of this me¬
thod in the bites of other poifonous animals and rep¬
tiles, fuch as the viper, &c. But from the trials of
Dr. Mead on the viper, it is evident, that on touch¬
ing the tongue and lips with this reptile’s poifon,
there is danger. This eminent phyfician and fome
other friends, in order to afcertain its nature, ventured
to tafte it diluted with water, and their tongues were
inftantly affefted with a fharp burning heat. One,
bolder than the reft, tafted it undiluted, and fuffered
for his temerity. The inflammation induced thereby

did not fubfide for two days.

It is not reafonable to fuppofe, therefore, that
fuftion would fucceed better where the poifon of a
rabid animal is introduced. In many cafes the teeth
penetrate deep, and in various directions, over which
the fuperincumbent parts form valves, preventing its
return to the furface. There is, likewife, no proper
evidence of its having been fuccefsfully employed.
That it could not be done with fafety to the operator
would appear from the exiftence of the difeafe from
the mere application of the poifon without a wound,
as above mentioned.

Of Extirpation, Ablution, and Cauftic. It would
be highly defirable to know the length of time the
poifon remains in the part bitten, before it begins to
exert its effe&s on the fyftem. A rule might hence
be formed, to guide us in our local treatment. The
following faffs are adduced on this head.

< Firft, Mr. Loftie had a patient who received the
bite twenty hours before the part was extirpated,
which is the operation under confideration. I he
difeafe did not take place.

£ Second, Of two cafes related by Mr. Foot * ex-
cifion was not performed in the one till near twenty-
three hours, and in the other not till fixty-eight had
elapfed. Both did well.

* * Vide Foot on Hydrophobia.

* Third,

Hamilton on Hydrophobia. 5 85

* Third, It was thirty hours in the cafe mentioned
by Doctor Shore*, before any thing was done to the
wound. The patient efcaped.

f Fourth, It was not till after twenty-eight days,
from the bite, in the cafe of the young lady at
Ipfwich'f, when extirpation was performed. She is
now, at the diftance of three years, in perfefl: health.

c Fifth, In fpring 1792, and the preceding winter,
the county of Suffolk was greatly infefted with mad
dogs, efpecially round Saint Edmund’s Bury. Several
accidents happened from them to men and other ani¬
mals. This afforded opportunities for exciffon at dif¬
ferent diftances from the bite. Some of them fell
under the care of Doctor White of that place J. In
one cafe he cut out the part three days after the
accident. The perfon has ever ftnce remained well.
Seven were bitten by rabid dogs about the fame time
in the neighbourhood. Three of them did not apply
till the third day: two came to him on the fecond
day ; the other two not till fame time (the period not
fpecified) after the accident. The parts were then
extirpated, and they all did well.

< Sixth, A foal was treated in the fame manner,
bitten five days before. The animal continued well
long after.

« On the other hand, the fame dog bit a horfe, a
cow, and two pigs on the fame day; no excifion was
ufed; and though internal remedies were adminifter-
ed, the animals were all dead within the month ; a
preemptive proof of the fuperiority of extirpation,

c Seventh, I ordered two of my patients, Field and
fon^f near this town, who had been bitten about forty

4 * Vide Meafe’s EfFay on the Bite of a Mad Dog, p. 12.5 .

4 f Vide page 23, note.

4 X The Do6tor was not inattentive to the advantages that might re-
fult from this mode. Vide his oblervations on the fuhjec.t, in an ap»
pendixto Meafe’s Eflay on the Bite of a Mad Dog, London, 1793.

4 qy Thefe are the two perfons mentioned in my firft edition. The
cafes were then too recent for a decided opinion as to the efficacy of

the

E c 2 hours,

584

Hamilton on Hydrophobia .

hours,, to fubmit to the extirpation of the wounded
parts, which was done. At the fame time i directed
them to chain up the dog, to determine refpedting his
diforder. The dog died mad on the third day, after

owing marks of a moft violent difeafe by fits of the
higheft exacerbation, and fury, exerted againit the
chain that bound him, and the rails of the cage
wherein he was confined, ihe men remain tree
from the difeafe at this day.

< From thefe examples we may hope favourably
even from late excifion. But have we reafon to hope
the fame at the commencement of the difeafe ; at the
re-inflammatlon of the wound, the harbinger of this
awful period ? Is the poifon latent in the part where
firft infer ted till this time ? From all parts of the evi¬
dence carefully weighed and taken together, I think,
there is reafon to conclude, that an operation, even
at this late period, may be fuccefsful in preventing the
approaching malady.5

The following inftance feems to fhew that preven¬
tion may take place at the very commencement of the
fymptoms. Hr. Guthrie had a patient at Peterf-
burgh, who was bitten by a dog. This was a boy, fer-
vant at that time to the Britifh minifter then refident at
the Ruffian Court. This animal bit two other dogs on
the fame day, both of which died mad in the {pace
of a month. This was evidence of the exiftence of
the difeafe in the animal. The wound was in the
foot. The Doctor fcarified it till it bled freely. After

tire operation, Twelve years and upwards have elapfed, and I may

now fpeak with pofitivenefs. ‘

< This dog had left home a day or two before, and remained abient
about two days; the family miffed him, but knew not the caufe of his
abfence. Soon after his return he committed the accident. He not
only ate and drank that day, but likewife after being chained. He ap¬
peared, on his return, as if fatigued and famifhed by abtlinence and
negleft, and knew the family as formerly; followed his mailer, who
went to labour at his farm, and flept contiguous as ufual, unfufpefted
of difeafe. "It was on his mailer’s walking abruptly up to him that he
flew on him, and bit him. The fon was bitten afterwards, in another
exacerbation ; a farther proof of fits, and intervals in the malady. y

385

Hamilton on Hydrophobia .

this it was dreffed with ftrong mercurial ointment for
fourteen days 3 and the fore was kept open by apply¬
ing, oceafionally, a fmall blifter over the part.

Farther, the wound was dreffed with Hill’s Ormf-
kirk medicine. By this means the fore was kept dif-
charging for five weeks. It was then differed to heal,
and remained fo tor ten days, which comprehended
a period of feven weeks from the accident. Ine boy
then felt {hooting pains in the cicatrix ; thefe lafted
for feveral days, and one of the cicatrices began to
inflame, and aflame the appearance which the incifion
of inoculation prefents before the eruption of the fmall-
pox. The Doctor immediately ordered the wounds
to be re-opened, and ftrong mercurial ointment again
to be applied. During its ufe the fhooting pains
ceafed, and the eruptive appearances fubfided; the
boy remained well long after.

On the whole, therefore, the author is of opinion,
that excifion ought not be omitted at any period, from
the infliftion of the wound by the rabid animal, to the
firft fymptoms of the approaching difeafe.

6 In removing the bitten part, much care and judg¬
ment are requifite. It cannot be doubted but a few
failures, of which we read,- arofe from want of atten¬
tion to the minuter circumftances in the operation.
On removing the piece, the under furface fhould be
carefully examined to find whether the wound pene¬
trated through. If this be difcovered, a deeper piece
ftill fhould be taken out, fo that no mark whatever of
the tooth be perceived, but the under fide be pure
and found. For fhould the lealt fpeck be left, which
had been touched by the poifoned tooth, there will be
no certainty of fafety 3 the operation will prove nuga¬
tory. I fpeak of recent injuries ; but it days have
elapfed, the enfuing inflammation, in the progrefs
towards cicatrization, will alter the appearance, and
render other cautions neceffary.

c Mr. Hunter, on cutting out the piece, in one cafe,
examined the under furface ; no marks of a tooth were

E e 3 perceptible.

386

Hamilton on Hydrophobia.

perceptible. But on examining the fuperftcies of the
wound from which the piece was removed, he oh-
ferved a part in the middle hollow underneath. This
was proot of his not having cut fufficiently deep, and
nothing but this nice examination could have con¬
vinced him to the contrary.

‘ l fhall, without hefitation, then, recommend, and
would enforce it, were I able, a piece to be cut out
round the part wounded, making the incifion at the
fame time pretty deep, to prevent accidents, from
leaving any of the animal’s faliva behind. I can fee
little cruelty in this, when we compare fhort tempo¬
rary pain to the dire fcene that we have reafon to
expend

The adlual cautery, befides its being often imprac¬
ticable, is lefs to be relied on than excifion. c Some¬
times it happens that the part bitten is unfavourable
for extirpation. This is the cafe when large vcounds
are received either in the lips, or about the face. In
thefe parts a fpeedy cicatrization is defirable to pre¬
vent the deformity, which muft fucceed fores long
kept open, where the bafes are enlarged, and the lofs
of fubftance becomes greater ; and, if with the pre¬
cautions already delivered, the wounded furfaces be
removed, there can be little room for future appre-
henfion.

c Extirpation either in the upper or under , lip, has
likewife inconveniencies : a fear from a large wound
muft remain altogether unfeemly, disfiguring the coun¬
tenance.

/ This was the part bitten in the unfortunate cafe
of Mailer Rowley. Cauftics, however, were applied,
foon after it was received. That they did not fuc¬
ceed might in part arife from the cauftic not having
touched every part of the wound ; but with as much
probability trom fome of the clog’s faliva adhering
about the gums or inlide of the lip, from whence it
was afterwards abforbed ; for, “ the lip was torn a

good

Hamilton on Hydrophobia * 387

good deal. The teeth” (of the dog) a had ^gone
through and through, and had torn out a piece.”

c In fuck cafes the phyfician hgs a molt difficult part
to aft. If he pays too great attention to appearances*
he may fall into' the oppofite extreme, and lofe his
patient from lenity and regard to his looks. If he
boldly advifes extirpation, and his patient ffiould fur-
vive, he may not efcape cenfure, but incur his dif-
pleafure through life for disfiguring him.

c The moft unfavourable places are about the face ;
and of thefe, the cheeks* nofe, and lips are moft lo.
The fore part of the neck alfo, is not without incon¬
veniences, yet it is better to ufe the knife on fuch
occafions, than to fuffer the patient to fall a facrifice
without attempting fo rational a prophylaftic* Should
the worft take place, we have discharged our duty
without trailing to chance for an efcape/

With refpeft to cauftics, in thefe cafes, the author
obferves, one general remark may be made, viz. That
the ftronger, not the weaker, ffiould be had recourfe
to. Whatever diffolves animal fubftances moft per¬
fectly and fpeedily, penetrating deep* is the fitted:
for the prefent purpofe. The kali purum is of this
kind. It forms immediately an efchar to fome depth,
which may be immediately removed by a fpatula ;
and by re-application of the cauftic, another be taken
off; and this being repeated, removing ftratum after
ftratum, we proceed to the depth intended. In this
mode of ufing cauftic it would feem equally fafe and
equally fuccefsful with excifion by the knife,

Specifics are next fpoken of. In all ages, from
almoft the firft appearance of the difeafe, men, as it
was natural, began to turn their thoughts not only
towards its prevention, but its cure. Various were
the fubftances which ignorance and fuperftition* in
condufting this refearch, led them to propofe. That
their inveftigations were not crowned with fuccefs* is

E e 4 too

388

Hamilton on Hydrophobia.

too well known: and although the darknefs of former
ages, with refpecl to fcience, might be an apology
for introducing the numerous train of inert trifles*
termed fpecifics, which their practice prefents ; yet
later times enjoying the advantages of more enlight¬
ened inveftigation, ainidft the various and luminous
difcoveries which patient labourers have produced,
can boaft of having penetrated but little farther than
the fages of 2050 years ago,* into the abftrufe nature
of this dreadful malady.

Specifics have abounded from their days, down to
the pyefgii t. The word has fomething fafcinating in
it ; and when pronounced, reafon feems to defert her
abode. The underftandings of the great dl men of
the refpeelive ages in which they ilourifhed, became
clouded, howfoever penetrating in other inveftiga-
tions, when this idea took pofteffion of their minds.
No illuftration is neceffary to prove this. The variety
of fpecifics, their ever-changing competitions, arid
their conflant failures, ftand forth as the monuments
of their infignificancy, and the truth of this obferva-
tion. Much mifehief have they produced ; while a
iingle inftance of advantage, howfoever loud their in¬
ventors may have proclaimed the contrary, cannot be
fairly and openly brought forth in their favour to fatisfy
rational invefligation.

W ith jiftliee, therefore, the author warns us againft
placing any reliance on fpecifics. The greater part
of them, indeed, have gone into merited oblivion ;
but two or three hill retain a fhare of the public
confidence. One of thefe is the Onnjkirk medicine,
which is ftill held infallible by many, especially in the
northern and weftera .parts of England, though its
infufficiency has been many times proved in the
molt decifive manner. From the analyfis of Dr.
Blackr- and that of his pupil Dr. Eleyfham, the

* The time, according to fome, when the difeafe firft appeared.

<■ - com po fit ion

Hamilton on Hydrophobia .

compofition of this medicine appears to he as fol¬
lows : / -

Half an ounce of powdered chalk.

Ten grains of alum.

,, o „ .

Three drams ot Armenian bole.

One dram of the powder of elecampane-root.

And fix drops of the oil of anifeed.

The Tonquin remedy, introduced by Sir George
Cobb, is well known to confift only of cinnabar and
mull : whilft that of Dr. Mead is a powder confiding
of afh-coloured ground liver-wort, and black pepper.
From the nature of the ingredients of which thefe
medicines are compounded, no one will now expedt
from them any adlive properties ; nor does their uti¬
lity reft on any degree of fatisfacfory proof; at the
fame time that their inefficacy has been repeatedly
and moft clearly eftablifhed.

Vinegar has of late been recommended as another
preventative, by Dr. Moneta, Phyfician to the King of
Poland, who has lately written on the fubjedf . The fol¬
lowing obfervations of the author, together with the
facts adduced, (hew clearly how little the recommen¬
dation of writers in favour of new remedies can be
confided in, in this as well as in other cafes. c Dr,
Moneta aflerts his having prevented the difeafe by it
(vinegar) in more than fixty cafes, when ufed as he
dired'is, immediately after the bite, and for nine fuc-
ceeding days, as an external application to the wound,
which is to be previoully w allied with warm water,
cupped, and fcarified. He mixes it with a fourth
part of melted butter, and dipping therein compreffes,
binds them over the part, renewing them frequently.
While this procefs goes on, an ounce and a half at
a dofe is frequently adminiftered internally ; and this
is continued till about the fifteenth day, not thinking
it neceftkry, however, to keep the wounds open longer

than

5 §6 Hamilton on Hydrophobia .

than the' ninth day. The difeafe, he allures us, has
been ftopt at its commencement by the fame means.
Did experience in the hands of other men furnilh
fimilar events, the difcovefy would be as valuable
as the method is Ample.

c Vinegar has alfo been applied in Italy, and
equally extolled ' but fmce that, we are informed
it has failed there in one inftance * and I am appre-
henfive, the inference to be drawn is* that in thofe
cafes wherein its fuceefs was announced, there exifted
no rabid infeftion ; and that in this cafe, where rabid
infection operated and proved fatal, the infallibility of
the remedy was put to the teft.

‘ At Warfaw it had like wife a tolerably fair trial
in two inftances.

£ Eleven perfons out of feventeen were committed
to the care of Dr. Wolf. He did not negleft this
opportunity of putting to the teft the moft noted fpe-
cifics which were recorded, or were fafhionable at
that time. It was the ninth day after the accident
when they applied. He made deep fcarifications in
their wounds ; ufed careful ablution, warm fomenta¬
tions, with vinegar, fait, and theriaca ; and kept open
the wounds for eighty days, in thofe who lived fo
long. Every fourteen days copious V. S. was ufed ;
and every feventh day a ftrong cathartic of falts and
jalap adminiftered. Their diet was chiefly vegetable ;
their drink only whey and water. The herb matri-
iylva, in as large a quantity as could be procured,
was recommended, which they daily ate. They like-
wife ate plentifully of the herb anagalis (flore puniceo)
another noted fpecific ; and at the fame time did not
omit the famous compofition of Palmerius. Befldes
this, which was the general treatment, two were
daily rubbed with a dram of mercurial ointment, and
were purged with calomel. To two others were
daily prefcribed four ounces of vinegar, three drams
of the tinfture of poppies ; and at night they were
ordered half an ounce of rob fambuci. Another took

every

1291

Hamilton on Hydrophobia .

every day fifteen grains of camphor, four fcruples of
nitre ; and at night half an ounce of the fame rob.
Two others took twenty-four grains of mufk, vfith
fifty grains of cinnabar; other two took from forty to
fixty drops of fpirit of fal ammoniac, prepared with
quick lime; and the laft took a fcruple of chryftal-
lifed fait of tartar prepared by the mixture of a little
fpirit of fal amnion, with a folution of that fait.

c An officer, one of the number bitten, came into
the city on the day after the accident, and had the
beft advice the place afforded ; befides which, as a’
preventative, he took the bark and camphor very co-
piouily ; yet, in the feventh week, he was feized with
the difeafe, and died. One of thofe under the vinegar
courfe fell ill on the thirty-third, and died hydrophobic
on the thirty-fixth day. They vomited and bled him
copioufly, but without effefit. The other, an old
man, is faid to have recovered after an indifpofition
which they attributed to the difeafe. He was purged
and bled, and took befides morfulm balfami Peru-
viani, and drank lemonade. After his recovery 100
drops of fp. fal arnmon. were daily taken. A curious
remark is added rcfp effing this man. It is affirmed,
that the blood drawn during this illnefs, which was
certainly not hydrophobic, had a very foetid firiell.
This, perhaps, might be attributed to the balfam, and
other medicines ufed.

4 The man to whom the camphor, nitre, & c. were
given, fell ill on the thirty-third day: he underwent
a very powerful treatment, but ineffectually. cc He
was thrice copioufly blooded ; was plunged forcibly
into the coldeft water, for the fpace of two hours,
and was nearly drowned. He was clyftered with
effect. He himfelf forced down, with incredible aver¬
sion and labour, a great quantity of drink ; by which
he vomited more than fifty times abundance of frothy
flime. He took feveral ounces of oil, and feveral
bolufes of caftor and opium, of each four grains,
without effeCt * and died the fourth day.”

4 A girl.

f92 Hamilton on Hydrophobia .

c A girl, who ufed the mulk with cinnabar, was
attacked with hydrophobia on the fixty-fecond day,
and died on the flxty-fifth. Her companion, a preg¬
nant woman, had taken, till this, the fame medicine,
which the now exchanged for fp. fal ammon. Nothing
further being faid, it is prefumed that fhe continued
uninfeCfed ; but a third woman, who had taken
nothing, fell ill on the fortieth day. She is defcribed,
as fuffering under the ufual fymptoms, wdth the ad¬
dition of excruciating pains in the bowels. She took,
in two days, no lefs than two bottles of brandy, re-
filling every other liquor. To this the doctor ordered
daily twm bolufes of caftor and opium, and advifed
her likewife to add to her brandy an equal portion of
oil. She recovered. This woman certainly never had
the hydrophobia. Apprehenfion of the fate of her
companions, bitten at the fame time, might have
alarmed her.

c The furvivors continued their prophylactic treat¬
ment to the hundredth day. How far the remaining
number would efcape, could not then be known, be-
caufe the time of danger w7as not over. He mentions
four of them, who took nothing, being in as good
health as anv of thofe under his care: and the con-

clufion from the whole is, that had his furviving pa¬
tients taken nothing, they would have been equally
in health/

With refpecf to the cold-bath, Dr. Hamilton is
certainly warranted in his conclution, that it never
at any time prevented the operation of rabid in fe 61 ion
from coming into action at the time of its proper lawr,
nor cured the difeafe when it had once taken place.

Of mercury too the eftimate is little more favour¬
able. It has failed in fo many inifances on record,
that we have great reafon to fulpeCt its virtues, and
might be juftified in configning it to the fame obli-
vkf with other noted fpecifics. From the following

cafes.

393

Hamilton on Hydrophobia.

cafes, afforded by authors of obfervation and expe¬
rience *, every doubt on the fubjeCl mull vanifh.

* Etienne Champion was treated with mercury,
and a ftrong falivation produced.

c Briquet in vain ufed mercury three or four weeks
to a falivation.

c The Sieur Gravan was falivated a confiderable
time, with the fame unfortunate event.

f Meffrs. Rebiere falivated no lefs than ten, and
unfuccefs fully.

‘ M. Theiffet treated feven hy prophobics with mer¬
cury, yet they all died.

c Dr. Oudot had a female patient who died alfo,
though it was largely exhibited.

* Three of Laffon’s patients died, though treated
in the fame manner.

c A woman under Revolot’s care ufed it unfuc-
cefsfully.

‘ Dr. Francis had three patients to whom mer¬
cury was likewife ineffectually exhibited.

c Roux has collected feveral cafes to prove its
inutility.’

To thefe the author adds two more. In the one.
Dr. Gray of Bengal exhibited it, keeping up ptyalifm
a confiderable time : and Dr. Raymond of Marfeilles
in the other, ufed it for forty days, railing a falivation
alfo : yet both thefe patients died hydrophobic.

The author next defcribes the Symptoms of the
Difeafe, as they appear in the Human Species. But
thefe, with the remaining parts of the work, mu ft be
referved for a future number.

* Mem. de la Soc. Roy. de Med. Anno 3783.

Art.

( 39f )

Art. XLII. Recherches Phyfiologiques , et Experi¬
ences Jur la Vitalite. i. e. Phyfolqgital Refearchesy
and Experiments on Vitality. By j. J. Sue,

M. D. and prof ef or of Anatomy.

Magazin Kncyclopedique. 1797.

fT^HE fcience of anatomy, or the defcription of
Jj^ the fituation and UruEture of the different parts
of the human body, has been carried in the prefent
age, to a confiderabie degree of perfection. The
moft celebrated an ate miffs and phyfiologifts perceived
that it was time to dire ft their inquiries towards the
caufes of the motive faculty of animals, and the hid¬
den fource of their fenfations : but as the nerves here
perform the principal part, the neceflity of an exaft
defcription of thefe parts became apparent. It was
with thefe views, M. Sue obferves, that Meckel em¬
ployed himfelr m defending the nerves of the face,
where are reprefented all the fentiments of the foul :
that Walker deferibed at confiderabie length, thefe
of the cheft and abdomen, the knowledge of which
is fo effential in a number. of difeafes : that Girardi
gave us an excellent defcription on the origin and
ramifications of the intercoftal nerve : that other ana¬
tomies, jn fine, have applied themfelves to the dif*
covery of the nature and ftrufture of ganglions and
plexufes, the knowledge of which, particularly the
former, the author confiders as calculated to throw
great light on the phenomena of animal motion and
fenfation. From the obfervalions he has made on
ganglions, he thinks they may be confidered as
fo many magazines, where the vital power and
fenfibility are united, to be carried at length to
the nerves which arife from, or which have commu¬
nication with them, and thus to increafe their aftive
force.

It has been fought to difeover, whether the nerv¬
ous fluid, or the fubfiance which ; appears to perme¬
ate

395

Sue fur la V Halite,

ate the nerves, has a circulatory motion ; but we have
gained nothing by the attempts which have been hi¬
therto made. Although, according to the older phy-
fiologifts, the brain was confidered as the foie feat
of feeling, and was regarded as the origin of all mo¬
tion and fenfation, this opinion appears at prefent,
after much obfervation, liable to great and numerous
difficulties. It has been remarked by feveral anato¬
mies, M. Sue obferves, that in many animals, and
even in man, appearing to enjoy the belt health, that
the brain has been almoft of a ftony hardnefs. M.
Le Roy informed the author, of a cafe he had wit-
neffed, of a man who died fuddenly, and in whom
he found a confiderable part of the brain offified,
although he appeared to enjoy perfect health to the
time of his death, and to poffefs the entire ufe of
his mental faculties.

If it be alked, how the vital functions, and the
powrer of fenfation, could exift under fuch a hate of
the brain, while the fmalleft injuries of this vifcus are
often fufficient to induce palfy ? the anfwer is, that
we are hill fo totally ignorant of the nature of the
brain and nerves, that we know not in what degree
thefe contribute to the produff ion of this affeffiom
For what can be oppofed to thefe faffs ? It is ini-
poffible not to conclude, that in the individuals fur-
nifhing the obfervations, the feat of fenfation muff
exift eifewdiere than in the offified portions of the
brain. There have been numerous inftances of foe-
tufes born at full time, or nearly fo, without a brain,
and even without a head, although ivell formed in
other parts. Many obfervations 'of this kind are ad¬
duced, from different authorities*. Two years ago,
the author diffecfed a foetus at full time, in which
there exifted neither cerebrum, cerebellum, medulla
oblongata, nor fpinal marrow, not even the rnedul-

* Comment, de Leipfic. tom. 17. — Hidoire de 1’Acad. de Scien.
3711, &c.

lary

396

Sue fur la Vitalite.

lary canal ; yet there were found the firft ten pair of
nerves, the cervical pairs, the ctorfal, lumbar, and
facral, with their diyifions and fubdivifions in the
extremities ; likewife the great fympathetics, the vif-
ceral, add the eighth pairs The child lived and
moved for feven hours. The author examined ano¬
ther foetus at five months, which had neither head,
bread, ftomach, nor final! inteftines.

From all tbefe facts one may conclude, that the
fource of fenfation and of organic life, which, in
tbefe individuals, conduced to the developement of
their' organs, could not be the brain.

The independence of the vital functions on the

brain, appears further from an experiment made on
the tortoife, which lived fix months after its brain
was removed, and performed all its ordinary move¬
ments. In the fame animal, the circulation of the
blood continued more than twelve hours after its
head was cut off.

It appears, therefore, from thefe observations, that
the feat of fenfation, which has been -attributed ex-
clufively to the brain, may exift in other parts, and
really does exift in the fpinal marrow; ftnce it is im-
poffible, without this fuppolition, to explain the pre¬
fence oi vitality and fenfation in beings deprived of
a brain.

The fpinal marrow, then, feerns, in a certain de¬
gree, to fupply the place of brain, and to fulfil its
functions. The real nature of nerves, and the man¬
ner in which they produce fenfation, is wholly un¬
known to us. Many phenomena feem to ihew, that
they poffefs properties of which we are ignorant ; they
poffefs powers which exift long after the parts to
which they belong are feparated from the boclv.
This property renders organized beings altogether
different from machines, with which they have fo
often been compared. In the latter, all movement
ceafes the inftant the parts ceafe to communicate
with the moving power; whilft the parts of an ani¬
mated

Sue fur la Vita Hie. 397

mated being, preferve, for a considerable time, their
movement or vitality.

In one of the author's experiments, the head of a
young turkey was feparated from the body by a tingle
ftroke : the animal fell down motionlefs, and appa¬
rently without life, but in a Short time raifed itfelf
on its feet, and clapped its wings, with great acti¬
vity. In this cafe it is difficult to conceive whence,
in the body of an animal deprived of its head, and
confequently where the fpinal marrow can no longer
communicate direftly with the heart, the nerves can
acquire their power of reproducing fuch diftindt and
powerful movements. If this vitality of animals, or
rather of their parts after Separation from the whole,
afford fuch finking phenomena in quadrupeds, birds,
fiffies, the amphibia, See. it is ftill more remarkable
in infefts and other Similar beings, although the dura¬
tion of their exiftence be ffiort : but thefe phenomena
Should the lefs excite our wonder, as they belong ef-
fentially to the nature of the organization of thefe
beings, which we are ftill So little acquainted with.
We perceive, in faff, that thefe phenomena are al¬
ways dependent on this organization ; and when, for
inftance, animals are fo conftituted as to Suffer the
divifion or removal of certain parts without deftruc-
tion to that harmony which fubfifts between the reft,
life, in fuch, may be preferved for a confiderable
Space of time : but we find it difficult to admit this,
from our habits of deducing too general laws from
individual observations ; and thus we are aftonifhed
at meeting with facts which appear to contradict
them.

(To be continued.)

Art.

VOL, V.

( 398 )

Art. XL! II. * Report of the Commijf oners appoint¬
ed by the National Inftitute to repeat the Experi¬
ments which have been made on Galvanifm: read
in the Name of the Commi/fion, by Cit . Halle.
From the Bulletin des Sciences, par la Societe
Philomath ique, Thermidor, An VI.

rT^HE commiffion was not fatisfied with repeating
JL a great part of the experiments already madel
they claffed them, and rendered them complete by the
addition of others which were wanting.

I. The phenomenon of Galvanifm, taken in gene¬
ral, is as follows : A communication is elfablilhed be¬
tween two points of a feries of nervous or mufcular
organs by means of certain determined fubftances.
At the moment when this communication is made,
them take place m the Hate of the organs changes,
the nature oi which is Hill unknown 3 but wrhich are
xnanifelied by fenfations more or lefs lively, or con¬
tractions more or lefs violent, ffhefe mufcular con-
ti aCtions take place even in feparated parts of the
body, and with as much force as when produced by
the molt effectual means of irritation, the” feries of
mufculai 01 nervous organs is called the animal arc j
the other fubftances form the exciting arc. The com-
polition of both may be varied many different ways..

II. Among the effects refultmg from the different
compontions of the animal arc, the following are the
molt remarkable : A ligature made on a nerve does
not intercept Galvanifm, unlefs it be made in the part
fm rounded with He Hi. If the nerve be cut, and its
two ends be in contaft, Galvanifm takes place. ; but

if they are only brought near to each other, without
contaCt, it is intercepted.

* We are indebted for this article to a very ufeful monthly pub-
MagaziJ, No f ^ Y “de “S aPPearance> th= Vhilojogcal

III. Among

S99

Report on Galvanifm.

III. Among the effefts refulting from the different
competitions of the exciting arc we fhall remark the
following : The moll favourable compotition is when
it contifts of three pieces, each of which is a different
metal. One muff touch the nerve, and the other the
mufcle : thefe are called the fupports , or armatures .
The third forms the communication. This is called
the communicator. But one or two of thefe maybe
omitted. Animal bodies, or water, may be placed
between them 3 or other fubftances, either metallic
combinations, or all other metals, 8c c. may be fub-
ftituted in their ftead. It has not yet been poftible to
determine exactly what are the moil ineffectual com-
binations ; but they have been already claffed to a
certain point, according to the degree of their effica¬
cy. Gold, tilver, zinc and tin, are the metals moft
favourable to Galvanifm, when introduced into the
exciting arc.

In general a tingle metal does not aft, except when
all other circumftances are favourable 3 but in that
cafe it has been often feen to aft. Error, however,
may readily here arife 3 for, if one of the ends of the arc
be alloyed, in a proportion ever fo little different, the
arc afts as if there were two metals. By rubbing one
end with a different metal, fometimes even with the
fingers, or by breathing upon it, efficacy may be
communicated to it, under circumftances where it
would not otherwise have poffeffed any.

Oxydes aft lefs efficacioufty, ejeteris paribus , than
their metals. Dry carbon afts as an actual metal. It is
not intercepted by water and moift fubtiances, nor by
the fingers if wet ; but this is not the cafe if the fin¬
gers be dry. The energy of Galvanifm is not inter¬
cepted or diminiflied by pieces of dead fiefh. The
effects of it are fenfibly checked by the epidermis ; and
they are incomparably greater in flayed animals, or in
parts of the human body from which the epidermis
has been removed.

It cannot be faid that Galvanifm is intercepted by
all idie-eleftric bodies 3 but, on the other hand, it is

3 inter-

400 ' Report on Galvanifm .

intercepted by all fubftances which are ftrong con¬
ductors of eledhicity. Such are dame, very dry ani¬
mal hones* the fteam of water, glafs brought to a red
heat, &c. •

IV. Galvanifm is influenced alfo by feveral circum-
fiances foreign to the compofition of the two arcs.
Such as, 1. The date of the parts which are fubjecied
to the operation : the frefher they are, the ftronger are
the effects. 2. The longer or fliorter exercife of Gab
vanifm : fufceptibility of Galvanifm is in general ex¬
cited by exercifing it ; is exhaufted by continuance,
and renewed by repofe. 3. The fucceflion of various
experiments. A difpofition of metals which at firfl
had been ineflfe£tual, has become effectual after a dif¬
ferent difpofition* Two uncertain experiments are
hurtful4 to each other, and become ftill more fo if
made in fucceflion. 4. The Hate of the atmofphere.
The atmofphere electric ; the animal on which the -
operation is performed charged and infulated, the ef-
fe£t is the fame. The wdiole apparatus placed under
water, the effect remains the fame.

V. There are various artificial means to weaken or
revive the fufceptibility of Galvanifm. Thus, a frog
exhaufted and brought near to a charged elebtropho-
rus refumed its fufceptibility. Alcohol, on the other
hand, weakens and even extinguifhes it fo as never
to return. Potafh produces the fame effeft, only
llowly. According to M. de Humboldt, this fuf¬
ceptibility is in many cafes reftored by oxygenated
muriatic acid gas. The commiflioners did not ob-
ferve this circumftance ; but they propofe to refume
the fubject, and to repeat feveral other experiments
of that learned philofopher.

They have already repeated thofe oii the action of
Galvanifm on the heart, and have obferved, as he
did, that its action is the fame as on the voluntary

mufcles, and that it accelerates their movement.

\ * .

No. XXIX.

THE

M EDICAL and CHIRURGICAL

R E V I E W.

, - . .. ■ v \ . ., ✓ ' ■ ' /. \

MARC H, 1799.

Art; XLIV. Philo fophical Tranf actions of the Royal
Society of London. Part II. for the Year 1798.
Elmsley. London.

THE fir ft paper in the prefent cohesion, relative
to medicine, is furniihed by Mr. Home, and is
entitled, * An Account of the Orifice in the Retina
of the human Eye, difcovered by Profeffor Soem¬
mering: to which are added. Proofs of this Ap¬
pearance being extended to the Eyes of other Ani¬
mals.’

The following account of Mr. Soemmering’s difco-
very was communicated to the author by Mr. Mau-
noir, an eminent Surgeon at Geneva. “ The war
being an obftacle to a free communication between
England and the Continent, you are not, perhaps, ac¬
quainted with a new difcovery in the anatomy of the
human eye, made by a profefior ot Mentz, Mr. Soem¬
mering; permit me, therefore, to fay fomething on
the fubjeH. He was diffe6ting, in the bottom of a
vefiel filled with a tranfparent liquid, the eyes of a
yol. v. N G g young

402 Philofophical Tranfactions of the Royal Society .

young man who had been drowned, and was (truck
on feeing, near the infertion of the optic nerve on the
retina, a yellow round fpot, and a (mall hole in the
middle, through which he could fee the dark cho-
roides , (looking at the furface of the retina which
covers the vitreous humour.) Fie differed other hu¬
man eyes, and conitantly, when the diffecfion was
carefully made, found the hole of the retina feemingly
at the pofterior end of the vifual radius, nearly two
lines on the temporal fide of the optic nerve, and
the hole (urrounded by the yellow zone, of above
three lines in diameter. The hole of the retina is not
diftin&ly feen, being covered with a fold of the retina
itfelf. An anatomift of Paris differed many eyes of
quadrupeds and birds, and found the yellow fpot and
hole in no animal but the human kind.

Should you think that nature has intended this
hole to grow large when the eye is oppofed to a
(Irong light, and thereby caufe a great part of the rays
to fall on the choroid, and vice verfa , w7hen the eye is
in darknefs ? And the want of fuch a conftruftion in
animals, is it owing to a greater powTer of augmenting
or diminifhing the pupil, than in men ? If Meffrs.
Mariotte and Le Cat (hould come to life again, they
would find, in that hole, the explanation of the phe¬
nomenon ot the twTo cards, one difappearing at a cer¬
tain diftanee from one eye, &c. which may be ex¬
plained by faying, that where the optic nerve enters
the ball, thebe is no choroid, and fo no vifion.

1 diffeeied fome human eyes a (hort time after
I had read the discovery, and found the fpot, the ruga
concealing it, and the yellow zone. The beft way,

A think, to fee' them, is to take oft' the half pof¬
terior part ol the fclerotica, then the correfpond-
ent part of the choroid ; both mu ft be cut round the
infertion ot the optic nerve. I he retina is to remain
bare and untouched, fuftaining alone the vitreous hu¬
mour • then you may lee the round fpot, wrhich reaches
the optic nerve, and a fold of the retina, marking a

diameter

Phihfophical Tranfactioris of the Royal Society * 403

diameter of the fpot. Then, if you prefs the ball a
little with your finger* fo as to pufh the vitreous hu¬
mour rather near the bottom of the eye* the ruga is
unfolded, and you will fee the hole perfefldy round,
of ~ of a line in diameter, and its edges very thin.

“ All this can be feen on the inflde of the eye* but
not fo perfectly ; and, in that cafe* you muft make your
obfervations in water ”

To obferve the appearances here pointed out, is
not always an eafy matter, and requires that the dif-
feftion be made with caution, and in a particular
manner. Some anatomifts, indeed* have altogether
denied their exiftence * on no other ground, as it
would feern, than becaufe they had themfelves failed
in endeavouring to deteft them. We fhall, therefore*
give the procefs followed by Mr. Home, together with
his remarks, in his own words.

c The mode I adopted*’ Mr. Home obfe’rves, c for
examining the retina, was that of removing the tranf- -
parent cornea ; then taking away the iris, and wound¬
ing the capfuie of the cryftalline lens, fo as to difen-
gage the lens, without removing that part of the
capfuie which adheres to the vitreous humour; by
which means, the retina remained undifturbed, and
could be accurately examined, when a ftrong light
was thrown into the eye. '

* The aperture in the retina, furrounded by a zone
with a radiated appearance; was diftinttly feen, on the
temporal fide of the infertion of the o|)tic nerve* and
about \ of an inch diftant from it, apparently a little
below the pofterior end of the vifual radius. The
aperture itfelf* in this view* was very fmall. After
having viewed it in two different eyes* I took an op¬
portunity of {hewing it to Sir Jofeph Banks and Sir
Charles Blagden, who both faw it with the fame de-
gree of diftinftnefs* 1

* At firft, I believed it neceffary to have a very
frefh eye for demonftrating this aperture, but I have
fmce found, that it is more readily feen in an eye two

G g 2 days

404 phtloji ophical Tran factions of the Royal Society .

days after death ; the zone, which is the moft confpi-
cuous part, being of a lighter colour the firft day,
than it is upon the fecond.

I have alfo fucceeded in preferving the pofterior
part of the eye in fpirits, without deftroying the ap-%
pearance of this aperture. This preparation I am un¬
willing to bring to a public meeting of the Society,
fmce it may be liable to be injured by being much
fliaken; but I hope my having (hewn it to Sir Jofeph
Banks and Sir Charles Blagden, will be fufficient
evidence, both to the Society and others, that fuch a
preparation can be made.

c I am induced to make this remark, by recoiled-
ing that a celebrated anatom iff of Edinburgh denied,
in his iafl publication, that the anterior lamina of the
cornea can be Separated from the others, as a conti¬
nuation of the tendons of the four ftraight mufcles of
the eye, for no other reafon than becaufe he could not
fucceed in the demonftration of it 3 the failure, pro¬
bably, ariftng from the eye not being fufficiently frefh
to admit of fuch a feparation. Had it been mention¬
ed in my former paper, that the preparation, from
which the engraving was made, had been fhewn to
this learned Society, or to any members of it, mv af~
fertion would probably have had more weight.

c In feparating the vitreous humour from the re¬
tina, l found a greater adhefion at this particular
part ; and, when the vitreous humour was removed,
the retina was^ulled forward, forming a final! fold,
in the centre on which was this aperture. This doub¬
ling was fometimes produced by endeavouring to cut
through the vitreous humour, to difengage the cry-
iiailine and its capfule.

^ £ I have been the more particular in defending the
appearance of this aperture in the retina of the human
eye, that, while I announce this curious difcovery of
Mr. Soemmering to this learned Society, I may give
the molt complete confirmation of it. To have this in
my power affords me a particular pleafure, as it gives

Philofophical Trarif actions of the Royal Society. 405

me an opportunity of doing juriice to the merit of a
foreign anatomih, who deferves fo highly of our art ;
and who has demonhrated to his cotemporaries, that
thofe who labour patiently, and follow their purfuits
with ardour, may hill hope to make difcoveries, in
the anatomy even of thofe parts of the body which
are confidered as the bell underhood ; fince the hujnan
eye, fo long the favourite objed of the moh eminent
anatomifts and philofophers, is hill but imperfedly
inveftigated.

€ After having made the preceding obfervatiops
upon this lingular appearance in the human eye, I
found, in Dr. Duncan’s Annals of Medicine for 1797,
an account of a publication concerning it by Profelfor
Reil, entitled, The plait, the yellow fpot, and the
tranfparent portion of the retina of the eye.

c After thefe are defcribed feparately, the following
circumhances are mentioned. “ Soemmering takes
this appearance to be a real hole. Buzzi, on the con¬
trary, thinks tlpat it is merely a tranfparent and thin
portion of the retina. Michaelis feems to agree with
him. Reil and Meckel are rather in favour of the
exihence of an aflual hole.

<c Michaelis faw the plait more di hi nelly in foetufes
of feven or eight months, than in adults and the
tranfparent portion lay concealed within it, but the
yellow fpot was wanting: nor is it to be obferved in
the eyes of newly-born children. After the firft year,
it becomes fo me what yellow, and the depth of the
colour increafes with the age of the fybjed. Soem¬
mering fa)S that this fpot is pale in children, bright
yellow in young people, and becomes again pale in
old age. Its degree of faturation feems to be inti¬
mately connected with the hate of vijfion : it conilaiit-
ly diminiihes, in proportion as virion is o b ft ru cried.
Where one eye only is difeafed, in it the yellow fpot
is wanting, and the plait is fmall and wrinkled ;
while, in the found one, they are rather .more dis¬
tinct than ufual.

rig 3 “ Michaelis

406 Pkilofopkical Tranfactions of the Royal Society ,

<c Michaelis difcovered no veflige of thefe appear¬
ances in the eyes of dogs, fwine, or calves.

* Profeffor Reil’s mode of differing the eye, to (hew
the aperture and plait, is exactly fimilar to that men¬
tioned in Mr, Maunoir’s letter.

It will appear, from the account of this orifice in
the retina, which precedes thefe obfervations of Pro-
feffor Reil, that the plait fo particularly mentioned is
an artificial appearance, which takes place in the clif-
fedlion of the eye, and arifes from the circumftance
of the vitreous humour adhering more firmly to the
edge of this orifice, than to any other part of the
retina ; fo that the fmalleft motion of the vitreous
humour, in confequence of dividing it, or removing
the choroid coat, produces a plait, by pulling forwards
this portion of the retina. What is faid of the colour
of the yellow fpot, and of the difference of opinion,
whether it is a hole or a tranfparent portion of the
retina, I fhall confider more fully in another part of
this Paper.

* After having afcertained the appearance of this
aperture in the human eye, and found what appeared
the bell, mode of feeing it, I determined to invelfigate
this fubjedf in the eyes of other animals.

4 The monkey was the firft animal which I pro¬
cured for obfervation ; being led, from previous know¬
ledge in comparative anatomy, to believe that the
ttrudture of its eye muff bear a very clofe refemblance
to that of the human fubjedt.

* The eye was examined immediately after the
death of the animal, and wa§ prepared in the fame
way that I have already defcribed the human eye to
have been for this pupofe ; fo that the concave furface
of the retina appeared in its moft natural tlate, and
the vitreous humour, being entire, kept it expanded,
and free from ruga. On the firfl view, nothing was
t<*be feen but one dark furface, furroundi >g the en¬
trance of the optic nerve. Two hours after death,
the retina became fuf&ciently opaque to be difti'nguifh-

ed,

Philofophical Tran factions of the Royal Society. 407

ed, and, immediately after, the orifice was vifible, ap¬
pearing to be an extremely fmail circular aperture,
without any margin ; but, in half an hour more, the
zone had formed, which, when very accurately exa¬
mined in a bright light, had an appearance of four
rays, at right angles, its fituation, refp effing the op¬
tic nerve, was precifely the fame as in the human eye.
As I confidered this to be a fa£t of fome importance,
fince it proved the aperture in the retina to be a part
of the flruflure of the eve, generally, and not a oecu-

m J J O J J i.

liarity in the human eye, I requeued Sir Jofeph Banks,
Sir Charles Blagden, and Dr. Baillie, to examine it :
to all of them it appeared very diftinfl. After having
(hewn it to thofe gentlemen, and having an accurate
drawing made of it, i preferved that portion of the
eye in fpirits ; where the aperture in the retina can
(till be diftindtly feen, but the radiated appearance is

loft.

c In the eye of a bullock, prepared in the fame
manner, i looked in vain for a fimilar appearance : if
it exifted, and bore any proportion to the fize of the
eye-ball, as it appears to do in the human eye and
that of the monkey, it mult have been very vifible.
The concave furface of the retina was examined in
different lights, under a variety of circumftances, and
by magnifying glades of different powers, but ftili no
aperture could be difcovered. I was, however, very
much (truck, while looking at the optic nerve, to fee
fomething in the vitreous humour, (in confequence of
a perfon accidentally ihaking the table,) that had not
been before obferved.

c This proved to be a femi-tranfparent tube, re-
fembling in its coats a lymphatic veiTei, rifing from
the retina, clofc to the optic nerve, on the temporal
fide of its infertion, and coming directly forwards into
the vitreous humour, in which it was loll, after being
diflinffly feen for ~yks of an inch of its courfe.

‘ This tube is not lb xlifii nelly feen in the eye im*
mediately upon the animal’s death, as fome hours'

C g 4 alter 5

40S Philofophical Trmf actions of the Royal Society 3

after; and is much more obvious in fotne eyes than
in others. As the coats of the tube mull be nearly
the fame in all eyes, this difference probably arifes
from its contents not always having the fame degree
of tranfparency.

* When the eye has been kept 24 hours after the
animal’s death, there is an appearance of a zone of a
circular form, a (hade darker than the reft of the eye,
in which the optic nerve is included : when this zone,
which is nearly ~c*ths of an inch in diameter, is atten¬
tively examined, the tube 1 have described is exadlly
in the centre of it. The tube feems to be confined
by the vitreous humour, (while that humour is entire,)
and only to move along with the central part of it ;
and, in fome inftances, when the vitreous humour is
divided, the tube falls down. Its attachment at the
retina appears ftrong'er than its lateral connection with
the vitreous humour ; for, when I coagulated the
vitreous humour in fpirits, and feparated it from the
retina, I found the tube was left with the retina, but
upon being touched was eafily torn.

c In the fheep’s eye there is a fimilar tube, in
exactly the fame fituation, refpefting the optic nerve,
but much fhorter, and much lefs eafily detected. It
does not appear to be more than of an inch in
length, before it is loft in the vitreous humour. After
having feen the tube diftindtly in two different eves,
and having had a drawing made of it, I looked for it
in feveral others, without finding it : but, examining an
eye from which the cryftalline lens had not been re¬
moved, only an aperture made into the vitreous hu¬
mour, by removing a portion of the ciliary proceffes
along with the iris, the tube was diftinctly feen. The
weight of the lens probably pulled forward the vi¬
treous humojLir, and kept the lhort tube ereft, in its
natural fituation.

c I mention this circumftance, to prevent, as much
as I am able, other anatomifts from being difappoint-

Philojhphical Tranfoctions of the Royal Society. 409

eel in not finding it; which may readily happen, if the
fearch be not made with confiderable attention.

4 In the fheep, there is no appearance of a zone
furrounding the tube.

c Thefe faffs, although few in number, are fuffi-
cient to prove, that this orifice is not peculiar to the
retina of the human eye ; and that its fituation in man
and in the monkey is the fame : in them, it is placed
at feme diftance from the optic 'nerve; but, in fome
other animals, its fituation is clofe to that nerve, and
it puts on the appearance of a tube, inftead of an
orifice.

4 There is one circumftance which is curious, and
which it will require further information upon this
fubjeff to explain; the yellow zone, found in the
human eye and that of the monkey, is not met with
in any other animal which I have examined.

‘ Having ftated the faffs, and alfo the opinions of
other anatomifts, that have come to my knowledge,
as well as my own obfervations, upon this orifice in
the retina of the human eye, difeovered by Mr. Soem¬
mering, and having added to thefe, feveral new faffs
refpeffing it in other animals, I (hall draw fome ge¬
neral conclufions from the whole, with a view to fhew
that the conjeffures which have been made, refpefl-
ing its ufe, are probably erroneous. I fhall after¬
wards point out feveral reafons for confidering it as
the orifice of a lymphatic veffel, intended to carry off
the vitiated parts of the vitreous humour and cryftal-
line lens.

4 In the human fubject, as no examination, can be
made for fome confiderable time after death, it is ira~
poffible to afeertain what is the real ftate of this orince
in the living eye, and what changes take place in it
after death ; we only learn, that the tinge of yellow
furrounding the orifice is very flight, when the eye is
examined recently, and that the next day it becomes
much deeper.

4 Thefe

410 Philof optical Tranf actions of the Royal Society .

c Thefe points appear to be fatisfa&orily cleared
up, by the examination that was made of the monkey's
eye, as it was begun before the parts had loft the ap¬
pearance belonging to them as living parts. In that
ft ate, the retina was tranfparent, and no orifice could
be feen ; fo that the orifice is rendered vifible, by re¬
maining tranfparent, while the furrounding retina be¬
comes opaque. This appears to decide the difpute
between Meffrs. Soemmering and Buzzi ; for, if this
part does not undergo the change peculiar to the
retina, we muff confider the retina as wanting there.
After the orifice is thus rendered vifible, the yellow
tinge is wanting, and does not take place for feveral
hours, and even then is fainter than it becomes after¬
wards ; which appears to be fufficient evidence, that
this tinge is the effedt of fome change after death, and
cannot, therefore, have any effect upon vifion.

c The orifice has been fuppofed to account for a
fmall objeft becoming invifible, when placed at a
certain diftance from the eye, and brought oppofite
a particular part of the retina. This, however, can¬
not be the cafe, as its fituation in the retina does not
cor re fpond with the part oppofed to the objeft, when
rendered invifible.

c The orifice itfelf is probably too fmall to produce
any defeat in vifion, as the trunks of the blood- veffels
which ramify upon the retina cover a larger fpace
than this orifice, for a confiderable extent, without
obflru&ing the fight of any part of the object.

c While my obfervations were confined to the hu¬
man eye, I was led to confider this orifice as a lym¬
phatic veffel, paffmgfrom the vitreous humour through
the retina, but could bring no abfolute proof of its
being fo. This opinion was ftrengthened by finding,
that in the monkey, the orifice was only rendered
vifible when the retina became opaque ; and it has
fmce been corroborated, by a diflinT tube being met
with in the eyes of iheep and bullocks.

c That

Philofophical Tranf actions of the Royal Society . 41 1

c That a change mull; be conftantly taking place in
the cryftalline and vitreous humours, to preferve to
them the neceffary degree of tranfparency, can hardly
be doubted ; and that the abforbent veffels which per¬
form that office fhould have one common trunk, which
follows the courfe of the artery and vein, perfeftly
agrees with what takes place in other parts of the
bodv.

4 In the human eye, and that of the monkey, the '
artery is in the centre of the optic nerve ; but that
would have been too circuitous a courfe for the lym¬
phatic veffel to follow, and, by going through the
retina, at fome diftance from the nerve, it can pafs
out of the orbit with the blood-veffels that go through
the foramen laeerum orbitale inferins. In the bul¬
lock and fheep, there is a plexus of veffels furround¬
ing the optic nerve, and the tube dips down, clofe by
the optic nerve, probably to accompany them.

4 From the obfervations made by Michaelis, of the
yellow fpot not being vifible in feetufes, or in infants
under a year old, or in eyes that are blind, alfo of its
being brighter in young people, and paler in old, it
would appear, that it is only when the eye is capable
of performing its functions, that there is any (lain
communicated to the retina/

The next paper contains an interefting Defcription
of a very unufual Formation of the human Heart : by
Mr. James Wilfon, Surgeon.

The heart, Mr. Wilfon obferves, is an organ of fo
much importance in the animal oeconomy, and is fo
immediately concerned in the fupport of life, that
any unufual deviation from its natural form and fitua-
tion in the human body, has always been con fide red
as a fubjefi of fome intereft by the phyfiologift. Many
circumftances refpefifing the circulation of the blood
and refpiration, wholly unknown to our anceftors, have
lately been afeertained : but we are not yet arrived at
a perfect knowledge of thefe important actions. Dif¬
ficulties

412 Phitofophical Tran factions of the Royal Society .

fieulties yet remain $ more information may ftill be
acquired ; and the reafoning upon thefe fubjefts will
be lefs liable to fallacy, in proportion to the number
of fafts which have been obferved, and the accuracy
of the obfervations- On this ground, the author has
been induced to lay before the public, a description
of a monftrofitv in the human heart, very Singular in
its nature, and hitherto undefcribed..

£ It is well known,’ Mr. Wilfon remarks, ‘ that the
circulation of the blood throughout the body, and ex-
pofure of it to the atmofpheric air in refpiration, feem,
in mod animals, to be neceffarily connefted ; but are
not equally fo in all. They are fo much connected in
the human fubjeft, and in moft quadrupeds, that after
birth there is a double heart ; viz. one for the circula¬
tion of the blood throughout the body, to be fubfer-
vient to the various purpofes of life and growth ; the
other for its circulation through the lungs, where it
undergoes a change which is effential to its general
circulation through the body: tbefe two circulations,
in the natural (kite, bear an ex aft proportion to each
other. In fiances, however, have occurred, even in
the human fuhjeft, where this exaft proportion has
not been prefer ved ; yet life has been prolonged for
home years, but in a feeble and imperfeft hate. In
Some of thefe inftances, the pulmonary artery has
been f inaller than ufu.al, fo that much lefs than the
natural quantity of blood was expofed to the influence
of the air in the lungs ; in others, the foramen ovale
has not been clofed, but a confiderable communica¬
tion has remained between the two auricles ; and, in
others, there has been a communication between the
two ventricles, from a deficiency in the feptum.. The
effect, of all thefe deviations- is the* fame, upon the
blood in the general circulation, viz. that a part of the
blood is not expofed to the air in the lungs ; fo that
if is lefs pure as it circulates over the body. A more
remarkable deviation in the ftrufture of the heart,
than any to which I have juft alluded, has been lately

publifhed

Philofophical Transactions of the Royal Society , 41 S

publifhed by Dr. Raillie, in his Morbid Anatomy,
In this heart, the aorta arofe from the right ventricle,
and the pulmonary artery from the left ; the reverfe
of what ought, in the regular oourfe of circulation,
to have taken place ; (the veins were as ufual ;) and
no communication w7as found between the one veffel
and the other, except through the remains of the
dubtus arteriofus, which was not larger than a crow
quill, and a final 1 part of the foramen ovale, which
dill continued open; yet this child lived for two
months. In the following cafe of mo nitrous forma¬
tion of the heart, there is this very great fingularity,
that nature feems to have fubftituted, very exabily,
the circulation which takes place in lome amphibious
animals, for that which is natural to the human
fpecies.

c The infant had arrived at its full time, and lived
feven days after its birth. Indead of the ufual inte¬
guments, mufcles, &c. a membranous bag appeared
to protrude on the upper and fore part of the ab¬
domen, extending from the lad bone of the dernum
fome way below the middle of the belly, and out¬
wards, fo as to be nearly circular: the navebftring
Teemed to enter this membrane near its middle, and
to wind fuperficiallv, for fome little way, towards the
left fide ; it then dipped into the abdomen, at the
place where this membrane joined the ufual cover¬
ings. Within this bag, the appearance of which was
very nearly fimilar to that of the chorion and amnios
which envelop the foetus at birth, but thicker in con¬
fidence, a tumour was perceived, poffeffing confider-
able motion, from the nature of which, no doubt was
entertained that it was the heart.

4 During the fhort period of the child’s life, it was,
feen and examined by a number of profefllonal men.
Upon its death, the tumour was carefully opened by
Mr. Morel], in the prefence of Dr. Poignand; when
the heart, as was previoufly fufpebled, appeared to be
fituated in the epigadric region of the abdomen, and

414 Philofophical Tranj actions of the Royal Society >

to be Imbedded, as it were, in a cavity formed on the
fuperior furfaee of the liver. In this (late, the child
was fent to Dr. Baillle, by whofe deiire I injected the
heart, and laid its principal veffeis bare, fo as to bring
their uncommon difiriBution and courfe into view : a
preparation of them hill remains in Dr. Bailiie’s pof~
feffion.

c A confiderable part of the tendinous portion of
the diaphragm appeared to be wanting, as likewife
the lower part oi the pericardium, which is ufually
affixed to it. The thorax being laid open on each
fide of the fterhum, the two pleurae were feen palling
from that bone to the fpine, and covering the lungs*
as ufual. The lungs appeared perfe£tly natural in
colour, and nearly fo in fhape ; but were larger and
fuller than ufual, in confequence of more room being
afforded for them in the thorax, from the peculiar
fituation of the heart. In the fpace correfponding to
the anterior mediadinuiru was the thymus gland, con-
fiderably longer than in other children, and extending
downwards the whole length of the dernum ; behind
this, was a peculiar arrangement of blood-veffels.

c The heart, indead of confiding of four cavities*
as in the natural dru&ure, confided of a dngle auricle
and ventricle, which were each of them large in their
iize. A large arterial trunk arofe from the ventricle,
and afcended into the thorax, between the pleurae,
immediately behind the thymus gland : it foon divided
into two large branches, one of which continued to
afcend, forming the aorta: the other paffied back¬
wards, and proved, upon examination, to be the
pulmonary artery.

4 The aorta, having reached the common place of
its curvature, formed it in the fame manner as it
tilually does ; fent off the veffeis belonging to the
head and upper extremities; defcended before the
vertebrae, and paffed into the abdomen between the
crura of the diaphragm. From the place where it
began to form the arch, it was in no refpeft different

from

Phitofophicai Transactions of the Royal Society. 415

from the aorta of any other infant, except that no
bronchial artery was lent to the lungs, from it, or any
of its ramifications.

‘ The veffel which proved to be the pulmonary
artery, almoft immediately divided into two branches ;
one going to the lungs of the left, the other to the
lungs of the right tide. Upon meafuring accurately
the circumference of the aorta, where it feparated
from the original trunk, it was found to be exactly
one inch and a quarter. Upon meafuring the circum¬
ference of the pulmonary artery, in the fame manner,
it was found to be fifteen fixteenths of an inch ; fo that
it was five fixteenths of an inch lefs than the aorta.

The vena cava inferior, having been partly fur-
rounded by the fubftance of the liver, entered the lower
and back part of the auricle. The fubclavian vein of
the right fide eroded over to the left of the mediaf-
tinum, where it joined the left fubclavian, and form¬
ed the vena cava fuperior. This puffed down on the
left ot the afeending, and before the defcencling, part
of the aorta ; it was then joined by a trunk formed by
two large veins, which came out of the lungs, and
which were fituated immediately behind the pulmo¬
nary arteries : the union of this trunk with the vena
cava fuperior was continued into a large veffel, which
gradually expanded itfelf into the auricle. The vena
azygos afeended on the left fide ; received fome
branches which palled under the aorta from the
right, and then entered the upper and back part of
the vena cava fuperior : there were no bronchial veins.
From there being neither bronchial arteries nor veins,
it would appear that the pulmonary arteries and veins,
in addition to their ufual offices, performed thole of
the bronchial veffels.

c The liver was not divided on its upper furface by
the fufpenfory ligament, but had a confiderable ca¬
vity fcooped, as it were, out of its fubftance; which,
in fnape, was adapted to, and contained, the heart ;
it was alfo, in fome other particulars, rather different

from

416 Philofophical Tr infections of the Royal Society .

from its natural fliape, but not fufficiently fo to require
being minutely deferibed. The reft o*f the infant was
examined, but was not found to be diffimilar to any
other*

< It is a well afeertained fadt, that the blood receives
a florid hue from the influence of the air on it in the
lungs; and this change is fuppofed to be effected by
the combination of a certain quantity of oxygen gas
with it. In pafling from the arteries to the veins, in
every part of the body except the lungs, it lofes the
florid hue, and becomes darker: the florid blood is
that which is employed for the purpofes of fupporting
life. In the natural circulation, it is well known, that
the whole of the blood conveyed to, and circulating
in, the pulmonary artery, is of a dark colour ; and the
whole of it, when returned by the pulmonary veins, is
florid.

6 It is obvious, in the cafe which I have deferibed,
that there always mutt have been florid and dark-
coloured blood mixed, and circulating in the arteries*
It would feem alfo, upon the firft reflexion, that the
quantity of dark-coloured blood would be the greateft,
in the fame proportion as the capacity of the aorta
was larger than that of the pulmonary artery. It is
therefore neceffary to recoiled!, that a confiderable
proportion of the blood carried to the lungs was
already florid or oxygenated ; and alfo, that the lungs
In this infant were larger in proportion, than in chil¬
dren of the fame age : a fmaller quantity of blood,
therefore, was to be oxygenated, and a larger furface
than.ufual was appropriated for this purpofe. It ap¬
pears alfo, from experiments, (fuch as making a pe.rfon
breathe air in which there is a greater proportion of
oxygen, gas than in our atmofphere,) that the blood
can°combine with more of it than it does in natural
re fpi r&tion ; it therefore is not an improbable fuppo-
fltion, that a larger quantity was combined here. A
fmall drawback mull be allowed, for the quantity of
oxygenated blood ufed in the fupport and fecretions

Fhilofophicat Tranf actions of the Royal Society, 417

of the lungs, and which is ufually conveyed to them
by the bronchial artery ; but this quantity is too fmall
to require more than this flight obfervation of it. The
blood alfo which palled to the lungs, muft have been
again conveyed to the heart fooner, from the fhort-
nefs of its circuit ; and muft have entered the heart
with a quicker or ftronger current, than that blood
which paffed to, and was returned from, the more
remote parts of the body ; as, in this child, the pub
monary artery and aorta were filed by the contrac¬
tion of the fame ventricle. In the hearts of other
children, fome time after birth, the mufcular fibres of
the right fide are much fewer in number than in the
left. „

e If them circumftances are admitted as faff, viz.
that the bipod circulating through the lungs of this
child was combined with a larger proportion of oxy¬
gen gas, and was returned in a quicker and ftronger
current into the auricle than that returned by the
venae cavae, it feems reafonable to infer, that this
blood, mixing and blending with the dark or unoxy¬
genated blood, would render the whole nearly as
much unoxygenated as it ufually is found in the Jeft
fide of the heart, and in the aorta ; therefore, that the
blood circulating in the arteries of this child would
be fully equal to the fupport of life. Previous to birth,
this peculiarity of ftrufture could not affect its health
or growth, as the placenta then anfwers the purpofe
which the lungs do afterwards ; and the fingle ven¬
tricle feemed as equal, from its fize, to propel the
blood on to tfye placenta, as both ventricles in the na¬
tural ftate are, by means of their communication
through the ductus arteriofus.

c The inference which has been drawn feems fur¬
ther confirmed, from the colour and heat of this child*
during life, being not perceptibly different from thofe
of other children. In all thofe cafes of malformation
of the heart where the foramen ovale, or the duftus
arteriofus, has continued open ; or where the feptura

vol. v. Hh * of

418 Philofophical Tvanf actions of the Royal Society .

of the ventricles has been perforated, and the pulmo¬
nary artery fmall, (and at the fame time two ven¬
tricles,) it has been obferved, that the body had a
livid colour, and, in general, that there was a de¬
ficiency of heat.

c From the particular inquiries which I made, con¬
cerning the heat and colour of this child, of the pro-
teffional gentlemen who faw it during life, and of the
nurfe who attended and dreffed it, I found that the
heat, fo far as could be judged by the feeling, (for it
was not tried by the thermometer,) was in no refpeft
different from that of other children; and that the
colour of the fkin was perfectly natural, except that,
on the day on which it was born, and a fhort period
before its death, the lips occafionally had fomething
of a livid appearance ; but that this did not fail any
time, as they were generally pale. This occafional
lividnefs would happen to a child in that date, fhould
the heart and circulation be in no way different from
what they naturally are.

* I could meet with no other remarkable circum-
ilances, either in the hiftory of the mother during
pregnancy, or in the child after birth. It cried occa¬
sionally, like other children, but feemed weak, and
in pain ; it flept ; it lucked heartily, even a few
hours before its death, and had apparently healthy
evacuations of urine and fences.

c Its death can be fatisfaftorily accounted for, from
another caufe than the extraordinary formation of its
heart and hlood-veffels. The membranous covering,
on the fore part of the abdomen, did not appear to
poffefs fufficient vafcularity to retain its life after birth ;
tor it immediately loft its living principle, and became
putrid and mouldy in parts. Previous to the child’s
death, a procefs ot reparation had begun, between
it and the living parts to which it was connected, and
a line of inflammation was diftinftly feen. Had this
procefs been completed, and the Hough thrown off,
the heart would have been expofed ; but, before this,

the

Philofophical Tranf actions of the Royal Society. 419

the heart itfelf had inflamed ; which was proved from
its being found covered writh a coat of coagulable
lymph recently thrown out, and from this inflamma¬
tion its death muft have arifen.

4 Had the heart been covered with the ufual pa-
rieties of the abdomen, it is probable, notwithftanding
its fituation, that this child might have lived in a
tolerable ftate of health for years ; but muft conftantly
have been expofed to have its heart injured by fome
external accident, from its not being defended by the
ribs and the fternum.

‘ The formation and difpofition of the heart and
veflels, in the child, refemble much thofe which are
found jin the frog, and fome other amphibious ani¬
mals ; but this infant could not, like them, be am¬
phibious. Thofe animals are extremely tenacious of
life/fo that they live fome time, even after their heart
and lungs are removed from their bodies; and, as
their circulation can go on without refpiration, it is
therefore not wonderful that they often live a con-
* fiderable time without change of air. Life, in the
human fpecies, depends equally on both thefe actions ;
for death takes place, if either of them fhould flop.
The circulation of the blood in this infant would have
met wdth no impediment, had it been immerfed in
water ; but, unlefs refpiration went on, which in that
ftate it could not do, the blood could undergo no
change in the lungs ; and this change is equally
effential to the fupport of life, as the circulation of
the blood. ’

One other paper remains to be briefly noticed, the
fubjeft of which is, a Tumour found in the human
Placenta, by Dr. John Clarke. — It is fufficiently
known, that the principal ufe of the placenta is,
to tranfmit, and apply refpedfively to each other, the
blood of the fcetus, and that of its mother. No other
aftion is carried on, as far as is yet known, by the
veflels of the flxtal portion of the placenta, unlefs fo

H h 2 much

420 Cullen's Clinical Lectures .

much as may be neceffary far their own growth and
nourifhment.

In the placenta which gave occafion to the prefent
paper, was found a tumour refembling in fhape, fize,
and confiftency, the human kidney. On being cut
into, feme parts were obferved to be highly vafcular,
whilft others were white, and remained uninje&ed.

The exiftence of the tumor in this part thews, that
the veffels of the placenta, like thofe of other parts,
are capable of forming folid organized matter ; and
that very confiderable deviations from the ordinary
ftrufture of the placenta may exift, and be perfeftly
compatible wTith the life and health of the foetus.

Art. XLV. Clinical Lectures: delivered in the
years 1765 and 1766. By William Cullen,
M. D. &c.

( Continued from page 337.J

IN our laft number we followed the author in his
. general hiftory of Head-achs. He next proceeds to
point out the diflinciions that occur, and to explain

* The principal head-achs, then, we refer to topical
fever. As in other fevers, fo here is a cold and hot
fit in various degrees. In fome fevers there is only a
cold fit, which immediately kills the patient ; in others
it is fucceeded by a hot fit, and this having various

proportions to the cold lit, and with various refolu-
tions.

c Thefe fevers of the head-ach are alfo of different
kinds, and mark out the different prevalency of the
cold and hot fits. To explain this, we muff make a
few remarks upon the nature of pains. There are
fome pains depending on a flimulus, or fome acrid
mallei applied to the part : but as this is common to

Cullen’s Clinical Lectures. 421

every part of the fyftem, we fliall omit it here, and
only take notice of thofe pains which are more im¬
mediately connected with the vafcular fyftem, and
occur in the extremities of veffels.. Thefe are of two
kinds, one of which proceeding from diftenfion, and
which occurs in the plethoric head-ach, is well under-
flood, and perhaps the only one generally thought of.
The other kind of pain is analogous to an external
force compreffing and conftrifting the nerves ; and
perhaps of this kind is the pain arifing from fpafmodic
eonftrictions. Such too is the pain arifing from cold:
this condenfes all bodies, and conftringes the extremi¬
ties of nerves ; but whether it a£ts merely thus, or
produces fpafmodic conftriftions, is difficult to deter¬
mine. Such conftriftions do arife from cold, and are

••

relieved by heat: thus many head-achs are accom¬
panied with a fenie of cold; and there are inftances
of the fame in other parts, as in particular joints,
which are only removed by reftoring the impetus of
the blood to them ; and though this caufes a diftenfion,
it cures them. This pain then appears to be opppfite
to the diftending pain, which occurs chiefly in attacks
of the head-ach and fevers, and often in chronic
rheumatifms. In feveral inftances of the head-ach,
thefe two points are more or lefs mixed : thus in the
febrile head-ach itfelf, the pain coming before the
cold fit, or accompanying it, cannot be of the diftend¬
ing kind, but muft certainly be the conftriftmg ; as
there is then every proof that the blood is not impell¬
ed into the heart with the fame impetus as ufuaL
Thefe pains thus differing, as they recur at different
periods of the head-ach, are often connected with
each other. Thus the diftending pain, as in haemor¬
rhages, by occafioning fpafms, lays the foundation for
the confirming; and the conftrifting pain, when pro¬
duced, proves a ftimulus, and occafions the diftending,
as in fevers, inflammation, &c. When the diftend¬
ing pain has continued in a part for any time, it leaves
it in a ftate to be affected by the confirming. Thus

II h 3 acute

422

Cullen's Clinical Lectures,

acute rheumatifm is often attended by the chronic,
and this by the palfy. This is often propagated to the
origin of the nerves ; fo that other parts are affeffed,
as being conne&ed with the fenforium commune : but
thefe pains are often Separate, and the conftrifting is
frequently found alone.

£ As the head ach proceeds from various caufes, either
of thefe different hates may prevail: thus, on the one
hand, various caufes produce paroxyfms of the dis¬
tending pain, which were marked out among the
occafional caufes, ■ under the titles of fulnefs, tempo¬
rary rarefaction, and determination to the veffels of
the head. On the other hand, the conftrifting pain
is occaftoned by cold, and all weakening caufes; — by
the paffions, as by fear and grief; by watchings, ftudy,
evacuations, abftinence, and all fuch as diminifh the
force of the nervous power, or, by an external appli¬
cation, bring on a conftriftion of the part. This
pain thus produced, does not always prove a Stimulus,
or bring on the diftending pain. What has been here
faid, will explain the various caufes of the head-ach.

‘ in the febrile there is a more certain paroxyfm ; in
the rheumatic, it is longer, and more uncertain. With
regard to the head-ach depending on a topical fever,
a queftion may ante, what fpecies of fever it might
be, and when it properly partakes of the nature and
genius of an intermittent. Sauvages has been fo
exaff here as to diftinguifh both a cephaUa and hemi-
crania^ intermittens, though there are Several oth ef
periodical fpecies. This, when difcovered, leads
more direffly to the method of cure, and (hews when
the bark may be properly applied.

lo diftinguifh then what periodical head-achs im¬
mediately partake of the nature of an intermittent,
the following considerations will be of Service, as,
1* Whether any intermittent is epidemical? then,
2. Whether the climate is fubject to thefe epidemic
Intel mitten ts, though they do not actually prevail at
the time ? 3. Whether it is the ufual feafon. of the

year

Cullen’s Clinical Lectures . 423

year for fuch, as fpring and autumn ? 4. If the pa¬
tient has formerly laboured under a head-ach, as con-
ne£ted with an intermittent? Thus, a perfon who had
before been cured by the bark of a periodical head-
ach, which he had during an epidemical intermittent,
on its returning, was cured of it on the footing of an
intermittent. 5. At what period thefe head-achs re¬
turn ? If it be a quotidian, it is more ambiguous
but if tertian, we may judge with more certainty*
6. What is the time of their coming on ? If it be in
the evening, they have lets of the nature of the inter¬
mittent, which is more common at noon, or in the
forenoon. 7. Whether thefe returns are ftriftly pe¬
riodical? for, in a proper intermittent, they are ufually
more or lefs poftponed. By thefe means we may in
forae meafure judge, how far they partake of the na¬
ture of the intermittent.

c There are fome fymptoms which exclude this in¬
termittent nature, as when we difcover the head-ach
to be connefted with any particular vifcus, or other
parts of the body, as with affections of the ftomach,
flatulency of the bowels, arthritic fits, &c. When
we difcover the head-ach to depend on occaflonal
caufes, and to have its intervals varied by thefe, there
is great reafon to fufpeCt that it is not of the proper in¬
termittent kind, though it is not a certain proof. For
the occafional caufes do take place in intermittent
fevers, yet thefe are wonderfully fleady in their pe¬
riods, independent of fuch caufes. We mutt now
add, that befides the principal idiopathic head-ach,
which may be looked upon as a topical fever, there
are other kinds, which we know not where to refer.
Such is the cephalalgia melancholic a , which is often
accompanied with climnefs of fight, vertigo, &c. and
fucceeded by epilepfies, apoplexies, palfles, and
often too with mania. This has.a manifeft connexion
with the ftagnation of the blood in the veffels of the
brain, and is particularly prevalent in the melancholic
temperament, and fo depending on a plethora in the

H h 4 venous

424

Cullen's Clinical Lectures .

venous fyftem. Whether it is purely plethoric, or
depending on a febrile paroxyfm, has not been de¬
termined ; but it feems rather of the firftkind. It doth
indeed appear fometimes in fits of a topical fever ,
but inch infiances are very rare. Its occafional caufes
may perhaps be referred to thefe two heads. 1. fuch
as hinder the reflux of the venous blood from the
vefifels or the head, as ftooping, &c. 2. whatever
weakens the fyftem, and diminiflies the impetus of
the nervous power. Thus melancholy, hypochondri-
afis, and fuch others, will excite occafional fits of
this head-ach, for it is feklom periodical. What is
its particular nature, has not been determined.

* Another of thefe fpecies of head-achs, which can¬
not eafily be referred to the principal idiopathic, is
that connected with the menftrual or hemorrhoidal
flux, and called cephalalgia catamenialis & if hcemor -
rhoidahs . Ihe coming-on of the hemorrhoidal flux,
is not exactly periodica], and is often foretold by this
head-ach.

* The notion which would molt readily occur here-is,
that the plethora is owing to fome refifiance made to
the blood, as it endeavours to pafs off by thefe veffels,
whereby it is made to regurgitate on the brain. But
this is liable to many difficulties,* and all the argu¬
ments brought upon the queftion, whether the ple¬
thora or the menftrual flux ismmiverfal or topical,
again ft a univerial plethora, will apply here.

c Still, however, the menftrual and hemorrhoidal
mix are to be looked upon as topical fevers, founded
on a tin gid ftate ot the veffels ot the uterus and anusa
even a moderate turgefcence here, without a plethora
m the other veffels, may excite a painful tenfton in
oilier parts of the fyftem, and promote the impetus
in them,* audit accordingly doth fo. Thus, when
the menftrual flux is obftrudted, it is fometimes deter¬
mined to the lungs, fometimes to the ftomach, and

may eafily be fo to the head 3 independent of anv
general plethora,

There

Cullen’s Clinical Led arcs. * 425

6 There is, indeed, either fomething particular in the
veffels of the head, or it is in confequeuce of its com-
munication with the fenforium commune , that the
head is fo much affedfed in all fevers. But why it is
fo, has not been yet fully folved. Taking the cat a*
menial and hemorrhoidal head-achs, then, in this
view, as topical fevers; we may obferve, that there is
a head-ach, which often follows thefe difcharges,
when they have been remarkably plentiful. This,
then, cannot be of the plethoric kind, but of the con-
ftridfing. Befides thefe, which are doubted concern¬
ing their being topical fevers, there is another fpecies,
which has been fo fince Riverius, the cephalalgia fto~
machiea. This is explained by confent, which 'we.
file wed before, not to depend on any connexion be¬
tween the nerves and the two parts, but upon an im-
preffion made on one part, and communicated to the
other, from a particular aptitude in the laft to receive
fuch: thus the different ftates of the ftomach are
found to affedt the head, and may undoubtedly be the
foundation of the head-ach.

c The ftomach has a particular connexion to the
nerves, all over the fyftem, whence it is fo much affedl-
ed in all fevers. Crudities of the ftomach are frequent¬
ly found to bring back an intermittent fever, after it
has once ceafed ; and perhaps, too, to give rife to it:
we may conclude, then, that the fame ftate of it
may bring on the head-ach. There is another cafe of
a ftomachic head-ach, where, from a change of the
determination to the uterus, the ftomach is affedled ;
and this may be tranflated to the head, with this effedt,
that the pains m the ftomach and head become alter¬
nate with each other. Thus they may continue in
the ftomach for fome days, and then remove to the
head, and the ftomach will be relieved : thus in a cafe
of a head-ach, accompanied with an inflammation in
the eyes, this inflammation, and the pains of the fto¬
mach, alternated with each other.

£ Befides thefe fpecies of head-achs, which, feem
doubtful, there are others which are not at all of the

febrile

426

Cullen's Clinical Lectures *

febrile kind : fuch are thofe depending on more par¬
ticular topical affeftions of the brain, or ftimuli, fuch
as tumours, and fo various erofions: thefe produce
head-achs of a permanent kind 3 but as they are
liable to be increafed by occafional caufes, they may
have exacerbations, and fo appear aim oft periodical,
coming on at a particular time of the day, as towards
the evening.

o \

£ Thefe laid lead to a queftion, Where the pains of
the head-ach are properly felt? Sometimes their feat
may be internal ; but, without doubt, it is more
commonly, even in this laft fpecies, in the external
parts. We have fufhcient inftances of this, and onO
in particular, where the patient had complained long
of a pain in the crown of his head, in whom, upon diff
icdlion, there was found a confiderable erofion at the
bafts of the head. Thus, in an epileptic patient un¬
der our care, where there is every reafon to fufpeft a
topical affection of the brain, the pain is in the verte¬
bras, which cannot bear the flighted; touch. It ap¬
pears, alfo, from the effects of compreffion, in aggra¬
vating or relieving the fymptoms. How internal af¬
fections affe& the external parts, is not known ; but
certainly there is a particular connexion between the
internal and external parts of the head. Thus,
wounds that affect only the common teguments of the
head, will often produce violent head achs. As this
ihews how the external parts affeft the internal, fo
the propofltion is eafily convertible.

c It may be afked, why the pain is circumfcribed in
the external parts, as it generally is to the vertex, or
temporal muffle, or over one eye-brow. Our anato¬
my is fcarcely carried fo far as to enable us to give a
folution to this problem. We muft look upon the
frontal and occipital muffles, as a digaflric, the inter¬
vening tendon of which, and that of the temporal,
are the chief feat of the pain. The pain, then, here
we look upon as analogous to the rheumatiffnin other
parts, which doth not feem to refide in the bodies of

muffles*

Cullen’s Clinical Lectures.

427

mufcles, but their tendons. Thus, in the fciatica9
though the pains fly acrofs the mufcles, they are only
violent at their extremities, as from the hip-bone to
the knee, and from the knee to the ancle. Haller, in¬
deed, fuppofes thefe tendinous parts to be infenfible^
but this feems not to be the cafe.

£ When we are able to explain the above phenome¬
non, and why the electrical fhock is only felt at the
joints, we fhall then, probably, underhand the rea~
ton of the head-ach, having its feat fo circumfcribed.
Before we proceed to fpeak of the method of cure,
we mull mention an obfervation of Lieutaud, on
this diforder. He fays that he cannot lay down any
diredt plan for the cure of it, but only mention what
medicines have been ufed for it. What he obferves of
this, is the hate of empiricifm in every difeafe.

* It is eafy to perceive, that there muft be different
methods of cure here, adapted to the nature of dif¬
ferent fpecies. In the fimple plethoric head-ach, im¬
mediate relief may be given by bleeding ; but its ef¬
fects are only tranfitory ; and, if often repeated, it
may be hurtful, as frequent bleeding is equally apt to
bring on a return of the plethora, as the molt plenti¬
ful diet is : it fhould, therefore, be ufed with caution,
and along with it may be employed abftinence, and
moderate exercife, to prevent any accumulation for
the future, by lupporting the ufual difcharges. But
it feldom happens that head-ach, which fubfifts for a
long time, is purely plethorical; it fhould therefore
be treated as a topical fever, but varioufly, according
to the various circumftances of it : thefe, whether
exadlly periodical or not, have their intervals and re¬
turns, and to prevent thefe returns is the chief bufi-
nefs of the phyfician ; thefe are often owing to a ple¬
thoric hate in the veffels of the head, either in confe-
quence of an univerfal plethora, or a particular deter¬
mination to that part. Where this is very evident, and
the fever produces a hot fit, attended with an increafq
of heat, a frequent pulfe, or only a full one, with

throb-

416 Cullen's Clinical Lectures .

throbbings, there the cure is to be found only in
blood-letting.

4 When there are only preemptions of a plethora,
regard mu ft be paid to circumftances, as, if it occurs
in young perfons, in the fpring feafon, &c. In gene¬
ral, bleeding fhould only be ufed, where the pletho¬
ra is evident. Topical bleeding is raoft proper, as
by leeches, or cupping-glaffes. If it is thought pro¬
per to open a vein, it will be more proper to open
the jugular than that of the arm : but here, too, we
muft obferve, that the effects of bleeding are only
temporary. A more effectual remedy is the ufe of
purgatives: thefe have not fuch an immediate effect
in taking off the plethora and diminifhing the heat,
though they do this too ; but they may be more fafe-
ly repeated, and fo are more permanent, and have a
peculiar advantage, in caufing a derivation from the
head. The head-ach has, accordingly, been frequent¬
ly cured by moderate, but habitual laxatives.

c If valerian ever cured this diforder, as has been af-
ferted, it was by afiting as a laxative, of which we
have feveral proofs now in this houfe : accordingly,
there are two mftances mentioned by Dr. Fordyce and
Dr. Whytt, in which valerian cured the head-ach, by
being given m a large dofe, as 511 or 5111 a day. There
is another remedy, which is lomewhat analogous to
this, in deriving from the head, a pediluvium; for,
by relaxing the lower extremities, it takes off the
lenfion from the veffeis and membranes of the head.

£ But the moft effedtual remedy, either in a more
general or partial plethora, efpecially in* young per¬
fons, is a low diet, confifting chiefly of vegetables :
keeping up a proper perfpiration at the fame time,
and equable determination of blood by moderate ex-
ercife. Thefe act more generally upon the fyftem.
There are others acting more topically on the head;
fuch are blifters, as acting either by evacuation only,
or by removing the fpafmodic affections, which are
the foundations of the difeafe. Iffiies are alio of con-

iiderable

Cullen’s Clinical Lectures .

429

fiderable fervice, if we confider the nature of the
matter evacuated by them, which is the coagulable
lymph: thefe, then, keep the veffels more relaxed
and empty 3 they are alfo ready as outlets to carry off
any fuperfluo-us matter, in cafe of any unequal deter¬
mination to the part. The nearer they are to the
part, the more effedt both they and the blifters mutt
undoubtedly have; though they may be of fervice,
too, at a greater diftance. In all cafes of congeftion
and determination to the particular parts, relief may
be obtained by increafmg the contiguous fecretions,
as here of the mucus of the nofe: this is the founda¬
tion of the application of fternutat ories, and particu¬
larly of the alarum, which may he managed fo as to
caufe a fecretron of the mucus, with the appearance
of pus, and then it is often an ufeful remedy. Thefe
remedies are proper where the returns depend on a
particular turgefcence of the veffels of the part.

£ When there are fymptoms of a cold fit approach¬
ing, other means fiiould be ufed to prevent its return*
If it comes at a conliderable interval and exadt period,
the bark is moft proper. Where the head-ach has
any properties of the intermittent fever, which has
been already mentioned, it is aim oil the only thing to
be depended on. But there are other cafes fomewhat
periodica], where it may be hurtful, as in thole above
depending on a turgefcence, either general or par¬
ticular: hence, it is not thought fafe to give the bark
in vernal intermittents, left it fhould excite inflamma¬
tion ; for it will, peihaps, prevent the cold fit, but
not the determination of the blood to the parts, and
the increafed impetus occafioned thereby.

c When the bark is employed in the head-ach, it
muft be given in the fame manner as in an intermittent,
in large dofes, and near the approach of the fit.
Where the bark is ufed, the ufe of evacuations, low
diet, &c. is excluded, as in the cafe of other intermit-
tents. Befides the bark, opium is a means of pre¬
venting the return of thefe fits. It has been tried

with

430

Cullen's Clinical Lectures .

with and without fuccefs, and fome times with bad
effects. There is a difpute concerning its ufe in in-
termittents, between Lieutaud and Storck ; and as
it is proper or improper in them, fo mull it be here,
A third means is, by exciting an artificial fever, by
promoting a determination to the furface, or even
bringing on an adlual fweat : this is done by emetics
and other fudorifics, and particular flimuli. This is
the foundation of the ufe of volatile alkali; thus,
large doles of lab corn. cerv. have been found to
prevent a return of the fit. Emetics and opium com¬
bined have often been of fervice, as in the cafe of
Dover’s Powder.

c We have now fliewn the proper idiopathic head-
achs to be paroxyfms of a topical fever. Thefe we
have divided into two kinds ; one, where the pa-
roxyims are occafioned by a more copious determi¬
nation of the fluids to the parts. This, we faid, wras
to be obviated by avoiding and removing this inereaf-
ed impetus, for which purpofe we recommend the ufe
or various evacuations ; the other kind was, where the
fit is not excited by any remote caufe ; but the plan of
cure muff turn, on obviating the return of thefe fits.

4 Where they are exactly periodical, they mull be
treated as other intermittents, with bark or opium :
but tl^iere is alio another method, which we mention¬
ed, as often followed, either when the fit is periodical,
or not exactly determinate ; and this is the ufe of
emetics and fudorifics, or both combined, as in the
cafe of Dover’s Powder. There is a third cafe ftill
remaining, of thofe which properly appear in the
paroxyfms of a topical fever, but have the cold-
fit more confiderably prevailing : the method of cure
mult here, too, turn on preventing the return of the
fits in general; every thing is proper, that tends to
invigorate the fyflem, as bark, bitters, chalybeates,
exercife, &c. But, further, thefe require a particular
confideration of occalional caufes, and of the means
of avoiding them : thefe may be referred to two ge¬
neral

C alien’s Clinical Lectures.

43 1

neral heads, one of which is cold, one of the moft
frequent occalions of the paroxyfms of this kind of
head-ach. The common way of preventing this, by
warm coverings, is very precarious ; for the utmoil
exaCtnefs is requidte in keeping them on ; and the
leaft negleft of this, expofes the patient to the effects
of cold ; betides this, they are feldom effectual, fo that
the patient is always wanting an addition to be made
to them.

c A much more effectual method is cold-bathing,
which has often proved of fervice, after warm cover¬
ings, and fuch other things, have been tried in vain,
by enabling the body to refill the cold air, when ap¬
plied. The fecond general head turns on avoiding
every thing which may weaken the fyftem, as ab-
ftinence, evacuations, &c. In this kind of head-ach,
two topical applications are more particularly admif-
lible during the fit.

c In hot fits of the head-ach, warm applications
rather aggravate the pain ; but cold applications have
been thought ufeful in this cafe : thefe, however, are
precarious, and even of dangerous effefl ; for, by pre¬
venting the increafed impetus, they often increafe the
force of the determination to the part. If they fhould
happen, too, to correfl the fit, they may perhaps
change it to fame more dangerous affection of the
brain : thus a paralytic affection of the external parts,
as particularly of the eye-lid, is often the confequence
of cold applications during fits of the head-ach. —
None of them are proper in a hot fit; but, in a cold
one, warm cloths, fomentations, warm bags, &c..
often give much relief. Their ufe feems to be con¬
fined to fuch cafes, where ftrong odours are of fer¬
vice. Thus, in a cold fit, the volatile or even
cauttic alkali, as in the eau de lace , is very ufeful,
or fpirits of wine, as Hungary water. There are
feme other external applications peculiarly adapted
to thefe fits, as sether, which is perhaps only proper
here. It a£ts* not only as an antifpafmodic, buff by

exciting

4S2 Cullen’s Clinical Lectures .

exciting heat, and a fwelling of the part : and, if it
has not this effefl, it is feldom of any great ferviee.
The ufual way of applying it, is to put a little of it in
the hollow of the hand, and hold it to the pained
part, till the glowing heat, is removed ; but it is apt
to efcape from the hollow of the hand ; fo that it is
better to dip a little ball of cotton in aether, and ap¬
ply it to that part, covering it with one’s hand, or
with a bladder between one’s hand and the forehead.
Warm applications, ftimuli, antifpafmodics, &c. may
alfo be ufed: thus, the effence of lemons, with vol.
alkali, is often of equal fervice with aether, and was
accordingly frequently ufed by the late Dr. Ward.
All thefe are improper in the hot fit, in which topical
bleedings are the mod fure method of relief. A pe-
diluvium may be of fervice here, as alfo a glider, in
taking off the impetus of the blood to the part, and
in promoting a relaxation : thefe are the principal re-
marks we had to offer, on the proper idiopathic head-
ach.

€ The fympathetic head-achs, as thofe depending
upon the gout, on the date of the mendrual or hemor¬
rhoidal flux, &c. mud be referred to thofe particular
fubjedfs. Omitting, therefore, all thefe, we fh'all pVp-
ceed to give fome account of thofe of our patients who
have laboured under head-achs, beginning with Ann
Hood,

e The firft account of her fymptoms, feems greatly
aggravated, with regard to the fevere tacking pain,
and condant head- ach ; for, from the fenfe of cold fhe
felt, from her former ailment, (hewing a debilitated
fydern, and from the more particular account of her
fymptoms, obtained fince, it plainly appears, that her
head-ach is of the lad fpecies mentioned, in which
there are paroxyfms; but that of the cold fit chiedv
prevails. Here, however, there appears fome little
degree of the hot fit, as the cold one terminated in a
fwdliiig in the eye, and that part of the head. Her
complaints .firft arofe. from a fuppreffion of the menfes.

Cullen's Clinical Lectures . 433

and were relieved by their return at firft ; but they
have never lince returned properly. The fuppreflion
and imperfect flow afterwards, produced fome hyf-
terical complaints firfl, which have fince turned out
mere Ample complaints of the ftomach'. Thefe com¬
plaints have a particular connexion with the month
of Auguft, having returned three years fucceflively at
that period. This is difficult to be accounted for, but
will admit of her conjectures : one is, that it is owing
to fome particular circumftances attending that month,
known from other conffderations, as of the dyfentery
and cholera morbus ; the other is, that the complaints
came on accidentally, at firfl:, at that period, but after¬
wards formed themfelves into an annual period. The
determination to the uterus, being firfl: fuppreffed, and
afterwards much diminifhed, was firfl: turned to the
ftomach, and then to the head : this laft is only to be
looked upon as a tranflation ; for the ftomach, then,
was not fo much fubjeft to its former complaints.
The conftant coftivenefs the laboured under, was a
fymptom of the lefs determination to the defcending
aorta, or of the weaknefs of the fyftem in the ali¬
mentary canal.

c Viewing the diforder in the light we have men¬
tioned, we propofed to treat it by blifters and iflues,
at the fame time obviating the determination to the
head, by keeping the belly open, and thereby deter¬
mining the fluids to the uterus. The blifters feem to
have had a very good effe6t here, and to have pro¬
duced a proper refolution of the paroxyfm in the fw el-
ling, as mentioned above. The common way of ap¬
plying a perpetual blifter, as it is called in England,
or what we call a perpetual iffue, is to apply the em-
plajlrum epifpajlicum ; and, when this has railed the
fkin, to add conftantly the ung. epijpa/l. and thereby
keep up a perpetual difcharge. Inftead of this, we
ordered a plafter, confifting of equal parts of cm-
plajlrum vejicat. Sf cereum , which we have often tried
with great advantage. This doth not raife the cu-

vo l, v. Ii tide*.

434

Cullen's Clinical Lectures .

tide, or erode the parts under it, but leaves them
entire, and lets the hair grow up. As thefe, in ten
or twelve days, pufh off the plafter, it is neceffary to
leave off the plafter, as foon as the fkin can bear the
razor, to take off the hair, and apply a frefh plafter.
This gives lefs pain, is free from the inconvenience
dually attending the bliftering plafter, where the can-
tharides is abforbed, and gets into the blood, where¬
by a ftrangury is brought on. To promote the dif-
charge by the belly, we applied the aloetic pills ; and
when thefe were not effectual, added 1 gr. of calomel
to 3 of aloes. This is one of the beft laxatives, giv¬
ing generally one ftool in the day ; it is what is gene-
rally known in thefe parts by the name of Chamber¬
lain's Pill. We made another experiment here with
aloes, which fucceeded in giving a temporary relief,
which is the onlything it does in general. We alfo
made ufe of warm applications, which produced a
fweat, and raifed a heat, but were not applied pro¬
perly in the paroxyfms : this has hindered us from em¬
ploying fome remedies, that we otherwife fhould have
attempted. We fhall only fubjoin another obferva-
tion here, yvhich is, that the menfes occurring, gave
confiderabje relief, for fome days, as did a fponta-
neous diarrhoea, which accompanied them. The next
cafe we fhall mention, is that of William Mac¬
millan. His diforder, though not very diftinft,
appears to be the cephalalgia rndancholica , from the
fymptoms accompanying it, as dimnefs of fight, dou¬
ble vifion, vertigo, tinnitus aurium , &c. and thefe,
too, occurring in a perfon of the melancholic tem¬
perament. A

5 This, then, is not to be referred to the general
head of a topical fever, but to fome particular caufe,
and perhaps of the veffels of the brain. There is
always reafon to fufpeci a venous plethora in fuch
cafes, and efpecially here, from the fymptoms being
increafed by Hooping. Thus the leaft return of his
diforder came on from harveft-work, in which much

ftooping

Cullen’s Clinical Lectures „

435

Hooping is requifite : add to this, that his complaints
are always increafed by cold of the feet ; yet it is not
certain whether this is to be looked upon as a caufe
or an effeSt. There are feveral cafes of the melan¬
cholic torpor, independent of this venous plethora ;
and whatever produces this torpor, may alfo occafion
the plethora.

c There feems to be fome peculiar affeftion of the
origin of the nerves here ; efpecially as this diforder
comes on in confequence of a fever, .which often
leaves affections in the origin of the nerves. In our
treatment of the patient, we firft ufed moderate eva¬
cuations, as bleeding by leeches, few in number, but
frequently repeated ; but we did not pufli thefe
largely, as they might have proved hurtful, by weak¬
ening the fyftem and increafmg the torpor ; betides,,
leeches have little effect in a venous plethora, and,
in fuch a cafe, it is much better to open the jugular
vein. We next attempted a derivation from the
head, by laxatives, or, perhaps, purgatives : but, as
his complaints feemed to be aggravated by thefe, we
defifted from the ufe of them, and perhaps too foon,
as this might be owing to occafional caufes only,
which will often recur in fuch cafes. W e then tried
a lefs ambiguous remedy, as blifters, which, at firft,
feemed to have confiderable effeft, but lefs fo after¬
wards. We alfo tried perpetual ifiues, in the man¬
ner mentioned in the preceding cafe.

As the emplajlrnm calidum had no effeft, we fub-
ftituted a ftronger; but this, for want of due atten-
rion, has not been properly conduced. As the cu¬
ticle was but little affeCled, and the fkin under it not
eroded, we have ventured on the application of a
frefh plafter, immediately : as we were Hill intent on
procuring a derivation from the head, we employed
valerian for that purpofe. This has been always on
the footing of a fpecific ; but in this, as well as in all
other fpecifics, we fhall aLvays find fome operation,
to which its effeCfs may be attributed. Accordingly,

I i 2 valerian

436 Crichton on Mental Derangement.

valerian has (hewn itfelf to be a laxative, in feverai
other cafes now in the houfe, and particularly in the
prefent patient, on whom it operated confiderably,
when given to 3ii.

c We alfo tried more eflfeQual purgatives, which
feern to have given relief, or, at lead, have not ag¬
gravated his fymptoms. He is now free from head-
ach entirely ; and his dimnefs of fight, tinnitus an -
rium , and giddinefs, are much better. A fponta-
neous diarrhaea has now come on, which, if not oc~
cafioned by our medicines, might, perhaps, be look¬
ed on as a refolution of the diforder. We at firfl fuf-
pefled it to be hemorrhoidal, as it came on without
febrile fymptoms ; but he had fome febrile fymptoms
yefterday, Jan. 27, and the night before : it is now
keeping off. We only tried fuch remedies as were
proper, fuppofing it to be a proper diarrhsea, or
dyfenteryd

Art. XLVI. An Inquiry into the Nature and
Origin of Mental Derangement , Sic. By Alex¬
ander Crichton, MAD.

(Continued from page 358 .)

■ ' • . 4^ ’

IN our lafl we followed the ingenious author through
the firft divifion of his work, containing the inquiry
into the phyfical caufes of delirium and other derange¬
ments of mind. In the fecond book he treats of the
difeafes of each faculty of the human mind, and alfo
of many kinds of diflurbance in our intellectual part,
which are occafioned by peculiar faults in the facul¬
ties* The phyfiology, or natural hiftory of the mind,
is here combined with its pathology or morbid hif-
tory. It would be impoffible, within the narrow limits
allotted to an individual article, to analyfe a fubjeft of
fo wide and varied an extent. We (hall, therefore*

confine

437

Crichton on Mental Derangement .

confine ourfelves to the author’s remarks on the Dif-
eafes of V olition. It will be then feen, how widely
he differs from Dr. Darwin in his view of this matter.

c Between the ideas which excite bodily a£tion,
and thofe which give exercife to the mental facul¬
ties alone, there feems to be this effential difference,
that feveral diftin£t feries of the former may go for¬
ward at one and the fame time, each producing its
peculiar bodily movements, without in any way ol>
ftru&ing each other ; whereas it appears that we can¬
not admit of more than one fubjeft of thought at a
time. A perfon may be impelled by one train of
ideas to walk, by another to perform certain opera¬
tions with his hands, and by a third to fpeak ; and
all thefe a£is, each arifing from an impulfe of this
mental principle called volition, fhall go on at the
fame time without impeding each other,; but no man
can entertain two fubjefts which excite memory, or
imagination, or judgment, at one and the fame mo¬
ment of time.

c It was neceffary to ftate thefe fa£ts in order to ex¬
plain the nature of certain very curious difeafes, which
arife from an irregular adtion of this principle.

‘ When two different fhades of the fame thought
arife in quick fucceffion, each of which neceffarily has
a tendency to affeft the fame fet of nerves, the in¬
fluence of the one is partially deftroyed by that of the
other, and an incomplete bodily a&ion takes place.
If a fudden thought makes a perfon who is in the
middle of a fpeech imagine that there is a better ex-
preffion for his thoughts than that which he is about
to employ, the aftion is immediately interrupted, and
he either hops, or hammers. When this complaint
is flight, it is called hejitation , when great,, ftammering.

c Every perfon is more or lefs expofed to the firft
of thefe affections. It may arife from various claffes
of ideas, but moft commonly it is the offspring of
doubt. Doubt often arifes from great timidity ; and
where this feeling is ftrong, and natural to the con-

I i 3 flitution

438 'Crichton on Mental Derangement .

flitution of fome people, hesitation becomes a very
early habit In other cafes it arifes from accidental
circumftances. There is one caufe which produces
it accidentally in many young people, which cannot
be too much reprobated : I mean the injudicious feve-
rity of fome parents and teachers. The fear of pain,
and the fear of offending, and the fear of being found
in fault, are often predominating features in the cha¬
racters of young people, and moft commonly in thofe
who are endowed with what is figuratively called
great fenfibility of mind. If fuch a youth, while he
is repeating his talk, be regarded wTith a look, or
threatened, as if it were expe&ed he wrould fail, he
commonly does fo from mere apprehend on, and this
being often repeated be acquires the habit of hefitat-
ing. Such a defect, although it be a real evil, is
feldom confidered as a difeafe ; and, unfortunately,
few parents are fufficie'ntly attentive to their children
at the early periods of life to obferve its approach.
Many others have it not in their power to do fo,
owing to their children being feparated from them,
and that up in feminaries, where the feeds of many
other mental diforders are fown.

c The origin of the diftreffing habit called Stam¬
mering, generally occurs alfo in early life. It arifes
either from a fpecies of doubt, or elfe from imitation,
for it is in no caie to be confidered as natural to any

constitution*

c A very lingular phenomenon concerning this im¬
pediment in fpeech is, that the hefitation is generally
confined to the pronunciation of a few letters,, and
this is the caufe w7hy its effects are always heard and
feen ; for if it concerned whole words, a total flop
would be put to fpeech. The perfon begins a con¬
catenated chain ot actions, or, to fpeak in plain lan¬
guage, he begins to pronounce the words which com
relpond to the thoughts that are prefent in his mind,
he arrives at one of the letters alluded to, and imme¬
diately a doubt arifes in his mind how it is to be pro¬
nounced.

Crichton on Mental Derangement . 439

nounced. I am at prefent (peaking of the origin of
the complaint — he then begins to pronounce in a dif¬
ferent way, and the doubt again arifes ; he then re¬
turns back to the lad pronounced fyliable of the word,
and repeats it, but upon coming to the letter, the
doubt again arifes, and gives a different direction to
the fenforial impreffion, and he again attempts to
fp eak another letter. He cannot flop, for he is in the
middle of a word, the pronunciation of which he has
been accuftomed to conclude, and he therefore con¬
tinues to druggie with it, till at lad, owing to fome
accidental caufes, which it is not eafy to difcover, he
accomplith.es its proper utterance.

c Volition, now and then, fails to produce its full
corporeal effect, from various difeafed dates of the
brain, or nerves, or from the influence of fome power¬
ful fenforial impreflion, counteracting thofe of voli¬
tion. In pally, and in the night-mare, a perfon is con-
fcious that he makes efforts of volition to move cer¬
tain parts of his frame, and yet cannot fuceed, for
the corporeal caufes which produce thefe difeafes,
prevent the impulfe from being conveyed to the
parts intended to be moved, and consequently they
cannot be dimulated into action by that principle.

c In order that a motive of adlion (hall produce its
corporeal effedl with due force and celerity, it is ne~
ceffary that the nervous fluid be fecreted in due quan¬
tity. If this is not the cafe, the impreffions which
are made by the action of this principle are too much
weakened before they reach the mufcular parts, and
hence a feeble motion only occurs. This is the rea-
fon of that didreffmg indolence which many people
who have long laboured under domachic complaints,
or other difeafed vifcera, or women affi idled with hyf-
teria, frequently are fubject to. Such people are con-
dantly agitated between the defire of accomplifhing
many duties which they are confcious they ought to
perform, and the painful bodily languor which op-
preffes them. The nervous fluid being fecreted in

I i 4 • final]

440 Crichton on Menial Derangement.

fmall quantity, the fenfation of fatigue is foon in¬
duced, and the body therefore does not eafily obey
the dilates of the will.

‘ All motives of addon which arife immediately
from external agents, a£t in general more powerfully
than reflex thoughts or ideas, which are merely re¬
called to the tnind. This does not require any iliuf-
tration.

‘ The longer any external objeft which yields a
motive of addon a£is upon us, the more forcibly, and
the more eafily does it produce its effefls. There is
a very remarkable cafe narrated by the learned Dr.
Herz, in Vol. VIII. of the Pfychological Magazine,
which may be confidered as an illuftration of this
pofition.

“ In Auguft, 1785,” fays the Doftor, “ I was call¬
ed to an officer of the artillery, a man about forty
years old, who, as I was informed, was feized with
a pally in confequence of cold, and violent anger.
His tongue, hands, and feet, were lamed by the
attack.

“ He was under the care of one of our firft phy-
ficians, at whofe defire I was confulted concerning
the propriety of applying elearicity. From the time
that this remedy was firft employed, until the follow¬
ing year, I never faw him ; but he then fent for me

again, as his own phyfician, he faid, had deferted
him.

I found him fo much recovered as to have the
complete ufe of his feet ; his hands alfo were ftronger ,
but in regard to his fpeech, the following very re¬
markable circumftance was to be obferved. He was
able to articulate diftinQly any words which either oc¬
curred to him fpontaneoufly, or when they were flowly
and loudly repeated to him. He ftrenuoufly exerted
himfelr to fpeak, but an unintelligible kind of murmur
was all that could be heard. The effort he made was
violent, and terminated in a deep figh.

" On

Crichton on Mental Derangement. 441

<c On the other hand, he could read aloud with
facility. If a book, or any written paper, was held
before his eyes, he read fo quick and diftinflly, that
it was impoffible to obferve that there was the flighteft
fault in his organs of fpeech. But if the book or
paper were withdrawn, he was then totally incapable
of pronouncing one of the words which he had read
the inflan t before. I tried this experiment with him
repeatedly, not only in the prefence of his wife, but
of many other people. The effeT was uniformly the
fame.”

c Dr. Hefz, who juftly attributes this lingular phe¬
nomenon to the fuperior ftrength, and to the longer
duration df impreffions received by the eyes, men¬
tions another cafe which fell under his obfervation,
and which has a great limilarity to the one already
cited. A young lady, who had fallen into a hate of
melancholy in confequence of deep grief, could not
be made to pronounce a word, either by means of
threats, or intreaties. But if a book was prefented
to her, and Are w~as requefled to read it, fhe did fo
with the facility of a perfon in perfefl health. In
fome cafes, the aftion of the will is totally checked
by a difeafed hate of the brain and nerves, as is the
cafe in that rare malady called catalepfy, of which the
following is a very remarkable mftance. It is extrafl-
ed from the Pfychological Magazine , V ol. V. part 3,
page 15.

“ A young lady, an attendant on the princefs

of - 3 after having been confined to her bed for a

great length of time, with a violent nervous diforder,
was at laft, to all appearance, deprived of life. Her
lips were quite pale, her lace refembled the coun¬
tenance of a dead perfon, and her body grew cold.

“ She was removed from the room in which fhe
died, was laid in a coffin, and the day of her funeral
was fixed on. The day arrived, and accord/ ng to
the cuflom of the country, funeral fongs and hymns
were fung before the door. Juft as the people were

about

442 Crichton on Mental Derangement .

about ro nail on the lid of the coffin, a kind of per*
fpiration was obferved to appear on the furface of her
body. It grew greater every moment, and at laft a
kind of convullive motion was obferved in the hands
and feet of the corpfe. A few minutes after, during
which time frefh figns of returning life appeared, the
at once opened her eyes, and uttered a rood pitiable
fhriek. Phyficians were quickly procured, and in
the courfe of a few days fhe was confiderably re*
ftored, and is probably alive at this day.

The defcription which fire herfelf gave of her
fituation is extremely remarkable, and forms a cu¬
rious and authentic addition to Pfychology.

She faid it Teemed to her, as if in a dream, that
fhe was ready dead ; yet fhe was perfectly confcious
of all that happened around her in this dreadful ftate.
She diftinftly heard her friends fpeaking and lament¬
ing her death at the fide of her coffin. She felt them
puli on the dead-clothes, and lay her in it. This
feeling produced a mental anxiety which is inde-
fcribable. She tried to cry, but her foul was without
power, and could not aft on her body. She had
the contradiftory feeling as if (he were in her own
body, and yet not in it, at one and fhe fame time.
It was equally impoffible for her to ftretch out her
arm, or to open her eyes, as to cry, although fhe con¬
tinually endeavoured to do fo. The internal anguifh
of her mind was, hov/ever, at its utmoft height when
the funeral hymns began to be Tung, and when the
lid of the coffin was about to be nailed on. The
thought that fire was to be buried alive was the hrft
one which gave aftivity to her foul, and caufed it to
operate on her corporeal frame. ”

c The relation of the above faft is faid, by the
gentleman who fent the account of it to the editors
of the Magazine, to have been obtained from the
moft refpeftable witnefles. Independently of the re-
. fleftions which rnuft naturally arife in the mind of
every intelligent phyfician, from 4he Angularity of the

cafe.

443

Crichton on Mental Derangement .

cafe, there is an aweful warning to be drawn from it,
which regards every perfon ; I mean the danger which
arifes from too early burials in the cafe of hidden, or
unexpected death. This is a c ire urn fiance which has
been often taken notice of, and which certainly re¬
ceives additional intereft from inch cafes as throne
which has been juft mentioned.

c No other difeafes can, in my opinion, be juftly
deemed difeafes of volition. This declaration will
probably excite furprife among the admirers of the
Zoonomia, in which work all the fpafmodic and con-
vulfive disorders are considered by Dr. Darwin as
efforts of volition, and are ranked among the difeafes
of this faculty. To me it appears that all the fpaf¬
modic difeafes arife from phyfical ftimuli, applied
either to the brain itfelf, or to diftant parts of the
nervous fyftern, as in themafe of worms, or acrid
matters in the ftomach and inteftmes, tumours,
wounds, fraftured bones, &c. ; and, that the nervous
impreffion of thefe ftimuli, fo far from exciting the
will, counteracts its efforts, and repreffes, as it were,
its adtionf The convuifions of epilepfy, and tetanus,
for inftance, are not, in my opinion, voluntary addons
excited, for the purpofe of counteracting pleafure or
pain, as Dr. Darwin imagines, but are involuntary
a£ts of the external mufeies, produced by the tranf-
million and irritation of a powerful and unufual nerv¬
ous impreffion ; and I therefore coincide with Sau-
va^e, Vogel, Hoffman, and Cullen, and all former
writers of repute, in confidermg thefe as difeafes
which ought properly to be called involuntary ones,'
It would require more time than what I deem at pre-
fent confiftent with the plan of this woix, to place
Dr. Darwin’s hypothefis in a proper point of view,
and to fhew the impropriety of his claflif cation ; per¬
haps this may be done at a future time.

The third and laft book treats of the Paffions, con-

fidered as the caufes of mental derangement. I he

following

444 Crichton on Mental Derangement .

following are the author’s general concluding re¬
marks,

* 1. The phenomena of delirium arife when difeafed
perceptions are. miilaken for realities.

c 2. Difeafed perceptions arife from phyfical or cor¬
poreal caufes, and from moral or mental caufes.

‘ 3. Corporeal caufes produce delirium, by exciting
fuch a derangement in the brain as prevents external
nervous imprefiions from exerciling their natural in¬
fluence on the mind; and hence delirious people
either miftake external objefts, or do not attend to
them.

‘ 4. Every altered hate of brain which does not
amount to a certain degree of deflruftive preffure,
excite, by the laws of thought, a mental perception ;
but as the fenforial imprefiions of difeafed action are
different from thofe which are derived from external
objefts, fo the images which are excited in the re*
prefentative faculty are alfo different. But nothing can
be reprefented in the mind which has not formerly
been received through the medium of the external
fenfes, or concluded by the operations of reafoning ;
and, therefore, all the ideas of delirious people, how¬
ever different they may appear to be from any thing
which has formerly been heard, touched, tailed, frnelt,
or concluded, are only new affemblages or combina¬
tions of prior fenfations and thoughts : the reprefen-
iations of delirium, therefore, are in this refpeft, like
thofe of the faculty of fiftion.

c 5, Corporeal caufes of delirium are of two kinds :
the firfl aft by altering the aftion of the arteries of
the brain and nerves ; the fecond by yielding morbid
imprefiions, which either impair, or prevent the tranf-
miifion of natural external nervous imprefiions, in their
progrefs to the mind.

‘ 6. The firfl clafs of corporeal caufes produce ma¬
nia and the delirium of fevers ; the fecond, hypo-
chondriafis and the delirium of nervous or hyflerical
patients.

£ 7. As

Crichton on Mental Derangement . 445

e 7. As it has been proved, that in mania there is
every appearance of a morbidly increafed action of
the veffels of the brain, more efpecially of thofe which
fecrete the nervous fluid ; and as all increafe and
every alteration, in the nature of this fluid, mail
increafe and alter fenflbility, and confequently caufe
the fenforial imprelfions to aft with unnatural vio¬
lence, fo the moft linking features of mania may be
accounted for ; as, for inftance, the want of ileep,
conftant raving, and fury.

c 8. Although it happens that mania (hall appear,
at times, to rife from the influence of violent paflions,
or from over-ftraining the faculty of aftion, yet this
feldom occurs except there be much predifpofition to
the complaint ; and as in fuch cafes, and indeed in
every cafe, infanity does not occur without its being
accompanied by marks of difeafed aftion of the vef¬
fels of the brain ; fo it may be concluded, that the
proximate caufe of mania is always to be fought for
in this ftate of the brain.

£ 9. The ideas or thoughts which appear to create
the mental difturbance of a perfon labouring under
mania, throw no light either on the origin or nature
of the complaint ; and this circumftance forms a very"
remarkable diftinftion between maniacal delirium,
and the delirium of hypochondriacs and melancholy ;
for, in thefe laft difeafes, a perfon acquainted with
the human mind, efpecially with the nature of mental
perception, may often receive confidexable light from
fuch fources,

£ 10. When the increafed aftion of the arteries of the
brain fubfides, a morbidly weakened aftion of thefe
veflels is the confequence, the nature of which it is
not eafy tp afeertain, but it is the caufe of another
delirium ; which delirium has a very different moral
charafter from that alluded to above ; for the patient,
inftead of being ferious, is gay and focial, but is ilill
not governed by external objefts, or reafonable con-
elutions.

c 10, Among

446 Crichton on Mental Derangement.

c 1 1. Among the moral or mental caufes which pro¬
duce delirium, grief and fear, and their modifications,
are the moil frequent ; for, although every variety of
pride and vanity, ambition, and feveral other paffions
which belong to the modifications of joy, feem at
times to produce delirium, yet they feldom do fo, ex¬
cept by ex poling a perfon to the frequent operation
of mental pain, fuch as arifes from neglect, difappoint-
ment, contempt, and many other kinds of painful hu¬
miliation.

€ 12. The painful thoughts produce dejeftion and
defpondency in the fame way that corporeal pain
acts ; namely, by exhaufting the energy of the brain
and nerves, or, in other words, by inducing a torpor
in thefe veflfels..

€ 13. The torpor and diminifhed fecretion of nervous
fluid occaiion an inienfibility to external objects, and
to the fenfations which accompany all natural wants
or delires: hence the conftant engagement of the
mind with ideal objects of pain, the folitude, anx¬
iety, and defpair of fuch patients.

4 14. There are, then, three diftindt kinds of de¬
lirium which belong to the order of difeafes called
Vefaniae. Thefe may be denominated, lit. Mania
furibunda ; 2dly. Mania mitis ; and, 3'dJy. Melan¬
cholia.

6 15. Mania furibunda caries according to the phy-
fical caufes which excite it.

c 16. Mania mitis varies according to its moral
character. *

17. Melancholia according to the paffions which
give birth to it, or the phylical caufes which in¬
duce it.

4 18. Independently of thefe diforders which dif-
iurb every faculty of the human mind, and all the
external fenfes, or rather the impreffions received by
the external fenfes, there are others which only de¬
range particular faculties ; the aftion of the mind be¬
ing, in other refpe&s, in a healthy Hate. Thefe,
3 * which

Crichton on Mental Derangement 447

which might be called partial difeafes of the mind,
are of two kinds, iff. illufions: and, 2nd. Weak-
neffes of the mental faculties.

f 19. illufions arife from corporeal caufes and from
mental caufes.

* 20. Corporeal caufes and mental caufes produce
illufions upon the fame general principle that the
phantoms which occur in delirium produce a convic¬
tion of their reality ; namely, by occafioning fuch im-
preffions as deftroyed, or greatly diminifhed the in¬
fluence of external objedls. It maybe added here,
by way of a remembrancer, that the proper influence
of all impreffions, ab externo, is excited on the facul¬
ty of attention ; and that when a fufficient degree of
attention to any pbjedl is not given, erroneous judg¬
ment arife s.

c 21. The impreffions of corporeal caufes which pro¬
duce illufions, do not diforder the healthy adlion of
the whole brain, or its arteries; and, therefore, all
external objedls, aflociations of ideas, and operations
of mind, the fenforiai impreffions of which do not
fall on the fame part of the brain as that which re¬
ceives the difeafed impreffion, produce their natural
effect, and the perfon, therefore, appears to think
and adl like a reafonable man, except on fuch fubjedts
as have a relation to the illufion.

c 22. Corporeal impreffions, producing, illufion, ge¬
nerally arife in parts of the nervous fyftem which are
at a diftance from the brain; as, for inf ance, in the
various vifcera of the abdomen or pelvis.

c 23. But all fenfations arifing from fuch caufes,
whether healthy or difeafed, are generally referred,#
by a fpecies of judgment, to the place where they
are felt: and, therefore, hypochondriacs entertain
falfe notions concerning their own frame.

c 24. The impreffions of difeafed vifcera, fuch as
the ftomach, inteftines, uterus, liver, pancreas; &c.
do not reach the brain until the healthy a cl ion of the
nerves has been impaired.

4 48 Crichton on Mental Derangement .

> "V v- ■ ' . •' \r . I- \ y ■ ) , ’ l

c 25. This injured hate of nerves is to be confidered
as particularly affedting the fmall arteries, which are
deftined to fecrete nervous matter ; but as the eafy
tranfmiftion of nervous impreffions depends on the
due proportion of folid, as well as fluid matters,
which enters into the compofition of thofe organs, it
follows, that the fenfations muftbe greatly difordered,
and confequently we find that, in hypochondriafis,
the nerves themfelves are fruitful fources of pain¬
ful feeling.

* 26. Hypochondriafis, therefore, is chiefly charafter-
ized by erroneous notions relating to the patient’s own
frame, and by painful corporeal feeling.

4 27. Ulufions, from moral or mental caufes, arife
either from an hereditary over-adtivity of the faculty
of fidlion, or from diredling attention too much to
imaginary objedts, or from the influence of paffions ;
by which means the fenforial impreflions of fuch ob¬
jects become ftronger than thofe of external objedts,
and their exiftence, therefore, is at laft more readily
believed in than that of objects of external fenfe.

4 28. In no infiance, whatever, do moral caufes feem
to produce real illufion, in fuch people as have no pre-
difpofition to the difeafe, until the healthy ftate of the
brain has been difordered by the unequal exercife
given to it by particular objedts of ftudy, or of pallion.
It may therefore be reafonably imagined that the he¬
reditary difpofition itfelf, confifts in a morbid fenfibility
of that part of the brain which receives the impreflions
from the imagination, or faculty of fidtion ; and that
the diforder, ftridtly fpeaking, does not exift in the
mind.

* 29. Where the difpofition to fuch a difeafe is either
born with a perfon, or artificially produced by par¬
ticular objedts of ftudy, the paflions may become ex¬
citing caufes of illufion.

* 30. As to the weaknefles of the mental faculties,
thefe feem to depend entirely on a weak, or debilitated
ftate of brain ; whereby the fenforial impreflions,

which

Crichton on Mental Derangement < 44.9

which arife from the operations of mind, are not of
fufficient ftrength and vivacity,

30. Each faculty of the mind is fubjeft to fuch im¬
pediments, and, confequently, may appear, to be
weakened.

31. Upon thefe deduftions is founded the follow-*
ing arrangement of mental difeafes.

Genera and Species and their Symptoms.

Clafs Neurofes. Order Vefanias.

G. 1. Deli rium . General derangement of the men-
tal faculties, in which difeafed perceptions are mif-
taken 'for realities ; with incoherent language,
and unruly conduct.

Species 1. Mania Furibunda. Delirium, with
conftant raving, audacity, and fury.

2. Mania Mitis. Delirium, with raving,
and appearance of gaiety and pleafure.

3. Melancholia . Delirium, with dejec¬
tion, defpondency, and defpair.

G. 2. Hallucination or Illujion. Error of the mind,
in which ideal objects are miftaken for realities ;
or, in which real objects are falfely represented,
without general derangement of the mental facul¬
ties. .

Species 1. Hypochondria /is. Error re fpe Er¬

in g a perfon’s own health or form, with anx¬
iety, apprehenfion, and dread; flatulency,
dyfpepfia, palpitation, tremor, and fenfe of
. pain.

2. Dfcmonornania. Firm belief in the
immediate communication with fpirits, or
perfuaflon of the power of working mi¬
racles, without other Symptoms of ge¬
neral derangement of mind..

3. Vertigo. Apparent rotatory motion
of external objects, and fenfe of undula¬
tion in the ground, with abolifhed atten¬
tion and thought.

vol. v. Kk

4. Sam-

450 Crichton on Mental Derangement .

4. Somnambulifmus ?

G. 3. Amentia. Diminifhed power of the mental
faculties.

Species 1. Fatuitas. Imbecility of all the fa¬
culties of the human mind, particularly thofe
concerned in aflociating and comparing ideas ;
accompanied with want of language, a ftupid
look, and general bodily weaknefs.

2. Memoria imminuta. Difficulty of re¬
calling thoughts, and incorredinefs as to
recognizing objedts formerly perceived.

3. Perceptio imminuta. Difficulty of form¬
ing diftindt reprefentations.

4. Vis idearum ajjociandi imminuta. De¬
ficiency or incapability of arranging one's
thoughts ; giving figns of confufion of in-
telledt.

5. Vis fingendi imminuta. Total want of
genius, or diminifhed genius.

6. Vis judicandi imminuta. Want of judg¬
ment and common fenfe.

In an appendix the author gives a tranflation of the
medical aphorifms of Dr. J. E. Greding, on melan¬
choly, and various other difeafes connected with it,
extradfed from his mifcellaneous writings. Very mi¬
nute defcriptions of the appearances on diffedtion in
the brains of infane patients are here given, and
which evince, that in almoft all cafes of this kind,
corporeal changes are found to take place. Thefe
remarks form a valuable addition to Dr. Crichton's
elaborate work.

r *

\ v

- - i ’• ; y' “ i v v

■ • ■ ■-/ ■ i ■ •

; •' : :■ ... ;; / ; - .

Hamilton on Hydrophobia .

451

Art, XLV1I. Remarks on Hydrophobia , fife.
Robert Hamilton, M. D.

(Continued from page 393.,/

THE fymptoms of the difeafe which fucceeds the

bite of a rabid animal come next to be con- -
fidered. In its commencement, they differ little from
thofe which are obferved to precede ordinary mala-
dies. It firft threatens by the ufual warnings of fenfe
of coldnefs, alternating with heat, pandiculation and
yawning ; and with fometimes a higher degree of ex¬
hilaration of fpirits. Thefe continue from three, four,
and even to fix or feven days, before the patient takes
the alarm : a feverer train of fymptoms, but more
charafteriftic, afterwards fucceeds. f

The firft fymptom is generally a pain in the part
where the bite has been received, ftretching upwards
towards the hip and groin, if in the lower; towards
the fhoulder and axilla, if in the upper extremities;
and fometimes with difcoloration : fometimes to the
temples, ear, and down to the throat, if about the face
or neck. Reftleffnefs, difturbed deep, convulftons,
efpecially when drink is offered, occafional illufions of
mind; great acutenefs of the external fenfes, irregu¬
lar pulfe, fenfe of fuffocation, copious flow of vifeid
faliva, fucceed, together with a great variety of irregu¬
lar fymptoms, till death clofes the feene.

The mufcular ftrength is little impaired in this ma¬
lady, nor do the lungs partake much of the difeafe.
Great irritability of the ftomach appears to be a com¬
mon fymptom. ♦

From the hiftory of the difeafe it is evident, the
author obferves, that the fyniptom hydrophobia is not
the commencement, but rather a middle point in the
malady. An attention to this is neceffary in form¬
ing our prognoftic; for after its appearance, not an
inftance is to be found of recovery ; every paroxyfm

K k 2 collefting

45£ Hamilton on Hydrophobia .

Collecting more ftrength, death hurries on apace.
Death generally takes place within four days from the
commencement of this fymptora.

With refpeft to the appearances obferved on diflec-
tion, it is feldom that their accuracy can be relied on.
It was univerfally believed, that man infefted man,
and that animals, of whatever fpecies, infedted ani¬
mals ot every fpecies. Hence we need not wonder
if attempts towards an inveftigation of hydrophobic
cad aver a iliould be made with caution and irrefolu-
tion when made at all. The diffedtions related by
authors prefent many deviations from the found fub-
jedf ; but in a dileafe where convulfions form fo cha~
rafteriftic a part, many of the injuries obferved muff
be fecondary. Morgagni in collecting directions, for
he had no experience himfelf on the fubjedf, found a
variety of appearances deforibed, and no two cafes
were the fame. He declines, therefore, drawing con-
clufions concerning the feat of the difeafe. Speedy
putrefaction, however, feeraed ' common to all; and
the fame has been very generally obferved by other
writers. An appearance, likewife, has in general
been feen on the inner coats of the ftomach near the
cardia, fimilar to what is found in the bodies of per-
lons who have had flight inflammation, that is, a
greater number of red veflels, with fmall breaks of
red blood. I he fame was obferved in the ftomachs
aiid oefophagus of dogs that died of the difeafe.

ir rom this we may conclude,’ the author obferves,
s that thefe are peculiar to animals, of whatever fpe¬
cies, dying of this affedfion ; and that the exceptions
noticed ^y Morgagni, Vaughan, and fome others, are
too few to deftroy the force of this general obfervation.

f inattention may have overlooked them in fome
in fiances, and in others, where more accuracy was
uteu, the change of appearance by the diflance from
death, before the inveftigation was begun, will ac-
£ount for their being feldomer noticed. If, however,

Hamilton on Hydrophobia: 453

we view thefe anatomical obfervations in a mafs, an
explanation will prefent itfelf of that diftrefling fymp-
tom common to every cafe, pain, and undefcribable
nneafinefs about the praecordia. The difeafed condi¬
tion however of the blood, as viewed after death, is tar
different from what it prefents during the difeafe,
when taken from the arm. In this hate authors con-
itantly fpeak of it as healthy. I recoiled! but one ob-
fervation in a large collection of examples to the con¬
trary, and in this the blood is only remarked to flow
from the vein tc very thick and black.”*

c The direction which we have lately been con-
fidering prefents no difeafe of the pulmonary fyftem;
for the flight adhefion in part of the left lobe could
only be accidental, arifing molt probably from a pre¬
vious catarrh. This would feem to confirm the ob-
fervation formerly made reflecting the freedom of this
organ from difeafe in hydrophobia ; but molt of the
inftances enumerated in the above collection, point
out the reverie. This cannot be reconciled otherwife
than by prefuming a want of' diftindtion of real cafes,
and attributing, at lealt in part, to this, what belongs
to other complaints.

‘ I fhall referve the infertion of feveral difledtions to
a future part of this work. What will be found there
do not however differ in many refpedts from thefe juft
confidered. Putrefadfion we find is fully eftablifhed
as an early occurrence in hydrophobic cadavera ; but
the appearances prefented go fome what farther; they
eftablifh likewife a high degree of debility antecedent
to death. In molt cafes the heart points out irregu¬
larity in its adtion, neither fyftole nor diafcole being
fynchronous. One ventricle is contracted, the other
at the fame time dilated : again, one is If uffed with
blood, and again dilated and fluffed, if i may fo fpeak,
with air only, i. e. dilated without blood. The great
arteries and veins in their union with the heart, fuller

* Mead.

Kk 3

the

454 Hamilton on Hydrophobia .

the fame irregular motion. Here are evidences of
powerful fpafmodic adlion which this mufcle under¬
goes.

We cannot wonder if the diftribution of the blood
be equally irregular, and the circulation flopped in
one part, while this vital fluid is hurried on with ce¬
lerity, and accumulated in another, whence, by ex¬
iting contractions in the courfe of the veffels, it can¬
not return to its origin in its ufual uniform and un¬
interrupted way.

6 To debility, therefore, may be afcribed all the
various phenomena obfervable both in the living and
the dead fubjedl ; while the variety in conflitution,
flrength, fex, and age, will influence its degree, and
the degree of irregularity in the fundlions of the in¬
dividual. To remove the impediment from circula¬
tion, and reftore the heart to its wonted energy, are
dejiderata of the highefl importance. It is not the
anxiety alone in the epigaflric region, nor oppreffion
at the cartilago enfiformis, a fymptom fo diflreffmg in
every cafe, which will thereby experience relief; but
the (late of the brain, the inordinate adlion and ir¬
regularity in the functions of this organ, caufing oc-
cafional fits of fury, the preternatural fenfibiiity of the
optic nerves, the difeafed lenfibility diffufed over the
furface, and other diftrefling fymptoms; even Hydro¬
phobia itfelf, with all the deliria of wild illufion, muft
equally difappear.

c Much remains to be difcovered before we arrive
at a knowledge of all the phenomena of this malady;
but perfeverance will accomplifh much, and I defpair
not of the treatment being as well underftood fome
time hence as the treatment of the fmall pox. If no
diffedlions were made till the prefent century, and if,
till lately, miflaken notions of the infedlious nature of
the complaint in the human fpecies were entertained,
it cannot be furprizixrg, that anatomy has given fo little
fatisfadlion. In a few' years, I truft, this defedt will
be i applied, and a better pathology be afforded/ — •
May thefe expeditions be realized !

The

455

Hamilton on Hydrophobia.

* * » - ■■ ^ ,

The tirffc volume concludes with fome remarks on
fpontaneous Hydrophobia, which we are under the
neceftity of paffing by. The fecond commences with
reflections on the method of cure, as hitherto profe-
cuted, and to thefe are added the author’s hints re¬
flecting fome new remedies. The particular reme¬
dies in ordinary ufe will engage little ot our notice.
They have been fo uniformly unfuccefsful, that it
would be a wafte of time to be diffufe. Emetics and
cathartics are rejetted, as foreign to every juft inten¬
tion of cure. The cold bath, which for fo many ages
has been a celebrated remedy in Hydrophobia,
has, however, no proper evidence of its utility,
nor does it offer any advantages to counterbalance
the fufferings it occafions to the patient. The warm
bath has been employed with apparent advantage at
firft ; but the utility experienced has been in every
inftance only temporary. Sudorifics and ftimulants
have equally failed.

Venefettion has been a favourite remedy, from
the earlieft accounts of the difeafe. Yet there are no
marks of inflammatory diathefis, the author obferves,
to warrant its ufe ; and its inutility has certainly been
proved on very fufficient trial.

Much has been written in favour of mercury as a
prophylactic, yet all the arguments fo fpecioufly ad¬
vanced, and the fuppofed proofs of its utility, by ne¬
gative inftances, fall to the ground, when properly ba¬
lanced with pofttive failures. It will appear from a
iimilar examination unprejudiced and open, that the
fame conclulion muft follow from its exhibition during
the continuance of the diforder. For the laft fifteen
or twenty years, from the refpeftability of the names
that fypported its adminiftration, praQitioners have
embraced every opportunity of putting it to the teft.
From this body of evidence we muft reject it, not only
as ufelefs, but even under fufpicion of its becoming
injurious.

K k 4

The

456 . Hamilton on Hydrophobia .

The application of cold to the cicatrices at the
time (hooting pains in thefe parts are firft felt, and li¬
gatures where they can be employed, for the purpofe
of benumbing the part, and thus preventing the com¬
munication of the impreffion from the part to the fyf-
tem, have been fuggefted ; but they have no fuppor-
from experience. Extirpation of the cicatrix the aut
thor thinks a more rational pra6li.ce. Suppofmg the
difeafe to be local till the commencement of the fymp-
toms, he confiders the chance of extirpating the
caufe, along with the cicatrized parts, to be great.
This, however, is at prefen t, a point of {peculation,
though doubtlefs of great importance.

Oil as a remedy, was employed by the ancients;
but it has long been neglected. A few years ago,
however, its ufe was revived by Dr. Shadwell.* In
one inftance it feemed to efFeflt a cure : but it is doubt¬
ful whether the cafe was truly hydrophobic. The
fymptoms arofe ten days after the accident, a very un~
ufual period. The patient’s mind was highly impreffi*
ed by terror. Add to this, that many fubfequent
trials have proved the inefficacy of this remedy.

Vinegar. Th is had excited the attention of Eng-

• O

lifh phyficians much about the time the ufe of oil was
introduced. It was exhibited in France prior to this.
There is, however, no proof of its efficacy.

Antisp asmodics : under this head are included
the mufk, and opium. Thefe have all been tried in
the greateft extent, and have all failed.

Tonics are the clafs of remedies from which Dr.
Hamilton teems to expeft the greateft advantage,
both from the.abfence of inflammatory fymptoms in
Hydrophobia, and from many appearances of debili¬
ty which are found to take place in it. Many of the
mod powerful, however, have been exhibited without
fuccefs, as zinc, and the cuprum ammoniacum. Re-
fpefting arfenic as a tonic, the following obfervations

* Vide Mem. Lond. Med. Soc. Vo!. 2.

occur

Hamilton on Hydrophobia . 457

occur. ‘ Dr. Ruffel, in his account of ferpents, con¬
firms the efficacy attributed by the natives in the Eaft
Indies to a compofition now known by the name of
tonic pills ; the chief ingredient of which con lifts of
this metallic fubftance. He affures us that it never
failed in the cure of the bites of venomous ferpents ;
and, le.d by fome kind of affinity, the natives ufe it
alfo, with equal fuccefs, in Hydrophobia, not only in
dogs, but in man.

Thefe tonic, or Tanjore pills confift of fix ingredi¬
ents : three of them we fhall call known , and three
unknown . The former are white arfenic, pepper,
andquickfilver ; the latter vegetable fubftances, called
by the natives, vellbnavi, neri-vifham, and nervalam.
The two firft of thefe lajt three would fee m to be of the
cauli-form, or herbaceous kind, as the powdered roots
are direfted for ufe : the other would appear to be of the
fhrub, or nut-tree kind, as the kernel in powder is the
part recommended. Equal parts of thefe fix articles (the
arfenic firft being levigated) are beat into a mafs, with
the juice of wild cotton, and formed into pills, ten or
eleven of which, when weighed, were found to be a
dram, which brings them fomewhat under five grains
each. The quickfilver is alfo to be rubbed with the
juice of wild cotton till the globules difappear.

c Swartz, a Moravian prieft, inftigated by the ce¬
lebrity thefe had obtained for the bite of the cobre
de capello, and other Indian ferpents, through the
nobieft motives of philanthropy, purchafed the fecret
from the Brachmins, and communicated it to the
Company’s furgeons. One of thefe communicated
it again to Dr. Ruffe!, with feveral experiments,
proving their fuccefs. The furgeon, having made
farther trials feparately on the three unknown ingre¬
dients, found, that almoft without exception, chickens
were killed by five grains of the velli-naVi root, in the
ipace of from an hour to an hour and twenty minutes.

c The progrefs of the fymptoms were, gentle purg¬
ing, convulfions of the neck, throat, and bread ; the

former

458

Hamilton cm Hydrophobia .

former being forcibly drawn down to the latter; uni-
verfal tremors over the body, paralyiis and lofs of
motion of the legs, and death. v. ,

4 in the dofe of half a dram to a dog, it vomited
violently, but in about fix hours he recovered. The
other two ingredients had lefs activity ; they proved
gently cathartic. The furgeon ufed in his experi¬
ments pills made in the fame proportion with the
Brachmins, and they anfwered in every refpedi equal¬
ly with theirs. As in general the number of pills
which completed a cure did not exceed fix, and fome-
times fewer, the quantity of mild quickfilver is too
trifling to have any fhare in it. The fame may be
faid of three others ; arfenic, therefore, and the velli-

navi only form the powerful parts of the prefcription.

6 We are farther allured, that the furgeon to whom
we are indebted for the communication of thefe pills,
had put them to the teft in hydrophobia. He exhi¬
bited them to no fewer than fourteen different per-
fons bitten by mad dogs, without any other fvmptom
than purging in moft, and a flight vomiting in a few
of them. This proves at leaft the fafety of thefe %
pills, though it cannot be politively afferted that they
cured the difeafe, unlefs the complaint was evident
when they were exhibited. If they be meant, how¬
ever, as preventive, they deferve no credit; there was.
no p/roof of difeafe.’

From cl i (Tech on s it appears, that hydrophobic bodies
tend to a rapid putrefaction. Hence the author in¬
fers, that a defeat of vital air in the habit, is one of
the effects of the difeafe. 4 If all the phenomena of
the difeafe be reviewed, and we can rely on the ap¬
pearances of putrefaction after death, which have been
affirmed, the vital air modified to our purpofe would
feem better adapted to a cure than the other fpecies
of eh flic fluids. Great exertions create proportionate
debility by the expenditure of this principle. No dif-
pifo, no condition of the body has been feen, where
greater exertion, or greater diftrefs of the mind takes

place.

459

Hamilton on Hydrophobia.

place. The exhauftion muft be in proportion. Great
temporary exertions indeed of mufcular motion have
been made in hydrophobia, without apparent incon¬
venience, nay even with fome momentary relief of a
diftreffing fymptom, but they were the laft efforts of
expiring ftrength. This is arguing, however, from
an. effeft, not from the caufe of the difeafe. The
poifoned faliva may poffefs the power in itfelf, like
opium, of exhaufting the frame, and creating a mor¬
bid deficiency of the vital principle, beyond what is
known in other difeafes.

if it be oxygene that gives power to mufcular
motion ; if its abfence be weaknefs, we cannot doubt
but a condition of the body is prefent in this difeafe,
containing a far lefs portion of this principle than is
requifite for the ftandard of health. If this fpecula-
tion be permitted, the mode of relief lies before us,
and air fupercharged with oxygene affords it. We
have feen that this can be done with fafety.’

c I have ventured thus to hazard a conjedfure on
the probable good effects of oxygene in the cure of
this diforder ; I have ventured it from a confederation
of the futility of every means of relief hitherto adopt¬
ed ; I have ventured it perhaps more on the prin¬
ciples of empiricifm, than on juft induftion from the
nature of the complaint ; but who is the inveftigator
hitherto able fatisfactorily to arrive at it ? 1 have

hinted this opinion under the fuppofition of hydro-
phobic virus entering the fyftem, and by a certain
modus operandi difficult to trace in every link, creat¬
ing a certain fet of actions, and inducing changes, of
which the abftra&ion of oxygene may form the prin¬
cipal. I would not, however, be underftood as ad-
vifing the inhalation of factitious gafes to fuperfede
the ufe of thofe fubftances denominated tonics , re¬
medies extolled by the lateft, and moft philofophic
writers on this difeafe.

‘ Arfenic efpecially I would recommend as one of
the moft powerful tonics perhaps yet difcovered. — ■

the

Hamilton on Hydrophobia .

the ufe of this, and the infpiratlon of modified airs
may proceed together. They are applied to different
furfaces, and in the exhibition will not interfere. If
difficult deglutition (hould give an opportunity (and in
many inftances we find it partially overcome/ the me¬
dicine may be exhibited, whether alone or in com¬
bination ; either in feme fubftance finely levigated,
as in the Tanjore pill; or in aqueous folution, or in¬
volved in other forms, in crumbs of bread.’

The following is a recapitulation of the author’s
remarks on the different remedies which have been,
or which may be employed in the treatment of hy¬
drophobia. J

The difeafe, it is admitted, is feated principally
in the nervous fyflem. Debility feems to form its
charafleriftic.

6 Two ftages are apparent in its courfe ; a firft, or
incipient ; and a fecond, commencing with hydro¬
phobia, and ending in death.

* The diforder is capable in the firft ftage perhaps
of cure ; but never yet performed in the fecond.

Emetics . The firft means of relief it ha s been
thought fhould be by emetics ; the reafon given is from
an appearance of bile in the primae viae ; bat emetics
are improper in a complaint of dire& debility. They
add to irritation, leldom diminifh it, unlefs by the re¬
moval ot obftruclions in the vefiels by the force of
concuffion ; or by the opening of the pores of the fur-
face to give an exit to retained perforation ; but the
latter is not indicated in hydrophobia.

c. Cathartics. Thefe are little better adapted
to the removal of this complaint, than emetics. They
are detrimental in cafes of debility, and often impro¬
perly exhibited here. ' Fcetid ftools are no teft of their
utility; no guide fdr perfifting in their adminiftration.
A gentle cathartic is admiftihle here, as in other dif-
eaies or debility ; blit farther it would be improper to

1/4
■4

r o fec'u fe them'.

3 d. In-

Hamilton on Hydrophobia ;

* 3tu Injections Thefe are far lefs exceptionable,
nay are often neceffary, feldom debilitating ; and may
be the medium for introducing medicines, or for nu¬
triment, or for both.

c 4 th. Battling. Neither the hot nor cold bath have
ever been fuccefsfully ufed. The former, though it
gives temporary relief in fame inftances, foon lofes its
effeft. The latter, though carried almoft to drown-
mg, produces no better confequences. Death has
even been battened by plunging the patient into cold
water. This concluflon is drawn from many trials,

4 Cavallo hints at fome cafes, faid to be cured by
opium and cold bathing ; by hidden fubmerfion, ak
moft to fufpenfion of life ; but he cannot remember
relpedling their authenticity ; whether he read of
them, or whether the communication came from the
relation of fome triend. It was moft probably the
former, for books tell of fuch cures ; but if cafes of
hydrophobia have been removed by this means, they*
were not rabid, , but tetanic inftances. They were
conyulfions, and difficult deglutition, arifing from te¬
tanus, not from the poifon of a rabid animal.

4 5th. Sudorifics — Stimulants. Sudorifics are even
left adapted to give relief. Volatile alkali, whether
as diaphoretic, or merely ftimulant, is like wife proved
deiufive. More, however, may be faid for this, than
for feveral of the others, and the practitioner would
do well to give it a fairer trial than what has vet been

done.

4 The ufe of the nitric acid has been fuggefted,
which merits confideration.

4 6th. Venajection. None of the remedies ever
propofed in this difeafe has been more abufed than
venaefeEtion. ' None has proved lefs ufeful, and none
fo univerfally employed, in fpite ot its conftant failure,
which ought to have long ago created doubt. One
man followed another in the fame beaten traEi, without
inquiry; but falfe theories of the difeafe, not left than
the repeated authority, ferved for its fupport. In

every

462

Hamilton on Hydrophobia .

every rabid cafe it is objectionable, nay even in te¬
tanus, or hydrophobia arifing from tetanus. None
more fuddenly creates depletion ; and the difeafe now
under review is marked in a peculiar manner with
debility.

c 1th. Blijlers. Whether they be ufed in their
capacity as fuch, or in their more partial capacity of
rubefacients, they are admiffible to a certain degree ;
but their limits are circumfcribed from the nature of
their operation, and when they are to be applied, re¬
quire attention, that abufe may not follow, where at
leaft fome ufe may be derived, under proper modi¬
fications. The abidance is found to be (lender.

£ %th. Embrocations , which are fomething of the
fame nature, if fufficiently ftimulant, may be applied
to the throat, the pit of the ftomach, and above all to
the fpine. They will ftimulate cutaneous veffels into
greater aCtion, and may meliorate the difeafed fen-
fibility to cold air, by their caufing, from their ftimu¬
lant power, a change in the mode of a&ion, and con-
fequently extrication of more heat.

„ « 9th . The intemperate and vexatious perfuafion of
the patient to fwaliow drink, is altogether improper.
Curiofity is here gratified at the expence of increafed
mifery, to a moil commiferable object. Antipathies,
were it nothing but antipathy, to certain fubftances,
in every fpecies of diforder, are to be regarded.

c 1 Oth. Mercury. This famous remedy, on which
fo much of late years has been written, may be dif*
miffed, without regret, from the remedies of hydro¬
phobia. Not an inftance of fuccefs can be fairly
brought forward to fupport its claims.

c llth. Running. It mult be obvious, that in run¬
ning, or violent exercife, a truly (lender folace is fet
forth. If we confider its operation, it would feem to
eftablifh a point in pathology of no final! magnitude ^
it is a clear indication of the patient’s general weak-
nefs. It proves a deficiency of due fenfibility in the
heart ; and that the ordinary ftimulus of the blood is
- <7 ’ on

463

Hamilton on Hydrophobia .

no longer able to give a force of fyftole equal to the
propullion of the contents with appropriated energy,
through the arterial fyftem. Hence ft-agnation in the
pulmonary fyftem, fenfe of fuffocation, &c. which
running, as an increafed ftimulus, temporarily re¬
moves.

‘ 12 th. Cold. The application of cold, or more
properly, hidden abftraftion of heat, to benumb the
parts, and (top ofcillation and irritation, it is evident,
cannot be permanently ufcful ; becaufe, if continued,
the death of the part mull follow. The fame objec¬
tion may be brought againft ligatures » yet thefe will
admit of application to a certain degree, till more ef¬
fectual means, for removing irritation in the part,
can be prepared.

" 13 th. This is its deftru&ion, by the knife, by
cautery, or by cauftic alkali. Let this be accompli (li¬
ed at the moment when fenfations ot pain, or ap¬
parent inflammation give warning of the approach¬
ing malady. I am not without hopes, that by proper
attention to this fymptom, the difeafe may be check¬
ed in its commencement.

c 14th. Oil. This has been tried, with no advan¬
tage, in rabid hydrophobia. Its ufe, even in hydro*,
phobia from fear, is problematical. It is not clear
but that the patients, to whom it has been apparently
fuccefsfully adminiftered, would have recovered from
the panic under which they laboured, had it never
been applied.

c 1 5th. Vinegar. Vinegar, in this country, has
been equally futile.

c It is no new remedy ; the practice is of an ancient
date. iEfchion, preceptor to Galen, exhibited crabV
claw powder againft the difeafe ; and Galen, who fol¬
lowed his mailer’s praclice, gave the fame powder in¬
ternally, and ufed it as an application to the wound,
with the addition of frankincenfe, opoponax, and
gentian root, mixing them together with the Jiarpcjl
vinegar. ■ ,

4 The

464

Hamilton on Hydrophobia .

i \

c The oxalic acid I have ventured to hint at, fhould
an acid be thought beneficial, as better adapted, from
an idea that the quantity of oxygene in a given bulk
is greater, and that its coheiion with its bate is loofer,
and more readily feparable, than that of the acetous
acid or vinegar. But the praftice cannot be enforced
on the ground of experience, as it has never been at¬
tempted.

c 1 6th. Antifpajmodics. The clafs of antifpafmo-
dics, as diftinguifhed by this name, have not anfwer-
ed. Opium, the molt powerful, inflead of proving
lifeful, appears to have been detrimental under every
management hitherto adopted. I apprehend that its
ufe mud be very guarded, to prevent the mifchief
attendant on its abufe. I am inclined to difcard it
entirely.

c llth. Hydro-carbonate Gas. Some late writers,
Mr. Barr, and Cavallo after him, have fuggefted the
ufe of the hydro-carbonate gas, to remove irritation,
and to induce deep. I have ventured to date objec¬
tions to it as a general remedy, though as an auxiliary,
in a limited degree, it is worthy of a place ; but from
its great aftivity, i. e. from its hidden effefts, and
thefe of a mod powerful kind, tending almod to im¬
mediate death in an imprudent dofe, the praftitioner
mud ufe the utmod caution in its adminidration. In
producing temporary ceffation from pain, where pain
is excedive, it appears to be powerful.

c A bath is fuggeded of this aerial fluid, with a
view to obtund cuticular fenfibility, fo excruciating
in hydrophobia. For this purpofe a narrow tall veflel,
inch as a fmall calk, may be procured, into which the
patient may be put, keeping his head above the calk.
Into this the hydro-carbonate, previoufly prepared,
may be introduced ; for no great difficulty will ob~
ftrubt the management, . when it may be confined in
the calk by cloths, or foft chamois leather, furrourid-
ing the patient’s body, and preventing its mixture
with the atmofpheiic air.

Ofc •

« This

Hamilton on Hydrophobia .

465

c This, however, is an employment of fome danger
to the affiftants, and to the patient, in the aft of ex¬
tricating him from the veffiel, to prevent its admixture
■with the air of the room, which may create, to fay no
worfe, vertigo and head-ach. it ought to be done
near a chimney, that it may be carried up by the
current. A commodious contrivance, air tight and
fecure, for fuch a bath, would not be difficult to
invent.

c This, perhaps, is not the only fpecies of difeafe
which fuch aerial immerfion may be confined.
Might it not be employed with advantage in cafes of
ievere burns, whether produced by explofions of gun¬
powder, or of hydrogene gas, m coal pits and other
mines, or by fcalding with boiling fluids? Its pro¬
perty of deflroying fenfibility, of mitigating fevere
pain, favour this fuggeftion. Burns are accompanied
with moil: excruciating pain.

1 %th. Tonics . This clafs of remedies is not only
unequivocally admiffible, from the pathology of the
difeafe, but ftrenuoufly to be inculcated. The difeafe
is ftrongly marked by debility, which tallies as throng-
ly oppofe. Bitters are many of them tonics ; but
vegetable bitters are bulky, and in a powdered form,
at lead, the ftomach here will rejeft them: even de¬
coctions, tor the fame reafon, are objeftionable. The
metallic tonics are, therefore, preferable : iron, zinc,
copper.

‘ from the mineral kingdom another fubfiance has
been lately recommended.

19th. Arfenic . This iubftance merits the highefl
attention, and promifes no fmall advantage. It is
llrange, that till lately this could not be mentioned
in medicine, yvithout exciting great apprehenfion and
terror; yet poifons not lefs deleterious, viz. prepara¬
tions of mercury, of antimony, and even opium itfelf,
were in daily ufe with the faculty. In the form of a
pill, named tonic or Tanjore pill, this mineral has
been exhibited both again!! the bites of ferpents and
- vol, v. LI * rabid

466

)

Hamilton on Hydrophobia .

rabid animals. From it high expe&ations are now
entertained.

* 2 Oth. Oxygene Gas. Under the head ot tonic
medicine 1 would clafs oxygene gas, or vital air. Its
ufe I have here recommended, from the penuafion of
too great a fubtr'aftion of it from the habit, created
by the force of the poifon in what way foever it may
operate. The mode of exhibition is ot late rnade
confiderably eafy by the labours of the ingenious
BeddOes. 'This" aflive fubftance is not introduced
here as a catholicon, but as an affiftant to other en¬
deavours, efpecially in co-operation with tonics.

< Such are the fuggeftions which have occurred in
reviewing this malady, and which the pathological
reader is. earneftly requefted to re-confider. Let him
feduloufly render his aid in bringing them to perfec¬
tion, or, by pointing out other means more certain,
remove their ambiguity and eitablifh the fafety of
mankind againft a diforder deplorable anci incut able,
from its firft difcovery in remote!! antiquity, to its
lateft inftance of fatality.’

Several points ot a mifcellaneous nature are {un¬
joined ; and in the appendix a confiderable number
of cafes are brought forward ; which, however, it
W'ouid much exceed the limits of our work to par¬
ticularize.

We mud not quit our account of the prefent ela¬
borate performance, without firft acknowledging the
fatisfaftion we have received in its perufal. 1 he view
we have here given of it, though it has carried us to
an unufual length, is very inadequate to convey a juft
idea of its merits. There is hardly a faff or opinion,
relative to the difeafe in queftion, which has not been
brought forward by Dr. Hamilton, and their refpedlive
values fairly appreciated.

Art.

( 467 )

Art. XLVII. Obfe? nations and Experiments on the
Broad-leaved Willow Bark, illaf rated with
Cafes . By W. White, Apothecary to the Bath
City-Infirmary and Difpenfary . Odtavo, 58 pages,
price Is. 6d. London. 1798. Ver NOR'and Hood.

rpHE Bark which forms the fubject of the prefent
1 eflay, was flrongly recommended to the atten-
tion ot the public in a pamphlet publhhed by Mr,
James a few 'years ago. Its life, however, has not
become fo general as it would feern to deferve, from
the teflimonies adduced in its favour both by Mr.
James, and by the author of the prefent remarks.
Perhaps the reafon may be, as Mr. James fuggefts,
that we are apt to overlook the merits of what is
eafily procured, and coffs but little, and to be cap¬
tivated with a commodity which can only be acquir¬
ed with difficulty and expence. However this be,
the willow bark feems well entitled to a candid trial ;
for if it poifefs lefs than the virtues here afcribed to
it, in comparifon with the Peruvian bark, it may ftill
have fufficient, to render it a very valuable article of
the Materia Me die a.

The broad-leaved willow is to be met with in the
woods, and hedges of hilly fituations, growing to a
pretty large buihy tree. Although fome botanical
writers enumerate as many as thirty different fpecies
and varieties of the willow, yet this fort is eafily dif-
tinguifhed by the fhape of the leaves, which is re-
fembled by none of the other fpecies except the bay¬
leaved ; but that again is foon diffinguifhed from the
former, by the leaees being fmooth and filming, in-
flead of the dowmy appearance, particularly on the
under furface of the falix caprea, the fpecies here
defcribed.#

* Synonma, Salix latifolia rotunda. Ran Syn. 449, — c:alix foliis
ovatis rugofis fubtu* tomeotofis undatis fuperne denticulatis, Linn ,

Li &

468

Medical Records and Reft arches.

This bark difcovers to the tafte a confiderable de¬
gree of aftringency, accompanied with a flight degree
of bitternefs. Its decoftion is of a bright red colour,
more aftringent than the cinchona, but with lefs bit¬
ternefs. It has been generally exhibited in the form
of decoftion, two ounces to two pints of water, boil¬
ed down to a quart, with a fmall quantity of pimento.
Dofe, two table-fpoonfuls three or four times a day.
In interm ittents it requires to be given in larger and
more frequent dofes.

We do not deem it neceffary to follow the author
in his chemical experiments, or in his detail of cafes
.wherein this bark has been employed; as it fo much
refembles, in both refpefts, the different fpecies of
the cinchona. As an antifeptic, it is confide red as in¬
ferior to the Peruvian, but as atonic, greatly its fupe-
rior in efficacy. The willow bark decofition has been
given, the author obferves, with confiderable advan¬
tage in cafes of general debility, accompanied with
lofs of appetite — in intermittents— remittents- — mild
cafes of typhus- — convalefcent ftate of all febrile com¬
plaints— fluor albus— prolapfus uteri. — —In ffiort, in
all cafes where the ufe of the Peruvian bark as a
tonic is indicated, its exhibition has been attended
with much fuccefs.

Art. XLVIII. Medical Records and Refe arches ,
J elected from the Papers of a private Medical Af-
fociation . Oftavo, 288 pages, price 6s. London,
• 1798. Cox.

MANY of our readers will doubtlefs recognife,
in the prefent colleftion of obfervations, the
Phyfical Society which is held weekly at Guy’s Hof-
pital during the winter feafon. The obfervations here
prefented to the public are not numerous ; at the fame
time they are not unimportant, as will be feen by the
view we are now to give of them.

The

Medical Records and Refearches. 469

The firft article is the relation of a Cafe of Strangu¬
lated Hernia, in which a part of the Abdominal Vif-
cera was protruded into the left Cavity of the Cheft :
by Mr. Aflley Cooper, LeElurer in Surgery at St.
Thomas’s Hofpital. — The fubjeEt of this cafe was
frequently attacked with fymptoms of ftrangulated in-
teffine, which at length deftroyed her. On diiTeElion,
the great arch of the colon, inffead of being ifretched
from one kidney to the other, was found to have been
pufhed into the left cavity of the cheft, through an
aperture in the diaphragm. This aperture was placed
in the m'ufcular part of the feptum, three inches from
the oefophagus : it was of a circular figure, and two
inches in diameter; and was probably an original
mai-conformation. — As this cafe affords little practical
inflruEdion, it is unneceflary to be more particular.

2. A Cafe of Tic Dolour eux, or painful Affection
of the Face , fuccefsfully treated by a Divijion of the
affected Nerve: by John Haighton, M.D . Lecturer
on Phyfiology and Midwifery , &T- — The affe Elion
here defcribed is not one of frequent occurrence,
nor has it been often treated of by medical writers.
In the 5th vol. of the Medical Obfervations and In¬
quiries, an accurate defcription of this complaint is
given by the late Dr. Fothergi.il . The following are
the leading circumftances in the cafe here narrated.

4 Mrs. hi - , of Stockwell, Surry, aged feventy-

four, a mother of children, of a fpare habit, placid
difpofition, and for her age much difpofed to activity,
was, about thirteen years ago, for the ijrft time, feized
with pain of the face. This pain at its commence¬
ment was very moderate, but in its progrefs became
violent ; at length it acquired a degree of acutenefs
which neither words can defcribe, nor the imagina¬
tion eafily conceive.

c The feat of this extreme pain was fomewhat
limited; being confined to the ala nafi and a fmall
portion of the upper lip, on the right fide. The pain

L I S was

470

Medical Records and Rejearches ,

was not of the continued obtufe kind, like that of chronic
rheumatifm ; but, on the contrary, rather tranfient, ex¬
ceedingly acute and lancinating during its attack. The
periods of its recurrence were indefinite, and in the
intervals of which (lie was generally in a date of per-
fe£t eafe. There was a ftriking uniformity both in
the origin and direction of the pain : it always began
in the ala nafi and upper lip, and darted upwards
towards the orbit ; but when the attack was more
than commonly violent, then indeed it extended to
other parts, and a fenfation of a fimilar kind, though
much lefs in degree, was frequently perceived along
the cheek towards the ear; the fame fenfation was
alfo obferved on the fieihy and bony palate, on the
gums and teeth of the upper jaw, and lometimes on
the fauces. She feerned particularly difpofed to this
pain in fevere, or windy weather : yet the was not
altogether free from it even in the mildeft feafon. It
was mod frequently excited by the more obvious
oecafiona! caufes, fuch as fpeaking, coughing, taking
food, blowing the nofe, &c. though fometimes it would
return from caufes lefs apparent. The duration of each
pain feldom exceeded half a minute ; but more fre¬
quently it was fomewhat lefs.

‘ Sometimes the had not more than five or fix of
thefe pains in the fpace of a day ; at others, nearly
twice that number in an hour. They varied fenfibly
in their degree of violence ; fometimes fo moderate as
only to fufpend the movement of the upper lip, but
more commonly fo pungent as to extort fcreams ex-
preffive of intenfe agony. Befides the fufpenfion of
the motion of the lips, a very oppofite effeft frequent¬
ly took place, viz. a tremulous movement, during
which it was fometimes drawn a little upward. Not-
withdanding there were fuch intenfe pains, neither
fwelling nor difcoloration could be perceived, except
fuch as were occafioned from time to tirpe by ex¬
ternal applications. Thefe were the general fymp-
toms.’

4 72

Medical Records and Hefearch.es .

The complaint was treated as a nervous affeftiori
In the ufual wa^ though without any (hiking or per¬
manent advantage : it continued with more or lets
violence for two years. At this period Dr. Haighton
began to entertain juft notions of the nature of the
difeafc. < While my patient/ fays he, £ was en¬
deavouring to defcribe her feelings, which (he at¬
tempted in a very inarticulate manner, Hie -flopped
fuddenly, and, upon looking at the part affected, I
perceived a tremulous motion of the upper lip, by
which it wras drawn upwards precifely at that part
where the miifcnlus levator lahu fuper ibns propriiis is
inferted ; and from recoil effing a wrell known faQ,
that a nerve, under irritation from ftimulating caufes,
produces motion in the mufcular parts to which it is
diftributed, it immediately occurred to me that the
fuborbitar branches of the fifth pair of nerves, which
are known to fuppiy thefe parts, mull be the feat of
the prefent difeafe.

f In order, therefore, to reduce (as far as poffible)
to certainty, what hitherto was only matter of furmife,
I waited for the next exacerbation, which took place
in a few minutes, and by making, at this time, rather
a forcible preffure upon the integuments covering the
fuborbitar foramen, the pain inftantly abated'.. I re¬
peated this feveral times, and uniformly with the
fame effeft.

* As my conjecture relative to the feat of this dif¬
eafe feemed to" gain confiderable fupport from this
experiment, I thought it effential to take a more
minute furvey of the fymptoms, particularly as being
feated in thofe parts which feemed affe&ed in a fecon-
dary or fym pathetic way.

< Now’- it appears from the hiftory of this cafe, that
the extreme pain w'as feated in the ala nafi and upper
lip, on the right fide ; but when it darted with more
than common violence, it affected other parts, as the
ear, by extending itfelf along the courfe of the cheek,
by means of communicating branches belonging to

L 1 4 the

472

Medical Records and Refearches.

the portio dura of the feventh pair, which pair begins
to fpread on the fide of the face as foon as it emerges
from behind t;lief condyles of the lowe*r jaw. It at-

palate, gums, and teeth of the upper
jaw, but no part bf fhe lower ; fometimes the fauces
but the part whicfl^feemed affefted next in degree
to the original £eMt|>^was immediately behind the
dentes incifiviJ H

‘ From comparing? ^&is affemblage of fymptoms
with the diftribution bfthe fecond or fuperior maxillary
portion of the fifth pair of nerves, I was flruck with
the coincidence, and at the fame time was perfuaded,
as has been already hinted, that the original difeafe
was in thofe branches of the nerve tr'anfmitted by the
fuborbitar foramen, and diflributed to the ala nafi and
upper lip; and that the darting pains extending to
the teeth, infide of the gurus and palate, arofe from
communicating filaments between the fuborbitar and
palatine branches. Thefe communications not only
complicated the cafe, but alfo placed the profpedt of
a cure at a great difiance, from the various channels
by which the pain could be conveyed from the part
primarily arrefted to the Senforium. But as a tempo¬
rary advantage had been frequently gained by pref-
fure of the fuborbitar nerves againfi the bone, the en¬
tire divifion of them feemed eligible; and it was pro-
pofed to my patient as an ultimate expedient. The
propofal, however, carried with it fome difficulties.
It was new to her. It could not infure fuccefs. Ex¬
perience, as far as my knowledge extended, had yet
to (lamp it with its fandtion. And in this diftradlion
of circumflances, the mind of my patient might have
remained lufpended in doubt, had not the infupport-
able urgency of pain compelled her to affent.

Having gained permiffion to operate, I began to
confider the circumflances of this nerve more attentive¬
ly j and as the intention was to effeft a complete di¬
vifion of its filaments, by an incifion of a moderate
length, the means conducive to that end became im¬
portant

473

Medical Records and Refe arches .

portant fubje&s of regard. It was effential therefore
to acquire a knowledge concerning the precife feat of
the difiribution of this branch of the fifth pair of
nerves ; the mode of its tranfition and exit from the
fuborbitar foramen ; together with a clear and correft
idea refpefting the feat of the foramen itfelf. Be-
Tides which, it was not altogether extraneous to at¬
tend to fuch contiguous parts as might, either from
neceffity or accident, be wounded in the operation.

c This nerve is tranfmitted by the fuborbitar fora¬
men, in a way very different from that which the com¬
mon form of expreffion on this occafion would lead
us to imagine. VVe ufually fpeak of it as one branch
under the name of fuborbitar 3 but in reality it ought
to be confidered as a feries of branches, for it divides
before its exit, and is afterwards diftributed in a radi¬
ated manner to the circumjacent parts, viz. the levator
labii fuperioris proprius, the inferior part of t\iQ orbi¬
cularis palpebrarum, to the mufcles and integuments
of the nofe and upper lip.

c From this radiated diftribution, it muff neceffarily
happen that the branches of this nerve are fpread
over anextenfive furface at their termination, though
contraffed into a fmall compals at their exit from the
foramen. It was therefore confidered a matter of im¬
portance to fix upon a proper part for the operation,
in order that its branches, by lying in a fmall fpace,
might be more conveniently divided.

‘ In its paffage through the fuborbitar foramen, it
is accompanied by a branch of the internal maxillary
artery, which from its contiguity muff neceffarily be
divided. Thefe are covered by the levator labii fu-
perioris proprius , and the common integuments.

c As the branches of this nerve lie clofe to each
other at the orifice of the foramen, that part feems
the moft convenient for their divifion, becaufe an in-
cifion of a moderate length will generally include
them all.

4 The-

474 Medical Records and Refear dies.

* The next confideration was to determine the exa£f
fituation of the foramen. This at firft feems very
eafy, but in reality is not fo ; becaufe in different
Ikulls the diftance of it from the orbit differs confider-
ably, and there does not appear any mode of deter¬
mining this more probable than by attempting to form
a ftandard from the meafurement of a confiderable
number of fkulls.

c I therefore meafured the fpace between the in-
ferior edge of the orbit and the Superior part ot the
foramen in thirty ikulls, and found the diftance as
follows.

In 2 ikulls, °f an inch.

In 16 - - |-

In 8 - -iV

In 3 — — fT

In 1 - i

* As the diftance in fixteen ikulls out of thirty, was
| of an inch, I dial! confider that the medium diftance
from the fuperior part of the foramen ; and if we al¬
low -f of an inch for the breadth ot the foramen, and
-f. below its inferior part, we confider half an inch
from the lower edge of the orbit a proper place for
performing the operation.

* Having endeavoured to eftablifh a rule for deter¬
mining its diftance from the orbit, it may be proper to
afcertain its fituation with refpedt to aline drawn from
the inferior part of the internal angular procefs of the
os frontis, obliquely acrofs the orbit, to the centre of
the os malax The meafurement of this line in thirty
Hulls did not vary more than •§• of an inch, and it was
found that a line drawn downward, perpendicular to
this oblique line, at the diftance of -J- of an inch from
the internal angle of the eye, paffed acrofs the orifice
of the fuborbitar foramen. By this rule I was able to
form a ftandard of the fituation of this foramen in a
living fubjecb

‘ Thefe

Medical Records and Ref e arches. 475

‘ Thefe preliminary circumftances being fettled,
the operation becomes exceedingly Ample, and con-
lifts in an incifion of -f- of an inch in length, carried
obliquely downward, the center of which mu ft cor-
refpond with the foramen, only -J- of an inch below it.
The incifion muft be made down the bone, otherwife
we cannot be certain of dividing the nerves, as they
are fituated very deep. And as there are fome irregu¬
larities on the furface of the maxillary bone at this
part from mufcular attachment, as well as a furrow'
which is fometimes continued from the foramen down¬
wards, a fmall pointed knife will be preferable to
any other, as it will enable the operator to divide
with more certainty fuch nervous filaments as may be
feated in thefe depreilions.

c The facial vein frequently paftes over the foramen,
and conceals it; from which it is liable to be divided
in the operation. If this really happens, or if any of
the fuborbitar branches of the internal maxillary ar¬
tery fhould bleed with freedom, a comprefs may be
made with advantage, as they are feated near the
bone.

c The wound being dreffed fuperficially, will prob¬
ably heal by the firft intention.

c In the manner juft deferibed I performed the ope~
ration, and the event has amply juftified its propriety.
It immediately put an end to the pain; and in a few
days the incifion healed. My patient, who has now
lived nine years fince the operation, contemplates
that event, I fcarcely need fay, with the higheft fatis-
faftion.

c It is worthy of remark, that the fenfation and ac¬
tion of that fide of the lip, though evidently diminifh-
ed, were not altogether loft, as might have been pre¬
dicted. The inconvenience was only temporary; we
may therefore fuppofe a reunion of the nerves had
taken place, but with this fortunate effeff, that no
difpofition to the return of the difeafe through the
new formed part has yet appeared/

' It

476 Medical Records and Refear ches.

It is of importance to diltinguifh accurately the com¬
plaint here fpoken of from others of the fame part ;
and even to diftinguifh the varieties of the fame fpecies :
for the fame treatment is not applicable in all. ‘ The
kind of pain/ the author remarks, 4 is very peculiar,
and the courfe of it correfponds exactly with that of
the nerves. The fecond branch of the fifth pair is
perhaps more frequently affedted than either the firft
or the third. But the portio dura of the feventh pair
which isdiffributed very extenfively upon the face* un¬
der the name of pes anferinns , is more frequently the
feat of this complaint than any of the branches of the
fifth pair are ; and this is a matter of confiderable re¬
gret, becaufe, in fuch cafes, neither the operation
propofed in this paper, nor any other with which I am
acquainted, can avail. If, indeed, an operator, mi¬
nutely verfed in the fituation of thefe different ner¬
vous filaments, were by an effort of {kill and addrefs
to fucceed in the undertaking, there is the higheft
probability that his patient would be relieved; but
by reafon of the manner in which this nerve fpreads
Its branches, even where it is piercing the parotid
gland, as well as the hazard of wounding contiguous
parts, moil prudent pradtitioners would decline the
operation. Thus we fee with how much more facili¬
ty the mind can project, than the hand can execute.

c When the feventh pair is afifedted, we can be at
no lofs to know ; for the patient complains of a pain
which begins in the fore part of the cheek, fometimes
as high as the forehead, and extends itfelf in the di-
redtion of the ear. In a cafe of this kind, no relief
whatever can be obtained by dividing the fecond
branch of the fifth, as fuch divjfion cannot pofiibly
give any interruption to the communication between
the fenforium and the feat of irritation. I find it ne~
ceffary to notice this, from having heard of a cafe in
which the practitioner, from mifconceiving my mean¬
ing, performed the operation agreeably to the mode
here advifed ; but the patient was not in the lead re¬
lieved by it, as might naturally be expedted.

Some

477

Medical Records and Refearches .

4 Some time ago I was requefted to attend a lady in
Queen-fquare, to confult with a phyfician of dif-
tinguifbed eminence, and high profeffional. refponfi-
biiity, concerning the propriety ot dividing the dil-
eafed nerves. This lady had the complaint feated
not only in the feventh pair, but likewife in the third
branch of the fifth. Here, befides the feat of the
pain juft defended, one half of the tongue, and the
teeth of the lower jaw on the fame fide, were affebted ;
for thefe parts are topplied with nerves from the third
branch of the fifth pair.

‘ In this cafe it was difficult, perhaps impoffible, to
decide in which of thefe two nerves the irritation ori¬
ginated. It is not neceffary that it fhould begin in
both in order to explain the fymptoms ; for it might
fir ft attack thofe branches of the fifth pair which top-
ply the tongue and teeth of the lower jaw, and after¬
wards affebt the feventh pair by certain well known
communicating branches, one of which is feated be¬
hind the condyle of the lower jaw ; or the irritation
might commence in the feventh pair, and the fifth
might be affebted by communication, In either cafe,
no operation was advifable, becaufe, firft, it was poffi
fible that the irritation might be propagated to the
fenforium in two directions ; therefore the impreffion
could not be intercepted in its courfe to the brain, fo
long as either channel was entire: and fecondly, be¬
caufe the deep fituation of the third branch of the
fifth pair made that nerve altogether inacceffible to
the knife. When the firft branch of the fifth pair is
affebfed alone, it is relievable by an operation. In
this cafe, the pain begins in the forehead and darts
downward towards the orbit: for this nerve, in com¬
ing out of the cavity of the cranium, paffes along
the upper part of the orbit, where it fends off fila¬
ments to adjacent parts, and, having paffed through
the toperior orbitar foramen (frequently only a notch),
is diftributed on the forehead. Here an operation is
very Ample, and confifts in nothing more than a di-

vifion

478 Medical Records and Refear ches.

vifion of that nerve a little above the foramen. The
branch of the optical artery, which accompanies it at
this part, will not furniih an hemorrhage of any mo¬
ment/

In the cafe above related, the pain always originat¬
ed in one part, from which it extended itfelf to others.
Whenever this happens. Dr H. obferves, we fhould
confider whether the nerve or nerves can be divided
between the part where the pain originated, and the
parts to which it afterwards extends. When this can
be done, there is a probability of operating with fuc-
cefs : but when feveral parts are attacked at the fame
time, or when the pain extends in feveral diredlions,
from the part primarily impreffed, there is but little
reafon to expedt advantage from an operation.

( to he continued. )

Art. XLIX. An Account of Indian Serpents , col¬
lected on the Co aft oft Coromandel; containing de¬
ft crip tions and drawings of each fpecies ; together
with Experiments and Remarks on their fteeeral poi-
fons. By Patrick Russell, M. D. F. R. . S.
Folio, 91 pages, with 44 coloured plates, price
3/, ISs. 6d. London, 1796. Nicol.

FOR reafons which are fufficiently obvious, the
branch of Natural Hi dory which is here treated
of, has been more imperfedlly invedigated than many
others. In a medical point of view, it is dill moreim-
perfedk It offers, as the author judly obferves, no at¬
tractive allurements; and thofe who devote their atten¬
tion to natural hidory are more likely to prefer objedls
Jefs difguding, and experiments accompanied with
lefs cruelty and perfonal danger. Even the eager and
refolute naturalid has to contend with many difficulties
in this path of refearch, He cannot at once dived

3 ! himfelf

RuffelPs Account of Indian Serpents . 479

himfelf of the abhorrence, next to Innate, of thefe
reptiles, nor can he loon acquire a dexterity in hand¬
ling them, with the calmnefs requifite tor his own
fafety.

The imperfect irate in which this part of natural
hiftory remains, fuggeiied to the learned author the
idea of collecting and describing the Serpents found
on the coaft of CoromandeL I he prefent work con¬
tains defcriptions of forty-three ferpents, illustrated
with coloured engravings.

The terror occafioned by thofe numerous reptiles
is immoderately aggravated by the indiscriminate ap-
prehenhon of all being poifonous. lo diking uifh,
therefore, thofe that are really fo, from fuch (by rar
the greater number) as are harmlefs, becomes a mat¬
ter next in importance to the difcovery of a remedy
again!! their poifon.

It would be vain to endeavour to convey to our
readers an idea of the merely descriptive part of the
work, without the affiflanee of the engravings. We
fliall only, therefore, remark the differences which
exift, between the poifonous, and the innocuous
fpecies. The poifonous ferpents are, for . the moil:
part, diftinguifhed by their fangs; which, in the Hy¬
ing animal, when held properly by tne neck, or irri¬
tated, are readily enough difcerned : though not ah
ways fo eaiily m a recumbent ftate, or in *-he dead
fubjefl. But the want of a row of teeth in tne upper
jaw, found in that of all harmlefs ferpents, ferves
alfo as a criterion, even where the fangs nave pur-
pofely been eradicated, or loft by accident In fer¬
pents' not venomous, there are three rows of common
teeth in the upper jaw: in the poifonous kinds, tne
external row is wanting.

The defer! ption of the different fpecies having been
gone through, the experiments and remaiks on their
poifons follow. Of the forty-three ferpents here ex¬
amined, feven only were found furnifhed with pqifon-
ous organs. The effects produced by the poiion of

480

RuiTell’s Account of Indian Serpents,

the Eaft India ferpents here defcribed feem to be near¬
ly fimilar to thofe occafioned by the bite of the rattle-
fnake, and the European viper, differing only in de¬
gree, or in the rapidity of their operation. The bite
of a rattfe-fnake in England, killed a dog in two mi¬
nutes; the bite of the moil pernicious fnake s here
mentioned, was never obferved to kill a dog in lefs
than twenty-feven minutes.

The fir ft feftion contains experiments on the poifon
of the fpecies denominated by the natives the Gedi
Paragoodoo: from thefe we extract the following.

‘ Experiment 1. Auguft , 1788. A fnake of this
fpecies was received from Bimblipatam, after a jour¬
ney of feven hours, in fo languid a ftate, that it was
with much difficulty he w^as made to bite a chicken
on the breaft : a little (peek of blood was vifible on
the Ikin, but without any mark of the fangs having
afted ; fo that I imagined the bird had not been in¬
jured : within twenty-five minutes, however, it began
to droop ; and in a few minutes more, growing rapid¬
ly worfe, it expired, without any confiderable con-
vulfion, in about forty minutes from the bite.

* Experiment 3. Augnji 17 - . A gedi para¬

goodoo, which had been caught at Cafem Cottah
the day before, was made to bite a ftout, large, dog,
on the thigh, near the groin The animal held faft
for more than twenty feconds, but the fangs feemed
to have penetrated no deeper than the Ikin; there
was barely an appearance of blood, and fume poifon
was found about the fuppofed place of the puncture.

4 c The dog howled a good deal, when wounded ;
but, on being fet at liberty, walked about without
any fymptoms of poifon. In ten minutes, he urined,
and the wounded thigh was a little drawn up, but he
ftil! continued on his legs. In a quarter of an hour,
he couched and howled ; the motion of his thigh was
vifibly more impaired, though he was ftill able to
raile himfelf. In twenty-five minutes, being forced
to fife, both hind legs were obferved to be paralytic.

‘ In

43 1

R u ffe 1 F s Account of L n dian Serpents .

c In the courfe of the fecond hour, he grew mani-
feflly more clifordered ; he did not howl much, but
vomited more than once ^ became more torpid, and
Jay along on one fide, panting. At the end of the
fecond hour, he died, having fcarcely fuffered any
convulfions.

‘ I examined the part bitten, four hours after death,
and found it hardly fwelled, or difcoloured : a cir-
cumflance different from what ufually is obferved in
the bites of other venomous fnakes.’

The fecond faction relates to the poifon of the
Cobra de Capello.

‘ Experiment 1. June , 1787. A dog, bitten on
the infide of the thigh, by the comboo nagoo, howled
at firft, as if in much pain. After two or three
minutes, he lay down, and continued, at intervals,
to moan and howl. After twenty minutes, he rofe,
but flood with difficulty, and was unable to walk ;
his whole frame feemed greatly clifordered. He foon
lay down again, and, in a few minutes, was feized
with convulfions, in which he expired, twenty-feven
minutes and a half after the bite.

f Experiment 11. Auguji — — — A cobra de ca¬
pello, which had loft his two longefl fangs, but retain¬
ed two of the fecond order, was made to bite a very
large, flout, dog. At firft the dog complained loudly,
though the thigh neither was drawn up, nor, for a
quarter of an hour, did any fymptoms of poifon appear.
About this time, breaking loofe, he was purfued j
and after a chace of an hour and a half, was brought
back extremely heated and fatigued.

c After retting a quarter of an hour, water was
offered him, but he would not drink, though he had
eat fome morfels of bread thrown into the water.

c it was intended to have given him the Tanjore
medicine ; but, befides that I was in doubt of his
being poifoned, the time of giving the medicine had
elapfed.

vol, v. Mm

‘ About

482

Ruilelf s Account of Indian Serpents.

f About a quarter of an hour after eating the
bread, he grew lick, vomited, began to howl, and
fhe wed much inquietude. After ten minutes, he
vomited a fecond time, and became extremely out¬
rageous ; ftruggled to get loofe, fnapped defperately
at the hake to which he was tied, and howled incef-
fantly. Alter the fecond vomiting, he lay down, and
was much agitated about the belly and liomach : the
mufcles ot his face wTere alfo convulfed. Being made
to rife, he walked without any feeming impediment
from the hind legs.

c At the end of the third hour, he ftill continued
extremely ferocious, in fo much that it became ne-
ceffary to tie his legs. From this time, his howlings
and ftruggling-s grew gradually weaker, and the con-
vulfive motions of his face increafed ; in wdiich ftate
be lingered about an hour longer, and then expired.
[Nearly the circumference of half a crown was quite
black, round the part bitten.

6 Objervations . The fymptoms of rage attending in
this cafe, were in a degree beyond, what I had ever
obferved before, or have obferved fmce. The dog
teemed quite furious, and gnawed the thick with in¬
credible ferocity.

c Could this be accounted for from the agitation ex¬
cited by the violent exercife of fo long a chafe, join¬
ed to the ftrong conftitution of the dog? And may
it be fuppofed, that the running retarded the mortal
effects of the poifon ?*

, c That no ufual fymptoms of poifon appeared at
firlh in the wounded thigh ; and that no other fymp¬
toms came on till after two hours, were remarkable
circumltances.

c Experiment 17. Augujt , 1788. An attempt was
made to make a cobra de capello bite a nooni para-
goodoo in the tail, but that being found too fmall a

# See Transitions of a Society for the Improvement of Medical
and Chirurgical Knowledge. Lond. 1793, p. 310, 321.

• ' , ' fubjefif.

Ruffeli’s Account of Indian Serpents. 483

fubjecl, the belly was bitten, a little above the anus.
The fnake foon loft its former aftivity, and when put
under a glafs died, coiled itfelf up. In this fituation
I left him ; and on my return after one hour, found
him dead : that is, in about an hour and a quarter
after the bite.

4 The part bitten was a little difcoloured, and fome
of the dry poifon had formed a kind of coat over it.

4 Upon opening the belly, the parts immediately
beneath the bite, appeared much inflamed, but I
could not difcover whether the fangs had penetrated
into the cavity.

4 The lungs feerned much fluffed with blood.

4 Experiment 18. A cobra de capello received
from Ganjam, under the name fatanag , was made
to bite another remarkably large cobra, brought from
the fame place, under the name coultiah. The poifon
was Iked on the place, but no marks of the fangs
could be perceived, and the coultiah remained well
as before. This experiment was repeated with the
like refult, though a little blood, as well as poifon,
was found on the part bitten.

4 Experiment 19. Some days after the laft expe¬
riment, a coodum nagoo was made to bite the coultiah
in the belly. Both fangs vifibly afled 3 blood appear¬
ed on the wound, but no other confequence followed.
A tar tiitta bitten immediately alter, in the fame part,
died within two hours/

In feci ion third experiments are related on the
poifon of the fpecies called Katuka Rekula Poda.

4 Experiment 14. March 26. A dog A. which had
been bitten three days before, and in confequence
of cauftics applied to the part, had a running ulcer
on the thigh, was bitten in the found thigh by a
katuka rekula of a dark brown colour, which had
been caught only a few hours before, and was calling
his Ik in. He had fired poifon on the flick employed

* M m 2 in

484

Ruffed's Account of Indian Serpents.

in catching him ; fo that none, for the purpofe of
infertion, could be procured by preffure on the dudts.

4 The bite was followed by no fymptoms of poifon >
but as the dog had formerly been infected and re¬
covered, he was, after an interval of two hours, bitten
a fecond time, by another katuka rekula, in order to
fee how far his former recovery might render him un~
fufceptible. The ufual fymptoms appeared imme¬
diately after the bite ; but the dog, after doling for
feveral hours, recovered.

4 Experiment 16. March 29. A fecond dog, B.
(which had before been infedted and recovered, and
kill had ulcers in confequence of cauftic,) was bitten
this day, by the dark coloured katuka ; and again a
fecond time, after an interval of two days > but both
times without effect.

' 4 Experiment 18, April 4. The dogs A. and R. (ex¬
periments 14 and 16) were again bitten on the thigh,
as alfo on the nofe, but neither of the dogs were
infecled.

4 Ohfervations . The total failure in both the above
inffances was imputed to fome defect in the quality of
the-venomg for though the quantity emitted might
not have been fufficient to kill, it might, at leaf!, have
been expected to produce fome vifible effedt. A trial,
therefore, was made on a fubject that feldom efcapes,
however much the fnake may happen to be exhaufted
by repeated exertions.

* c A chicken'' bitten on the thigh, immediatelyafter
tire dug's, the wed, in lefs than three minutes, manifeft
tokens' of being infedted, though the fymptoms were
flight, and difappeared in the evening.

Experiment 20. April 7. The dog A. bei

Sgain birten in the thigh, fhewed fymptoms imme¬
diately of the poifon having taken effect. In twenty-
five minutes he was To debilitated that he could not
rife ; he often moaned, and feemed to fuffer greatly.
At times, he lay comatous, and before the end of the
jirft hour, became fo ill as to be thought dying. To-

wards

485

Ruflelfs Account of Indian Serpents.

wards the end of the fecond hour, he appeared fome-
what better. In the third hour he ceafed moaning,
but refufed food, and could not be made to rife. In
this ftate he continued till night. The following day,
he was pretty well recovered, and began to eat.

* Objervdtious. The recovery in this cafe, con¬
sidering the formidable fymptoms which appeared fo
early, and the reduced ftate of the i abject, was con¬
trary to" expedition.

" Experiment 21. The fnake being left to reft
half an hour, was made to bite the dog B. (experi¬
ments 16 and 18.) The leg was immediately drawn
up, but in other refpeCts the dog feemed no wife af¬
fected. After lying along for half an hour, he rofe
cf himfelf, but was dull and ftupified, and foon lay
down again. After two hours, he was difpofed to
eat ; and at night, appeared very well.

s This was the laft experiment made on this poor
animal, which had been bitten fix times; had the
caultic applied twice ; and had once had the poifon
inferted artificially. The ulcers from the cauffic were
at this time healing fall, and the dog recovered per¬
fectly.

£ Experiment 22. April 12. The dog A. on
which fo many experiments had alfo been made,
being now much reduced in ftrength, while an
ulcer of enormous fi?e in the thigh (partly the con-
fequence of cauffic, and partly of poifon) fhewed
lefs difpoiition to heal than to fpread, it was deter¬
mined to difpatch him. With this view, one of two
katuka rekula podas, which had been for fome time
captive, but had not bit for feveral preceding days,
was made to bite the breaft of the dog; both fangs
acted, yet no fymptoms of diforder followed.

‘ After waiting above an hour, another fnake was
applied, to the thigh ; which owing to a fudden ftart
of the dog, left a fang flicking in the wound : to
make fiill more fure of liberating the dog, the fnake

M m 3 was

486 Rtiffell’s Account of Indian Serpents.

was provoked to bite him once more with the re¬
maining fang.

The dog inftantly funk, grew gradually worfe,
and expired within two hours after the firft bite of
the fecond brake.’

Seft. 4. contains experiments on the poifon of the
Bodroo Pam.

6 Experiment 4. October 20. Six days after the
above experiments, the fnake having been permitted
to reft, a dog was bitten on the infide of the thigh.
During the firft ten minutes, no figns whatever ap¬
peared of poifon; but at the end of fixteen minutes,
the dog, who fat half couched, was feized with a
trembling of the head and the fore legs. Being
railed up, he walked a few paces without any ap¬
parent lamenefs. At the end of twenty minutes,
the tremors increafed, and the thigh was contracted.
At the ena of fifty-five minutes, the tremors became
more univerfal, and the dog frequently ftretched the
neck, his mouth pointing upwards, as if gafping for
breath ; but he all along neither moaned, nor howl¬
ed. During the fecond hour, he lay along on one
fide, either in a torpid ftate, or, at intervals, writhing
his limbs: and fometimes differed a fubfultus ten -
dinnm. After the third hour, he grew better, and
foon recovered.

‘ Experiment 8. October 22, 1788. Two days
after the three foregoing experiments, the fame dog
wnich had eicaped before, (fee experiment 4.) was
bitten in both thighs. The legs were almoft imme¬
diately affected, and within five minutes, the legs and
breaft were, as before, feized with tremors. The dog
couched, but foon rofe again ; the trembling conti¬
nued, attended with a {lighter degree of ftupor than
the day before ; and in the courfe of the firft hour,
the mufcles of the wounded thigh were at times tre-
* ^ ^ tremors decreafed vifibly in the fecond

hour, the clog rofe of himfelf, and flood firmly on

his

RuffelFs Account of Indian Serpents . 487

his legs ; after another hour, he had pretty well re¬
covered,

c Obfervations . As the fangs adled on each thigh,
and the dog was more (lightly infedfed than in the
former experiment, it was probable, though the fnake
appeared very alert, that the power of the poifon muff
have been diminifhed. In order to try this,

c Experiment 9. A chicken was bitten in the
thigh, and immediately (hewed (igns of poifon ; but,
after continuing two hours in a (fate of (lupefaclion,
it recovered.

c Experiment 10. After an interval of half an
hour, a pigeon was bitten in the thigh. At firfl it
efcaped to a rafter in the room, whither being pur-
fued, it got out, and relied on the top of a rock, at a
little diftance. It foon tumbled down from this lad
refuge, and was brought back. In about fifteen mi¬
nutes from the bite, the bird feemed (lupified,
couched on the belly, and without convuliions, ex¬
pired in that pofture, three minutes after.

e Experiment 11. When the pigeon in the above
experiment fled, a fecond was immediately bitten ;
and though the fnake had bitten three times before,
in the fame forenoon, the fymptoms of poifon were
inflantly vifible.

c After fourteen minutes, convuliions fupervened,
which alternated with ftupor ^ and in forty-five minutes
the bird expired ; the convuliions having ceaied (hr

ten minutes before death.

£ The appearances about the wound, were found,
upon diffedlion, the fame as ufual.

< Obfervations. From the foregoing experiments,
the poifon of the bodroo pam appears to be lefs dele¬
terious, and (lower in its operation, than thofe of the
cobra de capello and the katuka rekula poda : the
fymptoms attending it appear alfo to be in feme
refpefts different.

e The firfl: chicken was convulled in an extraor¬
dinary manner, but lived eight minutes; the others

M m 4 were

488 Simmons on the Ccefarean Operation , Kc.

were {lightly convulfed, and lingered longer; fome
efcaped altogether; but all fuffered fomeC degree of
fhipor. The dog and the pig efcaped death, though
both fuffered confiderably : efpecially the dog in Exp. 4.
In Exp. 8, the ftrength of the poifon may be fuppofed
to have been impaired by .captivity and falling; but
its fatal efrefts on the pigeons, Exp. 10, and 1 1, '(hew¬
ed that it was not dellroyedd

The next fedlion relates to the artificial infertion of
the poifon of ferpents into the bodies of living animals.
Of this and the remaining parts we (hall give an ac¬
count in our next.

Art. L. Reflections on the propriety of performing
the C afar e an Operation • to which are added Qbfer-
vations on Cancer ; and Experiments on the fuppofed
Origin of the Cow-pox. By W. Simmons,
mor Surgeon to the Manchefter Infirmary . 8vo,
97 pages, price 3s. London, 1798. Vernor
and Hood.

• t ' v . r C v . ■ ' ■. r

HpHE Caffarean feclion has been a fubjecl of dif-
JL culfion among medical men for the two Jaft cen¬
turies. . The alledged -refult of their experience has
been ftnkingly different ; tor while it is faid to have
been praclifed with fuccefs in other nations on the
continent of Europe, it has proved fatal in England
in every inftance. From the hifiorical inquiry into
the operation, which Mr. Simmons has here inftituted,
there is great reafon to fufpect mifreprefentation in
many of the accounts which have been given of its
fuccefs. A cafe was related a fhort time ago in a
newfpaper, where this operation was faid to have
been fuccefsfully employed. On inquiry, however,
into the circumftances, the author found it to be ef-
fentially different. What was the real date of the

cafe

Simmons on the Cctfarean Operation , Sic. 489'

cafe, he does not fay. To prevent the revival of this
operation, is the principal motive which led to the
prefent publication. Very few, we imagine, will
hefitate to join with the author in this concluiion.

Inflead, therefore, of performing an operation
which is lo uniformly fatal to the mother, the author
propofes, that when a cafe ill all arife in which the
child cannot be delivered by the crotchet, from the
brim of the pelvis being no more than one inch in di¬
ameter, the two operations of the fedtion of the fym -
phi/is pubis , and that of the crotchet fhall be combin¬
ed : that is, to divide the fymphilis to make way for
the crotchet. Objections, doubtlefs, may be made to
this ; but they are out-weighed by the neceffity of the
cafe. Whilit the Gaefarean operation is certainly fatal
to the mother in this country — whilit it is agreed, that
the life of the child fhall not be put in competition
with that of the parent — whilit it is afeertained, that
the feet ion of the fymphyjis pubis is neither fo for¬
midable nor fo fatal as the Ccefarean operation, — and y
whilit the crotchet has been applied fuccefsfully in di-
nienfions which wTould probably be thus acquired — the
compound operation here recommended will furnifh a
refource, approved by reafon, though not fandt'ioned
by experience.

The next fubjedt of the author’s remark is cancer.
The diltindtion, he obferves, between a well-marked
cafe of cancer and other tumours, requires no great
(kill or penetration ; but, to diltinguilh it from an in¬
nocent glandular enlargement, in the earlier Itage, de¬
mands greater precifion fometimes than has been yet
attained. This uncertainty in the diagnofis- has been
a lource of calumny to the profeffion, and an en¬
couragement to artful and defigning men, to increafe
the fears, and impofe on the credulity of the public.
Whatfoever the intereftea fhall alfert, it is evident, in
the author’s opinion, that a remedy has not yet been
difeovered, poffeffed of the power of curing cancer:

490 Simmons on the C afar e an Operation, Sic.

or it is reafonable to fuppofe, that it would be as Gene¬
rally fuccefsful as mercury is in curing the venereal

difeafe. &

The two following cafes are related, to fhew that
tumours not cancerous, are fometimes consigned to all
the feverity of treatment fuppofed to be adapted to
cancer.

Cafe 2. c A florid healthy looking woman, of
middle-age, applied to me about three years fmce, for
a painful enlargement of her left breaft, of feveral
months Handing. The account fhe gave was— that
the difeafe came on without any evident caufe; that
the whole breaft was affected from the beginning; ;
that flie experienced lefs pain in the earlieft ftage; but
that for fome time paft, and particularly the week be-
foie, it had been fo fevere, as to induce her to apply
for help. She was told by the perfon to whom the ap¬
plied, that it was a ftomach cancer, for which he
could promife her no relief ; but that fhe muft attend,
and undergo the ufual dreffings. Knowing, from re¬
port, the fevere pain that would be occaftoned by
them ; and, receiving fo little promife of ultimate
benefit ^ (lie determined to try regular profeflional ad¬
vice, and accordingly came to the infirmary.

After a careful examination of the tumour;
and, having maturely weighed all the circumftances
or her cafe; I had nohefitation of pronouncing it not
to be cancerous. Leeches were direfted to be applied
twice a week ; a iol u f ion of neutral falls was ordered
to be taken every morning, fo as to procure three or
- lour evacuations in the courfe of the day ; and, fhe
was inftrucled to ufe the infufipn of hemlock with
litharge of vinegar, as an embrocation to the part. In
lefs than two months, the tumour was entirely difperf-
cd; and fhe returned thanks for her cure.

idle truth of my affertion was confirmed, a year
ago, from more refpeftable authority.

(.cue 3. c A lady, refident in Yorkfhire, perceiv¬
es a tumour in her left breaft, which was occaiion-

Simmons, on the Cafarean Operation , Sic. 491

ally painful, came over to Manchefter to afk my ad¬
vice. On her way hither, fhe was informed by fome
celebrated cancer-dofitors, whofe opinion fhe had de¬
termined to take, that it was a cancer; and, as the
dreflings neceffary to remove it would be painful, (lie
muft re fide near them, for the benefit of their direc¬
tion.

c T he difeafe appearing to me not to differ eifen-
tially from the former, I recommended a plan of treat¬
ment to be purfued, not materially varying from what
had been fuccefsfulin that cafe; and, in a few weeks,
I had the fatisfafifion to find that the tumour had en¬
tirely disappeared.’

The following is furniflied by Dr. Ferriar; and
Serves to fliew that if a man is fortunate enough to
make the world believe fuch cafes as this to be
cancer, he may cure a thoufarid in a week, with
little trouble to himfelf, and with a Single ap¬
plication of his remedy.

Cafe 4. s£ A gentleman called on me fome months
ago, in great agitation, to requeft my opinion re fpe fil¬
ing a hemorrhage, which had taken place from a
Small tumour near the point of his note. He inform¬
ed me, that a few days after the discharge of blood
happened, he had fhewed the tumour to fome em¬
pirical prafiiitioners in this neighbourhood, who aft
iured him that it was a bleeding cancer ; that he was
in imminent danger from its continuance ; and that
he muft put himfelf, without delay, under their care,
and fubmit to a Severe courfe of cauftics. This he
determined not to comply with, till he knew from
me whether the tumour was of a cancerous nature.
I found on examination, that it was merely a pimple,
of a larger Size than ufual, which, in Suppurating, had
probably opened a Small branch of an artery, and pro¬
cured a considerable difcharge of blood that was very
Salutary to him, as a hemorrhoidal evacuation, to which
he had been formerly Subject, was then fuppreffed. i
advifed him to Stay quietly at home, with an affurance

that

492 Simmons on the Cafarean Operation , Sc.

that this dreadful cancer would difappear in the courfe
of a very few days ; and indeed, in lefs than a week,
no vedige of it could be traced.”

Refpecting arfenic, which has been fo long and fo
generally recommended in cancerous complaints, Mr.
Simmons obferves, that when externally applied to an
open cancer, it leaves the parts underneath the efchar
lefs difpofed to heal, than any other cauilic he has
tried. The following cafe, and which we have much
pleafure in communicating to our readers, gives hopes*
that much advantage may be derived from its internal
life.

‘ Grace Graham, aged 45 years, a widow, and
mother of two children, had been fubjed to frequent
attacks of acute rheumatifm, from which (he reco¬
vered in the ufual way. About Chriflmas 1795, fhe
perceived a fmall indolent tumour in her left bread ;
which continued incfeafing in fize for twelve months,
without giving her any pain. Soon after this time, it
grew painful; and increafed in fize more rapidly than
before. The rheumatifm becoming troublefome again,
in the fpring 1797, fhe became an in-patient of the
Infirmary, under the Care of one of the phyficians.
She was relieved of her rheumatic complaints, but
the cancer went on increafmg. In July 1797, fhe
was admitted under my care as an out-patient; at
which time, the glandular part of the bread was near¬
ly confumed by the cancer ; and the lymphatics in
the courfe of, and the glands in the axilla, were en¬
larged and very much indurated ; the fkin originally
covering the bread was in many parts dedroyed, ex*
poling a foul ulcerated furface, with here and there
an interfedion of remaining fkin ; and the whole re.
mainingmafs was become firmly adherent to the pec¬
toral mufcle and ribs. The lymphatic glands in the
neck were alfo very much indurated: and hard knots
were fcattered round the bread, towards the fternum
and the clavicle on the fame fide. The pain was ai¬
med mediant, of a burning lancinating kind ; and a

filthy*

Simmons on the Carfare an Operation , Sic. 498

filthy, offenfive, famous fluid, was copioufly difcharg-
ed. She enjoyed little fleep, fuffered a lofs of ap¬
petite, and had the leaden hue ftrongly marked in
her countenance.

‘ Several courfes of different remedies were tried,
with no more than temporary relief from pain : and
the difeafe continued its ravages, affecting the whole
of the lymphatics of the left arm with pain and en«-
largement.

6 She was admitted an in-patient under thefe clr-
cumflances; and, without any hope or profped of
doing her fervice, I put her on a courfe of arfenic,
on the 5th of June, 1798, by directing her to take
twelve drops of the mineral folution of Doctor Fow¬
ler, three times a day. Large and repeated doles of
opium had been found neceffary, to procure fome eale
from her fufferings ; which were Hill continued. The
folution, at firft, excited coniiderable general diforder,
and great uneahnefs m her ftomach and bowels,
without flie wing the leaft effe£t on the cancerous
complaint. In five or fix weeks, however, the pain
abated ; the difeharge was lefs fetid, and of a better
confiltency ; and feveral infulated points of cicatri¬
zation appeared in different parts of the ulcerated
furface. She was now fo eafy, that opium feemed to
be no longer neceffary, and it was difeontinued.

£ 1 was encouraged to go on, by this favourable
change ; and, as the points of fkinning increafed in
number, although the parts had not yet fuffered ul¬
ceration .continued- to be flowly destroyed, 1 was dif-
pofed to think that, if the conftitution could bear an
increafed dofe of the folution, a cure might poifihly
be effected ; and, under this idea, I ventured to give
her fifteen drops, three times a day. The confe-
quences foon convinced me that I was mistaken ;
for not, only an alarming general indifpofition follow¬
ed; but, the ulcer became painful, foul, and fetid;
and the ulceration of the cicatrized parts was ra¬
pidly renewed. Thefe threatening fy mptoms fub-

fidecj*

494 Simmons on the C afar e an Operation , 8(c.

dded, however, on leaving it off for a few days, and
die then returned to the former dofe.

£ This quantity die has taken daily to the prefent
time, with the exception of an interval of five or fix
days, during a flight pneumonic affect ion ; and again,
during an attack of cholera morbus, which laded for
feveral days ; neither of which complaints feemed to
have the fmalled connexion, either with the cancerous
affeQion, or the taking of the arfenical folution.
For feveral months pail the has been pretty eafy , to
ufe her own words, the difcharge has not been at all
offenfive ; the cicatrization has gone on in a manner
beyond all expectation ; and the difeafed glands in
the neck have di min idled in fize, and become free
from pain. Many of the filial! fcattered knots have
been cad out, leaving a fmall ulcer at the bottom,
exquidtely tender to the touch, but foon healing ; and
the chief fource of what pain die has differed for
forne time. The only external application die has
ufed is hemlock; firft in the form of poultice, and then
by lint moidened in an infufion of the herb. The
life of hemlock can throw no ambiguity on the cafe ;
as die had gone through a complete courfe of it, both
internally and externally, before die took the fo-
lution ; with merely a temporary abatement of the
fymptoms.

c Great and furprizing as the relief afforded by the
arfenic has been, i am not fo fanguine as to expeft
the cure of a genuine confirmed cancer ; but, the
woman’s life has undoubtedly been prolonged by it ;
die has been kept afmoft free from pain ; and in a
condition not wholly unfit for enjoying the comforts
of life; which, contrafted with the ufual fcene at¬
tending the termination of cancer, will render it a
valuable acquidtion in medical praCfice. Her fpirits
latterly have been diffidently good f and die has
nearly loft the leaden hue in her countenance. A ge¬
nerous diet has been allowed, with four ounces of

wine

495

Sue fur la Vitalile.

wine daily. The drops have been taken in a tea-cup
full of water, or in a little tea.

On the fubjefl of the Cow-Pox, our readers will
recoiled!, that Dr. Jenner, in his Treatife on that
affeftion, referred the origin of the difeafe in the
cow, to the application of matter afforded by the
heels of the horfe, when affefled by the greafe. Dr.
Jenner had not himfelf, however, any experience of
the faff. From feveral direct experiments, made by
Mr. Simmons, with every requilite caution, it is
clearly afcertained, that the cow-pox poifon does not
originate in the horfe s’ heel. He has experimentally
proved, likewife, that cows are not affeffed by the
application of the matter of fmall-pox.

The cow-pox is a difeafe wholly unknown to farm¬
ers, both in Che hi ire and in Lancafhire ; where the
experiments, here recorded, were made : fo that dif-
appointment could not arife from the animals having
undergone that difeafe ; and, in Chefhire, a large-
dairy county, the author obferves, the men are em¬
ployed indifcriminately in cleaning the horfes, and in
milking the cows* *.

Art. LI. Reckerch es Phyfto logiq lies, el Experiences
fur la Vitalile , Vc. By J. J. Sue, M.l).

(Continued from page 397.^

NOT long fmce, the author obferves, it was con-
fidered as an univerfal law, that the fyftem of
organization adopted by nature in the vital parts of
a great number of individuals, was that of all ani¬
mated beings 3 but further observation has taught 11s,

* In our next, we fhall notire the collection of FaCts, by Dr.
Pear ton, refpecting the cow-pox.

4 that

496 Sue fur la V Halite.

that this concluflon was too haftily drawn, and is
contradided by oppofing fads ; which, although cal¬
culated to excite our wonder, are no lefs incontef-
tible. In fad, we fee beings, endowed with motion
and voluntary power, polypi for in fiance, not only
preferving their vitality, after being cut and divided
into numerous parts, but poffe fling a faculty a thou-
fand times more aftonifhing j that ot reprodudion ;
each part becoming a perfed animal, by the growth
of thofe parts which had been removed. And it mull
be obferved here, that it is not the mere reprodudion
of one part of the body, by the energy of a more impor¬
tant remaining portion, as we fee take place in lobfters
and lizards, that have loft their claws and extremities : it
is the parts Which we are accuftomed to confider as
effential to the life of the animal, which are found
to be thus, reproduced ; and this regenerative faculty
ex ills not only in the part which is confidered as the
head of thefe animals, but in every part without dif-
tindion.

We fee, from thefe obfervations, how bounded
our knowledge is, refpeding the nature of the organs
neceffary to life : tor we find individuals endowed
with voluntary motion, and, consequently, with life,
which, though cut and divided, ftill move, and even
reproduce ihemfelves ; yet without being in poffe f-
fion of heart, brain, and other vifcera, which we are
accuftomed to confider as indifpenfible in animal or¬
ganization.

if, from the contemplation ot the various means,
which nature employs in the formation of the organs
effential to animal life, we recur to the examination of
thofe wvhich Are employs in the re-produdion, or in
the propagation of individuals, we fhall find them
not lefs varied or extraordinary. It was efteemed
certain, that generation was performed in a uniform
manner, by the female furni thing either eggs or a
living off fpring ; but recent obfervation has fliewn,

. - . that

Su e./wr la Vitality 49t

that this mode of re-produffion does not hold good
in the female of the infedt called the vine-fretter (pu-
ceron) : (lie, by a fmgle copulation with the male,
produces eight or nine individuals, not proceeding,
as in other animals, immediately from herfelf, but the
fecond from the firft ; the third from the fecond ; and
fo on fucceffively to the laft. This infedt, like wife,
fometimes produces eggs — fometim.es young ones^
according to the feafon $ though it has hitherto been
fuppofed an invariable law of animals, to produce
either eggs, or young ones, folely.

It will be feen, alfo, that the laws which refpecf
the ceffation of life, or the caufes of death, andl.
which have been fuppofed fo conftaht hitherto, are
liable to great exceptions. When an individual
ceafes to move for a certain length of time, it has
been fuppofed, that this ceffation of aclion was fuf-
ficient to deprive the organs effentia! to life, of all
their fundtions ; in a word, to deffroy their life. But
here, too, the conclusion is too general, and drawn,
from what we fee take place in animals of a parti¬
cular clafs ; for many animalcules*, after being de¬
prived of motion, for feveral years, and which appear
entirely dry and fhrunk ; in fhort, which prefent aff
the phenomena of death ; are yet reftored to life, ana
refufcitated, by means of a fmgle drop of water:
The length of time that they can thus, lie dormant,
has not been ascertained. But Roffredi has proved,
that fome of them may be reftored to activity after
feven and twenty years of this apparent death.

Another ftriking phenomenon in the hiftory of cer¬
tain animals, is the faculty they poffefs of remaining
z longer or fhorter fpace of time without food. The
tortoife and the crocodile can continue two months
without taking nourhliment. A toad has lived eigh¬
teen months clofely fhut up in a box, without food or
airf, not to mention the numerous facts, many of
which feem to be well attefted, of other toads, en~
clofed for ages in the centre of trees and rocks.

* Le rotifere, 3e tardigrade, l’anguille des gouttieres,
f Effais philofoph, fur les crocodiles : anon,

vql . v. N n It

498 Coindet’s Obfervations on Animal Fat , &V*

It is, therefore, evident, M- Sue obferves, from
what has been faid, that we have drawn too general
conclufions, relative to the mod important points re^
fpe&ing vitality. Our obfervations mull be extended,
and our experiments multiplied, before we can ven¬
ture to deduce general and confident laws. ,

In a fubfequent memoir, M. Sue relates a number
of experiments made by him, on this interefting fub-
je£t 5 which we fhall probably notice on fome future
occafiom

Art. LIL Obfervations on Animal Fat , and the
Caufes of Corpulency. By !) r . Co index*
Journal de Phyfique , 1798.

ANIMAL fat, examined by the microfcope^
feems to exhibit yellowidi vedcles, formed o i
a very thin and transparent pellicle, which contains an
oily fluid. No pores can be obferved in it, and no
perfon but Malpighi has been able to difcover what
are called its.adipofe duds ( diictiis adipqfi ). In cer¬
tain cafes, however, fat is abforbed , and, in gene-
iral, it feems to undergo conftant changes: the Ik ins
of the negrces, $ftef violent p$:ercife, exhale an oily
odour.

The quantity of fat varies much, according to the
different dafles. of animals ; and, if we compare the
quantity of fit with the bulk of the body, it will be
found that flfhes exhibit the larged proportion ; then
amphibious animals^ and then the frugivorous* The
carnivorous prefent the lead ; but thefe are only ge¬
neral obfervations, which are fubjed to many excep¬
tions.

All the ufes of fat are not yet known ; but we
know, that in fome cafes it becomes exhaufted, and
foppiies the place of aliment- Thus, animals which
remain in a date of torpor for feveral months, with*
out taking nourifliment, lofe their plump appear¬
ance ; from which it would feem, that this is a re¬
source provided for them by nature. May it not,
perhaps* ferve to preferve animaf heat ? The circum-
’ 1 ‘ " 1 ‘ ' ' ' ' ? * ‘ fiances,

Coindet's Obfervations on Animal Fat , <9f c. 499

fiances which contribute to its formation are (till
more obfcure, and have given rife to many ingenious
ideas, dignified with the name of hypothefes. One
of the moft probable is that of Dr. Beddoes, which
appears to me to clear up many faffs hitherto inex¬
plicable, though it is fubjefl to many exceptions, a§
every hypothdis rnufl be. The foundation on which
it refts is, that whenever there is a certain diminrn
tion of oxygen in the animal fyftem, fat will be pro¬
duced. The following obfervations feem to fupport
this affertion : The chemical analyfis of fat Ihews,
that fix parts of it contain near five of carbon, and
one of hydrogen, and fome febacic acid* The fat
parts of animals differ from the flefhy parts only in
this, that the latter contain more oxygen and azot,
By this is explained the change of mufcles into a fub-
fiance like fpermaceti, as profeffor Fourcroy remarked
in the burying ground of the Innocents at Paris. It
has been obferved alfo, that the fat augments, at the
expence, of the mufcles, in the living body, and vice
verfa .

The want of oxygen, confidered as a caufe of cor¬
pulency* is indicated by the analogy which- exifts be^
tween obefity and the fea fcurvy, which fee ms to be
owing only to a gradual abftraciion of a part of the
oxygen in the fyftem. The fea fcurvy is never am
nounced by meagrenefs ; on the contrary, a fulnefs of
the habit is the firft fymptom of that malady. Dr*
Trotter obferves, that when a negro grows rapidly
corpulent, he does not fail to be attacked by the
fcurvy; from which, to make ufe of a companion of
Dr. Beddoes, it appears that corpulency is to the
fcurvy what cachexy is to the dropfy. All the fymp-
toms of the fcurvy prove that it arifes from a priva*
tion of oxygen : thus the furface of the body is cover¬
ed with livid fpots, the arterial blood is very little
florid, and, after death, the left auricle is found
filled with venous blood, which Dr. Goodwin found
in animals that had been deprived of life by oxygen.
Dr. Lind fays, that when death has been fudden, and
that no effufion is found in the cavities of the body,
the auricles and the ventricles are filled with blood,
3 *' and

« - ‘ „ •- . . i

566 Coindet9s Obfervations on Animal Fat , tfc*

and efpecially the left fide of the heart • which is a
very remarkable circumftance, fince that fide rarely
contains much blood after death.

People in the country know very well, from expe¬
rience, that when they with to fatten poultry, they
muft keep them in darknefs, and mix with their food
fubftances proper for prolonging their fleep, fuch as
tares, or fpirituous liquors. An obfervation which
appears curious is, that the age when the fecretion
of fat is moft confiderable, is towards the fortieth
year ; a time when the arterial fyftem ceafes to aft
fuch a confpicuous part in the animal ceconomy,
either becanfe it is then oiiified, or in part obli¬
terated, while the venous fyftem, becoming more
and more developed, feems to acquire that influence
fo confiderable in old age. Do arteries, the aftion of
which is vifibly diminifhed, furnifh at that period lefs
oxygen to the fyftem; and may not that be the caufe
of the corpulency of middle-aged people ? .

It may be objefted that children, whofe venous fyft
tern is not yet developed, have however a remarkable
plumpnefs. But this difficulty has been refolved in
the following manner. The venous blood when it
arrives at the lungs, undergoes there chemical changes,
too well known to require to be here particularized,
it may happen, that according as refpiration is more
or lefs perfeft, the blood may lofe a greater or lefs
quantity of carbon and hydrogen. In proportion as
it lofes lefs, the fecretion of the fat will be more abun¬
dant : this, then, will afford an explanation of the
enormous quantity of fat found in amphibious animals*
fifties, &c. in which refpiration is not fo perfefl, be-*
caufe being furrounded by water, they are not in con¬
tact with fo confiderable a quantity of oxygen as ani¬
mals that breathe in the open air. They retain, then*
more hydrogen and carbon, which palling into the
arteries, ofecafion that confiderable^ fecretion of fat*
and probably produce that voluminous fize of liver*
found in fifties ; in which circulation is fuch, that
alrnoft the whole blood goes to the liver, either to
operate there a fecretion of fat, or of bile, the con-
ftituent parts of which do not differ much from thofe
of the former.

No. XXX

mssssmm

THE

MEDICAL and CHIRURGICAL

REVIEW.

M A Y, 1799.

Art. LIIL An Account of Indian Serpents , <5fc.
By Pa trick Russell, M. D.

( Continued from page 488.)

IN our laft we felefted a number of the author’s
experiments, with the view of ill e wing the effects
produced on animals by the bite of different fer-
pents. The fifth Seftion contains Experiments on
the artificial Infertion of the Poifon. The pheno¬
mena here varied in fome degree from thofe which
prefented themfelves in the former cafe. Though
lome flight fymptoms in dogs were produced by the
artificial infertion of the poifon, it frequently failed
altogether, and in no inflance proved either mortal
or formidable. With refpeft to birds, though it fre¬
quently failed there alfo, yet it often produced fome
of the ufual fymptoms of poifon, in a certain degree,
and often death.

Sect. 6. contains Experiments on Remedies applied
to the Poifon of venomous Serpents. In many cafes,
vol, v. Go Dr.

502 RuffelFs Account of Indian Serpents.

Dr. Ruffel obferves, where the poifon is applied to
brute animals, its progrefs is fo extremely rapid, as
hardly to leave time for the operation of a medicine,
or the application of any means whatever, with a pro¬
bability of fuccefs. Where its progrefs is flower,
fhould the remedy be adminiftered before unequi¬
vocal fymptoms have removed all doubt of the poifon
having taken effe£t, recovery may be afcribed to the
medicine given, when, in reality, no malady exifted ;
and if deferred till our doubts are removed, the re¬
medy which, if applied in time, might have proved
efficacious, may come to be unjuitly profcnbed as
ufelefs. To this it may be added, that a bite of the
moft pernicious fnake does not conifantly prove fatal;
and chat e^en the tenderer animals, fometimes with¬
out the ufe of remedies, recover, in inflances where
the fymptoms were very formidable.

Similar difficulties in eftimating the efficacy of me¬
dicines occur in feme degree in many difeafes ; but
belong in a more peculiar manner to animal poifons.
A multitude of repeated experiments, only can juftify
general inferences ; and in transferring fuch inferences
to the human fubjedf, analogical reafoning fhould be
exercifed with the moil fcrupulous caution.

From the experiments detailed in the foregoing
feftions, it Efficiently appears, that the feveral poi¬
fons mentioned, though in different degrees, are all
deleterious.

That the fymptoms produced by them in the bodies
of different animals are very much alike.

That the progrefs of thefe fymptoms, after they
commence, is nearly the fame in order of progreff
lion, though in different degrees of rapidity.

That a like variation is obferved in the commence¬
ment of the fymptoms. Sometimes it is almoft inftan-
taneous ; in general from three to ten minutes, but
very feldom later than half an hour.

That when the fnake is firfl caught, its bite infefts
with more certainty than when kept fome time ; but

the

RuflelPs Account of Indian Serpents . 50S

the deleterious quality of the poifon, though impair¬
ed, is not by captivity (even where accompanied by
long falling) deftroyed. When it appears to have
loll the power of killing larger quadrupeds* it dill re¬
tains that of killing birds, though lefs fpeedily than
at firft.

That when the fnake is made to bite feveral times
fucceifively in the fame day, the frit bite, other cir-
cumdances being equal, is not only more certain of
infefting, but in general proves more quickly dele¬
terious.

That the poifon of brakes does not invariably kill
animals ; and that they fometimes unexpectedly efcape
from a concourfe of dangerous fymptoms ; though in
general the danger of death is in proportion to the
violence and early appearance of thefe fymptoms.

That the period of death varies considerably. Dogs*
in no inftance, were killed in fo Short a time as birds ;
but the variation with refpeft to both, fo far as thefe
experiments go, does not feem ftriCtly correfpondent
to the lize of the animal.

That the artificial infertion of poifon is lefs fee ure
of taking effeCl, than the bite of the animal, but the
confequent fymptoms are exaClly the fame, and the
event, with refpect to the fmaller animals, not lefs
fatal.

A multitude of experiments, made in Europe, on
the poifon of the viper, having fufficiently confirmed
the inefficacy of the mod celebrated internal remedies
ufually recommended againfl venomous bites, Dr.
RufTell gave the preference for trial to an Indian
remedy, fanflioned by unquedionable authority, as
much ufed with perfect fafety, and often with fuc-
cefs. This was the Tanjore pill, one of the prin¬
cipal ingredients of which is white arfenic. The ex¬
periments here recited are few, and by no means
fatisfa&ory. It appears altogether doubtful, whether
this remedy produced any benefit.

C audio

504 Ruffelfs Account of Indian Serpents .

Caufiic was applied, as well as the aftual cautery*
in fome indances. Thefe often failed, though ap¬
plied from four to fifteen minutes after the bite :
when applied later, they almoft invariably failed. A
few experiments of amputation made by the author
on chickens and pigeons proved unfuccefsful. In
one cafe, the limb was amputated in one minute
after the bite. In a few trials, a ligature applied
immediately to dogs, after being bitten in the leg by
a cobra de capello, failed in preventing the progress
of the poifon.

The following method of preparing the Tanjore
pill was fifrnifhed to the author by Mr. Dufun, Sur¬
geon to the Garrifon of Vellore :

“ White arfenic ; roots of velli-navi*; roots of
neri-vifham* ; kernels ofnervalam*; pepper ; quick-
diver ; — of each an equal quantity.”

The quickdlver is to be rubbed with the juice of
the wild cotton, till the globules become invifible.
The arfenic being fird levigated, and the other in¬
gredients reduced to a powder, are then added, and
the whole is beaten up together, with the above
juice, to a fit confidence.”

One pill is directed to be given mixed in a little
warm water. After a quarter of an hour, fhould the
fymptoms increafe, two more are to be given, and
another an hour after. — This remedy is likewife faid
to be fuccefsful againft the bite of the mad dog. The
author fays he gave it to fourteen perfons bitten, but
does not mention the refult.

In the feventh Se&ion, the Effeffs of the Poifon of
Snakes on the human Body are defcribed. It has
been called in quedion, the author obferves, whether
in Europe, the bite of the viper ever proves fatal to

* The two firft of thefe are poifonous roots, and the third is a draftic
purge. They are all indigenous on the Malabar coaft, and ufed in
compofition, by the native practitioners, in a variety of difeafes, befides
thofe from animal poifons.

man.

Ruffell’s Account of Indian Serpents. 505

man. The Abbe Fontana, who was at pains in
making enquiry, in different countries, never met
with one well-attefted inftance of its occaiioning
death. He found from his own experiments, that
to fome, even of the domeffic brute animals, repeated,
bites of more than one viper did not prove fatal ; and
he conffders the variety of oppoffte and trifling re¬
medies, to which cures have often been afcribed, as
a proof that the difeafe produced by the poifon of the
viper, cannot be very dangerous. 44 Une maladie
t<r qui cede a tous les remedes, meme a ceux qui
<c font oppofes entr’eux, n’eft jamais une maladie
<c dangereufe.”

The cafe is widely different in refpecf to the poi-
fons of the cobra de capello, and fome other Indian
ierpents. That man is fubjedted to their deleterious
power, is a fadl confirmed every year by too many-
fatal accidents ; and the experiments produced in the
preceding fediions, put it beyond all doubt, that the
ffronger animals, who refift the poifon of the viper,
rapidly give up life to the fingle bite of a cobra de
capello.

Of the remedies to which cures of venomous bites
are often afcribed in India, fome are certainly not
lefs frivolous than thofe employed in Europe for the
bite of the viper ; yet to inter from thence, that the
effects of the poifon cannot be very dangerous, would
not be more rational, than to afcribe the recovery of
a perfon bitten by a cobra de capello, to the applica¬
tion of a fnake-ftone, or to the words muttered over
the patient by a Rramin.

It is eftablifhed by experiments on brute animals,
that, highly deleterious as the poifon of ferpents is
allowed to be, it does not to them prove conftantly,
or infallibly fatal. The cafe from analogy, may be
prefumed to be the fame in refpeft to man : but is
with more certainty known, from the frequent reco¬
very after threatening fymptoms have come on, not
only where infignificant remedies alone wrere em-

O o 3 ployed*

506 RuffelFs Account of Indian Serpents .

ployed, but where no remedy whatever had been
applied.

Nine inftances are adduced of the bite of venomous
ferpents in the human fubjeft, one only of which came
under the immediate obfervation of the author : this
we fhall tranfcribe.

Cafe 9. In the beginning of June 1788, a
Gentoo man, about forty years of age, was bitten
by a cobra de capello, in the fleihy part between the
thumb and the fore- finger.

* He was one whom I retained in my fervice for
the purpofe of procuring ferpents, and alfo, as he
was very adroit in handling them, for affifting in ray
experiments. He met with the accident after funfet.
In attempting, at the requeH of fome neighbours, to
catch a cobra de capello, juft before difcovered in
one of the houfes of the village. His ufual caution
feemed to have deferted him, as he pretended to have
miffed his aim in the duff.

c The account he gave was, c<r that he felt inftantly
?c a iliarp pain in the part bitten, which foon fpread
on the palm, and upwards on the arm. He was
fenfible alfo of ffcknefs at the ftomacb, but did not
vomit. In lefs than an hour, the hand and the
wrift were confiderably fwelled ; the pain extended
nearer the ftio aider ; he was fenfible of a confufion
in his head, and a ftrong difpofition to dozed—
From this time he himfelf was for feveral hours ig¬
norant of what had palled ; but from the report of
thofe about him, (fo far as could be collected,) cc he
“ at times (hewed much inquietude, without making
any fpecifi c complaint ; at other times he lay
moaning, and dozing. Towards midnight, his
diforder increafed, ftartings about his throat were
obferved, his breathing became laborious, lie could
45 motdpeak articulately, and feemed not to perceive
, objects, though his eyes were open.”
c They had applied a poultice of herbs to the arm,
sod adminiftered a fecret antidote internally ; belides

which,

507

Ruffell’s Account of Indian Serpents.

♦

which, a Bramin performed his functions : but find¬
ing he grew worfe and worfe, it was determined after
midnight^ by the relations, to acquaint me with what
had happened.

c Between one and two in the morning, I fent back
the meflengers with two dofes of the Tanjore medicine
prepared in draughts. On their return they found the
patient much better ; he had recovered his fenfes, and
finding the meffengers had omitted to inform me of
his having already fw all owed a medicine, he declined
taking; the draught, left the two remedies fhould
happen not: to agree together.

c In the morning, I found the hand and arm mon-
ftroufly fwelled, and 1 fufpected the parts round the
pundtures were livid ; but part of the poultice ad¬
hered fo clofely, and had tinged the fldn.fo deep a
yellow, that I could not abfolutely determine.

4 The man had perfectly recovered his fenfes, he
had no fever, complained only of confufion in his
head, of languor, and of pain in the arm.

< The bark was ordered, but a few dofes only were
taken. The parts about the pundtures mortified firfi: ;
the gangrene then fpread over the back and palm of
the hand, and part of the wrift, laying the tendons
bare, and forming an ulcer of confiderabie extent ;
which, however, healed favourably under the ufual
treatment. Tie recovered his healih in eight or ten
days ; but it was feveral months before he recovered
the ufe of his hand. *

The other cafes did not all terminate fo favourably \
four of the patients fell victims to the bite ,

The eighth Section contains mifcellaneous Expe¬
riments and Remarks. ^ # .

The cobras de capellos were found to bite, each
other without any confequence afcribable to their
poifon, even where the fangs vifibly acted : nor was
the cobra affedted by the bite of the katuka rekula

O o 4 • poda.

508 RufTeiFs Account of Indian Serpents .

poda. The bite of the former proved- fatal to the
nooni paragoodoo, and to the tar tutti.

Snakes live a long time without food, but the de¬
leterious power of, their poifon is impaired by ab-
ffinence.

The poifons of all the venomous ferpents which
Dr. Ruffell examined, wTere, in colour and confidence,
very much alike, at the moment of emiffion through
the fangs. The poifon is fo me what mucilaginous
when firft emitted, but becomes quickly more fo
when expofed to the air ; while its colour, from pale
yellowifli white changes to yellowifh ; and when dry,
it refembles a yellow flafky refin. This refm, when
long kept, grows much darker in colour, and is not
eafily foluble ; but when recent, or in the intermediate
degrees of hardening, it mixes readily enough with
water, or with fpirits.

Refpedting the other fenfible qualities of the poi¬
fons, the author obferves, that the only ones he
applied to his own tongue were thofe of the cobra
de capello and the katuka rekula poda. One drop
of the former diluted with vrater, and quite recent,
was applied to the tongue, and five minutes allowed
to elapfe before the mouth was rinfed. He was not
fenfible of the fmalleft degree of acrimony. After an
interval of half an hour, lefs than a drop of the poifon,
undiluted, was applied to the tongue with repeated
fridtion. The refult was the fame as before. It ap¬
peared infipid and inert as pure water. This expe¬
riment was repeated more than once, at different
times, invariably with the fame refult. The poifon
of the katuka rekula poda was likewife applied, in
the quantity of two drops, and perfeftly recent : but
without any confequence. The other poifons were
not tried.

The recent poifon of fnakes applied to the eyes of
chickens, caufed no vifible irritation, nor was it fol¬
lowed by inflammation.

The

Ruffell’s Account of Indian Serpents. 509

The recent poifons of the cobra de capello and the
katuka rekula poda, under the ufual trials, gave no
indication of poffeffing either an acid or alkaline
quality. The other poiions were not tried.

Two drops of the recent poifon of the katuka re¬
kula poda, diluted with four drops of fpring-water,
were put into a wine-glafs, No. 1.; and fix diops of
water into another glafs, No. 2. : into each glafs was
then permittted to fall a teafpoonful of blood from
the neck of a chicken juft decapitated. Both mix¬
tures being ftirred for five minutes, with fmall fmooth
flicks, were left to fettle.

The blood in No. 1. appeared of a colour confider-
ably darker than that in the other, and a clot was
found adhering to the point of the flick, of a darker
colour, and more grumous confidence, than ordinary.
To the flick belonging to No. 2., a much fmaller clot
adhered, of a brighter colour, and more loofe con-
texture.

After Handing three hours the difference was more
remarkable; the blood in No. 1. remained uncoagu¬
lated, and much blacker, with a little livid-coloured
ferum above; in No. 2. it nearly retained its pri¬
mitive colour ; the Craflamentum was formed, and a
little ferum of the ufual colour remained at top.

Upon repeating this experiment the glades were
more carefully warmed, and the mixtures ftirred only
one minute. Very little blood was found adhering
to the flicks. The fame alteration in colour was ob-
ferved as before; but the blood in No. 1. was lefs
fluid than in the former experiment, though ftill
much more lo than in glais No. 2.

The work is concluded by an accurate anatomical
Defcription of the poifoning Organs of different
Snakes, illuftrated by Engravings. For this part
the author is indebted to Mr. Everard Itome.

Art.

.{ 510 )

Art. LIV. Medical Records and Ref e torches , de¬
flected from the Papers of a Private Medical
AJjociation .

( Continued from page 47 8. )

THE third Article in the collection before us,
contains an Account of a ligamentous Union
of the Tibia., after the removal of a carious Portion of
that Bone, by Mr. Richard Smith , Surgeon of the
Briflol Infirmary. — A confiderable portion of the
whole fubftance of the bone was removed by the
faw. The wound granulated, and the Ikinning pro-
cefs advanced rapidly, and after a month had elapfed,
the patient was able to walk along the ward. In
another fortnight he died of the confluent fmalhpox.
The fpace between the divided ends of the bone was
found filled with a tough thin ligamentous band.

IV. A Cafe of a penetrating Wound by a Bayonet
pajfing through the Heart , in zvhick the Patient fur -
vived the Accident upwards of nine Hours : comma -
moated by W. Babington, M D. Afiiflant Phyfician
to Guy’s Hofpital. — This cafe occurred in the year
1778 at Haflar Hofpital, and the particulars Were
drawn up bv Dr. Lind, on the examination of the
body after death. This is an extraordinary cafe in
every refpe£l. Not withffan ding the great extent of
the injury, as will be feen below, very few of the
fymptoms occurred which ufually attend wounds of
parts fo eflential to life.

The colon was twice pierced, and neither the
ftools were tinged with blood, nor upon diffeClion
were any feces difeovered in the cavity of the belly;
although both wounds were low in the intefline, in a
part from whence there would have been an eafy
paflage of blood fo the anus, and where the feces
are fufficiently indurated to have been rendered con-

fpicuous.

Medical Records and Refear ches. 511

fpicuous, had they been difcharged into the cavity
of the belly.

The ftomaeh was twice wounded, and yet there
was not any vomiting, except one flight fit when
coming on (bore. The naufea indeed was conftant

The wound of the liver was above half an inch in
depth, yet fcarcely yielded any blood.

The wound of the diaphragm, though nearly as
large as that of the (kin, produced no diftinguifhing
fymptom. Neither blood nor air efcaped through it
into the cavity of the abdomen, probably from its
being covered by the loofened membranes of the
pericardium.

The heart received two large wounds, yet its muff
cular aCtion continued regular, and the circulation
was afterwards fupported for above nine hours. The
wounded ventricle, upon each contraction, threw part
of the blood into the pulmonary artery, and part
through the wounds into the cavity of the bread;
refemblinsr, in feme meafure, the circulation of a
foetus, where each contraction fends only part of the
blood to the lungs, the reft palling by an opening
immediately from the right to the left fide of the
heart ; with this difference, that in a foetus all the
blood is retained in circulation, whereas in this cafe
that part which palled through the wounds was
thrown out of its courfe, and every contraction di-
miniihed the circulating mafs. The wounds of the
heart did not produce any different effeCt from the
wound of a blood-veffel in any diftant part of the
body; the difcharge of blood from them was even not
fo quickly mortal as it generally proves from wounds
of equal fize in any large veffel.

The middle and upper lobes of the lungs on the
right fide were both wounded : the wound of the
middle lobe was above an inch and a half in depth,
and of the upper lobe about hall an inch ; yet no
blood was coughed up. The paffage of the air in
refpiration from the wounded lungs into the cavity of

> the

512 Medical Records and Researches.

the breaft was productive of much difhrefs. Each di¬
latation of the bread; drew fome air through the
wounds into the cavity, and, during -the fubfequent
contraction, the loofe texture of the lungs on col-
lapfing acted as a valve to prevent its return. The
air, thus accumulated, impeded the free motion of
the lungs on that fide of the breaft, and at length
wholly deftroyed it'. The difficulty of breathing was
alfo in part owing to the quantity of blood difcharged
into the cavity from the wounds of the heart, which,
when become coiffiderable, might alone have been
iufficient to produce it. To the air within the cavity
ot the breaft another diftreffing fymptom is alfo to be
afcribed : compreffed in expiration by the contraction
of the breaft, part of the air from the cavity was con¬
stantly, in breathing, forced with violence into the
wound between the ribs, where, infmuating itfelf
into the cellular membrane, it .produced an emphy-
fema. This firft appeared upon the bread, but after¬
ward extended over the whole body, the fkin of
which crackled under the finger like dry ftraw. Not
only air wras forced through the wound, but alfo a
condderable quantity of blood. On differing, this
was found depofited between the fibres of the pec¬
toral mufcle, and in the neighbouring cellular mem¬
brane, where it formed an ecchymofis, much larger
than the wTound of the mufcle itfelf could have pro¬
duced, in which neither artery nor vein, but only a
few fleihy fibres, had been wounded.

V. An Account of a Rupture of the Aorta near the
Heart : by Mr. Lynn, jun. Surgeon at Woodbridge.

- — The fubjeCl of this cafe was a woman. A fudden
fainting dt took place in one of her labour pains, pre¬
ceded by a momentary but acute pain in the heart.
She lived a fortnight after this, but the extremities
continued colder than natural, the puife was finall
and quick, and uneafy fenfations were experienced in

the

Medical Records and Refear dies. 5 1 3

the ched. She died fuddenly by a fecond attack of
fyncope.

VI. On the Ufe of the Tinctura Ferri Mnriati in
thofe SuppreJJions of Urine which arife from a fpaf
modic A ffection of the Urethra. — This communication
is important, as pointing out a remedy in a very dif-
treffing and fometimes fatal difeafe. We are indebt¬
ed for the difcovery of its ufe to Mr. Cline.

“ A grazier, about 35 years of age, had a tincture
in the urethra during feveral years, for which bougies
were occafionally ufed. He was attacked with a
retention of urine, which continued nearly forty-eight
hours, without his obtaining any relief, although trial
was made of ail the ufuai remedies. This attack
WTas foon followed by another of the fame kind, and
the warm bath, opiates, clyiters, &c. were as inef-
fedlual as before, the urine being never evacuated
until his ftrength appeared almod exhaufted by the
complaint. At other times, with the aid of bougies,
he voided his urine in a favourable dream, and one
of moderate fize could be palled without difficulty :
but during the fpafmodic date of the lfridure neither
a drop of urine palfed, nor could the dualled bougie
be introduced. The return of fpafm of the urethra .
became afterwards more frequent, and each time the
retention of urine laded fo long as to endanger the
life of the patient. From the frequency of this com¬
plaint, and its fuppofed danger, he removed to Lon¬
don, and, in a few days after his arrival, was feized
with a retention of urine as before. As the common
methods of treatment had no effect in this cafe, it was
at once determined to try an unufual remedy, and a
tobacco clyder was directed. This produced languor,
a cold fweat, faintnefs, and infenlibiiity ; from which
he recovered in about an hour, and foon after voided
his urine without difficulty. However, in a few days
he had a return of the retention, and the clyder was
again propofed ; but being extremely averfe to its ufe,

514 Medical Records and Refe arches,

on account of the very ^liftreffing fymptoms which it
had before produced, it was propofed to give him
ten drops of the tinflura ferri muriati every ten
minutes, until it produced fome fenfible effeft. When
he had taken fix dofes of it, i. e. in an hour, he had
an irritation to void his urine, and it immediately
flowed freely ; although in every preceding attack the
complaint had continued about forty-eight hours, ex¬
cept when the tobacco clyfter was given. He had
feveral relapfes of the complaint, and was each time
relieved by taking the above medicine in fimilar
dofes, and became fo confident that he poffeffed a
fpecific for his diforder, that he no longer felt any ap-
prehenlion about its confequences.

<£ This medicine has fince been given in feveral
fimilar cafes with equal fuccefs ; but in all, the com¬
plaints were purely fpafmodic. Retentions of urine
trom other caufes cannot be affefted bv it.”

VII. Three Injlances of Ohjlruction of the Thoracic
Duct , with fame Experiments , Jhezving the Effects of
tying that VeJJel: by Mr. Aftley Cooper.* — The tho¬
racic du£l is a veffel of fo much confequence in the
animal ceconomy, from its being the medium by
which the nutritious part of the food is conveyed
into the blood, and the channel through wThich the
greater number of the abforbents empty themfelves
into the veins, that it might be reafonably expefied
an obliteration of its canal would produce the mod
fatal confequences. From the fafits here adduced,
however, it will be found, that nature, with a kind
regard to our prefervation, has provided fecurity
againft this evil, fo that a confiderable degree of
difeafe may exift in the principal trunk of the ab¬
forbents without any permanent interruption to the
progrefs of abforption.

In the inftances of obftruclion now defer i bed,
anaftomofmg veffels were found palling between the
inferior and fuperior portions of the duel, and which

ferved

Medical Records and Refear ches . 515

ferved to perform the fun&ions of the original veffels.
Such collateral abforbents are found in many fubje&s,
in whom the thoracic du£l is undifeafed.

From feveral experiments made on dogs by tying
the thoracic duft, it appears, that when this is clone
fuddenly, abforption is no longer continued, and the
confequences are fatal to the animal. The quantity
of the chyle extravafated varied according to the hate
of the ftomach and intefhnes; il thefe were diftended
with food, the cellular membrane was found loaded
with chyle ; but very little appeared if the animal
was empty at the time of the experiment.

‘ The contractile powers of the abforbents are
proved by thefe experiments to be very ftrong, for
it appears that their addon is fufficient to occahon a
rupture of their coats. It is true that the receptaculum
chyli, which was the part broken, is thinner, and lefs
capable of refinance than the thoracic duct ; yet it is
able to bear the prefture of a column of quickfilver,
more than two feet in height; the force, therefore,
exerted by the abforbents, mult be acknowledged
greater than that of fuch a column of mercury ; more

efpecially when it is remembered that living parts
will refill a force which will readily tear them when
dead.

c It is not necefiary to tie the duel, to produce this
effect ; if an animal is fed with milk, and after half an
hour the extremity of the duft is expofed, and com-
preiTed for only a few7 minutes, upon fubfequent exa¬
mination the receptaculum will be found ruptured.

c The time at which death enfued differed in dif¬
ferent animals ; thofe which were fed juft previous to
the experiment died fooner than thofe whole ftomachs
were at that time empty. Young dogs lived longer
than the old, and the lean much longer than the fat;
for thefe laft can fupport but very flight injuries.
None furvived the tenth day, nor did any of them die
under forty-eight hours, unlefs there was fome un¬
toward circumftance in the experiment. I am in¬
clined.

516

Medical Records and Ref ear dies.

dined, however, to believe that dogs which are very
young will live a longer time.

‘ That it is the interruption to abforption, and not
limply the wound, which is the caufe of death, is
proved by the inftances in which I did not fucceed in
tying the dud ; the animals then recovered, though
the wound was equally large as in thofe in which the
experiment was fuccefsful.

4 Other terminations of the abforbents in veins
have been fuppofed to exift befide thofe at the
lower part of the neck on the right and left fide.
This opinion has not been founded upon accurate
experiment, but only conjectured by thofe wTho firft
oppofed the idea of this fyftem of veffels performing
the office of abforption. Formerly the red veins
were fuppofed to abforb ; it was next thought that
abforption was in part performed by thefe veffels, and
in part by the veins ; and when this idea was obliged
to be relinquiffied, it was afferted that the abforbents
terminated in the veins, in various parts of the body.

4 Into this miftaken opinion fome good anatomifts
have fallen, from having found quickfilver efcape
from the abforbents into the different branches of the
vena portarum whilft they were injeCting the ftomach
and mefentery of the turtle. This has feveral times
happened to myfelf ; but I believe that the abforbents
arife from the veins in certain parts of the body, and
that the openings by which the quickfilver enters, are
the beginnings, and not the terminations, of thefe
veffels.

4 As proofs of this, we may obferve that the circum-
ffance is only feen in thofe animals in whom the valves
of the abforbents will admit of a retrograde motion of
the quickfilver, and I have never obferved it, except
whilft injeCting contrary to the courie of abforption.

4 The abforbent alfo always becomes fmaller as it
approaches the vein with which it communicates.

6 The branches of thefe abforbents pafs into them
in a direction from the vein.

4 And

Medical Records and Refear dies. 5 1 7

. 4 as a •:-lr^iCr proof, I may mention that my
friend Mr. Coleman, Profelior at the Veterinary Col-
3ege, has feveral times found blood in the thoracic duct
of horfes which had died without any rupture of the
blood-veflels, which (hews a direff absorption of blood
under certain circumftances.

\V he n q u i c k fi 1 v e r i s th ro w n into ab fo rb e n t gla n d s ,
it fometimes happens that the veins are .filled from
them, but this, upon attentive examination, is found
to a rife from previous cxtravafation. The fame may
be obferved when the abforbents of the teftes are
filled from the fpermatic artery or vein.

e The experiments which are here related furnifh a
powerful argument againft the idea of any other ter¬
minations of thefe vefiels, excepting thofe at. the lower
pare of the neck ; for when the thoracic duct was tied,
the abforbents, inftead of having emptied themfelves
into veins, were many of them ruptured, and thofe
which remained whole continued fully diftended with
their fluid,

‘ How far do thefe experiments confirm, or con¬
tradict, the opinion which fome have entertained of
a retrograde motion of the abforbents ? Should we
not have found, if this idea were true, that the fluids,
inftead of having ruptured the duff, when interrupted,
in their proper channel, would have returned into the
cavities from whence they had been removed ; and
how did it happen that thole abforbents which were
not ruptured remained diftended ?

* c An opinion has of late years prevailed that hunger
depends lefs upon an empty ftate of the ftomach, than
upon a fen fat ion of general want in the fyftem. The
fymptoms of tabes myfenterica have furniflied the
arguments which fupport this opinion, fince the pa¬
tient, during the progrefs of that difeafe, eats more
frequently, and in larger quantities, than ufual, and
although the ftomach is always diftended, there is ftill
a ftrong inclination for food.

vol. v. Fp

♦

‘ The

5 1 S Medical Records and Refear ekes .

* The difeafed date of the mefenteric glands, by
preventing the paffage of the chyle into the blood, has
been fuppofed to occafion thefe fymptoms.

« It might be expeHed that the experiments here
related, as they alfo occafioned an interruption to ab~
forption, would furnifh additional arguments in fup-
port of this opinion ; but the great irritation, produced
by a large wound, and by the fudden dedrubtion of fo
important a function, prevented any certain conclu-
fions with regard to this circumftanced

VIII. Two Cafes of Rabies Canina , in which Opium
was given , without Succefs , in unufually large Quan¬
tities : the one by William Babington, M.D.; the
other by William Wavell, M, D. — Thefe indances af¬
ford a further addition to the large catalogue of cafes
of hydrophobia redding the mod powerful remedies.
The quantity of opium adminiftered was indeed enor¬
mous. In the firft cafe, the patient fwallowed, in the
courfe of fifteen hours, one hundred and eighty grains
of drained opium ! It is natural to afk, what quantity
of this fubdance could a fydem unaccudomed to its
ufe, bear, confidently with life ?

home general remarks on the difeafe are added by
Dr. Babington, but the detailed account we have
lately given of Dr. Hamilton’s elaborate work on the
fame fubjebi, renders it unneceffary now to be more
particular.

IX. A Cafe of the C ajar e an Operation performed ,
and the Life of the Woman prejerved , by James
Barlow, Surgeon , of Chorley, Lancalhire.— In our lad
number, we accompanied Mr. Simmons in his re¬
marks on this operation, who obferved, that in this
country, it had proved fatal in every indance where
it had been attempted. The prefent cafe, furnifhes
an exception to his datement. The woman had had
feveral children born alive^, before the pelvis became

diiiorted.

Medical Records and Refearches . 519

diftorted, by the wheel of a cart palling over her as
the lay on the ground.

Notwithstanding the weight of the objections which
have been urged againft ever performing the Csefarean
operation, there is no difficulty in conceiving the
exiftence of cafes, where the life of neither mother
nor child can be preferved by any other means, and
where of courfe, in /peculation, it would become
requifite. Its great fatality to the life of the mother,
not its difficulty, conftitutes the grand objection to its
employment. Every initance where it has been fafe-
ly performed, fhould, therefore, be publicly recorded ;
tor however terrifying by the danger which attends
it, it may now and then become fully juftifiable. The
piefent cafe was witnefled by Mr. Hawarden, a prac¬
titioner in the village of BJackrod, and the following
is the mode of proceeding which was adopted.

c The patient being taken out of bed, and placed
upon a table, lying on her back with her head raifed
by pillows, I began by making a longitudinal incifion,
five inches and a half in length, as high as the navel,
parallel to the linea alba, and about two inches to the
left of that line. The integuments and the left reCius
ftiufcle being cut through, a fmall opening was made
through the peritoneum at the upper part, and, by
means of a probe-pointed biftory, this membrane was
dilated to the fame extent as the external parts. The
uterus w^as now expofed to view, and an incifion, of
the fame length, was continued through it. The child
prefen ted with its breech, and was extracted through
the artificial opening, but unfortunately was dead, yet
did not fhew any material figns of putrefaction. The
placenta and membranes were then extracted with the
greateft eafe. The uterus was very thin, fcarcely ex¬
ceeding that of the peritoneum, and equally fo through
the whole extent of the incifion. No attempt was
made to examine the pelvis from the abdominal
wound. The hands of an affiftant were applied on
each fide of the abdomen to prevent the admiifion ot

P p 2 external

520 Medical Records and Refe arches ,

external air, and to prefs out any blood that might b<?
diffufed among the inteftines ; after which, the Tides
of the wound were brought together* and fecured by
feven futures, over which flips of adhef ve plafter were
applied, and the drefling completed by a few turns
of a flannel roller around the body.

c The peritoneum was not included in the futures,
and no part of the vifcera protruded during the opera-
lion ; neither were there any blood-veffels divided
which required to be fecured by ligature. It was
a fortunate circumftance that no haemorrhage follow¬
ed the extraClion of the placenta, as ‘was to be appre¬
hended from an atonic condition of the uterus, the
effeft of long diftenfion. The womb contracted pro¬
perly, the lochia were about the ufual quantity* and
continued as in other cafes. The poor woman fcarce-
Jy complained during the operation, fo great was her
fortitude. Soon after, fhe was put into bed, , flept
without taking any medicine for that purpofe, and
paffed a good night. On the 29th fhe complained of
afulnefs about the region of the ftomach, with an in¬
clination to vomit ; and, on laying my hand on the
abdomen, a degree of tenfion was diftinguifhable.
Her tongue had a whitifh appearance, and her pulfe
about 120. A laxative clyfter was adminiftered with
the defired effeCt, and the tenfion of the abdomen,
with the pain, yielded to the ftimulating effefts of a
buffering pi after. In fhort, all the fymptoms which
had before indicated irritation, now fufFered a very
obvious remiflion. Four days having elapfed fince
the operation, it was thought eligible to remove every
other future ; on the fxth the remaining ones were
taken away, and the wound appeared healed.

‘ Though flie had been a nude to her other chil¬
dren, fie experienced no uneafnefs in her breads on
the prefent occafion. Her. health continued in an
improving condition until December 4th, when it re¬
ceived fome interruption for a few days from a diar¬
rhoea, hut which was checked by an aftringent mix¬
ture.

52 1

Medical Records and Re] ear dies.

lure. On the 10th fhe ventured out of bed; on the
17th the began to attend to her domeflic employ¬
ment ; from which time to the prefent, September
23d, 1796 (an interval of nearly three years), fhe has
continued in health, menitruated with regularity, but
has never been pregnant/

We fhall go out of our way to notice the 12th
Article, as it relates to the fame fubjedt : the title of
it is, 6 An Inquiry concerning the true and fpurious
Ctefarean Operation, in which their Diftincfions are
inlifted on, principally with a View of forming a more
accurate Eltimate ot Succefs ; tovwhich are annexed
fome Obfervations on the Caufe of the great Danger:
by John Haighton. M. D/ — Many of the cafes where
fuccefs attended the operation in queftion, are fup-
pofed by Dr. Haighton to have been cafes of extra-
uterine conception, and which he denominates fpu¬
rious. With refpedt to the caufes on which its great
fatality depends, he firft notices the opinion which
refers the danger to the admiffion of the air into the
cavity ot the abdomen. The mifchievous effedts of
air in cavities has, of late, found an opponent in Mr.
John Bell. He not only doubts the entrance of air
into cavities accidentally opened, by reafon of the
conftant preffure exerted on the contained parts from
the mufcular parietes ; but even queftions very much,
whether the mere prefence of air, fuppofing it to be
admitted, can produce thofe unfavourable fymptoms
ufually afcribed to it.

To determine whether the admiffion of air into
cavities is really injurious. Dr. Haighton inftituted
the following experiment, which was repeated various
times. In many brutes the cavities ot the abdomen
and tunica vaginalis teftis communicate with each
other during life. He took the advantage of this
anatomical fadl, and from a final! pundture made at
the
vag

, P p 3 were

bottom of the fcrotum, penetrating the tunica
inalis, feveral cubic inches of atmofphcrical air

522

Medical Records and Refear dies.

were conveyed by a fyringe into the peritonaea! cavity
of a dog. From the effects which refulted, he does
not hefitate to conclude, that atmofpherical air pe¬
netrating into cavities is perfectly harmlefs, and has
no influence over the confequences of the Caefarean
operation.

c Surely,’ adds Dr. Haighton, c no greater caufes
need be looked for than the large incifion made into
the uterus, the (fometimes) hidden difcharge of blood
in confiderable quantity, a great part of which often
efcapes into the cavity of the abdomen, where it foon
lofes the properties it poffiefied while in its veflels, and
confequently produces the fymptoms of an exceflive
irritation. No one, I think, will prefume to fay that
wounds of the uterus are not to be ranked among the
mortal ones ; and the inftances where that organ, or
even the vagina, has been lacerated by an injudicious
degree of force, amply prove the fufliciency of the
caufe to the production of the effeCt, and which efFeCt
nfually takes place before the fymptoms of an inflam¬
ed cavity have come on. It is to be regretted that
this part of the danger is never likely to be averted
by any human contrivance : but that part of it which
depends on the extravafation of blood into the ab¬
domen may fometimes be moderated by a gentle
preflure of the abdominal parietes on the anterior
portion of the uterus.’

We return now to the 10th Article defcribing a
Ji.ngular Cafe in Lithotomy , by R. B. Chefton, M. I),.
* — The difficulty in this cafe arofe from the bladder
being clofely contracted around the ftone, fo that it
became impoffible to introduce the blades of the for¬
ceps between the two. Dr. Chefton kept the ex¬
ternal wound open for five weeks, in hopes that the
fuppuration would fo relax the coats of the bladder,
as to allow of the forceps being introduced. This,
however, did not anfwer his expectations. He there¬
fore endeavoured to bring it away piecemeal, and for

Medical Records and Refearches . $2%

tliis purpofe paffed his feiftars upon his finger, and in
a little time made a coniiderabie impreffion on the
{tone, which, though hard upon its lurface, proved
to be of a loofe texture within. Proceeding with
caution in this manner, he at laft fucceeded in com¬
pletely fplitting it, and with the forceps and the nail
of his finger, broke the ftone into fuch pieces, that he
removed the whole by the forceps, fcoop, and fyringe.

Some years afterwards, the fame patient was cut a
fecond time for the ftone, and the fame circumftances
occurring, the operation was finifhed in a fimilar wayy
and terminated luccefsfully.

Art. 11. contains Obfervations on the Cure of the
Hvdrocele by Injection: by J. R. Farre, Surgeon.—
Ten cafes are here adduced, which, however, afford
nothing particularly worthy of notice. They ferve to
evince the uncertainty of this operation in effe&ing a
radical cure of hydrocele. The event of two of the
cafes remained undecided. Of the others, three fuc¬
ceeded, and four failed, under the firft injection, but
of thefe, two, on being again injefted, were cured.

It yet remains to be determined, which of the
modes of operating for the radical cure of hydrocele,
is, on the whole, to be preferred. That by injeftion
is’ recommended by its mildnefs ; but it appears more
uncertain than either of the otners. In the ufe of the
injeSion, it is difficult, or impoffible to apportion the
ftimulus to the particular irrnabihcv of tne part or
conftitution. An injection whicn gives no pain in
one cafe, will occafton great uneafinefs in another j
and that whicffls fcarcely felt at the time of its in-
troduaion, will often afterwards excite violent in¬
flammation. Nor is the chance of cuie in proportion
to the degree of pain excited.

The laft Article contains a Cafe of imperforated
Hymen, attended with uncommon Circumftances :

related ’by John Sherwen, M. D. of Enfield. -r-The

p p 4 nature

524- Rollo’s Cafes of the Diabetes Mellitus , 8Cc.

nature of this cafe was npt difcovered till the woman
had reached her thirty-eighth year, and had been
married fourteen years. On making an incifion in
the membrane with a lancet, feveral pounds of
thickened menfes were evacuated, of the colour and
confidence of treacle. It does not appear whether
die 'afterwards menftruated. She died after two years
of another complaint, and without having been
pregnant.

Art. LV. Cafes of the Diabetes Mellitus ; with the
Refults of the Trials of certain Acids , and other
Subftances , in the Cure of the Lues Venerea. By
]ohn Rollo, M. D. Surgeon-General Royal Ar¬
tillery. Second Edition, with large Additions.
Odtavo, 628 pages, price 9s. London, 1798.
Dilly.

IN our laft volume *, we gave as full an account as
our limits permitted of the former edition of this
valuable work. Although we then felt a difficulty in
coinciding with the ingenious author in his ideas re-
fpedling the proximate caufe of diabetes, we endea¬
voured to do Uriel juftice to his opinions, and to
place them in fuch a point of view, that our readers
might be enabled to decide for themfelves. Of his
fa£ts we fully admitted the importance, and their
pradlical utility. In our account of the prefent edi¬
tion, we fhall purfue the fame line of condudl, con¬
fining ourfelves, however, as might be expected, to
the new matter it contains, which is both extenfive
and important.

Several conliderations have induced the author to
comprefs the prefent edition into one volume ; the
principal of which was, that the knowledge of the

* Vide Med. and Chir. Rev, No. xx, vol. 4, p. 178.

new

Rollo’s Cafes of the Diabetes Mellitus, 8V\ 525

new method o.f treating the diabetes melhtus, and the
lues venerea might be more univerfally cliftufed. With
the fame view, and on account of the many recent
communications refpefiting the diabetes, and the ad¬
ditional trials of the new remedies in the lues, the
author has confined himfelf to theie fubjects entireiy.
The obfervations which were introduced on feverai
difeafes apparently ariftng from ftomach altediion, and
including the application oi the new doftrines of die-
miftry, as well as the delcription of a morbid poftom
formed on fores, have been in the prefent work pur-
pofely omitted.

Of the cafes and communications which the author
has received fmce the firft: edition of the work, the
firft: is furni filed by Dr. Marceft containing the con¬
tinuation of a cafe, before deicrioed, under the caie
of Dr. Gregory of Edinburgh, and in which a relapfe
had taken place after an interval of fome months:
this patient, however, continued weak for fome time.
The influence of the animal diet on the quantity of
urine was as apparent the fecond time, as at fir ft, and
he was difcharged apparently cured.

Two cafes of the difeafe are next given by _Dr.
Gerard of Liverpool. The firft was not materially
relieved by the animal diet, though ^conjoined with
the ufe of the hepatized ammonia. The carbonated
ammonia was next tried in very large dofes, (part of
the time daily) and continued for feverai months,
but without effect. The patient did not aoneie pro¬
perly to the plan of diet. The fecond cafe was re¬
lieved by the animal diet, but the general health was
not perfectly reftored.

Dr. C leghorn of Glafgow adduces four cafes cured
according to Dr. Rollo’s plan. Thefe cafes, with
fome others, feern to fnew, that a' tendency to in¬
flammation fucceeds the cure oi diabetes by animal.

food.

Dr.

526 Rollo’s Cafes of the Diabetes Meliitns , 8fe.

Dr. Storer of Nottingham has feen feven acute
cafes of the difeafe, previous to the publication of the
new method of treating it •> and all of them terminated
fatally. He takes notice of a mild or chronic fpecies
pf the complaint, which is frequently found prevail¬
ing in the different members of the fame family.-^-
Several other cafes are given, by different practi¬
tioners, where the influence of the animal diet on
the f ate of the urine was very evident.

Three cafes of the difeafe are next related by Dr.
Pearfon. In the firft of thefe, the quantity of urine
did not exceed nine pints in the twenty-four hours,
and was not materially influenced by the quantity of
liquids taken in. The appetite was not greater than
in health. Befides the ordinary remedies, the fol¬
lowing were ufed, but without advantage. Thirty
grains of carbonate of foda were given thrice daily.
Twenty to thirty drops of the oil of turpentine three
times a day. Two grains of calomel were given
daily for two months, without affedfing the mouth or
bowels. Daftly, perpetual blitters were kept on the
loins. This cafe exifted prior to the difperfion of
Dr. Rollo’s obfervations. On diffeftion after death,
the kidneys and ureters were in a found (fate, but
the bladder was much thickened, and the urethra
dilated to three or four times its ufual fize. There
was no mark of difeafe in the thorax or abdomen,
excepting that the mefentery was much thickened,
although the glands of it were not at all difeafed.

The fecond cafe likewife proved fatal, but it took
place feveral years back. In the third cafe, the urine
was not perceptibly fweet, but fmelt like hale beer,
and took on the acetous fermentation after ftanding
feme days. In other properties, the urine of this
patient agreed with that of people in health, in de¬
poll ting cryflals of uric oxide*, in containing fuper-

* See an account, of the nature of this fubltance in page 304 in the
prelent volume of the Med. and Chir. Rev.

phofphate

RalloVl7q/& of the Diabetes Mellitus , 8('c, 527

phofphate of lime, phofphate of ammoniac, muriate
of foda, &c.

The patient was direffed to live four days entirely
on vegetable food. The urine during this time proved
fo irritating to the urethra and glans penis, as to in¬
flame them, and a little of it was even palled invo¬
luntarily. The urine excreted at this time contained
none of the uric oxide ; but, according to Dr. Pear-
fon’s obfervations, the urine voided, when the food
was entirely animal, was equally acefcent, and fer-
mentible into vinegar, as when it was entirely vege¬
table matter. The quantity of urine in this cafe did
not exceed five or fix pints in twenty-four hours, and
never was greater than the quantity drank. When
vegetable fubftances were occafionally taken as food,
the urine was increafed in quantity, but no effects
were otherwife experienced different from thofe dur¬
ing the ufe of animal food.

Dr. Pearfon’s remarks on this and the former cafes,
and on the difeafe in general, are ingenious and in-
ierefting. They lead to conclulions different in many
refpeffs from thofe which Dr. Rollo has deduced
from his faffs. ‘ As in the malady above defcribedf
Dr. Pearfon obferves, (alluding to the cafe laft re¬
cited,) c the urine was not in greater quantity than
the drink ; as it was not in fo great quantity as is ex¬
pected to be difcharged in diabetes ; as it had feldom
a fweet tafte, I am aware the propriety of calling the
prefent dilfemper diabetes will not be acknowledged
by many perfons without hefitation. The confidera-
tions which induce me to conceive this to be an in-
ffance of that diforder are, Iff. the great appetite
for food ; the conffant thirlf for fo long a time 5 the
eonftantly unputrefcible, fometimes faccharine urine,
and which was frequently fufceptible of the acetous
fermentation 3 the quantity of urine being much more
than that of rnoft healthy perfons; and the gradual
emaciation. From the great quantity of feemingly
affimilable, or nutritious matter daily carried off with

•the

528 RqIJo’s Cafes of the Diabetes Mellitus , Cc.

the urine; which either contained . fugar, (although
not, in general, perceivable by the take,) or matter
fufceptible of the acetous fermentation ; and from
other fymptoms, it feems reafonable to conjecture that
the diabetes in this, and other fimilar inflances, con-
fids in deficient powers of the organs of affimflatiori.
According to this notion, diabetes may take place
without the quantity of urine being nece hardy greater
than in health, and the prefence of fugar perceptible
by the take may be confidered only as cafual. Hence
alfo, fuch a difeafe may probably take place much
more frequently than has been hitherto noticed ; and
fuch are, probably, many inflances of atrophy, or
confumption, which occur without any known local
affection, in which the urine may be loaded with
nutritious matter, as in the prefent inftance.

‘ It is plain, from thefe remarks, that 1 feelbnclin-
ed to adopt, for the prefent, the theory you have fo
ingenioufly framed, and fo well fupported by faffs ;
namely, that diabetes is not effentially a difeafe of
the urinary organs themfelves, but of the organs of
digeflion ; although you may not think as I do, that
the feat is not in the flomach, but in parts lefs remote
from thofe in which afiimila-tion of nutritious matter
takes place.

* Saccharine matter is not the immediate caufe of
diabetes, but the effeCt of this difeafe ; and if animal
food is beneficial, and vegetable food is detrimental,
it cannot, I think, be fhewn, that it is becaufe the
former does not afford fugar and the latter does.

( In fupport of your theory, that the diabetes is not
feated in the kidneys, it may be afferted, 1. That the
kidneys do not appear to be fecretory . organs, or
organs which compound matters of a different kind
from thofe which enter into them from the blood ;
for excepting, perhaps, the fe ere ted mucus from the
urinary paffages, there is nothing in urine that does
not exift in the fame flate of comnofition in the blood

itfelf. The water and faline fubftanecs are all con¬
tained

RqIIo’s Cafes of the Diabetes Mellitus , 8(c. 529

tained in the blood, and the mucilage of the urine
teems to be the recrementitious part of the blood,
mixed with fecrcted mucus of the urinary paffages.
The facility, and even rapidity, with which liquids,
containing various impregnating ingredients, may be
tranfmitted through the fanguiferous fyitem and kid¬
neys fhew, that the kidneys are rather to be confider-
ed as feparating than jeer ding organs.

c 2. From the great relief experienced on taking
a large quantity of mucilage in irritations irorfi the
urine, in various complaints of the urinary paffages,
it has been fuppofed the mucilage paffes indigefted
to thofe parts.

* It has been objected to this theory, that fugar
could not be detected in the blood of patients, whole
urine evidently contained it, and, confequently, that
it muff have been compounded in the kidneys ; but
the tell employed, namely, the take, does not appear
adequate to the detection of the fubftance fought for,
and that on two accounts. 1ft. Becaufe of its diffu-
fion through fo large a proportion of liquid. 2dly.
Becaufe the take of the fugar may be obfeured by its
intimate mixture with a variety ot falts and mucilages
of the blood. And for thefe reafons alfo, fugar may
be prefent in the urine, and not be perceivable by the
take, but yet it may prevent putrefaction, or render
fuch urine fulceptible of the acetous fermentation. It
is well known that ale and other malt liquors, which
are vapid, and not at all fweet, by keeping in bottles,
in a due temperature, will again ferment, fo as to be
inebriating from the alcohol, and extremely acidulous
from the great quantity of carbonic acid, compound¬
ed. Thefe vapid liquors rrmk, therefore, have con¬
tained either fugar, or matter capable of becoming
fugar.

c I underhand alfo that you have made the expe¬
riment of diffolving fugar in ferurn of blood, and, as
was to be expecled, found that a certain quantity
mav be contained in it, and not be perceptible to the

4 , i take ;

530 Rollers Cafes of the Diabetes Mellitus, S(c,

tafte ; but, like other extraneous matters in the blood,
this quantity, when feparated by the kidneys, may be
infufficient to give a fweet tafte to the urine. It has
been attefted by perfons whofe ftatements cannot be
doubted* that the blood has, in fome inftances of dia¬
betes, tafted fweet, and that it had other properties
denoting fugar. A Angle pofttive evidence of this
fort ought not to be reje&ed by any number of ne¬
gative ones. But, in fhort, blood and urine to moft
perfons’ tafte is commonly fomewhat fweet ; and there*
fore, it feems not improbable, that there is in general,
fugar both in the blood and urine of all animals at
certain times. It is not doubted that the fweetnefs
of chyle, and of milk, is from fugar. It feems alfo
that the digeftive and affimilating organs of animals
\compound fugar from merely animal, as well as ve¬
getable aliment; as appears on examining the chyle
and milk of animals which live entirely on animal
food ; namely, either thofe which are purpofely fed,
or which are naturally carnivorous. It does not feem
that the fluids of animals which feed on faccharine
matters, contain more fugar than thofe which feed on
animal fubftances. Vegetables manured with mere¬
ly animal matter contain as much fugar in their fluids
as when manured with vegetable matter, or probably
with fugar itfelf. But fugar can alfo be compounded
by fermentation, without the aid of live powers, from
dead animal matter and taftelefs farina. Thefe fa£fs,
it may be proper to notice, feem to juftify the obfer-
vation above made, that, on a theoretical ground, v/e
might conclude that animal food was not likely to be
either more beneficial, or lefs hurtful, than vegetable.

4 In this place it will be proper to point out, that
fermentation is a more delicate criterion of the pre¬
fence of fugar in urine than the tafte ; for the urine
of the above patient did not tafte fweet, but it fer¬
mented into acetous acid.

c 3. As great a variety in the appearances of urine
obferved as in the alvine excrements, but in fluids

fecreted

Rollo’s Cafes of the Diabetes Mellitus, Kc. 531

fecreted by glands, fuch great differences are not ob¬
served. Hence the urine has been juftly called the
feces of the blood. In diabetic diforders fome ob-
fervers have attelled that the urine made a few hours
after a meal had a chylous appearance.

c 4. Various other matters befides fugar may be
contained in the blood of certain perfons, and not be
perceived by the tafte, or other fenfes, nor even by
chemical tells, but which are very evident to the fenfes,
or to chemical tells, in the urine of fuch perfons. I
fhall mention a few inftances.

c The odorous matter of afparagus was not per¬
ceived in the blood at the fame time that the urine
fmelled lirongly of it. I have adminillered oil of tur¬
pentine to feveral patients in fuch quantities, that the
urine of all of them was lirongly impregnated, but
in the blood of one of thefe only could it be perceived
by the fin ell. I have very often adminillered car¬
bonate of potalh, and foda, alkalies in fuch quan¬
tities, that the urine effervefced with acids 3 and I
precipitated from urine, containing potalh alkali,
fupertartrite of potalh, on adding tartareous acid. In
one trial I adminillered 800 grains of carbonate of
potalh in water, fuperfaturated with carbonic acid,
between the hours of ten o'clock at night and two
the following day in the afternoon. Blood was drawn
at twelve on that day, and at which time urine was
excreted impregnated with alkali, as juft mentioned,
but not a trace of this fait could bt? detected irr fhe
ferum by the tefts of violet juice, and of turmeric.

‘ Nitrate of potalh has been given in large quan¬
tities, but it could not be traced in the blood, although
it was readily detefled in the urine.

‘ 5. If the diabetes be effentially an organic dif-
eafe of the kidneys, one might expeft to fee always
fuch a difeafed Hate on diffeflion ; which, however,
could not be perceived in Laurie’s cafe above related.
There are alfo diffe6tions publifned by various per¬
fons, in a few of which only was any difeafe feen in

the

532 Kollo's Cafes of the Diabetes Me Hi tus, & fc.

the kidneys ; nor are there, in general, any complaints
of the loins, urinary paffages, hips, &c. in diabetic
cafes. Wherefore, if organic affe&ion takes place,
it fhould be confidered as an accidental attendant, or
confequence ; and in this light fhould be regarded the
difeafed date of the liver, fpleen, lungs, & c. obferved
in fome inftances. At the mod, fuch organic difeafe
can only be confidered as productive of one fpecies of
diabetes, in which, on examination, it is probable the
urine will be found to be very different from that in
the other fpecies of this difeafe.

4 The date of the mefentery diould be more accu¬
rately attended to on diffe&ion of diabetic patients.
In Laurie’s cafe above defcribed, it was obferved to
be difeafed, but I was not prepared at that time for
examination of this part* with a view to any theory.
The urine ought alfo to be examined after the death
of the patient, as well as while alive. In fome cafes,
as the appetite fails, the urine diminifhes in quantity,
and Jofes its fweetnefs a diort time before death.

4 The theory that diabetes is a difeafed date of the
afdqailatory organs, accounts for fome of its mod cha-
ra fieri die fymptoms ; namely, for the urine containing
lugar and other nutritious matters, the wading of the
fiefh, frequent difeharges of urine, third, hunger,
weaknefs of the organs of voluntary action, &c. but
it does not account tor the quantity of urine much
exceeding the quantity of drink. In fome indances,
the excels may be accounted for by reckoning the
quantity of water contained in the folid food, and
which amounts to much more than has been ufually
calculated, or conceived. But in other cafes, taking
the water contained in fuch food into the reckoning,
is not fufficient to account for the quantity of urine ;
and in inch cafes fome addition may, on reafonable
grounds, be confidered to be made by the wade of
the conditlition of the patient. Water may alfo be
compounded in the blood- vedels, or other vedels ; the
conftituent .parts of it exibing in all the fluid and

folid

Rollo’s Cafes of the Diabetes Mellitus, SCc. 533

folid parts of the animal ceconomy ; but that fuch
a procefs goes forward is a mere hypothefis ; and
granting that in reality there is fuch a procefs, the
fupply of a large quantity of water by means of it
cannot long continue, without fymptoms of difeafe
appearing.

c In fome instances the quantity of urine is much
sweater than can be accounted for from all thefe fources

united. Cafes are recorded in which twenty-five to
thirty* and more pints, were difcharged in the fpace
of a natural day for many fucceffive weeks, and even
months; and in which the whole ingefta, as was
(aid, did not amount to half the weight of the urine.
The evidences for fuch cafes are fo numerous and
refpeclable, that we cannot refufe to admit them j
but, I confefs, it does not appear to me that the
quantities of drink have been fairly, calculated ; and
if they had been fo* it feems probable that the urine
would not have fo greatly exceeded the quantity of
liquids fwallowed, nor would birth have been given
to feveral hypothetical and analogical explanations of
the1 fuppofed fuperabundant quantity of water dif¬
charged to that of the drink. The explanation that
water is abforbed by the Ikin from the air has been
very generally accepted ; but this has no better fup-
port than the analogy of the deliquefcence of certain
Tilts ; and no experiments have demonfirated that
water is abforbed from the air by the furface of the
body. Another hypothefis,- which has great ingenuity
to recommend it, is, that an extraordinary quantity of
water is compounded in the lungs themfelves. I do
not know the faffs which countenance fuch a con¬
jecture : nor, in the fir It place, am I able to conceive
that the procefs of the compofition of water can go
forward in the lungs to fo great an amount* without
any fymptoms of it making their appearance in the
pulmonic fyftem. 2dly. Granting that in twenty-
four hours there is an augmentation of more than
eight pounds of oxygen gas infpired, which there
vol. v. Qq muft

534 Rollo's Cafes of the Diabetes Mellitus,

r£Liift be to compound ten pounds of water, (where
that quantity is to be accounted for) and fuppofing
the ingefta to be able to furnifh two ppunds of hy¬
drogen, is it confident that fo large a quantity of
oxygen gas can part with its caloric wdthout a very
extraordinary increafe of the temperature of the ani¬
mal oeconomy ? Or, indeed, be feparated Confiftently
with life ?*

The next cafe is furnifhed by Dr, Marfhgll. It
occurred feveral years ago, and is given from memory
only. On difleCtion, the kidneys were found of a
chocolate colour, enlarged, and flaccid.— A cafe is
related by Dr. Willan, which was greatly relieved by
the animal diet.

The laft cafe is given by Mr. Leigh Thomas, Sur¬
geon, of London. In this cafe, the animal diet wab
found to remove entirely the fweetnefs of the urine.
The urine voided in this cafe was frequently four.
Different vegetable matters feemed to have very dif¬
ferent effeCts in increafing the quantity of urine.—
Bread was raoft powerful in this refpeCL Parfnips,
it is faid, were eaten with impunity. The blood
was examined at different times. Once only the
ferum had a turbid wheyifh appearance*: the nicefl
tefts could not difeover any thing of a faccharine
quality. The rnafs of blood, on drying in the open
air, did not go into putrefaction. This cafe termi¬
nated fatally, and the body was accurately examined
after death. The immediate caufe of death w7as pul¬
monic affeftion ; of courfe confiderable marks of dif-
eafe were found in the thorax. The ftomach, with
its coats, appeared unchanged, except upon its in¬
ternal furface, where inflamed patches were found,
as well as in different parts of the alimentary canal,
through its w7hole courfe. This appearance, the
author obferves, may have been produced by the
aftion of repeated violent cathartics, that were taken
two days before, to remove an obftruciion in the

bowels

Rollo’s Cafes of the Diabetes Melliiusy & V. 535

bowels of a week’s Handing. The kidneys were
rather fmaller than common, and firm as in health.
Upon the under furface of the right kidney, a fmall
collection of pus was found, but too trifling, Mr.
Thomas thinks, to have interfered with the fecretory
funClion of the gland. On cutting through the ,fub-
ftance of one of the kidneys, it appeared redder than
ufual, which led Mr. Cruickfhank to conclude that
there was more than the common determination of
blood to this organ.

Dr, Rollo next gives a concife narration of what
has been hitherto advanced by authors, refpeCting
the Diabetes Mellitus : the fum of which we have
already given*.

The next Chapter contains a general View of the
Hiflory, Nature, and appropriate Treatment of the
Difeafe.

In Chapter 5th, Dr. Rollo endeavours to anfwer
the objections which have been made to his doCtrine,
and recapitulates the principal arguments in its fup-
port.

The firft objection is, that faccharine matter has
not been detected in the bloody or in the ft omach. lo
this it is replied, that it is difficult to afcertain the
exaCt period in the procefs of digeftion when this
change may be looked for, and therefore an emetic
might fail in affording the neceffary contents. With
refpeCt to the blood, Dr. Dobfon affirmed the ex~
iftence of faccharine matter in diabetic blood. In
feveral initances, the ferum was turbid and wheyifh,
and it did not, on (landing, undergo the ufual cnanges
of animal matter. Several experiments are adduced
by the author, where different portions of fijgar were
added to the ferum of the blood. From thefe the
following inferences are deduced :

'fs

* Vol. 4, p. xS 5,

Qq 2 "iff, That;

536 Rollo’s Cafes of the Diabetes Mellitus, tfe.

e lit. That fugar, and the pureft diabetic ext raft
may be contained in the ferum of the blood, without
being detefted by the tafte ; that with a certain quan¬
tity of the former it goes through fermentative
changes ; and that it is probable, in two or three
ounces of diabetic ferum from blqod taken at a proper
time after eating, the faccharine matter might be ob¬
tained.

c 2dly. That a given quantity of dried blood from
which the ferum had been feparated, probably yields,
when treated with nitrous acid, a larger quantity of
oxalic acid, than an equal quantity of diabetic blood.
This refult might have been expected; for, as fugar,
or certain parts of it, forms a conftituen.t part of an
animal body, and not being applied in the diabetes
mellitus, there mull be a watte of it. This is further
confirmed by dbferving that in Experiment N, the
proportion of oxalic acid was greater than in Ex¬
periment O. In N, the blood was drawn in Sep¬
tember, whereas in O, it. was drawn in the following
November; of courfe, the continuance of the difeafe

occalioned the deficiency found in O. The nitrous

acid not being fo pure in the one experiment as in the
other, might have produced a difference in the refult ;
but which could only have been trifling, as there is
only a difference of 14 grains between the twro healthy
refults.

c 3dly. That in diabetic blood, dried with its ferum,
more oxalic acid w^as obtained, than in healthy blood,
from which the ferum had been feparated ; therefore
it may be fuppofed, that the excels in diabetic blood
was obtained from the fugar which had been in its
ferum.

c 4thly. That there is probably more iron in dia¬
betic blood than in healthy.

5thly. That the ferum of blood contains lefs of the
bafe of oxalic acid than the craffamentum ; and that
the ferum of blood, with the addition of fugar, will

Rollo's Cafes of the Diabetes Mellitus , Sic. 537

be found to contain a proportional increafe ; there¬
fore, faccharine matter may be detefted.

. c bthly. That certain fubdances, as fugar, oak bark,
nitre, oxygenated muriate of potafh, &c. taken into
the ftomach, may pafs off undecompofed by the kid¬
neys, and can be detefted in the urine. The domach,
however, in time, feems to acquire the power of de¬
composing them, which may depend, in fome cafes,
on a healthy, and in others on a morbid date. This is
a fubjeft in its infancy.

f The kidneys being merely separating
organs, removing excrementitious, extraneous, or
unaffi'milated bodies, are very readily a£Ied upon, and
Ipeedily remove the injurious matter. It is fuppofed
that the renal veffels receive an eighth of the blood of
the whole body at a time. If fuch be the fact, inde¬
pendently of any peculiar Stimulus, it may be con¬
ceived how very quickly the ferum may lofe any fugar,
or other extraneous body, it may hold in folution, or
otherwife ; efpecially when we confider that the fugar
in diabetes is not conftantly fupplied, as it depends
entirely on the quality and quantity of the food taken
into the domacb, which mud be interruptedly. We
ftiould not probably deteft bile in the ferum of the
blood in jaundice, at lead not fo fenfibly, if the bile
was not unceabngly applied by the fecretion of the
liver. Beddes, if arterial blood contains more of the
watery part than the renal, the former may lofe the
greated part of the fuperabundance by the kidneys,
and with it any extraneous body, as fugar, &c. It
feems to be a law of the animal ceconomy, that
whatever is net affimilated during the procefs of
digedion, is carried off by the kidneys, or other out¬
lets, and that very quickly. This is a meafure of
necedity ; for example, were the faccharine matter
allowed to remain difen gaged in the blood, and to
circulate in the fydem, it would foon, by the opera¬
tion of fuch a dimulus, condantly applied to the
heart, &c. dedroy the animal. Thefe remarks fliew

Qq 3 the

538. Rollo’s Cafes of the Diabetes Mellitus , <$fc.

the great difficulty of detecting fugar in diabetic
ferum.’

The fecond objection which has been made to the
’ new doctrine is : that the difeafe often Jhexos fymptoms
of fyjfpepfy, or weahnefs of digeftion . To this the
author anfwers, that the increafed aCtion of the
ftomach is of a morbid kind, and connected with
debility : being, therefore, irregular and imperfect, it
does not accomplifh digeftion.

3d. Objection. That the fiomach affection may be
fympathetic of difeafecl kidney , from the intimate
confent fub fif ing between both*. To this Dr. Rollo
replies, that the fiomach affections which exift in dia¬
betes are entirely different from thofe which take
place in confequence of primary morbid conditions
of the kidney. Befides, he obferves, that moil cafes
of the difeafe have been preceded by ftomach de¬
rangement, or have been produced by caufes imme¬
diately operating on the fiomach.

4th. Objection. That the kidneys are capable of
forming or fecreting faccharinc matter under a pe¬
culiar action , fimilar to the breafts of women . Here
the author obferves, that the kidneys are not fecreting
organs, but feparating only, and that a much greater
change in their ftruCture than has ever been found
rauft take place, before they could become capable
of fecreting faccharine matter. In fome infiances of
diabetes, the ftruCture of the kidneys has not been
vifibly changed.

Dr. Rollo then ftates concifely the principal argu¬
ments in fupport of his doCtrine. Thefe are

111. The faCt, that a ftomach affeCtion generally
precedes the urinary charaCteriftic fymptoms of the
difeafe.

* This objection appeared to us of confiderable weight. Fide page

191 of our laft volume.

‘ 2dly. The

Rollo’s Cafes of the Diabetes Mellitus , 8 (c. 539

-dly. The fa£t, that a ilomach affeQion always
attends the difeafe, which materially differs from that
fympathetic of primary kidney affection.

3dly. The fa£t, that a diet of animal food, with an
entire abftinence from vegetable, or other matter ca¬
pable of forming fugar in the ftomach, removes fpeed-
ily the general fymptoms, the faccharine matter, the
quantity of the urine, and its unnatural ftate.

4thly. The faft, that diffedfion has (hewn no mor¬
bid condition of the kidneys, but what may be re¬
ferable to a continuance of increafed aftion from the
application of a limple ftimulus, and probably fym-
pathy, augmenting merely the capacity of their vef-
fels. The firft cafe of Dr. Pearfon, and the cafe of
Mr. Thomas, exhibited no difeafe of the kidneys
whatever.

The next Chapter is occupied by the ingenious
Experiments of Mr. Cruickfhank on Urine and Sugar,
From thefe trials there feems reafon to conclude, that
different difeafes produce different changes in the ftate
of the urine, and that the diagnofis may hence receive
confiderable illuftration. But the fubjeft is new, and
we have not room to be more particular at prefent. — •
Of the experiments on the nature of fugar, mucilage,
&c. we have already given a particular account*.

In addition to the number of cafes of Lues Ve¬
nerea treated by the new remedies, of which an ac¬
count was given in the former edition, feventy-eight
are now brought forward ; viz. twenty-eight by the
nitrous acid ; three by the oxygenated muriate of
manganefe $ twenty-eight by the oxygenated muriate
of potafh ; and twenty by the nitrous acid and oxy¬
genated muriate of potafh alternately, but without
any particular order. Molt of thefe have entirely

* Vide Med, and Chir. Rev. vol. 4, page 189 =

Q q 4

yielded

540 Rollo’s Cafes of the Diabetes Mellitus, 8Cc.

yielded to the new method of treatment, and all of
them afford fufficient evidence of its powers.

The volume concludes by the following Remarks of
Mr. Cruickfhank on the Effects of the new Remedies
in the Lues Venerea. c Eighteen months have
now e lap fed/ he obferves, 4 fince the firft cafes
treated by thefe remedies have been mired; and
of the firft feventeen, which were more immediately
under our own management, not one has relapfed,
nor have the fecondary fyrnptoms made their ap¬
pearance in a fingle initance. 1 hat the difeafe has
been completely eradicated can therefore admit of no
doubt.

c In our firft trials we confined ourfelves, in a great
meafure, to primary affections ; but for fome time paft
no diftin&ion has been made, and the fecondary as
well as primary fyrnptoms have been all treated by
the fame plan.

4 The total number which have now been cured,
in the Hofpital, fince the beginning of March, 1797,
amounts to one hundred and fifty-five, as will appear
from the table ; of thefe thirteen bad the fecondary
fyrnptoms of the difeafe. This fmall number of fe¬
condary cafes proves, in a great meafure, the cer¬
tainty and efficacy of this mode of treatment; for as
Dr. Wittman employed thefe remedies in all venereal
affections, whatever their nature might be, had the
cures not been perfect, the fecondary difeafe mu ft
have been very common ; befides, of the thirteen,
.three only could be afcnbed to this caufe, and thefe
were all afterwards cured by the oxygenated muriate
ofpotafh. Of the/ remaining ten, four appeared to
be the natural confequence and progrefs ot the clib
eafe, and fix followed a courfe of mercury.

c The cafes of Lijhman and Chriftly are, in our
opinion, particularly valuable, as neither of them, it
would feem, had continued the medicines for a fuf¬
ficient length of time, and in both, the fecondary
fyrnptoms made their appearance, but were afterwards

completely

Iloilo’s Cafes of the Diabetes Mellitus, Sic. 541

f r -

completely removed by perfevering in the fame mode
of treatment. Could mercury have done more ? We
would recommend thefe cafes, with thofe of Kel/t,
Johnfon, Donally , and Bofworth , to the ferious con-
fid era tion of all the advocates for mercury, and would
alk them, at the fame time, how many cafes of fecon-
dary difeafe might one hundred and fifty-five of the
above defcription, treated in the ufual way, have
afforded ?

£ Upon the whole, we are confident, that fewer
troublelome buboes have been met with, than ufually
occur under the mercurial treatment, and none of
them have fpread and ulcerated in the dreadful
manner, which too often happens under that remedy.

< In a few’ inftances glandular fwellings have made
their appearance, but thefe have been rare, and pro¬
bably were not altogether owing to the medicines.

c There are fome fa&s refpe&ing thefe remedies,
more particularly the oxygenated muriate of potafli,
which deferve to be noticed anci attended to.

< In the firft place, it fometimes happens, that in
certain conftitutions, the oxygenated muriate^ paffes
off by urine undecompofed, and produces but little or
no effedi, either on the difeafe, or conftitution, much
in the fame way as mercury runs off by the bowels,
in thefe cafes the patients generally complain of heat
of urine, which they void frequently, and in large
quantities; whenever, therefore, fuch fymptorns oc¬
cur, the urine fhould be examined by evaporating,
and’ then feparating the faline from the extractive
matter by fpirits of wine and repeated cryftallization.
This being done, the oxygenated fait may readily be
detected, °by the figure of the cryftals, and by its de¬
tonating when thrown upon red hot coals. In order
to remedy this deleft, we have propofed, that cacu
clofe of the fait fhould be immediately followed by
ten or fifteen drops of fome acid, diluted with water;
and for this purpofe the muriatic has been preferred,

although tbe nitrous might anfwer equally well, as
. * either

542 Rollo’s Cafes of the Diabetes Mellitus , Sc.

either of them decompofes the oxygenated muriate
a Atxi gi eat^ facility. This inconvenience is generally
met with in fciophulous conflitutions, where the ex-
traftive matter in the urine is naturally hut fmall, or
where the medicine has been given in very la7°-e
dofes,^ as thirty grains or more four times a day,°a
quantity, however, which we believe to be very fel-
dom neceffary. It may be remarked that, in our full
cafes, we commenced with very fmall dofes, as four
or five grams, but are now fatisfied that ten or fifteen

*"ipi * ^ • s-m limes a day at the very beginnin°,‘

I his quantity lhould be gradually increafed to twenty-
hve, or at moil: to thirty grains, according to circum-
rances; and whenever we iufpect, from the want of
action on the fyftem or difeafe, that it is not decom-
Poi_ed, it ought immediately to be joined with an acid,

effba ^eidom or never ms of having the delired

\ Another circumftance meriting attention, and
•which not unfrequently follows the ufe of thefe re¬
medies, more particularly the oxygenated muriate of
potafli, is an eruption on the flcin of a dull red colour
not very unlike venereal blotches. They may, how¬
ever, be difhnguiflied from thefe by the floridnefs of
die .colour, the itching with which they are accom¬
panied, and their disappearing without throwing off
IciaJes, or leaving any livid or copper coloured marks,
inele fpots never made their appearance but when
the patients were under the full aftion of the me¬
dicine, ana generally went off in two or three weeks
under a continuance of the fame treatment.

In one in fiance, where mercury had been riven
horn the beginning, and very freely, alonr with the
oxygenated muriate, the body was at one time co¬
hered with them, and they difappeared about the
iiiual period. This in a great meafure proves that
they are not venereal.

* A third obfervation which we would make re¬
jecting thefe remedies is, that they have always

4 ' aQed

Rollers Cafes of the Diabetes Mellitus , Sic. 543

a£i:ed with the greateft certainty, and quicknefs,
where the fyftem has been reduced. This would
feem to point out the propriety of evacuations, more
especially by blood-letting, in all full and robuft ha¬
bits, previous to their exhibition. In confirmation of
this, we may obferve, that in every inttance where
thefe have been employed, the practice has been at¬
tended with manifefl advantage.

c Since our firft publication, in July, 1797, we have
only tried one rlew preparation, viz. the black folution
of manganefe in the muriatic acid. This was given
in four cafes with fuccefs, but being difagreeable, and
not apparently poffeffing any fuperior advantages, it
has not been perfevered in.

c Of the different remedies employed, we formerly
gave the preference to the oxygenated muriate of
potaffi, and we are now more convinced of its fupe-
riority ; for there have been many cafes where it has
fucceeded much better than the nitrous acid.

‘ We were naturally led to fuppofe, that a combi¬
nation of thefe remedies with mercury would be more
efficacious and certain than either alone ; or, at leaf!,
that much lefs mercury might be neceffary. Accord¬
ingly, about thirteen cafes were treated in this way,
but the refult did not altogether anfwer our expecta¬
tions ; for although a few of the cures were accom-
pliffied in a very fhort time, the greater part proved
rather tedious. There have been, indeed, a few in-
ftances, where, after the conlfitution had for fome
time been fully under the aCtion of the new remedies,
mercury has been given ; and in thefe it appeared to
have completed a cure very quickly. It is poffible
that this may be the moft advantageous mode of
combination.

c We do not prefume to account for the numerous
failures which have been recorded, but fufpecd that
they are to be aferibed either to fome irregularity, or
impropriety in the adminillration of the remedies, or
to a want of perfeverance and lteadinefs in the prac¬
titioner

544 Pearfon's Inquiry into the Cow-Pox .

titioner or patient. It is aEo proper to remark, that
in thefe failures the remedies were too feldom varied,
fo that when one did not anfvver immediately, it was
dropped, and mercury had recourfe to. Now we are
confident that much of our uniform fuccefs has been
owing to the method which was very early adopted,
of changing the preparation whenever it feemed to
produce no further effeci on the difeafe or conftitu-
tion. In this way a number of cures were quickly
obtained by the oxygenated muriate of potafh, where
the nitrous acid, &c. had not fo immediately fee-
ceeded.

c We fhali conclude thefe remarks with obferving,
that one of the two following pofitions mud be ad¬
mitted— Either thefe remedies cure the lues venerea,
or, in ninety-nine cafes out of a hundred, the difeafe
cures itfelf. Our opponents may take which fide
they choofe ; for on either fuppofition, mercury rnuft
be unneceffary, and this is our principal objedtf

Art. LVI. An Inquiry concerning the Ilijiory of
the Cow-Pox, principally with a View to Juperfede
and extinguijh the Small-Pox . By George Pear¬
son, M. I). Phyjician to St. George's Hofpital.
Oftavo, 116 pages, price Ss. 6d. London, 1798,
Johnson.

DR. PEARSON's object in the prefent publi¬
cation is, to examine the evidence of the prin¬
cipal faffs which Dr. Jenner has adduced in his late
Treatife on the Cow-Pox*; and to hate the further
information which he has derived from his own ex¬
perience, or from the communications of other pro-
feffional men. ' „

Vide page 236 of the prefent volume.

545

Pearfon’s Inquiry into the Cow-Pox.

Dr. Pearfon arranges his matter under different
heads, and the firft objedt of his inquiry is, c how
far perfons who have undergone the fpecific Fever,
and local Difeafe, occafioned by the Cow-pox In-
fedtion, communicated in the accidental way, are
thereby rendered unfufceptible of the Small-Pox.’ —
Refpedfing this point, the author obferves, that the
body of evidence is numerous and refpedtable, in
proof of a perfon who has laboured under the cow-
pox fever, and local eruption, not being fufceptible
of the fmali-pox ; and it does not appear that a Angle
well-authenticated contravening inftance has fallen
under observation. Dr. Pearfon is aware, however,
that this fact will not, by all, be considered as irrefra-
gably eftabliffied : yet admitting it as true, its ufeful-
nefs in practice, as a fubftitute for the fmall-pox, muff
depend on a 'comparifon of its effedls, as to its degree
of danger, its duration, and fubfequent effedls on the
constitution.

No one, hitherto, has fallen a vidtim to the cow-
pox : but this argument in its favour is not con¬
clusive, from the want of a Sufficient number of in-
ftances to build our judgment on. With regard to
the nature and degree of the Symptoms, . and their
fubfequent effedls, in comparifon with the inoculated
fmall-pox, the fadls refpefting cow-pox are certainly
too few, to form a Satisfactory conclufion.

The cow-pox by inoculation fee ms to be little, if
at all, different from the difeafe when cafually caught:
nor is the former fo mild in comparifon with the
latter, as we find to take place in the fmall-pox.

It appears from fome of Dr. Jenner’s cafes, that
the poifon of the cow pox has the fame properties,
whether it be generated by the cow, or by the human
animal ; and thefe properties are the fame, however
remote from the origin in the cow. But it^has not
been determined by experiment, that the properties
of the poifon, when taken from the human fubjeft, '

are

546 Pearfoffls Inquiry into the Cow-Fox..

1 t

are the fame with regard to the brute* as thofe of the
matter from the cow.

It has been laid by feveral, that perfons having been
once affefted with the fpecilic fever and local difeafe
of the cow-pox, is liable to be again afte£ted as be¬
fore by the fame poifon ; and yet fuch perfon is not
fufeeptible of the fmall-pox. Others have denied the
truth of this pofition, but on no other grounds, than
that it is not lupported by analogy. The evidence*
in Dr. Pearfon’s opinion, only proves fatisfa£torily,
that the local affection of the cow-pox may occur
in the fame perfon more than once ; but whether
the peculiar fever alfo occurs more than once, is not
fo certain.

It feems fufficiently authenticated, the author ob~
ferves, that people may have the cow-pox after they
have had the fmall-pox, though fome have denied
this. But it is hardly determined, whether, in fuch
cafes, the cow-pox affe£ts the whole conhitution, or
is only a local affeftion.

The cow-pox poifon differs materially from the
variolous, in not being communicated in the hate of
effluvia, or gas. It does not appear that the difeafe
fpreads from any infefted cow among other cows
which are fed in the fame hable, like a contagious
difeafe. Perfons who deep in the fame bed with one
who is labouring under the cow-pox, are not, in this
way, liable to be infefted. It is not even propagated
from the cows to the milkers, for the moh part, unlefs
the fkin of the part of the hands to which the matter
is applied, be divided or abraded. This is an im¬
portant fa <h.

The local affection in the cow-pox, produced in
the cafual way, is generally more fevere, and of
longer duration, than ufually happens in the local
affe£tion in the inoculated fmall-pox 3 but in the cow-
pox, the fever is in no cafe attended with fymptoms
that denote danger. Some have faid that the difeafe
from the cow-pox poifon, is on the whole much more

fevere,

547

Pear ion’s Inquiry into the Coze-Pox.

fevere, than that from the inoculated {mall-pox. No
cow has been known to die of the cow-pox.

No confequential difeafe to the cow-pox has been
obferved, nor has any difeafe been excited, to which
there previouily exiited a predifpofitibn ; nor has it
been difcovered to produce a predifpofition to parti¬
cular difeafes. Thefe are points of great magnitude,
and require ample proof. At prefent they are ren¬
dered probable only.

Laftly, there appears reafon to conclude, that the
cow-pox infection may produce the peculiar local
difeafe belonging to it, but without the diforder of
the conftitution ; in which cafe, the confutation is
liable to be infefted by the fmall-pox infe&ion. In
this refpedt it refembles the fmall-pox.

Dr. Pearfon next refers to the practical concha-
dons which may refult from the facts before dated.
If it be true, that the fame conftitution is liable to
undergo repeatedly the cow-pox, to which diftemper
no one has fallen a victim, practitioners, he obferves*
may avail themfelves of this mean of exciting an
innocent fever, as a remedy of various diforders ; it
being a truth, admitted by men of experience, that
fevers are occafionally efficacious remedies, efpecially
for inveterate chronic maladies ; fuch as, epilepfy 5
by fieri a ; infanity; St. Vitus’s dance; tetanus; ikin-
deformities and difeafes ; &c. &c.

The cow-pox poifon, the author obferves, and the
hydrophobic, are the only fpecific morbific matters to
the human animal ceconomy, which are clearly proved
to be derived from brute animals ; for there is only
fmall probability on the fide of the opinion, that the
fvphilitic poifon is from the bull* j the fmall-pox
from the camel f ; and the itch from the dog. I he
ceconomy then of the human kind, and of cows,, re-

* Bulls fo difeafed, are faid to be ping,— Sir IJaac Pennington's
rotten,

t S*ee Bruce’s Travels, and Dr. Woodville’s Hillary of Inoculation.

iemble.

548 Peatfon’s Inquiry into the Cow-Poi\

femble each other, in the particular of being excitable
to a difeafe, the cow-pox, by a certain fpecific poifon.
Whether other animals, efpecially males of the bo¬
vine kind, can take the cow-pox, has not been de¬
termined by experiment, or accidental obfervation.
Morbific poifons, which produce fpecific difeafes, adl
in this way only on one fpecies of animal, except in
a few inftances ; fuch as the hydrophobic, and cow-
pox poifons. Camper, Ingenhoufz, and Woodville,
in vain, attempted to produce the fmall-pox by ino¬
culation, in a number of different brute animals*.
J. Hunter tailed in attempting to excite the fyphilis
in a dog, by inoculating him with the poifon of the
gonorrhoea, and of a fyphilitic ulcer. Camper attefls,
that in the mod malignant epizootic murrain, which
fpread mod; rapidly among oxen, yet other animals,
luch as iheep, horfes, affes, dogs, &c. were not in-
tefled by affociating with the didempered oxen ; nor
even by feeding with them in the fame compartments
of a ftable.

In the eruptive contagious difeafe among fheep in
France forty years ago, other fpecies of animals which
affociated with them were not infected.

The newly-obferved difeafe, which prevailed among
domeftic cats in 1796, throughout great part of Europe,
and even America, did not appear to affedt other
animals.

Thefe obfervations may ferve to remove the fears
of thofe who apprehend, that in confequence of do-
medicating brute creatures, we are liable to render
their difeafes endemial.

* Berrier, of Chartres, alTerts, that monkeys, dogs, Bleep, rabbits,
oxen, and other brute animals, are fufceptible of the fmall-pox ; but
his evidence has not the weight of a feather again It the contrary au¬
thorities.

SnvediauraTerts, that monkeys are never affected with the fyphilis,
although in England they are fubjeft to the fcrofula, and that other
animals are equally unfufceptible of the fyphilis, although Pau^iv af¬
firms, that in Peru, dogs are aftefted with this difeafe.

549

Pearfon’s Inquiry into the Cow-Pox .

As it appears that the cow-pox poifon, after its
admiffion into the human conftitution, takes effect,
or fenfibly exerts its agency upon the whole oeconomy*
in feven or eight days ; the knowledge of this fa£t may
enable us to anticipate, in many inftances, the agency
of the fmall-pox poifon.

On account of the notion, which by fome is enter*
tained, that the cow-pox infection is of the fame
nature as the variolous. Dr. Pearfon points out the
following diftin&ions between the two.

1. The cow-pox poifon, introduced by inoculation,
affefts the whole conftitution at the fame time, in the
fame degree, and manner, as when admitted in the
cafual way ; and if the local affection be more fevere
in the cafual, than in the inoculated way, it feems to
be owing to the ftrudture of the part, namely, the
thick cuticle in the palms of the hands.

2. The cow-pox poifon only affe&s the conftitution,
through the intervention of the part poifoned.

3. This morbific poifon produces no eruption or
inflammation, but of, and near, the part to which
the poifon is applied.

4. The cow-pox poifon from the human fubjeft
will, in all probability, infeft the cow with the cow*
pox ; which the variolous poifon will not.

5. It is afferted that a perfon may have the cow-
pox who has had the fmall-pox.

6. The local puftulous eruptions in the cow-pox
are rather of the nature of veficles, or phlyftenae, than
purulent eruptions •> and the ulceration is apt to be of
the phagedenic kind.

7. The cow-pox infection is not propagated in the
ftate of effluvia, or gas.

8. Cow-pox matter applied to the eyes, lips, and
various other foft parts, or to any parts which are
punctured, or wounded, in perfons who have already
had the cow-pox, or are then ill of the difeafe, will
excite the peculiar local affection from this poifon,
and perhaps fever.

VOL. v.

550 Pearfon's Inquiry into the Cow-Pox .

To thofe whofe inclination and opportunities lead
them to a further inveftigation of this curious fub-
je£t, Dr. Pearfon Hates the following as the principal
points of inquiry :

With refpect to Brutes .

1 . If a diHemper of cows has been noticed, called
the cow-pox, or by any other name, in which the
breafls, especially the paps, are affefted with puflulous,
and generally purple, or livid eruptions and fores, by
which the hands of milkers are infeCted ; what are its
fymptoms ?

2. Can any connexion be traced betwixt this dif¬
eafe and the greafe of horfes’ heels ? between the dif¬
eafe and particular kinds of food, and water? be¬
tween it and any particular Hates of the atmofphere ?
between it and any particular feafon ?

3. Is the fame cow liable to the difeafe more than
once ?

4. Has any cow ever appeared to die of this
difeafe ?

5. Is the cow fufceptible of the cow-pox by the
inoculation of the breaHs, with greafe matter of
horfes ?

6. Are males of the ox kind, or other different
kinds of brutes, fufceptible of the difeafe by inocula¬
tion with cow-pox matter of cows ?

7. Have cows, in a Hate of pregnancy, been ob»
ferved to be affeCted with this diHemper ?

8. Is the cow fufceptible of the difeafe by inocula¬
tion of other parts befide the breaHs ?

9. Is the cow-pox matter of human creatures ca¬
pable of producing the cow-pox in cows ?

With refpect to Human Creatures .

1. What parts are affefted, and what are the
fymptoms of the diHemper, when contracted in the
cafual way ?

2. Has any perfon been fuppofed to be in danger,
or to have died of this difeafe ?

3. Is

551

Pearfonfs Inquiry into the Cow-Pox.

3. Is the whole confutation 'difordered previonjly ,
or only at the fame time the puftules break oat ? Does
the diforder of the confutation difappear on the ap¬
pearance of the paftules ? Does the fame, or a dif¬
ferent diforder of the confutation again appear ; and
under what circumflances in the courfe of the dif*
eafe ?

4. If in the courfe of the difeafe, when there is no
diforder of the whole confutation, the infectious
matter of the cow, or of the human patient already
labouring' under the cow-pox, be applied to frefh
parts, does a diforder ot the whole conftittition arife,
as well as a local afteftion ; and of the fame kind as
thofe which have already taken place ?

5. Is the fame perfon fufceptible of the cow-pox
local affection, and fever, or diforder ot the whole
conilitution more than once ? or only of the local ai-
fection more than once ? In the inllances in which
the diforder of the whole conititution was faid to
have occurred more than once, is it not probable
that in one cafe only the fpecific rever of the infec¬
tion occurred, and in the others a different diforder of
the whole conilitution, fuch as was merely from the

irritation of the local affeflion ?

6. Is the local affeflion of the fame nature on a
fecond, or on farther attacks in the fame perfon, as

on the firft ? #

7. In the inllances of cow-pox in perfon s who had
cone through the fmall-pox, were the local affeflion
and diforder of the conilitution of the lame natm e,
as in perfons who had not laboured under the fmall-

pox ? r .

8. Has it been obferved that a perfon has ever

taken the fmall-pox, after having gone to rough tne
cow-pox? In the inllances in which the fmall-pox
was faid to have taken place, was it certain tmn t le
preceding cow-pox was attended with its Ipecihc
fever, or was there only a local aiieition, or at

R r 2 molt

552 Pearfon^s Inquiry into the Cow-Pox.

inoft, was there only diforder fymptomatic of the
local affeftion ?

9. Does the cow-pox render the human conftitu-
tlon unfufceptible of any other difeafe, befide the
fmall-pox; or, on the contrary, increafe its fufcep-
tibility to any particular difeafes ?

10. What are the eflfe&s of the cow-pox on preg¬
nant women ?

11. , In the inoculated cow-pox, is the fever lefs
confiderable than in the cafual way ?

12. In the inoculated cow-pox, is the local affec¬
tion {lighter and of Ihorter duration than in the cafual
cow-pox ?

13. How long after the infertion of the matter is it
before the conflitution is affe&ed ?

14. If a perfon were to be inoculated at the fame
time with the cow-pox and variolous matter, which
diforder would appear firft, or what other effcfts
would be produced ?

15. If the cow-pox morbific matter be applied to
a fecreting membrane, e. g. to the urethra, will it
produce a gonorrhoea, or puftulous fores ?

16. Does this difeafe appear to injure the conftitu-
tion, by producing or exciting other difeafes ?

17. Does this difeafe appear to eradicate any other
difeafes already prefent }

18. Does the mildnefs or feveritv of the inoculated
cow-pox depend upon the quantity of matter infert-
ed, or on the wounds inflicted for inoculation ?

19. Does the cow-pox matter produce the difeafe
as certainly in its dried as in its fluid ftate ; and wrhen
old, as when recent ; and with equal mildnefs ?

20. Are there any particular Itates of the conftitu-
tion, in which the cow-pox is particularly mild ; or,
on the contrary, fevere ; as after the mealies, hooping
cough, &c.?

21. Are there particular idiofyncralies in families
or individuals, which influence the cow-pox, as is
the cafe in the. fmall-pox ?

22. Is

Beddoes on the Venereal Dijeaje . 553

22. Is the inoculation of the cow-pox equally fuc-
Cefsful in infancy, manhood, and decrepit age ?

23. Do certain epidemic Hates appear to prevail* *
which influence this difeafe ?

Anfwers to the preceding queftions will be prin¬
cipally obtained by inoculation for the cow-pox, of
which there are many opportunities in provincial
fituations ; which praftice it is one of the chief ob-
jefts of this publication to encourage.

Art. LVII. A Collection of Tejlimonies refpecting
the Treatment of the Venereal Difeafe hy Nitrous
Acicl . Puhljhed by Thomas Beddoes, M. D«
Odfavo, 277 pages, price 5s. London, 1799.

Johnson.

SO many inftances have now been made public
which prove, in a fatisfaclory manner, the in¬
fluence poffeiTed by the new remedies over the lues
venerea, both in its primary and fecondary ftages,
that it is no longer neceffary to enter into the detail
of each individual cafe. It would perhaps be better
to confine our attention in great meafure to the un~
fuccefsful cafes, for the purpofe of difcovering, as far
as is poflible, the circumftances on which this dif¬
ference of refult depends, and of afcertaining the re*
lative values of the new and the mercurial methods
of cure.

The firfl communication in the volume before us,
is from Mr. Scott, to whom we are indebted for our
firft knowledge of the new remedies. He frit ob*
ferves, that his theory led him to fuppofe, that oxy¬
gen, applied to the internal furface of the inteftinal
canal, would anfwer the fame purpofe as the nitric
acid : but he has not found it fo in practice. In two
or three inftances, Mr, Scott has ieen people, when

R r 3 , taking

554

Beddoes on the Venereal D if cafe ,

taking the nitric acid, affefted with fcabs on the
body which appeared to be compofed of coagulated
lymph, and which difappeared, on leaving off the

acid.

With a view of procuring an agreeable fubftitute
for the nitrous acid, Mr. Scott thought of uniting it
with the fimple earths, and preferred the earth of
alum, as the acid has the weakefl affinity with it.
Though not more palatable, it produced the fame
e if efts in the fyftem as the nitric acid. He like wife
employed the black calx of rnanganefe, in the quan¬
tity of ieveral drachms daily ; and for the purpofe of
difengaging its oxygen gas, the common drink of the
patient was well acidulated with the acids of vitriol
or of nitre. But no evident advantage was derived
from this plan.

In one of his letters, Mr. Scott fpoke with much
confidence of the good effects of nitric bathing of the
lower extremities ; he even fuppofed, that this mode
of applying the acid was more effectual than its in¬
ternal ufe: In a fubfequent letter much of this is
retra&ed, and he (peaks with hefitation of the utility
of this mode of exhibition,

C, ^ ■ v , t • 4.J? i 4 • ■■ i ■' ; / • '■ ;■ . L , v ■'

T he next communication is from Dr. Trotter. Six
or feven cures by the nitrous acid, he obferves, have
come to his knowledge, and molt of them of long
Handing. In Tome, mercury had been ufed without
efieft; in others, the acid was the firft antifyphilitic
medicine. He has, however, tried it in a few with¬
out any apparent advantage. In one cafe, fevere
fyrnptoms of leurvy appeared, during the ufe of the
acid; fo much fo, that it was obliged to be given up
for fome time, and recourfe had to the citric acid, till
the fcorbutic complaints yielded : the cure was corn-
pleated afterwards by the acid, nitros. This fuper-
vention of fc.urvy, Dr. Trotter obferves, is a ftrong
proof of fome analogy between the aftion of mercury
Slid nitrous gas, for the mercury has always been
••• ‘ found

Beddoes on the Venereal Difeafe. 555

found hurtful in a fcorbutic difpofition of body. He
fees no proofs of its imparting oxygene to the fyflem,
unlefs the increafe of appetite may be thought fuch.

Three cafes are related by Dr. Garrick, in two of
which, the good effe£ls of the acid were very ap¬
parent: but mercury had in both been ufed, fome
time before. In two other cafes it was adminiftered
without fuccefs ; but he acknowledges, that in one,
it had not a fair trial.

Some extracts from a pamphlet of Dr. Swediaur
are next brought forward, wherein he quotes the
authority of M. Alyon in favour of the new remedies.
M. Alyon, it feems, has obtained feveral combinations
of oxygen, which he has employed with the greatefl
fuccefs in fyphilis. He contrived an ointment fupe-
rior to the blue ointment of mercury, and which has
produced the fame effects. Oxygen he confiders as
curing with greater promptitude and certainty, than
mercurials. Mercury, he fuppofes to be an impe¬
diment to oxygen, which alone he affirms to be me¬
dicinal, when the treatment confifls in friftions.

Mr. Bryer of Weymouth relates one inveterate
cafe, which yielded to the acid. It was likewife
employed with fuccefs on another man who could
not bear mercury.

Some remarks next occur on Mr. Blair’s pamphlet.
This gentleman’s obfervation and experience^ having
unfortunately led him to concluiions, conhderably
different from, thofe deduced on the other fide, his
ilatement has, of courfe, afforded occafion to many
critical and petulant remarks. Many p^ges are de¬
voted to an examination of the cafes brought forward
bv him, with the view of invalidating their force : but
we leave this matter to Mr. Blair himfelf. Our read¬
ers may form fome opinion of the weight of his tef-

R r 4 timony.

556 Beddoes on the Venereal Difeafe .

timony, by the account we have already given of his
pamphlet*.

The next article is a letter from Dr. Geach. He
obferves, that mercury had been but little employed
in the Plymouth Hofpital fince the nitrous acid was
adopted. Two inflances are mentioned of very frnall
chancres refilling the full ufe of the nitrous acid. He
remarks, that the lues has yielded to the acid, though
combined both with fcrophula and fcurvy.

Thirty-fix fuccefsful cafes are next brought forward
from the Royal Hofpital, Plymouth, by Mr. Ham-
mick, Jun. Thefe are followed by one unfuccefsful
cafe. The fymptoms were chancre and gonorrhoea.
Mercury was firfl employed fo as to excite copious
falivation. The chancre not yielding to this, nitrous
acid was employed in the ufual manner. The ulcer
leffened confiderably, but did not entirely heal. The
acid was continued for near three months, in which
time one hundred and twenty-fix drachms were
taken.' Mercury was then again reforted to, a co¬
pious ptyalifm followed, the chancre fpread under its
ufe, but in about fix days, it relented and healed.

1 hree cafes of chancre are next adduced by the
fame gentleman, which were cured by the fulphuric
acid. The quantity given was from one drachm, to
a drachm and a half daily. It feemed not to differ in
its effefts from the nitrous acid.

§ix cafes of gonorrhoea follow by Dr. Geach, which
were cured by the nitrous acid only, fome of them
without any kind of injection. The cure was com¬
pleted ip three weeks or a month. Eight or nine
in fiances in the whole, of lues venerea, are acknow¬
ledged to have refilled the new remedies, after a trial
of fufficient extent. Thefe afterwards yielded to mer¬
curial friflions, but fometimes very reluctantly.

Vide page 148.

Mr.

Beddoes on the Venereal Difeafe . 557

Mr, Cuftance, of Kidderminlfer, gives an account
of a fecondary cafe, which yielded to the nitrous
acid, after having refilled mercury. She took the
remedy for three months, for the moft part two
drachms daily, and, in the whole, one pint , /even
ounces^ and jive drachms of the acid .

Mention is made by Dr. Geach of the trial of phof-
phoric acid in one inftance of lues venerea. Two
drachms of this acid were given daily. The firlt ap¬
pearances of healing, it is obferved, were in the
middle of the ulcer, the cicatrix gradually extend¬
ing to the circumference.

Several other fuccefsful cafes are furnilhed by, dif¬
ferent practitioners, in many of which the fymptoms
had before refilled the effects of mercury.

Dr. Rollo obferves, c that in certain conilitutions
and flates of ftomach, the oxygenated muriate of
| potafh, when given in large dofes, infiead of pro¬
ducing its ufuai effedts upon the conftitution, runs
off by urine undecompofed ; in fuch cafes, the patient
generally complains of fharpnefs, and heat of urine,
with a frequent defire to pafs it ; this fa6t was de~
tedled by the following fimple procefs. — The urine
of a patient who had for fome days been taking fifty
grains four times a day, and who complained much
of lcalding, &c, was evaporated until it afforded, on
cooling, a mats of impure cryflals mixed with animal
extractive matter. — Thefe cryflals were feparated and
placed on filtering paper, and walked with a little
alcohol ; they were then redilfolved in hot water, and
fuffered to cryflallize a fecond time by cooling ; by
this means the oxygenated muriate of potalh was ob¬
tained in crylials mixed with fome ammoniacal falts,
and common muriate of potalh, and when thrown
upon red hot coals, detonated with its ufuai vivid
flame.

* From this fa£l if would appear, that too large
dofes of this medicine are not only unneceffary, but
prejudicial, as by exciting the & St ion Qt the urinary

organs

558 Bed does on the Venereal Bifedfe.

organs too much, the whole, or a confiderable part
may be carried off undecompofed, fomewhat in the
fame manner as mercury is carried off, when it pro¬
duces purging: to avoid this inconvenience, when
detected, and which it may readily be by the procefs
juft described, the dofe of the medicine fliould be
dirriiniflied, and a fmall quantity of fame acid, as
the nitrous, muriatic, or even vinegar, given after
each; by this means the fait muff unavoidably be
decompofed, and confequently rendered more acdive,
both on the fyftern and difeafe; as we have found
from experience to be the cafe.’

The evidence of Dr. Carmichael, of Birmingham,
refpefting the new remedies, is far 3efs fatisfa&ory.
He has prefcribed it in numerous inftances, and m
various ftages of the difeafe, but has in no inftance
been able to effect a cure. He, however, allows
them to poffefs feme influence over the fymptoms.
The diluting medium, cliredted by Dr. Carmichael,
was either water alone, or water gruel. He fufpects
the large addition of fugar in Mr. Hammick’s cafes,
may have been of more confequence than has hitherto
been fufpe&ed : for be has given the nitrous acid in
the full quantities.— This point deferves -inveftigation.

Dr. Currie’s (of Liverpool) teftimony on the fub-
ject, will have much weight. We, therefore, give
it in his own words. He obferves in a letter to
Dr. Beddoes, c i am truly forry I have occasioned you
the trouble of writing fo often to me, by neglecting
to comply with your willies refpefting the nitric acid ;
but the truth is, my experience of its effects in lues is
not fo extenlive, or fo uniform, as to enable me to
fpeak with confidence on a fubjeft, where accurate'
conclufions appear to be fo difficult. Neverthelefs,
fince you defire it, I will give you a fhort account
of what I have obferved.

c I began to ufe the nitric acid in lues, at our
Hofpital> in the beginning of 1797* In the two firff

cafes.

559

BeddoeS on the Venereal Difeafe .

cafes, there were ulcerations on the penis, and open
buboes in the groin, but no decided evidence of the
Syftem being affe&ed ; ahd the difeafe was in each
cafe of lefs than three months handing. In the third,
the difeafe had been in the habit upwards of a year ;
the furface was covered with venereal eruptions ; the
throat had been affedted, and the glands of the neck,
on each fide, had been indurated, and were in a ftate
of open ulceration. The patient had undergone a
courfe of mercury in the Hofpital ; but, after puffing
it as far as her fyftem would bear, ffe had been dis¬
charged, about fix weeks before, with little or no
amendment in her Symptoms. The laft fix weeks.
Hie had been in the country, on a milk diet, and her
health was fomewhat recruited. I paid much atten¬
tion to thefe three cafes, and have minutes by me re-
fpefting them, of confiderable extent. The two firffc
were males.

f Each of the men took a pint of water daily,
gratefully acidulated with the nitric acid ; a drachm
being at firft ufed in each pint, and afterwards a
drachm and a half ; but this lait proportion appearing
to effect the bowels by griping, the original propor¬
tion was returned to, and the patients took a pint
and a half of the acidulated water daily ; i. e. a drachm
and half of the acid, as already mentioned. In the
cafe of the female, we never exceeded a drachm, her
bowels being very irritable.

< In five weeks, every fymptom of difeafe in the
two men was gone; and I prefented them to the
Board, as remarkable infiances of lues being cured
without the ufe of mercury. They attended at my
houfe weekly, for Some time ; but, being Sailors, they
went afterwards to; Sea, and I have never heard of

them fince, „ .

< In the female, the fame happy progrefs continued

for nearly a month ; the eruption on the ficin diminifh-
ed, the no&urnal pains in the head and limbs went
off and the ulcerations in the neck affumed. a healing

appearance ;

560 Beddoes on the Venereal Dijeafe .

appearance; her general health, alfo, improved ra¬
pidly. But at this period, her progrefs towards a
cure flopped; and though we perfifted in the acid
fome time, it did not recommence. It was, there¬
fore, at the end of feven weeks, abandoned, and re-
courfe had again to mercury, but in fmall dofes, gra¬
dually increasing them, however, till ptyalifm com¬
menced. At firit, there were indications of benefit
from this new courfe of mercury ; but tbefe fpeediiy
tailed ; and her general health Suffering feverely, we
were once more compelled to abandon it ; the ulcera¬
tions in the neck having, during its ufe, evidently
Spread and become more morbid. The nitric acid
was had recourse to, as before. During this fecond
courie of the acid, her health again improved, and
the venereal fymptoms again appeared to give way.
But, after a few weeks, thefe favourable indications
tailed us; we abandoned the acid, and retorted to
mercury once more. It would be tedious to par¬
ticularize farther.. With the mercury, farfaparilla,
and mezereon, and opium, were fucceffively com¬
bined ; but in vain. Her health giving way, the
fores enlarged, and once more we returned to the
acid. At length we combined the acid with mer¬
cury, in what are called alterant dofes, and with evi¬
dent benefit. At the end of eight months, however,
the ulcerations continued, though much diminished.
Defpairing of any farther benefit from thefe combined
powers, we abandoned them altogether, and after a
proper interval, put the patient on a courfe of the
mineral folution of De Valengin, (fr$m which, in
obftinate venereal affections, I had before feen extra¬
ordinary effefts) and during this courfe the ulcera¬
tions fpeediiy healed, and the cure of the patient be¬
came complete, the treatment having occupied a
Ipace of upwards of ten months. In obftinate cafes
of this kind, it is ufual to fuppofe, that fome fcro-
fulous or other taint has combined with the venereal
virus, and this may have been the fact in the prefent

instance ;

Beddoes on the Venereal Difeaje . 56 i

inftance ; the refuit will, however, afford encourage¬
ment in fimilar fituations.

‘ The encouragement, arifing from the three cafes
juft mentioned, led me to try the nitric acid in a va¬
riety ot otner cafes. In fome of thefe, iny fuccefs has
apparently been complete ; in others, there has been
evident benefit without a perfect cure ; and in others,
it has feemed to fail entirely, it is not a little curious"
that in fome ot the cafes in which I ha^e fucceededu
the fymptoms were what are called fecondary, and the
difeafe in its molt rooted and obftinate ftate. One of
my patients, whole name is Elkins, has drawn out his
own cafe, ^the particulars of which are Ihortly thefe:
—About four years ago he wTas affehted by lues, with
the ufual fymptoms, for which he underwent a courfe
of mercury, and was fuppofed cured. In about nine
months afterwards, however, the difeafe appeared in
his throat, and in obftinate pains in his head, &c*
He was again falivated, and with fimilar good effects.
Twelve months after this, having been for aconfider-
able time fubjeft to what wTas fuppofed to be rheu-
matifrn, the difeafe appeared again, and refilled the
long-continued and repeated ufe of mercury, under a
praftitioner here, of the firft eminence. He was at
length obliged to abandon it, having been reduced to
a ftate of extreme weaknefs. About three months
after this, he was admitted a patient into our Hof-
pital, and under my care. At this time he had a
thickening of the pericranium in two different places,
the moff fevere pains, efpecially in the night, in the
bones of his head, arms, and legs, and a large increaf-
ing node on the right tibia. All his fymptoms were
at this time increafing ; and having taken lb much
mercury in vain, he was in a ftate of extreme de~
fpondence and depreffiom

c We preferihed the nitric acid, and his fufferings
abated from the third day } and being continued, the
thickening of the pericranium and the node of the
tibia entirely difappeared, with all his other fymp¬
toms.

562 Beddoes on the Venereal Difeafe,

toms. He took the nitric acid, in all, to the quantity
of eight ounces in eight gallons of water, which he
drank in fixty days.

c Elkins has been nearly a year difcharged, and
has never had any return of his complaints. This
cafe has made feme noife, and I have endeavoured to
attract the attention of feveral of my brethren to it,
as decifive of the influence of the acid in this de-
ftruCtive difeafe.

On the other hand, there are a fill more con-
fiderable number -of cafes, in which the acid has en¬
tirely failed me, or produced only partial benefit ; and
at prefen t, though I always order it internally, with
mercurial inunctions on the fkin, I do not truft the
cure to it alone in the fir ft injlance . Combined with
mercury in this way, the conftitution feems to fupport
the action of the metal better, and the cure to be
accomplilhed more fafely and more fpeedily. In
feveral infiances where, after a courfe of the nitric
acid, it has been thought advifeable to have re courfe
to mercury, a very fmall quantity of the ointment (in
one cafe two drachms only,) has produced complete
ptyalifm. This has occurred fo frequently, that I do
not think the conjunction accidental.

* The nitric acid has never been pufhed by me to
the extent, in which it has been ufed by others ; in
many of the cafes, in which it has apparently failed,
I cannot pretend to fay, that it would not have fuc-
ceeded, if pufihed to a greater length ^ but I have not
thought it proper to carry it to any extent injurious
to the ftomach or bowels, while the falutary e fie 61s of
mercurial inunCtion remained untried. In the quan-
titles in w7hich I have preferibed it, it has been uni¬
formly falutary to the confiitution, in this refpect its
aCtion contrafting very happily with that of mercury.
In the cafes in which it has apparently fucceeded (in
my hands) in the cure of lues, I have not known a
relapfe to take place ; but as the patients have been
chiefly feafaring perfons, it is not in my power to

trace

Beddoes on the Venereal Difeafe, 563

trace their hiftory fubfequent to our parting. In one
caie of the primary difeafe, in the hofpital of the 20th
regiment, the afliftant furgeon, who thought it had
effected a complete cure, found the difeafe break out
hi the throat, at the diftance of four months, and
finally removed it by mercury.

I ^ave experience of the effects of the nitric acid
in complaints of the ftomach, hypochondriaiis, aflhma,
and fome other difeafes, as well as in hepatitis ; but
a? your enquiries arediredted to its agency in a fingld
difeafe- — lues— -I forbear to enter on other points.

* But you will aik whether I can mark, by any par-
. ticular effedts, the circumftances attending its falutary
operation in lues ?— I think I can. In the cafes in
which it fucceeded, it evidently irritated the fyftem in
the following refpecis :

£ The gums were always affedted with tendernefs
and rednefs, and the aftion of the falivary glands in-
creafed. This affection may indeed be confidered as
depending on its local addon ; for it took place in one
cafe, where, for the fake of the experiment, the acid
was taken into the mouth, but not (wallowed. This
fiate of the gums, &c. was not attended by fee tor, as
during the addon of mercury, neither did it increafe
as the acid was continued, hut in a little while dif-
appeared. This affedtion of the gums and falivary
glands did not always appear in the cafes where the
acid failed.

£ 2. In every cafe in which it fucceeded or ope¬
rated beneficially, there was a confiderable increafe
of urine, and this difeharge became turbid ; fometimes
of a whitifh, and fometimes of a browniih hue ; it
amounted to about eight pounds in the twenty-four
hours. But the difeharge of urine did not go on in-
creating under the continued ufe of the acid; on the
contrary, it ceafed like the increafed difeharge of
faliva. The affedtion of the kidneys feerned to pre¬
cede the affedtion of the falivary glands.; but both

the

564* Beddoes on the Venereal Difeafe.

the one and the other occurred by the fifth day at
lateft. r

‘ 3. The patients had their appetites improved, and

felt a greater alacrity of fpirits.

c 4. In all of them the pulfe was rendered more
frequent, and the animal heat towards evening in-
creafed from one to two degrees, which in the night
was generally carried off by more or lefs of fenfible
perfpiration.

c I think that thefe fymptoms have not appeared
at all, or not in combination, wffiere the acid has
feemed to be inert.

But I wiili to fpeak with the diffidence becoming
my imperfect experience ; and I would not willingly
have fpoken at all in this ftage of the enquiry, had
not there appeared a danger of the attention of
medical men being wholly withdrawn from the in-
veftigation of a fubjeft, which, though difficult, feem^
to me not only curious in itfelf, but likely to produce
important confequences to the healing art. To affift
in preventing this, I am willing to offer a teftimony,
which is certainly imperfeft, and which in fome
refpe&s may ultimately be found erroneous/

Mr. Hammick gives the fum of his experience in
the Plymouth Hofpital, between November 1797,
and March 1798. It appears that thirty-feven men
were difcharged cured, by the acid alone, of different
ffages of the difeafe. Fourteen of thefe had not
taken any medicine previoufly; but the others had
ufed different preparations of mercury, fome of them
to a great extent, under which their diforders gained
ground. Sixteen were cured of gonorrhoea. In all
thefe, as foon as the inflammatory fymptoms went off,
an injection was ufed, compofed of from four to
fixteen drops of the nitrous acid, in eight ounces
of water.

Mr. Hammick allows that the acid has failed in
many cafes ; but this failure, he obferves, has been

565

Bell's Syft em of Directions.

in hot conquering the fymptoms at firft ; for, when
once removed, they have never, to his knowledge,
occurred again. The nitrous acid has never in any
inltance produced the fmalleft difpofition to ptyahfm.

Subjoined to the communications which have now
been noticed. Dr. Beddoes has furnifhed many re¬
marks, which it is unneceffary for us to detail. The
volume furniihes abundant evidence of the power of
the new remedies in the different ftages of the vene¬
real difeafe, whilft the cafes, where they have failed,
are comparatively few. The caufes of this variety
in their a£tion do not yet appear.

Art. LVill. A Syftem of Directions , explaining
the Anatomy of the Human Body , the Manner
of dif playing the Parts , and their varieties in
Difeafe . With Plates. By Charles Bell. Fart
L Folio, 65 pages, price 5s. 6d. Edinburgh,
1798. Cox, London.

WE have feldom feen a work better calculated,
by its matter to infiruct, or by its manner to
allure, the medical ftudent to the important* yet too
much negledred, ftudy of anatomy, and thus to fulfil
the intentions of its ingenious author, than the per-
formance now before us. We can only at prefent
give our readers a general idea of its nature and
objects , referving a more full account of this and
the remaining , parts, tor forne future opportunity.
And this cannot be better done than by quoting the
author's Preface,

4 For the ftudy of every faience,’ Mr. Bell obferves,
£ there are required fuch general views, as may enable
a ftudent to take a lively intereft in his gurfuits, to
direfct his enquiries to the points of true importance,
and to confirm in him a manly and heady refolution

566

Bell’s Syfiem of Directions.

to perfevere in learning the details and minutiae
which, although difagreeable and tedious in them-
felves, are yet abfolutely neceffary. In no cafe is
this more mdifpenfable, than in the ftudy of ana¬
tomy ; tor while the general refuits or economy, con¬
sidered as a whole, are interesting and important, the
details are intricate, and difficult to be acquired, and
often difagreeable. There are thus two departments
of this fcience ; both equally neceffary, but to be
Studied in a very different manner.

c What is detailed in elementary hooks of anatomy
is too often represented as comprehending the whole
of the art. Yet the object of fuch books is not prac¬
tical anatomy : by which is to be underftood the real
investigation and knowledge of the diffedted body.
The defcriptions are not adapted to the limited and
fucceffive views which, in difleftion, we muff have
of the parts ; they cannot he implicitly followed as
guides 5 but, on the contrary, the anatomy of any part
to be differed, or of parts implicated in a great ope¬
ration, muff; be collected from many different fources
— mufcles from one place, blood- veffels from another,
and nerves from a third. The defcriptions, too, will
be found infulated and defective in fuch views as can
give a lively inter eft and knowledge of the mutual
dependence of the parts. Now elementary books
fhould give Simple, introductory, and conneCted/dews ;
otherwise they are not only ufelefs, but become hurt¬
ful. To Study the details of anatomy without having
the parts before us, is pernicious ; and a man, who
has bv reading only, acquired a knowledge of names,
and of the derivations of nerves and arteries, without
at the fame time being able to put his finger upon the
body, and tell what parts lie concealed, is more apt
to be led affray, to heiitate, and be timorous, than to
be prompt and decisive in bis conduft as a furgeon.

* That the common books are not fuited to be
affiftants in diffeftion, every one muff allow, who has

taken the knife into his own hands, or been attentive

56 7

Bell’s Syftem of Directions.

to tile operations in a differing room. He will know,
that, in diiTection, it is not the want of minute descrip¬
tion that is fo much felt, as the want of arrangement,
and plans upon which to proceed. How often is it
found, that young men, who have began their ana¬
tomical labours with a true convidlion of the impor¬
tance of the fubjedf, and with the molt determined
refolutions to combat all difficulties which might op-
pofe themfelves to their progrefs, have, for want of
a plan and fyftem of proceeding, gone to work in fo
difordered a manner, that they have been foon be¬
wildered, and forced, in difguft and defpair, to give
up a purfuit, which, with their views better directed,
would have been moft plain, and certainly moil va¬
luable to them. The convidlion of the want of fome
guide to the younger Undents in their labour, has
emboldened me to this attempt.

c The objedl of this work is, to ferve as an affiftant
to the Undent in acquiring a knowledge of pradtical
anatomy ; in gaining a local memory of the parts ; in
learning to trace them upon the dead fubjedt, and to
be able to reprefent them to his oven mind upon the
living body. This being my objedt, the method to be
purfued is obvious ; to give a fhort detail of the ana¬
tomy ; to fhew how the parts are to be laid open, and
how they are to be diftinguiflied in ditfedlion, or
avoided in an operation ; to explain the confequence
of each part to the great functions of the body, and
to mark the difeafes to which it is liable.’

The prefen t number contains the diffedlion of the
abdominal mufcles, and vifcera, with the difeafes con-
riedled with the anatomy of there parts.

More fpiendid, but not more ufeful, is the fol¬
lowing—

Sf 2 Art.

( 563 )

Art. LIX. Anatomia Britt annicA. A Syf
tern of Anatomy , illujirated by upwards of Three
Hundred Copper-plates , from the mqft celebrated
Authors in Fair ope. In Six Parts . By Andrew
Bell, F. S. A. S. Engraver to his Royal High-
nefs the Prince of I Fates. He Work conducted
by Andrew Fyfe, Ajjijlant to Dr. Monro, Pro-
fejfor of Anatomy, Sc. in the Univerjity of Edin¬
burgh. Folio, Farts I. 11/ and Ill, price 71. 7s,
Edinburgh, 1798. Johnson, London.

HOUGH the progrefs of improvement in ana-

torriy, the author obferves, has kept pace with

that of the other fciences, yet that knowledge, which
might otherwife have been acquired, has been, in
fome degree, retarded by the want of a compleat
and comprehenfive fyftem, enriched with the modern
difcoveries, and accompanied with proper delinea¬
tions of the numerous parts of which the human
body is compofed ; for, without fuch delineations, no
language is fufficient to convey juft ideas of the va¬
rious parts. Whether this defeCt has proceeded from
the very great labour and expence which muft necef-
farily attend the publication of a feries of plates, fo
extenfive as to exhibit all the parts employed in per¬
forming the different functions of the body, or from
other caufes, it is certain that no fuch fyftem has
appeared fmce the commencement of this century.
Many ingenious and learned men, however, both in
Britain and in other countries, have, during that
period, favoured the public with the refult of their
labours in thofe various branches of anatomy, which
accident or inclination led them more efpecially to
cultivate. By collecting thefe different works, a
library may indeed be formed which would con¬
tain all the anatomical knowledge that has hitherto
been acquired. But, befides the enormous expence
of fuch a collection, fome of the molt valuable works

are

569

Bell's Anatomia Brit tannic a.

are fcarce, and others are entirely out of print.
Hence this interefting fcience is lefs underftood than
its importance deferves.

To remove thefe inconveniences, by giving as com¬
plete a view as poffible of the various parts which
compofe the human body, is the profeffed objedff of
the prefent work. This undertaking was in con¬
templation tor feveral years before its commence¬
ment ; and it is now upwards of twenty fince it was
ferioufly begun. During that period, the plan has
been confiderably enlarged by the acqtiifition of new
publications ; and it is prefumed, that when finiflied,
it will be the molt extenfive work of the kind that
was ever offered to the public, it will confift of
upwards of three hundred plates, in large folio, fe-
lecfed from the works of the moft eminent ana- '
tomilfs, particularly from thofe of Eufiachius, Du-
verney, Zin, Albinus, Haller, Morgagni, Waltherus,
Monro, Hunters, Hewfon, the Vifq, d’Azir, & c.
&c. ; and from that fcarce and valuable publication
of Bid loo, which appeared under the name of Cow-
peps Anatomy. Such a publication, by exhibiting
exadt reprefentations of the human body, as a whole,
and of all the different parts of which it is compofed,
and by conjoining with thefe, full explanations of the
different parts, cannot fail greatly to facilitate the
ftudies of thofe whofe profeflion renders a thorough
knowledge of anatomy indilpenfably neceffary.

The contents of the three parts now publifhed are
as follow7./

Part I. thews the front, back, and fide views of
the human fkeleton. A front view of the firft, fecond,
third, and fourth layers, or orders of mufcles ; the
firft, fecond, third, and fourth layers of mufcles on
the back parts ; and a view of the primary, or outer-
moft order of mufcles on the left fide of the body ; the
mufcles feated before the vcitebnc oi the neck, below

the head, with thofe of the larynx and pharynx,

S f 3 mufcles

570 Bell's Anatomia Brittannica .

mufcles of the month, bottom of the feet, infide of
the fternum, &c.

Part, II. contains the mufcles of all the particular
parts feparated from the body, together with the out-
lines of the bones to which they are affixed, or in
which they lie ; and fuch other parts belonging to
them as feemed neceffary, figured twice as large
as the former tables, but in the fame pofition, and
in all other refpefts the fame, as far as they are re-
prefented in the whole figures, excepting a few of
the mufcles, which required either to be drawn in a
different pofition, or in the natural magnitude, of
which the reader is informed.

Part III. exhibits the proportions of the human
body of both fexes in a living date ; microfcopic views
of the texture and formation of the {kin, and of the
hairs, on different parts of the body ; the external
mufcles, {hewing their proper fituation in the fore
and back views of the body, when in action, after
the {kin, fat, and membranes are removed ; various
pofitions and fedtions of the brain and medulla fpi-
nalis ; the falx, iinuffis, and microfcopic view of part
of the brain, and of a nerve ; the {kull, fhewing the
paffages of the blood-veffels, the egrefs of the me¬
dulla oblongata, and nerves iffuing from the brain to
the organs of the fenfes ; upwards of fifty figures of
the eye, with its different parts and appendages ;
near feventy figures of the ear, and of the various
parts which compofe that organ ; the nofe, mouth,
and tongue, with the glands which fecrete the juices,
and difcharge them in mafiicating the food ; the
larynx, pharynx, afpera arteria, &c. ; the mufcles of
the head and neck, with their different ufes in mov¬
ing the parts. And, as there is frequent occafion to
mention the bones, &c. which always ferve as an
index to the parts defcribed, a familiar acquaintance
with their different forms is abfolutely neceffary. It
is therefore hoped, that it Will not be thought im¬
proper

Hamilton on the Duties of a Regimental Surgeon . 57 i

proper to conclude this feftion with the different
bones, cartilages, and ligaments, reprefented nearly
as large as the life. The bones, cartilages, and li¬
gaments, &c. of the extremities, will be given at the
end of Fart VI.

Art. LX. The Duties . of a Regimental Surgeon
confidered ; with Obfervations on his general Qua¬
lifications ; and Hints relative to a more reflect able
Practice , and better Regulation of that Depart¬
ment. Wherein are interjperfed many Medical
Anecdotes , and Subjects dif cuffed , equally Me¬
re fling to every Practitioner. By R. Hamilton,
M. D. of the Royal College' of Phyficians, London,
Sc. Second Edition, with Additions and Correc¬
tions. Octavo, 2 vols. 680 pages, price Igs,

London, 1797. Longman.

< ■

WE have lately had occaiion to notice, in an
ample manner*, a Treatjfe on a very intereft-
ing fubjeft, by the ingenious author of the prefent
work. But it will not be neceffary for us to go much
at length into the volumes now before us. Not that
the fubject is in itfelf unimportant, but drat it is dif¬
ficult to con den fe into a fmall compafs, fuch a variety
of matter as we here find. There is, perhaps, no
branch of medical praftice, which has been fo ill
appointed, and fo ill performed, as that which is de¬
voted to the care of military men. Yet no one, in a
national point of view, can well be confidered as
more important. A variety o> ufeiul and intei effing
treatifes, indeed, Dr. Hamilton remarks, have been
written on military medical practice, wherein both
the prevention and cure of the diieafes to which
troops are liable, have been amply inveftigated: but

^ )

* Hamilton on Hydrophobia. See page 376.

Sf 4

572 Hamilton on the Duties of a Regimental Surgeon

no author has hitherto pointed out, in a more parti¬
cular manner. The Duties of a Regimental Surgeon ,
or tak;en up the fubjeft in the light in which it is
here fet forth.

It novelty, therefore, be any recommendation, the
prefent work has this to plead in its favour: but
it has more ; its objeft is utility, while it inculcates
humanity towards a clafs of men, whofe fituation, at
beft, is but uncomfortable, and yet to whom the com¬
munity are under great obligations at the fame time.
A review is taken of the general character and con-
duft of the regimental furgeon, as well with refpedt
to the accompliffiment of this, as to his own more
comfortable lit nation.

In drawing up the prefent work, much pains have
been taken by the author to ilJjuftrate and enliven it,
by the interfperfion of medical anecdotes; as well
to render it, in fome degree, fit for the perufal of
other pradlitioners befides thofe of the army, as to
explain more fully the different fubjecls which of¬
fered themfelves to his confideration.

The fir ft volume treats of the difficulties attending
a regimental furgeon’s ftation— of his qualifications,

and of his tendernefs to the fick foldiery _ of his

fpending too much time in amufements with the
officers, a!nd of the impropriety of granting him
double commiffions — of the greater criminality of
intoxication in the furgeon than in others of the

corps, from the nature and importance of his duty _

of the neceffary medicines and their dofes — of di flec¬
tions— of the neceffity of good inftruments, of fixabie
air, and of ele&icity, in regimental pradlice— of the
books which ffiould form part of his library— of the
utility of cultivating the acquaintance of medical men
in the different quarters ; of ftudying the nature of the
foil, and qualities of the water in each.

In the fecond volume, furgeons are diffuaded from
thing billets, and advifed to' keep a medical regifter
"the puniftiments of the foldiery, as far as the fur¬
geon

Hooper's Medical Dictionary , 571

geori is concerned, are difeufled— the utility of ex¬
periments pointed out, and the danger of over-hafty
prognoftics — the neceflary qualifications of the Sur¬
geon's mate — this office fliewn to be unneceflary ;
and the propriety of augmenting the Surgeon's pay
— of extra-medicines allowed each regiment, when
in camp, independent of the medicine-money; and
of their unneceflary expenditure — the necefiity of a
liberal education, to pra£tife medicine Successfully— -
regimental pra£lice more the province of the phy¬
sician than the furgeon. - Some Remarks are Sub¬

joined on the Influenza which appeared in the year

1782.

From this outline, our readers may form to them-
felves an idea of the fcope and tenor of the prefent
performance ; a work rendered interesting, by the
perfonal opportunities of information, enjoyed by the
author in his Situation of army-furgeon ; and ftill more,
by the exifting flate of things, when the military de¬
partment in the flate is So extenfive and So very
important.

Art. LXI. A compendious Medical Dictionary ,
containing an Explanation of the Terms in Ana¬
tomy , Phyfiology , Surgery , Materia Medica , Che -
miftry, and Practice of Phyfic . Collected from
the moft approved Authors , by R Hooper, M. D.
of Pembroke College , Oxford , Sc. twelves, about
300 pages, price 5s. 6d. London, 1798. Mur¬
ray and Highley.

rip LIE objeft of the author in the prefent work
JL is, to deliver in a concife and perfpicuous
manner, the explanation, &c. of all the terms ufed
in thd whole Science ot medicine.

This

\ ) \ .

574

The Medical Diary for 1799 .

This little volume will be a welcome addition to
the many ufeful compilations Dr. Hooper has already
prefented to the public. If it have the advantage of
being more eoncife and portable, than former works
of the fame nature, fomething, in regard to fulnefs, it
is plain, mii have been facrificed, to obtain this.

Art. LXII. An entire new Treatife on Leeches ,
wherein the Nature , Properties , and Ufe , of that
moft Jinguiar and valuable Reptile , is moft clearly
fet forth. By George Horn, Apothecary . Oc¬
tavo, 29 pages, price Is. 6d. London, 1798.
Symokds,

THIS little work is divided into five Sections. In
the firft, the author flievvs the different fpecies
of leeches, diftinguifhing the genuine from the fpu-
rious. In the fecond, he gives a; defcription of the
nature and conftitution of the animal. The third ex¬
plains the manner of preferving and keeping it healthy
for a conhderable length of time. In the fourth Sec¬
tion, the cafes of difeafe are pointed out, where
leeches are particularly applicable. And in the la ft,
the inode of applying them, and their management,
are explained.

Art. LXIII. The Medical Diary for the Ye'ar
1799 : containing ruled Pages for each Day's Bu~
finefs ; a correct Lift of the London and, Edinburgh
Royal Colleges of Phyftc ; an alphabetical Lift of
Surgeons and Apothecaries , with the M afters.
Wardens, and Courts of AJfiftants ; an Arrange¬
ment of the Anatomical, Medical, and other Lec¬
tures ; Public Hof pit als, Sic. With a Map. a f the
Roads Ten Miles round London. Eighteens, price
2s. London. Boose y. &c.

Art..

(

( 575 )

Art. LXIV. A Treatife on Scrophulous Difeafes ,
J hewing the good Effects of Factitious Airs : illuf
trated with Cafes and Ob/ervations. By Charles
Brown. Octavo, 168 pages, price 3s. 6d. Lon¬
don, 1798. Glendinning,

f $

difeafe which makes the fubjeFfc of the pre-
1 fent effay, is one of acknowledged difficulty,
both in its theory, and method of cure. Mr. Brown,
however, flatters us with the hopes of its at length
yielding to the efforts of art. He denies that it is
hereditary, and afferts that the doftrine of hereditary
difeafes altogether, is founded on a want of obferva-
tion, and has nothing to fupport it, but obftinacy and
prejudice. Yet Mr. Brown will not eafily fucceed
in difproving, that certain difpofitions may be, and
are frequently, tranfmitted from parents to their off-
fpring, giving the latter a tendency to the peculiar
difeafes of the parent. And this, we believe, is ail
that is contended for at prefent.

The author’s definition of the difeafe will (hew the
fchool whence his opinions are derived. Scrophula,
he obferves, is a weakened action in the fyftem, ma-
nifefting itfelf by the following difeafes, viz. fcrophu-
lous tumours and ulcers ; phthifis pulmonalifc-; tabes
fcrophulofa ; opthalmia tarfi ; hydarthrus ; broncho-
cele ; hydrocephalus ; lumbar-abfcefs 5 and rachitis.

Conformably with this idea, the mode of treatment
pointed out by the author, is that of giving Jone to
the fibre, and reftoring the general health. For this
purpofe, fteel, and the cold bath, are recommended ;
but efpecially the inhalation of oxygen gas. Several
cafes are recited in confirmation of the efficacy of
this remedy.

As the prefent is merely an outline of a much
larger work, which Mr. Brown intends fhortly to
lay before the public, we forbear to be more parti¬
cular.

Ar t.

( 576: )

LXV-. Jon. Gottl. Lei den frost, M. D.
et Prof. &c. Opufcula P hyfi co-C hem ica et Medica ,
antehac feorjim edita, nunc poji ejus obitum collecta ,
1 wolves, S vols. Lemgovuc, 1797. Imported by
Bqosey, London. Price 10s. 6d.

rjpPIE trafts here collected, are not all of them
the immediate produftion of .Profeffor Leiden-
froft, but of feveral of his pupils, as candidates for
medical degrees. Written, however, under his au-
fpices, and for the attainment of honours, of which
he was in part the arbiter and difpenfer, they may
be confidered as the opinions of the Profeffor and his
fchool.

The firft volume contains eight differtations, which
we fhall now notice in order.

The firft is by the Profeffor himfelf, and treats Be
Hernia , vel prolapju Cordis humani. — The length
and importance of this differtation require a fuller
notice than we can at prefent beftow on it. Referv-
Ing this, therefore, for a future confide ration, we pafs
on to the fecond, Be Oleorum dale him vir lute Medica
Refolvente. Auc. IV. A. Berniere , Venlonienji,— Re-
folvent medicines, the author obferves, are thofe
which are capable of reftoring to their former fluid¬
ity, in the living body, any infpiffated or concrete
matter obftrudfing the veffels and impeding their
funftions. Amongft medicines of this clafs, the
mild oils hold a diflinguiffied flation. Thefe are de¬
rived either from the animal or vegetable kingdom.
Of the former the author reckons the yolk of egg,
freili cream, and butter, the fat of deer and goats.
Of the latter, the exprefled oils of the poppy feed,
of fweet almonds, and of olives.

The, firft purpofe to which thefe remedies are ap¬
plicable, is that of refolving extravafated and coagu¬
lated blood, as in coptufions, &c, That they dif-

folve

Leidenfrofl Opufcula Phyficv-Chemica, 8V. 57? ‘

folve coagulated blood out of the body, the author af¬
firms from experiments made to determine this point.

In bilious difeafes, the mild oils are faid to be of
much feivice, from their power ot diftblving concrete
bile. But it may be afked here, and in the former
cafe, granting their folvent power, how are they to
be made to reach, unchanged, the peculiar feat of
thedifeafe? ^ '

In dyfentery the ufe of ojl is indicated by the Hate
of the tongue, which becomes covered with a denfe,
brown, and tenacious cruft, not to be removed by
trillion or wathing, but which readily difappears, the
author fays, on being fmeared over with fweet oil.
He thinks it probable, that the whole of the primal
vke is covered with the fame infpiffated mucus, re¬
quiring the internal ufe of the mild oils.

This^ refolvent quality of thefe fubftances, render
them, in the author’s opinion, ferviceable in cafes of
concreted wax in the ear, in the fcabby eruption on
the heads of children, termed favus , in every cafe,
in fhort, where infpiftated mucus is prefent," occa¬
sioning obftruftions, or otherwife impeding the animal
functions.-— We believe the author to be under a
miftake, in fuppofmg the mild oils capable of dif-
folving concreted mucus.

The next diftertation is on Afthma : the author*
Englebert R o nfi o rffc . — A ft h m a. , according to the au¬
thor, is diviftble into different, fpecies, according to
the parts immediately atfefted, and the caufes which
induce the difeafe. Thus we have the fpafmodic or
convulftve afthma ot W illis. In this fpecies, the
itrudture of the lungs is natural, and their functions
unimpaired, excepting during the time of the pa-
roxyfm, which is brought on by flight caufes, and
efpecially by paflions of the mind.

The fecond fpecies is that arifmg from debility, or
paralyfiSe In this cafe, the intercoftal mufcles and

diaphragm

578 Leidenfroft Opufcula P hyjico-Chem ica,

diaphragm are fuppofed to be the immediate feat of

the difeafe.

The feat of thev third fpecies is the larynx. This,
the author obferves, is by far the molt frequent,
though commonly afcribed to the lungs themfelvesr
In this cafe a peculiar hilling found is heard on in-
fp] ration 5 (hewing the rim a giottidis to be contracted,
or fome how obftruCled.

The fourth fpecies of afthma is that where the
lungs thernfelves are the immediate feat of the dis¬
order: fuch as, adhefion of the lungs to the pleura,
the confequence of previous inflammation ; an cede-
matous or emphyfematous ftate of thefe parts ; tu¬
bercles ; ulcers ; calculi ; polypous concretions, and
other organic affections.

In the fifth fpecies, the thorax is the part affefted,
exclufively of the lungs; fuch are a debilitated or
paralytic It ate of the mufcular parts before noticed ;
a gibbous ftate of the cheft ; a callous or oilified con¬
dition of the pleura in fome parts; fraCture of the
fternum ; and, dropfy of the cheft.

The next head refers to thofe afthmatic cafes
which arife from affeCtions of the heart, or its veffels.

Laftly, the author treats of the fpurious afthma,
the c.aufe of which is feated in the abdomen : as dif-
tenfion of this cavity, from various caufes.

The mode of treatment muft, of courfe, be regu¬
lated according to the different fpecies, and is, for
the moft part, fufficiently obvious.

(To he continued .)

Art.

( 579 )

Art. LXVI. A Collection of En g ravings , repre-
Jenting the moft Modern and improved Inftrnments
iifed in the Practice of Surgery : with appropriate
Explanations . By j. H. Savigny, Surgeons
Jnftmment Maker » London. Folio, price Si. Ss6
1798.

MR. S A VIGNY obferves, that in the courfe of
nearly twenty years engagement in the bu¬
ll nets of inftrument-making, he has frequently had
caufe to lament, as a workman, that we were not
better furnilhed with engravings ands fuitahle expla¬
nations of the numerous articles which conftitute in-
difpenfable appendages to a branch of fcience, pe¬
culiarly dignified by its importance to mankind, by
the talents of its profeflbrs, and by its rapid improve¬
ments : he has Hill more deeply regretted that fuck
a deficiency Ihould exift in this country (juitly famed
for the cultivation and encouragement of every de-
fcription of ufeful arts), when, in two others, works
have been publhhed, in which the accomplifhment
of what he now aims at, has been very nearly attain¬
ed. He means thofe of Brambilla at Vienna, and
of Peret at Paris. Without wifhing to depreciate
the merit, or leffen the utility of thofe performances,
he is compelled to obferve the ill-execution of the
former, while the latter, whofe plates are finhhed in
a ftyle altogether mafterly, has admitted fo many
tedious minutiae, both in the defigns and letter-prefs,
that much ufeful information is thereby excluded.

In the publication of thefe engravings, which are
thirty-nine in number, the author nas lendeied an
important fervice to lus fellow-workmen, in the pio-
fecution of their callings, and a welcome audition to
the libraries of the curious. He has not entered into
a comparative biftory of old and new inftruments, nor
reprefented thofe which are now obfoletc , but has ,

confined himfelf to thorn which are mod. appro\ed,

and

580 Savignys Collection of Engravings,

and generally in ufe at the London hofpitals. In the
defcriptive part of the work, he has pointed out the
particular inventions of diftinguilhed furgeons; and,
as occaiion required, has given a detail of the altera¬
tions and improvements fuggefted by himfelf.

The engravings reprefent the exadt fize and pro¬
portion ot each inftrument ; except in fome large
machines, which are reduced to a more commodious
fcale. In the general arrangement, due attention has
been paid to the connexion and ufes of the inftru-
ments.

general

GENERAL VIEW

OF THE

PROGRESS OF MEDICINE,

THE prefent age is peculiarly characterized by

an ardent third after knowledge* and, its ge~

general concomitant, an ,eager defire of novelty.

In medicine, thefe have led to a driCt inveftigation
of former doCtrines, and, generally, to their down¬
fall ; for fpecuiations on the fcience of medicine,
have been more i&gue, and lefs fupported by faCts,
than any other branch of human knowledge. —
Hence, it is little to be wondered at, that fyftem
has followed fyftem, and that every fucceeding
profefifor has laboured to eftablifh his own hypo-
thefis on the ruins of that of his predeceffor. The
fame love of novelty has prompted men to an eager
fearch after new remedies, though not always,
there is veafon to believe, to the advantage of
the art. The materia medica has fwellcd, by this
means, to an enormous bulk: and an imperfeCt
acquaintance with the virtues and powers of me¬
dicines has been the neceffary confequence. For
the mod extenfive experience, and mod indefati¬
gable zeal, will hardly fuffice to make us thorough¬
ly acquainted with even a few of the mod aCtive

remedies in general ufe.

VOL, V,

A wider

582

Progrefs of Medicine .

A wider diffujion of knowledge, likewife, cha¬
racterizes the times we live in. Science no longer
fixes her abode in the recedes of the College ; nor
are fkill or fame monopolized, as heretofore, by a
few. If this be an advantage to fcience in general,
to medicine it is peculiarly fo. This is altogether
a fcience of obfervation. Its principles are found¬
ed in experiment, and could not be inferred, a
priori , by any depth of refearch. The field of
medicine is of wide extent, embracing, indeed,
the whole of human-. nature-. Opportunities for ob¬
fervation are never wanting to him who is ready
to lay hold ot them. Every village is a fchool of
medicine to the induftrious and obfervant prac¬
titioner.

Thefe truths are now generally felt, and the com
fequences that might have been expected, have
actually followed. Practitioners of fkill and judg¬
ment are not confined to the metropolis. Many of
the lateft and molt important difcoveries take their
origin from the provinces, which begin to contri¬
bute their fhare to the general flock of knowledge.
The exertions of individuals have done more to¬
wards the extenfion of fcience, than has ever been
accomplifhed by the collective efforts of corporate
bodies, (if, indeed, any efforts have been made.)

Efiablifhments of this kind are much better fuited
to prelerve, than to advance, the principles of

knowledge ; and in an art fo imperfeCt as that

of medicine is, -are much more likely to perpetuate

prejudice and error, than to foiler improvement, or

to ftimulate- to extraordinarv exertion.

„ +

v & •

This

Progrefs of Medicine, 583

.. " i s.t . .s . '■ f .t'. V n . *

is diffufion of knowledge and ardour for en¬

quiry, are attributable, in part, to a better mode
of education, but principally, without doubt, to the
circulation of compendious and periodical publica¬

tions. Fa that would other wife be confined to

the ftudious and the opulent, by the help of thefe
ready vehicles, make their way with facility to the
remoteft parts. Thus the number of obfervers is
multiplied, the field for difcovery is enlarged, and
fcience advances with rapid ftrides.

If fuch be the advantages accruing to medicine
from the prefent ftate of things, it is not to be de¬
nied, that evils have at the fame time crept in.
Men are prone to run into extremes. Obfervations
are too haftily made. The love of novelty carries,
us too rapidly along: ever in the purfuit of fome-
thing beyond us. We negleft fufficiently to cultivate
the objects which are immediately under our notice.
No fooner are a few fafts obferved, and thofe.

perhaps, imperfe&ly, and with a prejudiced eye*
than we haften to conftruct a fyftem, and torture

former obfervations to bend them to our purpofe.
Faffs are no longer feen in their proper colours.
They take a tint from the medium through which
they pafs. Hence, the very fource of knowledge
becomes polluted, and it is with he fixation and
referve, that we can venture to appeal to writers
for the moil fimple faffs*. The advantages of ac¬
cumulated experience, and of fucceffive obfervers
are thus diminifhed, and in great meafure loft, and
each inquirer has to begin the fame career. Thus

Tt 2 it

584 Progrejs of Medicine .

it is that the real advances of our art are fo flow
and queftionable.

The caufe of all this, undoubtedly, is our great
ignorance of the laws which regulate the animal
oeconomy. If we ever attain to a clear knowledge
of the operations of nature ; could we but apply
the fure principles of chemiftry or mathematics, to
the explanation of the fun£tions of living bodies,
then might wTe, indeed, build medicine on a liable
bafts. Our art would no longer merit the epithet
of conjeftural, nor would it longer be made a quef-
tion, whether on the whole it be a blefling or an
injury to mankind.

In reviewing the progrefs which has been mad®
in the different branches of our art. Pneumatic Me¬
dicine firft attrafts attention. In this, little has been
done of late, and that little has by no means tended
to enhance our expectations of its utility. We
have hardly any teftimonies on the fubje£l, befides
thofe which have been brought forward by Dr.
Beddoes in his late Colleftion*. A few inftances
are adduced, in favour of the infpiration of different
gaffes, but they have been felefted from a mafs of
a very mixed complexion. The propofal formerly
made by the author, of living with cows, for the
relief of pulmonary confumption, has been carried
into effeft in four inftances. In two of them, no

' 'K.

* Contributions to Phyficai and Medical Knowledge, chiefly

from the Weft of England,

effe£l

585

Progre/s of Medicine,

effeCt was obferved. In the others, fome apparent
relief of the fymptoms took place, though they
both terminated fatally. In the greater number of
inftances, where modified airs have been employed,
other obvious means of relief have accompanied
their exhibition, and the event has thus been left
in uncertainty. Further and more elaborate re-
fearches. Dr. Beddoes candidly acknowledges, are
undoubtedly wanting, to determine what {hare the
gaffes had in the favourable refult. On the Con¬
tinent, the matter has been taken up with much
eagernefs, and practitioners are as much at variance,
as in this country.

On this fubjett, the teftimony of M. Fourcroy is
of the firfi: weight. He will not be fufpeCted of
detracting in any degree from the juft merits of
the new doCtrines. He is, however, fufficiently
aware of the revolutionary fpirit which has in-
feCted medicine, no lefs than politics. 4 That che¬
mical doCtrine/ he obferves, * * the moderate and
prudent application of which may extend our know¬
ledge of the animal ceconomy, feems already to mif-
lead minds, in other refpeCts enlightened and in¬
genious. They wifli to rear an edifice, without
having collected the materials. We are yet far
from pofleffing the requifite data, and that collec¬
tion of truths neceffary to form a complete doc¬
trine, a new medical fyftem. Scarcely do wTe know
fome of the phenomena of certain functions in the

* Annales de Chimie, No. 34.

T t 3

animal

CSC

Prpgrefs of Medicine

economy ; Scarcely have we made any fbrtu~
pate applications of the modern pneumatic difcoye-
ries 3 and already we begin to draw from them ge¬
neral induftions on the nature and caufes of difeafe $

fir ■* \ '■ •' • 4 ‘ -* f ' ‘ " ‘ • 7 ' ' ' ■■■■•- '■ i * • '-■> 4 * .»»••£.< -

fearcely have we iketched the analyfis of feme of
the principal humours in a ftate of health, and al¬
ready pretend to clafs difeafes after the chemical
changes of liquids, and to form a humoral nofolo-
gy. We fpeak of claffing difeafes according to the
excefs or defeiepey pf azote, oxygen, or carbon,
before the proportion of the principal co.nftituen.tS in
any particular apimal fubftance is ascertained/

Upon the whole, with refpeft to the aerial reme*
dies, there is no reafon to doubt, that they are ca¬
pable of powerfully impreffing the living aft ions,
and thus of becoming valuable auxiliaries in the
treatment of difeafe. But there does not yet feem
Sufficient ground, for concluding, that they aft che-
mically, effefting a change in the composition of the
folids or fluids, a point which has been much infilled
on by the chief favorers of the pneumatic fyftem.
Chemical changes are induced with much greater
fimplicity and certainty. The aftion of modified
qirs on the human body is equally uncertain and in-
calculable, a priori , with that of the moft fimple
exciting powers. Candour, however, mult allow,
that the queftion has not yet been fully and fairly
brought to the teft of experiment. The inhalatioq
of modified airs for a few minutes daily, is very in¬
adequate to fhew what may be pxpefted from their

continued

Progrcjs of Medicine . 58?

continued infpiration. Nor can it be properly and
effedtually tried, but by means of fome public in-
flitution. On this head we are happy to announce,
that the Pneumatic Infirmary, proje&ed by Dr. Bed*
does, is likely to be fcon fet on foot.

The application of the acids, and other analogous
fubfiances, for the cure of the venereal difeafe, may
be confidered as a branch of the chemical patholo¬
gy. No one will hefitate to admit, from the extent
of the evidence brought forward, that the new re¬
medies poffefs a very confiderable power over the
difeafe in ail its ftages, and that they have, in nu¬
merous inftances, effected permanent cures. It ap¬
pears, likewife, fufficiently afeertained, that their
operation is lefs injurious to the general health, thaii
the long continued employment of mercury, many
of the ill effefts of which, they obviate or remove.
At the lame time, it is no lefs certain, that many re-
lapfes have occurred after apparent cures by their
ufe, and that they have fometimes failed altogether
in affording any relief, in the hands of able and im¬
partial praftitione-rs. Sometimes, this has evidently
arifen from the want of minute attention to quanti¬
ty, and other circumftances, Yet With every allow¬
ance of this fort, mercury appears to poffefs fupe-
rior powers, which it has often fhown, by fpeedily
removing fymptoms that had before refilled the full ap-
plicatipp of the new remedies. We have yet to learn
the particular circumftances which give decidedly a
preference to one rather than the other.

T t 4

The

58S Progrefs of Medicine.

The Second Edition of Dr. Rollo’s valuable
Treatife on Diabetes affords much additional evi¬
dence in favour of the treatment by a ftri£t animal
diet. Whether it tends equally to confirm his
theory, admits of queftion. The arguments adduc¬
ed againft the fuppofition of the kidneys being the
primary feat of the difeafe have great weight, and
detract much from the confidence we felt on the
fubjech Morbid changes have often been obferved
in the kidneys, in the ftomach, and in other organs $
but none of them have been conftant, and cannot,
therefore, be confidered as effential. In Ihort,
there are difficulties attending every hypothefis
which has been hitherto offered on the fubje£t;
and we are (till, probably, ignorant of the firfl and
jnoft important points. The value of the praftice,
however, will remain ; but, as the difeafe is founded
originally in a morbid aftion fomewhere, it cannot
he expefted to be uniformly fuccefsful, though it'
may relieve the rooft preffing and troublefome fymp»
toms,

A more curious and mterefting fubjeft of inquiry
has feldom appeared, than that of the Cow-Pox.
The being able to fuperfede a difagreeable and
fometimes dangerous difeafe, by one of comparative
mildnefs, and ultimately perhaps to exterminate a
loathfome and very fatal malady, prefented advan*
tages, the value of which could not eafily have been
eftimated. Refpefting its origin in the cow, it be¬
came a very natural fpeculation, to refer the origin

569

Progrefs of Medicine .

of fmall pox, and perhaps of the other contagious
difeafes, which have made their appearance in the
later ages, to the fame or fimilar fources. The points
of difagreement, however, are fo many, that it is
impoffible, at prefent, - to admit fo general a con-
clufion.

With regard to fubdituting cow-pox for variolous
matter in the practice of inoculation, the fird point
to be afeertained is, the eondant and certain pre¬
vention, by this means, of the fmall pox. Many di-
re£l experiments have proved, that the fufceptibili-
ty for the latter has been dedroyed, by inoculation
w ith the cow-pox poifon; but whether permanent¬
ly, or only for a time, has not been {hewn. At the
fame time, more than one indance has been adduc¬
ed* of the fmall pox taking place, and that feverely,
where the cow-pox had before exifted. Should
thefe turn out to be clear and well-atteded fadis,
the new pradtice, we apprehend, mud drop. For
the fuperior advantages of this over the variolous
inoculation, though allowed by mod, are yet fo
trifling, or fo equivocal, as to be altogether denied
by others. The cow-pox is faid never to have
proved fatal : but the number of cafes of the dif-
eale on record is comparatively fmall. Out of more
than feventeen hundred patients inoculated in the
courfe of the lad year, at the Small-pox Hofpital,
two only died. The inference is obvious— We are
glad to announce, that a publication on this intend¬
ing fubjedt is Ihortly expefted from Dr. Woodville.

* Vide Contributions to phyfical and med. Knowledge, p.387, and
medical and phyfical journal, p«

390 Progress of Medicine .

On Gal vanifm we have of late had nothing new
in this country, unlefs the Metallic' Traftors- of
Dr. Perkins be referred to this head. We fated
fairly the pretentions which this novel praftice h&d
in its favour, and left the queftion to the teft of fur¬
ther trial. Many perfons have declared that they
have experienced all the benefits from the metallic
traftors, which their author taught them to expect.
Others, again, have doubted their efficacy, after
trial. Some, we have found, imagine that they ope¬
rate by a magnetic influence of the fteel point* on
the iron contained in the blood ; and thefe have
found the fame effeft from the fteel point only, as
from both combined, and have even fubftituted a
pair of fciffars, or other inftrument of iron, fox the
fame purpofe : whilft Dr. Perkins infifts on the union
of the two metals, as forming the effential caufe of
their effeft. Profeffor Schumaker of Copenhagen
tried traftors of ebony and ivory, which are faid to
have cured a pain in the knee— In this contrariety of
opinion/one is apt to conclude, that too much has
been attributed to the fubjeft ; and, admitting their
good effefts, to impute them to more than one caufe.
They may aft as conductors of eleftricity, as me*
cha.nical ftimuli, and alfo by the effects of imagi¬
nation.

Dr. Crichton, in his valuable work on Mental
Derangement, has done more than his title led us
to expect. It is, in fact, a hiftory’of the faculties

* The tractors con fi ft of two fmall tapering pieces of metal about
three inches long ; the one apparently of fteel, and the other of a
yellow metaJU

and

Prog rf/s of Medicine . 591

p.QWS of the human mind. We cannot, how¬
ever, think him warranted inaffuming the exigence
pf a pei^ous fluid, calculating, even, its quantity,
and reafoning on its effe£ls, as if it were capable of
deraonftration. The gratuitous admiflion of this,
is certainly not reconcilable with thofe found princi¬
ples of philofophy which govern him in the general
execution of his work.

m- • y.

Amongft the individual fuggeftions for improv¬
ing the practice of medicine, that of Mr. Ware,
with regard to Fiftula Lachrymalis, merits particu¬
lar notice. The cure of this difeafe, in the hands
even of the afaleft furgeons, has been painful, te¬
dious, and uncertain. The operations pra&ifed
for its cure have very frequently failed to effeft it,
and feeming cures have as often been followed by
lelapfe. By the employment of a llyle, for the
purpofe of keeping the lachrymal duft pervious,
in the manner here pointed out, the treatment of
a very troublefome affeflion is materially Amplified,
from the known accuracy of the author, there is
po room to doubt, that it will prove as fuccefsful
in the hands of other prafiitoners, as it feems to
have done in his own.

The effe&s of compreffing the larger arteries, by
means of tourniquets, as related by Mr. Kellie,
^re highly deferving notice. Though feveral years
have elapfed, fmee his Arfl: mention of the fubje£t.
We Ute forry to fee it has not been purfued by other

inquirers0

1*1, ' - i

592 Progrefs of Medicine .

inquirers. Compfeffion of the extremities, indeed,
by ligatures, made a part of the older materia
medica ; but the rationale of its operation, and the
praCtice itfelf, have both become obfolete and for¬
gotten. It is not improbable, that here, as on
many other occafions, in rejecting an hypothefis,
we have facrificed along with it an ufeful aid in
the removal of difeafe. From Mr. Kellie's ac¬
count, compreflion of the larger arteries affords a
powerful means of influencing the general (eco¬
nomy, and there is little doubt that it is applicable
in the treatment of many diforders.

The remarks of Mr. Simmons on cancer afford
fome grounds to hope, that this terrible fcourge of
mankind may at length find a powerful opponent
in arfenic. Yet when we reflect, that this fubftance
has generally formed the principal bafis of the
boafted panaceas of empirical practitioners ; and
that it has never long together retained its fame ;
we are involuntarily led to withhold our confidence.
In reality, the proper diftinCtive marks of cancer
are no where fatisfaCtorily laid down. Difeafes
have been called cancer, which were of a very
different nature ; and thus cures have been a fi¬
ler ted, and encomiums bellowed on remedies, to
which further trials have fliewn them to have no
fort of pretention. A character of cancer, that
flball enable us to cliftinguifh it with certainty, in
its different ftages, from other affections, to which it

bears

Progrefs of Medicine. S9S

bears a refemblance, is ftill a defideratum of our
art.

The fame powerful remedy above-mentioned
feems, in many trials, to have produced con-
fiderable effects in hooping cough, a difeafe which
has been little influenced by any former propofal
for its relief. When we recoile£t the great and de¬
cided powers of arfenic in checking the progrefs of
intermittents, analogy, no lefs than experiment,
firengthen our hopes of its good effefls in the cafe
under confideration.

. * i * #

Dr. Ferriar’s remarks on the Croup, fpeak with
much confidence in favour of the antiphlogiftic
mode of treatment in that formidable difeafe of
infancy. Of late, a new practice has iprung up in
America, and which is faid to have been eminently
fuccefsful, confifting in keeping up a conftant fti-
mulus in the throat and fauces, by gradually fwal-
lowing a ftrong deco&ion of the Seneka root ; and
if this fails of fpeedily affording relief, the full ufe
of mercury is reforted to. Of this practice we fhall
loon have occafion to fpeak more fully.

In treating of Difeafes of the Skin, Dr. Willan
has undertaken a difficult and important talk. There
is, perhaps, no branch of medicine which has been
handled with lefs fuccefs. Writers are not at all
agreed in the terms which they have adopted, and
have often given different names to the fame affec¬
tion, and claffed others which are widely different

upder

594 Progrefs of Medicine*

under the lame head. It is indeed difficult to con¬
vey in language all the minute fhades which the
eye perceives, without calling in the pencil's aid„
This has now been done with much fuccefs, and a
ftandard been begun, to which future enquirers may
With confidence refort.

The judicious 'regulations adopted at Manchefter
in the inftitution of Fever Wards, as fuggefted chief¬
ly by Dr. Ferriar, niuft not pafs uniVoficed. They
fhew how much the health and welfare of the com¬
munity depend on local management and {kill.—
Medicine, indeed, compared with this, is but a
fecondary confide ration? in as much as prevention
is better than cure.

Our readers will fee that we have palled over
many articles which are interefting in a cohfider-
able degree. Their merits* will beft appear on
perufaL

CATALOGUE

* <fe

CATALOGUE OF BOOKS,

IN THE

different Branches of Medicine and Surgery ,

.r .

PUBLISHED IN THE YEAR 1798.

1. A NEW Syttem of Phyfiology, comprehending
the Laws by which animated Beings in ge¬
neral, and the human Species in particular, are go¬
verned, in the various States of Health and Difeafe*
By R. Saumarez, Surgeon to the Magdalen HoP
pital. 2 vols, .8 vo. boards, 1 4s. Cox.

2. A Treatife on Leeches, wherein the Properties,
Ufe, &tc. of that valuable Reptile is clearly fef forth,
B y George Horn. Is. 6d. bound. Symonds.

3. A new Edition of Dr. Wallis on the Art of
preventing Difeafes and reftoring Health, with con-
fiderable Alterations and Additions. 7s, 6d. bound.
Robinfons.

4. Enchiridion Syphiliticum ; or Directions for the
domeftic Treatment of Venereal Complaints. Byf
/L P . Buchan , M. D. 2s. 6d. Callow,

5. An Effay on the Gout, with a candid ExamU

nation, &c. of Dr. Latham’s Principles. By George
JValiis, M. D. &c. 4s. Robinfons.

6. A Lecture introductory to a Courfe of popular,
InftruCtion, on the Conftitution and Management of
the human Body. By Lhomas Beddoes , M, D. 8vo.

Is. 6d. Johnfon. . , ,

7. Nereis Britanmca; ora Botanical Delcriptiorrot

Britidi Marine Plants, in Latin and Lngiifh, with .
Drawings from Nature. By /. Stdckhoufe , Efq. *
F. S. L. Fafciculus Secundus, contaming/rwenty-two
Specimens of f uci 12s. 6d, White.

496

Catalogue of Books.

8. A Philofophical and Praftical Treatife en
Horfes. By John Lawrence. In 2 vols. 8vo.
15s. in boards. Longman.

9. Defcription and Treatment of Cutaneous Dif-
eafes ; Order I. containing papulous Eruptions on
the Skin. By Robert Willan , M. D. F. A. S. With
Seven Plates, printed in Colours, 15s. Johnfon.

10. Annals of Medicine, vol. 2. for the Year 1797,
exhibiting a concife View of the lateft and mold im¬
portant Difcoveries in Medicine and Medical Philo¬
sophy. By. Meffrs. A. Duncan , Sen. and Jun. M. D.
7s. boards. Robinfons.

1 1. An Appendix to the firft Edition of the Morbid
Anatomy. By Matthezv Baillie , M. D. F. R. S.
2s. 6d. Johnfon.

12. An Effay on the Medicinal Properties of Fac¬
titious Airs, with an Appendix on the Nature of
Blood. Bv Tiberius Cavallo , F. R. S. 5s. boards.
Dilly.

13. The Soldier’s Friend; or, the Means of Pre¬
ferring the Health of the Military Men who may be
called into the Service of their Country in the prefent
Crifis. By Mr. Blair , A. M. Surgeon of the Lock
Hofpital. 2s. 6d. Longman.

14. An Enquiry into the Nature and Caufes of the
great Mortality among the Troops of St. Domingo.
By Hector M‘Lean , M. D. 6s. boards. Cadell and
Davies.

15. A Syftem of Dilfe&ion; explaining the Ana¬
tomy of the human Body, the Manner of difplaying
the Parts, and their varieties in Difeafe. By Charles
Bell. Folio, 5s. 6d. Johnfon.

16. An Enquiry into the Nature of Mental De¬
rangement ; comprehending a concife Syftem of the
Philofophy and Pathology of the human Mind ; and
an Hiftory of the Paffions i nd their Eifefts. By
Alexander Crichton , M. D. Phyfician to the Weft-
minfter Hofpital, and Public Lecturer in the Theory
and Practice of Phyfic and Chemiftry. 2 vols, 12s*
boards. Cadell and Davies.

• , . v V. J. I , \ f\ ■

Catalbgue of Books ; 597

' f j / . ....

17. Reflexions on the Surgeon’s Bill, in an Anfwer
to three Pamphlets in Defence of that Bill. By John
Ring, Member of the Corporation of Surgeons. 4s. 6d.
boards. Hookham and Carpenter.

18. The Influence of Metallic TraXors on the
human Body, in removing various painful inflam¬
matory Difeafes. By B. D . Perkins , M. M. Son of

Dr. Perkins of North America, the Difcoverer. 2s. 6d
John fon.

19. Obfervations on Infanity, with praXical Re¬
marks on the Difeale, and an Account of the morbid
Appearances on DifleXion. By John Hajlam. 3s.
Rivingtdhs.

20. A Third Diflertation on Fever, Part 1ft. con¬
taining the Hiftory and Method of Treatment of a
regular continued Fever, fuppdfing it is left to purfue
its ordinary Courfe. By George Fordyce , M, D.
F.R.S. 4s. Dilly. 1

21. Remarks on the Fiftula Lachrymalis,' with the ;

Defcription of an Operation different from that com¬
monly ilfed, and Cafes annexed. By James Ware ,7
Surgeon. 3 s. Diiiy. . . , ; -

22: Maxims of Flealth. By R. Squirrel /, M. D.
Is. Mb r ray and Highley.

23. Medical Hiffories and RefleXions. Bv John

j .

Ferriar, M. D. Volume 3d. 5s. boards. Cadell ,
and Davies. . '

24. Medical Refearches, feleXed from the Papers
of a Private Medical Affociatioii. Vol. 1. part 1.

Cox.

25. ; Defcription and Treatment of Cutaneous Dif¬
eafes, illuftrated with Plates. By Robert Willan,
M. D. F. A. S. Parti. 4to. 1 5 s. John fon.

26. Obfervations on the StruXure, Economy, and
Difeafes of the Foot of the Horfe, and on the Prin¬
ciples and Practice of Shoeing. By Edxvard Cole¬
man, Profeffor of the Veterinary College, Ike. 4to.
12s. boards. Johnfon.

27. Dr. Underwood on the Diforclers of Childhood.

3 vols. 12mo. 10s. 6d. fewed. Mathews.

VOL, V.

598

Catalogue of Books .

28. EfTay on the Venereal Difeafe and its conco¬
mitant Affeftions, illuftrated by a variety of Cafes.
Effay 1, Part 1.

lft. On the antivenereal Effefts of Nitrous Acid,
Oxygenated Muriate of Potaih, and feveral analogous
Remedies, which have been lately propofed as fub-
ftitutes for Mercury. By William Blair , A. M. Sur¬
geon of the Lock Hofpital and Afylum, and of the
Old Finfbury Difpenfary. 4s. johnfon.

29. A comparative View of the Chemical and Me¬

dical Properties of the Briftol Hotwell Water; to
which are added, diet Rules for Invalids. By Dr,
Willich , Phyfician to the SaxOn Embafly, Author of
the Elements of the Critical Philofophy, &x. 6d.

Longman.

SO. A J unification of the Right of every well-
educated Phyfician of fair Character and mature Age,
refiding within the Jurifdi£tion of the College of Phy-
ficians of London, to be admitted a Member of that
Corporation ; with the Opinion of the legal Judges,
&c. By Chrijiopher Stanger , M. D. 8vo, 8s.
Johnfon.

31. The Seaman's Medical Advocate ; an Attempt
to fhew that Five Thoufand Seamen are Annually,
during War, loft to the Nation in the Weft Indies,
through the Yellow Fever, and other Difeafes, from
Caufes which, it is conceived, are chiefly to be ob¬
viated, By Elliott Arthy , Surgeon in the Weft India
Service. 5s. boards. Richardfon and Egerton.

32. A Third Difiertation on Fever, Part 1. con¬
taining the Hiftory and Method of Treatment of a
regular continued Fever, fuppofing it is left to purfue
its ordinary Courfe. By George Fordycey M. D.
4s. fewed. Johnfon,

S3. View of the Science of Life ; or, the Principles
eftablifhed in the Elements of Medicine, of the late
John Brown, M. D. : with an Attempt to correft
fome important Errors in that Work ; and Cafes in
Uluftration, felefted from Records of their Practice at
the General Hofpital at Calcutta. To which is

599

Catalogue of Books .

added, a Ireatife on the Aft ion of Mercury upon
living Bodies, and its Application for the Cure of
Difeafes of indireft Debility, and a Differtation on
the Source of Epidemic and Peftilential Difeafes, 8cc.
By William Yeates and Charles Maclean of Calcutta.
5s. boards. Philadelphia printed. Cuthell.

34. The Arguments in favour of an inflammatory
Diathefis in Hydrophobia confldered ; with Reflec¬
tions on the Nature and Treatment of the Difeafe.
By Richard Pearfon , M D, Is. 6d. Seeley.

35. General Rules and Infractions, very neceflary
to be attended to by thofe of both Sexes who are af-<
flifted with Ruptures. By -William Turnbull, A. M.
Surgeon to the Eaftern Difpenfary, and the Society for
the Relief of the Ruptured Poor. Is. 6d. Johnfon.

36. A View of. the Perkinean Eleftricity; an En¬
quiry into the Influence of the Metallic Tractors,
founded on a newly-difcovered Principle in Nature,
and employed as a Remedy in many painful inflam¬
matory Difeafes ; as Rheumatifm, Gout, 8c c. Scalds,
Burns, and a variety of other topical Complaints:
with a Review of Mr. Perkins’s late Pamphlet on the
Subjeft. To which are added, a variety of Expe¬
riments for ascertaining the Truth of this Doctrine.
By Charles Langivorthy, Curate of Bath. Is. (> d»
Johnfon.

37. Cautions to Women refpefting the State of
Pregnancy, the Progrefs of Labour, and Delivery ;
and on fome conftitutional Dileafes. By Sequin
Henry Jackfon , M. D. Phyficiari to the Infirmary
of St. George, Hanover Square, 4s, boards. Robfon.

38. An Effay to inftruft Women how to proteft
themfelves from the Diforders incident to Pregnancy,
or how to Cure them ; with Obfcrvations on the 1 reat-
ment of Children, By Mrs. Wright , Midwife. Is.
Barker.

39. A compendious Medical Dictionary. By R.
Hooper, M. D. 5s. 6d. boards. Murray and Highley.

40. Cafes of the Diabetes Mellitus, with the Re-
fults of the Trials of certain Acids, and other Sub-

U u 2

600

Catalogue of Books.

fiances in the Cure of the Lues Venerea. By John
RollOy M. D. Surgeon-General of the Royal Artillery.
Neve Edition, with large Additions, 8vo. 8s. boards.
Billy.

'41. One Hour’s Advice reipeCting their Health to
Perfons going out to Jamaica, with a Defcnption of
the In and. By R. Wife* Is, 6d. Johnfon.

42. Lecture on Diet Regimen ; being an Enquiry
into the Means of preferring Health; with Physiolo¬
gical and Chemical Explanations : calculated chiefly
for the Ufe of Families, in order to banifih the >pre~
vailing Abides and Prejudices in Medicine. By
A< T.M. TVillichy 1VL D. 8vo. 12s. boards. Long¬
man.

43. Obfervations and Experiments on the Broad-
leaved Willow Bark. By W. White , Is. 6d. Ver-
bot and Hood.

44. A Treatife on Scrophulous Difeafes, {hewing
the good Effects of Factitious Airs: with Cafes and
Obfervations. By Charles Brown . 8vo. 3s.- 6d.
Glen dinning.

45. Efims du Sommeil, et de la Veille dans le
Traitement des maladies Externes. 8vo. Paris .

. 4-6, Recherches Critiques fur la IVme Section d’un
Ouvrage ayant pour litre, e£ Be la Connexion dc la
vie avec la Refpiration,” par E. Goodwin. Par 7. 6.
Caron. 8vp. Paris.

47. Effai fur la Nouvelle Doctrine Medicale de
Brown, en forme de Lettres. Par Pvianuel Rizo , de
Conftantinople, DoCteur en Medecine. Paris.

4.8. Analyfe Raifonee du Syfterae de Brown, con-
cernant une M'ethode Nouvelle et Simplifiee de
Trailer les Maladies en general, appuyee de diffe-
rentes Obfervations. Par Rodolph Abram Schiferti ,
M. D. et Chir. Pams.

49. Nofographie Philofophique ; ou la Methode
pl’Analalyfe appliquee a la Medecine. Par Ph .
PhineU Profeffeur a l’Ecole de Medecine a Paris.

50. Sur la Dyfenterie, Par Wedekind , Medecin
Enchef dTHofpital Militaire de Mayence. Paris .

Catalogue of Books .

601

51. Tabulae Anatomicae quas ad Illuftrandam Ilu-
mani Corporis Fabricam, Collegit et Curavit /. C.
Loder , fafc. 1 — 5 fob Vinariae. 41. 5s.

52. Ludmigii , C. id de Quarundum iEgritudinurn
Humani Corporis, Sedibus et Cautis Tabulae fedecim
Meditat. Nonnullis liluRratae. Fob Leipfic.

53. tickle gel> Thefaurus Materia Mediae et Artis
Pharmaceutical quam Collegit atque Edidit. 3 yob
Svo. Lips.

INDEX.

INDEX

TO THE

FIFTH VOLUME,

1 A*

A BERNETH Y, Mr, J. on the Foramina Thebefii of the
J,. X Heart - _ - - -

Abforbents, on the retrograde Motion of -

Account of Indian Serpents — - - 47 S,

Acids, ancient Ufe of in Lues Venerea _

Adhefive Plainer, Effects of in Tinea - _

Aerial Fluids, Mode of obtaining - - - —

Airs different, Effe6fs of in Cellular Membrane — — .

Alibert, M. furies Odeurs - - — _

Alyon. M. EffeUs of Oxygen in Lues Venerea - -

Amputation at the Shoulder, Cafe of - -

Amentia, Definition of — — _ _

Animal Heat, Remarks on — — - _ _ _

Anatomia Brittannica — — — .

Annals of Medicine for 1 797 - - - -

Aorta, Account of Rupture of — — . _ _ _

Apparent Death, Obfervations on - -

Appendix to Morbid Anatomy of Dr, Baillie

Argentum Nitratum, Ufe of in Epilepfy — —

Arguments in favour of inflammatory Diathefis in Hydrophobia

Arfenic, Ufe of in Hooping Cough - - JiU

- - — Effects of in Cancer - - 204,

Afthma, Tjeatife on — — — —

- - ■ — Cafe of, effe&uaily Cured - - — _

Differtation on

3r3

$ll

501

151

182

207

102

450

*3*

568

512

114

291
2 26
492
26

577

35*

Attempt to afcertain the Nature of the Pulfe - —

Baillie, Dr. M. Appendix to his Morbid Anatomy — . —

Bark of the Willow, Ufe of — — — — —

Bell, Mr. Benjamin, Remarks on Nitrous Acid - -

Bleeding from Wounds, Means of Stopping - - —

Babington, Dr, W. extraordinary Cafe of Wound of the Heart
Ibrlw, Mr. j. Cafe of f'sefarean Se£lion fuccefsfully performed 518

467

1 16

337

510

Index .

Beddoes, Dr. T. Teftimomes refpe&ing Nitrous Acid * —

• s introdudlory Le6iure to a Courfe of popular Inftru&ion

Bell, Mr. Charles, Syflem of Diffe&ions

Blood, Obfervations on the Natural Hiftory of * -

- -velfels, on the Situation of the larger — -

Bladder, Difeafed, new Method of treating - - -

Blair, Mr. W. Effays on the Venereal Difeafe —

Blizard, Mr. W. on the Situation of the larger Blood-vefTels

Bonhomme, M. Memoir on Rachitis - -

Brain, difeafed Appearances in - - - -

- - - Examination of - -

does not contain a Fluid in Health

48,

Bree, Dr. Robert, Inquiry on Difordered Refpiration

Britiih Lying-in Hofpital, Account of -

Brown, Obfervations on his Syltem of Medicine
Brunonian Syltem, Remarks on — — - -

603

Page.

5*3

278

129

33 7
82

148

33 7
1 12

18
287
198
2 6
11 6
121
121

Caillau, M. Prern. Lignes de Nofologie Infantile ~ 199

Calculus of the Stomach — — - 1 %

— — — - — Urinary, Obfervations on * - - — — 301

Caefarean Operation, Refleftions on - - — 488, 521

- - - - fuocefsfui Performance of — - — 518

Cancer, Obfervations on — — - — 489

— — — . of the Stomach, Symptoms of — 13

Cancerous Ulcer, Cafe of 1 ■ ■ — * - • 204

Carbonic Acid Gas, Means of procuring - 47

Carmichael, Dr. Teftimony of, resetting the New Remedies 558
Cafes of the fuccefsful Practice of VeficaLotura — 82

Cauftics, good Effects of in difeafed Joints — — 245

Ceratum Sabins, good Effe&s of — — - — - — - 245

Cavallo, Mr. T. ElTay on Fa&itious Airs — 40

. — — - on the Nature of the Blood — — 48

Clarke, Dr. J. Account of a Tumour in the Placenta — * 419

Chefton, Dr. R. B. fingular Cafe of Lithomoty 522

Clinical Ledures of Dr. Cullen - — - 318

Cline, Mr. H. new Remedy for Spafm of the Urethra — 513

Colours, extraordinary Fa&s relating to ■ — — - 1

Compreflion of Arteries, Effects of • * 55

Cours d’Etude Pharmaceutique — - - & 1

College of Phyficians, Remarks on - — — 95

Conflipation, Cafe of — “7

Confumption, Cure of by Mephitic Air - - - - 105

Continued Fever, Differtation on — * 208

Confiderations Philofophiques fur les Odeurs — 182

Cooper, Mr. A. curious Cafe of ftrangulated Inteftine — 469

_ 7 _ _ Account of Obltruaion of the Thoracic Du#

Cow-Pox, Inquiry into, by Dr. Jenner — 236

U u 4

604

Index .

Cow-Pox, Remarks on _ - _ -

Coindet, Dr. Obfervations on Animal Fat
Corpulency, Remarks on

Collection of Teftimonies relating to the Nitrous Acid in

Venerea - - - - - -

Compendious Medical Dictionary, by Dr. R. Hooper
Collection of Engravings of Surgical Inftruments — — .

Crichton, Dr. A. Inquiry into Mental Derangement

Croup, Obfervations on . _ _ _

Crowther, Mr. Bryan, on difeafed Joints

Lues

Page.
495
4.98
49 8

Curry, Dr. James, on apparent Death from Drowning
Currie, Dr. reftimony refpeCting the New Remedies

Cullen, Dr. W. Clinical I.eCtures -

Cutaneous Difeafes, Treatife on - — -

Dalton, Mr. J. extraordinary Fafts relating to Vifion

Darwin, Remarks on his Syltem - — -

Depreffion of Cranium, Recovery from without1 Operation

Defcription and Treatment of Cutaneous Difeafes _ _ —

Delirium, Remarks on ~ -

Death, Remarks on Apparent — — - -

De Corporis Humani Fabrica - -

Diabetes Mellitus, Treatife on — — — .

- - — State of Kidneys in - - -

Diaphragm, Remarks on . . - _ _ _

DiffeCtions, Syltem of - — — a- -

Dictionary, compendious Medical — — — -

Diary, Medical, for 1799 - - —

Dumas, M. Syft. Methodique des Mufcles _ _ _

Duties of a R egimental Surgeon, Treatife on - - ,

Duncan’s Annals of Medicine for 1797 — -

Dying, Remarks on the Treatment of - - -

52<

Entire new Treatife on Leeches — -

Epilepfy, employment of Argentum Nitratum in
EfTays on the Medicinal Properties of Factitious Airs

• - on the Gout - - - _

- on the Venereal Difeafe - - —

Extra-uterine Foetus, Cafe of
Examen fur l’Exiltence d’un Fluide
Cerebrales —

Experiments on Urinary Concretions

queux dans les Cavites'

553

573

579

343

221

2 45
93.

558

3,s

361

445

361

345

286

524

*33

565

573

574
184

57i

TOI

23O

574

114

4°

148

105

198

301

Factitious Airs , belt Means of procuring
— - - - good Effects of in Scrophula

Index.

Fat, Animal, Obfervations on

Farre, Mr, J. R. Remarks on Cure of Hydrocele by In]e£tion
Febrile Difeafes, Effects of arterial Gompreffion in

Fever, Differtation on ■ - ■ — - — —

Fever Wards, in Manchefter, Account of — •

Ferriar, Dr. {. Medical Hiflories and Reflexions, vol. 3 164,

Few general Rules and InftruXions in Ruptures • — •

Fifher, Mr. Miers, Account of change of Colour in a Negro —

Fiflula Lachrymalis, improved Treatmept of —

Foot, Mr. JefTe, on Vejica Loiura — •

Foramina Thebefii of the Heart, Obfervations on — >

Fordyce, Dr. G. Third DifTertation on Fever — -

Fyfe, Mr. A. Anatomia Brittannica

605

Page.

49^

523

*34
171

221
284

5
67

Sz
3i3
F34
568

Galvan ifm, Report on - — 119

Gattric Fluid, life of in Ulcers - - — 113

Geach, Dr. his Remarks on Nitrous Acid — —— 556

Generation, Remarks on - — - — 1 19

Greafe in Horfes, fuppofed Origin of Cow-Pox — 119

Gout, Effay on _ - . - ■— 1 - •— -f

Haighton, Dr. J. Cafe of Tic Doloreux — — —

Haflam, Mr. j. Obfervations on Infanity —
Hammick, Mr. Teftimony refpeXing the New Remedies
Hamilton, Dr. R. Duties of a Regimental Surgeon

- - Treatife on Hydrophobia - — — •

Hallucinatio, Nature of _ — — — -

Hsemorrhoidal Affections, Obfervations on —

Heavy Inflammable Air, Means of procuring ■ -

Heat, Enquiry refpeXing -

Head-ach, Remarks on — —

/ Heart, unufual Formation of w- — —

Hermaphrodite, Inftance of — — -

Hole, newly-difcovered in the Retina •**— ”

Home, Mr. E. Remarks on the Retina
Hooper, Dr. R. compendious Medical Dictionary

Hooping Cough, Remarks on '

_ _ _ — : - Ufe of Arfenic in - — —

Hops, external Ufe of in Ulcers
Horn, Mr. G. Treatife on Leeches _ — —

Hydrocephalus, Appearances on DiffeXion
Hydrocarbonate Air, Means of procuring

, do. —

Treatife on, by Dr. R. Pearfon —

_ _ _ _ _ by Dr. Hamilton

Hydrocele, Remarks on

Hydrogen Air
Hydrophobia,

469

bH
5 n
45 *
449

308

4I£

1 6

401

573

225

1 1 1

1 *3

574.

18'

295

45 1
523

606 Index .

Hymen, Imperforate, Cafe of -

Hypochondriacs, Definition of

Jenner, Dr. E. Inquiry on Variolas Vaccmx

Imperforate Hymen, Cafes of - - —

Inflammable Air, Remarks on — - —

Intermitten ts, Effects of Compreflion of Arteries in
Injections, Ufe of in difeafed Bladder

107, 523

449

Inquiry into the C-aufes and EfFeCts of Variolas Vaccinse

■ - into the Source of the Heat excited by Friction

• - - into the Nature and Origin of Mental Derangement

Influence of Metallic Traitors, Treatife on ■ —

Infanity, Obfervations on
Infpiiation, Remarks on

InftruCtion Sommaire fur BArt des Panfemens — — —

Inftruments, Surgical, Engravings of — -

Joints, Obfervations on difeafed . - .

Irritability, Remarks on — — — -

Hues, good Effects of in difeafed Joints - - - —

Kali Purum, Ufe of in Hydrophobia « — -

Kellie, Mr. G. on the Effects of Compreflion by Tourniquets

- - - - on the Nitrous Acid in Syphilis

Kidneys, State of in Diabetes - - —

Lagrange, M. Cours d’Etude Pharmaceutique —

Latham, Dr. Remarks on his Hypothefis on Gout — —

Le Roy, M. on the Medicinal Effects of Phofphorus
Letter introductory to a Courfe of popular InftruCtion —

- — - — on the Situation of the large Blood-velfels — —

Leeches, Treatife on

Leidenfroft, M. Opufcula Phyfico-Chemica —

Life, Obfervations on - — - —

Lithic Acid, Experiments on the Nature of -

Lichen, Obfervations on — -

Ligamentous Union of the Tibia, Cafe of -

Lithotomy, fmgular Cafe of ■»

Lombard, M. fur BArt des Panfemens — — *

Lues V enerea, Cafes of, cured by the New Remedies

*53

101

205

278

337

574

576

120

3°5

367

510

522

i99

539

Manchefter, Memoirs of the Philofophical and Literary Society

of, vol. 5, part 1 — - — I

Ma^ckie, Mr. j. Cafe ot Deprefiion of the Cranium — 65

Index .

607

Page,

Maniacs, Account of DifleXion of — — — - j 88

Mania, Obfervations on — — 446

Memoirs of the Literary and Phiiofophical Society of Manchefler,

vol. 5, part 1 - *— — » 1

Medical Hiilories and Reflexions, vol. 3 — 164, 220

Medical Gloflary — - — — 1 200

Memoirs de la Societe Medicale d’Emulation — . — 20 f

Medical Difcipline on Ship-board, Remarks on — — 256

Metallic TraXors, Treatife on - - 258

Methode Medicale Simplifiee d’ A pres les Principes de Brown 285
Mental Derangement, Inquiry into the Nature of 343, 436

- - Difeafes, Claffification of — — . 449

Mercury, Inutility of in Hydrophobia — ■— 449

Medical Records and Refearches - — - , 468, 510

Medical Diary for 1799 - — - - 574

Morifon, Mr. T. on Tinea Capitis — •

Muriatic Acid, Medicinal EffeXs of - 2 29

Mufcles, Claihfication of 184

Negro, extraordinary Change of Colour in — — -

Nerves, Obfervations on - - -

N erv e-fuborbitar, Divifion of, in Tic Doloreux. - -

New Remedies in Lues Venerea, Obfervations on —

New Syftem of Phyfiology -

Nitrous Acid, Remarks on 101, 116, 153, 226, 234,

' 1 1 \ \.

Obfervations on apparent Death from Drowning

*53?

95>

539?

289

469

54a

118

553

— 93

and Experiments on the Broad-leaved Willow Bark 467

498
189

51 4

182

- on Animal Fat
on Infanity

Obftruction of the Thoracic DuX, Three Inftances of

Odours, Confiderations on - — — —

Oil, Utility of in the Plague - - -

^ — Inutility of in Hydrophobia * — — - — •

Oils, on the Medicinal UTe of - -

Opium, Observations on, in Fever - -

hurtful in Infanity

Opufcula Phyfico-Chemica - -

Oxygen, EffeXs of in Lues Venerea and Pfora

_ _ _ denied to be the Caufe of irritability

- - - Air, hurtful in the Dry Afthma

_ _ beft Means of procuring

Oxygenated Muriate of Potalh, Obfervations on

476

576

217

*97

526

zbj

347

115

'Paify, a frequent Caufe of I dainty * -

Papula?, Obfervations on - - ‘ ~

•■'142

36-5

608 Index .

Page.

PafTions of the Mind, Obfervations on — — — 443

Petechiae fine Febre, Cafe of - - — 62

Perkins, Mr. Treatife on Metallic TraXors — — — — 258

Pearfon, Dr. G, on Urinary Concretions - - — — 301

- - 1 - Inquiry on Cow-Pox - — — 544

• - — — Dr. R. Treatife on Hydrophobia — - 291

Phthifis Pulmonalis, Cure of by Mephitic Air — - . 105

Phofphorus, EfFe<5is of in Medicine - — - 199

Phofphoric Acid, Trial of in Lues Venerea - — 556

Philofophical TranfaXions, parts 1 and 2, for 1798 — 301, 401

Piles, Obfervations on - - - - 81

Plait of the Retina, Account of — - — * 53

Plague, Cure of by Oil - - — - 109

Placenta, Account of a Tumour in - — — — - 419

Poifon of Serpents, Treatife on — — — - 480

Practical Inquiry on Difordered Refpiration - — — — 26

Predifpofition, Remarks on - - - * 119

Premieres Lignes de Nofologie Infantile — — — 199

'PraXicaP Obfervations on Difeafes of the Joints — 245

Prurigo, Remarks on - 7— 369

Pulfe, Remarks on - - - i'40

— - - Treatife on * — - - 358

Punch, Utility of, in Scurvy -■ — - — — 257

Putridity in Fever, Remarks on 142

Rachitis, Memoir on — — — 1 12

Rabies Canina, Remarks on -r— — — - 221

*- — - - — Two Cafes of - - — • 518

Red Particles of the Blood, Remarks on ~—r~ 48

Pvetina, Difcovery relating to - 52, 401

Remarks on Fillula Lachrymal is - — - — — — 67

Remarks on Hydrophobia - - - 376, 451

Refpiration, Remarks on — - — 133

Recherches Phyfiologiques - — 394, 495

Report of Commiffioners on Galvanifm - - — — ' 398

Reflexions on the Csefarean Operation - - 488

Rheumatifm, Remarks on — - 137

- - - Chronic, Ufe of Compreffion of Arteries in 38

Rollo, Dr. J. Effay on Diabetes Mellitus, 2d edition — • 524

Rouffelot’s Cauftic Powder for Cancers - - 204

Ruptures, Remarks on — - - - 284

Rumball, Mr. J. Treatife on the Pulfe — — — 358

Rumford, Count, Inquiry into the Source of the Heat excited by

FriXian * - • 308

Savigny, Mr. ColleXion of Engravings of Surgical Inflruments 579
Saumarez, Mr. New Syftem of Pnyfiology «— 95, 1 18

Index .

Scurvy, Cure of by Oxygenated Muriate of Potaili

Scott, Mr. Remarks on Nitrous Acid - -

Scrophula, Treatife on -

Senfation, Remarks on - - ■ — •

Serpents, Indian, Account ot - -

Simmons, Mr. W. Remarks on Nitrous Acid - —

- - Reflexions on the Caefarean Operation

Sherwen, Dr. J. Cafe of Imperforate Hymen * —

Small- Pox during Pregnancy, Two Cafes of * —

Snakes, Account of Indian : -

Soemmering, Dr. Difcovery relating to the Eye

r78>

De Corporis Humani Fabrica
Small Pox, Prevention of by Cow-Pox
Spleen, Remarks on the Ufe of ~

Specifics, Inutility of in Hydrophobia
Slover, Dr. Account of an Hermaphrodite
Stimulants, EfFeXs of in Fever

Stomach difeafed, Appearances of on DififeXion

- - - Appearances of in Hydrophobia •

— - Calculi in - • ’

'Stuart,- Mr. A. Medical Difcipline - ■

Strophulus, Remarks on — y

Strangulated Hernia, extraordinary Cafe of - - -

Sue, M. Recherches Phyfiologiques ^ - *

Suborbitar Nerve, Divifion of in Tic Doloreux 1

Surgical Inflruments, ColleXion of Engravings of ^ - *

Symptoms conneXed with difeafed Appearances in the Stomach
_ _ _ _ _ - in the Brain

Sympathy, Remarks on -

Syphilis, EfFeXs of Nitrous Acid in - - ‘

Syfteme Methodique des Mufcles — — —

Syftem of DiifeXions * - -

609

Page.

115

553
573
350
478> 5ox

233

488

523
359
5°3
52
286
242

129

387

16
218
12
12
12
256
366

469

497

469

579
12

3*9
101

184
S6>

Taenia, Account of * - “

_ _ Difcharge of, from the Stomach - -

Tanjore Pill, Account of * —

Tape Worm, Account of '

_ Difcharge of from the Stomach *

Third Diflertation on Fever, by Dr. Fordyce - l34>

Thoracic DuX, Three Inflances of ObdruXion of
Tic Doloreux, Cafe of ‘

Tinea, Cure of by Adhefive Plaifter ~

TinXura Ferri Muriati, Ufe of in Spafm of the urethra
Tonics, eminently Ufe fill in Aftlima
Tourniquet, EfFeXs of in Intermittents, See.

Treatife on Scrophulous Difeafes -

Tumour in Placenta, Account of -

Turnbull, Mr. W. Treatife on Ruptures

T 3

102

504

l3
1 02

207

514

469

63
51 3
34

575

419

284

6 1 0 Index,

Page,

Tu rton, Dr. W. Medical Gloffary - - — * 200

Typhus, Cafe of, fucceeded by Meades - - - 14

Variolse Vaccinae, Inquiry refpe&ing — - - * 236, 549

Variolous Poifon, comparifon of, with of that Cow-Pox 549 -

V enereal Difeafe, Elfays on - - 1 48

— - Treatment of by Nitrous Acid — . . 553

Venefe£Hon, Inutility of in Hydrophobia - - — * 457

V ertigo, Remarks on - 43 7

Vitality, Experiments on ■ — - — - - - — — 497

Villon, extraordinary Fa6ts relating to — — — * f

Ulcers of the Legs, Remarks on — — — ™

- - — • Utility of the Gaftric Fluid in — - - 1 J 3

- — — — - - of Hops as an external Application — 113

Voice, uncommon Anedlion of - — - - 202

Volition, Obfervations on the Difeafes of - — - 437

Vomiting, unfavourable in Infanity — — — — — 197

Urinary Concretions, Experiments on - — - 301

Uric Oxyd, Account of - — — - 306

Urethra, Remedy for Spafm of - — 513

Uterus Inverted, Cafe of • — - — 502

Walker, Mr. J. Cafe of Petechias fme Febre — — • 62

Wallis, Dr. Treatife on Gout — - - 87

Ware, Mr. J. Remarks on Fiflula Lachrymalis _ 67

Weikard, M. Mefhode Medicale Simplifiee ■ — — 285

White, Mr. W. Treatife on the Broad-leaved Willow Bark 467
Willan, Dr, R* Treatife on Cutaneous Difeafes — ' — 361

Willow Bark, Treatife on — - — 467

Wilfon, Mr. J. Cafe of unufual Formation of the Heart 41 1

W ound of the Heart, extraordinary Cafe of - - — 5 1 o

Wounds, Remarks, on - 338

Y«Uow Spot in the Retina, Account of v— — — . 52

' ’ ’ * ,v . <&• sk >v

FINIS

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Full text of "Medical and chirurgical review. Volume 5, May 1798 - May 1799."

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